RESUMO
OBJECTIVE: To be fit-for-purpose, oral health-related quality of life instruments must possess a range of psychometric properties which had not been fully examined in the 16-item Short Form Child Perceptions Questionnaire for children aged 11 to 14 years (CPQ11-14 ISF-16). We used advanced statistical approaches to determine the CPQ's measurement accuracy, precision, invariance and dimensionality and analyzed whether age range could be extended from 8 to 15 years. METHODS: Fit to the Rasch model was examined in 6648 8-to-15-year-olds from Australia, New Zealand, Brunei, Cambodia, Hong Kong, Malaysia, Thailand, Germany, United Kingdom, Brazil and Mexico. RESULTS: In all but two items, the initial five answer options were reduced to three or four, to increase precision of the children's selection. Items 10 (Shy/embarrassed) and 11 (Concerned what others think) showed an 'extra' dependency between item scores beyond the relationship related to the underlying latent construct represented by the instrument, and so were deleted. Without these two items, the CPQ was unidimensional. The three oral symptoms items (4 Food stuck in teeth, 3 Bad breath and 1 Pain) were required for a sufficient person-item coverage. In three out of 14 items (21 %), Europe and South America showed regional differences in the patterns of how the answer options were selected. No differential item functioning was detected for age. CONCLUSION: Except for a few modifications, the present analysis supports the combination of items, the cross-cultural validity of the CPQ with 14 items and the extension of the age range from 8 to 15 years. CLINICAL SIGNIFICANCE: The valid, reliable, shortened and age-extended version of the CPQ resulting from this study should be used in routine care and clinical research. Less items and a wider age range increase its usability. Symptoms items are needed to precisely differentiate between children with higher and lower quality of life.
Assuntos
Saúde Bucal , Qualidade de Vida , Adolescente , Austrália , Brasil , Criança , Europa (Continente) , Alemanha , Hong Kong , Humanos , Nova Zelândia , Reprodutibilidade dos Testes , Inquéritos e Questionários , Reino UnidoRESUMO
This study used data from the 1982 Pelotas Birth Cohort Study, Brazil, to estimate the controlled direct effect of early-life socioeconomic position (SEP) on periodontitis at age 31 years, controlling for adulthood income and education, smoking, and dental hygiene. Sex was included as a covariate. Early-life SEP was measured at participant birth based on income, health services payment mode, maternal education, height, and skin color (lower versus middle/higher SEP). Periodontitis was assessed through clinical examination at age 31 years (healthy, mild periodontitis, or moderate-to-severe disease). Adulthood behaviors (smoking, dental hygiene) were the mediators, and adulthood SEP (education and income) represented the exposure-induced mediator-outcome confounders. A regression-based approach was used to assess the controlled direct effect of early-life SEP on periodontitis. Multinomial regression models were used to estimate risk ratios and their 95% confidence intervals. The prevalences of mild and moderate-to-severe periodontitis were 23.0% and 14.3%, respectively (n = 539). Individuals from the lowest early-life SEP had a higher risk of moderate-to-severe periodontitis controlled for mediators and exposure-induced mediator-outcome confounders: risk ratio = 1.85 (95% confidence interval: 1.06, 3.24), E value 3.1. We found that early-life SEP was associated with the development of periodontitis in adulthood that was not mediated by adulthood SEP and behaviors.
Assuntos
Experiências Adversas da Infância/estatística & dados numéricos , Periodontite/epidemiologia , Adulto , Brasil , Feminino , Humanos , Masculino , Saúde Bucal/estatística & dados numéricos , Higiene Bucal/estatística & dados numéricos , Análise de Regressão , Índice de Gravidade de Doença , Fumar/epidemiologia , Fatores SocioeconômicosRESUMO
AIMS: To quantify the impact of life course income trajectories on periodontitis in adulthood. MATERIALS AND METHODS: Data from the 1982 Pelotas Birth Cohort Study, Brazil, were used. Information on family income was collected at birth and ages 15, 19, 23 and 30 years. Group-based trajectory modelling was used to identify income trajectories. Periodontal measures were assessed through clinical examination at age 31. Log-Poisson regression models were used to estimate prevalence ratios (PRs) of any and moderate/severe periodontitis, as outcomes. RESULTS: Prevalence of any periodontitis and moderate/severe periodontitis was 37.3% and 14.3% (n = 539). Income trajectories were associated with prevalence of moderate/severe periodontitis. Adjusted PR in participants in low and variable income trajectory was 2.1 times higher than in participants in stable high-income trajectory. The unadjusted association between income trajectories and prevalence of any periodontitis was explained by the inclusion of behavioural and clinical variables in the model. CONCLUSIONS: Low and variable life course income increased the prevalence of moderate/severe periodontitis at age 31 years. The findings may inform programmes in identifying and targeting potentially at-risk groups during the life course to prevent periodontitis.
