Avaliação da saúde bucal em uma coorte de idosos não institucionalizados / Oral health assessment in a cohort of non-institutionalized elderly

Resumo Introdução Sabe-se que os instrumentos epidemiológicos comumente utilizados para aferir as condições bucais, como o CPO-d e CPI, não são sensíveis o suficiente para discriminar idosos em relação à saúde bucal. Objetivo Identificar as alterações na progressão da condição de saúde bucal de idosos não institucionalizados, a partir da aplicação de um indicador multidimensional. Método Trata-se de um estudo longitudinal, realizado em uma coorte de 183 idosos do município de Macaíba/RN. Uma análise fatorial possibilitou que todas as variáveis coletadas, tanto as de saúde bucal quanto as socioeconômicas, demográficas e do estado geral de saúde, fossem consideradas para a produção do indicador multidimensional de saúde bucal. Ademais, foram utilizados o teste t de Student para amostras dependentes, o teste do Qui-Quadrado e o Risco Relativo (IC 95%), na busca de associações entre a saúde bucal dos idosos e as variáveis independentes. Resultados Observou-se que 22,2% dos idosos pioraram sua condição de saúde bucal ao longo do tempo, e que ser casado foi fator de proteção para evitar essa deterioração. Os fatores mais relacionados à mudança da condição de saúde bucal foram "cárie radicular e necessidade de extração", e "idosos jovens com maior densidade domiciliar". Conclusão O indicador proposto reforça a importância de buscar instrumentos que vão além das dimensões dentárias para discriminar a saúde bucal, facilitando o planejamento de ações em prol da saúde bucal dos idosos.

Abstract Background It is known that the epidemiological instruments commonly used to assess oral conditions, such as DMFT and CPI, are not sensitive enough to discriminate elderly people in relation to oral health. Objective To determine changes in the oral health status of non-institutionalized elderly over time, based on the application of a multidimensional indicator. Method This is a longitudinal study performed in a cohort of 183 elderly in the city of Macaíba/RN. A factor analysis allowed all variables collected, both oral health and socioeconomic, demographic, and general health status, to be considered to produce oral health multidimensional indicator. In addition, Student's T-test for dependent samples, Pearson's Chi-Square test and Relative Risk (CI 95%) were used in the search for associations between oral health of the elderly and the independent variables. Results It was observed that 22.2% of elderly worsened their oral health condition across time and that being married was a protective factor for such worsening. Among the factors that composed the indicator, those most related to the change in the oral health status were "root caries and need for extraction" and "young older people with higher home density". Conclusion The proposed indicator reinforces the importance of considering instruments that further study the dental dimensions to assess oral health, facilitating the planning of actions for the older people oral health.

COVID-19 no Brasil: tendências, desafios e perspectivas após 18 meses de pandemia

[RESUMO]. Objetivo. Analisar as tendências de incidência e mortalidade por COVID-19 no Brasil, nas unidades da fede- ração e nas capitais. Método. Realizou-se um estudo ecológico com dados de incidência e de mortalidade por COVID-19 referen- tes ao período de 25 de fevereiro de 2020 (primeiro caso notificado no Brasil) a 31 de julho de 2021. Os dados foram agrupados por mês para cálculo das taxas brutas (por 100 000 habitantes) e avaliação das tendências temporais das unidades da federação e de suas capitais. As modificações significativas nas tendências tem- porais foram analisadas pelo método de regressão por joinpoint. Resultados. Foram identificadas duas ondas de novos casos e óbitos. As unidades da federação com as maiores taxas de incidência foram Amapá, Rio Grande do Norte, Rondônia e Roraima; Amazonas e Rondônia tiveram as maiores taxas de mortalidade. Em geral, as taxas de incidência e mortalidade foram piores na segunda onda. Na primeira onda, a média de meses até o início de uma redução de casos novos foi maior nas capitais, enquanto na segunda onda, o início da redução demorou mais nos estados. Quanto aos óbitos, as capitais necessitaram de menos tempo para apresentar redução tanto na primeira quanto na segunda onda. Conclusão. A heterogeneidade regional detectada reforça a ideia de que a incidência e a mortalidade por COVID-19 estão associadas a fatores políticos, geográficos, culturais, sociais e econômicos.

[ABSTRACT]. Objective. To analyze the incidence and mortality trends from COVID-19 in Brazil as well as in federation units and their capitals. Method. An ecological study was performed using COVID-19 incidence and mortality data covering the period from 25 February 2020 (first case recorded in Brazil) to 31 July 2021. Data were grouped by month for calculation of crude rates (by 100 000 population) and assessment of time trends in federation units and capitals. Significant changes in time trends were analyzed by joinpoint regression. Results. Two waves of new cases and deaths were identified. The highest incidence rates were recorded in the states of Amapá, Rio Grande do Norte, Rondônia, and Roraima. The states of Amazonas and Rondônia had the highest mortality rates. In general, incidence and mortality rates were worse in the second wave. In the first wave, the mean number of months until the onset of reduction in new cases was higher in capitals, whe- reas in the second wave the onset of reduction in new cases took longer in the federation units. The decline in mortality began earlier in capital cities in both waves. Conclusion. The regional differences detected underscore the notion that COVID-19 incidence and mortality are associated with political, geographic, cultural, social, and economic factors.

