Oral and tracheal microbiota of pediatric and adolescent patients in an intensive care unit.

OBJECTIVE: To characterize the oral and tracheal microbiota of patients admitted to a pediatric intensive care unit (PICU). METHODS AND RESULTS: This is an exploratory study conducted on patients aged 5 months to 13 years admitted to the PICU of a referral hospital. Two microbiological samples were collected with a swab in the posterior region of the tongue from patients receiving spontaneous and mechanical ventilation within the first 24 and 48 h after admission to the PICU. Among patients receiving mechanical ventilation, tracheal secretion was also collected in a second sampling. The caries experience was evaluated using the DMFT/dmf index, and the quality of oral hygiene was assessed based on the visual plaque index (VPI). A questionnaire was applied to obtain data on hospital routine and sample characteristics. The DMFT/dmf index was 1.66 (SD = 2.18) and the mean VPI was 43.03 (SD = 36.93). The most prevalent microorganisms were Klebsiella pneumoniae (15%). Oral colonization by opportunistic pathogens was significantly higher in patients receiving mechanical ventilation compared to those on spontaneous ventilation (p < .05). There was no relationship of VPI or DMFT/dmf with oral microbiological changes. CONCLUSION: The results indicate that PICU patients are susceptible to colonization by respiratory and opportunistic pathogens since the first hours of hospitalization.

Avaliação do perfil e satisfação de adolescentes com o tratamento endodôntico realizado na unidade de referência do município de Camaçari - BA / Evaluation of the profile and satisfaction of adolescents with endodontic treatment performed at the reference unit of the city of Camaçari - BA

Objetivo: avaliar o perfil do usuário e o nível de satisfação associado ao tratamento endodôntico de pacientes atendidos no CEO de Camaçari-BA. Material e métodos: o desenho de estudo foi de corte transversal, tendo como população os usuários de 12 a 20 anos que demandaram o serviço durante o período de dezembro de 2017 a novembro de 2018 (n=45). Foram realizadas entrevistas para identificação de variáveis sóciodemográficas, além da avaliação da satisfação por um questionário validado (QASSaB). Realizou-se a análise estatística dos dados, registrando a média e respectivo desvio-padrão para as variáveis contínuas, frequência absoluta e relativa para variáveis categoriais e teste qui-quadrado para avaliação de possíveis associações entre elas. Resultados: os participantes tiveram média de idade de 16,8 anos (±2,067), com renda familiar média de R$ 972,00 e maioria do sexo feminino (55,6%). Dos dentes tratados 31,1% foram molares, 31,1% pré-molares e 37,8% caninos e incisivos, sendo que maior parte pertenciam ao arco superior (75,6%). Os resultados mostraram que no geral houve um bom grau de satisfação do usuário com o atendimento, porém foram verificados pontos de menor satisfação, como foi o caso da acessibilidade e resolutividade. Na dimensão eficácia os pacientes atendidos por especialistas relataram ter menos incômodo durante o tratamento, porém não foi estatisticamente significante (p=0,391). Conclusões: este tipo de estudo tem grande valia já que se podem estabelecer comparativos e realizar planejamentos adequados a partir da identificação dos pontos de necessidade de intervenção.

Objective: to evaluate the user profile and level of satisfaction of patients associated with the endodontic treatment of patients treated at the CEO of Camaçari-BA. Material and methods: The study design was cross-sectional, with a population varying from 12 to 20 year old who demanded the service during the period from December 2017 to November 2018 (n=45). Interviews were carried out to identify socio-demographic variables, as well as satisfaction assessment by a validated questionnaire (QASSaB). Statistical analysis of the data was performed, recording the mean and respective standard deviation for the continuous variables and chi-square test (χ2) for the evaluation of possible associations between categorical variables. Results: participants presented a mean age of 16.8 years (±2.067), with an average family income of R$ 972.00 and majority of females (55.6%). Among the treated teeth, 31.1% were molars, 31.1% premolars and 37.8% canines and incisors, most of which belonged to the upper arch (75.6%). The results showed that in general there was a good degree of user satisfaction with the service, but points of less satisfaction were verified, as was the case of accessibility and resolution. In terms of efficacy, patients attended by specialists reported less discomfort during treatment, but this data was not statistically significant (p=0.391). Conclusions: this study has great value since it is possible to establish comparatives and to carry out adequate planning from the identification of the need points of intervention