Assuntos
Escolaridade , Renda , Periodontite/economia , Adolescente , Adulto , Brasil/epidemiologia , Estudos de Coortes , Feminino , Humanos , Recém-Nascido , Masculino , Mães , Análise Multivariada , Índice Periodontal , Periodontite/epidemiologia , Prevalência , Fatores de Risco , Adulto JovemRESUMO
BACKGROUND: Prediction of periodontitis development is challenging. Use of oral health-related data alone, especially in a young population, might underestimate disease risk. This study investigates accuracy of oral, systemic, and socioeconomic data on estimating periodontitis development in a population-based prospective cohort. METHODS: General health history and sociodemographic information were collected throughout the life-course of individuals. Oral examinations were performed at ages 24 and 31 years in the Pelotas 1982 birth cohort. Periodontitis at age 31 years according to six classifications was used as the gold standard to compute area under the receiver operating characteristic curve (AUC). Multivariable binomial regression models were used to evaluate the effects of oral health, general health, and socioeconomic characteristics on accuracy of periodontitis development prediction. RESULTS: Complete data for 471 participants were used. Periodontitis classifications with lower thresholds yielded superior predictive power. Calculus, pocket, or bleeding presence at age 24 years separately presented fair accuracy. Accuracy increased using multivariable models; for example, the Beck et al. classification AUC from 0.59 to 0.75 combining proportion of teeth with calculus, bleeding, or pocket with income; number of lost teeth; sex; education; people living in the house; prosthetic needs; or number of decayed, missing, or filled teeth (DMFT). Proportion of teeth with pocket, bleeding, or calculus; number of DMFT; toothbrushing frequency; blood pressure; sex; and income were most frequently associated. CONCLUSIONS: Choice of classification might have an impact on accuracy to predict periodontitis occurrence. Regardless of the classification, predictive value for development of periodontitis in young adults might be increased by combining periodontal information, sociodemographic information, and general health history.
Assuntos
Indicadores Básicos de Saúde , Periodontite/classificação , Periodontite/epidemiologia , Adulto , Brasil/epidemiologia , Feminino , Humanos , Masculino , Anamnese , Saúde Bucal , Índice Periodontal , Valor Preditivo dos Testes , Fatores de Risco , Fatores SocioeconômicosRESUMO
AIM: This study aimed to conduct a systematic review assessing the effects of weight gain on the incidence of periodontitis in adults. METHODS: Electronic searches in four databases were performed up to and including February 2015. Only prospective longitudinal studies assessing the association between weight gain and the incidence of periodontitis in adults were eligible to be included in this study. All studies should state a clear description of nutritional status (Body Mass Index; Waist Circumference) as well as the case definition of periodontitis. Pooled relative risks (RR) for becoming overweight and obese on the incidence of periodontitis were estimated by meta-analysis. Quality was assessed with the Newcastle-Ottawa scale for cohort studies. RESULTS: Five articles were included in this review and meta-analysis with 42,198 subjects enrolled. Subjects who became overweight and obese presented higher risk to develop new cases of periodontitis (RR 1.13; 95%CI 1.06-1.20 and RR 1.33 95%CI 1.21-1.47 respectively) compared with counterparts who stayed in normal weight. CONCLUSIONS: A clear positive association between weight gain and new cases of periodontitis was found. However, these results are originated from limited evidence. Thus, more studies with longitudinal prospective design are needed.
Assuntos
Periodontite/etiologia , Aumento de Peso/fisiologia , Índice de Massa Corporal , Humanos , Estado Nutricional , Obesidade/complicações , Sobrepeso/complicações , Circunferência da CinturaRESUMO
OBJECTIVE: To assess changes over time of the absolute and relative household income-related inequalities in inadequate dentition (ID) among Australians, Brazilians and USA adults. METHODS: This study used nationwide oral health survey data from Australia (n = 1200 in 1999; n = 2729 in 2005), Brazil (n = 13 431 in 2003; n = 9779 in 2010) and USA (n = 2542 in 1999; n = 1596 in 2005). Absolute income inequalities were calculated using Absolute Concentration Index (ACI) and Slope Index of Inequality (SII), while relative inequalities were calculated using Relative Concentration Index (RCI) and Relative Index of Inequality (RII). RESULTS: Prevalence of ID in the studied period dropped from 8.7% to 3.1% in Australia; from 42.1% to 22.4% in Brazil; and remained stable in USA, nearly 8.0%. Absolute income inequalities were highest in Brazil, followed by the USA and Australia; relative inequalities were lower in Brazil than in Australia and the USA. ID was higher among Brazilian females (2010) and for the poorest group in all countries and periods. A remarkable reduction in absolute inequalities were found in Australia [Slope Index of Inequality (SII) and AIC 60%] and in Brazil (SII 25%; ACI 33%) while relative inequalities increased both in Australia (RCI and RII 40%) and in Brazil (RCI 24%; RII 38%). No changes in absolute and relative income inequalities were found in the USA. CONCLUSION: There were still persistent absolute and relative income inequalities in ID in all examined countries. There has been a reduction in absolute income inequalities in ID but an increase in relative income inequalities.