Social capital and oral health

Orientador: Antonio Carlos PereiraTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de PiracicabaResumo: Nos últimos tempos, tem aumentado o interesse pela importância do capital social e a sua influência nos comportamentos e práticas de saúde dos individuos. Contudo, na odontologia, o tema ainda precisa ser melhor explorado. Dessa forma, o objetivo dessa tese foi avaliar a influência do capital social com os desfechos em saúde bucal através de três estudos. O primeiro estudo, trata de um trabalho teórico no qual se discutem os vários conceitos e dimensões do capital social e a relação com a saúde geral e bucal. O segundo estudo, trata de um artigo de revisão sistemática e metanálise, registrado no PROSPERO (CRD42016036639), que teve o objetivo de investigar o capital social e a sua influência na saúde bucal na população de 0 a 65 anos ou mais de idade. Uma pesquisa eletrônica de 12 bases de dados foi realizada: PubMed, Scopus, Web of Knowledge, Cochrane Library, Lilacs, Embase, SciELO, Joanna Briggs, Campbell collaboration, Cinahl, SIBI/USP e Grey Literature, sem restrições de idioma, publicação ou idade. O pacote meta implementado no programa R 3.4.1 foi utilizado para análise de dados. Os resultados foram expressos como odds ratios com intervalos de confiança de 95%. O modelo de efeito aleatório foi escolhido e a heterogeneidade foi avaliada usando o teste I². Um total de 2.910 artigos foram inicialmente recuperados. Foram excluídos 567 duplicatas e 2185 artigos com base no título e resumos. 128 artigos eliminados após a análise de texto completo e somente 2 estudos foram adicionados após leitura manual das referências. 32 estudos que incluíram uma população de 291.184 de crianças, adolescentes, adultos e idosos foram adicionados na revisão sistemática e, desses, vinte estudos foram selecionados na metanálise. Concluiu-se que o capital social individual teve um impacto positivo na saúde bucal (OR = 1,45 (IC-95%: 1,12 ¿ 1,88) em estudos longitudinais. O terceiro estudo, refere-se a um artigo no qual utilizou-se a análise de correspondência múltipla para explorar e ilustrar as relações conjuntas entre o capital social e a saúde bucal dos adolescentes, adultos e idosos do Levantamento Estadual do Estado de São Paulo ¿ SB São Paulo. Um total de 16.696 indivíduos foram examinados em 163 municípios do estado de São Paulo para as três faixas etárias - 15-19 anos (5440 indivíduos), 35-44 (5970 indivíduos) e 65 anos e mais (5386 indivíduos). As variáveis investigadas neste estudo foram: capital social mensurado em alto, moderado e baixo; sociodemográficos (idade, sexo, cor de pele, renda familiar); escolaridade e uso de serviços (escolaridade, visita ao dentista no último ano, tipo do serviço odontológico, motivo da última consulta); autopercepção e impacto em saúde bucal (relação com os dentes/boca, OIDP - Impacto Odontológico no desempenho diário) e variáveis clínicas (cárie dentária, dor de dente, má-oclusão, alterações periodontais, perdas dentárias). Na análise estatística utilizou-se a Análise de Correspondência Múltipla. Os resultados mostraram que o alto capital social teve desfechos similares para os três grupos etários estudados. Diferenciando-se entre eles em relação ao sexo (feminino) e ao número de dentes remanescentes, ambos no grupo dos idosos. Pode-se concluir, que os indivíduos, independentemente da sua idade, relacionados com o alto capital social, apresentaram melhores condições de saúde bucalAbstract: In recent times, interest in the importance of social capital and its influence on individuals' behavior and health practices has increased. However, in dentistry, the theme still needs to be explored better. Thus, the objective of this evaluation was the influence of social capital with the outcomes in oral health through the three studies. The first study, is a theoretical work that does not discuss the various concepts and dimensions of social capital and a relationship with general and oral health. The main study is a systematic review and meta-analysis paper, registered in PROSPERO (CRD42016036639), which aimed to investigate the social capital and its influence on oral health in the population aged 0-65 years or over. An electronic search of 12 databases was performed: PubMed, Scorpus, Web of Knowledge, Cochrane Library, Lilacs, Embase, SciELO, Joanna Briggs, Campbell collaboration, Cinahl, SIBI / USP and Gray Literature, without language, publication or age. The meta package implemented without program R 3.4.1 was used for data analysis. Results were expressed as odds ratios with 95% confidence intervals. The random effect model was chosen and a heterogeneity was assessed using the I² test. A total of 2,910 articles were initially recovered. We excluded 567 duplicates and 2185 articles based on the title and abstracts. 128 articles deleted after a full text analysis and two studies were added to the references manual. 32 studies that included a population of 291,184 children, adolescents, adults, and the elderly were added to the systematic review, industries, productions, and selected studies in the meta-analysis. It was concluded that individual social capital had a positive impact on oral health (OR = 1.45 (CI-95%: 1.12 - 1.88) in longitudinal studies.The third study was carried out in an article in which multiple correspondence analysis was used to explore and illustrate the joint relationships between social capital and oral health among adolescents, adults and the elderly of the State Survey of the State of São Paulo Paulo. A total of 16,696 individuals were examined in 163 municipalities in the state of São Paulo for the three age groups - 15-19 years (5440 individuals), 35-44 (5970 individuals) and 65 years and over (5386 individuals). The variables investigated in this study were: social capital measured in high, moderate and low; socio-demographic variables (age, gender, skin color, family income); schooling and use of services (schooling, visit to the dentist in the last year, type of dental service, reason for the last visit); (dental caries, toothache, malocclusion, periodontal changes, tooth loss). The results of the present study were similar to those of the present study. In the statistical analysis, the Multiple Correspondence Analysis was used. The results showed that the high social capital had similar outcomes for the three age groups studied. Differentiating between them in relation to the sex (female) and the number of remaining teeth, both in the elderly group. It can be concluded that individuals, independent of their age, related to high social capital presented better oral health conditionsDoutoradoSaude ColetivaDoutora em Odontologi