Práticas de autocuidado em saúde bucal de usuários do programa saúde da família / Oral health practices of users of the family health program / Prácticas de salud oral de los usuarios del programa de salud de la familia

As práticas de autocuidado são fundamentais para a manutenção da saúde bucal. Conhecer como elas estão inseridas na população favorece o planejamento de ações educativas e preventivas mais eficazes. O objetivo deste estudo foi avaliar a associação entre o perfil sociodemográfico e as práticas de saúde bucal de usuários do Programa Saúde da Família de um município de médio porte do estado da Bahia, Brasil. Trata-se de estudo transversal, realizado por meio de inquérito epidemiológico domiciliar com amostra de 475 usuários. Os resultados mostraram que a maioria foi do sexo feminino, entre 20 e 59 anos, e de etnia parda e negra. A média de renda familiar foi de 791,46 reais e a de escolaridade foi de 7,4 anos de estudo. A escovação, o uso do fio e do palito foram as práticas de autocuidado mais frequentes (55,8%, 59,1% e 54,9%, respectivamente). O uso de bochecho foi relatado por 16,1% dos usuários. Aqueles com maior escolaridade e mais jovens escovavam os dentes mais vezes ao dia e usavam mais o fio dental. O palito dental foi o menos utilizado por aqueles de maior escolaridade e entre mais jovens de 15-19 anos. Concluiu-se que quanto maior o nível de escolaridade e entre os adultos jovens, melhores são os hábitos de higiene oral.

Self-care practices are fundamental for maintaining oral health. Knowing how they are inserted in the population favors the planning of more effective educational and preventive actions. The objective of this study was to analyze the association between socio-demographic profile and oral health practices of users of the Family Health Program of a medium-sized municipality in the state of Bahia, Brazil. It is a cross-sectional study, carried out by means of a household epidemiological survey with 475 users was conduced. The results showed that most of them were female, between 20-59 years of brown and black ethnicity. The average family income was 791.46 Reais and the average education was 7.4 years of study. Brushing and the use of floss and toothpick were the most common self-care practices (55.8%, 59.1% and 54.9%, respectively). The use of mouthwash was reported by 16.1% of users. Those with higher education and younger brushed more times a day, and used more the floss. The toothpick was less used by those with higher education and among younger 15-19 years. It was possible to conclude that the higher the level of schooling and among young adults, the better the habits of oral hygiene.

Las prácticas de autocuidado son fundamentales para el mantenimiento de la salud bucal. Conocer como están insertadas en la población favorece la planificación de acciones educativas y preventivas más eficaces. El objetivo de este estudio fue analizar la asociación entre el perfil sociodemográfico y las prácticas de salud oral de los usuarios del Programa de Salud de la Familia de un municipio de tamaño medio del estado de Bahía, Brasil. Tratase de un estudio transversal, realizado por medio de una encuesta epidemiológica domiciliar con 475 usuarios. Los resultados mostraron que la mayoría eran mujeres, entre 20-59 años de etnia parda y negra. El ingreso medio de la familia fue de 791,46 reales y el promedio de años de educación fue de 7,4 años. Cepillado, el uso de hilo y de palillo dental fueron las prácticas de autocuidado más comúnmente reportadas (55,8%, 59,1% y 54,9%, respectivamente). El uso de colutorios fue informado por 16,1% de los usuarios. Las personas con educación superior y más jóvenes cepillaron los dientes más veces al día y utilizaron más el hilo dental. El palillo dental fue menos utilizado por aquellos con educación superior y entre los jóvenes de 15-19 años. Concluyóse que cuanto mayor la escolaridad y entre los adultos jóvenes, mejores son los hábitos de higiene oral.

Factors associated with the utilization of dental health services by the pediatric population: an integrative review. / Fatores associados à utilização dos serviços de saúde bucal pela população pediátrica: uma revisão integrativa.

This integrative literature review aimed to analyze studies about factors associated with the utilization of dental health services by the pediatric population between zero and 15 years old, published between 2006 and 2016 and available in Portuguese, English or Spanish. A survey of articles in the Lilacs and Medline databases was carried out, using the search strategy: ("dental care/utilization" OR "dental health services/utilization") AND ("child" OR "child, preschool") AND NOT adult. To analyze the methodological quality, the adapted Critical Appraisal Skill Programme (CASP) and the Agency for Healthcare and Research and Quality (AHRQ) were used. The following predictors of use of dental health services stood out: factors associated with children or adolescents (age, frequency of tooth brushing, chronic conditions), caregivers (schooling, perception of child's dental health, perceived oral health needs), dentists (availability at night and on the weekends) and follow up of oral health by the family health team. These are inherent factors for the planning of oral health policies or programs for the pediatric population. However, these factors vary according to the context, and therefore, a contextual analysis should be conducted.

