Roger Keller Celeste

The relationship between smoking and age at the menopause: A systematic review

CONTEXT AND OBJECTIVE Increasing life expectancy has made it ever more important to study the factors that influence the age at the menopause, given that when it is reached outside of the normal range, it is associated with increased risk of osteoporosis and cardiovascular diseases, among other conditions. Among the factors studied in relation to early menopause, smoking is prominent. Destruction of the ovarian follicles is one of the mechanisms postulated for this effect. The aim of this study was to review and describe the associations between age at the menopause and the habit of smoking, its duration and its intensity. METHOD A systematic review of the literature indexed in the MEDLINE and LILACS databases was conducted, without restriction on publication date. After initially identifying 1325 articles and preselecting 161 articles for consideration of their complete texts, 96 articles reporting on the results from 109 studies were selected for analysis. RESULTS A great majority of the studies reported an association between the habit of smoking and early menopause, but there was no clear evidence that the duration of smoking and quantity of cigarettes smoked had any association with age at the natural menopause. CONCLUSION Additional studies are needed, preferably of prospective nature and with a large number of women, in order to deepen the knowledge of the effects of various aspects of smoking on age at the menopause. Experimental studies on animals may also contribute towards clarifying the physiopathological mechanisms through which smoking influences age at the menopause.

The individual and contextual pathways between oral health and income inequality in Brazilian adolescents and adults

We evaluate the association between income inequality (Gini index) and oral health and in particular the role of alternative models in explaining this association. We also studied whether or not income at the individual level modifies the Gini effect. We used data from an oral health survey in Brazil in 2002-2003. Our analysis included 23,568 15-19 and 22,839 35-44 year-olds nested in 330 municipalities. Different models were fitted using multilevel analysis. The outcomes analysed were the number of untreated dental caries (count), having at least one missing tooth (dichotomous) and being edentulous (dichotomous). To assess interaction as a departure from additivity we used the Synergy Index. For this, we dichotomized the Gini coefficient (high vs low inequality) by the median value across municipalities and the individual income in the point beyond which it showed roughly no association with oral health. Adjusted rate ratio of mean untreated dental caries, respectively for the 15-19 and 35-44 age groups, was 1.12 and 1.16 for each 10 points increase in Gini scale. Adjusted odds ratio of a 15-19 year-old having at least one missing tooth or a 35-44 year-old being edentulous was, respectively, 1.19 and 1.01. High income inequality had no statistically significant synergistic effect with being poor or living in a poor municipality. Higher levels of income inequality at the municipal level were associated with worse oral health and there was an unexplained residual effect after controlling for potential confoundings and mediators. Municipal level income inequality had a similar, detrimental effect, among individuals with lower or higher income.

How much of the income inequality effect can be explained by public policy? Evidence from oral health in Brazil.

OBJECTIVES To evaluate the association between income inequality, a public policy scale and to oral health. METHODS Analysis, using the Brazilian oral health survey in 2002-2003, included 23,573 15-19-year-old subjects clustered in 330 municipalities. Missing and decayed teeth and malocclusion assessments were the outcomes. Gini coefficient and a novel Scale of Municipal Public Policies were the main exposure variables. Individual level covariates were used as controls in multilevel regressions. RESULTS An increase from the lowest to the highest Gini value in Brazil was associated with an increase in the number of missing (rate ratio, RR=2.11 confidence interval 95% 1.18-3.77) and decayed teeth (RR=2.92 CI 95% 1.83-4.65). After adjustment for public policies and water fluoridation, the Gini effect was non-significant and public policies explained most of the variation in missing and decayed teeth. The public policy scale remained significant after adjustment with a rate ratio of 0.64 for missing and 0.72 for decayed teeth. Neither Gini nor public policies were significantly related to malocclusion. The public policy effect on missing and decayed teeth was stronger among those with higher education and income. CONCLUSIONS Income inequality effect was explained mainly by public policies, which had an independent effect that was greater among the better-off.

