Correlação entre indicadores de desenvolvimento municipal e de saúde bucal em uma mesorregião metropolitana do Brasil / Correlation between municipal development indicators and oral health in a Brazilian metropolitan mesoregion

Resumo Introdução O estudo da relação entre indicadores sociais e indicadores de saúde bucal pode contribuir para a avaliação dos impactos das políticas e ações de saúde. Objetivo Investigar a correlação entre indicadores de desenvolvimento municipal e indicadores de saúde bucal dos municípios integrantes da mesorregião metropolitana de Curitiba, Paraná, Brasil. Método Estudo epidemiológico do tipo ecológico, por meio de dados referentes ao Índice de Desenvolvimento Humano Municipal (IDHM) do ano 2010, obtidos no portal Atlas Brasil; Índice Ipardes de Desempenho Municipal (IPDM) dos anos 2015 e 2016, obtidos no portal do Ipardes; e indicadores de saúde bucal dos anos 2015 a 2018, oriundos do SIA/SUS. Posteriormente, foi empregado o teste de correlação de Spearman. Resultados Verificou-se correlação positiva estatisticamente significativa entre indicadores de desenvolvimento municipal e indicadores de primeira consulta odontológica programática no ano de 2017; correlação negativa entre IDHMs e exodontias nos anos de 2015 e 2016; correlação positiva entre IPDMs e procedimentos odontológicos individuais básicos dos anos 2015 a 2018. Conclusão Houve correlação significativa entre os indicadores de desenvolvimento municipal e os indicadores de saúde bucal. Municípios com maiores índices de desenvolvimento proporcionaram maior acesso aos serviços de saúde bucal e menores proporções de exodontias por habitante.

Abstract Background The study of the correlation between social and oral health indicators can contribute to evaluating the impacts of health policies and actions. Objective To investigate the correlation between municipal development indicators and oral health indicators in the metropolitan region of Curitiba, Paraná, Brazil. Method Epidemiological study of the ecological type was carried out, using data from the Municipal Human Development Index (MHDI) of the year 2010, obtained from the Atlas Brasil portal; Ipardes Municipal Performance Index (IPDM) of the years 2015 and 2016, obtained from the Ipardes portal; and oral health indicators from 2015 to 2018, from SIA/SUS. Subsequently, the Spearman correlation test was used. Results There was a statistically significant positive correlation between municipal development indicators and indicators of the first programmatic dental consultation in 2017; a negative correlation between MHDI and tooth extractions, in the years 2015 and 2016; a positive correlation between IPDM and basic individual dental procedures from the years 2015 to 2018. Conclusion There was a significant correlation between the municipal development indicators and the oral health indicators. Municipalities with higher development rates provided greater access to oral health services and lower proportions of tooth extractions per inhabitant.

A relação entre indicadores de desenvolvimento humano e de saúde materna nos municípios da Região Metropolitana de Curitiba - PR / The relation between human development indicators of maternal health in the cities of Metropolitan Region of Curitiba - PR

Resumo Introdução A melhoria da saúde materna pode ser avaliada e monitorada por meio dos indicadores de saúde, os quais refletem não somente a qualidade das ações de promoção em saúde pública, mas também as iniquidades sociais. O objetivo deste estudo consistiu em analisar a relação entre os indicadores de desenvolvimento humano e os de saúde materna dos municípios da região metropolitana de Curitiba/PR. Método Este estudo é classificado como descritivo, correlacional, com o uso de dados secundários quantitativos. Na análise estatística utilizou-se o teste de correlação de Pearson, com nível de significância de 95%. Resultados Os indicadores de desenvolvimento humano apresentaram correlação positiva com o percentual de crianças nascidas vivas com sete ou mais consultas pré-natais; correlação negativa com o percentual de crianças nascidas vivas por parto normal; correlação positiva com a porcentagem de crianças nascidas vivas por cesariana; e correlação negativa com o percentual de crianças nascidas de mães adolescentes. Conclusão Os piores indicadores encontrados nos municípios com menor desenvolvimento humano evidenciam a necessidade de ampliar as ações destinadas às populações mais vulneráveis, reduzindo as iniquidades sociais, a fim de ampliar o acesso às ações e serviços de saúde.

