Oral primary care: an analysis of its impact on the incidence and mortality rates of oral cancer

Can predictive factors determine the time to treatment initiation for oral and oropharyngeal cancer? A classification and regression tree analysis

This ecological study aimed to identify the factors with the greatest power to discriminate the proportion of oral and oropharyngeal cancer (OOC) records with time to treatment initiation (TTI) within 30 days of diagnosis in Brazilian municipalities. A descriptive analysis was performed on the variables grouped into five dimensions related to patient characteristics, access to health services, support for cancer diagnosis, human resources, and socioeconomic characteristics of 3,218 Brazilian municipalities that registered at least one case of OOC in 2019. The Classification and Regression Trees (CART) technique was adopted to identify the explanatory variables with greater discriminatory power for the TTI response variable. There was a higher median percentage of records in the age group of 60 years or older. The median percentage of records with stage III and IV of the disease was 46.97%, and of records with chemotherapy, radiation, or both as the first treatment was 50%. The median percentage of people with private dental and health insurance was low. Up to 75% had no cancer diagnostic support services, and up to 50% of the municipalities had no specialist dentists. Most municipalities (49.4%) started treatment after more than 30 days. In the CART analysis, treatment with chemotherapy, radiotherapy, or both explained the highest TTI in all municipalities, and it was the most relevant for predicting TTI. The final model also included anatomical sites in the oral cavity and oropharynx and the number of computed tomography services per 100,000. There is a need to expand the availability of oncology services and human resources specialized in diagnosing and treating OOC in Brazilian municipalities for a timely TTI of OOC.

The Brazilian National Oral Health Policy and oral cancer mortality trends: An autoregressive integrated moving average (ARIMA) model

OBJECTIVE

This study analyzes the effect of the Brazilian National Oral Health Policy (NOHP) on oral cancer mortality rates (OCMR).

METHOD

This is an ecological study with secondary oral cancer death data, using interrupted time series analysis (ARIMA, Autoregressive Integrated Moving Average). Annual death data were collected from the Mortality Information System (1996-2019). The outcome was the OCMR, standardized by gender and age We considered the NOHP, categorized as "0" (before its implementation), from 1996 to 2004, and "1 to 15", from 2005 to 2019. ARIMA modeling was carried out for temporal analysis, and regression coefficient estimation (RC).

RESULTS

The Brazilian NOHP implementation was associated with an increase in OCMR in the North region (CR = 0.16; p = 0.022) and with a decrease in the Southeast region (CR = -0.04; p<0.001), but did not affect the other macro-regions nor Brazil. The forecast models estimated an increase in OCMR for the North, and Northeast, a decrease for the Southeast, and stability for the South and Brazil.

CONCLUSION

The Brazilian NOHP is not being effective in reducing the OCMR. The trends behaved differently in the Brazilian territory, highlighting health inequities. We recommend that the NOHP strengthen the oral health care network, incorporating oral cancer as a notifiable disease, adopting strategies for prevention, screening, and providing opportunities for early treatment of the disease.

Oral cancer care in the "Metropolitan I" health region in the state of Rio de Janeiro, Brazil: enabling and constraining factors

The aim was to identify constraining and enabling factors related to the organization of health care networks that influence access to oral cancer diagnosis and treatment. A case study in the "Metropolitan I" health region using data collected from health information systems and 26 semi-structured interviews with health managers and professionals. The data were analyzed using descriptive statistics and strategic conduct analysis, drawing on the theory of structuration proposed by Giddens. The findings reveal that coverage of oral health care in primary care services is generally low and prioritizes specific groups and urgent cases, hampering access to oral cancer diagnosis. While the presence of a network of secondary care services in the municipalities that make up the health region facilitates diagnosis, there are major barriers to treatment. Informal partnerships established with dental schools play an important role in diagnosis, but do not receive funding. The regulation of appointments for diagnosis was not restrictive. In contrast, the regulation of referrals for treatment lacked transparency, was subject to long delays, and shortage of places. Despite advances, constraining factors related to structure and the actions of agents involved in the care process persist, hampering the timely diagnosis and treatment of oral cancer.

Oral cancer care in the “Metropolitan I” health region in the state of Rio de Janeiro, Brazil: enabling and constraining factors

Abstract The aim was to identify constraining and enabling factors related to the organization of health care networks that influence access to oral cancer diagnosis and treatment. A case study in the “Metropolitan I” health region using data collected from health information systems and 26 semi-structured interviews with health managers and professionals. The data were analyzed using descriptive statistics and strategic conduct analysis, drawing on the theory of structuration proposed by Giddens. The findings reveal that coverage of oral health care in primary care services is generally low and prioritizes specific groups and urgent cases, hampering access to oral cancer diagnosis. While the presence of a network of secondary care services in the municipalities that make up the health region facilitates diagnosis, there are major barriers to treatment. Informal partnerships established with dental schools play an important role in diagnosis, but do not receive funding. The regulation of appointments for diagnosis was not restrictive. In contrast, the regulation of referrals for treatment lacked transparency, was subject to long delays, and shortage of places. Despite advances, constraining factors related to structure and the actions of agents involved in the care process persist, hampering the timely diagnosis and treatment of oral cancer.