Associação entre procedimentos preventivos no serviço público de odontologia e a prevalência de cárie dentária

OBJETIVO: Avaliar a associacao entre as atividades odontologicas preventivas do servico publico de odontologia e a saude bucal de jovens. METODOS: Foram utilizados dados de 4.033 jovens de 15 a 19 anos, de 85 municipios do estado do Rio Grande do Sul, obtidos no inquerito epidemiologico Saude Bucal Brasil, realizado no periodo de 2002-2003. As variaveis estudadas foram: idade, sexo renda, escolaridade, tempo desde a ultima visita ao dentista, motivo da visita, e presenca de fluor na agua de abastecimento. Dados sobre as atividades odontologicas foram extraidos da base de dados do Sistema de Informacoes Ambulatoriais do Sistema Unico de Saude. Para analise estatistica foi utilizada a regressao logistica multinivel. RESULTADOS: Os individuos dos 21 municipios com menores taxas de procedimentos (por 100 habitantes) de procedimentos individuais preventivos (limpeza + fluor + selante) tiveram 2,27 (IC 95%: 1,45;3,56) vezes mais chance de ter uma carie nao restaurada do que residentes dos 21 municipios com maiores taxas. Essa chance permaneceu mesmo depois de ajustada por fatores individuais e contextuais, mas decresceu para 1,76 (IC 95%: 1,13;2,72). A proporcao da variabilidade atribuivel aos municipios foi de 14,1% para o modelo vazio e 10,5% para o modelo cheio. CONCLUSOES: O servico publico de odontologia no Rio Grande do Sul pode ter contribuido para a reducao no numero de caries nao restauradas em jovens. Porem, nao foi possivel detectar influencia desse servico na experiencia total da carie .

Effect of orthodontic treatment on oral health-related quality of life

OBJECTIVE To assess changes in oral health-related quality of life (OHQoL) in children undergoing fixed orthodontic treatment and compare it to that of two groups not receiving treatment. MATERIALS AND METHODS Two hundred eighty-four subjects aged 12-15 years were followed for 2 years; 87 were undergoing treatment at a university clinic (TG), 101 were waiting for treatment at this clinic (WG), and 96 were attending a public school and had never sought treatment (SG). OHQoL was assessed using the Oral Health Impact Profile (OHIP-14). All subjects were examined and interviewed at baseline (T1), 1 year later (T2), and 2 years later (T3). OHIP-14 scores were analyzed using negative binomial regression in generalized estimating equations for correlated data. RESULTS During the follow-up period, the WG and TG OHIP-14 scores showed a statistically significant increase and decrease, respectively (P < .001). At T1, the TG had an OHIP-14 score that was 1.9 times higher than that of the SG; however at T3, the TG score was 60% lower than the initial score of the SG. Adjusting for age, gender, dental health status (DMFT), socioeconomic position, malocclusion severity, and self-perceived esthetics did not change the effect of orthodontic treatment on OHQoL. CONCLUSION Fixed orthodontic treatment in Brazilian children resulted in significantly improved OHQoL after 2 years.

Feasibility of a new system of classification of submucous myomas: a multicenter study.

OBJECTIVE To evaluate the performance of the STEPW (size, topography, extension, penetration, wall) classification system in predicting partial or complete fibroid removal on hysteroscopic myomectomy. DESIGN Multicenter, prospective study (Canadian Task Force classification II-2). SETTING Four hysteroscopy centers in Brazil, China, Italy, and the United States. PATIENT(S) Four hundred forty-nine women who underwent hysteroscopic resection of 465 submucous fibroids. INTERVENTION(S) Resection of the submucous fibroids (hysteroscopic myomectomy). Fibroids were scored according to the European Society for Gynaecological Endoscopy (ESGE) and STEPW classifications. The validation of the two classifications was assessed using sensitivity and specificity of each classification, with their best cutoff point. A test of equality of the two areas under the receiver operating characteristic curves was performed for correlated samples. MAIN OUTCOME MEASURE(S) Correlation of ESGE and STEPW classifications with complete or incomplete removal of submucous fibroid. RESULT(S) Removal of the myoma was complete in 432 (92.9%) of 465 myomectomies and incomplete in 33 (7.1%). All 320 fibroids (100%) with a score≤4 in the STEPW classification were completely removed, and 112 of 145 fibroids (77.2%) with a score>4 were removed. All 33 cases of incomplete hysteroscopic myomectomy (100%) had a STEPW score>4. Using the ESGE classification, 85 of 86 cases (98.9%) of type 0 fibroids, 278 of 298 (93.3%) of type 1, and 69 of 81 (85.2%) of type 2 were completely resected. CONCLUSION(S) Classifying submucous fibroids using the STEPW classification permits greater correlation with complete or incomplete removal of the myoma by hysteroscopic myomectomy.