Periapical Status and Quality of Root Canal Obturation in Elderly Population: A Systematic Review

The aim of this study was to investigate the relationship between root fillings and the presence of apical periodontitis in studies with samples containing elderly patients. The data were obtained by means of a systematic review of studies that evaluated the quality of root fillings and their relationship with periapical health. 1,376 potentially relevant articles were selected, of which 667 were repeated and 16 were duplicates. 693 abstracts were analyzed, with 608 of these being excluded and 85 selected for reading in full. Fourteen (14) articles were included, totaling data of 135,566 teeth. Of these, 13,704 (10.1%) had endodontic fillings, with 6,455 (47.1%) being considered adequate and 7,249 (52.9%) inadequate. Among the teeth with apical periodontitis, 2,084 (32.3%) had adequate endodontic fillings and 3,749 (51.6%) had inadequate fillings. There was a significant correlation between the quality of endodontic fillings considered adequate and lower frequency of apical periodontitis in elderly patients

Aspectos individuais e contextuais associados a cárie em adolescentes brasileiros : dados nacionais

Este estudo é composto por um artigo, cujo objetivo principal foi avaliar a associação entre a prevalência e gravidade da cárie em 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 Cárie, mensurada pelo CPO-D (dentes cariados, perdidos e obturados). 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 cárie. Artigo 1: Foram analisadas de 1 a 250 crianças/cidade em 172 cidades do Brasil, totalizando 5.445 adolescentes foram avaliados em 176 cidades do Brasil na faixa etária de 15 a 19 anos. No modelo 1 observamos que a média do CPOD nas cidades da amostra foi de 5,23 com erro padrão de 0,18. Observa-se ainda que a variação do CPOD entre as cidades é significativa (p<0,0001), porém a variação entre os voluntários dentro das cidades é cerca de 4 vezes maior do que a variação entre as cidades. Pelo coeficiente de correlação intraclasse pode-se afirmar que a variação entre as cidades representa aproximadamente 18% da variação total. No Modelo 2, quando incluímos as variáveis do nível individual, observa-se que apresentam maior CPOD os indivíduos que necessitam de prótese (p<0,0001), com maiores escores de CPI (p<0,0001), com maior percepção de necessidade de tratamento (p=0,0002), que apresentam dor de dente (p=0,0014), com maior gravidade da dor (p=0,0288), que consultaram CD (p=0,0063), com menor frequência de consultas (p<0,0001), que consultaram para tratamento (p<0,0001), com maior insatisfação (p=0,0003), maior percepção de necessidade de prótese (p=0,0015) e que responderam que vi sua condição bucal atrapalhava o sono (p=0,0059). No modelo 3, as variáveis do segundo nível (cidades) foram incluídas para avaliar a influência das mesmas na explicação da variabilidade do CPOD. Observa-se que nenhuma variável relativa às cidades influencia no CPOD (p>0,05), sendo que permaneceram significativas as variáveis necessidade de prótese (p<0,0001), de CPI máximo (p<0,0001), percepção de necessidade de tratamento (p=0,0002), dor de dente (p=0,0010), gravidade da dor (p=0,0170), consulta ao CD (p=0,0051), frequência de consulta (p<0,0001), satisfação (p=0,0006), percepção da necessidade de prótese (p=0,0018) e que relataram que a condição de saúde bucal atrapalhava o sono (p=0,0057). Conclui-se que as variáveis individuais influenciam a prevalência da cárie dentária em adolescentes, fornecendo parâmetros para as ações diretas de planejamento de políticas em saúde bucal.This study consists of an article whose main objective was to evaluate the association between the prevalence and severity of dental caries in Brazilian adolescents aged 15-19 years with individual and contextual variables. It is a cross-sectional study used data from the national epidemiological survey of oral health, SB Brazil 2010. The outcome studied was the decay, measured by DMFT (decayed, missing and filled). The independent variables were classified into individual (demographic, oral health diseases will, socioeconomic, educational, morbidity and utilization of dental services, health perception and impact) and contextual (Human Development Index-HDI Index Performance Evaluation System Health-IDSUS, Bolsa Família, GDP per capita, fluoridated water). The data were analyzed with SAS software (2008) by chi-square and multilevel model, with 5% significance. In the multilevel analysis were used 3 models: 1 was used in the intercept. In model 2 were introduced individual variables and the contextual model 3, in order to explain the variability of dental carie. Article 1: We analyzed 1-250 children / city in 172 cities in Brazil, totaling 5,445 adolescents were evaluated in 176 cities of Brazil in the age group 15-19 years. In model 1 we observe that the mean DMFT in the cities of the sample was 5.23 with a standard error of 0.18. It was also observed that the variation of DMF is between cities significantly (p <0.0001) but the variation between the subjects in the cities is around 4 times larger than the variation between cities. By intraclass correlation coefficient can be argued that the variation between cities represents approximately 18% of the total variation. In Model 2, when we include the variables at the individual level, it is observed that a higher DMFT individuals who need prosthesis (p<0.0001), with higher scores CPI (p<0.0001), with greater perceived need of treatment (p=0.0002), which have a toothache (p=0.0014), with greater pain severity (p=0.0288), who consulted CD (p=0.0063), with lower frequency of visits (p<0.0001), who consulted for treatment (p<0.0001), with greater dissatisfaction (p=0.0003), greater perceived need for prostheses (p=0.0015) and responded your oral condition interfered sleep (p=0.0059). In model 3, the variables of the second level (cities) were included to assess the influence of the same in explaining the variability of the DMTF. It is observed that viii no variable influence on the cities in DMFT (p>0.05), and remained significant variables need of prostheses (p<0.0001), CPI max (p<0.0001), perceived need of treatment (p = 0.0002), toothache (p=0.0010), pain severity (p=0.0170), refers to the CD (p=0.0051), frequency of consultation (p<0.0001), satisfaction (p=0.0006), perceived need for prosthesis (p=0.0018) and reported that the oral health condition interfered with sleep (p=0.0057). We conclude that the individual variables influence the prevalence of dental caries in adolescents, providing parameters for the direct actions of policy planning in oral health

