Strategies for Monitoring Microbial Life in Beach Sand for Protection of Public Health.

The 2021 revised guidelines of the World Health Organization recommend monitoring the quality of sand in addition to water at recreational beaches. This review provides background information about the types of beaches, the characteristics of sand, and the microbiological parameters that should be measured. Analytical approaches are described for quantifying fungi and fecal indicator bacteria from beach sand. The review addresses strategies to assess beach sand quality, monitoring approaches, sand remediation, and the proposed way forward for beach sand monitoring programs. In the proposed way forward, recommendations are provided for acceptable levels of fungi given their distribution in the environment. Additional recommendations include evaluating FIB distributions at beaches globally to assess acceptable ranges of FIB levels, similar to those proposed for fungi.

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 (ß = 0.103) and sedentary behaviour (ß = 0.102) directly predicted the incidence of dental caries. A higher socio-economic status was directly linked with lower sugar consumption (ß = -0.243) and higher sedentary behaviour (ß = 0.227). Higher social support directly predicted lower sugar consumption (ß = -0.114). Lower socio-economic status (ß = -0.046) and lower social support (ß = -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.

Parasite Viability as a Measure of In Vivo Drug Activity in Preclinical and Early Clinical Antimalarial Drug Assessment.

The rate at which parasitemia declines in a host after treatment with an antimalarial drug is a major metric for assessment of antimalarial drug activity in preclinical models and in early clinical trials. However, this metric does not distinguish between viable and nonviable parasites. Thus, enumeration of parasites may result in underestimation of drug activity for some compounds, potentially confounding its use as a metric for assessing antimalarial activity in vivo. Here, we report a study of the effect of artesunate on Plasmodium falciparum viability in humans and in mice. We first measured the drug effect in mice by estimating the decrease in parasite viability after treatment using two independent approaches to estimate viability. We demonstrate that, as previously reported in humans, parasite viability declines much faster after artesunate treatment than does the decline in parasitemia (termed parasite clearance). We also observed that artesunate kills parasites faster at higher concentrations, which is not discernible from the traditional parasite clearance curve and that each subsequent dose of artesunate maintains its killing effect. Furthermore, based on measures of parasite viability, we could accurately predict the in vivo recrudescence of infection. Finally, using pharmacometrics modeling, we show that the apparent differences in the antimalarial activity of artesunate in mice and humans are partly explained by differences in host removal of dead parasites in the two hosts. However, these differences, along with different pharmacokinetic profiles, do not fully account for the differences in activity. (This study has been registered with the Australian New Zealand Clinical Trials Registry under identifier ACTRN12617001394336.).

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

Abstract 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.

Individual- and City-Level Socioeconomic Factors and Tooth Loss among Elderly People: A Cross-Level Multilevel Analysis.

This study aimed to test the association of contextual and individual socioeconomic status with tooth loss among Brazilian elderly people aged 65-74 years. Data from 5435 elderly participants from the Brazilian National Oral Health Survey (2010) were linked to city-level data for 27 state capitals and the Federal District. Tooth loss was clinically assessed according to the number of missing natural teeth. Contextual social variables included Human Development Index income (HDI-income) and HDI-education. Individual socioeconomic measures were monthly family income and years of schooling. Covariates included sex, skin colour, number of residents per room and number of goods. Multilevel Negative Binomial regression models were used to estimate rate ratios (RR) and 95% confidence intervals between contextual and individual variables and tooth loss. Contextual and individual income and education measures were consistently associated with tooth loss. Elderly people living in cities with low HDI-income and low HDI-education were respectively 21% and 33% more likely to present tooth loss. Cross-level interaction suggested that the relationship of lower income and lower schooling with tooth loss is different across levels of city-level income and city-level education inequality, respectively. Public policies aiming to reduce the income and education gaps and preventive dental interventions are imperative to tackle tooth loss among elderly people.

Predisposing, enabling, and need characteristics of dental services utilization among socially deprived schoolchildren.

