[Mortality due to ill-defined causes in Brazil (1979-2002) and a predictive model for age]. / Mortalidade por causas mal definidas, Brasil, 1979-2002, e um modelo preditivo para idade.

This study focused on the percentage of deaths due to ill-defined causes in Brazil, from 1979 to 2002. The objectives were to: (a) describe changes over the 24-year period; (b) identify the age group in which the percentage of ill-defined causes correlated most closely with the total percentage of ill-defined causes; (c) select a predictive model for the percentage of ill-defined causes in such age group, given the total percentage of ill-defined causes; (d) describe changes in the distributions of each age group in the total ill-defined causes; and (e) verify whether the percentage of deaths in-hospital shows any relationship to the percentage of ill-defined causes. Results showed that the total percentage of deaths from ill-defined causes decreased in Brazil. The percentage of ill-defined causes in the > 50-year age group correlated most closely with the total percentage of ill-defined causes, and cubic regression was the most appropriate predictive model. Age > 50 showed the highest increase in its share of total ill-defined causes from 1979 to 2002. The percentage of in-hospital deaths showed an inverse relationship with the percentage of deaths from ill-defined causes.

AIDS by mother-to-child transmission: survival analysis of cases followed from 1983 to 2002 in different regions of Brazil.

Antiretroviral therapy contributes to decreasing morbidity and mortality, and ultimately to increasing survival. In Brazil, there are regional differences in HIV epidemiology regarding pregnant women and children with HIV/AIDS. This study evaluates survival time after AIDS diagnosis in 914 children infected by mother-to-child transmission, reported between 1983 and 1998 and followed until 2002, in Brazil's five regions. Time between birth and HIV diagnosis decreased over the years, mainly in the South and Southeast Regions. There was a significant improvement in survival; more than 75% of cases were still living four years after diagnosis in the 1997-1998 group. This Brazilian study demonstrates that even with regional inequalities in health care infrastructure it is possible for a developing country to establish an effective system of universal and free access to antiretroviral therapy that produces a significant increase in survival for children with AIDS.

[Internal migration and distribution of Chagas disease mortality, Brazil, 1981-1998]. / Migração interna e a distribuição da mortalidade por doença de Chagas, Brasil, 1981/1998.

In Brazil, mortality from Chagas disease occurs even in regions classified as free of vector transmission. Because death rates refer to residents, and considering that a huge migratory movement has occurred inside the country, this study was intended to quantify the contribution of Brazilian internal migration to overall mortality from Chagas disease, from 1981 to 1998. If the PAHO Southern Cone Initiative actually achieved its objectives, one could expect declining death rates and increasing age at death from this cause. The results showed that out of 68,936 deaths in Brazilians with known birthplace, 32,369 (32%) occurred in people born in States other than those of their current residence (range: from 0.3% in Rio Grande do Sul to 100% in Roraima and Amapá). Most (67%) of the deaths in migrants occurred in individuals born in the States of Minas Gerais (51%) and Bahia (16%). Death rates in residents showed a consistent decline in the Southeast, South, and Central West of the country, but not in the Northeast and North, where median age at death was the lowest.

Severity of malocclusion in adolescents: populational-based study in the north of Minas Gerais, Brazil.

OBJECTIVE: To identify the factors associated with severity of malocclusion in a population of adolescents. METHODS: In this cross-sectional population-based study, the sample size (n = 761) was calculated considering a prevalence of malocclusion of 50.0%, with a 95% confidence level and a 5.0% precision level. The study adopted correction for the effect of delineation (deff = 2), and a 20.0% increase to offset losses and refusals. Multistage probability cluster sampling was adopted. Trained and calibrated professionals performed the intraoral examinations and interviews in households. The dependent variable (severity of malocclusion) was assessed using the Dental Aesthetic Index (DAI). The independent variables were grouped into five blocks: demographic characteristics, socioeconomic condition, use of dental services, health-related behavior and oral health subjective conditions. The ordinal logistic regression model was used to identify the factors associated with severity of malocclusion. RESULTS: We interviewed and examined 736 adolescents (91.5% response rate), 69.9% of whom showed no abnormalities or slight malocclusion. Defined malocclusion was observed in 17.8% of the adolescents, being severe or very severe in 12.6%, with pressing or essential need of orthodontic treatment. The probabilities of greater severity of malocclusion were higher among adolescents who self-reported as black, indigenous, pardo or yellow, with lower per capita income, having harmful oral habits, negative perception of their appearance and perception of social relationship affected by oral health. CONCLUSIONS: Severe or very severe malocclusion was more prevalent among socially disadvantaged adolescents, with reported harmful habits and perception of compromised esthetics and social relationships. Given that malocclusion can interfere with the self-esteem of adolescents, it is essential to improve public policy for the inclusion of orthodontic treatment among health care provided to this segment of the population, particularly among those of lower socioeconomic status.