[RESUMEN]. Objetivo. Analizar las tendencias de la incidencia de COVID-19 y la mortalidad por esta enfermedad en Brasil (unidades federativas y capitales). Método. Se realizó un estudio ecológico con datos sobre incidencia de COVID-19 y la mortalidad por esta enfermedad en el período comprendido entre el 25 de febrero del 2020 (fecha del primer caso notificado en Brasil) y el 31 de julio del 2021. Los datos se agruparon por mes para calcular las tasas brutas (por 100 000 habitantes) y evaluar las tendencias temporales observadas en las unidades federativas y sus capitales. Las modificaciones significativas en las tendencias temporales se analizaron con el método de regresión de punto de inflexión (joinpoint). Resultados. Se identificaron dos olas de casos nuevos y muertes. Las unidades federativas con las mayores tasas de incidencia fueron Amapá, Rio Grande do Norte, Rondônia y Roraima; Amazonas y Rondônia tuvieron las mayores tasas de mortalidad. En general, la incidencia y la mortalidad fueron peores en la segunda ola. En la primera ola, el promedio de meses transcurridos hasta que empezó a reducirse el número de casos nuevos fue mayor en las capitales, mientras que, en la segunda ola, fue mayor en los estados. En ambas olas, el número de muertes se redujo en menos tiempo en las capitales. Conclusión. La heterogeneidad regional detectada refuerza la idea de que la incidencia de la COVID-19 y la mortalidad por esta enfermedad guardan relación con factores políticos, geográficos, culturales, sociales y económicos.

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.

Construção de um indicador multidimensional de saúde bucal para a população idosa da cidade de Manaus, AM / Construction of a multidimensional oral health indicator for the older population in the city of Manaus-Amazonas

Resumo Objetivo Produzir um indicador multidimensional de saúde bucal, a partir de variáveis dentárias e não dentárias, para a pessoa idosa da zona urbana do município de Manaus, AM, Brasil. Método Os dados utilizados são oriundos de um estudo transversal de base populacional conduzido no ano de 2008, com indivíduos de 65 a 74 anos de idade, aleatoriamente selecionados, residentes na cidade de Manaus. Para a produção do indicador proposto, consideraram-se as variáveis dentárias (CPO-D - Índice de Dentes Perdidos, Cariados e Obturados; CPI - Índice Periodontal Comunitário; PIP- Índice de Perda de Inserção Periodontal) e não dentárias (socioeconômicas e índice GOHAI - General Oral Health Assessment Index). Uma Análise Fatorial Exploratória sintetizou essas variáveis, facilitando a construção do indicador multidimensional. Resultados A análise gerou três fatores que, em conjunto, explicaram 72,9% da variância do modelo (KMO = 0,749 e p< 0,001 para o teste de esfericidade de Bartlett). Esses três fatores foram reduzidos à variável "soma", calculada a partir da soma dos escores fatoriais por indivíduo. A mediana dessa nova variável foi o valor de referência para categorização da condição de saúde bucal do indivíduo em "favorável" ou "desfavorável". Conclusão O indicador foi capaz de agregar diversas dimensões da saúde bucal em uma única medida, além de possibilitar sua reprodutibilidade para construção de outros indicadores de saúde.

Abstract Objective Produce a multidimensional indicator of oral health, based on dental and non-dental variables, for the older adult in the urban area of the city of Manaus-AM. Method The data used are from a cross-sectional population-based study conducted in 2008 with randomly selected individuals aged 65 to 74 years, residing in the city of Manaus. To produce the proposed indicator, the dental variables (DMFT- Decayed, Missing and Filled Teeth; CPI- Community Periodontal Index; PIP- Periodontal Insertion Loss Index) and non-dental (socioeconomic and index GOHAI- General Oral Health Assessment Index) were considered. An exploratory factor analysis synthesized these variables, facilitating the construction of the multidimensional indicator Results The analysis generated three factors that, together, explained 72.9% of the model's variance (KMO = 0.749 and p<0.001 for Bartlett's test of sphericity). These three factors were reduced to the "sum" variable, calculated from the sum of the factor scores per individual. The median of this new variable was the reference value for categorizing the individual's oral health condition into "favorable" or "unfavorable". Conclusion The indicator was able to aggregate several dimensions of oral health into a single measure, in addition to enabling its reproducibility for the construction of other health status indicators.

FEEDING PRACTICES IN THE FIRST YEAR OF LIFE: CHALLENGES TO FOOD AND NUTRITION POLICIES.

