Cost-effectiveness of conventional and modified supervised toothbrushing in preventing caries in permanent molars among 5-year-old children

The cost-effectiveness of a modified supervised toothbrushing program was compared to a conventional program. A total of 284 five-year-old children presenting at least one permanent molar with emerged/sound occlusal surface participated. In the control group, oral health education and dental plaque dying followed by toothbrushing with fluoride dentifrice was carried outfour times per year. With the test group, children also underwent professional cross-brushing on surfaces of first permanent molar rendered by a dental assistant five times per year. Enamel/dentin caries were recorded on buccal, occlusal and lingual surfaces of permanent molars for a period of 18 months. The incidence density (ID) ratio was estimated using Poisson's regression model. The ID was 50% lower among boys in the test group (p = 0.016). The cost of the modified program was US$ 1.79 per capita. The marginal cost-effectiveness ratio among boys was US$ 6.30 per avoided carie. The modified supervised toothbrushing program was shown to be cost-effective in the case of boys.

Associação ecológica entre características dos municípios e o risco de homicídios em homens adultos de 20-39 anos de idade no Brasil, 1999-2010

No Brasil, a mortalidade por homicídios persiste como importante problema de saúde pública, principalmente entre homens adultos jovens. O objetivo do presente estudo foi analisar o risco de morte por homicídios entre homens de 20-39 anos de idade e sua associação com características sociodemográficas dos municípios brasileiros. Foi realizado estudo ecológico, tendo como unidades de análise todos os municípios do País. Foram estudadas as tendências temporais entre 1999-2010 e as associações do desfecho com indicadores dos municípios em análise transversal referente ao quatriênio 2007-2010. Entre os quatriênios 1999-2002 e 2007-2010, houve aumento das taxas medianas de mortalidade por homicídios entre homens de 20-39 anos, de 22,7 para 35,5 por 100 mil habitantes. No quatriênio 2007-2010, os riscos de homicídios foram estatisticamente superiores (p<0,001) nos municípios de maior porte populacional, maior taxa de fecundidade, baixa proporção de alfabetizados, maior desigualdade aferida pela renda 20/40 e maior urbanização. Para a proporção da população de baixa renda e renda média per capita, as associações indicam excessos nas estimativas de risco de homicídios nos municípios com valores intermediários desses indicadores. Os achados podem auxiliar na focalização de políticas públicas.

Economic Cost of Air Pollution in Cubatao - SP Based on Health Expenses Related to Diseases of the Respiratory and Circulatory Systems

The aim of this research was to evaluate economic costs of respiratory and circulatory diseases in the municipality of Cubatao, in the state of Sao Paulo, Brazil. Data on hospital admissions and on missed working days due to hospitalization (for age group 14 to 70 years old) from the database of Sistema Unico de Sa de (SUS - Brazilian National Health System) were used. Results: Based on these data, it was calculated that R$ 22.1 million were spent in the period 2000 to 2009 due to diseases of the respiratory and circulatory systems. Part of these expenses can be directly related to the emission of atmospheric pollutants in the city. In order to estimate the costs related to air pollution, data on Cubatao were compared to data from two other municipalities that are also located at the coast side (Guaruja and Peru be), but which have little industrial activity in comparison to Cubatao. It was verified that, in both, average per capita costs were lower when compared to Cubatao, but that this difference has been decreasing in recent years.

