Prevalence and severity of dental caries in schoolchildren of Porto, Portugal

Objectives: To measure the prevalence and severity of dental caries in adolescents of the city of Porto, Portugal, and to assess socioeconomic and behavioural covariates of dental caries experience. Methods: A sample of 700 thirteen-year-old schoolchildren was examined. Results from the dental examination were linked to anthropometric information and to data supplied by two structured questionnaires assessing nutritional factors, socio-demographic characteristics and behaviour related to health promotion. Dental caries was measured using the DMFT index, and two dichotomous outcomes, one assessing the prevalence of dental caries (DMFT>0); the other assessing the prevalence of a high level of dental caries (DMFT=4). Results: Consuming soft drinks derived from cola (irrespective of sugared or diet) two or more times per week, attending a public school, being female and having parents with low educational attainment were identified as risk factors both for having dental caries and for having a high level of dental caries. Conclusion: Caries levels were positively associated with frequency of intake of sweetened foods and drinks.

The economic impact of progressive neurological illness on quality of life in Australia

The current study examined the impact of financial costs and self-reported economic pressure on the quality of life of patients with progressive neurological illness. Participants were 423 people from four illness groups in Australia. Participants completed measures of: 1. quality of life, 2. income, 3. expenses, 4. economic pressure, 5. social support, 6. relationship satisfaction, and 7. severity of illness. There was a strong negative association between quality of life and economic pressure (but not income or expenses) for all groups. Subjective assessment of economic pressure was strongly associated with quality of life for people with motor neurone disease and multiple sclerosis. Implications of these results for assisting people with progressive neurological illnesses to cope with the financial changes that occur due to their illness are discussed.

Associations of obsessive-compulsive symptoms with clinical and neurocognitive features in schizophrenia according to stage of illness

This study aimed to investigate the association of obsessive-compulsive symptoms with clinical and neurocognitive features in patients with schizophrenia. This study enrolled 163 people with schizophrenia who were receiving risperidone monotherapy. Comorbid obsessive-compulsive symptoms were assessed using the Yale-Brown Obsessive-Compulsive Scale, and subjects with a score≥10 constituted the obsessive-compulsive symptom group (n=30, 18.4%). The learning index was significantly higher in patients with obsessive-compulsive symptoms than in those without such symptoms after adjusting for age, stage (early and chronic), duration of illness, and CDSS score. However, there was no significant interaction between obsessive-compulsive symptoms and stage of illness. Scores on Positive and Negative Syndrome Scale, Calgary Depression Scale for Schizophrenia, and Beck Depression Inventory were significantly higher in the obsessive-compulsive symptom group. In addition, the Subjective Well-being under Neuroleptic Treatment score was significantly lower in the obsessive-compulsive symptom group. In conclusion, comorbid obsessive-compulsive symptoms in patients with schizophrenia were associated with a higher learning ability without a significant interaction with stage of illness. However, schizophrenia patients with obsessive-compulsive symptoms had more severe psychotic and depressive symptoms and poorer quality of life.

Associations of obsessive-compulsive symptoms with clinical and neurocognitive features in schizophrenia according to stage of illness

This study aimed to investigate the association of obsessive-compulsive symptoms with clinical and neurocognitive features in patients with schizophrenia. This study enrolled 163 people with schizophrenia who were receiving risperidone monotherapy. Comorbid obsessive-compulsive symptoms were assessed using the Yale-Brown Obsessive-Compulsive Scale, and subjects with a score ≥ 10 constituted the obsessive-compulsive symptom group (n=30, 18.4%). The learning index was significantly higher in patients with obsessive-compulsive symptoms than in those without such symptoms after adjusting for age, stage (early and chronic), duration of illness, and CDSS score. However, there was no significant interaction between obsessive-compulsive symptoms and stage of illness. Scores on Positive and Negative Syndrome Scale, Calgary Depression Scale for Schizophrenia, and Beck Depression Inventory were significantly higher in the obsessive-compulsive symptom group. In addition, the Subjective Well-being under Neuroleptic Treatment score was significantly lower in the obsessive-compulsive symptom group. In conclusion, comorbid obsessive-compulsive symptoms in patients with schizophrenia were associated with a higher learning ability without a significant interaction with stage of illness. However, schizophrenia patients with obsessive-compulsive symptoms had more severe psychotic and depressive symptoms and poorer quality of life.