[Prevalence of a set of risk factors for chronic diseases in the city of São Paulo, Brazil]. / Prevalência de alguns fatores de risco para doenças crônicas na cidade de São Paulo.

OBJECTIVE: To estimate the prevalence of a set of risk factors for non-transmissible chronic diseases and compare it to that found 15-16 years ago in a similar survey. METHODS: A cross-sectional household survey was carried out comprising a random sample of people aged 15-59 years in the city of São Paulo between 2001 and 2002. The total of 2,103 people answered a questionnaire and had their blood pressure, weight, height, waist and hip circumferences measured. For a third of these participants, their total cholesterol, HDL-cholesterol, triglycerides and glucose levels were determined. RESULTS: The total age-adjusted prevalences in the study age group were as follows: smoking, 22.6%; uncontrolled blood pressure, 24.3%; obesity, 13.7%; increased waist circumference, 19.7%; total cholesterol >or =240 mg/dL, 8.1%; HDL-cholesterol <40 mg/dL, 27.1%; triglycerides > or =200 mg/dL, 14.4%; and blood glucose > or =110 mg/dL, 6.8%. Smoking, uncontrolled blood pressure, high total cholesterol, low HDL-cholesterol and high triglycerides were significantly more prevalent in men than women. CONCLUSIONS: The prevalences of a set of risk factors for chronic diseases showed men to have a poorer condition than women. In comparison to the previous survey, the prevalence of uncontrolled blood pressure remained unchanged but the prevalence of smoking has significantly lowered.

[Tooth decay and associated factors among adolescents in the north of the State of Minas Gerais, Brazil: a hierarchical analysis]. / Cárie dentária e fatores associados entre adolescentes no norte do estado de Minas Gerais, Brasil: uma análise hierarquizada.

This is a cross-sectional population-based study (n = 763) conducted in the north of the State of Minas Gerais, which aimed to investigate the prevalence of tooth decay among adolescents and to identify the potential determinants of same. Probability sampling by conglomerates in multiple stages was used. Trained and calibrated professionals performed the data collection by means of intraoral examination and interviews in the previously selected households. In the analysis of the determinant factor for the presence of tooth decay, hierarchical binary logistic regression models were used. The prevalence of tooth decay, decayed, missing and filled teeth were 71.3%, 36.5%, 55.6% and 16%, respectively. The following averages were observed: DMFT (3.4 teeth), number of decayed (0.8 teeth), restored (2.4 teeth) and missing (0.2 teeth). The incidence of tooth decay was higher among adolescents who stated they were black/indigenous/brown (OR = 1.76), lived in crowded households (OR = 2.4), did not regularly visit or had never been to a dentist (OR = 1.9), used public or philanthropic services (OR = 1,8), had smoking habits (OR = 4.1), consumed alcohol (OR = 1.8), perceived their oral health negatively (OR = 5.9 and OR = 1.9) and had toothac in the last six months (OR = 2.0).

Improving survival among Brazilian children with perinatally-acquired AIDS.

UNLABELLED: Brazil was the first developing country to provide free, universal access to antiretroviral treatment for AIDS patients. The Brazilian experience thus provides the first evidence regarding the impact of such treatment on the survival of perinatally acquired AIDS cases in the developing world. MATERIAL AND METHODS: This retrospective cohort study used medical record reviews to examine characteristics and trends in the survival of a representative sample of 914 perinatally acquired AIDS cases in 10 Brazilian cities diagnosed between 1983 and 1998. RESULTS: Survival time increased steadily and substantially. Whereas half of the children died within 20 months of diagnosis at the beginning of the epidemic, 75% of children diagnosed in 1997 and 1998 were still alive after four years of follow-up. CONCLUSIONS: Advances in management and treatment have made a great difference in the survival of Brazilian children with AIDS. These results argue strongly for making such treatment available to children in the entire developing world.