Enhancing Self-care Among Oral Cancer Survivors: Protocol for the Empowered Survivor Trial

BACKGROUND

Survivors of oral cavity and oropharyngeal cancer frequently experience difficulties in swallowing; tasting; speaking; chewing; and maintaining comfortable movements of the head, neck, and shoulder. Engagement in regular self-care can reduce further loss of function and mitigate late effects. Despite the substantial self-care requirements, there are no empirically based interventions to enhance the skills and confidence of these survivors in managing their ongoing care.

OBJECTIVE

The aim of this study is to describe the rationale and methodology for a randomized controlled trial evaluating Empowered Survivor (ES) versus Springboard Beyond Cancer, a general web-based program for cancer survivors, on self-efficacy in managing care, preparedness for managing survivorship, and health-related quality of life (QOL).

METHODS

This study will recruit a total of 600 individuals who were diagnosed with oral cavity or oropharyngeal cancer in the past 3 years and are currently cancer free primarily from state cancer registries; these individuals will be randomly assigned to either the ES or Springboard Beyond Cancer condition. The participants complete measures of self-efficacy in managing care, preparedness for survivorship, health-related QOL, and engagement in oral self-examination and head and neck strengthening and flexibility exercises at baseline and 2 and 6 months after baseline. The primary aim of this study is to evaluate the impact of ES versus Springboard Beyond Cancer on self-efficacy, preparedness, and health-related QOL. The secondary aim is to examine the mediators and moderators of ES's impact on self-efficacy in managing care, preparedness, and health-related QOL at 6 months. The exploratory aim is to conduct a process evaluation of ES to identify potential oncology or community settings for future implementation.

RESULTS

Multilevel modeling will be used to examine whether there are significant differences between the ES and Springboard Beyond Cancer interventions over time. Mediational models will evaluate the indirect effects of ES on outcomes. Quantitative analyses will evaluate the predictors of ES use, and qualitative analyses will evaluate the preferred timing and settings for the implementation of ES.

CONCLUSIONS

This randomized controlled trial evaluates a completely web-based intervention, ES, versus a general web-based program for cancer survivors, Springboard Beyond Cancer, on self-efficacy in managing care, preparedness for managing survivorship, and health-related QOL and identifies the putative mediators and moderators of the intervention's effects. If an effect on the primary outcomes is illustrated, the next step could be an implementation trial to evaluate the intervention's uptake in and impact on an oncology care setting or nonprofit organizations.

TRIAL REGISTRATION

ClincalTrials.gov NCT04713449; https://clinicaltrials.gov/ct2/show/NCT04713449.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/39996.

Spatial-temporal analysis of hospitalizations with death caused by oral cancer in Brazil and its correlation with the expansion of healthcare coverage

BACKGROUND

Oral cancer (OC) is a growing public health problem worldwide. In Brazil, the National Oral Health Policy, implemented in 2004, expanded access to oral health services and prioritized OC care. However, it is not known whether this expansion resulted in a reduction in hospital admissions with death. This study aimed to analyze the proportion of hospital admissions who progressed to death due to OC in Brazil from 2007 to 2019 and its correlation with the coverage of health services.

MATERIAL AND METHODS

This study is an ecological, longitudinal, and analytical study of hospital admissions with death due to OC recorded in the Brazilian Hospital Information System. The following analyses were performed: descriptive, spatial (choropleth maps and Moran index), and negative binomial regression, with a hierarchical approach, estimating crude and adjusted regression coefficients (β) and respective 95% confidence intervals (95% CI) (alpha=5%).

RESULTS

In 2019, Moran's index (I) of spatial autocorrelation showed a negative association between hospital admissions with death and dentist surgeon/inhabitant rate (I=-0.176), physician/inhabitant rate (I=-0.157), family health strategy (FHS) coverage (I=-0.080), oral health team (OHT) coverage (I= -0.129), dental specialty centers (DSC)/inhabitant rate (I= -0.200), and oncology bed/inhabitant rate (I= -0.101). In the adjusted regression analysis, the proportion of hospitalizations with deaths caused by OC was higher in Brazilian states with a lower medical ̸inhabitant ratio (β= -0.014; p=0.040), a lower dentists/inhabitant ratio (β= -0.720; p=0.045), a lower number of DSC (β= -0.004; p<0.000), a lower amount paid per hospitalization (β= -10.350; p<0.001), and a lower number of biopsies (β= -0.00008; p=0.010). The proportion of hospitalizations that progressed to death showed a positive association with the number of days of hospitalization (β= 0.00002; p=0.002).