Relationship between severity of obesity and mental health: an Australian community survey

Introduction
In Australia the incidence of obesity is increasing rapidly and has become a significant public health concern. In addition to the many physical consequences of obesity many studies have reported significant mental health consequences, including major depression, mood and anxiety disorders. The purpose of this study was to explore the relationship between severity of obesity and perceived mental health in an Australian community sample.

Methods
A cross-sectional survey design was used. A total of 118 participants, aged between 19 and 75 years with a body mass index (BMI) ≥ 30 kg/m2 returned a completed questionnaire. The SF-36 Health Survey, Kessler Psychological Distress Scale, Social Interaction Anxiety Scale and the Multidimensional Scale of Perceived Social Support were used.

Results
After adjusting for age, gender, perceived social support and physical health quality of life, obesity was not significantly associated with mental health quality of life (SF-36). The strongest factor influencing mental health was perceived physical health. Mediation analyses suggest that physical health mediates the relationship between obesity and mental health quality of life.

Discussion
Our findings support the view that physical health mediates the relationship between obesity and mental health. Public health interventions should focus on reducing the impact of obesity on physical health by encouraging participation in healthy lifestyles, which in turn, may improve mental wellbeing.

Socio-behavioral factors influence prevalence and severity of dental caries in children with primary dentition

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Prevalence and severity of caries in 3-12-year-old children from three districts with different fluoridation histories in Araraquara, SP, Brazil

Objective: To determine the prevalence and severity of caries in 3-12-year-old children in three districts of the city of Araraquara, Design: An epidemiological survey was carried out by trained and calibrated examiners in 1995 and 1996, using the WHO diagnostic criteria. Setting: Two districts, Araraquara and Vila Xavier had been fluoridated since 1963 and one, Gavião Peixoto, since 1994. Subjects: The study included 1,191 children from Araraquara, 653 from Vila Xavier and 652 from Gavião Peixoto. Outcome measures: Prevalence of caries, dmft, dmfs, DMFT and DMFS indices. Results: Results showed moderate caries experience in all three districts. Differences between districts in relation to fluoridation history were particularly obvious in primary teeth. In 3-4-year-old children, one third of those in Araraquara and Vila Xavier had some caries experience compared to 58% in Gavião Peixoto. In permanent teeth, 20% or less of the mean DMFT was made up of untreated decay in Araraquara and Vila Xavier whereas in Gaviao Peixoto it made up between 50 and 57% of values in 7-12-year-old children. Conclusions: The prevalence and severity of caries was lower in dentitions of children from the districts fluoridated since 1963. Improvements are likely in the future in Gaviao Peixoto as the benefit of fluoridation continues but additional means of promoting oral health are needed in all three districts.

