Access to oral health in early childhood in the city of Porto Alegre, Brazil. / Acesso à saúde bucal na primeira infância no município de Porto Alegre, Brasil.

The goal was to assess the access and factors connected to dental visits in children up to age five in the city of Porto Alegre, Brazil. The cross-sectional study was conducted in 10 Basic Health Units through a questionnaire and clinical examination on 560 children. Clinical (visible plaque, gingival bleeding and defs), socio-demographic, and visit access variables were assessed. Poisson Regression was used to calculate the Prevalence Ratios (PR), with a 95% confidence interval. Results showed that 68.2% of children had never gone to a dentist. The main reason reported for not visiting a dentist was not feeling the need (48.7%) and difficult access to a health clinic (15.8%). The purpose of going to the dentist was for prevention/revision (55.8%), and the most sought-after places for visits were the private office (43.9%) and health clinic (39.5%). The final multivariate model showed that age of the child (95%CI, PR = 1.03 (1.02-1.05)), household income (PR = 1.05; (1.01-1.08)), and the mother having completed high school (PR = 1.69 (1.15-2.56)) were associated with seeking dental consultation. Thus, it is crucial to recognize the importance of the family setting during the first years of life.

O objetivo foi avaliar o acesso e fatores associados à consulta odontológica em crianças de até 5 anos no município de Porto Alegre, Brasil. Estudo transversal realizado em 10 Unidades Básicas de Saúde, através de questionário e exame clínico em 560 crianças. Foram avaliadas variáveis clínicas (placa visível, sangramento gengival e ceo-s), sociodemográficas, e de acesso à consulta. Regressão de Poisson foi utilizada para cálculo de Razões de Prevalência (RP), com intervalo de confiança de 95%. Os resultados mostraram que 68,2% das crianças nunca haviam ido ao dentista. O principal motivo relatado para a não realização de consulta odontológica foi não ter sentido necessidade (48,7%) e dificuldade de acesso ao posto de saúde (15,8%). A procura pelo dentista teve como propósito a prevenção/revisão (55,8%) e os locais mais procurados para consultas foi o consultório particular (43,9%) e o posto de saúde (39,5%). O modelo multivariado final mostrou que a idade da criança (IC95%, RP = 1,03 (1,02-1,05)), a renda familiar (RP = 1,05; (1,01-1,08)) e a mãe ter concluído o ensino médio (RP = 1,69 (1,15-2,56)) estiveram associados com a procura por consulta odontológica. Assim, torna-se fundamental reconhecer a importância do contexto familiar durante os primeiros anos de vida.

Acesso à saúde bucal na primeira infância no município de Porto Alegre, Brasil / Access to oral health in early childhood in the city of Porto Alegre, Brazil

Resumo O objetivo foi avaliar o acesso e fatores associados à consulta odontológica em crianças de até 5 anos no município de Porto Alegre, Brasil. Estudo transversal realizado em 10 Unidades Básicas de Saúde, através de questionário e exame clínico em 560 crianças. Foram avaliadas variáveis clínicas (placa visível, sangramento gengival e ceo-s), sociodemográficas, e de acesso à consulta. Regressão de Poisson foi utilizada para cálculo de Razões de Prevalência (RP), com intervalo de confiança de 95%. Os resultados mostraram que 68,2% das crianças nunca haviam ido ao dentista. O principal motivo relatado para a não realização de consulta odontológica foi não ter sentido necessidade (48,7%) e dificuldade de acesso ao posto de saúde (15,8%). A procura pelo dentista teve como propósito a prevenção/revisão (55,8%) e os locais mais procurados para consultas foi o consultório particular (43,9%) e o posto de saúde (39,5%). O modelo multivariado final mostrou que a idade da criança (IC95%, RP = 1,03 (1,02-1,05)), a renda familiar (RP = 1,05; (1,01-1,08)) e a mãe ter concluído o ensino médio (RP = 1,69 (1,15-2,56)) estiveram associados com a procura por consulta odontológica. Assim, torna-se fundamental reconhecer a importância do contexto familiar durante os primeiros anos de vida.

Abstract The goal was to assess the access and factors connected to dental visits in children up to age five in the city of Porto Alegre, Brazil. The cross-sectional study was conducted in 10 Basic Health Units through a questionnaire and clinical examination on 560 children. Clinical (visible plaque, gingival bleeding and defs), socio-demographic, and visit access variables were assessed. Poisson Regression was used to calculate the Prevalence Ratios (PR), with a 95% confidence interval. Results showed that 68.2% of children had never gone to a dentist. The main reason reported for not visiting a dentist was not feeling the need (48.7%) and difficult access to a health clinic (15.8%). The purpose of going to the dentist was for prevention/revision (55.8%), and the most sought-after places for visits were the private office (43.9%) and health clinic (39.5%). The final multivariate model showed that age of the child (95%CI, PR = 1.03 (1.02-1.05)), household income (PR = 1.05; (1.01-1.08)), and the mother having completed high school (PR = 1.69 (1.15-2.56)) were associated with seeking dental consultation. Thus, it is crucial to recognize the importance of the family setting during the first years of life.