Abstract Introduction Improving maternal health can be assessed and monitored by the health indicators, which not only reflect the quality of health promotion in public health but also social inequities. The aim of this study was to analyze the relationship between human development indicators and maternal health of municipalities in the metropolitan region of Curitiba - PR. Method This study is classified as descriptive, correlational, with the use of quantitative secondary data. Statistical analysis was performed using the Pearson correlation test with 95% significance level. Results The human development indicators showed a positive correlation with the percentage of live births with seven or more prenatal visits; negative correlation with the percentage of live births by natural childbirth; positive correlation with the percentage of live births by cesarean section; and a negative correlation with the percentage of children born to teenage mothers. Conclusion The worst indicators found in the municipalities with the lowest human development show the need to expand the actions aimed at the most vulnerable populations, reducing social inequities in order to expand access to health actions and services.

[Social determinants and adult oral health in Brazilian state capitals]. / Determinantes sociais e saúde bucal de adultos nas capitais do Brasil.

OBJECTIVE: To assess the correlation between the social determinants of oral health (SDOH) index and social indicators, indicators of oral health, and intermediary social determinants expressed by the indicators of the Government of Brazil's National Oral Health Policy. METHODS: This ecological study included 5 915 adults aged 35 to 44 years from 27 Brazilian capitals. Indicators of oral health outcomes-tooth loss, restored teeth, and dental care index (DCI)-were extracted from the 2010 National Oral Health Survey. Social indicators (structural social determinants) and indicators of the National Oral Health Policy were obtained from census data and from the Ministry of Health. RESULTS: A moderate Pearson correlation (r) was observed between SDOH and DCI (r = 0.580), restored teeth (r = 0.545), and tooth loss (r = - 0.490). The social equity component was strongly correlated to DCI (r = 0.856), restored teeth (r = 0.822), and tooth loss (r = - 0.665). These oral health outcomes were not statistically associated with the components related to primary and secondary oral health care. The social equity component explained 44% of the variance in tooth loss, 68% of the variance in the number of restored teeth, and 73% of the variance in DCI. CONCLUSIONS: A significant correlation was observed between SDOH and the social equity component with oral health outcomes in adults in Brazilian capitals. Therefore, equity policies should prioritize actions focused on the SDOH, such as increased sanitation coverage and water fluoridation, and on reducing poverty and regional inequities.

Determinantes sociais e saúde bucal de adultos nas capitais do Brasil / Social determinants and adult oral health in Brazilian state capitals

OBJETIVO: Investigar a correlação entre o índice Determinantes Sociais de Saúde Bucal (DSSB) e indicadores sociais, indicadores de saúde bucal e determinantes sociais intermediários, representados pelos indicadores da Política Nacional de Saúde Bucal. MÉTODOS: Este estudo ecológico abrangeu 5 915 adultos de 35 a 44 anos em 27 capitais no Brasil. Os indicadores de desfechos em saúde bucal - perda dentária, dentes restaurados e Índice de Cuidados Odontológicos (ICO) - foram obtidos do levantamento epidemiológico SB Brasil 2010. Os indicadores sociais (determinantes sociais estruturais) e da Política Nacional de Saúde Bucal foram obtidos de censos demográficos e do Ministério da Saúde. RESULTADOS: Uma correlação de Pearson (r) moderada foi observada entre o índice DSSB e ICO (r = 0,580), dentes restaurados (r = 0,545) e perda dentária (r = - 0,490). Houve uma correlação forte do componente equidade social com o ICO (r = 0,856), dentes restaurados (r = 0,822) e perda dentária (r = -0,665). Não houve associação estatisticamente significativa desses desfechos em saúde bucal com os componentes relativos à atenção primária e secundária à saúde bucal. O componente equidade social explicou 44% da variância da perda dentária, 68% da variância de dentes restaurados e 73% da variância do ICO. CONCLUSÕES: O índice DSSB e seu componente equidade social se correlacionaram significativamente com desfechos em saúde bucal de adultos nas capitais brasileiras. Portanto, políticas equitativas devem priorizar ações direcionadas aos DSSB, tais como ampliação da cobertura de saneamento e de água fluoretada, e redução da pobreza e das iniquidades regionais.

