Rafael da Silveira Moreira

O risco espacial e fatores associados ao edentulismo em idosos em município do Sudeste do Brasil

This study aimed to identify factors associated with edentulism and spatial risk of tooth loss in the elderly. A cross-sectional study was conducted using a random sample (n = 372) of individuals 60 years and older in Botucatu, Sao Paulo State, Southeast Brazil, in 2005. Crude and adjusted prevalence ratios were estimated by Poisson regression with robust variance. Spatial analysis was performed using Kernel intensity estimation. Prevalence of edentulism was 63.17%. Socio-demographic factors associated with edentulism according to multiple regression were low schooling, household crowding, not owning a car, older age, lack of a regular dentist, and the last dental visit three previously or longer. Spatial analysis showed greater risk of edentulism in the peripheral areas of the city. The results help understand the high prevalence of tooth loss among the elderly, thus providing essential information for planning oral health interventions.

Tooth loss in Brazilian middle-aged adults: multilevel effects

Abstract Objective. To examine the link between tooth loss and multilevel factors in a national sample of middle-aged adults in Brazil. Material and methods. Analyses were based on the 2003 cross-sectional national epidemiological survey of the oral health of the Brazilian population, which covered 13 431 individuals (age 35–44 years). Multistage cluster sampling was used. The dependent variable was tooth loss and the independent variables were classified according to the individual or contextual level. A multilevel negative binomial regression model was adopted. Results. The average tooth loss was 14 (standard deviation 9.5) teeth. Half of the individuals had lost 12 teeth. The contextual variables showed independent effects on tooth loss. It was found that having 9 years or more of schooling was associated with protection against tooth loss (means ratio range 0.68–0.76). Not having visited the dentist and not having visited in the last ≥3 years accounted for increases of 33.5% and 21.3%, respectively, in the risk of tooth loss (P < 0.05). The increase in tooth extraction ratio showed a strong contextual effect on increased risk of tooth loss, besides changing the effect of protective variables. Conclusions. Tooth loss in middle-aged adults has important associations with social determinants of health. This study points to the importance of the social context as the main cause of oral health injuries suffered by most middle-aged Brazilian adults.

Spatial clusters of suicide in the municipality of São Paulo 1996-2005: an ecological study.

BackgroundIn a classical study, Durkheim mapped suicide rates, wealth, and low family density and realized that they clustered in northern France. Assessing others variables, such as religious society, he constructed a framework for the analysis of the suicide, which still allows international comparisons using the same basic methodology. The present study aims to identify possible significantly clusters of suicide in the city of São Paulo, and then, verify their statistical associations with socio-economic and cultural characteristics.MethodsA spatial scan statistical test was performed to analyze the geographical pattern of suicide deaths of residents in the city of São Paulo by Administrative District, from 1996 to 2005. Relative risks and high and/or low clusters were calculated accounting for gender and age as co-variates, were analyzed using spatial scan statistics to identify geographical patterns. Logistic regression was used to estimate associations with socioeconomic variables, considering, the spatial cluster of high suicide rates as the response variable. Drawing from Durkheim’s original work, current World Health Organization (WHO) reports and recent reviews, the following independent variables were considered: marital status, income, education, religion, and migration.ResultsThe mean suicide rate was 4.1/100,000 inhabitant-years. Against this baseline, two clusters were identified: the first, of increased risk (RR = 1.66), comprising 18 districts in the central region; the second, of decreased risk (RR = 0.78), including 14 districts in the southern region. The downtown area toward the southwestern region of the city displayed the highest risk for suicide, and though the overall risk may be considered low, the rate climbs up to an intermediate level in this region. One logistic regression analysis contrasted the risk cluster (18 districts) against the other remaining 78 districts, testing the effects of socioeconomic-cultural variables. The following categories of proportion of persons within the clusters were identified as risk factors: singles (OR = 2.36), migrants (OR = 1.50), Catholics (OR = 1.37) and higher income (OR = 1.06). In a second logistic model, likewise conceived, the following categories of proportion of persons were identified as protective factors: married (OR = 0.49) and Evangelical (OR = 0.60).ConclusionsThis risk/ protection profile is in accordance with the interpretation that, as a social phenomenon, suicide is related to social isolation. Thus, the classical framework put forward by Durkheim seems to still hold, even though its categorical expression requires re-interpretation.

