Brazilian adolescents’ oral health trends since 1986: an epidemiological observational study

Oral health is part of general health, and in adolescence, it represents a good individual health indicator. Three country-based oral health epidemiological studies have been developed in Brazil (1986, 2003 and 2010). The objective of this study was to analyze oral disease trends among Brazilian adolescents and to compare these trends to the World Health Organization's goals with a focus on public health policies implemented between 1986 and 2010. This is an epidemiological observational study performed with secondary data from Brazilian Oral Health surveys (1986, 2003 and 2010). The DMFT (number of decayed, missing and filled teeth) index was used for the 12-year-old and 15- to 19-year-old groups, and periodontal disease (CPI) and the percentage of individuals who needed and/or had prostheses were evaluated in the 15- to 19-year-old group. Between 1986 and 2010, DMFT decreased from 6.65 to 2.07 (68.9 % reduction) in the 12-year-old group and from 12.68 to 4.25 (66.5 % reduction) in the 15- to 19-year-old group. In all groups, the missing component had the strongest decrease. Adolescents had a reduction of 20.3 % in access to dental care. In 2003, in the 15- to 19-year-old group, 89.5 % of teenagers had at least one decayed tooth, while in 2010, the value was 76.1 %. In 2010, the percentage of adolescents without gingival problems varied among different regions of Brazil, with 30.8 % in the North and 56.8 % in the Southeast. Regarding DMFT, the difference between the North and Southeast Regions was 84 %. Improvement trends regarding adolescent oral health were observed, which seem to be supported by health education and promotion activities along with the reorganization of the Brazilian health system.855

Dependence in instrumental activities of daily living and its implications for older adults’ oral health

We aimed to assess the association between dependence in instrumental activities of daily living (IADL) and oral health in older adults. We conducted a cross-sectional study of 280 people aged �60 years served at public primary health care centers in Northeastern Brazil. Sociodemographic, oral discomfort and general health data were collected. The Lawton and Brody scale were used to assess IADL. This research adheres to the STROBE checklist. Most participants were married (n = 139; 49.6%), women (n = 182; 65.0%) and retired (n = 212; 75.7%). A total of 37 (13.2%) older adults had some degree of dependence in IADL. Dependence in IADL was associated with: retirement (p<0.040), poor general health (p = 0.002), speech problems (p = 0.014), use of medications (p = 0.021), difficulty chewing and swallowing food (p = 0.011), voice changes (p = 0.044), edentulism (p = 0.011), use of toothbrush (p<0.001), use of toothpaste (p<0.001), and visit to the dentist in the previous year (p = 0.020). Functional disability was associated with older age, cardiovascular diseases, speech problems, chewing and swallowing difficulties, use of medication and brushing deficiency. The functional dependence in IADL can be considered an indicator of oral health status in older adults.info:eu-repo/semantics/publishedVersio

Programa de Melhoria do Acesso e Qualidade da Atenção Básica:: estratégicas utilizadas em dois estados nordestinos

OBJETIVO:&nbsp;Analisar a utilização das dimensões estratégicas propostas pelo Programa de Melhoria do Acesso e da Qualidade da Atenção Básica nos estados do Piauí e Ceará.&nbsp;METODOLOGIA:&nbsp;Trata-se de um estudo transversal utilizando dados provenientes da Avaliação Externa e apresentados diante do cruzamento de variáveis explicativas: estado, porte populacional, estrato de certificação e percentual de cobertura pela Estratégia Saúde da Família.&nbsp;RESULTADOS:&nbsp;Foi possível identificar diferenças significativas nos resultados das dimensões entre equipes de municípios de porte populacional diferente e constatar que mesmo sendo estados com similaridades, Piauí e Ceará apresentaram diferentes resultados na utilização das estratégicas propostas (Autoavaliação, monitoramento, educação permanente e apoio institucional).&nbsp;CONCLUSÕES:&nbsp;As estratégias de melhoria do acesso e qualidade, apesar de seu papel indutor de mudanças, ainda não protagonizaram as ações diante do programa nos estados investigados

Factors associated with self-rated health in older adults receiving oral prosthetic rehabilitation

Objectives: To assess factors associated with self-perception of health in older adults submitted to oral prosthetic rehabilitation in order to contribute to a more contextualized planning of public policies, actions and health services aimed at healthy aging. Design: Analytical cross-sectional study. Setting: Dental specialty centers. Participants: 244 people aged 60 years and older enrolled for oral prosthetic rehabilitation. Intervention: Interviews, oral examination and anthropometric measurements. Measurements: A questionnaire assessed demographic and economic data, general health and oral health and self-perception of oral health-related quality of life was measured by the Geriatric Oral Health Assessment Index (GOHAI). Performance in instrumental activities of daily living was assessed by the Lawton and Brody scale, mood was assessed by the Geriatric Depression Scale and nutritional status was assessed by the Mini Nutritional Assessment. Results: The multivariate analysis showed that factors such as hospitalization in the previous year, diabetes and risk of malnutrition determined the negative self-perception of general health and current health status compared with 12 months ago. Needing assistance to perform AIDL significantly influenced self-perception of general health while income and vision problems interfered with older adults’ perception of their current health status compared with 12 months ago. Conclusion: Older adults who needed oral prosthetic rehabilitation exhibited a predominantly negative self-perception of oral health.info:eu-repo/semantics/publishedVersio