OBJECTIVES: To test the relationship of predisposing, enabling and need characteristics with dental services utilization and pattern of dental attendance among 12-year-old schoolchildren living in a socially deprived urban area. METHODS: A cross-sectional study was carried out involving 358 children enrolled in public schools located in a deprived area of the city of Manaus, Brazil. Predisposing, enabling, and need characteristics were selected according to Andersen's behavioral conceptual model. Self-completed questionnaires were used to collect the predisposing characteristics (child's gender, sense of coherence, self-esteem, oral health beliefs). Parents or guardians provided data on enabling characteristics, including dental health insurance and socioeconomic status. Evaluated need characteristics included oral clinical status assessed through dental examinations conducted by five calibrated examiners. Structural equation modeling was used to test the predictors of dental services utilization and pattern of dental attendance. RESULTS: Predisposing characteristics, including male gender and low parents/guardians sense of coherence predicted poor dental services utilization and inadequate pattern of dental attendance, respectively. Low socioeconomic status and poor oral clinical status were linked to poor dental services utilization and worse children's pattern of dental attendance. CONCLUSIONS: The present findings suggest that predisposing (child's gender and parental sense of coherence), enabling (socioeconomic conditions) and evaluated need characteristics (oral clinical status) are associated with dental services utilization among children.

Socioeconomic status, social support, oral health beliefs, psychosocial factors, health behaviours and health-related quality of life in adolescents.

PURPOSE: This study assessed the relationships between socioecononic status (SES), social support, oral health beliefs, psychosocial factors, health-related behaviours and health-related quality of life (HRQoL) in adolescents. METHODS: A school-based follow-up study involving 376 12-year-old adolescents was conducted in Manaus, Brazil. Baseline data included sociodemographic characteristics (sex, parental schooling, family income, household overcrowding and number of goods), social support (SSA questionnaire), oral health beliefs and psychosocial factors (Sense of Coherence [SOC-13 scale] and self-esteem [Rosenberg Self-Esteem Scale]). Health-related behaviours (toothbrushing frequency, sedentary behaviour, smoking and sugar consumption) and HRQoL [KINDL questionnaire] were assessed at 6-month follow-up. Structural Equation Modelling assessed the relationships between variables. RESULTS: Greater social support (ß = 0.30), higher SOC (ß = 0.23), higher self-esteem (ß = 0.23), higher toothbrushing frequency (ß = 0.14) and less smoking (ß = - 0.14) were directly linked with better HRQoL. SES (ß = 0.05), social support (ß = 0.26), oral health beliefs (ß = - 0.02) were indirectly linked to HRQoL. Higher SES directly predicted higher toothbrushing frequency (ß = 0.14) and less smoking (ß = - 0.22). Greater social support also directly predicted higher SOC (ß = 0.55), positive oral health beliefs (ß = - 0.31) and higher self-esteem (ß = 0.58). Greater social support indirectly predicted less smoking via oral health beliefs (ß = - 0.05) and less sugar consumption via SOC (ß = - 0.07). CONCLUSION: Socioeconomic status, social support, oral health beliefs and psychosocial factors were important predictors of adolescent's health behaviours and HRQoL over 6-month period through direct and indirect mechanisms. Health behaviours also directly influenced HRQoL.

Contextual and individual determinants of non-utilization of dental services among Brazilian adults.

OBJECTIVES: To examine the association of contextual and individual determinants with non-utilization of dental services among Brazilian adults. METHODS: Data were from adults aged 35-44 years (N = 7,265) from the 2010 Brazilian Oral Health Survey (SB Brasil Project). Non-utilization of dental services was assessed whether the individual has never had a dental visit over the whole life time. Independent variables were selected according to Andersen's behavioral model. Contextual variables included Human Development Index-longevity (HDI-Longevity) (predisposing demographic), HDI-Education and Gini index (predisposing social), integration of oral health teams into Primary Care (enabling health policy), and HDI-Income (enabling financing). Individual data were age and sex (predisposing demographic), ethnicity and schooling (predisposing social), family monthly income (predisposing enabling), perceived dental treatment (perceived need), and decayed teeth (evaluated need). The relationship of contextual and individual variables with non-utilization of dental services was assessed through multilevel logistic regression analysis to estimate odds ratios (ORs) and 95% confidence intervals (95% CI). RESULTS: The prevalence of non-utilization of dental services was 4.7 percent. Adults living in cities with high HDI-Income were less likely to never have a dental visit. The odds of non-utilization of dental services were lower for adults living in cities with high HDI-Longevity. Sex, skin color, dental treatment needs, poor socioeconomic characteristics, perceived dental treatment needs, and decayed teeth were also associated with non-utilization of dental services. CONCLUSIONS: The results suggest that contextual enabling and predisposing factors, individual sociodemographic, and needs-related characteristics influence non-utilization of dental services by Brazilian adults.