Development of a simplified dysphagia assessment by dentists in older persons.

OBJECTIVE: This study aimed to evaluate the diagnostic accuracy of a simplified clinical examination of swallowing by dentists and the Eating Assessment Tool (EAT-10), when compared with the diagnosis provided by a speech pathologist (gold standard). METHODS: Three dentists and 1 speech pathologist clinically evaluated 265 older persons in southern Brazil, 123 were residents in long-term care and 142 were community-dwelling, all able to respond to the research protocol independently. Accuracy, sensitivity, specificity, positive and negative predictive values (+PV and -PV), and positive and negative likelihood ratios (+LR and -LR) were calculated according to standard methods. This study was approved by the Ethics Committee of the Federal University of Rio Grande do Sul. RESULTS: Mean age of the participants was 73.5 (±8.9) years and most of them were women (N = 157, 59.2%). The prevalence of dysphagia as diagnosed by a speech pathologist was 45.3%. The accuracy of diagnosis was 0.84 for the clinical examination of swallowing by dentists. Furthermore, sensitivity was 0.77, specificity was 0.89, +PV was 0.85, -PV was 0.83, +LR was 7.02 and -LR was 0.25. The accuracy of EAT-10 was 0.72, the sensitivity was 0.45, specificity was 0.94, +PV was 0.87, -PV was 0.67, +LR was 8.31 and -LR was 0.57. CONCLUSIONS: Simplified clinical examination of swallowing by dentists was found to be an accurate method to screen dysphagia in older persons.

Perceptions of primary health care service users regarding dental team practices in Brazil.

BACKGROUND: The Unified Health System (SUS) is the Brazilian set of public health services that offers global access to health care and disease treatments for all citizens. These services have been evaluated by means of a national survey assessing the users' perceptions.AimTo explore and characterize the SUS users' perceptions regarding primary dental team practices in the five Brazilian geographical regions. METHODS: Descriptive study. The sample consisted of 37 262 subjects. Data were collected by means of the Ministry of Health survey, conducted between 2012 and 2014. Variables used in the present study are associated with SUS users' perspectives of satisfaction, access, and use of services. The study utilized bivariate data analysis, and dichotomous variables were derived for analysis following 95% reliability.FindingsThis study observed similarities and proportionality of perceptions in the Brazilian territory. In most macro-regions, dental teams did not develop an active search for dental treatment absentees. However, the SUS users reported very good and good perceptions, which were homogeneously distributed across five Brazilian regions, thereby showing an overall positive perception of primary dental treatment.

Discrimination, gender and self-reported aesthetic problems among Brazilian Adults.

OBJECTIVES: To explore factors associated with discrimination in healthcare services and to assess whether discrimination based on dental aesthetics differs by sex. METHODS: Cross-sectional analysis based on a household survey carried out in a city in Southern Brazil. Fifteen primary health care (PHC) units with a dental team were randomly selected, and individuals who used the public services in the catchment areas of the PHC units were interviewed. The survey questionnaire included experiences with discrimination related to health services, sociodemographic and dental characteristics. Multiple logistic regressions were estimated with dental appearance as outcome. RESULTS: The final sample was composed of 433 individuals, with 15.2% reporting being discriminated in health services. Participants with ≥20 teeth were significantly more likely to report discrimination than those with <20 teeth (16.6% vs 9.1%, respectively), and people with twisted and stained teeth reported more discrimination than those with white and aligned teeth (23.2% vs 9.9%, respectively). Overall, individuals with twisted and stained teeth were more likely to report discrimination (OR=3.13; 95% CI: 1.46-6.71). When the analyses were stratified by sex, women with twisted and stained teeth showed an OR=3.62 (95% CI: 1.55-8.46) and men OR=0.54 (95% CI: 0.05-6.18). CONCLUSION: Dental appearance may lead to discrimination in healthcare services, but this seems to be more important for women than men.

Dental status, oral prosthesis and chewing ability in an adult and elderly population in southern Brazil.