[Ischemic heart disease: mortality in natives and migrants, São Paulo, Brazil, 1979-1998]. / Doenças isquêmicas do coração: mortalidade em nativos e migrantes, São Paulo, 1979-1998.

OBJECTIVE: The State of S o Paulo has been a major center of attraction for foreign and Brazilian migrants since the 19th century. The pattern of mortality due to ischemic heart disease according to place of birth is, however, unknown. Thus, the objective of the study was to identify differences in mortality due to ischemic heart disease among residents of the State of S o Paulo according to their place of birth. METHODS: Analytical time series study based on secondary data. Rates were not calculated due to lack of denominators. Instead, non-census indicators (proportional mortality and standardized mortality ratio weighted for years of potential life lost before the age of 100 years) and medians were utilized. Temporal trends were analyzed by means of simple linear regression. RESULTS: In the State of S o Paulo, about 40% of deaths due to ischemic heart disease occurred among migrants. The trend was negative for foreigners and positive for Brazilian migrants. Those born in northeastern Brazil, who presented the highest percentage of deaths in hospitals, had the worst performance: their proportional mortality due to ischemic heart disease remained unchanged throughout the study period (while this clearly declined for all other groups) and they died at younger ages. CONCLUSIONS: Migrants' share of total deaths due to ischemic heart disease in the State of S o Paulo is very high. While there is a declining trend for foreigners, it is growing among Brazilian migrants. Among the compared groups, mortality due to ischemic heart disease in the State of S o Paulo is most prominent for those born in northeastern Brazil.

[Breastfeeding among teenage and adult mothers in Brazil]. / Amamentação entre mães adolescentes e não-adolescentes, Montes Claros, MG.

OBJECTIVE: To estimate the prevalence of breastfeeding among teenage (younger than 20 years old) and adult mothers of six-month-old children and to identify factors associated with weaning. METHODS: A cross-sectional study of a sample of 237 teenage mothers and 239 adult mothers living in the city of Montes Claros, Brazil, whose babies were six-month-old at the time of the interview was carried out. Mothers answered a questionnaire at home. To assess factors associated with weaning, univariate, Mantel-Haenszel, and multiple logistic regression analyses were performed. RESULTS: Breastfeeding prevalence in children aged 6 months was 71.3% among teenage mothers and 77.4% among adult mothers (crude OR=1.38; p=0.128), but after adjusting for control variables the role of adolescence added considerable weight to weaning. Factors associated with weaning were: marital status, mother's occupation after delivery (both showed interaction with teenage years), difficulty to breastfeeding in the first days after delivery, and exclusive breastfeeding at the time of hospital discharge. CONCLUSIONS: The observed interactions with teenage in regard to weaning suggest that motherhood in this age group has unique features that should be further investigated.

[Medication use patterns among elderly people in urban area in Northeastern Brazil]. / Perfil de utilização de medicamentos por idosos em área urbana do Nordeste do Brasil.

OBJECTIVE: To identify medication use patterns among elderly people residing in areas with different socioeconomic status in the city of Fortaleza, Brazil. METHODS: A total of 668 elderly (aged 60 years or older) residing in the city of Fortaleza, Ceará, Brazil, selected from a multistage random sampling stratified by socioeconomic status (higher, intermediate, and lower areas), were interviewed in a household survey. Descriptive statistics for dichotomous variables were presented as percent of the respective totals, and those for continuous variables as mean +/- SD. Multivariate analyses were performed to identify factors associated with the use of prescription, non-prescription and inappropriate) drugs. RESULTS: Most (80.3% in the higher area) were on at least one non-prescription drug. More than one third (37.4%) were on at least one non- prescription drug and nearly 20% used at least one inappropriate in the lower area. PD use was associated with advanced age (OR=1.7, 95% CI=1.1-2.8); male sex (OR=0.5, 95% CI=0.3-0.7); health service visits (OR=2.5, 95% CI=1.9-3.1); chronic diseases (OR=4.0, 95% CI=2.5-6.2); and higher socioeconomic status (OR=2.0, 95% CI=1.5-2.6).Non- prescription drug use was associated with disability (OR=1.5, 95% CI=1.1-2.2), and higher socioeconomic status (OR=0.6; 95% CI=0.5-0.8). Inappropriate drugs use was mainly associated with male sex (OR=0.4, 95% CI=0.2-0.8); chronic diseases (OR=2.0, 95% CI=1.2-3.3); and higher socioeconomic status (OR=0.7, 95% CI=0.5-0.9). CONCLUSIONS: The proportions of elderly using prescription, non-prescription and inappropriate drugs were remarkable and inequalities were seen particularly among those from different socioeconomic status. These results emphasize the need for strategies to optimize the access and rationalize the use of drugs for elderly people in Brazil.