CONCLUSIONS

Increased health care coverage has decreased serious hospital admissions with deaths caused by OC in Brazil.

Bolsa Família Program and deaths from oral cancer in Brazil: an ecological study

Objective

To assess the effect of coverage of the Bolsa Família Program (BFP) on oral cancer mortality rates in Brazil between 2005 and 2017, adjusting for health care coverage and socioeconomic characteristics of the Brazilian federative units.

Methods

This is an ecological study using annual data (2005-2017) from all the Brazilian federative units. The dependent variable for this study was the oral cancer mortality rate, standardized by gender and age using the direct standardization technique. BFP coverage was the main independent variable, calculated as the ratio of the number of BFP beneficiaries to those families that should potentially be entitled to this conditional cash transfer. Socioeconomic background and health care coverage were covariables. Choropleth maps were drawn, and space-time cube analysis was used to assess changes in the spatiotemporal distribution of BFP and oral cancer mortality rates. Mixed-effects linear regression analysis estimated the coefficients (β) and 95% confidence intervals (CI) for the association between BFP coverage and oral cancer mortality rates.

Results

BFP coverage trends increased and oral cancer mortality rate trends stabilized in Brazilian federative units, except for Maranhão, Goiás, and Minas Gerais, where the oral cancer mortality rates have increased. In the adjusted model, greater BFP coverage was associated with lower oral cancer mortality rates (β -2.10; 95% CI [-3.291, -0.919]).

Conclusions

Egalitarian strategies such as BFP can reduce the oral cancer mortality rate. We recommend the follow-up of families benefiting from conditional cash transfer program by oral health teams to reduce the oral cancer mortality rate.

Association between Sociodemographic Factors, Coverage and Offer of Health Services with Mortality Due to Oral and Oropharyngeal Cancer in Brazil: A 20-Year Analysis

To investigate the association between sociodemographic factors and variables related to oral health services in oral and oropharyngeal cancer mortality in Brazil, between 2000 and 2019. This study had an ecological design. Standardized mortality rates were compared between age group, sex, and regions. Age-Period-Cohort analysis was applied. Oral health services variables were analyzed in correlation tests. Survival analysis included Kaplan-Meier estimators, log-rank tests, and Cox regression. The mortality rate increased with age and was higher in men. Southeast and south regions had the highest rates for men, and the northeast and southeast had it for women. Age-Period-Cohort analysis showed a slight increase in female deaths and an increasing trend in the annual percent change in mortality for men over age 55. In survival analysis, males, Black individuals and southern residents were more strongly associated with death. The correlation between oral health teams' coverage was high and negative, while the number of dental specialty centers and soft tissue biopsies had a high and positive correlation. Mortality and survival patterns were dependent on sex, age, geographic region and race/ethnicity. It was observed that preventive and diagnostic procedures were not being performed, which may be related to the increase in mortality.

Tendência Temporal da Mortalidade por Câncer de Boca e da Cobertura de Atenção Primária no Estado do Rio de Janeiro

Introdução: O câncer de boca e comumente diagnosticado de forma tardia, comprometendo a qualidade de vida dos indivíduos ou os levando a óbito. Objetivo: Verificar a tendencia temporal da mortalidade por câncer de boca no Estado do Rio de Janeiro e da cobertura da Estratégia Saúde da Família (ESF) e de equipes de saúde bucal (ESB). Método: Estudo ecológico com análise da tendencia temporal da mortalidade por câncer de boca, entre 1999 e 2018, e da cobertura da ESF e ESB, no período de 2002 a 2018, no Estado e Regiões de Saúde. Utilizou-se a regressão linear generalizada de Prais-Winsten no cálculo das tendencias para o Estado, cada Região de Saúde, sexo, faixa etária e localização do tumor. Resultados: Houve tendencia de mortalidade por câncer de boca decrescente no Estado e nas Regiões Metropolitana I e II; nas demais Regiões de Saúde, foi estacionaria. As tendencias dos óbitos em homens, das faixas etárias 40 a 59 anos e 80 anos ou mais, foram decrescentes. Na localização do tumor, houve tendencia decrescente entre óbitos por outras partes e partes não especificadas (C06) e uma tendencia crescente na mortalidade por câncer de base de língua (C01). Na cobertura de ESF e ESB, na maioria das Regiões de Saúde e no Estado, a tendencia foi crescente. Conclusão: A tendencia decrescente na mortalidade por câncer de boca e a tendencia crescente de ESF e ESB, no Estado do Rio de Janeiro, não foram observadas em todas as Regiões de Saúde.