Contextual and individual assessment of dental pain period prevalence in adolescents: a multilevel approach

Abstract Background Despite evidence that health and disease occur in social contexts, the vast majority of studies addressing dental pain exclusively assessed information gathered at individual level. Objectives To assess the association between dental pain and contextual and individual characteristics in Brazilian adolescents. In addition, we aimed to test whether contextual Human Development Index is independently associated with dental pain after adjusting for individual level variables of socio-demographics and dental characteristics. Methods The study used data from an oral health survey carried out in São Paulo, Brazil, which included dental pain, dental exams, individual socioeconomic and demographic conditions, and Human Development Index at area level of 4,249 12-year-old and 1,566 15-year-old schoolchildren. The Poisson multilevel analysis was performed. Results Dental pain was found among 25.6% (95%CI = 24.5-26.7) of the adolescents and was 33% less prevalent among those living in more developed areas of the city than among those living in less developed areas. Girls, blacks, those whose parents earn low income and have low schooling, those studying at public schools, and those with dental treatment needs presented higher dental-pain prevalence than their counterparts. Area HDI remained associated with dental pain after adjusting for individual level variables of socio demographic and dental characteristics. Conclusions Girls, students whose parents have low schooling, those with low per capita income, those classified as having black skin color and those with dental treatment needs had higher dental pain prevalence than their counterparts. Students from areas with low Human Development Index had higher prevalence of dental pain than those from the more developed areas regardless of individual characteristics.

Perfil da demanda por microcomputadores no Brasil: o que os microdados da POF-IBGE indicam?

Neste estudo, analisou-se a relação entre a despesa domiciliar com a compra de computadores e as características demográficas e socioeconômicas dos domicílios brasileiros. Foram utilizados os microdados de duas Pesquisas de Orçamentos Familiares (POF), elaboradas pelo Instituto Brasileiro de Geografia e Estatística (IBGE): 2002-2003 e 2008-2009. Essas bases permitiram que se utilizasse a despesa total per capita como variável definidora do poder aquisitivo do domicílio. Foi adotada uma abordagem econométrica para a natureza desse tipo de análise, isto é, o modelo de seleção de Heckman, que envolve dois estágios. No primeiro, analisaram-se os fatores associados à probabilidade de ocorrência da despesa e, no segundo, foram avaliados os fatores associados aos valores da despesa efetuada. Os principais resultados indicaram que o perfil do chefe (gênero e idade) e a composição dos domicílios e escolaridade dos moradores são fatores relevantes tanto para a decisão de gastar quanto para a decisão sobre o valor a ser gasto. A redução da elasticidade que relaciona as despesas com computador ao poder aquisitivo do domicílio (em 2002-2003 foi 0,56763, enquanto em 2008-2009 caiu para 0,41546) pode ser explicada pela queda no preço dos computadores e pelo aumento do poder de compra das famílias.

Avaliação econômica dos custos da poluição em Cubatão - SP com base nos gastos com saúde relacionados às doenças dos aparelhos respiratório e circulatório

O objetivo básico do trabalho foi avaliar os custos econômicos relacionados às doenças dos aparelhos respiratório e circulatório no município de Cubatão (SP). Para tanto, foram utilizados dados de internação e dias de trabalho perdidos com a internação (na faixa dos 14 aos 70 anos de idade), na base de dados do Sistema Único de Saúde (SUS). Resultados: A partir dos dados levantados, calculou-se o valor total de R$ 22,1 milhões gastos no período de 2000 a 2009 devido às doenças dos aparelhos circulatório e respiratório. Parte desses gastos pode estar diretamente relacionada à emissão de poluentes atmosféricos no município. Para se estimar os custos da poluição foram levantados dados de outros dois municípios da Região da Baixada Santista (Guarujá e Peruíbe), com menor atividade industrial em comparação a Cubatão. Verificou-se que, em ambos, as médias de gastos per capita em relação às duas doenças são menores do que em Cubatão, mas que essa diferença vem diminuindo sensivelmente nos últimos anos.

