Individual and contextual factors associated with malocclusion in Brazilian children

OBJETIVO: Evaluar la asociación entre la prevalencia de maloclusión en niños a los 12 años de edad con variables individuales y contextuales MÉTODOS: Se realizó un estudio transversal analítico con datos de la Investigación Nacional de Salud Bucal – SBBrasil 2010. El aspecto estudiado fue la maloclusión, categorizada en ausente, definida, severa y muy severa. Las variables independientes fueron clasificadas en individuales y contextuales. Los datos fueron analizados por medio de modelo multinivel, considerando el nivel de 5% de significancia. RESULTADOS: La prevalencia de maloclusión severa y muy severa en los niños con 12 años de edad no se diferenció entre las regiones brasileñas, pero sí entre las ciudades (pOBJECTIVE: To assess the association between the prevalence of malocclusion in Brazilian 12 years-olds with individual and contextual variables. METHODS: A cross-sectional, analytical study was conducted with data from the Brazilian Oral Health Survey – SBBrazil 2010. The outcome studied was malocclusion, categorized as absent, set, severe and very severe. The independent variables were classified as individual and contextual. Data were analyzed using a multilevel model with a 5% significance level. RESULTS: It was found that the prevalence of severe and very severe malocclusion in 12-year-olds did not differ between the Brazilian regions, although variation between the cities was significant (p < 0.001). Male children (p = 0.033), those on lower income (p = 0.051), those who had visited a dentist (p = 0.009), with lower levels of satisfaction with mouth and teeth (p < 0.001) and embarrassed to smile (p < 0.001) had more severe malocclusion. The characteristics of the cities also affected the severity of malocclusion; cities with more families on social benefits per 1,000 inhabitants, with lower scores on the health care system performance index and lower gross domestic product per capita were significantly associated with malocclusion. CONCLUSION: Significant associations between the presence and severity of malocclusion were observed at the individual and contextual level.OBJETIVO: Avaliar a associação entre a prevalência de má oclusão em crianças aos 12 anos de idade com variáveis individuais e contextuais. MÉTODOS: Foi realizado um estudo transversal analítico com dados da Pesquisa Nacional de Saúde Bucal – SBBrasil 2010. O desfecho estudado foi a má oclusão, categorizada em ausente, definida, severa e muito severa. As variáveis independentes foram classificadas em individuais e contextuais. Os dados foram analisados por meio de modelo multinível, considerando nível de 5% de significância. RESULTADOS: A prevalência de má oclusão severa e muito severa nas crianças com 12 anos de idade não diferiu entre as regiões brasileiras, mas sim entre as cidades (p < 0,001). Crianças do sexo masculino (p = 0,033), de menor renda (p = 0,051), que consultaram o dentista (p = 0,009), com menor satisfação com a boca e os dentes (p < 0,001) e com vergonha de sorrir (p < 0,001) apresentaram má oclusão de maior gravidade. As características das cidades também afetaram a gravidade da má oclusão; cidades com mais famílias com benefício social por 1.000 habitantes, com menores notas do índice de desempenho do sistema de saúde e menor renda per capita foram estatisticamente associadas com a má oclusão. CONCLUSÕES: Associações significativas entre a presença e gravidade da má oclusão foram observadas em nível individual e contextual

Can the primary health care model affect the determinants of neonatal, post-neonatal and maternal mortality? A study from Brazil

The state of SAo Paulo recorded a significant reduction in infant mortality from 1990 to 2013, but the desired reduction in maternal mortality was not achieved. Knowledge of the factors with impact on these indicators would be of help in formulating public policies. The aims of this study were to evaluate the relations between socioeconomic and demographic factors, health care model and both infant mortality (considering the neonatal and post-neonatal dimensions) and maternal mortality in the state of SAo Paulo, Brazil.MethodsIn this ecological study, data from national official open sources were used to conduct a population-based study. The units analyzed were 645 municipalities in the state of SAo Paulo, Brazil. For each municipality, the infant mortality (in both neonatal and post-neonatal dimensions) and maternal mortality rates were calculated for every 1000 live births, referring to 2013. Subsequently, the association between these rates, socioeconomic variables, demographic models and the primary care organization model in the municipality were verified. For statistical analysis, we used the zero-inflated negative binomial model. Gross analysis was performed and then multiple regression models were estimated. For associations, we adopted p at 5%.ResultsThe increase in the HDI of the city and proportion of Family Health Care Strategy implemented were significantly associated with the reduction in both infant mortality (neonatal + post-neonatal) and maternal mortality rates. In turn, the increase in birth and caesarean delivery rates were associated with the increase in infant and maternal mortality rates.ConclusionsIt was concluded that the Family Health Care Strategy was a Primary Care organization model that contributed to the reduction in infant (neonatal + post-neonatal) and maternal mortality rates, and so did actors such as HDI and cesarean section. Thus, public health managers should prefer this model when planning the organization of Primary Care services for the population1