OBJECTIVE: To evaluate the feeding practices for infants under one year of age, according to food and nutrition policies. METHODS: This is a descriptive cross-sectional study based on secondary data from the Chamada Neonatal project (research on prenatal, childbirth, and infant care) in the state of Rio Grande do Norte. The sample analyzed comprised 837 mother/child (under one year of age) pairs. We found a prevalence of data on exclusive breastfeeding (EBF) in the first hour of life - partial and total -, as well as on food consumed by children 24 hours prior to the interview. We estimated the probability of consumption according to the child's age in days using the probit analysis. RESULTS: Among the interviewed mothers, 64.8% (95%CI 62.4-70.8) declared breastfeeding in the first hour of life, and 60% (95%CI 56.41-63.07) of the children were still breastfed at the end of their first year of life. The median duration of EBF was 63 days (95%CI 60-67). Water or tea, dairy products, fruits, and vegetables were introduced early, with medians lower than 180 days. The probit analysis revealed that the consumption of breast milk tended to decrease and food intake to increase as the child gets older, with exponential growth in the "unhealthy food" group. CONCLUSIONS: Although most children were breastfed up to one year of life, few did so exclusively. Foods were introduced early, with increased consumption of unhealthy ones, resulting in inadequate dietary quality according to recommendations from food and nutrition public policies.

Health production: analysis of doctors' health actions in the More Doctors program.

OBJECTIVE Analyze the health actions carried out by the Cuban cooperated physicians and their relationship with socioeconomic characteristics of the municipalities, contained in the first supervision visit report, in 2015. METHODS This is a quantitative research that used secondary data from the reports of the 1st supervision visit of the "More Doctors Program". The dependent variables were the health actions, and the independent variables were the type of municipality, Human Development Index (HDI), Investment in Primary Health Care (PHC), health center coverage, rural population, and total population. Multiple correspondence analysis was used to identify the latent variable, related to the profile of the professional with respect to the actions/procedures carried out to which the characteristics of the municipalities were associated through frequency analysis. RESULTS Three profiles of professionals were obtained, who have their practices associated with the professional training, consolidating as a determining factor for carrying out actions compatible with the actual needs of the population. Such findings were associated with the socioeconomic variables, with emphasis on funding, health center infrastructure, and coverage. CONCLUSIONS From the observed results, we suggest strategies to expand the scope of the practices carried out in Primary Health Care, from the perspective of training and continuing education of health professionals, and the focus on the everyday life of the service being of paramount importance.

The effect of lockdown on the outcomes of COVID-19 in Spain: An ecological study.

It is paramount to expand the knowledge base and minimize the consequences of the pandemic caused by the new Coronavirus (SARS-Cov2). Spain is among the most affected countries that declared a countrywide lockdown. An ecological study is presented herein, assessing the trends for incidence, mortality, hospitalizations, Intensive Care Unit admissions, and recoveries per autonomous community in Spain. Trends were evaluated by the Joinpoint software. The timeframe employed was when the lockdown was declared on March 14, 2020. Daily percentage changes were also calculated, with CI = 95% and p<0.05. An increase was detected, followed by reduction, for the evaluated indicators in most of the communities. Approximately 18.33 days were required for the mortality rates to decrease. The highest mortality rate was verified in Madrid (118.89 per 100,000 inhabitants) and the lowest in Melilla (2.31). The highest daily percentage increase in mortality occurred in Catalonia. Decreasing trends were identified after approximately two weeks of the institution of the lockdown by the government. Immediately the lockdown was declared, an increase of up to 33.96% deaths per day was verified in Catalonia. In contrast, Ceuta and Melilla presented significantly lower rates because they were still at the early stages of the pandemic at the moment of lockdown. The findings presented herein emphasize the importance of early and assertive decision-making to contain the pandemic.

More Doctors Program: health work process and socioeconomic indicators.

OBJECTIVE: To analyze the working process of the professionals of the More Doctors Program and its relationship with socioeconomic indicators. It is a quantitative study, in which secondary data from supervision reports of PMM were used. The dependent variable was the quality of work processes in Primary Care facilities, and the independent ones were the type of municipality, education, Gini index, Primary Health Care investments, and health facilities coverage. Data were analyzed with multiple modeling based on Poisson regression with robust variance. RESULTS: 16,000 doctors within 3816 municipalities were analyzed. Variables related to the working process the remained significant in the final model were the investments in Primary Health Care and the health facilities coverage. The results expressed the equity principle, as those municipalities with more vulnerable conditions and with higher coverage are prone to perform more activities in their working process. CONCLUSIONS: The implementation of the More Doctors Program and hence the provision of doctors in deprived regions promoted the consolidation of three main aspects, namely the health working process, primary health care and equity, making it possible to carry out a health working process focused on PHC. This implies performing a greater number of activities that are inherent to PHC, which were not carried out due to the absence of doctors. The More Doctors Program fulfills its role in the combat of inequalities, particularly regarding more vulnerable municipalities.