Epidemiology of Severity of Temporomandibular Disorders in Brazilian Women

Aims: To evaluate the severity of temporomandibular disorders (TMD) of women in the municipality of Araraquara (Brazil) as well as the contribution of the perception of oral health, mandibular functional limitation, and sociodemographic variables on the severity of TMD. Methods: The participants were interviewed by telephone. Information regarding age, marital status, economic level, education, and use and type of dental prostheses was surveyed. To evaluate TMD severity, mandibular functional limitation and perception of oral health, Fonseca's Anamnesic Index (IAF), the Mandibular Function Impairment Questionnaire (MFIQ), and the General Oral Health Assessment Index (GOHAI) were used. To evaluate the contribution of these variables on TMD severity, a structural equation model (SEM) was fitted to the data and assessed by usual goodness-of-fit indices. Results: A total of 701 women with a mean age of 44.36 years (SD = 16.31) participated. According to the IAF, 59.6% (95% confidence interval = 56.00%-63.2%) of the women were classified as having TMD, of which 63.9% presented light, 26.8% moderate, and 9.3% severe TMD. Mandibular functional limitation was low in 91.0% of the women, moderate in 7.1%, and severe in 1.9%. Goodness-of-fit for the structural model was adequate. The predictors explained 43% of the variation in the TMD severity, with significant contributions of the variables dental prostheses (beta = -.008; P = .006), perception of oral health (beta = -.43; P < .001), and mandibular functional limitation (beta = .014; P = 014). Conclusion: The severity of TMD among Brazilian women was greater in non-users of dental prostheses and was also associated with greater mandibular functional limitation and poor perception of oral health.

Effectiveness of Colors used on Safety and Health Signs for Communicating Severity of Injury

Signs are used extensively in workplaces and on products to identify hazards and provide instructions for appropriate behavior. A fundamental element of these signs is the signal-word panel located at the top of the sign. The colors and words in this panel are intended to convey information about the hazard identified. One type of hazard information concerns the severity of injury/illness associated with the hazard. The standard of the American National Standards Institute (ANSI) for facility signs uses three severity categories: 1) death or serious injury, 2) minor or moderate injury, and 3) property damage. The standard specifies which signal-word panel format, including color, to use based in part on the severity category. The purpose of this study was to determine if college students associate color with severity. The sample population consisted of 59 students tested in nine small groups. Twelve signs were shown to them in random order. Five of the signs had a color for the background of the signal-word panel. The colors were red, orange, yellow, blue, and gray. The signal word was a nonsense word and the text panel contained repetitions of the letter x in sentence format. Subject rated their impressions of the colors using two ordered rating scales for severity. Results indicated that color had a highly significant effect on severity ratings. Median ratings were generally consistent with the ANSI standard, except for orange. Red rated highest on both scales. Blue and gray rated lowest. Yellow and orange were in between red and blue. According to the ANSI standard, orange should indicate the same severity as red. These results indicated that orange was associated with less severity than red. Apparently, the ANSI standard's use of orange to identify a hazard associated with death or a serious injury is questionable.

A comparison of Markov and generalized linear models of hospital mortality

This paper reports a comparison of three modeling strategies for the analysis of hospital mortality in a sample of general medicine inpatients in a Department of Veterans Affairs medical center. Logistic regression, a Markov chain model, and longitudinal logistic regression were evaluated on predictive performance as measured by the c-index and on accuracy of expected numbers of deaths compared to observed. The logistic regression used patient information collected at admission; the Markov model was comprised of two absorbing states for discharge and death and three transient states reflecting increasing severity of illness as measured by laboratory data collected during the hospital stay; longitudinal regression employed Generalized Estimating Equations (GEE) to model covariance structure for the repeated binary outcome. Results showed that the logistic regression predicted hospital mortality as well as the alternative methods but was limited in scope of application. The Markov chain provides insights into how day to day changes of illness severity lead to discharge or death. The longitudinal logistic regression showed that increasing illness trajectory is associated with hospital mortality. The conclusion is reached that for standard applications in modeling hospital mortality, logistic regression is adequate, but for new challenges facing health services research today, alternative methods are equally predictive, practical, and can provide new insights. ^

Severity assessment tools in ICU patients with 2009 influenza A (H1N1) pneumonia.

