Street-level implementers of population-based oral health policies: the case of water fluoridation supply in Brazil's small towns.

BACKGROUND: Knowledge of conditions influencing the performance of street-level operators when implementing population-based policies could increase the understanding of local implementation dynamics. OBJECTIVE: We analyzed how street-level operators claim to act to implement fluoridation policy in the water treatment units of small Brazilian municipalities and identified conditions shaping behavior against adherence to policy. METHODS: A case study using narratives obtained through in-depth interviews with key informants in two pairs of municipalities with contrasting levels of implementation. Analysis identified themes in the data and in the street-level bureaucracy literature. RESULTS: Institutional characteristics such as administrative fragility of local entities, low priority given locally to policy, poor physical structure of the water treatment plants, isolated working relations, low effectiveness of monitoring devices, and local actors' uncertainties about the policy favored the expansion of the discretionary power of street-level operators configuring important barriers for water fluoridation. CONCLUSION: These data highlight the complexity of policy implementation and inform policymakers about the importance of inter-federal and inter-sectoral coordination when implementing population-based health policies in small towns.

Municipality-Level Characteristics Associated with Very Low to Good Quality of Water Fluoridation in São Paulo State, Brazil, in 2015.

INTRODUCTION: Community water fluoridation (CWF) is a measure of recognized importance due to its effectiveness in preventing tooth decay at the population level. However, for the maximum benefit to be achieved, the high-quality standard of CWF must be maintained over time. OBJECTIVE: To analyze the municipality-level characteristics associated with quality of water fluoridation in São Paulo state, Brazil. METHODS: An ecological study was performed using official data sources on fluoride concentration surveillance in 2015. The outcome was municipalities that have not met the quality standard, identified as those with less than 80% of water samples within the optimal level for caries prevention. The independent variables were municipality-level indicators related to demographics, economics, and sanitation characteristics. Crude and adjusted prevalence ratios were estimated using Poisson regression with robust variance. RESULTS: In total, 43.4% municipalities exhibited the outcome. Adjusted by Gini index, the prevalence ratio was 32% higher in municipalities with lower annual gross domestic product per capita. Adjusted by social responsibility index and earlier variables, the prevalence was higher in the municipalities with higher per capita expenditure on sanitation and health surveillance, where the urban population rate was lower, and with a human development index ≤0.761. Adjusted by earlier variables, the prevalence ratio was twice and 3.5 times higher for municipalities, respectively, with per capita income less than or equal to US$574 and where the type of sanitation utility was municipal and private; 50% higher in those with less than 100,000 habitants; and 20% higher in those with a chlorine concentration nonconformity rate above 0.82%. CONCLUSIONS: To ensure high quality of CWF, additional management measures should be implemented in municipalities with less than 100,000 habitants, a higher chlorine concentration nonconformity rate, a lower per capita income, and where the type of sanitation utility was municipal or private. KNOWLEDGE TRANSFER STATEMENT: The study showed that the quality of fluoridation was associated with municipality-level characteristics. The findings can be used by policy makers to identify and support municipalities that will need to improve fluoridation quality if they are to reach oral health goals.

Kinetics of mobilization and differentiation of lymphohematopoietic cells during experimental murine schistosomiasis in galectin-3 -/- mice.

