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BACKGROUND: Excess weight (EW), especially in women of childbearing age, those who are pregnant, as well as postpartum, is a problem worldwide. Fat accumulation deregulates the inflammatory response, contributing to the development of health problems, such as periodontitis. This study investigated the association between EW and periodontitis during pregnancy. METHODS: A cross-sectional, multicenter study involved 1745 postpartum women in Brazil. Socioeconomic-demographic data, gestational history, lifestyle behavior, and general and oral health conditions were obtained. Pre-pregnancy body mass index (BMI) was collected from medical records with EW being the exposure. Both tooth loss and clinical attachment level (CAL) were evaluated, and the presence of periodontitis was the outcome. Logistic regression, odds ratio (OR) and 95% confidence interval (95% CI), and quantile regression, beta coefficient and 95% CI, estimated the association between EW (BMI) and periodontitis and its combined effect with tooth loss ≥3, as dichotomous and continuous variables (CAL and tooth loss), with 5% significance level. RESULTS: The EW was 27.7% prevalent and periodontitis was 11.7%. There was a positive association between EW and periodontitis: ORadjusted:1.39; 95% CI:1.01;1.92 and between EW and periodontitis combined with tooth loss ≥3: ORadjusted:1.73; 95% CI:1.36;2.20. The adjusted association between EW and periodontitis as continuous variables was also positive, showing that for each unit of increased BMI, there was an elevation in the mean CAL (p = 0.04) and tooth loss (p < 0.01), with statistical significance. CONCLUSIONS: There was a moderate association between EW and periodontitis during pregnancy, with an even greater association of pregnant women with EW presenting periodontitis combined with tooth loss.

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The diversity of criteria used in the diagnosis of periodontitis in pregnant women makes it difficult to define and compare the disease. Using a systematic review, this study evaluated the accuracy of criteria for diagnosing periodontitis in pregnant women. Searches were carried out in the databases: Medline/PubMed, Embase, Scopus, Web of Science, SciELO, Lilacs, ProQuest, and CINAHL. Validation studies of the criteria used for diagnosing periodontitis met the inclusion criteria. The study steps were performed by three independent reviewers. A qualitative synthesis of the included articles was carried out and the quality methodological analysis using the QUADAS-2 instrument. The assessment of the quality of the evidence was obtained through the GRADE tool. A total of 592 records were identified, of which only 6 made up this systematic review. The included studies analyzed different criteria for diagnosing periodontitis, evaluating 3,005 pregnant women. The criteria selected as a test presented results equivalent to the performance of those recognized as the gold standard. The self-reported criteria were of lower diagnostic accuracy. A major limitation of this review was the small number of primary studies that evaluated clinical diagnosis of periodontitis in pregnant women, which was highly heterogeneous, making it impossible to carry out accuracy meta-analysis and additional analyzes. There is a lack of consensus on the criteria for the diagnosis of periodontitis, with great variability in the accuracy and prevalence of the disease in pregnant women.

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INTRODUCTION: Neuropsychiatric diseases, particularly dementias, has become more prominent with a great impact on the quality of life of the elderly population. OBJECTIVE: To verify the rate of increase in mortality due to Alzheimer's disease in the Federal District, Brazil from 2010 to 2018. METHOD: An ecological study was conducted, with a time series, about the evolution of the mortality coefficient in the Federal District, Brazil carried out at the Federal District State Department of Health. Mortality rates were defined as the dependent variable and years evaluated as the independent variable-from 2010 to 2018. For temporal trend analysis, the Prais-Winsten linear regression model was used and the increment rate with the respective 95% confidence interval was estimated. RESULTS: From 2010 to 2018, 1665 deaths which had Alzheimer's disease as the underlying cause were recorded in the Mortality Information System. The results showed an overall mortality rate of 6.55 deaths per 100,000 inhabitants, with a higher predominance in females, non-Black people, and those aged 80 years or older. There was an increase in the annual trend of the overall mortality coefficient in both sexes. CONCLUSION: The findings demonstrated a significant increase in the temporal evolution of mortality due to Alzheimer's disease in the Federal District, Brazil. It was recommended to conduct original studies to evaluate the factors that can cause the disease in order to collaborate in the process of formulating policies in the area of public health and improvements in clinical practice.

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A anemia em gestantes é um relevante problema de ampla expansão geográfica, típica de grandes centros urbanos que atinge diversos países, como os da América. Estimar a prevalência nas Américas de anemia materna e anemia ferropriva em gestantes.Revisão rápida com busca no Medline, via PubMed, Scopus, Web of Science, SciELO, Lilacs e Open Grey. Incluíram-se estudos do tipo transversal, que estimassem a prevalência de anemia materna e anemia ferropriva. Foram realizadas metanálises com efeito randômico. 5.148 artigos foram encontrados, apenas 39 atenderam aos critérios de elegibilidade. As metanálises apresentaram prevalência de 30% (IC95%: 28%; 32%. I2: 99,4%) para anemia materna e frequência de 32% (IC95%: 25%; 40%. I2: 96,6%) para anemia ferropriva.Anemia materna é um evento frequente na população das Américas, com 30% para anemia materna e 32% para anemia ferropriva, destacando a necessidade de medidas de prevenção e promoção à saúde mais eficazes.