[Prevalence of asthma and asthma symptoms among 13 and 14-year-old schoolchildren, Brazil]. / Prevalência de asma e sintomas asmáticos em escolares de 13 e 14 anos de idade.

OBJECTIVE: Before the use of the ISAAC (International Study of Asthma and Allergies in Childhood) questionnaire in epidemiologic surveys, little could be told about the comparative occurrence of asthma in the world due to differences in employed methods. In Brazil, the ISAAC questionnaire has been used in some urban regions. In this study it was applied in both, urban and rural areas, in order to estimate the prevalence of asthma among schoolchildren living in Montes Claros, Brazil. METHODS: A cross-sectional study was carried out using the ISAAC written questionnaire with four questions added on exposures of interest. The questionnaire was self-applied in 3,770 randomly selected schoolchildren aged 13 and 14 years. RESULTS: The prevalence of "wheezing in the last year" was 15.8%, and "asthma or bronchitis ever" was 23.8% with no statistically significant difference between boys and girls. There were significant differences between girls and boys regarding "wheezing ever" (37.8% and 33.6%), "sleeping disturbed by wheezing" (13.7% and 9.5%), and "nocturnal dry coughing without respiratory infection" (36.6% and 28.7%), respectively. "Wheezing in the last year" was found to be positively associated with "pet contact" (OR=1.27; 95% CI: 1.03-1.56), and "family history of asthma" (OR=1.79; 95% CI: 1.50-2.14), and negatively associated with "rural school" (OR=0.63; 95% CI: 0.44-0.91). But no association was found with sex, age, private/public school, and passive smoking. CONCLUSIONS: The prevalence of asthma in Montes Claros was high and some symptoms were seen mainly among girls. The occurrence of "wheezing in the last year" showed to be associated with family history, contact with pets and urban schools.

Impact of oral health on physical and psychosocial dimensions: an analysis using structural equation modeling.

This study aimed to estimate the prevalence of impact of oral health conditions on physical and psychosocial dimensions among adolescents and to identify factors associated with severity of impact. The impact of oral health status was assessed by the instrument Oral Health Impact Profile (OHIP-14). The covariates were: socioeconomic status, habits and health care, use of dental services, and normative conditions of oral health. Structural equation modeling was performed, and 15.6% of adolescents reported impact in at least one dimension of the OHIP-14. The dimensions that showed the highest prevalence of impact were psychological distress (11.8%) and physical pain (6.6%). The number of teeth needing dental treatment, number of filled teeth, and CPI significantly affected severity of impact. In this adolescent population, unfavorable socioeconomic conditions were associated with reduced use of dental services, associated in turn with precarious oral health conditions and increased severity of impact.

Periodontal condition of adolescents and associated factors / Condição periodontal de adolescentes e fatores associados

ABSTRACT Objective: This study aimed to describe the periodontal condition of adolescents and identify its potential determinants. Methods: This is a cross-sectional population-based study (n=763) conducted in a city in Northern Minas Gerais. Multistage probability cluster sampling method was used. Trained and calibrated professionals carried out the intraoral examinations and the interviews at the participants' homes. Logistic regression model was used to identify the factors associated with the periodontal condition. Results: It was found that around 30% of the adolescents presented periodontal changes, being gingival bleeding (14.1%) and dental calculus (14.0%) the most prevalent impairments. Periodontal changes were associated in adolescents who did not attend school (OR=1,9; p=0.031), attended public schools (OR=2,0; p=0.005), never went to the dentist (OR=1,7; p=0,047), used public/philanthropic services (OR=1,7; p=0,002), smoked (OR=1,6; p=0,003), consumed alcohol (OR=1,6; p=0,016) and self-perceived their oral health as too bad/bad (OR=2,4; p=0,032) and regular (OR=1,5; p=0,023). Conclusion: About one-third of adolescents have periodontal changes, which were associated with the type of school and type of dental service they attend, smoking, alcohol consumption and self-perception of oral health.