OBJECTIVE: To assess the correlation between the social determinants of oral health (SDOH) index and social indicators, indicators of oral health, and intermediary social determinants expressed by the indicators of the Government of Brazil's National Oral Health Policy. METHODS: This ecological study included 5 915 adults aged 35 to 44 years from 27 Brazilian capitals. Indicators of oral health outcomes-tooth loss, restored teeth, and dental care index (DCI)-were extracted from the 2010 National Oral Health Survey. Social indicators (structural social determinants) and indicators of the National Oral Health Policy were obtained from census data and from the Ministry of Health. RESULTS: A moderate Pearson correlation (r) was observed between SDOH and DCI (r = 0.580), restored teeth (r = 0.545), and tooth loss (r = - 0.490). The social equity component was strongly correlated to DCI (r = 0.856), restored teeth (r = 0.822), and tooth loss (r = - 0.665). These oral health outcomes were not statistically associated with the components related to primary and secondary oral health care. The social equity component explained 44% of the variance in tooth loss, 68% of the variance in the number of restored teeth, and 73% of the variance in DCI. CONCLUSIONS: A significant correlation was observed between SDOH and the social equity component with oral health outcomes in adults in Brazilian capitals. Therefore, equity policies should prioritize actions focused on the SDOH, such as increased sanitation coverage and water fluoridation, and on reducing poverty and regional inequities.

Governança, sustentabilidade e equidade no plano de saúde de São José dos Pinhais, Brasil / Governance, sustainability, and equity in the health program for the municipality of São José dos Pinhais, Brazil

OBJETIVO: Analisar o Relatório Final da VIII Conferência de Saúde e o Plano Municipal de Saúde de São José dos Pinhais 2010-2013 e verificar se esses documentos contemplaram os temas sustentabilidade, governança e equidade e as interfaces entre esses temas - políticas de governo e estado, balanço de poder e processo inclusivo e resultados impactantes -, que compõem um Modelo Conceitual para Desenvolvimento Humano e Promoção da Saúde proposto pelos autores. MÉTODOS: Neste estudo de caso, foram analisadas as 331 propostas aprovadas para incorporação no Plano Municipal de Saúde. Foram analisadas as seis categorias temáticas do Modelo Conceitual para Desenvolvimento Humano e Promoção da Saúde pelo programa ATLAS Ti 5.0. As propostas foram classificadas pelo número de temas e interfaces do Modelo Conceitual: propostas plenas de promoção de saúde continham as seis categorias de conceitos e interfaces; propostas de promoção parcial continham três categorias; e propostas incipientes continham uma categoria. RESULTADOS: Das 331 propostas aprovadas, 162 (49%) contemplaram as seis categorias temáticas, sendo classificadas como propostas plenas de promoção da saúde. Noventa e cinco (29%) contemplaram três categorias, sendo classificadas como de parcial promoção da saúde. Dessas, 38 (12%) contemplaram as categorias governança, sustentabilidade e políticas de governo/estado, 33 (10%) contemplaram governança, balanço de poder e equidade e 24 (7%) contemplaram equidade, processo inclusivo/resultados impactantes e sustentabilidade. Finalmente, 74 (22%) propostas contemplaram uma categoria, sendo classificadas como proposta de incipiente promoção da saúde: 36 (11%) contemplaram governança, 27 (8%) contemplaram sustentabilidade e 11 (3%) contemplaram equidade. CONCLUSÕES: Tendo em vista que 49% das propostas foram classificadas como de promoção plena da saúde, o controle social, a partir da participação popular na construção do plano de saúde, contribuiu para a promoção da saúde no município.