Sociodemographic correlates of cervix, breast and oral cancer screening among Indian women

INTRODUCTION

Cervix, breast and oral cancers account for about one-third of all cancers in India which as a group is a major contributor to all non-communicable disease-related morbidity and mortality among women. Existing evidence suggests that early diagnosis plays a pivotal role in the prevention and intervention of these cancers, and many community-based early screening and awareness programs have been in place in developed countries. Currently, there is not enough research evidence regarding the sociodemographic correlates of cervix, breast and oral cancer screening among Indian women. In the present study, we aimed to assess the self-reported percentage and sociodemographic factors associated with the use of these three types of cancer screening services among Indian women aged 15-49 years.

METHODS

Data were collected from National Family Health Survey conducted during 2015-16. Sample population was 699,686 women aged 15-49 years. Associations between self-reported cervical, breast and oral cancer screening status and the associated sociodemographic factors were analyzed using multivariable logistic regression methods.

RESULTS

The percentage of screening for cervical (21%), breast (8.95%), and oral cancers (13.45%) varied significantly across the population sub-groups. Higher age, urban residence, higher education, having employment, health insurance, use of electronic media, higher household wealth quintile, having healthcare autonomy, showed a positive effect on taking screening services. Further analyses revealed that the strength of the associations varied considerably between urban and rural residents, denoting the need for region-specific intervention strategies. Sex of household head, age, watching TV, using radio, and having health insurance were the most significant contributors to the outcome effects.

CONCLUSIONS

The present study provides important insights regarding the current scenario of seeking cancer screening services among women in India. These findings could inform policy analysis and make an avenue for further in-depth analysis for future studies. Our findings conclude that cancer prevention policies should focus on leveraging the positive effects of better socioeconomic status, employment, health insurance ownership, exposure to electronic media, and better healthcare autonomy to improve the cancer screening service uptake among Indian women.

Advances and weaknesses of the work process of the oral cancer care network in Brazil: A latent class transition analysis

OBJECTIVE

To analyse the provision of oral cancer (OC) care services in the Dental Specialties Centers (Centros de Especialidades Odontológicas-CEO) in Brazil and identify changes over two cycles of external evaluation of the Program for the Improvement of Access and Quality-PMAQ, in 2014 and 2018.

METHOD

This is a nationwide panel ecological study, including 916 CEO. Data from interviews with managers and dentists of the CEO were used, including variables related to training on OC, clinical protocols, biopsies, referral for diagnosis and treatment, and registration of users with OC. We carried out Latent Transition Analysis (LTA) to identify patterns (latent status LS) of service adequacy and work processes' changes between the two assessment cycles. We tested models with three, four, and five LS, selecting the one with the best conceptual interpretability and good model fit parameters. Data from the LS were plotted on choropleth and hotspots maps in Brazil allowing us to identify areas with the better or worse provision of specialized OC services.

RESULTS

The model with four LS was chosen. The four LS were named: 1.'Most indicators inadequate for OC care' (the worst); 2. 'Most indicators suitable for OC care' (the best); 3. 'CEO with a poor relation with Primary Health Care (PHC) services'; and 4. 'CEO with a poor relation with tertiary hospital services'. The comparison of the LS transition between the two cycles revealed that 419 (45.7%) CEO remained in the same LS (1→1, 3→4, 2→2); 228 (24.9%) switched to a worse status (2→1, 2→4, 3→1) and 269 (29.4%) switched to a better LS (1→2, 1→4, 3→2). While the majority of the CEO improved, we identified a decline of 17.8% in those who reported performing biopsies and 18.3% in the number of CEO that had hospitals for referring confirmed OC cases. Almost all Brazilian states had CEO that improved the work process. The Southeast and South regions had the highest percentage of CEO with the better work process in both cycles. Hotspots showed areas concentrating improvements in the work process in the Northeast region. However, some hotspots in the North revealed some CEO where the work process deteriorated or remained unsatisfactory.

CONCLUSIONS

There are regional inequities in the provision of OC care in CEO. Most services improved their work process or remained stable. However, the biopsies and the referral to hospital care for confirmed cases declined, indicating that CEO need to improve planning and care provision to reduce OC morbimortality.

Diagnostic significance of serum and salivary lipid levels in oral precancer and oral cancer

Introduction

Lipids are one of the major constituents of the cell. Variations in the serum lipids have been considered a cofactor of carcinogenesis, as lipids play a crucial role in cell integrity. Saliva is an ultrafiltrate of plasma and correlates with the serum, which may be used as an alternate method of serum lipid level estimation. The study was conducted to find any correlation between serum and salivary lipid levels and to evaluate the changes in serum and salivary lipid levels in oral precancer and cancer patients.

Aims and Objectives

This study aimed to evaluate the changes in serum and salivary lipid levels in oral precancer and cancer patients and to correlate salivary lipid levels with serum lipid levels.