Need of Dental Prosthesis in Older People and the Offer of Specialized Care in the Unified Health System, Brazil

Objective: To analyze the offer of dental prosthesis by Centers of Dental Specialties (CEO) considering the need by individuals aged 65-74 years in state capitals and other regions of the country. Material and Methods: The study was conducted with data from the external evaluation of the Improving Access and Quality Program (AVE/PMAQ CEO) and with data from the SBBRASIL 2010 project. AVE / PMAQ CEO is an evaluative investigation using a cross-sectional research design, performed in all CEOs of Brazil, totaling 932 services evaluated. The analysis of data and distribution of CEOs that offered dental prosthesis was described by maps, using TabWin (DATASUS) and quantitative description of the following variables: need for total and partial dentures, CEO, Regional Prosthodontic Laboratories (RLDP), average monthly number of delivered prostheses and the proportion of capitals with RLDP, number of CEOs, RLDP and prostheses delivered per 100,000 inhabitants in state capitals and other regions. Results: Of the 5,570 municipalities in the country, 780 have CEO, mainly located on municipalities with larger populations. Most CEOs were located in the northeastern (38.3%) and southeastern regions of Brazil (36.2%) with the northern and mid-western regions presenting the lowest absolute number of units. Low offer of prostheses was observed, considering the high need of dentures, as well as an unequal distribution among Brazilian regions. A high percentage of older adults aged 65-74 years require total (74.6%) or partial (99.8%) prosthetic rehabilitation, more critical situation is observed in the northern and northeastern regions. Conclusion: The provision of dental services in CEOs is still limited and unevenly distributed, especially for PPR, compromising the universality and integrality of oral health care.

Equity in the Accessibility to Specialized Care in Oral Health in Brazil: Analysis of PMAQ-CEO External Evaluation Data According to the User's Perspective

Objective: To analyze the distribution of Centers of Dental Specialties (CEO) implemented in Brazil until 2014 and identify the contextual and individual variables associated with the geographical accessibility, considering the user's perspective. Material and Methods: The study was conducted with data from the Improving Access and Quality of CEOs (AVE/PMAQ CEO) External Evaluation and contextual characteristics of states and municipalities. The AVE/PMAQ CEO was an evaluative research with cross-sectional observational character, performed in all CEOs in Brazil, with 932 services evaluated and 8,897 users interviewed. Data analysis was conducted in two stages, considering the study dimensions. Analyses were conducted on the availability of units by region, state, population size of the municipality and contextual variables. Then, the relationship between explanatory variables and the user's displacement time and with the intention to change the service location was evaluated using generalized linear regression analysis. Results: The 932 CEOs evaluated were located in 780 of the 5,570 municipalities of the country and the majority was located in the northeastern (38.3%) and southeastern regions (36.2%), with the northern and midwestern regions presenting the lowest absolute number of units. The average displacement time to the CEO was 28.4 minutes, while the intention to change CEO location due to the distance from home was reported by 7.8% of users. Lower geographical accessibility was reported in the northern region and for individuals who reported living in the rural area and in cities with larger populations. Conclusion: The availability of CEOs in the country is still low and not equitably distributed among states and regions.

The relationship between oral health education and quality of life in adolescents.

