Accuracy of the Simplified Thylstrup & Fejerskov Index in Rural Communities with Endemic Fluorosis

The aim of the present study was to compare the values of the Thylstrup & Fejerskov Index (TF index) for the determination of the prevalence of dental fluorosis using either all teeth (gold standard) or six upper anterior teeth (simplified TF index). The sample was made up of 396 individuals aged six to 22 years from three Brazilian cities with endemic fluorosis caused by the ingestion of water with high fluoride concentration. The prevalence of dental fluorosis was evaluated by a single trained examiner with excellent intraexaminer agreement (kappa = 0.95). Intraexaminer reproducibilities were calculated at tooth level. Sensitivity, specificity, positive and negative predictive values of the simplified TF compared to gold standard were 90.6 (95%CI: 86.6 to 93.6), 100 (95%CI: 95.3 to 100), 100 (95%CI: 98.3 to 100) and 77.5 (95%CI: 69.8 to 83.5), respectively. The ROC value was 0.953 (95%CI: 0.933 to 0.973). The simplified TF index proved suitable for determining the prevalence of dental fluorosis in regions with endemic fluorosis caused by the ingestion of water with high concentrations of fluoride

Factors Associated to Endemic Dental Fluorosis in Brazilian Rural Communities

The present paper examines the relationship between hydrochemical characteristics and endemic dental fluorosis, controlling for variables with information on an individual level. An epidemiological survey was carried out in seven rural communities in two municipalities in the state of Minas Gerais, Brazil. The Thystrup & Fejerskov index was employed by a single examiner for the diagnosis of dental fluorosis. A sampling campaign of deep groundwater in the rural communities of interest was carried out concomitantly to the epidemiological survey for the determination of physiochemical parameters. Multilevel modeling of 276 individuals from seven rural communities was achieved using the non-linear logit link function. Parameters were estimated using the restricted maximum likelihood method. Analysis was carried out considering two response variables: presence (TF 1 to 9) or absence (TF = 0) of any degree of dental fluorosis; and presence (TF ≥ 5—with loss of enamel structure) or absence of severe dental fluorosis (TF ≤ 4—with no loss of enamel structure). Hydrogeological analyses revealed that dental fluorosis is influenced by the concentration of fluoride (OR = 2.59 CI95% 1.07–6.27; p = 0.073) and bicarbonate (OR = 1.02 CI95% 1.01–1.03; p = 0.060) in the water of deep wells. No other variable was associated with this prevalence (p > 0.05). More severe dental fluorosis (TF ≥ 5) was only associated with age group (p < 0.05). No other variable was associated to the severe dental fluorosis (p > 0.05). Dental fluorosis was found to be highly prevalent and severe. A chemical element besides fluoride was found to be associated (p > 0.05) to the prevalence of dental fluorosis, although this last finding should be interpreted with caution due to its p value

O acesso aos serviços públicos de saúde em área limítrofe entre municípios

Este artigo analisa o acesso aos serviços de saúde. O conceito de acessibilidade é descrito como uma característica dos serviços de saúde podendo ser abordado sob diferentes enfoques. Por isso o acesso aos serviços de saúde deve ser estabelecido em cada Unidade Básica de Saúde (UBS) com a participação efetiva, no processo, dos servidores de nível local e da comunidade. Foi empregada metodologia qualitativa, a pesquisa-ação e, para a coleta de dados, foram realizadas entrevistas e grupos focais. O trabalho foi desenvolvido junto às gerentes de duas UBS " Confisco, em Belo Horizonte, e Estrela Dalva, em Contagem " e moradores da área de abrangência das unidades. O acesso dos moradores aos serviços de saúde mostrou-se problemático por se tratar de uma área limítrofe entre dois municípios. Apesar de o trabalho ter sido desenvolvido durante dois anos, há dúvidas se ele contribuiu para a melhoria do acesso da população, em função das questões políticas que envolvem o tema. No entanto, toda a problemática detectada durante o desenvolvimento da pesquisa foi apresentada e debatida com os gestores de ambos os municípios.This study analyses access to health services. The concept of access is described as a characteristic of the health services and it may be approached in different ways. Therefore, access to health services must be determined by each Primary Care Unit with the participation of local staff and the community. The qualitative methodology was employed through action research, and data collection was conducted through interviews and focus groups. The study was conducted with the managers of two primary care units " Confisco, in Belo Horizonte, and Estrela Dalva, in Contagem -, and dwellers in the units' catchment area. The community's access to health services was difficult for it was a borderline area between two cities. Although the study lasted two years, doubts remain about whether it contributed to improve the access of the population, due to political matters involving the topic. However, all problems detected during the research were presented and debated with the administrators of both cities