Materials and Methods

The study was an in vivo study conducted on randomly selected 129 patients with oral cancer and oral precancer. The selected subjects were divided into four groups as Group 1 - healthy control, Group 2 - oral submucous fibrosis, Group 3 - leukoplakia, and Group 4 - oral cancer. Serum and salivary lipid levels were estimated biochemically and statistically analyzed for any correlation with oral precancer and cancer.

Results

Lipid level estimation showed no statistically significant difference on comparison of intergroup serum and saliva total cholesterol level and high-density lipoproteins among all four groups, whereas intergroup comparison of serum and saliva triglycerides (TG) levels among the four groups showed a statistically significant difference in saliva TG level. The correlation of serum and salivary lipid levels showed a significant positive correlation.

Conclusion

In the present study association between serum/salivary lipid levels and oral precancer and oral cancer could not be established. A positive association was there in serum and salivary lipids hence salivary lipid levels may be used as a noninvasive technique for serum lipid level estimation.

Data-driven risk stratification for preterm birth in Brazil: a population-based study to develop of a machine learning risk assessment approach

Background

Preterm birth (PTB) is a growing health issue worldwide, currently considered the leading cause of newborn deaths. To address this challenge, the present work aims to develop an algorithm capable of accurately predicting the week of delivery supporting the identification of a PTB in Brazil.

Methods

This a population-based study analyzing data from 3,876,666 mothers with live births distributed across the 3,929 Brazilian municipalities. Using indicators comprising delivery characteristics, primary care work processes, and physical infrastructure, and sociodemographic data we applied a machine learning-based approach to estimate the week of delivery at the point of care level. We tested six algorithms: eXtreme Gradient Boosting, Elastic Net, Quantile Ordinal Regression - LASSO, Linear Regression, Ridge Regression and Decision Tree. We used the root-mean-square error (RMSE) as a precision.

Findings

All models obtained RMSE indexes close to each other. The lower levels of RMSE were obtained using the eXtreme Gradient Boosting approach which was able to estimate the week of delivery within a 2.09 window 95%IC (2.090-2.097). The five most important variables to predict the week of delivery were: number of previous deliveries through Cesarean-Section, number of prenatal consultations, age of the mother, existence of ultrasound exam available in the care network, and proportion of primary care teams in the municipality registering the oral care consultation.

Interpretation

Using simple data describing the prenatal care offered, as well as minimal characteristics of the pregnant, our approach was capable of achieving a relevant predictive performance regarding the week of delivery.

Funding

Bill and Melinda Gates Foundation, and National Council for Scientific and Technological Development - Brazil, (Conselho Nacional de Desenvolvimento Científico e Tecnológico - CNPQ acronym in portuguese) Support of the research project named: Data-Driven Risk Stratification for Preterm Birth in Brazil: Development of a Machine Learning-Based Innovation for Health Care- Grant: OPP1202186.

Inclusion of oral health teams in primary health care promotes early diagnosis of oral and oropharyngeal cancers: a nationwide study

Background

Oral and oropharyngeal cancers are considered important public health problems worldwide. This study aims to analyze the association between late diagnosis of oral and oropharyngeal cancers in Brazil and the contextual indicators of socioeconomic variables and coverage of Primary Health Care (PHC), and to assess the temporal trend of late diagnosis.

Methods

In this cross-sectional observational study, secondary data were evaluated with a time series analysis. All Brazilian cities that reported at least one case of oral and oropharyngeal cancers each year in the period between 2000 and 2013 were included; and the staging was analyzed by calculating the ratio risk for late diagnosis for each municipality. The association between staging and socioeconomic variables and offer of PHC was calculated using multiple linear regression. The time trend of the risk ratio for late-stage diagnosis was calculated using the Prais–Winsten method.

Results

One hundred and sixty Brazilian municipalities had at least one annual case of oral and oropharyngeal cancers notified to the INCA hospital system between 2000 and 2013. The adjusted model showed that the higher the Gini value (greater social inequality) and the lower the HDI value (less human development) was, the higher was the number of tumors diagnosed at a late stage, considering the size of the tumor. A greater risk for late diagnosis was identified, as early as at the stage of lymph node involvement, when there was a higher level of social inequality and lower level of coverage by Oral Health Teams (OHT) in PHC. The greater the social inequality, the greater was the risk of late diagnosis, as early as in the stage of metastasis.

Conclusions

We concluded that, during the evaluated period, there was an increase in the number of cases diagnosed at the most advanced stage. Furthermore, there was association between higher levels of social inequality and an increase in the proportion of late diagnosis of oral and oropharyngeal cancers. In addition, the inclusion of Oral Health Teams in Primary Health Care promoted the early diagnosis of these types of cancers.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-021-01664-3.