OBJECTIVE: To analyze the Final Report of the VIII Health Conference and the São José dos Pinhais City Health Program for 2010-2013 and investigate whether these documents addressed the themes of sustainability, governance, and equity and the interfaces between these themes-government policies, power balance, and inclusive processes/impacting results-that make up the Concept Model for Human Development and Health Promotion developed by the authors. METHOD: This case study analyzed 331 proposals approved for incorporation in the City Health Program. The six thematical categories of the Concept Model were analyzed using ATLAS Ti 5.0 software. The proposals were classified according to the number of themes and interfaces of the Concept Model: full health proposals contained all six categories; partial proposals contained three categories; and incipient proposals contained one category. RESULTS: Of 331 proposals approved, 162 (49%) contemplated the six thematical categories and were classified as full health promotion proposals. Ninety-five (29%) contemplated three categories (partial health promotion). Of these, 38 (12%) addressed Governance, Sustainability, and Government Policies, 33 (10%) addressed Governance, Power Balance, and Equity and 24 (7%) addressed Equity, Inclusive Processes/Impact Results, and Sustainability. Finally, 74 (22%) proposals contemplated only one category and were classified as incipient: 36 (11%) addressed Governance, 27 (8%) addressed sustainability, and 11 (3%) addressed equity. CONCLUSIONS: Based on the fact that 49% of the proposals approved were classified as full health promotion, it is considered that the effectiveness of social control and popular participation in the construction of health policies at the local level contritute to the promotion of health in the city.

[Governance, sustainability, and equity in the health program for the municipality of São José dos Pinhais, Brazil]. / Governança, sustentabilidade e equidade no plano de saúde de São José dos Pinhais, Brasil.

OBJECTIVE: To analyze the Final Report of the VIII Health Conference and the São José dos Pinhais City Health Program for 2010-2013 and investigate whether these documents addressed the themes of sustainability, governance, and equity and the interfaces between these themes--government policies, power balance, and inclusive processes/impacting results--that make up the Concept Model for Human Development and Health Promotion developed by the authors. METHOD: This case study analyzed 331 proposals approved for incorporation in the City Health Program. The six thematical categories of the Concept Model were analyzed using ATLAS Ti 5.0 software. The proposals were classified according to the number of themes and interfaces of the Concept Model: full health proposals contained all six categories; partial proposals contained three categories; and incipient proposals contained one category. RESULTS: Of 331 proposals approved, 162 (49%) contemplated the six thematical categories and were classified as full health promotion proposals. Ninety-five (29%) contemplated three categories (partial health promotion). Of these, 38 (12%) addressed Governance, Sustainability, and Government Policies, 33 (10%) addressed Governance, Power Balance, and Equity and 24 (7%) addressed Equity, Inclusive Processes/Impact Results, and Sustainability. Finally, 74 (22%) proposals contemplated only one category and were classified as incipient: 36 (11%) addressed Governance, 27 (8%) addressed sustainability, and 11 (3%) addressed equity. CONCLUSIONS: Based on the fact that 49% of the proposals approved were classified as full health promotion, it is considered that the effectiveness of social control and popular participation in the construction of health policies at the local level contritute to the promotion of health in the city.

Sustainable development and child health in the Curitiba metropolitan mesoregion, State of Paraná, Brazil.

The purpose of this study was to analyze social determinants of health through the relationship between Sustainable Development and child health outcomes. The population studied lives in 37 municipalities of the Curitiba mesoregion, in the State of Paraná, Brazil. It is a cross-cutting ecological study. In the 1st phase of the study, 16 contextual indicators were obtained from the 2010 demographic census performed by the Brazilian Institute of Geography and Statistics. Principal Components Factor Analysis was undertaken to demonstrate possible correlations between social determinants of health, resulting in Sustainable Development indices for the places where the children live. In the 2nd phase the mortality rate in children aged under 5 was obtained from the Ministry of Health database. Pearson's correlation demonstrated statistically significant, moderate and negative association between the mortality rate in children aged under 5 (2001-2010) and the Sustainable Development Index (r = -0.62, p<0.01); with the Equity component (r = -0.70, p<0.01); and with the clusters (r = -0.68, p<0.01). Contextual indicators of Sustainable Development for the places where the children live showed themselves to be associated with the child health outcome. As such, equitable and sustainable social policies, based on inclusive health promotion strategies, need to be integrated into the children's life context.