National reseach about caries in brasilian children and adults : association factors

Orientador: Luciane Miranda GuerraDissertação (mestrado profissional) - Universidade Estadual de Campinas, Faculdade de Odontologia de PiracicabaResumo: Este estudo é disposto em dois capítulos e seu objetivo principal foi avaliar a associação entre a experiência da cárie com variáveis individuais e contextuais em crianças de 5 anos e adultos de 35 a 44 anos de idade. Trata-se de um estudo transversal com dados da Pesquisa Nacional de Saúde Bucal - SBBrasil 2010. O desfecho estudado foi a experiência da cárie (dicotomizada em ausência/presença), mensurada pelos índices ceod (dentes decíduos cariados, perdidos e obturados) e CPOD (dentes permanentes cariados, perdidos e obturados). As variáveis independentes foram classificadas em individuais e contextuais. Os dados foram analisados pelos testes qui-quadrado e modelo multinível, com significância de 5%. Capitulo 1: No nível individual, na análise bivariada, observou-se que apresentaram maior ceod os indivíduos do sexo masculino (p=0,0002), com necessidade de tratamento odontológico (p<0,0001), com maior número de pessoas residentes no domicilio (p<0,0001), com menor número de dormitórios na residência (p=0,0204), com menor número de bens (p=0,0059) e menor renda familiar (p=0,0015) e, quando incluídas as contextuais, apenas os indivíduos que pertenciam ao maior Grupo homogêneo foi significativo. No modelo multinivel, permaneceram significativas, as variáveis sexo (p=0,0005), oclusão (p=0,0437), necessidade de tratamento odontológico (p<0,0001), número de pessoas residentes no domicilio (p<0,0001), número de dormitório na residência (p=0,0152), número de bens (0,0147) e renda familiar (p=0,0044). Capitulo 2: Observou-se que apresentaram maior índice CPOD as variáveis individuais do sexo feminino (p<0,0001), com maiores escores do Índice Periodontal Comunitário - CPI (p=0,0045), com menor número de dormitórios na residência (p=0,0398), menor número de bens (p<0,001), com maior percepção de necessidade de tratamento odontológico (p=0,0046), que apresentou dor de dente nos últimos 6 meses (p=0,0014), com maior gravidade da dor de dente (p=0,0288), que nunca consultou o dentista (p=0,0139), com menor frequência de consulta (p<0,0001), que consultou o dentista para tratamento odontológico (p<0,0001), com maior insatisfação com os dentes/boca (p<0,0001), maior percepção de necessidade de prótese (p<0,0001), responderam que devido aos seus dentes deixaram de sair e se divertir (lazer) (p=0,0440), que responderam que sente vergonha ao sorrir (p<0,0001). As variáveis contextuais foram incluídas a fim de se avaliar a influência das mesmas na explicação da variabilidade do CPOD. Observou-se que apresentam maior CPOD os adultos das cidades com menor número de bolsa família (p=0,0002) e de menor acesso e qualidade dos serviços (p=0,0117). No nível individual, foram significativas as variáveis sexo (p<0,0001), CPI (p=0,0080), número de dormitórios na residência (p=0,0221), número de bens na residência (p=0,0004), anos de estudo (p=0,0215), percepção da necessidade de tratamento odontológico (p=0,0059), consulta ao dentista (p=0,0149), frequência de consulta (p<0,0001), motivo da consulta ao dentista (p<0,0001), satisfação com dentes/boca (p<0,0001), percepção da necessidade de prótese (p<0,0001) e vergonha ao sorrir (p<0,0001). Conclusão: Variáveis individuais e contextuais em crianças e adultos foram estatisticamente significantes à experiência da cárie, sugerindo-se que estes dados sejam analisados sob a perspectiva de planejamento em saúde, buscando-se ações