Má oclusão em crianças e adolescentes brasileiros: modelo multinível

Exportado OPUSMade available in DSpace on 2019-08-14T04:43:14Z (GMT). No. of bitstreams: 1 disserta__o___val_ria_brizon.pdf: 1421007 bytes, checksum: fe59922b9261320e5fe12751f139132d (MD5) Previous issue date: 4Este estudo é composto por dois artigos, cujo objetivo principal foi avaliar a associação entre a prevalência e gravidade da má oclusão em crianças de 12 anos de idade e adolescentes brasileiros, na faixa etária de 15 a 19 anos, com variáveis individuais e contextuais. Trata-se de um estudo transversal em que foram utilizados dados do inquérito epidemiológico nacional de saúde bucal, SB Brasil 2010. O desfecho estudado foi a má oclusão, mensurada pelo Índice de Estética Dental (DAI) e categorizada em ausente, definida, severa e muito severa. As variáveis independentes foram classificadas em individuais (demográficas, agravos á saúde bucal, socioeconômicas, escolaridade, morbidade e utilização dos serviços odontológicos, autopercepção e impacto à saúde) e contextuais (Índice de Desenvolvimento Humano-IDH, Índice de Avaliação de Desempenho do Sistema Único de Saúde-IDSUS, Bolsa Família, PIB percapita, água fluoretada). Os dados foram analisados no software SAS (2008) pelos teste qui-quadrado e modelo multinível, com significância de 5%. Na análise multinível foram utilizados 3 modelos: no 1º foi utilizado o intercepto. No modelo 2 foram introduzidas as variáveis individuais e no modelo 3 as contextuais, com o objetivo de explicar as variabilidades da má oclusão. Artigo 1: Foram analisadas de 1 a 250 crianças/cidade em 172 cidades do Brasil, totalizando 7.328 crianças aos 12 anos de idade. Verificou-se que a prevalência de má oclusão severa e muito severa não apresentou associação estatística entre as regiões brasileiras. No modelo um observou-se que a variação da má oclusão entre as cidades foi significativa (p<0,001). O modelo 2 mostrou que as crianças do sexo masculino (p=0,033), de menor renda (p=0,051), que consultaram o dentista (p=0,009), com menor satisfação com a boca e os dentes (p<0,001) e com vergonha de sorrir (p<0,001) apresentaram maior gravidade de má oclusão. No modelo 3, as variáveis do segundo nível (cidades) foram incluídas, evidenciando que as características das cidades influenciaram a gravidade da má oclusão. As cidades com um maior percentual de famílias com benefício social por 1000 habitantes, com menores notas do IDSUS e menor PIB percapita foram estatisticamente associadas com a má oclusão. Artigo 2: Foram analisados de 1 a 402 adolescentes/cidade em 174 cidades do Brasil, totalizando 5.445 adolescentes na faixa etária de 15 a 19 anos. Verificou-se que a prevalência de má oclusão severa e muito severa não apresentou associação estatística entre as regiões brasileiras. No modelo 1, a variação da má oclusão entre as cidades foi estatisticamente significante (p=0,008), com baixo coeficiente de variação (1,3%). No modelo 2, os adolescentes que apresentaram maior gravidade da má oclusão tinham menor renda (p=0,010), já haviam consultado um dentista (p=0,003), tinham menor satisfação com a boca e com os dentes (p<0,001), dificuldade em falar (p=0,036) e vergonha ao sorrir (p<0,001). No modelo 3, as variáveis do segundo nível (cidades) foram incluídas. Verificou-se que a má oclusão mais severa foi observada nas cidades com mais famílias e benefício social por 1000 habitantes (p=0,001) e menor PIB percapita (p=0,016). Conclui-se que a má oclusão apresentou uma associação significativa com as variáveis individuais e contextuais.This study is composed of two papers that aimed to evaluate the association between the prevalence and severity of malocclusion in 12-year-old children and Brazilian adolescents aged 15-19 years, with individual and contextual variables. This is a cross-sectional study in which were used data of national epidemiological survey of oral health, SB Brazil 2010. The outcome was malocclusion, measured by the Dental Aesthetic Index (DAI), classified as absent; defined, severe and very severe. The independent variables were classified into individual (demographic, oral health diseases, socioeconomic, educational, morbidity and utilization of dental services, self-perception and impact on health) and contextual (Human Development Index-IDH; Performance Index of the Health System-IDSUS; Bolsa Familia, GDP per capita; fluoridated water). Data were analyzed using the chi-square test and the multilevel model in SAS software (2008) with a significance level of 5%. In the multilevel model three models was used: The intercept was used in Model 1. In model 2, individual variables were introduced and contextual variables in model 3 were used in order to explain the variability of malocclusion. Article 1: A total of 1 to 250 children / the city in 172 cities in Brazil totaling 7,328 children aged 12 years. It was observed no statistical association between the Brazilian region related to prevalence of severe and very severe malocclusion. In the first model, the variation of malocclusion between the cities was significant (p<0.001). The second model showed that the children who presented a higher gravity of malocclusion were male (p=0.033), lower income (p=0.051), reported consulation (p=0.009), affirmed less satisfaction with the mouth and teeth (p<0.001) and being ashamed of smiling (p<0.001). In the third model, the variables of the second level (cities) were included, showing that the characteristics of cities influenced the gravity of malocclusion. Cities with more families with social benefit per 1000 inhabitants, with lower notes of the IDSUS and lower GDP per capita were significantly associated with malocclusion. Article 2: Were evaluated from 1 to 402 adolescents/city in 174 cities in Brazil, totaling 5,445 adolescents aged 15-19 years old. It was observed no statistical association between the Brazilian region related to prevalence of severe and very severe malocclusion. In model 1, the variation of malocclusion between the cities was statistically significant (p=0.008), with low coefficient of variation (3%). In model 2, the adolescents who showed a high severity of malocclusion had lower income (p=0.010), consultation (p=0.003), less satisfaction with mouth and teeth (p<0.001), difficulty to speak (p=0.036) and ashamed to smile (p<0.001). In model 3, the variables of the second level (cities) have been included and it was observed that higher severity of malocclusion was identified in cities with more families with social benefit per 1000 population (p=0.001) and lower GDP per capita (p=0.016). It is concluded that malocclusion showed a significant association with the individual and contextual variables