BACKGROUND: There is no study on the association between oral health education and oral health quality of life (OHQoL). AIM: To assess the relationship between oral health education activities integrated into primary care services and OHQoL in adolescents. DESIGN: A retrospective observational survey was conducted on 300 randomly selected 12-14 years-of-age adolescents living in two publicly funded health service administrative areas in Manaus, Brazil. Between 2006 and 2008, dental treatment and oral health education were offered in one area (DT/OHE group), whereas in the other area, only dental treatment was provided (DT group). Collected data included socio-demographic characteristics, health services use, health-related behaviours, dental pain, dental caries and Child-OIDP. Independent variables were compared between groups by Mann-Whitney and chi-square tests. The association between one or more OIDP (Child-OIDP ≥ 1) and DT group tested using multivariate logistic regression. RESULTS: Caries, use of dental services and health-related behaviours did not differ between groups (P > 0.05). Child-OIDP ≥ 1 was higher in DT group (90.0%) compared with DT/OHE group (79.3%) (P = 0.01). Child-OIDP ≥ 1 was independently associated with DT group [OR = 4.4 (1.1; 17.0)]. CONCLUSIONS: Adolescents living in an area where OHE and DT were provided had better OHRQoL than those living in an area where only DT was provided.

[Dental pain in the previous 3 months in adolescents and Family Health Strategy: the comparison between two areas with different to oralhealth care approaches]. / Dor dental nos últimos 3 meses em adolescentes e Estratégia Saúde da Família: a comparação entre duas áreas com abordagens diferentes de atenção em saúde bucal.

This study sought to compare the prevalence and intensity of dental pain in the last 3 months in adolescents living in two areas within the scope of Family Health Strategy with different to oralhealth care approaches. A cross-sectional study was conducted with 300 adolescents selected from public schools in the city of Manaus, Brazil. Adolescents living in an area with an Oral Health Team in which of health promotion is predominant (Group I, N = 150) were compared with those living in an area in which only dental treatment is offered (Group II, N = 150). Demographic and socio-economic characteristics, oral health-related behavior and use of dental services were gathered. Prevalence and intensity of dental pain in the last 3 months was assessed using a tested and validated Likert scale. The mean age of the participants was 12.9 ± 0.8 years, of which 46.7% were male. The prevalence of dental pain in the last 3 months was 33.7%, and did not differ between Groups I and II (P > 0.05). Medium to high intensity dental pain in the last 3 months was associated with Group II (OR: 2.11 [CI95 %=1.17-3.81]), after adjustment for covariates. Adolescents living in the area where only dental treatment is offered were more prone to severe dental pain compared to those living in the area where health programs are predominant.

Dor dental nos últimos 3 meses em adolescentes e Estratégia Saúde da Família: a comparação entre duas áreas com abordagens diferentes de atenção em saúde bucal / Dental pain in the previous 3 months in adolescents and Family Health Strategy: the comparison between two areas with different to oralhealth care approaches

O estudo objetivou comparar a prevalência e a intensidade da dor dental nos últimos 3 meses em adolescentes moradores de duas áreas de abrangência da Estratégia Saúde da Família com diferentes abordagens de atenção em saúde bucal. Um estudo transversal foi realizado com 300 adolescentes de 12 a 14 anos, selecionados em escolas públicas, na cidade de Manaus, Brasil. Adolescentes de uma área com Equipe de Saúde Bucal, onde são realizadas ações de promoção de saúde (Grupo I, N=150), foram comparados com moradores de uma área onde somente é oferecido (Grupo II, N=150) tratamento odontológico. Características demográficas e socioeconômicas foram coletadas, bem como a prevalência e a intensidade de dor dental nos últimos 3 meses, empregando-se uma escala do tipo Likert. A média de idade dos participantes foi de 12,9 ± 0,8 anos, sendo 46,7 por cento meninos. A prevalência de dor dental nos últimos 3 meses foi de 33,7 por cento, e não diferiu entre os Grupos I e II (P>0,05). A intensidade de dor dental média a alta, nos últimos 3 meses, foi associada com o Grupo II (OR: 2,11 [IC95 por cento=1,17-3,81]) após ajuste para covariáveis. Adolescentes moradores da área onde somente tratamento odontológico é oferecido foram mais propensos à dor dental de maior intensa em relação àqueles moradores da área onde predominam ações de promoção de saúde.