OBJECTIVE: The objective of this study was to explore the factors associated with inadequate chewing in an adult and elderly population of a city in the southern region of Brazil. METHODS: This was a cross-sectional study based on a population home-based inquiry (DCH-POP) in southern Brazil. Individuals were interviewed by trained interviewers to create a standardized procedure. In a pilot study, the Questionnaire of Human Communication Disorders (DCH-POP) was created and validated to identify self-reported speech and language, swallowing and hearing disorders. The outcome was dichotomized into either having adequate chewing or not, as assessed by a series of questions about chewing ability. Analyses of absolute and relative frequencies were measured according to the studied variables. A Poisson regression was applied at a significance level of 5%. RESULTS: A total of 1,246 people were interviewed. Inadequate chewing was found in 52 (5.6%) individuals, with a higher prevalence in the elderly (11.8%) than in adults (5.2%). In the final model, the following factors were associated with inadequate chewing: being 61 years of age or older (prevalence ratio or PR=9.03; 95% CI: 1.20-67.91), loss of teeth and use of unadjusted prosthesis (PR=3.50; 95% CI: 1.54-7.95), preference for foods of soft consistency (PR=9.34; 95% CI:4.66-8.70) and difficulty in nasal breathing (PR=2.82; 95% CI: 1.31-6.06). CONCLUSION: Age, oral health status through dental prosthesis, preference for foods of soft consistency and difficulty breathing through the nose were factors associated with chewing inability in adults and the elderly.

Dental status, oral prosthesis and chewing ability in an adult and elderly population in southern Brazil

OBJECTIVE: The objective of this study was to explore the factors associated with inadequate chewing in an adult and elderly population of a city in the southern region of Brazil. METHODS: This was a cross-sectional study based on a population home-based inquiry (DCH-POP) in southern Brazil. Individuals were interviewed by trained interviewers to create a standardized procedure. In a pilot study, the Questionnaire of Human Communication Disorders (DCH-POP) was created and validated to identify self-reported speech and language, swallowing and hearing disorders. The outcome was dichotomized into either having adequate chewing or not, as assessed by a series of questions about chewing ability. Analyses of absolute and relative frequencies were measured according to the studied variables. A Poisson regression was applied at a significance level of 5%. RESULTS: A total of 1,246 people were interviewed. Inadequate chewing was found in 52 (5.6%) individuals, with a higher prevalence in the elderly (11.8%) than in adults (5.2%). In the final model, the following factors were associated with inadequate chewing: being 61 years of age or older (prevalence ratio or PR=9.03; 95% CI: 1.20-67.91), loss of teeth and use of unadjusted prosthesis (PR=3.50; 95% CI: 1.54-7.95), preference for foods of soft consistency (PR=9.34; 95% CI:4.66-8.70) and difficulty in nasal breathing (PR=2.82; 95% CI: 1.31-6.06). CONCLUSION: Age, oral health status through dental prosthesis, preference for foods of soft consistency and difficulty breathing through the nose were factors associated with chewing inability in adults and the elderly.

Experiências de discriminação relacionadas aos serviços de saúde: análise exploratória em duas capitais do Sul do Brasil / Experiences of health service-related discrimination: exploratory analysis in two Southern Brazilian State capitals / Experiencias de discriminación relacionadas a los servicios de salud: análisis exploratorio en dos capitales del Sur de Brasil

OBJETIVO: descrever a prevalência de discriminação relacionada aos serviços de saúde, suas motivações e fatores associados. MÉTODOS: análise seccional realizada com bancos de dados oriundos de dois inquéritos realizados no município de Porto Alegre, Rio Grande do Sul, com usuários de serviços de saúde, e no município de Florianópolis, Santa Catarina, com amostra representativa de universitários, entre 2010 e 2012. RESULTADOS: a prevalência de discriminação relacionada aos serviços de saúde foi de 13,6% (IC95%: 10,5-17,2) em Porto Alegre-RS e de 7,4% (IC95%: 5,8-9,1) em Florianópolis-SC; o principal motivo para a discriminação foi ser de baixa posição socioeconômica; em ambas as capitais, observou-se maior prevalência de discriminação entre fumantes, autoclassificados pretos/negros e indivíduos de 31 a 40 anos de idade. CONCLUSÃO: a prevalência de discriminação foi relativamente baixa; reforça-se a necessidade de se investigar a discriminação no âmbito dos serviços de saúde, para a provisão de cuidados adequados à população.