More Doctors Program: health work process and socioeconomic indicators

SUMMARY OBJECTIVE To analyze the working process of the professionals of the More Doctors Program and its relationship with socioeconomic indicators. It is a quantitative study, in which secondary data from supervision reports of PMM were used. The dependent variable was the quality of work processes in Primary Care facilities, and the independent ones were the type of municipality, education, Gini index, Primary Health Care investments, and health facilities coverage. Data were analyzed with multiple modeling based on Poisson regression with robust variance. RESULTS 16,000 doctors within 3816 municipalities were analyzed. Variables related to the working process the remained significant in the final model were the investments in Primary Health Care and the health facilities coverage. The results expressed the equity principle, as those municipalities with more vulnerable conditions and with higher coverage are prone to perform more activities in their working process. CONCLUSIONS The implementation of the More Doctors Program and hence the provision of doctors in deprived regions promoted the consolidation of three main aspects, namely the health working process, primary health care and equity, making it possible to carry out a health working process focused on PHC. This implies performing a greater number of activities that are inherent to PHC, which were not carried out due to the absence of doctors. The More Doctors Program fulfills its role in the combat of inequalities, particularly regarding more vulnerable municipalities.

RESUMO OBJETIVO Analisar a relação entre o processo de trabalho dos médicos do Programa Mais Médicos (PMM) no Brasil e alguns indicadores socioeconômicos no período de 2015. MÉTODO Trata-se de uma pesquisa quantitativa que utilizou dados secundários dos relatórios de supervisão do PMM. A variável dependente foi a qualidade do processo de trabalho e as variáveis independentes foram o tipo de município, expectativa de anos de estudo, índice de Gini, investimento em Atenção Primária à Saúde (APS) e cobertura de unidades de saúde. Na análise dos dados foi realizada a modelagem múltipla por regressão de Poisson com variância robusta. RESULTADOS Foram analisados dados de 3.816 municípios, abrangendo 1.537 profissionais. Destacam-se como variáveis socioeconômicas estratégicas e que explicam o modelo do processo de trabalho do PMM: o investimento e a cobertura da atenção básica. Tornou-se bastante evidente o princípio da equidade, pois os municípios mais vulneráveis e de maior cobertura realizam maior número de atividades em seu processo de trabalho. CONCLUSÕES Com a implantação do PMM e o provimento de médicos em regiões desassistidas ocorreu a consolidação do tripé processo de trabalho em saúde, atenção básica e equidade, tornando possível a efetivação de um processo de trabalho focado na APS. Isso implica a realização de maior número de atividades inerentes à APS, as quais não eram realizadas em função da ausência do profissional médico. Nesse sentido, o programa cumpre o seu papel de combater as desigualdades em municípios mais vulneráveis.

Spatial inequality of dental caries in the Brazilian territory.

The distribution of harms to health varies spatially determined by the socioeconomic conditions of the environment. This research aimed to assess the spatial distribution of dental caries in 12-year-old children and their correlation with socioeconomic indicators in Brazilian states. The sample of this ecological study comprised all the 26 Brazilian states and the Federal District. Thematic and correlation maps were constructed in order to assess the spatial dependency, as well as the correlation between dental caries and socioeconomic factors. The results showed that the states with the worst DMFT indexes were located in the north and northeast, showing spatial autocorrelation. These regions also had the worst results for the following variables: poverty, illiteracy, education, and income. The bivariate analysis showed that household income and education level had negative spatial correlation with the DMFT index, while illiteracy and poverty rates showed positive correlation. Despite advances in the decline of DMFT index in recent years, there is still an inequity in the distribution of the caries disease.

Health production: analysis of doctors health actions in the More Doctors program

SUMMARY OBJECTIVE Analyze the health actions carried out by the Cuban cooperated physicians and their relationship with socioeconomic characteristics of the municipalities, contained in the first supervision visit report, in 2015. METHODS This is a quantitative research that used secondary data from the reports of the 1st supervision visit of the "More Doctors Program". The dependent variables were the health actions, and the independent variables were the type of municipality, Human Development Index (HDI), Investment in Primary Health Care (PHC), health center coverage, rural population, and total population. Multiple correspondence analysis was used to identify the latent variable, related to the profile of the professional with respect to the actions/procedures carried out to which the characteristics of the municipalities were associated through frequency analysis. RESULTS Three profiles of professionals were obtained, who have their practices associated with the professional training, consolidating as a determining factor for carrying out actions compatible with the actual needs of the population. Such findings were associated with the socioeconomic variables, with emphasis on funding, health center infrastructure, and coverage. CONCLUSIONS From the observed results, we suggest strategies to expand the scope of the practices carried out in Primary Health Care, from the perspective of training and continuing education of health professionals, and the focus on the everyday life of the service being of paramount importance.

