The role of health literacy as a factor associated with tooth loss

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ABSTRACT

OBJECTIVE

The objective was to analyze the role of health literacy (HL) as a factor associated with tooth loss among users of the Brazilian Health System with chronic non-communicable diseases.

METHODS

The cross-sectional analytical study was conducted with adult and elderly users chosen at ten Family Health Clinics in a draw in the town of Piracicaba, São Paulo State, Brazil. A questionnaire was applied with sociodemographic data (sex, age, skin color and education), behavioral data (brushing and flossing), determinants in health (type of dental health services and how often) and clinical data (pain). Mouth conditions were collected by intraoral examination of visible dental biofilm and community Pediodontal Index. The systemic clinical conditions (blood glucose, glycated hemoglobin and blood pressure) were extracted from the medical records. The explanatory variable was HL (low, medium and high), measured with the Health Literacy Scale (HLS-14).

RESULTS

The outcome was tooth loss measured by the index of decayed, missing and filled teeth. Logistic regression was performed using a conceptual model for HL (p < 0.05). For the 238 subjects, the mean age was 62.7 years (± 10.55). Tooth loss was associated with HL in regression models adjusted by type of dental service, dental frequency, and dental floss. In the final model, the factors associated with tooth loss are older age (OR = 1,12; 95%CI: 1,07–1,17), a lower education (OR = 3,43; 95%CI: 1,17–10,10), irregular use of dental floss (OR = 4,58; 95%CI: 1.75 in–7,31), irregular use of dental services (n = 2,60; 95% 1,32–5,12), periodontal pocket (> 4 mm) (n = 0,31; 95%CI: 0,01–0,08), having visible dental biofilm (OR = 7,23; 95%CI: 3,19–16,41) and a higher level of blood sugar (glucose) (n = 1,98; 95%CI: 1.00–3,92).

CONCLUSIONS

tooth loss was associated with HL when adjusted by health behaviors; when sociodemographic variables and clinical conditions were included, it was less significant. In the final model, behaviors, determinants in health and clinical conditions were risk indicators of tooth loss, showing the multifactorial nature of this phenomenon.

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Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Christopher J L Murray, Aleksandr Y Aravkin, Peng Zheng … (2021)

Summary Background Rigorous analysis of levels and trends in exposure to leading risk factors and quantification of their effect on human health are important to identify where public health is making progress and in which cases current efforts are inadequate. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a standardised and comprehensive assessment of the magnitude of risk factor exposure, relative risk, and attributable burden of disease. Methods GBD 2019 estimated attributable mortality, years of life lost (YLLs), years of life lived with disability (YLDs), and disability-adjusted life-years (DALYs) for 87 risk factors and combinations of risk factors, at the global level, regionally, and for 204 countries and territories. GBD uses a hierarchical list of risk factors so that specific risk factors (eg, sodium intake), and related aggregates (eg, diet quality), are both evaluated. This method has six analytical steps. (1) We included 560 risk–outcome pairs that met criteria for convincing or probable evidence on the basis of research studies. 12 risk–outcome pairs included in GBD 2017 no longer met inclusion criteria and 47 risk–outcome pairs for risks already included in GBD 2017 were added based on new evidence. (2) Relative risks were estimated as a function of exposure based on published systematic reviews, 81 systematic reviews done for GBD 2019, and meta-regression. (3) Levels of exposure in each age-sex-location-year included in the study were estimated based on all available data sources using spatiotemporal Gaussian process regression, DisMod-MR 2.1, a Bayesian meta-regression method, or alternative methods. (4) We determined, from published trials or cohort studies, the level of exposure associated with minimum risk, called the theoretical minimum risk exposure level. (5) Attributable deaths, YLLs, YLDs, and DALYs were computed by multiplying population attributable fractions (PAFs) by the relevant outcome quantity for each age-sex-location-year. (6) PAFs and attributable burden for combinations of risk factors were estimated taking into account mediation of different risk factors through other risk factors. Across all six analytical steps, 30 652 distinct data sources were used in the analysis. Uncertainty in each step of the analysis was propagated into the final estimates of attributable burden. Exposure levels for dichotomous, polytomous, and continuous risk factors were summarised with use of the summary exposure value to facilitate comparisons over time, across location, and across risks. Because the entire time series from 1990 to 2019 has been re-estimated with use of consistent data and methods, these results supersede previously published GBD estimates of attributable burden. Findings The largest declines in risk exposure from 2010 to 2019 were among a set of risks that are strongly linked to social and economic development, including household air pollution; unsafe water, sanitation, and handwashing; and child growth failure. Global declines also occurred for tobacco smoking and lead exposure. The largest increases in risk exposure were for ambient particulate matter pollution, drug use, high fasting plasma glucose, and high body-mass index. In 2019, the leading Level 2 risk factor globally for attributable deaths was high systolic blood pressure, which accounted for 10·8 million (95% uncertainty interval [UI] 9·51–12·1) deaths (19·2% [16·9–21·3] of all deaths in 2019), followed by tobacco (smoked, second-hand, and chewing), which accounted for 8·71 million (8·12–9·31) deaths (15·4% [14·6–16·2] of all deaths in 2019). The leading Level 2 risk factor for attributable DALYs globally in 2019 was child and maternal malnutrition, which largely affects health in the youngest age groups and accounted for 295 million (253–350) DALYs (11·6% [10·3–13·1] of all global DALYs that year). The risk factor burden varied considerably in 2019 between age groups and locations. Among children aged 0–9 years, the three leading detailed risk factors for attributable DALYs were all related to malnutrition. Iron deficiency was the leading risk factor for those aged 10–24 years, alcohol use for those aged 25–49 years, and high systolic blood pressure for those aged 50–74 years and 75 years and older. Interpretation Overall, the record for reducing exposure to harmful risks over the past three decades is poor. Success with reducing smoking and lead exposure through regulatory policy might point the way for a stronger role for public policy on other risks in addition to continued efforts to provide information on risk factor harm to the general public. Funding Bill & Melinda Gates Foundation.