Dental caries associated factors in 12 year-old schoolchildren from a municipality in the state of São Paulo, Brazil

Objective To analyze the possible association between dental caries, fluorosis and the need for treatment in 12 year-old schoolchildren and the socioeconomic conditions of parents/guardians in the city of Franca, in the state of São Paulo. Methods A random sample of schoolchildren aged 12 was obtained from the school records in Franca, using a systematic random technique. The epidemiological survey was carried out by a single calibrated examiner, on 258 public and private schoolchildren in order to obtain the prevalence of dental caries, the need for treatment and the severity of dental fluorosis. Parents/guardians were also interviewed to assess their socioeconomic conditions (education and per capita income). We used multiple correlation analysis to investigate associations between category variables. Results It was possible to identify two distinct groups, with associations between the variables: the first group, represented by schoolchildren with average prevalence of caries, need for treatment, low level of parental education and income; and a second group represented by schoolchildren with low prevalence of caries, no need for treatment, high parental education and income. The two dimensions explained approximately 35% of total inertia. The factors within each group are related. Conclusion High income and parental education are associated with the low prevalence of dental caries but there is no association with dental fluorosis.

Perceived neighborhood problems: multilevel analysis to evaluate psychometric properties in a Southern adult Brazilian population

Abstract Background Physical attributes of the places in which people live, as well as their perceptions of them, may be important health determinants. The perception of place in which people dwell may impact on individual health and may be a more telling indicator for individual health than objective neighborhood characteristics. This paper aims to evaluate psychometric and ecometric properties of a scale on the perceptions of neighborhood problems in adults from Florianopolis, Southern Brazil. Methods Individual, census tract level (per capita monthly familiar income) and neighborhood problems perception (physical and social disorders) variables were investigated. Multilevel models (items nested within persons, persons nested within neighborhoods) were run to assess ecometric properties of variables assessing neighborhood problems. Results The response rate was 85.3%, (1,720 adults). Participants were distributed in 63 census tracts. Two scales were identified using 16 items: Physical Problems and Social Disorder. The ecometric properties of the scales satisfactory: 0.24 to 0.28 for the intra-class correlation and 0.94 to 0.96 for reliability. Higher values on the scales of problems in the physical and social domains were associated with younger age, more length of time residing in the same neighborhood and lower census tract income level. Conclusions The findings support the usefulness of these scales to measure physical and social disorder problems in neighborhoods.

Determinants of child undernutrition in India. A micro-case study to operationalize the Capability Approach

The present research aims at shedding light on the demanding puzzle characterizing the issue of child undernutrition in India. Indeed, the so called ‘Indian development paradox’ identifies the phenomenon according to which higher level of income per capita is recorded alongside a lethargic reduction in the proportion of underweight children aged below three years. Thus, in the time period occurring from 2000 to 2005, real Gross Domestic Production per capita has annually grown at 5.4%, whereas the proportion of children who are underweight has declined from 47% to 46%, a mere one point percent. Such trend opens up the space for discussing the traditionally assumed linkage between income-poverty and undernutrition as well as food intervention as the main focus of policies designed to fight child hunger. Also, it unlocks doors for evaluating the role of an alternative economic approach aiming at explaining undernutrition, such as the Capability Approach. The Capability Approach argues for widening the informational basis to account not only for resources, but also for variables related to liberties, opportunities and autonomy in pursuing what individuals value.The econometric analysis highlights the relevance of including behavioral factors when explaining child undernutrition. In particular, the ability of the mother to move freely in the community without the need of asking permission to her husband or mother-in-law is statistically significant when included in the model, which accounts also for confounding traditional variables, such as economic wealth and food security. Also, focusing on agency, results indicates the necessity of measuring autonomy in different domains and the need of improving the measurement scale for agency data, especially with regards the domain of household duties. Finally, future research is required to investigate policy venues for increasing agency in women and in the communities they live in as viable strategy for reducing the plague of child undernutrition in India.

