Psychometric Properties of the Brazilian Version of GOHAI among Community-Dwelling Elderly People

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Dentifrício fluoretado, vigilância sanitária e o SUS: o caso de Manaus-AM

OBJETIVO: Determinar o potencial anticárie dos dentifrícios distribuídos pelas unidades básicas de saúde (UBS) de Manaus-AM. MÉTODOS: Noventa e nove bisnagas de dentifrícios de quatro marcas comerciais foram coletadas de 7 de outubro de 2019 a 11 de outubro de 2019 em 16 UBS, que foram codificados por marca e UBS de origem. De acordo com a embalagem, os dentifrícios das quatro marcas e seus lotes foram formulados com monofluorfosfato de sódio (Na2FPO3) e a maioria (91%) tinha carbonato de cálcio (CaCO3) como abrasivo. Foram determinadas as concentrações de fluoreto total (FT = FST + Fins) e de fluoreto solúvel total (FST = íons F- ou FPO32-), para certificar se atendiam à Resolução ANVISA RDC Nº530 (máximo de 1.500 ppm de FT) e se tinham potencial anticárie (mínimo de 1.000 ppm de FST). As análises foram feitas com eletrodo íon específico. RESULTADOS: As concentrações (ppm F) de FT [média; desvio padrão (DP); n] encontradas nos dentifrícios A (1.502,3; DP = 45,6; n = 33), B (1.135,5; DP = 52,7; n = 48) e D (936,8; DP = 20,5; n = 8) foram próximas ao descrito na embalagem, 1.500, 1.100 e 1.000 ppm F, respectivamente. No dentifrício C, foi encontrada média de 274,1 ppm (DP = 219,7; n = 10) de FT, divergindo da concentração declarada de 1.500 ppm F. Em acréscimo, as cinco bisnagas do lote no 11681118 do dentifrício C não foram fluoretadas. Quanto ao FST, à exceção do dentifrício D (937,9; DP = 40,29), os demais apresentaram concentração inferior ao seu respectivo FT. CONCLUSÃO: Observou-se problemas graves de quantidade e qualidade do fluoreto nos dentifrícios distribuídos pelo SUS em Manaus, mostrando a necessidade de vigilância desses produtos e ratificando a urgência da revisão da resolução ANVISA RDC Nº 530.OBJECTIVE: To determine the anticaries potential of toothpastes distributed by the primary health care public clinics (UBS) of Manaus, AM. Methods: Ninety-nine tubes of toothpaste from four commercial brands were collected from October 7, 2019 to October 11, 2019 in 16 UBS. They were assigned a code by brand and source UBS. According to the information on the packaging, the four brands and their batches were formulated with sodium monofluorophosphate (Na2FPO3) and most (91%) had calcium carbonate (CaCO3) as an abrasive. We determined the concentrations of total fluoride (TF = TSF + InsF) and total soluble fluoride (TSF = F ions- or FPO32-), to certify whether they were in compliance with Resolution ANVISA RDC No. 530 (maximum of 1,500 ppm TF) and whether they had anticaries potential (minimum of 1,000 ppm TSF). The analyses were performed with a ion- specific electrode. RESULTS: The concentrations (ppm F) of TF [mean; standard deviation (SD); n] found in toothpaste brands A (1,502.3; SD = 45.6; n = 33), B (1,135.5; SD = 52.7; n = 48) and D (936.8; SD = 20.5; N = 8) were close to those stated on the package, 1,500, 1,100 and 1,000 ppm F, respectively. In toothpaste C, we found a mean of 274.1 ppm (SD = 219.7; n = 10) of TF, which diverges from the declared concentration of 1,500 ppm F. In addition, the five tubes of lot no. 11681118 of toothpaste C did not contain fluoride. Regarding TSF, with the exception of toothpaste D (937.9; SD = 40.29), the others had a lower concentration than their respective TF. CONCLUSION: We found serious problems of quantity and quality of fluoride in toothpaste distributed by the SUS in Manaus, which shows the need for surveillance of these products and confirms the urgency of revising Resolution RDC No. 530

A fluoretação das águas de abastecimento público: uma análise a partir do princípio da equidade