O objetivo desta revisão integrativa da literatura foi analisar estudos publicados entre 2006-2016, disponibilizados em português, inglês ou espanhol, sobre fatores associados à utilização dos serviços de saúde bucal pela população pediátrica entre 0 e 15 anos. Foi realizado um levantamento nas bases de dados Lilacs e Medline, utilizando a estratégia de busca: ("dental care/utilization" OR "dental health services/utilization") AND (child OR "child, preschool") AND NOT adult. Para análise da qualidade metodológica, utilizou-se o Critical Appraisal Skill Programme (CASP) adaptado e o Agency for Healthcare and Research and Quality (AHRQ). Destacam-se como preditores do uso: fatores da criança ou adolescente (idade, frequência de escovação, condições crônicas), do cuidador (escolaridade, percepção da saúde bucal do filho, necessidades bucais referidas), do dentista (disponibilidade à noite e nos finais de semana) e o acompanhamento da saúde bucal pela equipe de saúde da família. Estes fatores são inerentes ao planejamento de políticas ou programas em saúde bucal na população pediátrica, entretanto, variam de acordo com o contexto em que se inserem. Portanto, uma análise contextual é necessária.

Fatores associados à utilização dos serviços de saúde bucal pela população pediátrica: uma revisão integrativa / Factors associated with the utilization of dental health services by the pediatric population: an integrative review

Resumo O objetivo desta revisão integrativa da literatura foi analisar estudos publicados entre 2006-2016, disponibilizados em português, inglês ou espanhol, sobre fatores associados à utilização dos serviços de saúde bucal pela população pediátrica entre 0 e 15 anos. Foi realizado um levantamento nas bases de dados Lilacs e Medline, utilizando a estratégia de busca: ("dental care/utilization" OR "dental health services/utilization") AND (child OR "child, preschool") AND NOT adult. Para análise da qualidade metodológica, utilizou-se o Critical Appraisal Skill Programme (CASP) adaptado e o Agency for Healthcare and Research and Quality (AHRQ). Destacam-se como preditores do uso: fatores da criança ou adolescente (idade, frequência de escovação, condições crônicas), do cuidador (escolaridade, percepção da saúde bucal do filho, necessidades bucais referidas), do dentista (disponibilidade à noite e nos finais de semana) e o acompanhamento da saúde bucal pela equipe de saúde da família. Estes fatores são inerentes ao planejamento de políticas ou programas em saúde bucal na população pediátrica, entretanto, variam de acordo com o contexto em que se inserem. Portanto, uma análise contextual é necessária.

Abstract This integrative literature review aimed to analyze studies about factors associated with the utilization of dental health services by the pediatric population between zero and 15 years old, published between 2006 and 2016 and available in Portuguese, English or Spanish. A survey of articles in the Lilacs and Medline databases was carried out, using the search strategy: ("dental care/utilization" OR "dental health services/utilization") AND ("child" OR "child, preschool") AND NOT adult. To analyze the methodological quality, the adapted Critical Appraisal Skill Programme (CASP) and the Agency for Healthcare and Research and Quality (AHRQ) were used. The following predictors of use of dental health services stood out: factors associated with children or adolescents (age, frequency of tooth brushing, chronic conditions), caregivers (schooling, perception of child's dental health, perceived oral health needs), dentists (availability at night and on the weekends) and follow up of oral health by the family health team. These are inherent factors for the planning of oral health policies or programs for the pediatric population. However, these factors vary according to the context, and therefore, a contextual analysis should be conducted.

Utilization of oral health services network among children and adolescents with leukemia.

AIM: To evaluate the use of the network of oral health services by children and adolescents with leukemia, according to the phase of cancer treatment, type of dental treatment received, and access barriers. METHODS AND RESULTS: An exploratory cross-sectional study carried out in a referral hospital in cancer in northeast of Brazil, with all children and adolescents (3-16 years old) with leukemia who used dental services and who attended the medical consultation in the outpatient clinic between March and August 2016. The analysis of the medical records and a structured interview with caregivers were performed. The majority who used only the specialized network were in a single phase of cancer treatment (49.1%), had oral mucositis treatment (79.2%), and had a time of displacement for oral health services greater than 40 minutes (92.6%). In addition, dental care was centered in the specialized network (76.8%) and during hospitalization (37.7%). CONCLUSIONS: The findings suggest that the oral health care of these individuals is centered on tertiary care, reflecting a deficiency in communication between the network services, as well as the nonrecognition of the basic network as a caregiver source by its users. Despite this, more research is needed.