Anemia in pregnant women is a relevant problem of wide geographical expansion, typical of large urban centers and that affects several countries, such as America. To estimate the prevalence of maternal anemia and iron deficiency anemia in pregnant women in the Americas.Rapid review with search in Medline, Pubmed, Scopus, Web of Science, SciELO, Lilacs and Open Grey databases. Cross-sectional studies that estimated the prevalence of maternal anemia and iron deficiency anemia were included. Random-effects meta-analyses were conducted. 5148 articles were found, only 30 met the eligibility criteria. Meta-analyses showed a prevalence of 30% (95%CI: 28%; 32%. I2: 99.4%) for maternal anemia and a frequency of 32% (95%CI: 25%; 40%. I2: 96.6%) for iron deficiency anemia. Maternal anemia is a frequent event in the population of the Americas, with prevalence of 30% for maternal anemia and 32% for iron deficiency anemia, highlighting the need for more effective prevention and health promotion measures.

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Background: Sepsis currently represents a challenge for health systems, this fact may be related to the spread of bacterial resistance, the increase in the population of elderly, immunosuppressed individuals, and the improvement of emergency care, favoring the survival of critically ill patients. This article aimed to evaluate the accuracy of mortality indicators due to sepsis in 2018. Method: Validation study of death certificates that occurred in the Federal District in 2018. Declarations whose basic causes of death identified were classified as garbage codes were identified, which were investigated by a multidisciplinary team, capable of reclassifying them with codes that allow for the improvement of health data. In order to assess accuracy, sensitivity, specificity, positive and negative predictive values, positive and negative likelihood ratios of death certificates from sepsis were calculated, with 95% confidence intervals. Results: A total of 6.244 statements were evaluated, of which 233 (3.74%) presented sepsis as the underlying cause before being investigated and only 35 (0.56%) maintained it after the investigation. The filling of statements with sepsis as the underlying cause by physicians showed a sensitivity of 0.9% (95%CI: 0.6 to 1.3) and a specificity of 92.0% (95%CI: 90.9 to 93.1). Conclusion: The low accuracy of the declarations demonstrates the non-reliability of the underlying cause of death from sepsis, especially the completion of death certificates that occurred in the Federal District in 2018.(AU)

Justificativa: A sepse, atualmente, representa um desafio para os sistemas de saúde, tal fato pode estar relacionado com a disseminação da resistência bacteriana, o aumento da população de idosos, os indivíduos imunossuprimidos, e a melhoria do atendimento de emergência, favorecendo a sobrevivência de pacientes críticos. Este artigo teve por objetivo avaliar a acurácia dos indicadores de mortalidade devido à sepse em 2018. Método: Estudo de validação da causa básica dos óbitos ocorridos no Distrito Federal em 2018. Foram identificadas as declarações de óbito cujas causas básicas de morte apontadas foram classificadas como garbage code sepse, as quais foram investigadas por uma equipe multidisciplinar, capacitada para reclassificá-las com códigos que permitem o aprimoramento dos dados em saúde. A fim de avaliar a acurácia, foram calculados os valores de sensibilidade, especificidade, valores preditivos positivo e negativo, razões de verossimilhança positiva e negativa das declarações dos óbitos por sepse, com intervalos de confiança de 95%. Resultados: Um total de 6.244 declarações foram avaliadas, das quais 233 (3,74%) apresentavam a sepse como causa básica antes de serem investigadas e apenas 35 (0,56%) mantiveram-na após a investigação. O preenchimento das declarações com a sepse enquanto causa básica pelos médicos apresentou sensibilidade de 0,9% (IC95%: 0,6 a 1,3) e especificidade de 92,0% (IC95%: 90,9 a 93,1). Conclusão: A baixa acurácia das declarações demonstra a não fidedignidade da causa básica de óbito por sepse, sobretudo, do preenchimento das declarações dos óbitos ocorridos no Distrito Federal em 2018.(AU)