RESUMO Objetivo: Objetivou-se descrever a condição periodontal entre adolescentes e identificar seus potenciais determinantes. Métodos: Trata-se de um estudo transversal de base populacional (n=763) realizado em município da região norte de Minas Gerais. Adotou-se amostragem probabilística por conglomerado em múltiplos estágios. Profissionais treinados e calibrados realizaram os exames intrabu-cais e entrevistas nos domicílios. Foi utilizado modelo de regressão logística para identificar os fatores associados à condição periodon-tal. Resultados: Verificou-se que 29,5% dos adolescentes apresentaram alterações periodontais, sendo que o sangramento gengival (14,1%) e o cálculo dentário (14,0%) foram os agravos mais prevalentes. As alterações periodontais foram associadas em adolescentes que não estudavam (OR=1,9; p=0.031), que estudavam em escolas públicas (OR=2,0; p=0.005), que nunca foram ao dentista (OR=1,7; p=0,047) utilizaram os serviços públicos/filantrópicos (OR=1,7; p=0,002), que fumavam (OR=1,6; p=0,003), que consumiam bebida alcoólica (OR=1,6; p=0,016) e que autoperceberam auto perceberam sua saúde bucal como péssima/ruim (OR=2,4; p=0,032) e regular (OR=1,5; p=0,023). Conclusão: Cerca de um terço dos adolescentes possui alterações periodontais, que foram associadas ao tipo de escola e ao tipo de serviço odontológico que frequentam, tabagismo, consumo de bebida alcoólica e autopercepção da saúde bucal.

[Quality of life among adolescents: a cross-sectional study using the SF-12 questionnaire]. / Qualidade de vida entre adolescentes: estudo seccional empregando o SF-12.

Adolescence is a stage of life when potentially harmful behaviors to health can be initiated. For this reason, the assessment of quality of life at this age is useful to identify higher risk groups that may prejudice general well-being. This study aimed to evaluate the quality of life and associated factors in a sample of 754 adolescents between the ages of 15 and 19. For the measurement of quality of life a Portuguese language version of the 12-item short-form (SF-12) Health Survey questionnaire was used. The results revealed that satisfactory levels of quality of life are higher with the frequent practice of physical activities and the absence of conditions such as work activities and the consumption of tobacco and alcohol. The female sex was correlated with lower scores in mental aspects of quality of life.

Child and adolescent abuse in the state of São Paulo, Brazil, 2009.

OBJECTIVE: To describe the profile of the reports of child and adolescent abuse in the state of São Paulo in 2009, and to analyze possible associated factors. METHODS: A total of 4,085 reports regarding children and adolescents younger than 15 years recorded by the Domestic, Sexual, and Other Interpersonal Violence Surveillance System (Sistema de Vigilância de Violência Doméstica, Sexual e Outras Violências Interpessoais - VIVA) were analyzed using a logistic regression model. RESULTS: The females comprised 61.4% of the total cases. The most common age group among females was 10 to 14 years (38.8%) and among males was < 5 years (35.8%). Physical abuse accounted for 43.3% of cases in males, and sexual abuse cases accounted for 41.7% of cases in females. The main perpetrators of the abuse were parents (43.8% of the total) and acquaintances (29.4%). Male aggressors were 72.0% of the total. The abuse occurred at home in 72.9% of cases; repeated abuse was reported in 51.4% of cases. Differences between the cases of physical and sexual abuse: a) physical abuse - mostly males (50.9%), parents as perpetrators (48.4%), and women as perpetrators (42.8%), b) sexual abuse - mostly females (77.2%), known aggressors (48.4%), and men as perpetrators (96.1%). Variables associated with physical abuse: male gender (OR: 2.22), age 10-14 years (OR: 1.68), and parents as perpetrators (OR: 2.50). Sexual abuse was associated with female gender (OR: 2.84), age 5-9 years (OR: 1.66), and unknown authors (OR: 1.53). CONCLUSION: Public policies should guarantee that children and adolescents have a healthy and violence-free life. The analysis of the notifications is an important tool to establish prevention strategies.