Impatto ambientale dei rifiuti e degli sprechi agroalimentari in Europa e in Italia

Nonostante il fatto che una gran parte del mondo viva ancora oggi a livelli di sussistenza, i dati in nostro possesso ci indicano che le attività umane stanno esaurendo le risorse ambientali del pianeta. La causa di questo eccessivo sfruttamento delle risorse è da ricercare nei pattern non sostenibili di produzione e consumo dei paesi sviluppati. La preoccupazione per le conseguenze sull'ambiente e la lotta al cambiamento climatico hanno posto le politiche ambientali al centro dell'attenzione internazionale. Il Protocollo di Kyoto e la Commissione Europea hanno stabilito degli obiettivi di riduzione delle emissioni di gas serra, rispettivamente del 12% entro il 2012 e del 20% entro il 2020. All'interno del Protocollo di Kyoto l'obiettivo per l'Italia è ridurre del 6,5% le emissioni di gas serra nazionali rispetto al 1990. Le politiche mirate alla riduzione delle emissioni di gas serra hanno in genere come obiettivo gli impianti energetici e i trasporti. Poca attenzione viene data alla filiera agroalimentare pur sapendo che l'agricoltura ha un forte impatto sull'ambiente e recenti studi stimano che circa il 50% del cibo prodotto viene perso o buttato via dalla produzione al consumo. Alla luce di questi dati, il mio lavoro di tesi ha avuto come obiettivo quello di quantificare i rifiuti e gli sprechi agroalimentari in Europa e in Italia e stimare l'impatto ambientale associato. I dati raccolti in questa tesi mettono in evidenza l'importanza di migliorare l'efficienza della filiera agroalimentare per ridurre l'impatto ambientale nazionale e rispettare gli accordi internazionali sulla lotta ai cambiamenti climatici.

Integration of MFA and LCA methodologies: the anthropogenic aluminium cycle in Italy

MFA and LCA methodologies were applied to analyse the anthropogenic aluminium cycle in Italy with focus on historical evolution of stocks and flows of the metal, embodied GHG emissions, and potentials from recycling to provide key features to Italy for prioritizing industrial policy toward low-carbon technologies and materials. Historical trend series were collected from 1947 to 2009 and balanced with data from production, manufacturing and waste management of aluminium-containing products, using a ‘top-down’ approach to quantify the contemporary in-use stock of the metal, and helping to identify ‘applications where aluminium is not yet being recycled to its full potential and to identify present and future recycling flows’. The MFA results were used as a basis for the LCA aimed at evaluating the carbon footprint evolution, from primary and electrical energy, the smelting process and the transportation, embodied in the Italian aluminium. A discussion about how the main factors, according to the Kaya Identity equation, they did influence the Italian GHG emissions pattern over time, and which are the levers to mitigate it, it has been also reported. The contemporary anthropogenic reservoirs of aluminium was estimated at about 320 kg per capita, mainly embedded within the transportation and building and construction sectors. Cumulative in-use stock represents approximately 11 years of supply at current usage rates (about 20 Mt versus 1.7 Mt/year), and it would imply a potential of about 160 Mt of CO2eq emissions savings. A discussion of criticality related to aluminium waste recovery from the transportation and the containers and packaging sectors was also included in the study, providing an example for how MFA and LCA may support decision-making at sectorial or regional level. The research constitutes the first attempt of an integrated approach between MFA and LCA applied to the aluminium cycle in Italy.