Introduction: Public water supply fluoridation represents an important public health measure for preventing dental caries, and should be monitored for the fluoride content in an ideal dose, as well as in relation to its population reach with a view to reducing inequalities and providing benefits in oral health. Objective: The study evaluated the equity in the distribution of fluoridated water in the city of Manaus, AM, through therelationship between fluoride levels in the water supply of the neighborhoods that compose the city’s health districts and contextual indicators of municipal development. Method: Cross-sectional ecological study that was performed from 2016 to 2018. Water samples were collected monthly from each health district, whose fluoride concentrations were determined using a specific electrode. Municipal Human Development Index (MHDI), infant mortality, number of children out of school and life expectancy represented the municipality’s contextual indicators, obtained from the Human Development Atlas in Brazil. Data were submitted to a descriptive analysis, bivariate statistics and spatial analysis. Results: A large variation in fluoride levels was found in the analyzed samples, of which 50.02% showed inadequate fluoride concentrations and the highest concentrations predominated in the samples collected in the second half of the year. The spatial distribution indicated that the neighborhoods with the best MHDI values, infant mortality, number of children out of school and life expectancy had a better concentration of fluoride in the water supply. Conclusions: The lack of equity in the distribution of fluoridated water is evident, suggesting that access to fluoridated  water reflects the social inequalities present in the city itself.Introdução: A fluoretação das águas de abastecimento público representa uma importante medida de saúde pública para prevenção da cárie dentária, devendo ser monitorada quanto ao teor de fluoreto em dose ideal, bem como em relação ao seu alcance populacional na perspectiva de reduzir as desigualdades e proporcionar benefícios em saúde bucal. Objetivo: O estudo avaliou a equidade na distribuição de água fluoretada na cidade de Manaus/AM, por meio da relação entre indicadores contextuais de desenvolvimento municipal e os teores de fluoreto na água de abastecimento dos bairros que compõem os distritos sanitários da cidade. Método: Realizou-se estudo ecológico transversal no período de 2016 a 2018. Amostras de água foram coletadas mensalmente de cada distrito sanitário, cujas concentrações de fluoreto foram determinadas utilizando-se um eletrodo específico. Índice de Desenvolvimento Humano Municipal (IDHM), mortalidade Infantil, número de crianças fora da escola e expectativa de vida representaram os indicadores contextuais do município, obtidos a partir do Atlas do Desenvolvimento Humano no Brasil. Os dados foram submetidos a uma análise descritiva, estatística bivariada e análise espacial. Resultados: Observou-se grande variação nos teores de fluoreto das amostras, das quais 50,02% apresentaram concentrações de fluoreto inadequadas e as maiores concentrações predominaram nas amostras coletadas no segundo semestre do ano. A distribuição espacial indicou que os bairros com melhores valores de IDHM,  mortalidade infantil, número de crianças fora da escola e expectativa de vida apresentaram melhor concentração de fluoreto na água de abastecimento. Conclusões: Evidenciou-se a ausência de equidade na distribuição de água fluoretada, sugerindo que o acesso à água fluoretada reflete as desigualdades sociais presentes na própria cidade

Fluoride Concentration in Public Water Supply in a City in the Amazon Region

Objective: To analyze the fluoride concentration in the public water supply in Manaus, Brazil. Material and Methods: Water samples were collected in 50 mL polyethylene bottles, identified, and labeled. The collection was performed from September 2016 to August 2018. For the selection of collection points, all neighborhoods of the city of Manaus, divided into four health districts (North, South, East, and West), were mapped. From each district, 30 samples were collected, totaling 120 monthly samples. Water samples were analyzed using an ion analyzer, ORION 720-A, and a specific electrode, ORION 96-09. The ion analyzer and electrode were calibrated in standard solutions. The levels were classified in intervals based on technical consensus to guide the health surveillance agencies. Results: Of the 2,874 water samples, 50.3% were within the recommended range, and 49.7% were inadequate, with 31.6% considered above the parameters and 18.1% below. Among the districts, the North had the highest percentages of unsatisfactory samples, resulting in limited action to prevent tooth decay. During the 24 months of analysis, there were large oscillations in the values in all four districts of Manaus. Conclusion: Results reinforce the importance of heterocontrol for the city to guarantee the effectiveness of this public health measure