Prevalence and health promotion actions related to hyposalivation and mouth discomfort in a nursing homesfor elders

Objectiveto verify the prevalence of hyposalivation inan institutionalized elder population and its relationship with oral discomfort. A cross-sectional study was conducted with older people living in a Nursing Homein Fortaleza-Brazil. Data collection occurred through the application of sociodemographic questionnaire; sialometry examination, test for evaluating the salivary flow speed; and by a subjective quantification of dry mouth intensity (Visual Analog Scale). Results: sixty-five older people aged between 61 and 91 years (mean74.5±8.0) were evaluated, 30(46.2%) were women and 35(53.8%) men. The majority had low monthly income (55;84.6%) and low schooling (44;67.7%). The mean salivary flow was 0.4 ±0.2, withvery low flow (0.1-0.3 ml/min) being more prevalent; females presented lower salivary flow (p=0.033) than males; there was an association between salivary flow and dry mouth sensation (p<0.001) and halitosis (p<0.001). The correlation between sialometry and VAS showed that the lower the salivary flow, the greater the perception of dry mouth sensation. Health promotion actions and treatment (proper hydration; tooth brushing; saliva stimulants) can be performed in order to minimize dry mouth/ hyposalivation impact on elders’ quality of life. Conclusion: Low salivary flow was prevalent in the study subjects. It interferes in oral discomfort and causes dry mouth sensation.info:eu-repo/semantics/publishedVersio

Reflexions on oral health in Brazil

In the last century, numerous advances in biomedical researches and technology in the dentistry field have been responsible for improvements in health and wellbeing of populations(1). However, despite major achievements in the context of oral health, many problems still remain, such as dental caries, the most common of oral diseases. The prevalence of dental caries showed a downward trend over the last three decades of the XX century and in early twenty-first century, especially in developed countries, however, it is still considered an important worldwide public health issue, affecting 60% to 90% of school children, besides the vast majority of the adults(2-4). In the Pesquisa Nacional de Saúde Bucal do Ministério da Saúde – Projeto SB 2010(5) (National Survey of Oral Health of the Ministry of Health - SB Project 2010), improvements in the oral health status of Brazilians were observed, however, caries prevalence is still high. Among adolescents aged 15 to 19 years, for example, the average of affected teeth was 4.25 - more than twice the mean number found at the age of 12. Among the elderly aged 65 to 74 years, the number of decayed, missing and filled (DMF) teeth hardly changed, remaining at 27.5 in 2010, while the average was 27.8 in 2003. In international context, according to the Brazilian Ministry of Health(5), a study by the World Health Organization (WHO) in 2004 indicated that, on data from 188 countries, the average DMF at age 12 was 1.6, reaching the average of 2.8 in the Americas, while in Europe it was 1.6. In South America, only Venezuela had an average DMF at age 12 similar to the Brazilian (2.1). In other countries, the averages were higher, as in Argentina (3.4), Bolivia (4.7), Colombia (2.3), Paraguay (2.8) and Peru (3.7). The epidemiological findings on 2010 oral health in Brazil(5) showed that the country joined the group of those with low prevalence of caries at the age of 12. Although results have been encouraging in this regard, the study showed, as previously described, a prevalence of caries still significant in several age groups assessed, as well as significant regional differences in the prevalence and severity of dental caries. These findings indicate the need for policies aimed at equity in the attention and innovative actions of promotion and prevention, which should also be sensitive to regional differences promotion and prevention. The promotion of oral health is embedded within a broad concept of health bthat transcends the mere technical dimension of the dentistry sector, integrating it into other collective health practices. It expresses the construction of healthy public policies directed to all people in the community, as well as policies that create opportunities for access to actions of health promotion and prevention, ensuring the availability of appropriate basic dental care. The oral health practices, starting from epidemiological references, have been reorganized in order to reduce inequities and give social responses to oral health problems and needs of the population, based on the principles of the Sistema Único de Saúde - SUS (Unified Health System), which brings in its very essence a guarantee of qualified access and integration of health services(6). However, the actions of health assistance, promotion and prevention should be evaluated in order to substantiate their effectiveness, efficiency and effectiveness, and extend them to other regions. Vieira-da-Silva(7) reports a relation between evaluation and ‘the process of determining the effort, merit or worth of something, or the value associated with the product of that process’. For the author, the assessment is considered important, firstly because it is associated with the possibility and need for interventions to modify health frameworks and, secondly, for taking into account the difficulties faced by these same practices to alter epidemiological indicators of morbidity and mortality in many other circumstances. The evaluation of health services can be regarded as a means to promote the continuous improvement in care, providing the user a quality service(8). In this context, evaluating these actions is an essential factor to determine their performance, efficacy and behavior in oral health services and, based on the references produced, meet the needs for public policies that generate oral health promotion in primary care. In the current issue of the Revista Brasileira em Promoção da Saúde - RBPS (Brazilian Journal in Health Promotion), two papers discuss the evaluation of actions aimed at promotion and prevention in oral health. One of them verifies the habits of oral hygiene and the oral hygiene index in schoolchildren, while the other evaluates the efficacy of oral hygiene instructions, particularly in the control of dental biofilm. REFERENCES 1. Benjamin RM. Oral health: the silent epidemic. Public Health Rep. 2010;125(2):158-9. 2. Narvai PC, Frazão P, Roncalli AG, Antunes JL. Cárie dentária no Brasil: declínio, polarização, iniqüidade e exclusão social. Rev Panam Salud Pública. 2006;19(6):385–93. 3. World Health Organization, Organização Mundial de Saúde. Oral Health: Media Centre [acesso em 2013 Fev 28]. (Fact sheet n° 318, Abril 2012). Disponível em: http://www.who.int/mediacentre/factsheets/fs318/en/ index.html. 4. Petersen PE, Bourgeois D, Ogawa H, Estupinan- Day S, Ndiaye C. The global burden of oral diseases and risks to oral health. Bull World Health Organ. 2005;83(9):661-9. 5. Ministério da Saúde (BR), Secretaria de Atenção à Saúde, Secretaria de Vigilância em Saúde. SBBrasil 2010: Pesquisa Nacional de Saúde Bucal: resultados principais. Brasília; 2011. 6. Valença AMG, Senna MAA, Faria LCM. Paradigmas do Atendimento de Crianças no Contexto da Saúde Pública Brasileira. In: Maia LC, Primo LG. Odontologia Integrada na Infância. São Paulo: Santos; 2011. p. 11- 22. 7. Vieira-da-Silva LM. Conceitos, abordagens e estratégias para a avaliação em saúde. In: Hartz ZMA, Vieira-da-Silva LM, organizadores. Avaliação em saúde: dos modelos teóricos à prática na avaliação de Programas e Sistemas de Saúde. Rio de Janeiro: FIOCRUZ; 2005. p. 15-39. 8. Colussi CF, Calvo MCM. Avaliação da Atenção em Saúde Bucal no Brasil: uma revisão da literatura. Saúde Transform Social. 2012;3(1):92-100