The relationship between levels of income inequality and dental caries and periodontal diseases

The objective of this study was to evaluate the association between income inequality at a lagged time of 2 and 11 years with two short latency outcomes (untreated dental caries and gingivitis) and two long latency outcomes (edentulism and periodontal attachment loss > 8mm). We used data from the Brazilian oral health survey in 2002-2003. Our analysis included 13,405 subjects aged 35-44 years. Different lagged Gini at municipal level were fitted using logistic and negative binomial multilevel analyses. Covariates included municipal per capita income, equivalized income, age, sex, time since last dental visit and place of residence (rural versus urban). Crude estimates showed that only untreated dental caries was associated with current and lagged Gini, but in adjusted models only current Gini remained significant with a ratio of 1.19 (95%CI: 1.09-1.30) for every ten-point increase in the Gini coefficient. We conclude that lagged Gini showed no association with oral health; and current income Gini was associated with current dental caries but not with periodontal disease.

Age, class and race discrimination: their interactions and associations with mental health among Brazilian university students

Embora a pesquisa sobre discriminacao e saude tenha progredido expressivamente, ela tem enfatizado a discriminacao racial em populacoes dos Estados Unidos. Este trabalho explorou diferentes tipos de discriminacao, suas interacoes e associacoes com transtornos mentais comuns em universitarios do Rio de Janeiro, Brasil, em 2010. Associacoes entre discriminacao e transtornos mentais comuns foram examinadas com regressao logistica, ajustando-se para confundidores. Interacoes entre discriminacao e caracteristicas sociodemograficas foram examinadas. Discriminacao por idade, classe e cor/raca foram as mais frequentemente relatadas. No modelo totalmente ajustado, discriminacao atribuida a cor/raca e classe foram ambas associadas com odds aumentadas de transtornos mentais comuns. O relato simultâneo de discriminacao por raca/cor, classe e idade esteve associado com a maior razao de odds. Nao foram observadas interacoes estatisticamente significativas. As discriminacoes de classe e raca/cor foram importantes, mas seu relato simultâneo, em conjunto com a discriminacao por idade, esteve associado com a maior ocorrencia de transtornos mentais comuns.Abstract Although research on discrimination and health has progressed significantly, it has tended to fo-cus on racial discrimination and US popula-tions. This study explored different types of dis -crimination, their interactions and associations with common mental disorders among Bra-zilian university students, in Rio de Janeiro in 2010. Associations between discrimination and common mental disorders were examined using multiple logistic regression models, adjusted for confounders. Interactions between discrimina-tion and socio-demographics were tested. Dis-crimination attributed to age, class and skin color/race were the most frequently reported. In a fully adjusted model, discrimination attrib -uted to skin color/race and class were both in-dependently associated with increased odds of common mental disorders. The simultaneous re-porting of skin color/race, class and age discrimi -nation was associated with the highest odds ratio. No significant interactions were found. Skin color/race and class discrimination were important, but their simultaneous reporting, in conjunction with age discrimination, were as-sociated with the highest occurrence of common mental disorders.Prejudice; Mental Health; Epidemiologic StudiesAlthough research on discrimination and health has progressed significantly, it has tended to focus on racial discrimination and US populations. This study explored different types of discrimination, their interactions and associations with common mental disorders among Brazilian university students, in Rio de Janeiro in 2010. Associations between discrimination and common mental disorders were examined using multiple logistic regression models, adjusted for confounders. Interactions between discrimination and socio-demographics were tested. Discrimination attributed to age, class and skin color/race were the most frequently reported. In a fully adjusted model, discrimination attributed to skin color/race and class were both independently associated with increased odds of common mental disorders. The simultaneous reporting of skin color/race, class and age discrimination was associated with the highest odds ratio. No significant interactions were found. Skin color/race and class discrimination were important, but their simultaneous reporting, in conjunction with age discrimination, were associated with the highest occurrence of common mental disorders.