Justificación: Sepsis representa en la actualidad un desafío para los sistemas de salud, este hecho puede estar relacionado con propagación de resistencias bacterianas, aumento de la población de ancianos, inmunodeprimidos, y mejora de la atención de urgencias, favoreciendo la supervivencia de los pacientes críticos. Este artículo tuvo como objetivo evaluar la precisión de los indicadores de mortalidad por sepsis en 2018. Método: Estudio de validación de causa básica de muertes ocurridas en Distrito Federal en 2018. Se identificaron actas de defunción cuyas causas básicas de muerte fueron clasificadas como sepsis código basura y fueron investigadas por un equipo multidisciplinario capacitado para reclasificarlas con códigos que permitan la mejora de datos de salud. Para evaluar la precisión, se calcularon sensibilidad, especificidad, valores predictivos positivo y negativo y razones de verosimilitud positiva y negativa de certificados de defunción por sepsis, con intervalos de confianza del 95%. Resultados: se evaluaron 6.244 declaraciones, de las cuales 233 (3,74%) tenían como causa básica la sepsis antes de ser investigadas y solo 35 (0,56%) mantuvieron después de investigación. Realización de declaraciones con sepsis como causa subyacente por parte de los médicos mostró sensibilidad del 0,9% (95%IC: 0,6 a 1,3) y especificidad del 92,0% (95%IC: 90,9 a 93,1). Conclusión: Baja precisión de las declaraciones demuestra la poca confiabilidad de la causa subyacente de muerte por sepsis, especialmente la finalización de los certificados de defunción ocurridos en Distrito Federal en 2018.(AU)

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The objective of this study was to investigate the association between periodontitis severity and metabolic syndrome (MetS) through systematic review, registered in PROSPERO: CRD42021232120. Selected articles were independently chosen by three reviewers from six databases, including using article reference lists, up until March 2022. Eligible studies were observational, without language limitation, and in subjects aged at least 18 years. The methodological quality of selected studies was assessed using the Newcastle-Ottawa Scale. Random effects models calculated summary measurements (odds ratio-OR, 95% confidence interval, 95%CI). The I2 test evaluated the statistical heterogeneity of the data. Sensitivity, subgroup, and meta-regression analyses were performed. For the reliability of evidence, the Grading of Recommendations, Assessment, Development, and Evaluations tool was used. A total of 2133 records were identified, and 14 studies were included comprising 24,567 participants. The summary odds ratio showed a positive association between individuals with moderate (ORadjusted  = 1.26; 95%CI = 2.10-5.37; I2  = 45.85%), and severe periodontitis (ORadjusted  = 1.50; 95%CI:1.28-1.71; I2  = 56.46%), and MetS. Subgroup and meta-regression analyses showed that study effect size was influenced by year of publication, study design, and MetS diagnostic criteria, contributing to inter-study variability. The findings showed that moderate and severe levels of periodontitis are associated with MetS, suggesting a possible dose-response effect.

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Cocaine use is an increasingly frequent event, especially in young people, and can cause irreversible consequences, such as suicide. To evaluate the factors associated with cocaine use in the moments preceding to suicide. This is a population-based, cross-sectional, and analytical study conducted in the Brazilian Federal District by researchers from the Department of Health and the Civil Police Institute of Criminalistics. All people who died due to suicide in 2018 were included in the survey. Cocaine use was considered the dependent variable, and robust Poisson regression was performed to estimate the crude and adjusted prevalence ratios and their respective population confidence intervals. In 2018, 12,157 deaths were recorded, of which suicide accounted for 1.56% of all deaths. It was observed that being between 25 and 44 years old, male, and under the influence of alcohol or cannabis, had a strong positive association with cocaine consumption among suicide victims. Males, people with black skin, with lower level of education, with employment, and who were under the effect of the use of cannabis and/or alcohol in the previous hours of death had a higher propensity to consume cocaine immediately before suicide, with a moderate to strong magnitude of prevalence ratio. The findings of this research indicated the need for monitoring, by health services, of people most vulnerable to suicide through the consumption of psychoactive substances.

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OBJECTIVE: To investigated the effect of oropharyngeal colostrum immunotherapy in reducing the time required for very low birth weight preterm newborns (VLBW-PTNB: < 1,500g and < 37 weeks) to achieve full enteral nutrition. METHODS: Literature search was conducted using four databases, including gray literature, with additional manual search of the references of selected articles. Eligibility criteria consisted of randomized clinical trials, without restriction regarding the date or language of the publication. Two independent reviewers performed the article selection and data extraction. The random-effects meta-analysis used a non-standard technique to assess the mean difference in days to achieve full enteral nutrition, carried out by the Stata 15 statistic program. RESULTS: The systematic review comprised 10 studies, and five were selected for meta-analysis, with a population of 764 VLBW-PTNB and gestational age of birth between 25 and 32 weeks. The studies were conducted between 2011 and 2018 in North America, Asia and Africa, with only one conducted in South America. Altogether, they reported the number of days it took 708 VLBW-PTNB to achieve full enteral nutrition, with newborns treated with immunotherapy showing a shorter time in only three studies. Meta-analysis showed a mean difference of -4.26 days, (95% CI -7.44; -1.08d), with high heterogeneity (I2 = 83.1%). CONCLUSION: The use of oropharyngeal colostrum immunotherapy can reduce the time for VLBW-PTNB to achieve full nutrition when compared to those who used a placebo or received routine care.