Determinação do risco periodontal em usuários de antipsicóticos típicos / Determination of periodontal risk in patients under typical antipsychotic medications

Objetivo: avaliar o risco periodontal de portadores de transtorno mental e comportamental assistidos no Núcleo Docente Assistencial de Odontologia e Saúde Mental, vinculado ao Hospital Juliano Moreira, em Salvador. Material e métodos: 40 pacientes ( >= 18 anos) foram classificados em baixo, moderado e alto risco periodontal, por meio do polígono do risco preconizado por Lang & Tonetti (2003). Através do teste Qui-quadrado, foi calculada a associação entre o risco periodontal e idade, sexo, raça/etnia, escolaridade, renda mensal, índice de placa visível e modelo assistencial psiquiátrico. Resultados: 25% da amostra apresentou baixo risco periodontal, 35% médio risco e 40% alto risco. Após análise bivariada, o índice de placa foi a variável associada com alto risco periodontal. Conclusão: entre os portadores de transtornos mentais e comportamentais, usuários de antipsicóticos típicos, a maioria apresentou alta prevalência de médio e alto risco periodontal, e o alto risco periodontal teve associação com o elevado índice de placa ( >= 40%), não havendo correlação com as variáveis socioeconômicas e com o modelo assistencial psiquiátrico. Esses resultados podem subsidiar a implantação de ações de promoção, restauração e manutenção da saúde bucal dos pacientes psiquiátricos assistidos nas diferentes modalidades terapêuticas.

Objective: to evaluate the periodontal risk in patients with mental and behavioral disorders in Teaching Core Care Dentistry and Mental Health linked to Juliano Moreira Hospital, Bahia, Brazil and its association with age, gender, race/ethnicity, education level, monthly income, visible plaque index and model psychiatric care. Material and methods: 40 patients ( >= 18 years) were classified as low, moderate and high periodontal risk, through risk polygon by Lang & Tonetti (2003), and the association between periodontal risk and age, gender, race/ethnicity, education level, monthly income, visible plaque index and psychiatric assistencial model were calculated. Results: 25% of the sample presented a low periodontal risk, 35% medium risk and 40% high risk. After the bivariate analysis the plaque index was the variable associated with high periodontal risk. Conclusion: among patients with mental and behavioral disorders, users of typical antipsychotics, the majority showed high prevalence of medium and high risk periodontal and high periodontal risk was associated with the high plaque index ( >= 40%), there was no correlation between socioeconomic variables and the psychiatric assistencial model. These results may support the implementation of actions for the promotion, restoration and maintenance of oral health of psychiatric patients, assisted in different therapeutic modalities.

[Characteristics of the access and utilization of public dental services in medium-sized cities]. / Características do acesso e utilização de serviços odontológicos em municípios de médio porte.

This cross-sectional study sought to describe the main characteristics of access and utilization of primary and specialized public dental services in two medium-sized cities in Bahia with 100% coverage of the Family Health Program. A survey of 952 households and 2.539 individuals aged over 15 years was conducted. The main variables analyzed were: perceived oral health needs, demand for the service, barriers of organizational access and the type of service and procedure utilized. The use of specialized public dental services was of 11.7% and primary care was 26%. In the city where there was greater use of public dental services, there was less use of private services. The main barrier to access remained in primary care (from 5.0% to 15.2%). There was little interface between secondary care a primary care, as only 16.6% of users returned to this level of care. In conclusion, the main barrier to access in cities with specific organizational and geographic realities appears to be in primary dental care. Individual preventive actions were little reported. It is recommended that barriers to access in primary care be eliminated, and also that a protocol (clinical guides) be established to foster the continuity and longitudinality of primary dental care.