Risk factors for incidental parathyroidectomy during thyroidectomy.

UNLABELLED: Incidental parathyroidectomy is a common event in thyroid surgery. The literature shows a finding of parathyroid glands ranging from 6.4% to 31% in pathological specimens of the thyroid gland. OBJECTIVE: To collect the amount of parathyroid glands found in surgical specimens of thyroidectomy and correlate with the histopathological and demographic variables. METHODS: Retrospective study based on pathological reports of thyroidectomy from January 2007 to December 2008. RESULTS: 442 patients were submitted to total thyroidectomy, and 2.93% had parathyroid glands, which corresponded to 13 of this total. The presence of papillary thyroid carcinoma associated with incidental parathyroidectomy was 10.11%, compared to the benign lesion: 1.4%. CONCLUSION: Papillary thyroid carcinoma was the variable associated with increased number of incidental parathyroidectomy.

[Papanicolaou smear screening: coverage in two home surveys applied in the city of São Paulo in 1987 and 2001-2002]. / Teste de Papanicolaou: cobertura em dois inquéritos domiciliários realizados no município de São Paulo em 1987 e em 2001-2002.

PURPOSE: To compare the coverage of conventional Papanicolaou cytology in women aged 15 to 59 years between two home surveys, related to some personal attributes and to the tendency to die from cervical cancer. METHODS: We analyzed data collected in two home surveys, with complex sampling, in the city of São Paulo, Brazil, over the years from 1987 to 2001 and 2002. The self-reported answers of 968 women in the first inquiry and of 1,125 women in the second inquiry were compared regarding the reply to the question about the execution of the Papanicolaou test "sometimes in a lifetime" in relation to age distribution, black skin, marital status, years of education and tendency to die because cervical cancer during the period from 1980 to 2007. The Fisher exact test was used to compare the sample regarding each item, with the level of significance set at p value >5%. RESULTS: From the first to the second inquiry there was a 24% increase in the execution of conventional Papanicolaou cytology (from 68.8% to 85%). The greatest variations in the increased coverage related to the personal attributes of the women were detected in black skin color, among single women and among women of lower schooling. Regarding the tendency to mortality rates due to cervical cancer, no clear ascending or declining tendency was observed along the 28 years studied (1980 to 2007). CONCLUSION: There was an increase in access to the cytological Papanicolaou test among the most vulnerable women. Since 2001 and 2002, the 85% coverage already reached WHO recommendation, although without a clear trend of decline in mortality due to cervical cancer in the following years, indicating that screening is only part of an effective and organized program for the control of cervical cancer, whose model must guarantee full women's health care.

Severity of malocclusion in adolescents: populational-based study in the north of Minas Gerais, Brazil / Gravidade da maloclusão em adolescentes: estudo de base populacional no norte de Minas Gerais, Brasil

ABSTRACT OBJECTIVE To identify the factors associated with severity of malocclusion in a population of adolescents. METHODS In this cross-sectional population-based study, the sample size (n = 761) was calculated considering a prevalence of malocclusion of 50.0%, with a 95% confidence level and a 5.0% precision level. The study adopted correction for the effect of delineation (deff = 2), and a 20.0% increase to offset losses and refusals. Multistage probability cluster sampling was adopted. Trained and calibrated professionals performed the intraoral examinations and interviews in households. The dependent variable (severity of malocclusion) was assessed using the Dental Aesthetic Index (DAI). The independent variables were grouped into five blocks: demographic characteristics, socioeconomic condition, use of dental services, health-related behavior and oral health subjective conditions. The ordinal logistic regression model was used to identify the factors associated with severity of malocclusion. RESULTS We interviewed and examined 736 adolescents (91.5% response rate), 69.9% of whom showed no abnormalities or slight malocclusion. Defined malocclusion was observed in 17.8% of the adolescents, being severe or very severe in 12.6%, with pressing or essential need of orthodontic treatment. The probabilities of greater severity of malocclusion were higher among adolescents who self-reported as black, indigenous, pardo or yellow, with lower per capita income, having harmful oral habits, negative perception of their appearance and perception of social relationship affected by oral health. CONCLUSIONS Severe or very severe malocclusion was more prevalent among socially disadvantaged adolescents, with reported harmful habits and perception of compromised esthetics and social relationships. Given that malocclusion can interfere with the self-esteem of adolescents, it is essential to improve public policy for the inclusion of orthodontic treatment among health care provided to this segment of the population, particularly among those of lower socioeconomic status.