Trend of hospitalized cases of oral cancer in Brazil and its relationship with oral health coverage in public health system between 2009 and 2017

Background

This study aimed to analyze the trend in the number of hospitalized cases of oral cancer in Brazil, according to the coverage of oral health services in public health system, and also investigate the influence of healthcare and clinical characteristics on the severity of oral cancer cases.

Material and Methods

This retrospective study considered the period between 2009 and 2017. Data from the Hospital Registry of Cancer from the National Cancer Institute were used, considering the primary locations C00 to C06. Detailed information including sex, age, alcohol and tobacco use, year of first consultation, and the clinical stage of the cases were also collected. The frequency of hospitalized cases was correlated with the coverage of Primary Care Oral Health Teams (ESB) and the number of Dental Specialty Centers (CEO). It was also estimated the chance of advanced oral cancer cases, according to healthcare and clinical characteristics. Data were analyzed using Tweedie's multiple regression and multiple binary logistic regression (α<0.05).

Results

There was an increasing trend in the number of hospitalized cases of oral cancer in Brazil between 2009 and 2017 (B=0.043, p<0.001, PR=1.044). The increase in ESB coverage was associated with small increase in the number of hospitalized cases of oral cancer (B=0.001, p=0.003, PR=1.001). The increase in the number of CEO was associated with decrease in the number of hospitalized cases of oral cancer (B=-0.085, p<0.001, PR =0.918). The increase of ESB (OR=0.998) and CEO (OR=0.974) contributed for reducing the number of stage IV cases, whilst the history of alcohol and tobacco use (OR=1.574) was associated with an increase in the number of stage IV cases.

Conclusions

Although an increasing trend was detected, the expansion of the public health system reduced the number of hospitalized cases and the frequency of advanced oral cancer cases in Brazil.

Key words:Mouth neoplasms, squamous cell carcinoma, oral diagnosis.

Influence of Public Oral Health Services and Socioeconomic Indicators on the Frequency of Hospitalization and Deaths due to Oral Cancer in Brazil, between 2002-2017

Background: Oral cancer is a frequent neoplasm worldwide, and socioeconomic factors and access to health services may be associated with its risk. Aim: To analyze effect of socioeconomic variables and the influence of public oral health services availability on the frequency of new hospitalized cases and mortality of oral cancer in Brazil. Materials and Methods: This observational study analyzed all Brazilian cities with at least one hospitalized case of oral cancer in the National Cancer Institute database (2002-2017). For each city were collected: population size, Municipal Human Development Index (MHDI), Gini Coefficient, oral health coverage in primary care, number of Dental Specialized Centers (DSC) and absolute frequency of deaths after one year of the first treatment. The risk ratio was determined by COX regression, and the effect of the predictor variables on the incidence of cases was verified by the Hazard Ratio measure. Poisson regression was used to determine factors associated with higher mortality frequency. Results: Cities above 50,000 inhabitants, with high or very high MHDI, more unequal (Gini > 0.4), with less oral health coverage in primary care (<50%) and without DSC had a greater accumulated risk of having 1 or more cases (p < 0.001). Higher frequency of deaths was also associated with higher population size, higher MHDI, higher Gini and lower oral health coverage in primary care (p < 0.001). Conclusions: The number hospitalization and deaths due to oral cancer in Brazil was influenced by the cities' population size, the population's socioeconomic status and the availability of public dental services.

Orale Immunkompetenz in der Corona-Pandemie vs. Systemrelevanz der Zahnmedizin

Die Covid-19-Pandemie hat das deutsche Gesundheitssystem im Jahr 2020 vor erhebliche Herausforderungen gestellt. In diesem Zusammenhang ist es bemerkenswert, dass für die Zahnmedizin kein sogenannter Rettungsschirm aufgespannt wurde. Dies bedeutet, dass nach Ansicht der Bundesregierung Zahnärzte als nicht systemrelevant eingestuft wurden und somit offiziell auch nicht zu den Ärzten gehören. Diese Annahme ist grundfalsch und gefährlich, wie im Folgenden anhand eines wichtigen Beispiels erörtert wird.