RESUMO OBJETIVO Analisar as ações em saúde realizadas pelos médicos cooperados cubanos e sua relação com características socioeconômicas dos municípios, contidas no primeiro relatório de visita de supervisão, em 2015. MÉTODOS Pesquisa quantitativa que utilizou dados secundários dos relatórios da primeira visita de supervisão do Programa Mais Médicos. A variável dependente foram as ações em saúde e as variáveis independentes foram o tipo de município e infraestrutura. Utilizou-se a análise de correspondência múltipla para a identificação da variável latente, relativa ao perfil do profissional com relação às ações realizadas, a qual foi associada às características dos municípios por intermédio de análise de frequência. RESULTADOS Foram obtidos três perfis de profissionais, que possuem suas práticas associadas à formação profissional, consolidando-se como um fator determinante para efetivação de ações condizentes com as reais necessidades da população. Tais achados estiveram associados às variáveis socioeconômicas, tendo como destaques a infraestrutura das unidades e o tipo de município. CONCLUSÕES A partir dos resultados observados, sugerem-se estratégias para ampliar o escopo das práticas desenvolvidas na APS, na perspectiva de formação e educação permanente de profissionais de saúde, sendo fundamental a ênfase no cotidiano do serviço.

Feeding practices in the first year of life: challenges to food and nutrition policies / Práticas alimentares no primeiro ano de vida: desafios para as políticas de alimentação e nutrição

ABSTRACT Objective: To evaluate the feeding practices for infants under one year of age, according to food and nutrition policies. Methods: This is a descriptive cross-sectional study based on secondary data from the Chamada Neonatal project (research on prenatal, childbirth, and infant care) in the state of Rio Grande do Norte. The sample analyzed comprised 837 mother/child (under one year of age) pairs. We found a prevalence of data on exclusive breastfeeding (EBF) in the first hour of life - partial and total -, as well as on food consumed by children 24 hours prior to the interview. We estimated the probability of consumption according to the child's age in days using the probit analysis. Results: Among the interviewed mothers, 64.8% (95%CI 62.4-70.8) declared breastfeeding in the first hour of life, and 60% (95%CI 56.41-63.07) of the children were still breastfed at the end of their first year of life. The median duration of EBF was 63 days (95%CI 60-67). Water or tea, dairy products, fruits, and vegetables were introduced early, with medians lower than 180 days. The probit analysis revealed that the consumption of breast milk tended to decrease and food intake to increase as the child gets older, with exponential growth in the "unhealthy food" group. Conclusions: Although most children were breastfed up to one year of life, few did so exclusively. Foods were introduced early, with increased consumption of unhealthy ones, resulting in inadequate dietary quality according to recommendations from food and nutrition public policies.

RESUMO Objetivo: Avaliar as práticas alimentares em menores de um ano de idade, de acordo com as políticas de alimentação e nutrição. Métodos: Estudo transversal descritivo, com dados secundários da Chamada Neonatal no Estado do Rio Grande do Norte. A amostra analisada foi de 837 pares mãe/filho menor de um ano de idade, e observou-se a prevalência de dados do Aleitamento Materno Exclusivo (AME), na primeira hora de vida, parcial e total, assim como dos alimentos ingeridos pelas crianças nas últimas 24 horas anteriores à entrevista. Por meio da análise de probitos, estimaram-se as probabilidades de consumo dos alimentos por idade da criança, em dias. Resultados: A prática de aleitamento na primeira hora de vida foi relatada por 64,8% (IC95% 62,4-70,8) das mães entrevistadas e, ao final do primeiro ano de vida, 60% (IC95% 56,41-63,07) das crianças ainda estavam sendo amamentadas. A mediana de aleitamento exclusivo foi de 63 dias (IC95% 60-67). Água ou chá, alimentos lácteos, frutas, legumes e verduras foram introduzidos precocemente, com medianas menores que 180 dias. Observou-se por análise de probitos que o consumo de leite materno tendeu a diminuir e o de alimentos a aumentar, de acordo com a idade da criança, com aumento exponencial do grupo "alimentos não saudáveis". Conclusões: Apesar de a maioria das crianças ser amamentada até um ano de vida, poucas estavam em aleitamento exclusivo. Alimentos foram introduzidos precocemente, com aumento do consumo dos não saudáveis, resultando em inadequação da qualidade alimentar frente ao preconizado pelas políticas públicas de alimentação e nutrição.