RESUMO OBJETIVO Identificar os fatores associados à gravidade da maloclusão em uma população de adolescentes. MÉTODOS Neste estudo transversal de base populacional, o tamanho da amostra (n = 761) foi calculado considerando prevalência de maloclusão de 50,0%, com nível de 95% de confiança e precisão de 5,0%. Foi adotada correção para o efeito de delineamento (deff = 2), e acréscimo de 20,0% para compensar perdas e recusas. Adotou-se amostragem probabilística por conglomerado em múltiplos estágios. Profissionais treinados e calibrados realizaram os exames intrabucais e entrevistas nos domicílios. A variável dependente, gravidade da maloclusão, foi avaliada pelo Índice de Estética Dental. As variáveis independentes foram agrupadas em cinco blocos: características demográficas, condição socioeconômica, uso de serviços odontológicos, comportamento relacionado à saúde e condições subjetivas de saúde bucal. Foi utilizado modelo de regressão logística ordinal para identificar os fatores associados à gravidade da maloclusão. RESULTADOS Foram entrevistados e examinados 763 adolescentes (taxa de resposta de 91,5%), dos quais 69,6% não apresentou anormalidades ou apresentou maloclusão leve. Maloclusão definida foi observada em 17,8% dos adolescentes, sendo grave ou muito grave em 12,6% dos adolescentes, com tratamento ortodôntico altamente necessário ou fundamental. As chances de maior gravidade de maloclusão foram maiores entre adolescentes que relataram ser negro, índio, pardo ou amarelo, ter menor renda per capita, ter hábitos bucais deletérios, ter percepção negativa de sua aparência e percepção do seu relacionamento social afetado pela condição bucal. CONCLUSÕES As maloclusões graves ou muito grave foram mais prevalentes entre adolescentes com desvantagem social, que relataram hábitos deletérios, que perceberam comprometimento estético e nas relações sociais. Visto que as oclusopatias podem interferir na autoimagem dos adolescentes, torna-se fundamental o aprimoramento de políticas públicas voltadas para a inclusão do tratamento ortodôntico entre os procedimentos de saúde acessíveis a essa população, sobretudo aos menos favorecidos socioeconomicamente.

Cárie dentária e fatores associados entre adolescentes no norte do estado de Minas Gerais, Brasil: uma análise hierarquizada / Tooth decay and associated factors among adolescents in the north of the State of Minas Gerais, Brazil: a hierarchical analysis

Estudo transversal de base populacional (n = 763), realizado na região norte do estado de Minas Gerais, que objetivou investigar a prevalência de cárie dentária entre adolescentes e identificar seus potenciais determinantes. Adotou-se amostragem probabilística por conglomerado em múltiplos estágios. Profissionais treinados e calibrados realizaram os exames intrabucais e entrevistas nos domicílios. Foi utilizado modelo de regressão logística para identificar os fatores associados à cárie dentária. As prevalências de cárie dentária, dente cariado, restaurado e perdido foram 71,3%, 36,5%, 55,6% e 16,%, respectivamente. Observaram-se as seguintes médias: índice CPOD (3,4 dentes), número de dentes cariados (0,8 dente), restaurados (2,4 dentes) e perdidos (0,2 dente). As chances de cárie foram maiores em adolescentes que se autodeclararam negro/índio/pardo (OR = 1,6), moravam em domicílios com maior aglomeração (OR = 2,4), não fizeram visitas regulares ao dentista ou nunca foram ao dentista (OR = 1,9), utilizaram os serviços públicos ou filantrópicos (OR = 1,8), possuíam hábitos tabagistas (OR = 4,1), consumiam bebida alcoólica (OR = 1,8), que autoperceberam negativamente sua saúde bucal (OR = 5,9 e OR = 1,9) e sentiram dor nos dentes nos últimos seis meses (OR = 2,0).