Estudo espacial da mortalidade por acidentes de motocicleta em Pernambuco

OBJETIVO: Analisar a distribuicao espacial da mortalidade por acidentes de motocicleta no estado de Pernambuco. METODOS: Estudo ecologico de base populacional, usando os dados de mortalidade por acidentes de motocicletas ocorridos de 01/01/2000 a 31/12/2005. As unidades de analise foram municipios. Para a analise da distribuicao espacial dos obitos foram construidos coeficientes medios de mortalidade, tendo como numerador os obitos por acidentes de motocicletas registrados no Sistema de Informacoes sobre Mortalidade e, como denominador, a populacao do centro do periodo. Utilizaram-se tecnicas de analise espacial, suavizacao do coeficiente pelo metodo bayesiano empirico local e o diagrama de espalhamento de Moran, aplicados sobre a base cartografica digital do estado. RESULTADOS: O coeficiente medio de mortalidade por acidentes de motocicletas em Pernambuco foi de 3,47/100 mil habitantes. Dos 185 municipios, 16 faziam parte de cinco conglomerados identificados com coeficientes de mortalidade que variaram de 5,66 a 11,66/100 mil habitantes, considerados areas criticas. Tres dessas areas localizam-se na regiao de desenvolvimento sertao e duas no agreste. CONCLUSOES: O risco de morrer por acidente de motocicleta e maior nas areas de conglomerado em regioes fora do eixo metropolitano, sugerindo medidas de intervencao que considerem o contexto de desenvolvimento economico, social e cultural.OBJECTIVE To analyze the spatial distribution of mortality due to motorcycle accidents in the state of Pernambuco, Northeastern Brazil. METHODS A population-based ecological study using data on mortality in motorcycle accidents from 01/01/2000 to 31/12/2005. The analysis units were the municipalities. For the spatial distribution analysis, an average mortality rate was calculated, using deaths from motorcycle accidents recorded in the Mortality Information System as the numerator, and as the denominator the population of the mid-period. Spatial analysis techniques, mortality smoothing coefficient estimate by the local empirical Bayesian method and Moran scatterplot, applied to the digital cartographic base of Pernambuco were used. RESULTS The average mortality rate for motorcycle accidents in Pernambuco was 3.47 per 100 thousand inhabitants. Of the 185 municipalities, 16 were part of five clusters identified with average mortality rates ranging from 5.66 to 11.66 per 100 thousand inhabitants, and were considered critical areas. Three clusters are located in the area known as sertão and two in the agreste of the state. CONCLUSIONS The risk of dying from a motorcycle accident is greater in conglomerate areas outside the metropolitan axis, and intervention measures should consider the economic, social and cultural contexts.

Determinantes individuais e contextuais da cárie em crianças brasileiras de 12 anos em 2010

OBJECTIVE To estimate the prevalence and severity of dental caries in Brazilian children and the association with individual and contextual factors. METHODS Data were taken from the Brazilian Oral Health Survey (SBBrasil 2010) a sample of 7,247 12-year-olds. The data were collected using clinical examinations and interviews. The dependent variables were the prevalence of dental caries (decayed, missing and filled teeth [DMFT] ≥ 1 and DMFT ≥ 4). Bivariate (Rao Scott test) and multivariate (Poisson regression) analyses were carried out. The individual variables were sociodemographic variables, periodontal health and reporting discomfort while brushing. Contextual factors were the presence of water fluoridation, the percentage of residences connected to the water supply and median income of the municipality. RESULTS The prevalence of DMFT ≥ 1 was 56.0%. Mean DMFT was 2.04 (95%CI 1.76;2.31) and 22.2% of children had DMFT ≥ 4. Caries experience was significantly more common in children with black, brown or yellow skin; in low-income families; in children with dental calculus or bleeding gums and in those who reported discomfort while brushing. Living in towns with fluoridated tap water, with low coverage of water supply and with low median income were contextual factors associated with the disease. CONCLUSIONS The prevalence of dental caries in Brazilian 12-year-olds was low, according to World Health Organization criteria. There were significant geographical and socioeconomic inequalities in levels of the disease.OBJETIVO: Estimar a prevalencia e gravidade de carie em criancas brasileiras e sua associacao com fatores individuais e contextuais. METODOS: Foram utilizados os dados da Pesquisa Nacional de Saude Bucal (SBBrasil 2010), em uma amostra de 7.247 criancas de 12 anos. Os dados foram coletados por meio de exames clinicos e entrevistas. As variaveis dependentes foram as prevalencias de carie (dentes permanentes cariados, perdidos ou obturados [CPOD] ≥ 1 e CPOD ≥ 4). Foram realizadas analises bivariadas (teste de Rao-Scott) e multinivel (regressao de Poisson). As variaveis individuais foram sociodemograficas, condicao periodontal e relato de incomodo ao escovar os dentes. Os fatores contextuais foram a presenca de agua fluoretada, a porcentagem de domicilios ligados a rede de abastecimento de agua e a renda mediana do municipio. RESULTADOS: A prevalencia de CPOD ≥ 1 foi 56,0%. O CPOD medio foi igual a 2,04 (IC95% 1,76;2,31) e 22,2% das criancas tinham CPOD ≥ 4. A experiencia de carie foi significantemente mais elevada em criancas de cor de pele preta, parda e amarela; em familias com renda mais baixa; em criancas com calculo dentario ou sangramento gengival; e naquelas que relataram incomodo ao escovar. Viver em cidades sem agua fluoretada, com menor cobertura da rede de abastecimento de agua e com renda mediana baixa foram fatores contextuais associados a doenca. CONCLUSOES: A prevalencia de carie em criancas brasileiras de 12 anos foi baixa, de acordo com os criterios da Organizacao Mundial da Saude. Houve significantes desigualdades geograficas e socioeconomicas nos niveis da doenca.

