Inadequate prenatal care utilization and associated factors in São Luís, Brazil.

BACKGROUND: Over the last decades there has been a reduction of social inequalities in Brazil, as well as a strong expansion of health services, including prenatal care. The objective of the present study was to estimate the rate of inadequate prenatal care utilization and its associated factors in São Luís, Brazil, in 2010 and to determine whether there was a reduction of inequity in prenatal care use by comparing the present data to those obtained from a previous cohort started in 1997/98. METHODS: Data from the BRISA (Brazilian birth cohort studies of Ribeirão Preto and São Luís) population-based cohort, which started in 2010 (5067 women), were used. The outcome variable was the inadequate utilization of prenatal care, classified according to the recommendations of the Brazilian Ministry of Health. The explanatory variables were organized into three hierarchical levels based on the Andersen's behavioral model of the use of health services: predisposing, enabling and need factors. RESULTS: Only 2.0% of the women did not attend at least one prenatal care visit. The rate of inadequate prenatal care utilization was 36.7%. Despite an improved adequacy of prenatal care use from 47.3% in 1997/98 to 58.2% in 2010, social inequality persisted: both low maternal schooling (prevalence ratio (PR) = 2.78; 95% confidence interval (95% CI) 2.23-3.47 for 0 to 4 years of study) and low family income, less than 0.5 monthly minimum wage per capita (PR = 1.37; 95% CI 1.22-1. 54), continued to be associated with higher rates of inadequate prenatal care utilization. Racial disparity regarding adequate utilization of prenatal services was detected, with black (PR = 1.19; 95% CI 1.04-1.36) and mulatto (PR = 1.14; 95% CI 1.02-1.26) women showing higher rates of inadequate use. On the other hand, women covered by the FHP - Family Health Program (PR = 0.92; 95% CI 0.85-0.98) showed a lower rate of inadequate prenatal care utilization. CONCLUSIONS: Despite strong expansion of health services and expressive improvements in adequate prenatal care use and social indicators, inequalities in prenatal care use still persist. The FHP seems to be effective in reducing inadequate prenatal care utilization.

[Access to and use of the services of the family health strategy from the perspective of managers, professionals and users]. / Acesso e utilização dos serviços na Estratégia Saúde da Família na perspectiva dos gestores, profissionais e usuários.

Questionnaires adapted to the Brazilian reality (Primary Care Assessment Tool) to evaluate access to and use of services were distributed to 30 managers, 80 professionals and a random sample of 882 Family Health Strategy (FHS) users in São Luís in the state of Maranhão. The differences between the evaluations of managers, professionals and users were identified by the Kruskal-Wallis test and Dunn's post test. Users faced difficulties in access to and use of the services, which were also considered unsatisfactory by managers and professionals. Access was the dimension with the worst evaluation, and non-functioning of units after 6 p.m. and at weekends were the main difficulties. The evaluations of the managers and professionals were almost always divergent from those of the users, with the evaluation of the managers being more favorable. The fact that the service was free of charge, the use of preventive services and the FHS services before the specialized care were well evaluated. The operation of units should attend users' needs, especially that of the working population. Strengthening social participation in local management of the FHS may assist in identifying these needs, thereby reducing the divergent opinions of the players involved.

Prevalencia de terceros molares incluidos en estudiantes de una escuela pública de São Luís, Maranhão, Brasil / Prevalence of third molars in students of a public school in São Luís, Maranhão, Brazil

Los terceros molares presentan características muy particulares referentes a la erupción, inclusión, y complicaciones que requieren una evaluación clínica y radiológica más detallada para definir mejor el diagnostico y tratamiento cuando necesario. El objetivo era investigar la prevalencia de los terceros molares incluidos en estudiantes de una escuela pública de la ciudad de São Luís - Maranhão. Fue realizado un estudio transversal descriptivo de las características clínicas y radiológicas de los terceros molares de 155 estudiantes desde los 18 a los 21 años de edad de ambos sexos de un Instituto Federal de Educación Tecnológica de Maranhão. Los molares presentes con rizogénesis completa fueron clasificados según su nivel de inclusión. Todos los datos fueron registrados en historias clínicas propias, tablas del EPI - INFO 2000 y sometidos al test chi-cuadrado para verificar la existencia de asociaciones entre las variables del estudio, con un nivel significativo del 5%. De una población de 155 estudiantes, se obtuvo 531 (85,6%) terceros molares presentes y 89 (14,4%) terceros molares ausentes. De aquellos presentes 462 (87%) terceros molares fueron evaluados en cuanto a su nivel de inclusión. De estos, 239 (51,7%) se encontraban en algún estadio de la fase de inclusión, siendo que 201 (84,1%) estaban parcialmente incluidos y 38 (15,9%) totalmente incluidos. Hubo asociación positiva entre dientes incluidos y terceros molares (p = 0.0015). Los molares incluidos fueron una condición frecuente en la muestra (51%), donde fueron observados terceros molares en distintas fases de inclusión

Third molars have characteristics that are very peculiar regarding the eruption, inclusion and complications. Accordingly, they often require particular clinical and radiological assessments, in order to better define diagnosis and treatment. The aim of this study was to investigate the prevalence of dental inclusions of the third molars within students from a public school in São Luís - Maranhão. We conducted a transverse, descriptive study assessing the clinical characteristics, as well as the radiographies of the third molars, from 155 students (ages from 18-21 years, both genders), from the Federal Institute of Technological Education, in Maranhão. Teeth with complete rhizogeneses were classified according to different inclusion state. Data were transferred to summary files, and then entered in a database (EPI-INFO 2000). Groups were compared using the Chi-Square test in order to assess associations among the study variables. Significance level was established in 5%. Among 155 students, 531 (85.6%) teeth were present, and 89 (14.4%) were not. Among the present, 462 (87%) third molars were assessed according to the inclusion pattern. From them, 239 (51.7%) were in any inclusion state, while (84.1%) had partial inclusion and 38 (15,9%) in total inclusion We found a positive association between dental inclusion and third molars (p=0.0015). Dental inclusion was frequent in our sample (51%), where we observed third molars in different patterns of inclusion

[Profile of public dental care for children and adolescents in São Luís, Maranhão State]. / Perfil da assistência odontológica pública para a infância e adolescência em São Luís (MA).

This profile of public dental care for children/adolescents in São Luís, Maranhão State, Brazil, is based on a survey conducted through interviews, designed to identify these services and help upgrade Health Services available in this city. It describes the pediatric dental care available and the age groups attended, the qualifications of the practitioners involved, the types of treatment for primary and permanent teeth and oral health education programs run at the Municipal Healthcare Units with dental facilities, analyzed through visits and structured interviews. The findings show that dental care was available for children/adolescents (mainly between 6 and 12 years old) at 91.1% of the Healthcare Units offering daily and universal care (65.75%), as well as at those whose services are limited to certain specialties and/or specific days (34.15%). All the public Healthcare Units offered surgical treatment for permanent teeth. Fillings are used more for permanent teeth than primary teeth. Among the public Healthcare Units, 25 (55.5%) did not offer or run oral health programs. At most (75.5%) of the Units visited, dental treatment for children and adolescents is limited to basic care and directed mainly to permanent teeth. The traditional welfare model of providing care as freely demanded remains in place.