Dental vulnerability scale in primary health care: evidence of content and structure internal validity.

BACKGROUND: Access to oral health services remains a challenge in the Brazilian healthcare system, especially in the primary health care setting, where the use of a risk stratification tool that could identify individuals with higher dental vulnerability would be extremely valuable. However, there literature on this theme is scarce, and there is no validated instrument in Brazil that is capable of measuring dental vulnerability. Hence, this psychometric study aimed at the development and evaluation of content and internal structure validity of the Dental Vulnerability Scale for Primary Health Care (PHC). METHODS: The items were developed based on a qualitative exploratory analysis. A total of 172 items were prepared and submitted to a panel of specialists, with content validity analyzed with the Content Validity Ratio (CVR), resulting in an the initial version of the instrument composed by 41 items. Internal structure validity was analyzed by Exploratory Factor Analysis (EFA), Confirmatory Factor Analysis (CFA), and by applying 3 reliability indicators (Cronbach's Alpha, McDonald's Omega and Greatest Lower Bound - GBL), with a sample of 1227 individuals. RESULTS: The final configuration indicated a scale of 15 items divided into 4 dimensions (overall health, oral health, infrastructure, and healthcare services) with explained variance of 72.11%. The factor loads varied from 0.37 to 0.96. The model adjustment indices were set at × 2/df(51) = 3.23, NNFI = 0.95, CFI = 0.98, GFI = 0.96, AGFI = 0.97, RMSEA = 0.04 and RMSR = 0.03. CONCLUSION: DVS presented satisfactory evidence of validity, indicating its suitability to be used by healthcare professionals, students and managers to plan oral health actions and services at PHC.

Spatial analysis and climatic factors related to dengue in a small municipality of São Paulo, Brazil / Análise espacial e fatores climáticos relacionados à dengue, em município de pequeno porte de São Paulo, Brasil

Objective: to analyze the relationship of climatic variables, temperature and rainfall, - with dengue, in addition to identifying possible areas of greater spatial concentration of confirmed dengue cases. Methods: This is an ecological study with secondary data in the city of Ubirajara / SP. The confirmed cases of Dengue, assumed as an outcome, were obtained from the Aging and Notification Information System (SINAN) of the Ministry of Health; while the climatic data were used as independent variables and temperature and precipitation were provided by IPMet - Center of Meteorology of Bauru / SP, from 2007 to 2015. Pearson's correlation (r) was used for statistical analyzes. The addresses were geocoded and related to the digital cartoFigureic base of the municipality through the software QGIS and elaborated the thematic map through the kernel intensity estimator. Results: 187 cases of dengue were reported in the study period, with 119 cases (63.7%) occurring in 2015 with an incidence coefficient of 25.39 cases per 1,000 inhabitants. Mean annual temperature correlated positively with dengue and (r) (Pearson) cases = 0.6889, p = 0.0401 (α = Type I error) and ß = 0.6652 (Type II error). The Kernel map identified four areas of greatest concentration for dengue transmission. Conclusions: The relationship between temperature increase and dengue cases requires adequate responses from the institutions, with continuous monitoring of trends, construction of predictive models for the formulation of plans by using spatial analysis in the identification of the priority areas for actions that will be performed. (AU)

Objetivo: analisar a relação das variáveis climáticas, temperatura e precipitação pluviométrica, com a dengue, além de identificar possíveis áreas de maior concentração espacial de casos confirmados de dengue. Métodos: Trata-se de um estudo ecológico com dados secundários do município de Ubirajara/ SP. Os casos confirmados de Dengue, assumidos como desfecho, foram obtidos junto ao Sistema de Informação de Agravos e Notificações (SINAN) do Ministério da Saúde; enquanto os dados climáticos utilizados como variáveis independentes foram temperatura e precipitação, os quais foram fornecidos pelo Centro de Meteorologia de Bauru/ SP - IPMet, no período de 2007 a 2015. Utilizou- se a correlação Pearson (r) para as análises estatísticas. Os endereços foram geocodificados e relacionados com a base cartográfica digital do município, por meio do software QGIS. Foi elaborado o mapa temático segundo o estimador de intensidade de Kernel. Resultados: Foram notificados 187 casos de dengue no período do estudo; no entanto, somente em 2015 registraram-se 119 casos (63,7%), com um coeficiente de incidência de 25,39 casos por 1.000 habitantes. A temperatura média anual se correlacionou positivamente com os casos de dengue e r (Pearson) = 0,6889, p = 0,0401 (α = Erro tipo I) e ß = 0,6652 (Erro tipo II). O mapa de Kernel identificou quatro áreas de maior concentração para a transmissão da dengue. Conclusões: A relação do aumento da temperatura com os casos de dengue exige respostas adequadas das instituições, como o acompanhamento permanente de tendências, de construção de modelos preditivos e de formulação de planos que façam uso de análise espacial na identificação de áreas prioritárias para as ações que serão realizadas. (AU)