Galectin-3 (gal-3), a beta-galactoside-binding animal lectin, plays a role in cell-cell and cell-extracellular matrix interactions. Extracellular gal-3 modulates cell migration and adhesion in several physiological and pathological processes. Gal-3 is highly expressed in activated macrophages. Schistosoma mansoni eggs display a large amount of gal-3 ligands on their surface and elicit a well-characterized, macrophage-dependent, granulomatous, inflammatory reaction. Here, we have investigated the acute and chronic phases of S. mansoni infection in wild-type and gal-3(-/-) mice. In the absence of gal-3, chronic-phase granulomas were smaller in diameter, displaying thinner collagen fibers with a loose orientation. Schistosoma-infected gal-3(-/-) mice had remarkable changes in the monocyte/macrophage, eosinophil, and B lymphocyte subpopulations as compared with the infected wild-type mice. We observed a reduction of macrophage number, an increase in eosinophil absolute number, and a decrease in B lymphocyte subpopulation (B220(+/high) cells) in the periphery during the evolution of the disease in gal-3(-/-) mice. B lymphopenia was followed by an increase of plasma cell number in bone marrow, spleen, and mesenteric lymph nodes of the infected gal-3(-/-) mice. The plasma IgG and IgE levels also increased in these mice. Gal-3 plays a role in the organization, collagen distribution, and mobilization of inflammatory cells to chronic-phase granulomas, niches for extramedullary myelopoiesis, besides interfering with monocyte-to-macrophage and B cell-to-plasma cell differentiation.

Dental caries experience in Indians of the Upper Xingu, Brazil.

The present study describes the experience of dental caries in Indians communities of the Xingu, in order to supply parameters for further analysis of trends of the disease in Indians. We performed oral health examination in 288 Indians from four communities (Yawalapiti, Aweti, Mehinaku and Kamaiura) living in the southern part of the Xingu National Park, using international criteria defined by the World Health Organization. The outcome measures were the DMFT and dmft scores, and the care index. Indians of the Upper Xingu presented high levels of caries, in all age groups. The average DMFT for 11 to 13-year-old children - 5.93 - was lower than the index measured in 1993 for 12-year-old schoolchildren in nearby cities - 8.23 -, whose United Nations' human development index ranked medium. However, Indians presented a much lower care index, per age group, than these cities, and a high ratio of missing teeth for persons above 20 years old. These observations indicate low incorporation of dental care services. The irregularity of the services programmed for these communities, and the changing dietary and cultural patterns, mainly derived from their contact with the non-indigenous population of Brazil, reinforce the pressing need for health promotion initiatives aimed at these groups.

[Dental caries prevalence in permanent teeth of schoolchildren in the Municipality of Sao Paulo, Brazil, 1970-1996]. / Prevalência de cárie em dentes permanentes de escolares do Município de São Paulo, SP, 1970-1996.

OBJECTIVE: To assess the evolution of dental caries in permanent teeth of schoolchildren in S. Paulo City, Brazil, during the period of 1970-1996. METHODS: The World Health Organization methodology for oral health surveys was applied in 2,491 schoolchildren, both male and female from 103 public and private schools. A probabilistic sample stratified by age, school category, and city zones was obtained by the Education State Service data system. Computational resources were used. RESULTS: Data from the 1996 S. Paulo survey were compared with others data provided by studies such as the one conducted in the same city and the reference-population in the second half of the 20th century. In the 60s and 70s the DMF-T Index among 12-year-old schoolchildren was around 7.0. In 1986 it was 6.5 and in 1996 it was registered 2.1, a decline of 68%. CONCLUSION: Dental caries in permanent teeth among S. Paulo City 12-year-old schoolchildren changed from a "very high" to "low" prevalence.

[Participation of dental auxiliary personnel in local health systems]. / La participación del personal auxiliar de odontología en los sistemas locales de salud.

Though numerous local health systems (sistemas locales de salud, or SILOS) in Brazil employ dental assistants, there is little information on the contributions these workers make to oral health programs. The purpose of this study was to examine the role of such workers in 10 SILOS in five municipalities in the state of São Paulo. Of the 325 dental assistants and dental hygienists employed in those systems, 245 (75.4%) answered a questionnaire that had been prepared. The results showed variations in the degree to which dental assistants participated in oral health promotion activities in the SILOS studied. In some SILOS, these workers devoted more time to dental health promotion activities than to helping perform dental tasks with individual patients. The most frequent oral health promotion activities were fluoride rinses, plaque detection followed by supervised brushing, and educational activities at basic health units and schools. In all cases, dental assistants working in the SILOS played a significant role in helping transform the practice of dentistry within the sphere of public health.