Demography in eusocial Hymenoptera

In my doctoral thesis I investigated the evolution of demographic traits within eusocial Hymenoptera. In the social bees, wasps and ants, eusociality has a unique effect on life span evolution as female larvae with the same genetic background can develop through phenotypic plasticity to a queen or a worker with vastly diverging life-history traits. Ant queens belong to the longest-lived insect species, while workers in most species live only a fraction of the queen’s life span. The average colony size of a species is positively correlated with social complexity, division of labor and diverging morphological female phenotypes all of which also affect life span. Therefore the demographic traits of interest in this thesis were life span and colony size. To understand the evolution of worker life span I applied a trade-off model that includes both hierarchical levels important in eusocial systems, namely the colony- and the individual-level. I showed that the evolution of worker life span may be an adaptive trait on the colony level to optimize resource allocation and therefore fitness in response to different levels of extrinsic mortality. A shorter worker life span as a result of reduced resource investments under high levels of extrinsic mortality increases colony fitness. In a further study I showed that Lasius niger colonies produce different aging phenotypes throughout colony development. Smaller colonies which apply a different foraging strategy than larger colonies produced smaller workers, which in turn have a longer life span as compared to larger workers produced in larger colonies. With the switch to cooperative foraging in growing colonies individual workers become less important for the colony caused by their increasing redundancy. Alternatively a trade of between growth and life span may lead to the results found in this study. A further comparative analysis to study the effect of colony size on life span showed a correlation between queen and worker life span when colony size is taken into account. While neither worker nor queen life span was associated with colony size, the differences between queen and worker life span increase with larger average colony sizes across all eusocial Hymenoptera. As colony size affects both queen and worker life span, I aimed to understand which factors lead to the small colony sizes displayed by some ant species. I therefore analyzed per-capita productivity at different colony sizes of eight cavity dwelling ant species. Most colonies of the study species grew larger than optimal productivity predicted. Larger colony size was shown to increase colony homeostasis, the predictability of future productivity and in turn the survival probability of the colony. I also showed that species that deploy an individual foraging mode may circumvent the density dependent decline in foraging success by splitting the colony to several nest sites.

The implementation of DRG-based hospital reimbursement in Switzerland: A population-based perspective

Background Switzerland introduces a DRG (Diagnosis Related Groups) based system for hospital financing in 2012 in order to increase efficiency and transparency of Swiss health care. DRG-based hospital reimbursement is not simultaneously realized in all Swiss cantons and several cantons already implemented DRG-based financing irrespective of the national agenda, a setting that provides an opportunity to compare the situation in different cantons. Effects of introducing DRGs anticipated for providers and insurers are relatively well known but it remains less clear what effects DRGs will have on served populations. The objective of the study is therefore to analyze differences of volume and major quality indicators of care between areas with or without DRG-based hospital reimbursement from a population based perspective. Methods Small area analysis of all hospitalizations in acute care hospitals and of all consultations reimbursed by mandatory basic health insurance for physicians in own practice during 2003-2007. Results The results show fewer hospitalizations and a relocation of resources to outpatient care in areas with DRG reimbursement. Overall burden of disease expressed as per capita DRG cost weights was almost identical between the two types of hospital reimbursement and no distinct temporal differences were detected in this respect. But the results show considerably higher 90-day rehospitalization rates in DRG areas. Conclusion The study provides evidence of both desired and harmful effects related to the implementation of DRGs. Systematic monitoring of outcomes and quality of care are therefore essential elements to maintain in the Swiss health system after DRG's are implemented on a nationwide basis in 2012.

Cost-effective intervention thresholds against osteoporotic fractures based on FRAX® in Switzerland

FRAX-based cost-effective intervention thresholds in the Swiss setting were determined. Assuming a willingness to pay at 2× Gross Domestic Product per capita, an intervention aimed at reducing fracture risk in women and men with a 10-year probability for a major osteoporotic fracture at or above 15% is cost-effective.

Income, Trade and Pollution in Central Asia, Russia and China: An Econometric Analysis

The study performs a panel estimation of the relationship between per capita income, trade, and airborne pollution in the five Central Asian nations, Russia and China between 1992 and 2008. First, this study uses an environmental Kuznets curve hypothesis (EKC)- an inverted-U relationship between the increase in income and the level of environmental degradation - to examine how income and pollution are related. Second, the study uses a gravity model to estimate the effect of a regional trade agreement (Shanghai Cooperation Organization: SCO) on incomes and carbon dioxide emissions in the region. Empirical analysis confirms the existence of the rising portion of the EKC curve in the region - a positive correlation between per capita income growth and carbon dioxide emissions- and that the volume of bilateral trade, and not the existence of a regional trade agreement, contributes to the increasing level of environmental pollution.