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Recent evidence points to the influence of periodontal inflammatory processes on the occurrence of low birth weight. Although many studies employed robust investigation methods, there is still no general agreement on the relationship between maternal periodontitis and low birth weight. The search for studies was conducted until April 2019. The studies included cohort and case-control studies that estimated the association between periodontitis and low birth weight, with no restriction on language or date of publication. Analysis of the heterogeneity of studies, subgroup analyses and meta-analyses with a random effects model were performed. Summary association measurements were estimated using the crude and adjusted Odds Ratio, with respective 95% confidence intervals. Visual inspection of graphs was used to assess publication bias. A total of 21 articles were identified, all of which were selected for the meta-analysis. The final model indicates that periodontitis in pregnant women was associated with low birth weight (ORgross=2.13; CI95%=1.60-2.83; I2=80.0% and ORadjusted=2.64; CI95%=2.04-3.42; I2=17.4%). Pregnant women with periodontitis may be more than twice as likely to have low birth weight babies.

Evidências recentes apontam para a influência de processos inflamatórios periodontais na ocorrência de baixo peso ao nascer. Embora muitos estudos empregaram métodos robustos de investigação, ainda não existe consenso sobre o tópico. Analisar sistematicamente a relação entre a periodontite materna e o baixo peso ao nascer. A busca por estudos foi realizada até abril de 2019. Os delineamentos de estudos incluídos foram coorte e caso-controle que estimaram a associação entre a periodontite e o baixo peso ao nascer, sem limite quanto ao idioma ou data da publicação. Análise de heterogeneidade dos estudos, análises de subgrupo e metanálises com modelo de efeitos randômicos foram realizadas. Foram estimadas as medidas de associação sumária por meio da Odds Ratio bruta e ajustada, com respectivos intervalos de confiança a 95%. A inspeção visual de gráficos foi empregada para avaliar viés de publicação. Um total de 21 artigos foram identificados e todos foram selecionados para a metanálise. O modelo final aponta que a periodontite em gestantes se associou ao baixo peso ao nascer (ORbruta=2,13; IC95%=1,60-2,83; I2=80,0% e ORajustada=2,64; IC95%=2,04-3,42; I2=17,4%). Gestantes com periodontite podem ter mais que o dobro de probabilidade de terem filhos com baixo peso ao nascer.

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Resumo Evidências recentes apontam para a influência de processos inflamatórios periodontais na ocorrência de baixo peso ao nascer. Embora muitos estudos empregaram métodos robustos de investigação, ainda não existe consenso sobre o tópico. Analisar sistematicamente a relação entre a periodontite materna e o baixo peso ao nascer. A busca por estudos foi realizada até abril de 2019. Os delineamentos de estudos incluídos foram coorte e caso-controle que estimaram a associação entre a periodontite e o baixo peso ao nascer, sem limite quanto ao idioma ou data da publicação. Análise de heterogeneidade dos estudos, análises de subgrupo e metanálises com modelo de efeitos randômicos foram realizadas. Foram estimadas as medidas de associação sumária por meio da Odds Ratio bruta e ajustada, com respectivos intervalos de confiança a 95%. A inspeção visual de gráficos foi empregada para avaliar viés de publicação. Um total de 21 artigos foram identificados e todos foram selecionados para a metanálise. O modelo final aponta que a periodontite em gestantes se associou ao baixo peso ao nascer (ORbruta=2,13; IC95%=1,60-2,83; I2=80,0% e ORajustada=2,64; IC95%=2,04-3,42; I2=17,4%). Gestantes com periodontite podem ter mais que o dobro de probabilidade de terem filhos com baixo peso ao nascer.

Abstract Recent evidence points to the influence of periodontal inflammatory processes on the occurrence of low birth weight. Although many studies employed robust investigation methods, there is still no general agreement on the relationship between maternal periodontitis and low birth weight. The search for studies was conducted until April 2019. The studies included cohort and case-control studies that estimated the association between periodontitis and low birth weight, with no restriction on language or date of publication. Analysis of the heterogeneity of studies, subgroup analyses and meta-analyses with a random effects model were performed. Summary association measurements were estimated using the crude and adjusted Odds Ratio, with respective 95% confidence intervals. Visual inspection of graphs was used to assess publication bias. A total of 21 articles were identified, all of which were selected for the meta-analysis. The final model indicates that periodontitis in pregnant women was associated with low birth weight (ORgross=2.13; CI95%=1.60-2.83; I2=80.0% and ORadjusted=2.64; CI95%=2.04-3.42; I2=17.4%). Pregnant women with periodontitis may be more than twice as likely to have low birth weight babies.

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