intersetoriais que reflitam em melhor qualidade de vidaAbstract: This study is arranged in two chapters and its main objective was to evaluate the association between the presence/absence of dental caries experience with individual and contextual variables in children 5 years and adults aged 35 to 44 years old. This is a cross-sectional study with data from the National Survey of Oral Health - SBBrasil 2010. The outcome studied was the experience of caries, measured by dmft (deciduous teeth decayed, missing and filled) and DMFT (decayed permanent teeth, missing and filled) indices. The independent variables were classified into individual and contextual. Data were analyzed by chi- square test and multilevel model, with 5% significance. Chapter 1: It was observed that the average dfmt cities in the sample were 2.93. It is noted that the range of between cities dfmt was significant (p<0.0001). At the individual level, in the bivariate analysis, it was observed that individuals had higher dmft males (p=0.0002), in need of dental treatment (p<0.0001), with the largest number of people living in a household (p<0.0001), with fewer bedrooms in the residence (p=0.0204), with fewer assets (p=0.0059) and lower family income (p=0.0015) and when including contextual, only individuals who belonged to the largest homogeneous group was significant. In the multivariate model remained significant, the variables gender (p=0.0005), occlusion (p=0.0437), need for dental treatment (p<0.0001), number of people living in a household (p<0.0001), the number of dormitory residence (p=0.0152), number of goods (p=0.0147) and family income (p=0.0044). Chapter 2: It was observed that the mean DMFT in the cities of the sample was 17.49. The variation in DMFT between cities was significant (p<0.0001). When individual variables were included, it was noted that had higher DMFT the females (p<0.0001), with higher scores the Community Periodontal Index - CPI (p=0.0045), with fewer bedrooms the residence (p=0.0398), fewer goods (p<0.0001), with greater perceived need for dental treatment (p=0.0046), which had toothache in the last 6 months (p=0,0014), more severe tooth pain (p=0.0288), who never consulted the dentist (p=0.0139), with lower polling frequency (p<0.0001), which consulted the dentist for treatment dental (p<0.0001), with greater dissatisfaction with teeth/mouth (p<0.0001), greater perceived need for prosthesis (p<0.0001), responded that due to their teeth and if left out fun (recreation) (p=0.0440), who responded that he feels ashamed to smile (p<0.0001). The contextual variables were included in order to evaluate the influence of the same in explaining the variability of the DMTF. Observed with higher DMFT cities with fewer family allowance (p=0.0002) and more homogeneous group (p=0.0117). At the individual level, significant variables were sex (p<0.0001), CPI (p=0.0080), number of bedrooms in the residence (p=0.0221), number of goods in the residence (p=0.0004), years of education (p=0.0215), perceived need for dental treatment (p=0.0059), dental appointments (p=0.0149), frequency of consultation (p<0.0001), reason the dental visit (p<0.0001), satisfaction with teeth/mouth (p<0.0001), perceived need for prosthesis (p<0.0001) while smiling and shame (p<0.0001). Conclusion: individual and contextual variables in children and adults were statistically significant to the experience of caries, suggesting that these data are analyzed from the perspective of health planning, seeking intersectoral actions that reflect better quality of lifeMestradoOdontologia em Saude ColetivaMestra em Odontologia em Saúde Coletiv