This is a cross-sectional population-based study (n = 763) conducted in the north of the State of Minas Gerais, which aimed to investigate the prevalence of tooth decay among adolescents and to identify the potential determinants of same. Probability sampling by conglomerates in multiple stages was used. Trained and calibrated professionals performed the data collection by means of intraoral examination and interviews in the previously selected households. In the analysis of the determinant factor for the presence of tooth decay, hierarchical binary logistic regression models were used. The prevalence of tooth decay, decayed, missing and filled teeth were 71.3%, 36.5%, 55.6% and 16%, respectively. The following averages were observed: DMFT (3.4 teeth), number of decayed (0.8 teeth), restored (2.4 teeth) and missing (0.2 teeth). The incidence of tooth decay was higher among adolescents who stated they were black/indigenous/brown (OR = 1.76), lived in crowded households (OR = 2.4), did not regularly visit or had never been to a dentist (OR = 1.9), used public or philanthropic services (OR = 1,8), had smoking habits (OR = 4.1), consumed alcohol (OR = 1.8), perceived their oral health negatively (OR = 5.9 and OR = 1.9) and had toothac in the last six months (OR = 2.0).

Impact of oral health on physical and psychosocial dimensions: an analysis using structural equation modeling / Impacto de la salud oral en las dimensiones física y psicosocial: un análisis de modelos de ecuaciones estructurales / Impacto da saúde bucal nas dimensões física e psicossocial: uma análise através da modelagem com equações estruturais

This study aimed to estimate the prevalence of impact of oral health conditions on physical and psychosocial dimensions among adolescents and to identify factors associated with severity of impact. The impact of oral health status was assessed by the instrument Oral Health Impact Profile (OHIP-14). The covariates were: socioeconomic status, habits and health care, use of dental services, and normative conditions of oral health. Structural equation modeling was performed, and 15.6% of adolescents reported impact in at least one dimension of the OHIP-14. The dimensions that showed the highest prevalence of impact were psychological distress (11.8%) and physical pain (6.6%). The number of teeth needing dental treatment, number of filled teeth, and CPI significantly affected severity of impact. In this adolescent population, unfavorable socioeconomic conditions were associated with reduced use of dental services, associated in turn with precarious oral health conditions and increased severity of impact.

El objetivo de este estudio fue evaluar el impacto de las condiciones de salud bucal en sus dimensiones físicas y psicosociales entre adolescentes. La gravedad del impacto fue tratada como variable latente, medida por medio de un cuestionario Oral Health Impact Profile (OHIP-14). Las covariables fueron: el nivel socioeconómico, los hábitos y el cuidado de la salud, utilización de servicios dentales y condiciones de salud bucal. Se realizó un modelado de ecuaciones estructurales y los modelos fueron estimados por máxima verosimilitud. El efecto del número de dientes con necesidad de tratamiento, número de dientes restaurados y el CPI de la gravedad del impacto fue significativo. En esta población, las condiciones socioeconómicas desfavorables se asocian con una menor frecuencia de uso de los servicios dentales, que están asociadas con malas condiciones de salud oral, y que a su vez se correlacionaban con una mayor gravedad del impacto.

O objetivo deste estudo foi estimar a prevalência do impacto das condições de saúde bucal nas suas dimensões física e psicossocial entre adolescentes, bem como identificar os fatores associados à gravidade do impacto. O impacto das condições de saúde bucal foi avaliado pelo instrumento Oral Health Impact Profile (OHIP-14). As covariáveis foram: condição socioeconômica, hábitos e cuidados com a saúde, uso de serviços odontológicos e condições normativas de saúde bucal. Foi realizada a modelagem de equações estruturais. Quinze vírgula seis por cento dos adolescentes relataram impacto em, pelo menos, uma dimensão do OHIP-14, as dimensões que apresentaram maior prevalência de impacto foram desconforto psicológico (11,8%) e dor física(6,6%). O efeito do número de dentes com necessidade de tratamento, número de dentes restaurados e o CPI sobre a gravidade do impacto foram significativos. A condição socioeconômica desfavorável mostrou-se associada à menor frequência de uso dos serviços odontológicos, que estão associados às precárias condições de saúde bucal, que se relacionaram à maior gravidade do impacto.