Das SARS-CoV-2-Virus führt bei infizierten Personen zu einem Beschwerdebild von leichten Erkältungszeichen bis hin zu lebensbedrohlichen beatmungsbedürftigen COVID-19-Pneumonien. Ein besonderes Risiko für schwere Verläufe haben Menschen höheren Alters sowie Patienten mit Diabetes, Bluthochdruck und anderen schweren Erkrankungen. Die Haupteintrittspforte für das SARS-CoV-2-Virus in den menschlichen Körper ist u. a. die orale Mukosa, denn die Viren reichern sich dort bevorzugt an und der ACE2-Rezeptor wird dort hochgradig exprimiert. Dieser Penetrationsweg erklärt die häufigeren schweren Verläufe bei älteren Diabetespatienten, deren Immunsystem bereits generell beeinträchtigt ist. Diabetes mellitus induziert eine chronische systemische Entzündung, die sich gerade im Mundbereich regelmäßig als Parodontitis manifestiert. Bei Diabetikern zwangsläufig oft auftretende Hyperglykämien schwächen die Mukosa-Barriere zusätzlich. Es ist daher dringend ratsam, bei Präventionsmaßnahmen für Diabetespatienten den Mund- und Rachenraum nicht zu ignorieren. Neben der parodontalprophylaktischen Betreuung ist gerade in Absenz von Zahnärzten die aktivierte Matrix-Metalloproteinase 8 (aMMP8) ein etablierter Biomarker. Die aktuellen Empfehlungen zur Prävention der SARS-CoV-2-assoziierten COVID-19-Erkrankung sollte daher um die Aspekte der Messung und Sanierung des Mund- und Rachenraums sowie einer regelmäßigen Desinfektion der oralen Mukosa erweitert werden.

The interval since first symptoms until diagnosis of squamous cell carcinoma in the head and neck region is still a problem in southern Brazil

Background

The aim was to examine the interval since first symptoms until final diagnosis of squamous cell carcinoma (SCC) in the head and neck region in southern Brazil.

Material and Methods

The individuals were prospectively selected and underwent anamnesis, physical examination and interview in the first medical consultation at a Cancer Hospital from south of Brazil.

Results

From 488 patients who underwent clinical examination, 105 were included in the study with diagnosis of SCC. Patients average interval from first symptoms to final diagnosis was 152 days (median 86; max:1105; min: 1), the average professional interval was 108 days (median: 97; max:525; min: 1) , and the average total period interval was 258 days (median: 186; max:1177; min: 45). Factors statistically associated with patient and diagnosis itinerary intervals were smoking and poorly adapted dentures and distance from home to hospital, respectively.

Conclusions

The identification of the itinerary characteristics of this specific population may reflect in more effective public policies, such as primary and secondary prevention programs, aiming to increase the survival of oncological patient. Furthermore, the knowledge of the variables that influence the late diagnosis minimizes patient's journey in search of care to cancer centers through health programs.

Key words:Head and neck cancer, time interval, time to diagnosis, diagnosis delay, squamous cell carcinoma.

Upregulation of long non-coding RNA FOXD2-AS1 promotes progression and predicts poor prognosis in tongue squamous cell carcinoma

BACKGROUND

Accumulating evidences suggest that lncRNA FOXD2-AS1 plays an important role in tumor progression, however, its function in tongue squamous cell carcinoma (TSCC) remains unknown. This research aims to investigate the function and mechanism of FOXD2-AS1 in the modulation of tongue squamous cell carcinoma progression.

METHODS

Expression of FOXD2-AS1 was detected in TSCC tissues and TCGA data. Receiver operating characteristic curves (ROCs) analysis and bioinformatic analysis of TCGA data were performed to investigate the role of FOXD2-AS1 in TSCC prognosis. After siRNA-mediated downregulation of FOXD2-AS1, wound healing assay, Transwell migration and invasion assays, and MTS proliferation assay were conducted to explore the effects that FOXD2-AS1 exerted on SCC-9 and CAL-27 cell lines. Western blotting was performed to detect the downstream protein changes.

RESULTS

Compared to the normal tissues and samples, FOXD2-AS1 significantly highly expressed in TSCC tissues and in TSCC samples of TCGA data, and high expression of FOXD2-AS1 was associated with lymphatic metastasis and poor TNM stages. ROC analysis and bioinformatic analysis of TCGA data further suggested that high expression of FOXD2-AS1 was associated with TSCC poor prognosis. Downregulation of FOXD2-AS1 inhibited the migration and invasion of SCC-9 and CAL-27 cell lines. Western blotting showed that the expression of p-p44 and p-p65 downregulated after FOXD2-AS1 knockdown.

CONCLUSION

High expression of FOXD2-AS1 promotes TSCC progression through modulating NF-kB and ERK MAPK signaling pathways and is associated with TSCC poor prognosis, it could be a novel therapeutic target and prognostic biomarker for TSCC.

Smokeless tobacco use and related oral mucosal changes in Bengali Women

BACKGROUND

Tobacco use is called the single most cause of preventable cause of death all over the world. The various study confirmed that smokeless tobacco use is directly related to oral cancer and pre-cancer. The prevalence of smokeless tobacco use varies widely in different countries and states based on age group, gender, with varied socioeconomic, cultural and educational backgrounds.

CONTEXT

Bengali female population.

AIM

Explore the pattern of smokeless tobacco use and oral mucosal changes caused by it.

METHODS

155 women aged 15 years and above were selected. Face-to-face interview was conducted using a structured questionnaire. Data were summarized and statistically, analysis was done.

STATISTICAL ANALYSIS USED

Chi-square test and univariate logistic regression done.