Impact of implementation intentions on physical activity practice in adults: A systematic review and meta-analysis of randomized clinical trials.

OBJECTIVE:The aim of this study was to verify the efficacy of using theory-based strategies on implementation intentions in promoting physical activity (PA) among adults. METHODS:This review was conducted in accordance with the PRISMA recommendations. The search was carried out in seven electronic databases (LILACS, PubMed, SciELO, Cochrane, Web of Science) and two searches of the "grey literature" were performed (Openthesis and OpenGrey). Randomized clinical trials (RCT), published up to September 2016, were considered eligible for this study. Two reviewers independently and systematically evaluated the eligibility criteria, and performed data extraction. A meta-analysis was performed for the purpose of comparing the effect between the intervention and control groups. The effect sizes were grouped in two subgroups with the purpose of more accurately verifying the effect caused by reinforcing the implementation intentions strategy, and using the inverse variance statistical method with random effects models to estimate the main effect of the implementation intention strategy on the PA behavior. Heterogeneity among the studies was evaluated by using I-square statistics, and the Jadad scale to evaluate the quality of included papers. RESULTS:The search resulted in 12,147 records, of which 13 RCTs were considered eligible for this review. Sample age ranged from 18 to 76 years, and participants had conditions such as medullary lesion, coronary disease, obesity, diabetes mellitus, sedentarism or occupational stress. When the summary of the effect was analyzed in the meta-analysis, the result found in the subgroup with reinforcement of the implementation intentions strategy was 0.25 (IC 95% = 0.05-0.45) in favor of the intervention group. This demonstrated that application of the implementation intentions strategy was capable of increasing PA practice in the participants of these studies, in comparison with others that did not use this reinforcement. CONCLUSION:The findings of this review indicated that application of the theory of implementation intentions promoted PA behavior among the adults who received reinforcement of this strategy. The systematic review protocol was registered in the PROSPERO database under the number CRD42018090482

