New pathways in an age of ecological and ethical concerns

Advances in dental public health

Dental public health has been defined as 'the science and art of preventing oral diseases, promoting oral health and improving the quality of life through the organised efforts of society'. Dental practitioners most often have the oral health of individual patients as their primary focus but the aim of public health is to benefit populations. Early developments in dental public health were concerned largely with demonstrating levels of disease and with treatment services. With greater appreciation of the nature of oral health and disease, and of their determinants has come recognition of the need for wider public health action if the effects of prevention and oral health promotion are to be maximized.

The incidence of dementia: a meta-analysis

OBJECTIVE

To carry out a meta-analysis of the age-specific incidence of all dementias, including AD and vascular dementia.

BACKGROUND

Several meta-analyses have been carried out on dementia prevalence, but none on its incidence.

METHODS

We used loess-curve fitting to analyze data from 23 published studies reporting age-specific incidence data.

RESULTS

The incidence of both dementia and AD rose exponentially up to the age of 90 years, with no sign of leveling off. The incidence rates for vascular dementia varied greatly from study to study, but the trend was also for an exponential rise with age. There was no sex difference in dementia incidence (p = 0.21), but women tended to have a higher incidence of AD in very old age, and men tended to have a higher incidence of vascular dementia at younger ages. East Asian countries had a lower incidence of dementia than Europe (p = 0.0004), and also tended to have a lower incidence of AD.

CONCLUSIONS

The incidence of dementia rises exponentially to the age of 90 years. Any sex differences are small, and incidence is lower in East Asia than in Europe.

Social differences in health: life-cycle effects between ages 23 and 33 in the 1958 British birth cohort

OBJECTIVES

The purpose of this study was to determine whether social differences in health persist or widen during early adulthood.

METHODS

A longitudinal follow-up of the 1958 British birth cohort was investigated, using social class at birth and six health measures at ages 23 and 33. A slope of inequality was estimated to represent social differences in health.

RESULTS

Social gradients in health were evident by age 23: the prevalence of poor health increased with decreasing social position. This was observed for several but not all health indicators. Social gradients persisted to age 33. The slope of inequality was greatest for malaise (odds ratio [OR] = 3.37 for men, 3.21 for women) and obesity (OR = 4.80 for men and 2.84 for women), both at age 23, and for self-rated health in women at age 23 (OR = 2.94) and age 33 (OR = 3.22). Inequality increased significantly between ages 23 and 33 for limiting illness in men, and lessened, although not significantly, for malaise, overweight, and obesity; social gradients remained constant for self-rated health, respiratory symptoms, and asthma or wheezing.

CONCLUSIONS

Social gradients in health evident in this sample by age 23 persisted to age 33. Inequalities did not appear to widen consistently, but variable findings for several health measures suggest that inequalities reproduce through different pathways.

Perinatal characteristics in relation to incidence of and mortality from prostate cancer

OBJECTIVE

To test the hypothesis that factors causing morbidity and mortality from prostate cancer may operate in utero.

DESIGN

Matched case-control study of singleton men born between 1874 and 1946 at one hospital.

SETTING

Uppsala University Hospital.

SUBJECTS

250 patients with prostate cancer and 691 controls, including 80 patients who died from prostate cancer and their 196 matched controls.

MAIN OUTCOME MEASURES

Mother's age at menarche, parity, pre-eclampsia or eclampsia before delivery, age at delivery and socioeconomic status; case or control's birth length and weight, placental weight, prematurity derived from gestational age, and presence of jaundice.

RESULTS

Both pre-eclampsia (odds ratio 0, 95% confidence interval 0 to 0.71) and prematurity (0.31, 0.09 to 1.04) were inversely associated with incidence of prostate cancer. Among subjects born full term, placental weight, birth weight, and ponderal index (weight/height 3) showed non-significant positive associations with prostate cancer incidence, and stronger associations with mortality.

CONCLUSION

Prenatal exposures that are likely correlates of pregnancy hormones and other growth factors are important in prostate carcinogenesis and influence the natural course as well as the occurrence of this cancer.