This study sought to compare the prevalence and intensity of dental pain in the last 3 months in adolescents living in two areas within the scope of Family Health Strategy with different to oralhealth care approaches. A cross-sectional study was conducted with 300 adolescents selected from public schools in the city of Manaus, Brazil. Adolescents living in an area with an Oral Health Team in which of health promotion is predominant (Group I, N=150) were compared with those living in an area in which only dental treatment is offered (Group II, N=150). Demographic and socio-economic characteristics, oral health-related behavior and use of dental services were gathered. Prevalence and intensity of dental pain in the last 3 months was assessed using a tested and validated Likert scale. The mean age of the participants was 12.9±0.8 years, of which 46.7 percent were male. The prevalence of dental pain in the last 3 months was 33.7 percent, and did not differ between Groups I and II (P>0.05). Medium to high intensity dental pain in the last 3 months was associated with Group II (OR: 2.11 [CI95 percent=1.17-3.81]), after adjustment for covariates. Adolescents living in the area where only dental treatment is offered were more prone to severe dental pain compared to those living in the area where health programs are predominant.

Quality of life related to oral health: contribution from social factors.

UNLABELLED: Sociodental indicators have been widely used in epidemiological research related to oral health, as they add the dimension of the impact of oral health on the quality of life of individuals and populations. Various studies have been done in order to validate new instruments to assess these subjective perceptions, however, the association between social parameters and impact on oral health-related quality of life (OHRQoL) has not been systematically studied, thus there is still doubt as to the role of the main social variables as OHRQoL impact modulators. This study aims to systematically review the literature in order to evidence the association between six social parameters and OHRQoL. Based on six exclusion criteria, the literature search revealed 40 eligible publications for analyses. The frequency of expected (positive) association between the social parameters and OHRQoL was greater than the non-expected (negative) associations for the six parameters. CONCLUSIONS: The social conditions most clearly associated with the perception of negative impact on OHRQoL were: women, with poor education and low income, immigrants or people belonging to minority ethnic groups.

Quality of life related to oral health: contribution from social factors / Qualidade de vida relacionada à saúde bucal: contribuição dos fatores sociais

Sociodental indicators have been widely used in epidemiological research related to oral health, as they add the dimension of the impact of oral health on the quality of life of individuals and populations. Various studies have been done in order to validate new instruments to assess these subjective perceptions, however, the association between social parameters and impact on oral health-related quality of life (OHRQoL) has not been systematically studied, thus there is still doubt as to the role of the main social variables as OHRQoL impact modulators. This study aims to systematically review the literature in order to evidence the association between six social parameters and OHRQoL. Based on six exclusion criteria, the literature search revealed 40 eligible publications for analyses. The frequency of expected (positive) association between the social parameters and OHRQoL was greater than the non-expected (negative) associations for the six parameters. Conclusions: The social conditions most clearly associated with the perception of negative impact on OHRQoL were: women, with poor education and low income, immigrants or people belonging to minority ethnic groups.

Indicadores sociodentais têm sido largamente utilizados nas pesquisas epidemiológicas em saúde bucal, pois adicionam a dimensão de impacto da saúde bucal na qualidade de vida (OHRQoL) de indivíduos e populações. Inúmeros trabalhos têm sido realizados com a finalidade de validar novos instrumentos para mensurar estas percepções subjetivas; entretanto, a associação entre parâmetros sociais e OHRQoL não foi estudada de forma sistemática, havendo dúvida em relação ao papel das principais variáveis sociais como moduladores de impactos. Este estudo objetivou revisar sistematicamente a literatura para evidenciar a associação entre seis parâmetros sociais e OHRQoL. Baseados em seis critérios de exclusão, a pesquisa bibliográfica revelou quarenta artigos para análise. A frequência de associações esperadas (positivas) entre os parâmetros sociais e OHRQoL foi maior que as associações não esperadas (negativas) para os seis parâmetros. Concluiu-se que as condições sociais mais claramente associadas à percepção de impactos negativos da saúde bucal na qualidade de vida foram mulheres, de baixa escolaridade e baixa renda, imigrantes ou pessoas pertencentes a grupos étnicos minoritários.

Psychometric properties of the OHIP-14 and prevalence and severity of oral health impacts in a rural riverine population in Amazonas State, Brazil.