Spatial inequality of dental caries in the Brazilian territory

Abstract: The distribution of harms to health varies spatially determined by the socioeconomic conditions of the environment. This research aimed to assess the spatial distribution of dental caries in 12-year-old children and their correlation with socioeconomic indicators in Brazilian states. The sample of this ecological study comprised all the 26 Brazilian states and the Federal District. Thematic and correlation maps were constructed in order to assess the spatial dependency, as well as the correlation between dental caries and socioeconomic factors. The results showed that the states with the worst DMFT indexes were located in the north and northeast, showing spatial autocorrelation. These regions also had the worst results for the following variables: poverty, illiteracy, education, and income. The bivariate analysis showed that household income and education level had negative spatial correlation with the DMFT index, while illiteracy and poverty rates showed positive correlation. Despite advances in the decline of DMFT index in recent years, there is still an inequity in the distribution of the caries disease.

Dental Functionality: construction and validation of an oral health indicator for institutionalized elderly persons in the city of Natal, Rio Grande do Norte / Funcionalidade Dentária: construção e validação de um indicador de saúde bucal para idosos institucionalizados da cidade do Natal, RN

Abstract Objective: to suggest a composite indicator that identifies the oral health condition of institutionalized elderly persons. Method: an observational and cross-sectional study was performed. A total of 315 elderly persons were investigated in long-stay care facilities for the elderly in the city of Natal, Rio Grande do Norte, Brazil. Such individuals underwent an epidemiological evaluation of their oral health conditions, based on the DMFT index, CPI and the PAL (periodontal attachment loss) index. Factor analysis was used to identify a relatively small number of common factors by principal component analysis. Results: five oral health variables were included in factor analysis, and using the Kaiser criterion, which considers the percentage of variance explained by the factors, a single factor which together explained 79.7% of the total variance of the variables included in the analysis model was selected. This factor was analyzed and interpreted according to the dimension to which it related, and was entitled the factor of Dental Functionality. Conclusion: this factor generated an objective indicator to characterize the oral health of the elderly in long-term care facilities for the elderly of Natal, Rio Grande do Norte, and represents a parameter for studies of the oral health outcomes of this elderly population. It also revealed a change in the dental profile of this population with more teeth present in the mouth and a reduction in edentulism. AU

Resumo Objetivo: sugerir um indicador composto que discrimine a condição de saúde bucal dos idosos institucionalizados. Método: o estudo se caracteriza por ser do tipo observacional e transversal. Foram investigados 315 idosos nas Instituições de Longa Permanência para Idosos (ILPI) da cidade do Natal, RN, Brasil. Esses idosos foram avaliados quanto às condições de saúde bucal, a partir dos índices CPO-d, CPI e PIP. Uma análise fatorial buscou identificar um número relativamente pequeno de fatores comuns, por meio da análise de componentes principais. Resultados: foram incluídas na análise fatorial cinco variáveis de saúde bucal e, a partir do critério de Kaiser que considera o percentual de variância explicado pelos fatores, foi selecionado um fator que, em conjunto, explicou 79,7% da variância total das variáveis incluídas no modelo de análise. Tal fator foi analisado e interpretado segundo a dimensão a qual se referia, denominando-se o fator de Funcionalidade Dentária. Conclusão: esse fator foi capaz de gerar um indicador objetivo que caracteriza a saúde bucal do idoso das ILPI de Natal, RN, servindo como parâmetro para estudos que tenham como desfecho a saúde bucal dessa população idosa, além de mostrar uma mudança no perfil dessa população com o aumento de dentes em boca e diminuição do edentulismo. AU

Determinantes socioeconômicos da saúde do idoso: um estudo ecológico no estado do rio grande do norte / Socioeconomic determinants of elderly health: an ecological study in Rio Grande do Norte state

Objetivos: Propor variáveis estatísticas que resumam os fatores socioeconômicos com potencial efeito sobre a saúde dos idosos nos municípios do Rio Grande do Norte e identificar os locais de maior vulnerabilidade. Métodos: As variáveis deste estudo ecológico foram oriundas do Instituto Brasileiro de Geografia e Estatística - IBGE, Programa das Nações Unidas para o Desenvolvimento - PNUD, Instituto de Pesquisa Econômica Aplicada - IPEA e Departamento de Informática do SUS - DATASUS, referentes ao ano 2000. Partiu-se de mais de 800 variáveis relacionadas à renda, educação, desenvolvimento humano, demografia e habitação, as quais foram submetidas a uma análise da plausibilidade teórica, da distribuição dos dados, da correlação, Análise Fatorial e à Análise Espacial exploratória. Resultados: A aplicabilidade da técnica foi comprovada pela matriz de correlações, determinante (0,001), matriz anti-imagem, teste de esfericidade de Bartlett (p<0,001) e Índice de Kaiser-Meyer-Olkin (KMO= 0,7). Formaram-se quatro componentes que explicaram 74,01% da variância do modelo, sendo eles: Melhores condições socioeconômicas, Maior dependência do Estado, Desigualdade e Menos emprego e saúde. A análise visual dos mapas demonstrou que tais componentes apresentam distintos padrões de distribuição espacial, no qual parte das microrregiões Borborema Potiguar, Angicos e Agreste Potiguar tiveram características mais desfavoráveis para todos os componentes. Conclusões: Além de facilitar a identificação dos pontos críticos, os componentes agregaram diversos dados em informações mais simples, facilitando o planejamento de políticas públicas e estudos relacionados aos determinantes da saúde dos idosos do Rio Grande do Norte (AU).