Características do acesso e utilização de serviços odontológicos em municípios de médio porte / Characteristics of the access and utilization of public dental services in medium-sized cities

Este estudo de corte transversal descreve as principais características de acesso e utilização de serviços odontológicos básicos e especializados em dois municípios de médio porte da Bahia com 100% de cobertura da Estratégia de Saúde da Família. Realizou-se um inquérito com 2.539 indivíduos de idade acima de 15 anos em 952 domicílios. As principais variáveis analisadas foram a necessidade de saúde bucal percebida, a procura pelo serviço, a barreira de acesso organizacional e o tipo de serviço e o procedimento utilizado. A utilização de serviços públicos odontológicos especializados foi de 11,7% e básicos de 26%. No município com maior utilização de serviços públicos odontológicos, foi menor o uso de serviços privados. A principal barreira de acesso situou-se na AP (Atenção Primária), entre 5,0% e 15,2%. Observou-se pouca interface da atenção secundária com a AP já que apenas 16,6% dos usuários retornaram a esse nível de atenção. Pode-se concluir que a principal barreira de acesso, em municípios com realidades organizacionais e geográficas específicas parece se situar na AP. Ações preventivas individuais foram pouco relatadas. Recomenda-se a redução de barreiras de acesso na AP, bem como a instituição de um protocolo que estimule a longitudinalidade do cuidado nesse nível.

This cross-sectional study sought to describe the main characteristics of access and utilization of primary and specialized public dental services in two medium-sized cities in Bahia with 100% coverage of the Family Health Program. A survey of 952 households and 2.539 individuals aged over 15 years was conducted. The main variables analyzed were: perceived oral health needs, demand for the service, barriers of organizational access and the type of service and procedure utilized. The use of specialized public dental services was of 11.7% and primary care was 26%. In the city where there was greater use of public dental services, there was less use of private services. The main barrier to access remained in primary care (from 5.0% to 15.2%). There was little interface between secondary care a primary care, as only 16.6% of users returned to this level of care. In conclusion, the main barrier to access in cities with specific organizational and geographic realities appears to be in primary dental care. Individual preventive actions were little reported. It is recommended that barriers to access in primary care be eliminated, and also that a protocol (clinical guides) be established to foster the continuity and longitudinality of primary dental care.

[Distribution of body fat and breast cancer: a case-control study in the South of Brazil]. / Distribuição da gordura corporal e câncer de mama: um estudo de caso-controle no Sul do Brasil.

The scope of this study is to verify the association between body fat distribution and breast cancer in women in the state of Rio Grande do Sul, Brazil. Case-control methodology was used in this study, in which 100 women with a histopathological diagnosis of breast cancer were compared to an out-patient control group (400 women) between January and October 2005. The anthropometric variables collected were: body mass (kg), height, waist circumference (WC), and hip circumference. No association was found between the body mass index (BMI) and the waist/hip ratio (WHR) with the occurrence of breast cancer. In relation to WC, it was observed that women with a high measurement (≥ 88 cm) showed 2.08 times greater chance of developing the disease than those with normal or moderate measurements (< 80 cm-87 cm). When these women were grouped by (pre- and post-) menopausal state and anthropometric variables, only WC showed an adjusted OR association=3.15. The accumulation of fat in the upper part of the body (WC ≥ 88 cm) is a predisposing factor for breast cancer, especially in pre-menopausal women.

Distribuição da gordura corporal e câncer de mama: um estudo de caso-controle no Sul do Brasil / Distribution of body fat and breast cancer: a case-control study in the South of Brazil

O presente estudo tem como objetivo verificar a associação entre a distribuição da gordura corporal e o câncer de mama em mulheres do Rio Grande do Sul. Para este estudo, utilizou-se um delineamento de caso-controle, no qual foram avaliadas cem mulheres com diagnóstico histopatológico de câncer de mama em comparação com o grupo controle ambulatorial (400 mulheres) durante os meses de janeiro a outubro de 2005. As variáveis antropométricas coletadas foram: massa corporal (kg), estatura, circunferência da cintura (CC) e perímetro do quadril. Não foi encontrada associação entre o índice de massa corporal (IMC) e a razão cintura/quadril (RCQ) com ocorrência de câncer de mama. Já para CC, observou-se que mulheres com essa medida elevada (> 88 cm) apresentam 2,08 vezes mais chance de desenvolver a doença do que aquelas com as medidas normais ou moderadas (< 80 cm-87 cm). Quando essas mulheres foram agrupadas por estado menopausal (pré e pós) e variáveis antropométricas, somente a CC apresentou associação OR ajustado=3,15. Conclusão: acúmulo de gordura na parte superior do corpo (CC > 88 cm) é um preditor de câncer de mama especialmente em mulheres pré-menopausa.