Edentulism and shortened dental arch in Brazilian elderly from the National Survey of Oral Health 2003

OBJECTIVE: To describe the distribution of edentulism and estimate the prevalence of functional dentition and shortened dental arch among elderly population. METHODS: A population-based epidemiological study was carried out with a sample of 5,349 respondents aged 65 to 74 years obtained from the 2002 and 2003 Brazilian Ministry of Health/Division of Oral Health survey database. The following variables were studied: gender; macroregion of residence; missing teeth; percentage that met the World Health Organization goal for oral health in the age group 65 to 74 years (50% having at least 20 natural teeth); presence of shortened dental arch; number of posterior occluding pairs of teeth. The Chi-square test assessed the association between categorical variables. The Kruskal-Wallis and Mann-Whitney tests were used to assess differences of mean between number of posterior occluding pairs teeth, macro-region and gender. RESULTS: The elderly population had an average of 5.49 teeth (SD: 7.93) with a median of 0. The proportion of completely edentulous respondents was 54.7%. Complete edentulism was 18.2% in the upper arch and 1.9% in the lower arch. The World Health Organization goal was achieved in 10% of all respondents studied. However, only 2.7% had acceptable masticatory function and aesthetics (having at least shortened dental arch) and a mean number of posterior occluding pairs of 6.94 (SD=2.97). There were significant differences of the percentage of respondents that met the World Health Organization goal and presence of shortened dental arch between men and women. There were differences in shortened dental arch between macroregions. CONCLUSIONS: The Brazilian epidemiological oral health survey showed high rate of edentulism and low rate of shortened dental arch in the elderly population studied, thus suggesting significant functional and aesthetic impairment in all Brazilian macroregions especially among women

Conselheiros usuários do conselho municipal de saúde de Belo Horizonte: características sociais e representatividade

A preocupação com os representantes dos usuários do Sistema Único de Saúde (SUS) em Conselhos Municipais de Saúde é uma realidade, pois mesmo com todo aparato jurídico que garante a paridade com relação aos demais membros, não se pode garantir a representatividade de sua participação. O objetivo desta pesquisa foi conhecer os Conselheiros Usuários do Conselho Municipal de Saúde de Belo Horizonte, suas características sociais, bem como sua relação com a base que representa. Foram aplicadas técnicas de pesquisa quantitativa para conhecer as características e qualitativa para avaliar o relacionamento com a base. Quanto às características encontradas, observa-se que os conselheiros são na maioria homens, aposentados e com baixa escolaridade. Os mandatos repetem-se sugerindo profissionalização dessa categoria. O relacionamento com a base apresenta limitações, principalmente quanto à comunicação, e, ao que tudo indica, a educação continuada dos conselheiros pode ser uma solução para esse problema.The concern about the representatives of the users of SUS (Brazil's National Health System) in Municipal Health Councils is a reality, because even with all the legal apparatus that guarantees parity with regard to the other members, it is not possible to guarantee the quality of their participation. The objective of this research was to learn who the Councillors Users of the Municipal Health Council of Belo Horizonte are, their social characteristics, as well as their relation with the base they represent. Quantitative research techniques were applied to learn the characteristics, and qualitative techniques were employed to evaluate the relationship with the base. Regarding the characteristics, it was observed that the majority of the Councillors are retired men with low level of schooling. The terms of office are repeated, suggesting professionalization of this category. The relationship with the base has limitations, mainly concerning communication, and it seems that the continuing education of the Councillors to work adequately with their base may be a solution to this problem