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Health literacy and public health: A systematic review and integration of definitions and models

Karen Kristine Sørensen, Stephan Van den Broucke, James Fullam … (2012)

Background Health literacy concerns the knowledge and competences of persons to meet the complex demands of health in modern society. Although its importance is increasingly recognised, there is no consensus about the definition of health literacy or about its conceptual dimensions, which limits the possibilities for measurement and comparison. The aim of the study is to review definitions and models on health literacy to develop an integrated definition and conceptual model capturing the most comprehensive evidence-based dimensions of health literacy. Methods A systematic literature review was performed to identify definitions and conceptual frameworks of health literacy. A content analysis of the definitions and conceptual frameworks was carried out to identify the central dimensions of health literacy and develop an integrated model. Results The review resulted in 17 definitions of health literacy and 12 conceptual models. Based on the content analysis, an integrative conceptual model was developed containing 12 dimensions referring to the knowledge, motivation and competencies of accessing, understanding, appraising and applying health-related information within the healthcare, disease prevention and health promotion setting, respectively. Conclusions Based upon this review, a model is proposed integrating medical and public health views of health literacy. The model can serve as a basis for developing health literacy enhancing interventions and provide a conceptual basis for the development and validation of measurement tools, capturing the different dimensions of health literacy within the healthcare, disease prevention and health promotion settings.

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Oral diseases: a global public health challenge

Marco A. Peres, Lorna M D Macpherson, Robert J. Weyant … (2019)

Oral diseases are among the most prevalent diseases globally and have serious health and economic burdens, greatly reducing quality of life for those affected. The most prevalent and consequential oral diseases globally are dental caries (tooth decay), periodontal disease, tooth loss, and cancers of the lips and oral cavity. In this first of two papers in a Series on oral health, we describe the scope of the global oral disease epidemic, its origins in terms of social and commercial determinants, and its costs in terms of population wellbeing and societal impact. Although oral diseases are largely preventable, they persist with high prevalence, reflecting widespread social and economic inequalities and inadequate funding for prevention and treatment, particularly in low-income and middle-income countries (LMICs). As with most non-communicable diseases (NCDs), oral conditions are chronic and strongly socially patterned. Children living in poverty, socially marginalised groups, and older people are the most affected by oral diseases, and have poor access to dental care. In many LMICs, oral diseases remain largely untreated because the treatment costs exceed available resources. The personal consequences of chronic untreated oral diseases are often severe and can include unremitting pain, sepsis, reduced quality of life, lost school days, disruption to family life, and decreased work productivity. The costs of treating oral diseases impose large economic burdens to families and health-care systems. Oral diseases are undoubtedly a global public health problem, with particular concern over their rising prevalence in many LMICs linked to wider social, economic, and commercial changes. By describing the extent and consequences of oral diseases, their social and commercial determinants, and their ongoing neglect in global health policy, we aim to highlight the urgent need to address oral diseases among other NCDs as a global health priority.