Objective: To propose statistical variables that resume the socioeconomic factors with potential effect on elderly health in the municipalities of Rio Grande do Norte and to identify the most vulnerable places. Methods: The variables of this ecological study were collected from the Instituto Brasileiro de Geografia e Estatística ­ IBGE, Programa das Nações Unidas para o Desenvolvimento - PNUD, Instituto de Pesquisa Econômica Aplicada - IPEA and Departamento de Informática do SUS - DATASUS, about the year 2000. We started with more than 800 variables related to income, education, human development, demography and housing. These variables were submitted to theoretical plausibility analysis, data distribution, correlation, Factorial Anlysis and Exploratory Spatial Analysis. Results: The applicability of the technique was confirmed by the correlation matrix, determinant (0,001), anti-image matrix, Bartlett's sphericity test and Kaiser-MeyerOlkin index (KMO= 0,7). Four components were formed, which explained 74,01% of the model variance, they are: Better socioeconomic conditions, Greater government dependence, Inequity and Less employment and health. The visual analysis of the maps showed that these components have different patterns of spatial distribution, in which part of Borborema Potiguar, Angicos and Agreste Potiguar microregions had more unfavorable characteristics for all the components. Conclusions: Besides facilitating the identification of critical points, the components gathered several data in simpler information, helping in the planning of public policies and studies related to determinants of elderly health in Rio Grande do Norte (AU).

Oral health conditions and activities of daily living in an elderly population in Brazil / Condições de saúde bucal e atividades da vida diária em uma população de idosos no Brasil

Abstract Objective: To analyze the relationship between the oral health status and functional capacity in performing basic activities of daily living of a population of elderly persons. Method: A cross-sectional population-based study with 441 individuals aged 60 years or over both genders was performed in the municipality of Macaíba, Rio Grande do Norte. From intraoral epidemiological examination, the degree of caries attacks (CPO-D index), periodontal condition (CPI and PIP indexes), the use and need for dental prosthesis and the presence of oral lesions were evaluated. Independence in Activities of Daily Living was used to evaluate functional capacity. Socioeconomic and demographic characteristics were surveyed using a structured questionnaire. Results: Oral health variables were subjected to factor analysis, which resulted in four indicators. There was no association between these indicators and the functional capacity of the elderly. Gender, age, presence of caregiver, dominant area of residence, time of last visit to the dentist, type of care sought during such visit and self-perception regarding prosthesis replacement were significantly associated with oral health indicators. Conclusion: Given the non-identification of the effect of functional capacity on the oral health of the elderly, the time of measurement of the events investigated should be considered. It is suggested that dependency among the elderly occurs at different times from when the consequences of oral problems are observed, considering the cumulative effects of a previous history of invasive dental care. AU

Resumo Objetivo: Analisar a relação entre as condições de saúde bucal de uma população de idosos e a capacidade funcional na realização das atividades básicas da vida diária. Método: Foi realizado um estudo seccional de base populacional, com 441 indivíduos com 60 anos de idade ou mais de ambos os sexos, tendo como cenário o município de Macaíba, Rio Grande do Norte. A partir de exame epidemiológico intraoral, avaliou-se o grau de ataque de cárie (índice CPO-d), a condição periodontal (índices CPI e PIP), o uso e necessidade de prótese dentária e a presença de lesões bucais. Para avaliação da capacidade funcional foi utilizada a Escala de Independência em Atividades da Vida Diária. Características socioeconômicas e demográficas foram pesquisadas através de questionário estruturado. Resultados: As variáveis de saúde bucal foram submetidas à análise fatorial, da qual resultaram quatro indicadores. Não se observou associação entre tais indicadores e a capacidade funcional dos idosos. As variáveis sexo, idade, presença de cuidador, zona de residência dominante, tempo da última visita ao dentista, tipo de serviço procurado em tal visita e autopercepção quanto à substituição de prótese apresentaram associações significativas com os indicadores de saúde bucal. Conclusão: Diante da não identificação de efeito da capacidade funcional na saúde bucal dos idosos, aponta-se como aspecto a ser considerado o momento de aferição dos eventos investigados. Sugere-se que a condição de dependência do idoso ocorra em momento distinto daquele em que se observam as sequelas dos problemas bucais, considerados efeitos cumulativos de uma história pregressa de assistência mutiladora. AU

Produção e validação de um indicador de saúde bucal para idosos a partir de dados secundários do SB Brasil 2010 / Production and validation of an indicator of oral health for seniors from secondary data from SB Brazil 2010