RELAÇÃO TEORIA-PRÁTICA NOS CURSOS DE MESTRADO ACADÊMICO E PROFISSIONAL NA ÁREA DA SAÚDE COLETIVA

Resumo O presente estudo partiu da percepção da existência de semelhanças e diferenças na relação teoria-prática em cursos de mestrado, modalidades acadêmica e profissional na área da Saúde Coletiva. Adotou-se como pressuposto que, nesta relação, as propostas de mestrado profissional não partem da prática profissional dos agentes como cenário para construir novos conhecimentos e tecnologias, mas tendem a reproduzir o modelo hegemônico de formação consolidado no mestrado acadêmico. A partir das categorias ‘relação academia-contexto profissional’, ‘quadro docente’, ‘trabalho final e justificativa para o curso’, o estudo com abordagem qualitativa realizou-se por meio de análise documental e de propostas de cursos, além de entrevistas com coordenadores dos cursos. Para aprofundar a discussão, selecionaram-se sete instituições de ensino superior que ofereciam cursos nessas modalidades. Conclui-se que essa relação é mais complexa no mestrado profissional, e que este, como prevê a legislação, buscou consolidar uma identidade distinta da especialização e do mestrado acadêmico, o que pode caracterizar a principal diferença entre as modalidades. No entanto, seus processos ainda adotam os mesmos referenciais e práticas que o mestrado acadêmico

CONSTRUÇÃO TEÓRICO-METODOLÓGICA E APRENDIZADOS COM A EXPERIÊNCIA NO MESTRADO PROFISSIONAL EM SAÚDE DA FAMÍLIA

Resumo No Brasil, ainda são escassos os estudos voltados à formação profissional em nível de pós-graduação para atuar no Sistema Único de Saúde. Este artigo tem por objetivo relatar a experiência de construção do Mestrado Profissional em Saúde da Família, oferecido pela Rede Nordeste de Formação em Saúde da Família. Para tanto, apresenta os antecedentes dessa proposta e discute a concepção teórico-metodológica que permeou todo o processo. Conceitos de educação permanente, aprendizagem significativa e educação de adultos são discutidos de forma contextualizada com a criação do mestrado. Espera-se que esta experiência possa subsidiar reflexões em outros contextos de formação, sabendo que é um processo em andamento e que as questões relacionadas à concepção do curso e aos resultados percebidos até o momento fazem parte de um desafio maior que é o da educação de adultos