The objectives of this study were: (1) test the psychometric properties of OHIP-14 in a rural population; and (2) compare the oral health impacts in two riverine communities in the Brazilian Amazon that were living at different distances from an urban center. Data were obtained from a cross-sectional study in a consecutive sample (n = 126). The validity was assessed through the association of OHIP with clinical and subjective variables, which showed a more significant association with: pain, caries, need of extraction or endodontic treatment; than with tooth loss, periodontal disease or need of prostheses. The stability and internal consistency were good (ICC = 0.97; Cronbach's alpha = 0.89). The prevalence of oral impacts was greater in the community far from the urban center [70.3 (59.9-80.7)] than in the community closer to it [44.3 (30.7-57.7)], and in women [66.7 (56.0-77.3)] in comparison with men [49.1 (35.3-62.7)]. The OHIP-14 adapted to rural populations in Amazonas State was valid, reproducible, and consistent. There was high prevalence of impacts, especially for riverine communities that lived far from urban centers.

Psychometric properties of the OHIP-14 and prevalence and severity of oral health impacts in a rural riverine population in Amazonas State, Brazil / Avaliação das propriedades psicométricas do OHIP-14 e da prevalência dos impactos da saúde bucal, em população rural ribeirinha no Amazonas, Brasil

The objectives of this study were: (1) test the psychometric properties of OHIP-14 in a rural population; and (2) compare the oral health impacts in two riverine communities in the Brazilian Amazon that were living at different distances from an urban center. Data were obtained from a cross-sectional study in a consecutive sample (n = 126). The validity was assessed through the association of OHIP with clinical and subjective variables, which showed a more significant association with: pain, caries, need of extraction or endodontic treatment; than with tooth loss, periodontal disease or need of prostheses. The stability and internal consistency were good (ICC = 0.97; Cronbach's α = 0.89). The prevalence of oral impacts was greater in the community far from the urban center [70.3 (59.9-80.7)] than in the community closer to it [44.3 (30.7-57.7)], and in women [66.7 (56.0-77.3)] in comparison with men [49.1 (35.3-62.7)]. The OHIP-14 adapted to rural populations in Amazonas State was valid, reproducible, and consistent. There was high prevalence of impacts, especially for riverine communities that lived far from urban centers.

Os objetivos do trabalho foram: (1) testar as propriedades psicométricas do OHIP-14 em população rural e (2) comparar os impactos da saúde bucal em duas comunidades ribeirinhas amazônicas, com diferentes distâncias do centro urbano. Os dados foram obtidos de uma amostra consecutiva de pacientes (n = 126) em estudo de corte transversal. A validade do instrumento foi testada pela associação do OHIP com variáveis clínicas e subjetivas, sendo mais significativa para as variáveis: dor, cárie, necessidade de extração e de endodontia que para perda dentária, doença periodontal e necessidade de prótese. Estabilidade e consistência interna foram boas (CCI = 0,97; α Cronbach = 0,89). A prevalência de impactos foi maior na comunidade mais distante do centro urbano [70,3 (59,9-80,7)] que na mais próxima [44,3 (30,7-57,7)], e nas mulheres [66,7 (56,0-77,3)] comparadas aos homens [49,1 (35,3-62,7)]. O OHIP-14 adaptado às populações rurais da Amazônia foi válido, reproduzível e consistente. A prevalência dos impactos foi alta, especialmente para ribeirinhos que vivem distante dos centros urbanos.

Prevalência de cárie dentária e condições socioeconômicas em jovens alistandos de Manaus, Amazonas, Brasil / Prevalence of dental caries and socioeconomic conditions among young conscripts in Manaus, Amazonas, Brazil