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Author and article information

Journal

Journal ID (nlm-ta): Rev Saude Publica

Journal ID (iso-abbrev): Rev Saude Publica

Journal ID (publisher-id): rsp

Title: Revista de Saúde Pública

Publisher: Faculdade de Saúde Pública da Universidade de São Paulo

ISSN (Print): 0034-8910

ISSN (Electronic): 1518-8787

Publication date (Electronic): 09 December 2021

Publication date Collection: 2021

Volume: 55

Electronic Location Identifier: 116

Affiliations

[I ] orgnameUniversidade Estadual de Campinas orgdiv1Faculdade de Odontologia de Piracicaba orgdiv2Programa de Pós-Graduação em Odontologia Piracicaba São Paulo Brasil originalUniversidade Estadual de Campinas. Faculdade de Odontologia de Piracicaba. Programa de Pós-Graduação em Odontologia. Piracicaba, São Paulo, Brasil

[II ] orgnameUniversidade Estadual de Ponta Grossa orgdiv1Faculdade de Odontologia orgdiv2Departamento de Odontologia Ponta Grossa Paraná Brasil originalUniversidade Estadual de Ponta Grossa. Faculdade de Odontologia. Departamento de Odontologia. Ponta Grossa, Paraná, Brasil

[III ] orgnameUniversidade Estadual de Campinas orgdiv1Faculdade de Odontologia de Piracicaba orgdiv2Departamento de Ciências da Saúde e Odontologia Infantil iracicaba São Paulo Brasil originalUniversidade Estadual de Campinas. Faculdade de Odontologia de Piracicaba. Departamento de Ciências da Saúde e Odontologia Infantil. iracicaba, São Paulo, Brasil

[IV ] orgnameFaculdade de Medicina de Jundiaí orgdiv1Departamento de Saúde Coletiva Jundiaí São Paulo Brasil originalFaculdade de Medicina de Jundiaí. Departamento de Saúde Coletiva. Jundiaí, São Paulo, Brasil

[I ] Brasil original Universidade Estadual de Campinas. Faculdade de Odontologia de Piracicaba. Programa de Pós-Graduação em Odontologia. Piracicaba, São Paulo, Brasil

[II ] Brasil original Universidade Estadual de Ponta Grossa. Faculdade de Odontologia. Departamento de Odontologia. Ponta Grossa, Paraná, Brasil

[III ] Brasil original Universidade Estadual de Campinas. Faculdade de Odontologia de Piracicaba. Departamento de Ciências da Saúde e Odontologia Infantil. Piracicaba, São Paulo, Brasil

[IV ] Brasil original Faculdade de Medicina de Jundiaí. Departamento de Saúde Coletiva. Jundiaí, São Paulo, Brasil

Author notes

Correspondence: Marília Jesus Batista Avenida Limeira, 901 13414-018 Piracicaba, SP, Brasil E-mail: mariliamota@ 123456g.fmj ,br

Authors’ Contribution: Study design and planning: CFT, MJB. Data collection, analysis and interpretation: CFT, CML, MJB. Writing and revision of unpublished study: CFT, MFSJ, CML, MLRS, MJB. Approval of the final version: CFT, MJB, MFSJ, MLRS. Public responsibility for the content of the study: CFT, MFSJ, CML, MLRS, MJB.

Conflict of Interest: The authors declare no conflict of interest.

Correspondência: Marília Jesus Batista Avenida Limeira, 901 13414-018 Piracicaba, SP, Brasil E-mail: mariliamota@g.fmj.br

Contribuição dos Autores: Concepção e planejamento do estudo: CFT, MJB. Coleta, análise e interpretação dos dados: CFT, CML, MJB. Elaboração ou revisão do manuscrito: CFT, MFSJ, CML, MLRS, MJB. Aprovação da versão final: CFT, MJB, MFSJ, MLRS. Responsabilidade pública pelo conteúdo do artigo: CFT, MFSJ, CML, MLRS, MJB.

Conflito de Interesses: Os autores declaram não haver conflito de interesses.

Author information

Carla Fabiana Tenani https://orcid.org/0000-0001-7203-2763

Manoelito Ferreira Silva Junior https://orcid.org/0000-0001-8837-5912

Carolina Matteussi Lino https://orcid.org/0000-0001-6686-3296

Maria da Luz Rosário de Sousa https://orcid.org/0000-0002-0346-5060

Marília Jesus Batista https://orcid.org/0000-0002-0379-3742

Article

Other ID: 00296

DOI: 10.11606/s1518-8787.2021055003506

PMC ID: 8664067

PubMed ID: 34932703

SO-VID: 4566aebd-b09b-4770-b239-b598cf61a7ee

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 18 January 2021

Date accepted : 6 April 2021

Page count

Figures: 4, Tables: 6, Equations: 0, References: 62

Funding

Funded by: Coordenação de Aperfeiçoamento de Pessoal de Nível Superior

Award ID: 2018/88882.329879/2019-01

Funding: Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (Capes - 2018/88882.329879/2019-01).

The role of health literacy as a factor associated with tooth loss

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ABSTRACT

OBJECTIVE

METHODS

RESULTS

CONCLUSIONS

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SciELO Public Health

Most cited references 72

Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Health literacy and public health: A systematic review and integration of definitions and models

Oral diseases: a global public health challenge

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