Dentre os vários aspectos da saúde do idoso, a saúde bucal merece atenção especial pelo fato de que, historicamente, nos serviços odontológicos, não se considera esse grupo populacional como prioridade de atenção. Por isso, se faz necessária a produção de um indicador multidimensional capaz de mensurar todas as alterações bucais encontradas em um idoso, facilitando a categorização da saúde bucal como um todo. Tal indicador representará um importante instrumento capaz de elencar prioridades de atenção voltadas à população idosa. Portanto, o estudo em questão propõe a produção e validação de um indicador de saúde bucal a partir dos dados secundários coletados pelo projeto SB Brasil 2010 referente ao grupo etário de 65 a 74 anos. A amostra foi representada pelos 7619 indivíduos do grupo etário de 65 a 74 anos que participaram da pesquisa nas 5 (cinco) regiões do Brasil. Tais indivíduos foram submetidos à avaliação epidemiológica das condições de saúde bucal, a partir dos índices CPO-d, CPI e PIP. Além disso, verificou-se o uso e necessidade de prótese, bem como características sociais, econômicas e demográficas. Uma análise fatorial identificou um número relativamente pequeno de fatores comuns, através da análise de componentes principais. Após a nomenclatura dos fatores, foi realizada a soma dos escores fatoriais por indivíduo. Por último, a dicotomização dessa soma nos forneceu o indicador de saúde bucal proposto. Para esse estudo foram incluídas na análise fatorial 12 variáveis de saúde bucal oriundas do banco de dados do SB Brasil 2010 e, também 3 variáveis socioeconômicas e demográficas. Com base no critério de Kaiser, observa-se que foram retidos cinco fatores que explicaram 70,28% da variância total das variáveis incluídas no modelo. O fator 1 (um) explica sozinho 32,02% dessa variância, o fator 2 (dois) 14,78%, enquanto que os fatores 3 (três), 4 (quatro) e 5 (cinco) explicam 8,90%, 7,89% e 6,68%, respectivamente. Por meio das cargas fatoriais, o fator um foi denominado "dente hígido e pouco uso de prótese", o dois "doença periodontal presente", o três "necessidade de reabilitação", já o quarto e quinto fator foram denominados de "cárie" e "condição social favorável", respectivamente. Para garantir a representatividade do indicador proposto, realizou-se uma segunda análise fatorial em uma subamostra da população de idosos investigados. Por outro lado, a aplicabilidade do indicador produzido foi testada por meio da associação do mesmo com outras variáveis do estudo. Por fim, Cabe ressaltar que, o indicador aqui produzido foi capaz de agregar diversas informações a respeito da saúde bucal e das condições sociais desses indivíduos, traduzindo assim, diversos dados em uma informação simples, que facilita o olhar dos gestores de saúde sobre as reais necessidades de intervenções em relação à saúde bucal de determinada população. (AU)

Among the various aspects of the health in the elderly, oral health deserves special attention by the fact that, historically, the dental services not considered this population group as a priority for attention. Therefore, the production of a multidimensional indicator capable of measuring all oral abnormalities found in an elderly is necessary, facilitating the categorization of oral health as a whole. This indicator will be an important instrument to list priorities for attention focused on the elderly population. Therefore, the present study proposes the production and validation an indicator of oral health from the secondary data collected by the project SB Brasil 2010 concerning the age group 65-74 years. The sample was represented by 7619 individuals of the age group 65-74 years participated in the survey in five (5) regions of Brazil. These subjects underwent epidemiological assessment of oral health conditions, from DMFT, CPI and PIP indices. In addition, there was the use and need for prostheses, as well as social, economic and demographic characteristics. A factor analysis identified a relatively small number of common factors by principal components analysis. After naming the factors, was performed the sum of the factor scores for the individual. Finally, the dichotomy that sum provided in the proposed indicator of oral health. For this study were included in the factor analysis of 12 variables derived from the oral health database SB Brasil 2010 and also 3 socioeconomic and demographic variables. Based on the Kaiser criterion, it is observed that five factors that explained 70.28% of the total variance of the variables included in the model were retained. Factor 1 (one) alone explains 32.02% of variance, factor 2 (two) 14.78%, while the factors three (3) four (4) and five (5) explain 8.90% 7.89% and 6.68%, respectively. By means of factor loadings, factor one was called " healthy tooth and little prosthesis use," the second "gift periodontal disease," the three 'need for rehabilitation, "already the fourth and fifth factor was called" decay "and "favorable social condition", respectively. To ensure the representativeness of the proposed indicator, there was a second factor analysis on a subsample of the elderly population investigated. Moreover, the applicability of the indicator produced was tested by the same association with other variables in the study. Finally, it is worth noting that the indicator produced here has put together various information about oral health and social conditions of these individuals, translating so many data in a simple information, which facilitates the look of health managers about the real needs assistance with their oral health of a given population. (AU)