Factors associated with the prevalence of anterior open bite among preschool children: A population-based study in Brazil

INTRODUCTION: The aim of this study was to identify factors associated with the prevalence of anterior open bite among five-year-old Brazilian children. METHODS: A cross-sectional study was undertaken using data from the National Survey of Oral Health (SB Brazil 2010). The outcome variable was anterior open bite classified as present or absent. The independent variables were classified by individual, sociodemographic and clinical factors. Data were analyzed through bivariate and multivariate analysis using SPSS statistical software (version 18.0) with a 95% level of significance. RESULTS: The prevalence of anterior open bite was 12.1%. Multivariate analysis showed that preschool children living in Southern Brazil had an increased chance of 1.8 more times of having anterior open bite (CI 95%: 1.16 - 3.02). Children identified with alterations in overjet had 14.6 times greater chances of having anterior open bite (CI 95%: 8.98 - 24.03). CONCLUSION: There was a significant association between anterior open bite and the region of Brazil where the children lived, the presence of altered overjet and the prevalence of posterior crossbite

Fatores individuais e contextuais associados à má oclusão em crianças brasileiras

Objective: 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 classifi ed as individual and contextual. Data were analyzed using a multilevel model with a 5% signifi cance 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 signifi cant (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 benefi ts per 1,000 inhabitants, with lower scores on the health care system performance index and lower gross domestic product per capita were signifi cantly associated with malocclusion. Conclusion: Signifi cant associations between the presence and severity of malocclusion were observed at the individual and contextual level473111CONSELHO NACIONAL DE DESENVOLVIMENTO CIENTÍFICO E TECNOLÓGICO - CNPQsem informaçãoOBJETIVO: 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 contextua

Did the Family Health Strategy have an impact on indicators of hospitalizations for stroke and heart failure? Longitudinal study in Brazil: 1998-2013.

INTRODUCTION:The objective was to analyze whether socioeconomic factors related to the context and those related to the model of care-specifically the coverage of primary care by the Family Health Strategy (ESF)-had an impact on hospitalizations due to heart failure (HF) and stroke, in the State of São Paulo/Brazil between 1998 and 2013. METHODS:A longitudinal ecological study involving 645 municipalities was conducted in the state of São Paulo/Brazil from 1998 to 2013, using the Hospital Information System (SIH-DataSUS database). The hospitalizations for primary care sensitive conditions: Stroke and heart failure (HF) that correspond to the International Classification of Diseases (ICD 10): I50, I63 to I67; I69, G45 to G46 were analyzed longitudinally during the period indicated regarding the percentage of people covered by the Family Health Program (PSF) adjusted for confounders (population size, gross domestic product -GDP and human development index- HDI). RESULTS:There was a significant decrease in the number of hospitalizations for heart failure and stroke per 10000 (inhabitants) in the period (p <0.0001), with a significant relationship with increased proportion of ESF (p <0.0001), and this remained significant even when possible confounders (population size, GDP and HDI) were included in the model (p <0.0001). CONCLUSIONS:GDP per capita was close to or higher than that if many European countries, which shows the relevance of the study. The health care model based on the Family Health Strategy positively impacted hospitalization indicators for heart failure and stroke, indicating that this model is effective in the prevention of primary care sensitive conditions