The role of dental pain and psychosocial factors on the relationship between dental caries and oral health‑related quality of life in children

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The influence of change on sense of coherence on dental services use among adolescents: a two‑year prospective follow‑up study

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Socio-economic status, psychosocial factors, health behaviours and incidence of dental caries in 12-year-old children living in deprived communities in Manaus, Brazil

Objectives This study examines the relationships between socio-economic status, psychosocial factors, health-related behaviours and the incidence of dental caries amongst 12-year-old schoolchildren living in deprived communities in Manaus, Brazil. Methods A longitudinal study involving 312 children aged 12 years was conducted in the city of Manaus, Brazil. Baseline data including socio-economic status (number of goods, household overcrowding, parents’ schooling, family income), psychosocial factors (sense of coherence [SOC-13], social support [Social Support Appraisals questionnaire]) and health-related behaviours (frequency of toothbrushing, sugar consumption, sedentary behaviour) were collected through structured questionnaires. The number of decayed teeth was clinically assessed at baseline and one-year follow-up. A hypothesised model evaluating the direct and indirect pathways between the variables was tested using confirmatory factor analysis and structural equation modelling. Results The incidence of dental caries at the one-year follow-up was 25.6%. Sugar consumption (β = 0.103) and sedentary behaviour (β = 0.102) directly predicted the incidence of dental caries. A higher socio-economic status was directly linked with lower sugar consumption (β = -0.243) and higher sedentary behaviour (β = 0.227). Higher social support directly predicted lower sugar consumption (β = -0.114). Lower socio-economic status (β = -0.046) and lower social support (β = -0.026) indirectly predicted the incidence of dental caries via sugar consumption and sedentary behaviour. Conclusions In the population studied, sugar consumption and sedentary behaviour are meaningful predictors of the incidence of dental caries amongst schoolchildren living in deprived communities. Indirect pathways of lower socio-economic status and low social support with dental caries incidence via sugar consumption and sedentary behaviour were detected. These findings should be considered in oral interventions and oral health care policies to prevent dental caries amongst children living in deprivation. Clinical significance Social conditions, social support, sedentary behaviour and sugar consumption directly influence dental caries in children.acceptedVersionPaid open accessUNIT agreemen

Implementation of services of oral health care: a case study in Manaus-AM, Brazil