A cárie dentária tem origem multifatorial e a condição socioeconômica está inserida neste contexto. O objetivo deste estudo foi conhecer a prevalência de cárie, além de verificar sua associação com variáveis socioeconômicas em jovens alistandos de 17 a 19 anos de idade, sexo masculino, em Manaus, Amazonas, Brasil. Foi realizado um estudo transversal com uma amostra de conveniência dos conscritos das Forças Armadas Brasileiras. Os critérios de diagnóstico e questionário socioeconômico foram baseados no levantamento nacional SB Brasil e OMS. Uma única examinadora (kappa = 0,96) realizou o exame bucal em 578 alistandos. Foi utilizado o teste Shapiro-Wilk para verificação de normalidade dos dados; não sendo aceita a normalidade (p = 0,0001), foi utilizado o teste não-paramétrico Kruskall-Walis para comparação das médias e assim verificar a diferença significativa entre CPOD e seus componentes com as variáveis avaliadas. A prevalência de cárie encontrada foi de 88,8 por cento e o índice CPOD médio foi igual a 5,16 ± 0,17. Diferenças estatisticamente significantes foram encontradas nas médias dos componentes Cariado, Perdido e Obturado do índice CPOD, sendo os piores indicadores verificados nos grupos de menor escolaridade, menor renda e procedentes de escola pública, demonstrando maior necessidade de medidas preventivas e assistenciais para estes grupos.

[Provision and utilization of dental services in Amazonas State, Brazil: a case study in a riverine population in Coari municipality]. / Oferta e utilização de serviços de saúde bucal no Amazonas, Brasil: estudo de caso em população ribeirinha do Município de Coari.

This case study described the conditions in the provision and utilization of dental services in two riverine populations in the municipality (county) of Coari, Amazonas State, Brazil. Structured questionnaires were applied to individuals 18 years and older to measure dental services utilization rates. Semi-structured interviews were also conducted with key informants to characterize the provision of such services. Although the bivariate analysis did not detect any statistically significant differences, residents of the area farthest from the county seat had gone more time since their last dental visit and received less care from public health services and riverboat clinics. The qualitative analysis showed: no permanent dental services in the communities; sporadic services provided by riverboat clinics, with less frequent visits to the remotest community; high transportation cost for river-dwellers to seek treatment in the county seat; and dental treatment focused on pain control, mainly through tooth extraction. Limited access to dental services for riverine populations highlights the need to implement comprehensive health promotion measures and expand the availability of services.

Oferta e utilização de serviços de saúde bucal no Amazonas, Brasil: estudo de caso em população ribeirinha do Município de Coari / Provision and utilization of dental services in Amazonas State, Brazil: a case study in a riverine population in Coari Municipality

O presente estudo de caso teve o objetivo de descrever a oferta e utilização de serviços odontológicos em duas comunidades ribeirinhas do Município de Coari, Amazonas, Brasil. Para tanto, foram colhidos dados sobre freqüência de utilização de serviços de saúde bucal, por entrevistas estruturadas com indivíduos acima de 18 anos, e dados sobre oferta de serviços obtidos por entrevistas semi-estruturadas com informantes-chave. Nas análises bivariadas, embora sem diferença estatística, os indivíduos da comunidade mais distante da sede do município apresentaram maior tempo decorrido da última consulta, e menor proporção de atendimentos pelo serviço público e por barcos de saúde. A análise qualitativa das entrevistas revelou: ausência de serviço odontológico permanente nas comunidades; oferta esporádica através de barcos da saúde, com menor ocorrência dos serviços na comunidade mais distante; alto custo do deslocamento do ribeirinho à sede do município; e tratamento odontológico voltado para o controle da dor, basicamente se resumindo à extração dentária. O acesso precário dos ribeirinhos aos serviços de saúde bucal aponta para a necessidade de implantação de medidas amplas de promoção de saúde, aliada a maior oferta de serviços.

This case study described the conditions in the provision and utilization of dental services in two riverine populations in the municipality (county) of Coari, Amazonas State, Brazil. Structured questionnaires were applied to individuals 18 years and older to measure dental services utilization rates. Semi-structured interviews were also conducted with key informants to characterize the provision of such services. Although the bivariate analysis did not detect any statistically significant differences, residents of the area farthest from the county seat had gone more time since their last dental visit and received less care from public health services and riverboat clinics. The qualitative analysis showed: no permanent dental services in the communities; sporadic services provided by riverboat clinics, with less frequent visits to the remotest community; high transportation cost for river-dwellers to seek treatment in the county seat; and dental treatment focused on pain control, mainly through tooth extraction. Limited access to dental services for riverine populations highlights the need to implement comprehensive health promotion measures and expand the availability of services.