Explicit discrimination and health: development and psychometric properties of an assessment instrument

OBJETIVO: Desenvolver instrumento para avaliar os efeitos de experiencias discriminatorias sobre condicoes e comportamentos em saude, capaz de distinguir efeitos patologicos da exposicao a tratamentos diferenciais de sua interpretacao como eventos discriminatorios. METODOS: Versoes sucessivas do instrumento foram elaboradas com base em uma revisao sistematica da literatura sobre escalas de discriminacao, grupos focais e apreciacao por um painel de sete especialistas. O refinamento do instrumento foi atingido por meio de entrevistas cognitivas e estudo-piloto, de modo que sua versao final foi aplicada em 424 estudantes de graduacao no Rio de Janeiro, RJ, em 2010. A estrutura dimensional, dois tipos de confiabilidade e validade de construto foram avaliadas. RESULTADOS: A analise fatorial exploratoria corroborou a hipotese de unidimensionalidade do instrumento e sete especialistas indicaram que este apresentava validade de face e conteudo. A consistencia interna foi de 0,8 e a confiabilidade teste-reteste foi maior do que 0,5 para 14 dos 18 itens. O escore foi estatisticamente mais alto em individuos socialmente desprivilegiados e associou-se com comportamentos/condicoes de saude adversos, especialmente quando tratamentos atribuidos a discriminacao foram considerados. CONCLUSOES: Estes resultados sugerem validade e confiabilidade do instrumento desenvolvido. A escala apresentada permitira investigar aspectos inovadores das relacoes entre discriminacao e saude.OBJECTIVE To develop an instrument to assess discrimination effects on health outcomes and behaviors, capable of distinguishing harmful differential treatment effects from their interpretation as discriminatory events. METHODS Successive versions of an instrument were developed based on a systematic review of instruments assessing racial discrimination, focus groups and review by a panel comprising seven experts. The instrument was refined using cognitive interviews and pilot-testing. The final version of the instrument was administered to 424 undergraduate college students in the city of Rio de Janeiro, Southeastern Brazil, in 2010. Structural dimensionality, two types of reliability and construct validity were analyzed. RESULTS Exploratory factor analysis corroborated the hypothesis of the instruments unidimensionality, and seven experts verified its face and content validity. The internal consistency was 0.8, and test-retest reliability was higher than 0.5 for 14 out of 18 items. The overall score was higher among socially disadvantaged individuals and correlated with adverse health behaviors/conditions, particularly when differential treatments were attributed to discrimination. CONCLUSIONS These findings indicate the validity and reliability of the instrument developed. The proposed instrument enables the investigation of novel aspects of the relationship between discrimination and health.

Chlorhexidine application in adhesive procedures: a meta-regression analysis.

PURPOSE To evaluate the association between chlorhexidine application and the bond strength of an adhesive system to dentin and to assess the association among eight other variables. MATERIALS AND METHODS Laboratory studies evaluating the use of chlorhexidine on dentin that verified the immediate and longitudinal bond strength were included. The terms were selected according to the Medical Subject Headings (MeSH) for PubMed and adapted for the other databases accordingly. Systematic searches were conducted in 3 electronic databases in December 2010: PubMed, EMBASE, and LILACS. Languages were limited to English, Spanish, and Portuguese. RESULTS All longitudinal bond strength studies were analyzed in accordance with the inclusion/exclusion criteria, totaling 16 articles. A meta-regression analysis was performed with articles containing complete mean bond strength data (n = 14 articles). CONCLUSION Our results showed that the association between the concentration of chlorhexidine and the bond strength is, apparently, not linear. Therefore, future large-scale studies should be developed to investigate the association between the chlorhexidine concentration and hybrid layer preservation.