RESULTS

The prevalence of current smokeless tobacco use was found to be 18.7%. On univariate logistic regression, it was found that there was a significant association between smokeless tobacco use and less educated females, odds ratio 0.4209 (0.1855-0.9550) family income less than 10,000, odds ratio 3.9773 (1.3047-12.1242), and oral changes odds ratio 0.2693 (0.1027-0.7061).

CONCLUSIONS

Health care providers, as well as social workers, should give all efforts to bring the women from behind the curtain and educate them about the hazards of smokeless tobacco use.

Mortality from oral and oropharyngeal cancer in Brazil: impact of the National Oral Health Policy

The objective was to investigate if there is an association between the mortality rates due to oral and oropharyngeal cancer in Brazil and the expansion of access to public primary and specialized dental care services that resulted from the implementation of the National Oral Health Policy, between 2000 and 2013. The mortality data were obtained from the records of the Mortality Information System and the exposure variables were obtained from databases of the Brazilian Ministry of Health and the Brazilian Institute of Geography and Statistics. The main exposures investigated were "coverage of primary dental care" and "number of specialized dental care centers". Additional covariates included "Gini index of household income", "average number of years of study", "proportion of unemployed people" and "proportion of smokers". For the statistical analysis, a random coefficient model was used. There was a statistically significant association between the mortality rates by oral and oropharyngeal cancer with coverage by primary dental care and the number of specialized dental care centers with males. This study found that the expansion of the coverage of primary dental care and the number of specialized dental care centers are associated with the reduction of mortality rates due to oral and oropharyngeal cancer in Brazil. There is plausibility for the association found, which needs to be confirmed by implementation studies.

Describing mortality trends for major cancer sites in 133 intermediate regions of Brazil and an ecological study of its causes

BACKGROUND

In Brazil, 211 thousand (16.14%) of all death certificates in 2016 identified cancer as the underlying cause of death, and it is expected that around 320 thousand will receive a cancer diagnosis in 2019. We aimed to describe trends of cancer mortality from 1996 to 2016, in 133 intermediate regions of Brazil, and to discuss macro-regional differences of trends by human development and healthcare provision.

METHODS

This ecological study assessed georeferenced official data on population and mortality, health spending, and healthcare provision from Brazilian governmental agencies. The regional office of the United Nations Development Program provided data on the Human Development Index in Brazil. Deaths by misclassified or unspecified causes (garbage codes) were redistributed proportionally to known causes. Age-standardized mortality rates used the world population as reference. Prais-Winsten autoregression allowed calculating trends for each region, sex and cancer type.

RESULTS

Trends were predominantly on the increase in the North and Northeast, whereas they were mainly decreasing or stationary in the South, Southeast, and Center-West. Also, the variation of trends within intermediate regions was more pronounced in the North and Northeast. Intermediate regions with higher human development, government health spending, and hospital beds had more favorable trends for all cancers and many specific cancer types.

CONCLUSIONS

Patterns of cancer trends in the country reflect differences in human development and the provision of health resources across the regions. Increasing trends of cancer mortality in low-income Brazilian regions can overburden their already fragile health infrastructure. Improving the healthcare provision and reducing socioeconomic disparities can prevent increasing trends of mortality by all cancers and specific cancer types in Brazilian more impoverished regions.

Public knowledge about oral cancer in Uganda: a free dental camp experience

Purpose–

The purpose of this paper is to assess the levels of awareness and knowledge about oral cancer, its causes and or risk factors among Ugandan patients seeking oral healthcare.

Design/methodology/approach–

This was a cross-sectional study on adult patients who attended a free dental camp. An assistant-administered questionnaire either in English or Luganda was provided to every even-numbered registered adult who consented to participate in the study. Information on demographics and known risk factors for oral cancer were captured. The two knowledge questions on oral cancers were scored by adding up all the correctly identified causes, non-causes and risk factors then scored out of the total. Data analysis was done by calculating proportions, Student’s’ t-tests and χ² tests with significant p-value set at 0.05.

Findings–

The results showed a low level of awareness/knowledge about oral cancer in studied population. In total, 60 percent and less than 50 percent of respondents identified smoking and alcohol use as risk factors for oral cancer, respectively. Majority of respondents (88.8 percent) would seek help from medical personnel if diagnosed with oral cancer. Screening for cancer was low despite awareness and knowledge that it improves the chances of successful treatment.

Research limitations/implications–

Emphasis on risk factors including alcohol use in public health messages, use of mass media, religious and community leaders to disseminate messages to the communities and further research were recommended.

Practical implications–

We need to emphasize the role of alcohol in oral cancer causation just as we do for tobacco consumption.

Originality/value–

No study has been conducted in Uganda on the level of awareness yet the incidence of the disease and use of high-risk products are rising.