[Intersectoriality in health promotion actions carried out by the oral health team of Curitiba, Paraná State]. / Intersetorialidade nas ações de promoção de saúde realizadas pelas equipes de saúde bucal de Curitiba (PR).

This study sought to explore the intersectoral actions developed by the oral health teams of Curitiba, Paraná State, and to analyze the local managers' perception about intersectoral approach. A cross-sectional study with quantitative and qualitative methodology was used, with data collection by a self-response questionnaire and focal group technique. The results showed that most health promotion actions carried out by the teams are interdisciplinary and when other sectors are involved it is in turning physical spaces available, without jointed and integrated perspectives. The managers' perception reinforces in the concept the teams' practices. It was observed that the Family Health Strategy facilitate intersectoral actions and the intersectorality is a challenging way of work, but possible to become reality.

Intersetorialidade nas ações de promoção de saúde realizadas pelas equipes de saúde bucal de Curitiba (PR) / Intersectoriality in health promotion actions carried out by the oral health team of Curitiba, Paraná State

O objetivo deste estudo foi explorar as ações intersetoriais desenvolvidas pelas equipes de saúde bucal na rede Municipal de Saúde de Curitiba (PR) e analisar a percepção dos gestores locais ligados a estas equipes sobre a intersetorialidade. Utilizou-se um modelo de estudo transversal de metodologia quantitativa e qualitativa, com coleta de dados por meio de um questionário autoaplicável e a técnica do grupo focal. Os resultados mostraram que as maiorias das ações de promoção de saúde realizadas pelas equipes são interdisciplinares e quando há envolvimento de outros setores é na disponibilização de espaços físicos, sem uma perspectiva de ação conjunta e integrada. A percepção dos gestores reitera no conceito as práticas das equipes. Observou-se que a Estratégia da Saúde da Família é facilitadora de ações intersetoriais e que, apesar das dificuldades, a intersetorialidade é uma forma de trabalho desafiadora, mas possível de tornar-se realidade.

This study sought to explore the intersectoral actions developed by the oral health teams of Curitiba, Paraná State, and to analyze the local managers' perception about intersectoral approach. A cross-sectional study with quantitative and qualitative methodology was used, with data collection by a self-response questionnaire and focal group technique. The results showed that most health promotion actions carried out by the teams are interdisciplinary and when other sectors are involved it is in turning physical spaces available, without jointed and integrated perspectives. The managers' perception reinforces in the concept the teams' practices. It was observed that the Family Health Strategy facilitate intersectoral actions and the intersectorality is a challenging way of work, but possible to become reality.

Millennium development goals and oral health in cities in Southern Brazil.

OBJECTIVES: To investigate social determinants of oral health, analysing the occurrence of associations between millennium development goals (MDG) indicators and oral health (OH) indicators. METHODS: An ecological study was performed in two distinct phases. In Phase 1, MDG indicators and related covariates were obtained from the demographic census of the Brazilian Institute of Geography and Statistics, the Ministry of Health database and the 2000 Human Development Atlas, making up the whole set of independent variables. Principal component analysis was carried out for the independent variables showing the correlations among the variables comprising the main components, and generating a synthetic index allowing the performance of the cities to be known with regard to the MDG (MDG index). In Phase 2, the DMFT index (mean number of decay, missing or filled permanent teeth) and the CF index (prevalence of caries-free individuals), in 12 years old were obtained from the epidemiological survey undertaken in 2002-2003, in 49 cities in southern Brazil, and were analysed in relation to the MDG index using Spearman's correlation. RESULTS: A statistically significant correlation was found for the DMFT and CF indices, respectively, with: the MDG index (R(2)=0.49 and 0.48; P = 0.00); the socioeconomic status of the population (R(2)= 0.12 and 0.12; P = 0.02); the socioenvironmental characteristics (R(2)=0.41 and 0.46; P= 0.00). CONCLUSIONS: The MDG synthetic index of the cities analysed and the respective components relating to their socioeconomic and socioenvironmental status demonstrated a positive correlation with OH indicators. As such, intersectoral public policies based on population strategies that act on social determinants of general and oral health need to be integrated so as to impact on the MDG and OH outcomes.