The aim of this study was to determine if severity assessment tools (general severity of illness and community-acquired pneumonia specific scores) can be used to guide decisions for patients admitted to the intensive care unit (ICU) due to pandemic influenza A pneumonia. A prospective, observational, multicentre study included 265 patients with a mean age of 42 (±16.1) years and an ICU mortality of 31.7%. On admission to the ICU, the mean pneumonia severity index (PSI) score was 103.2 ± 43.2 points, the CURB-65 score was 1.7 ± 1.1 points and the PIRO-CAP score was 3.2 ± 1.5 points. None of the scores had a good predictive ability: area under the ROC for PSI, 0.72 (95% CI, 0.65-0.78); CURB-65, 0.67 (95% CI, 0.59-0.74); and PIRO-CAP, 0.64 (95% CI, 0.56-0.71). The PSI score (OR, 1.022 (1.009-1.034), p 0.001) was independently associated with ICU mortality; however, none of the three scores, when used at ICU admission, were able to reliably detect a low-risk group of patients. Low risk for mortality was identified in 27.5% of patients using PIRO-CAP, but above 40% when using PSI (I-III) or CURB65 (<2). Observed mortality was 13.7%, 13.5% and 19.4%, respectively. Pneumonia-specific scores undervalued severity and should not be used as instruments to guide decisions in the ICU.

SEVERITY OF IRON DEFICIENCY ANEMIA AND ITS RELATIONSHIP TO GROWTH AND MORBIDITY IN A POPULATION OF PRE-SCHOOLERS IN RURAL GUATEMALA (IRON DEFICIENCY, MORBIDITY, GROWTH)

The objectives of this study were to determine the nature of the relationship between severity of iron deficiency anemia, response to iron treatment, respiratory and gastrointestinal illness and weight change. Seventy-five pre-school children from rural Guatemala received daily oral iron therapy for an eleven week period, and were classified into one of three groups having different degrees of iron deficiency anemia. Anthropometric and biochemical data were collected prior and after iron treatment; morbidity data were collected throughout the period of treatment. The outcome variables were percentage weight change, percentage of total days ill with any type of symptom, percentage of total days ill with gastrointestinal symptoms, percentage of total days ill with respiratory symptoms, percentage of total days ill with combination syndrome symptoms. Age, sex and socio-economic status, were independent of any of the independent or outcome variables used. On the other hand, the level of hemoglobin covaried with the height of the children, the smallest children were the most severely anemic. The relationships between hemoglobin levels and weight change, frequency of morbidity (gastrointestinal, respiratory and combination syndrome) and total number of days ill with any symptomatology were investigated. No statistical significance was found in these analyses except when contrasting children with normal hemoglobin levels to iron deficient children, where the findings indicated the normal children experienced more gastrointestinal morbidity. The same relationship were again analyzed but including delta hemoglobin as covariate in the analysis, this latter one was found to be significant at 7% when the percentage of days ill from gastrointestinal morbidity was tested against the hemoglobin groups. The relationship found indicates that, all other covariates accounted for, the percentage of days ill from gastrointestinal morbidity will decrease approximately 1% for each 1% increase in delta of hemoglobin. ^

The effects of storage duration, temperature and cultivar on the severity of garlic clove rot caused by Fusarium proliferatum.

Diseases that affect garlic during storage can lead to severe economic losses for farmers worldwide. One causal agent of clove rot is Fusarium proliferatum. Here, the progress of clove rot caused by F. proliferatum and its dependence on different storage conditions and cultivar type were studied. The effect of temperature on mycelial growth, conidial viability, and fungal survival during garlic commercial storage was documented. Samples of 50 bulbs from a randomized field trial with three different clonal generations for purple garlic (F3, F4 and F5) and the F4 clonal generation for white garlic were labeled and stored for two months (short-term storage). In addition, another sample of the F5 clonal generation of purple garlic was stored for 6 months after harvest (long-term storage). The presence of the pathogen and the percentage of symptomatic cloves were evaluated. A notable difference in the rot severity index (RSI) of different garlic varieties was observed. In all studied cases, clove rot increased with storage time at 20 ◦ C, and the white garlic variety had a higher index of rot severity after two months of storage. Additionally, there were clear differences between the growth rates of F. proliferatum isolates. Studies conducted on the temperature responses of the pathogen propagules showed that expo- sure for at least 20 min at 50 ◦ C was highly effective in significantly reducing the viability of fungal conidia. Pathogenicity studies showed that the fungus is pathogenic in all commercial varieties. However, there were significant differences in varietal susceptibility between Chinese and white garlic type cultivars (81.84 ± 16.44% and 87.5 ± 23.19% symptomatic cloves, respectively) and purple cultivars (49.06 ± 13.42% symptomatic cloves)