Individual and contextual determinants of dental caries in Brazilian 12-year-olds in 2010

OBJECTIVE To estimate the prevalence and severity of dental caries in Brazilian children and the association with individual and contextual factors. METHODS Data were taken from the Brazilian Oral Health Survey (SBBrasil 2010) a sample of 7,247 12-year-olds. The data were collected using clinical examinations and interviews. The dependent variables were the prevalence of dental caries (decayed, missing and filled teeth [DMFT] ≥ 1 and DMFT ≥ 4). Bivariate (Rao Scott test) and multivariate (Poisson regression) analyses were carried out. The individual variables were sociodemographic variables, periodontal health and reporting discomfort while brushing. Contextual factors were the presence of water fluoridation, the percentage of residences connected to the water supply and median income of the municipality. RESULTS The prevalence of DMFT ≥ 1 was 56.0%. Mean DMFT was 2.04 (95%CI 1.76;2.31) and 22.2% of children had DMFT ≥ 4. Caries experience was significantly more common in children with black, brown or yellow skin; in low-income families; in children with dental calculus or bleeding gums and in those who reported discomfort while brushing. Living in towns with fluoridated tap water, with low coverage of water supply and with low median income were contextual factors associated with the disease. CONCLUSIONS The prevalence of dental caries in Brazilian 12-year-olds was low, according to World Health Organization criteria. There were significant geographical and socioeconomic inequalities in levels of the disease.OBJETIVO: Estimar a prevalencia e gravidade de carie em criancas brasileiras e sua associacao com fatores individuais e contextuais. METODOS: Foram utilizados os dados da Pesquisa Nacional de Saude Bucal (SBBrasil 2010), em uma amostra de 7.247 criancas de 12 anos. Os dados foram coletados por meio de exames clinicos e entrevistas. As variaveis dependentes foram as prevalencias de carie (dentes permanentes cariados, perdidos ou obturados [CPOD] ≥ 1 e CPOD ≥ 4). Foram realizadas analises bivariadas (teste de Rao-Scott) e multinivel (regressao de Poisson). As variaveis individuais foram sociodemograficas, condicao periodontal e relato de incomodo ao escovar os dentes. Os fatores contextuais foram a presenca de agua fluoretada, a porcentagem de domicilios ligados a rede de abastecimento de agua e a renda mediana do municipio. RESULTADOS: A prevalencia de CPOD ≥ 1 foi 56,0%. O CPOD medio foi igual a 2,04 (IC95% 1,76;2,31) e 22,2% das criancas tinham CPOD ≥ 4. A experiencia de carie foi significantemente mais elevada em criancas de cor de pele preta, parda e amarela; em familias com renda mais baixa; em criancas com calculo dentario ou sangramento gengival; e naquelas que relataram incomodo ao escovar. Viver em cidades sem agua fluoretada, com menor cobertura da rede de abastecimento de agua e com renda mediana baixa foram fatores contextuais associados a doenca. CONCLUSOES: A prevalencia de carie em criancas brasileiras de 12 anos foi baixa, de acordo com os criterios da Organizacao Mundial da Saude. Houve significantes desigualdades geograficas e socioeconomicas nos niveis da doenca.