Made available in DSpace on 2011-05-04T12:42:06Z (GMT). No. of bitstreams: 0 Previous issue date: 2010Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sergio Arouca. Rio de Janeiro, RJ, Brasil.Por meio do presente estudo, objetivou-se analisar a implantação do serviço de atenção à saúde bucal no município de Manaus. Para tanto, procedeu-se a uma pesquisa avaliativa do tipo análise de implantação abordando os determinantes contextuais do grau de implantação do serviço de atenção à saúde bucal, incorporando a avaliação normativa nas dimensões estrutura e processo. A estratégia utilizada foi o estudo de caso único, em que os materiais foram coletados de fontes primárias, por meio de questionário estruturado e entrevista com roteiro semiestruturado (sujeitos da gestão municipal e unidades de saúde), de observação da rotina dos diferentes tipos de Estabelecimentos Assistenciais de Saúde (EAS) e de fontes secundárias. Foram definidas 59 EAS, com base na proporção de unidades instaladas em cada distrito de saúde, e foram realizadas 106 entrevistas. Os indicadores utilizados para medir o grau de implantação em relação à estrutura foram: instalação física, equipamentos odontológicos, manutenção dos equipamentos odontológicos, instrumentais permanentes, materiais de consumo, materiais educativos e recursos humanos, pontuados com escore 0 ou 1. A pontuação recebida entre o observado e o esperado foi dividida, obtendo-se uma pontuação por indicador, por unidade de saúde, até chegar-se a um valor global. A classificação proposta foi a de quartis , em que o grau de implantação foi considerado satisfatório com valores acima de 75 por cento; aceitável, entre 50 por cento e 75 por cento; regular, entre 25 por cento e 49 por cento; e crítico, abaixo de 25 por cento. O grau de implantação do serviço de atenção à saúde bucal, em relação à dimensão estrutura (dados primários) foi considerado regular, alcançando um valor de 41,18 por cento. Os resultados gerados a partir da coleta dos dados secundários para compor as dimensões estrutura e processo, foram analisados de acordo com os parâmetros vigentes do MS e com as pactuações do município, não recebendo uma classificação quantitativa. Pelos dados observados, pode-se sugerir que os instrumentos de gestão existem para cumprir uma exigência legal e não para o exercício de uma adequada gerência do serviço de saúde bucal, assim como os indicadores do pacto de 2005 a 2007 e as ações de saúde bucal informadas no SIAB e SIA-SUS em relação aos procedimentos da atenção básica e especializada, mostraram estar aquém do que foi pactuado e da real necessidade da população manauara. O contexto organizacional local apresentou relação com o grau de implantação do serviço de atenção à saúde bucal, tendo como consequência a efetivação de práticas do modelo hegemônico, não condizentes com a política atual de saúde bucal.The present study aimed to analyze the implementation of an oral health service in the municipality of Manaus. An evaluation research was carried, in the form of implementation analysis, involving contextual determiners of the rate of implementation of the oral health service, incorporating normative analysis of the dimensions “structure” and “process”. The strategy used was the single-case study, where the materials were collected from primary sources through a structured questionnaire and interview with semi-structured script (with subjects from the municipality management and health units), from routine observation of the different types of Assistance Health Establishments (EAS) and secondary sources. Fifty-nine EAS were defined based on the ratio of installed unit in each health district, and 106 interviews were carried on. The indicators used to measure the rate of implementation related to structure were: physical installation, dental equipments, maintenance of dental equipments, permanent instruments, consumer goods, educational materials and human resources, scored 0 or 1. The scores received between what was observed and what was expected was divided, thus obtaining one grade per indicator per health unit, until a global score was reached. The classification proposed was of “quartiles”, where the grade of implementation with values above 75% were considered satisfactory, between 50% and 75% were considered acceptable, between 25% and 49%, regular, and lower than 25%, critical. The rate of implementation of oral health service compared to the dimension “structure” (primary data) was considered regular, reaching 41.18%. The results obtained from secondary data collection to compose the dimensions “structure” and “process”, analyzed according to the parameters proposed by the Health Ministry and obliged by the municipality did not receive a quantitative score. By the data observed it can be suggested that management instruments exist in order to comply a legal exigency and not for the exercise an adequate management of the oral health service, similarly to the indicators of the 2005 and 2007 pacts and oral health actions informed at SIAB and SIA-SUS regarding procedures of basic and specialized attention, which proved to be short of those complied and the real needs of the population of Manaus. The local organizational context presented relationship to the rate of implementation of oral health services, with effectuation of practices from the hegemonic model as consequence, which are not in accordance to the present policy of oral health

Dental caries and gingivitis among 15 to 19 year-old students in Manaus, AM, Brazil

In the light of the scarcity of epidemiological studies on the oral health of the general population within the context of the Amazon region, this study aimed to estimate the prevalence of dental caries and gingivitis, as well as to evaluate the need for restorative treatment, among school students aged 15 to 19 years in the city of Manaus, AM, Brazil. A cross-sectional study was carried out on a sample of 889 students from within city limits who were enrolled in 26 public and private schools. Dental examinations were performed to obtain the DMFT index (decayed, missing and filled teeth) as well as to determine the treatments needed. The gingival index (Lõe & Silness) was used to classify gingivitis. The intra-examiner diagnostic concordance was 94% and the Kappa statistic was 0.91. The DMFT index found was 4.65 (± 0.12), without significant difference between the sexes or skin color groups. The prevalence of dental caries was 87.4%. Restoration of a dental surface was the greatest need (59.3%). Slight gingival inflammation was present in 78.5% and gingival bleeding following probing occurred in 53.3%. Although the DMFT index was lower than that observed for the northern region of Brazil, restorative dental services are lacking for this population. Additional studies are suggested to better understand the differences found