OBJETIVO: describir la prevalencia de discriminación relacionada a los servicios de salud, sus motivaciones y factores asociados. MÉTODOS: análisis seccional realizado con bancos de datos originarios de dos encuestas realizadas en el municipio de Porto Alegre, Rio Grande do Sul, con usuarios de servicios de salud, y en el municipio de Florianópolis, Santa Catarina, con una muestra representativa de universitarios, entre 2010 y 2012. RESULTADOS: la prevalencia de discriminación relacionada a los servicios de salud fue de 13,6% (IC95%: 10,5-17,2) en Porto Alegre-RS y de 7,4% (IC95%: 5,8-9,1) en Florianópolis-SC; el principal motivo para la discriminación fue el de ser de baja posición socioeconómica; en ambas capitales, se observó una mayor prevalencia de discriminación entre fumadores, que se auto clasifican como negros e individuos de 31 a 40 años de edad. CONCLUSIÓN: la prevalencia de discriminación fue relativamente baja; se refuerza la necesidad de investigar la discriminación en el ámbito de los servicios de salud, para proveer cuidados adecuados a la población.

OBJECTIVE: to describe the prevalence of health service-related discrimination, as well as its motivations and associated factors. METHODS: this is a cross-sectional analysis based on data from two population-based surveys carried out in Porto Alegre-RS with health service users and in Florianópolis-SC with a representative sample of university students, between 2010-2012. RESULTS: the prevalence of health service-related discrimination was 13.6% (95%CI: 10.5;17.2) in Porto Alegre and 7.4% (95%CI: 5.8;9.1) in Florianopolis; the main reason for being discriminated against was being of low socioeconomic status; in both state capitals the highest prevalence of discrimination was observed among smokers, self-classified Black people, and individuals aged between 31 and 40. CONCUSION: the results show a relatively low prevalence of discrimination; the study reinforces the need to investigate discrimination in health services in order to provide adequate care to the population.

Teaching at primary healthcare services within the Brazilian national health system (SUS) in Brazilian healthcare professionals' training / O ensino nos serviços de atenção primária do sistema único de saúde (SUS) na formação de profissionais de saúde no Brasil / La enseñanza en los servicios de atención primaria del sistema gubernamental de salud brasileño (SUS) en la formación de los profesionales de salud en Brasil

The aim of this study was to analyze the role of teaching at primary healthcare services within the Brazilian National Health System (SUS) in dentists' training, at a public university in the south of Brazil. A qualitative methodological approach (case study) was used. Interviews were conducted with 12 dentistry students, six dentists who were preceptors working in public primary healthcare services and three teachers connected with this curricular training. Our findings showed that the curricular training in SUS primary healthcare services had an impact on the dentists' education through establishment of bonds, autonomy in problem-solving and multiprofessional teamwork. It was seen that they learned about how healthcare services function, about healthcare and about development of cultural competence. There is a need to maintain constant questioning regarding these practices, and to ensure the presence of infrastructure and qualified professionals for teaching at these services.

O objetivo desse estudo foi analisar o papel do ensino nos serviços de atenção primária do Sistema Único de Saúde (SUS) para a formação do cirurgião-dentista em uma universidade pública no sul do Brasil. A abordagem metodológica foi qualitativa (estudo de caso), realizando-se entrevistas com 12 estudantes de Odontologia, seis preceptores cirurgiões-dentistas com atuação nos serviços públicos de atenção primária e três professores vinculados ao estágio curricular. Os achados mostraram que o estágio curricular nos serviços de atenção primária do SUS impactou na formação do cirurgião-dentista por meio do estabelecimento de vínculos, autonomia na resolução de problemas e trabalho em equipe multiprofissional. Foram evidenciadas aprendizagens sobre funcionamento dos serviços de saúde, cuidado em saúde e desenvolvimento de competência cultural. Há necessidade da problematização permanente sobre as práticas e que se assegure infraestrutura e profissionais qualificados para o ensino nos serviços.

El objetivo de este estudio fue el examen del papel de la enseñanza en los servicios de atención primaria del sistema gubernamental de salud brasileño (SUS) para la formación de los cirujanos-dentistas en una universidad pública del sur del Brasil. El enfoque metodológico fue cualitativo (estudio de caso) y se realizaron entrevistas con 12 estudiantes de Odontología, seis preceptores cirujanos-dentistas y tres profesores relacionados con el plan de estudios de prácticas curriculares. Los resultados mostraron que las prácticas curriculares en los servicios de atención primaria tienen impacto en la formación del cirujano-dentista mediante el establecimiento de vínculos, autonomía para resolución de problemas y trabajo en equipo multi-profesional. Hubo aprendizajes sobre el funcionamiento de los servicios de salud, cuidado en salud y el desarrollo de competencia cultural. Hay necesidad de cuestionamiento permanente de las prácticas y de asegurar infraestructura y profesionales calificados para la enseñanza en los servicios.