The effect of timing and severity of water deficit on growth, development, yield accumulation and nitrogen fixation of mungbean

Mungbean (Vigna radiata L.), as a dryland grain legume, is exposed to varying timing and severity of water deficit, which results in variability in grain yield, nitrogen accumulation and grain quality. In this field study, mungbean crops were exposed to varying timing and severity of water deficit in order to examine: (1) contribution of the second flush of pods to final grain yield with variable timing of relief from water deficit, (2) the sensitivity to water deficit of the accumulation of biomass and nitrogen (N) and its partitioning to grain, and (3) how the timing of water deficit affects the pattern of harvest index (HI) increase through pod filling. The results showed that the contribution of the second flush to final yield is highly variable (1-56%) and can be considerable, especially where mid-season stress is relieved at early pod filling. The capacity to produce a second flush of pods did not compensate fully for yield reduction due to water stress. Relief from mid-season stress also resulted in continued leaf production, N-2 fixation and vegetative biomass accumulation during pod filling. Despite the wide variation in the degree of change in vegetative biomass and N during pod filling, there were strong relationships between grain yield and net-above-ground biomass at maturity, and grain N and above-ground N at maturity. Only in the extreme situations were HI and nitrogen HI affected noticeably. In those treatments where there was a large second flush of pods, there was a pronounced biphasic pattern to pod number production, with HI also progressing through two distinct phases of increase separated by a plateau. The proportion of grain yield contributed to by biomass produced before pod filling varied from 0 to 61% with the contribution greatest under terminal water deficit. There was a larger effect of water deficit on N accumulation, and hence N-2 fixation, than on biomass accumulation. The study confirmed the applicability of a number of long-standing physiological concepts to the analysis of the effect of water deficit on mungbean, but also highlighted the difficulty of accounting for timing effects of water deficit where second flushes of pods alter canopy development, biomass and yield accumulation, and N dynamics. Crown Copyright (C) 2003 Published by Elsevier B.V. All rights reserved.

Prevalence and severity of dental fluorosis among students from João Pessoa, PB, Brazil

The aim of this study was to determine the prevalence and severity of dental fluorosis among 12-15-year-old students from João Pessoa, PB, Brazil before starting a program of artificial fluoridation of drinking water. The use of fluoridated dentifrice was also surveyed. A sample of 1,402 students was randomly selected. However, 31 students refused to participate and 257 were not permanent residents in João Pessoa, thus leaving a final sample of 1,114 students. Clinical exams were carried out by two calibrated dentists (Kappa = 0.78) under natural indirect light. Upper and lower front teeth were cleaned with gauze and dried, and then examined using the TF index for fluorosis. A questionnaire on dentifrice ingestion and oral hygiene habits was applied to the students. The results revealed that fluorosis prevalence in this age group was higher than expected (29.2%). Most fluorosis cases were TF = 1 (66.8%), and the most severe cases were TF = 4 (2.2%). The majority of the students reported that they had been using fluoridated dentifrices since childhood; 95% of the participants preferred brands with a 1,500 ppm F concentration, and 40% remembered that they usually ingested or still ingest dentifrice during brushing. It was concluded that dental fluorosis prevalence among students in João Pessoa is higher than expected for an area with non-fluoridated water. However, although most students use fluoridated dentifrices, and almost half ingest slurry while brushing, the majority of cases had little aesthetic relevance from the professionals' point of view, thus suggesting that fluorosis is not a public health problem in the locality.