Fatores associados à necessidade subjetiva de tratamento odontológico em idosos brasileiros

The demographic transition in Brazil in recent years had reproduced a phenomenon known worldwide as population aging. The objective of this study was thus to identify the factors related to self-perceived need for dental treatment among elderly Brazilians. An in-depth analysis was performed with data from the 2003 national oral health survey, with a sample of 5,349 elderly individuals. Poisson regression models were used to identify the individual variables involved in self-perceived need for dental treatment. The variables associated with subjective need for dental treatment were different for edentulous and non-edentulous elders. These findings are important for planning the supply of dental services to the population, providing estimates of the main problems reported by these individuals and the number requiring treatment.The demographic transition in Brazil in recent years had reproduced a phenomenon known worldwide as population aging. The objective of this study was thus to identify the factors related to self-perceived need for dental treatment among elderly Brazilians. An in-depth analysis was performed with data from the 2003 national oral health survey, with a sample of 5,349 elderly individuals. Poisson regression models were used to identify the individual variables involved in self-perceived need for dental treatment. The variables associated with subjective need for dental treatment were different for edentulous and non-edentulous elders. These findings are important for planning the supply of dental services to the population, providing estimates of the main problems reported by these individuals and the number requiring treatment.

Autopercepção da saúde bucal entre adultos na região Nordeste do Brasil

OBJETIVO: Identificar la auto percepcion de la salud bucal por adultos y variables asociadas. METODOS: Estudio realizado con los datos del SBBrasil 2010 relativos a 2.456 adultos de 35 a 44 anos de la region Noreste. La variable dependiente fue la auto percepcion de la salud bucal. Las variables independientes fueron agrupadas en: demograficas, predisposicion/facilitacion, condicion de salud bucal y relacionadas a la auto percepcion de la necesidad de tratamiento. La prueba de Rao y Scott fue utilizada para evaluar la asociacion entre tales variables. El efecto de las variables independientes sobre el resultado fue evaluado por el modelo de regresion logistica mulninomial segun modelo jerarquizado, en dos etapas: analisis simple y analisis multiple jerarquizado. RESULTADOS: La auto percepcion positiva de la salud bucal fue observada en 37% de los participantes. En el modelo final, las caracteristicas directamente asociadas a esa auto percepcion fueron: ser blanco, tener renta familiar superior a R

Spatial study of mortality in motorcycle accidents in the State of Pernambuco, Northeastern Brazil

500,00 poseer numero de bienes por encima de la mediana, tener mayor numero de dientes higidos, no presentar sangramiento, no necesitar de protesis, Oral Impacts on Daily Performances = 0, no necesitar de tratamiento y haber ido al dentista hace menos de tres anos. CONCLUSIONES: Los resultados muestran que la auto percepcion de la salud bucal de los adultos residentes en el Noreste Brasileno esta directamente asociada a una estructura multidimensional de factores. Las bajas condiciones economicas asociadas a las condiciones clinicas deficientes de esa poblacion causan gran impacto en su auto percepcion de la salud bucal.OBJECTIVE To identify self-perceived oral health in adults and associated variables. METHODS The study involved primary data from the Brazilian Oral Health Survey (SBBrasil) 2010 with 2,456 adults aged 35 to 44 in the Northeastern Brazil. The dependent variable was self-perceived oral health and the independent variables were grouped into four blocks: demographic, predisposing/facilitation, oral health status and those related to self-perceived need for treatment. The Rao and Scott test was used to test the association between these variables. To test the effect of the independent variables on the outcome, a multinomial logistic regression model was used according to the hierarchical model, resulting in an analysis divided into two stages: simple analysis and hierarchical multiple regression analysis. RESULTS Positive self-perception of oral health was observed in 37% of the participants. In the final model, the features directly associated with this perception were being white, having a household income exceeding R

Association of traumatic dental injuries with individual-, sociodemographic- and school-related factors among schoolchildren in midwest Brazil

500.00, owning goods number above the median, having more sound teeth, not experiencing bleeding, not requiring prosthesis, Oral Imparcts on Daily Performances = 0, not requiring treatment, having gone to the dentist less than 3 years ago. CONCLUSIONS The results show that self-perceived oral health in adults living in the Northeast is directly associated with a multidimensional structure of factors. The poor economic conditions associated with poor clinical conditions impact heavily on this populations self-perception of oral health.