The scope of this study is to verify the association between body fat distribution and breast cancer in women in the state of Rio Grande do Sul, Brazil. Case-control methodology was used in this study, in which 100 women with a histopathological diagnosis of breast cancer were compared to an out-patient control group (400 women) between January and October 2005. The anthropometric variables collected were: body mass (kg), height, waist circumference (WC), and hip circumference. No association was found between the body mass index (BMI) and the waist/hip ratio (WHR) with the occurrence of breast cancer. In relation to WC, it was observed that women with a high measurement (> 88 cm) showed 2.08 times greater chance of developing the disease than those with normal or moderate measurements (< 80 cm-87 cm). When these women were grouped by (pre- and post-) menopausal state and anthropometric variables, only WC showed an adjusted OR association=3.15. The accumulation of fat in the upper part of the body (WC> 88 cm) is a predisposing factor for breast cancer, especially in pre-menopausal women.

Política Nacional de Saúde Bucal: fatores associados à integralidade do cuidado / Brazilian Oral Health Policy: factors associated with comprehensiveness in health care / Política Nacional de Salud Bucal: factores asociados a la integración del cuidado

OBJETIVO: Analisar fatores relacionados à integralidade na assistência à saúde bucal em centros de especialidades odontológicas segundo os princípios norteadores da Política Nacional de Saúde Bucal. MÉTODOS: Estudo exploratório transversal baseado em entrevista com 611 usuários de quatro centros de especialidades odontológicas da Bahia em 2008. A variável dependente foi descrita como "integralidade na saúde bucal", correspondente à realização de tratamento odontológico básico antes do tratamento especializado ou concomitante a este. As principais co-variáveis se referiram a cobertura da estratégia saúde da família no município, características sociodemográficas dos usuários, acessibilidade organizacional e geográfica ao serviço, além do tipo de especialidade demandada. RESULTADOS: Residentes de cidades em que o Programa Saúde da Família tinha cobertura > 50 por cento tiveram mais chance de concluir o tratamento odontológico (RP = 2,03, IC 95 por cento: 1,33;3,09) em relação àqueles residentes em locais com cobertura menor. Quem buscou tratamento endodôntico teve mais chance de receber assistência integral à saúde bucal do que os usuários em busca de outras especialidades (RP = 2,31, IC 95 por cento: 1,67;3,19). Os usuários com maior facilidade no acesso geográfico ao serviço especializado (RP = 1,22, IC 95 por cento: 1,03;1,41), com ficha de referência (RP = 2,95, IC 95 por cento: 1,82;4,78) e oriundos da atenção primária (RP = 3,13, IC 95 por cento: 1,70;5,77) tiveram mais chance de alcançar a integralidade na assistência à saúde bucal em relação aos demais usuários. CONCLUSÕES: Usuários com facilidade de acesso geográfico, mais jovens e necessidade de serviço endodôntico tiveram mais chance de receber assistência integral. A implantação de centros de especialidades odontológicas em municípios nos quais a atenção primária à saúde não esteja adequadamente estruturada não é recomendada, visto que a atenção secundária estaria atendendo a livre demanda e executando procedimentos básicos e, portanto, não cumprindo o princípio da integralidade pretendida.

OBJECTIVE: To analyze the factors associated with comprehensiveness in oral health care in Centers of Dental Specialists, according to the guiding principles of the Brazilian Oral Health Policy. METHODS: An exploratory cross-sectional study, based on an interview with 611 users of four specialized dental care centers, was performed in the state of Bahia, Northeastern Brazil, in 2008. The dependent variable was described as "comprehensiveness in oral health care", corresponding to having a primary dental care performed before specialized treatment or concomitantly with it. The main covariables referred to the level of coverage of the family health strategy in the city, users' sociodemographic characteristics, and organizational and geographic accessibility to the service, in addition to the type of specialized care required. RESULTS: Residents of the cities where the Family Healthcare Program had a coverage >50 percent were more likely to conclude their dental treatment (PR=2.03, 95 percent CI: 1.33;3.09), compared to those who lived in places with lower coverage. Individuals who sought endodontic treatment were more likely to receive comprehensive oral health care than users who were seeking other types of specialized care (PR=2.31, 95 percent CI: 1.67;3.19). Users with better geographic accessibility to specialized services (PR=1.22, 95 percent CI: 1.03;1.41), with a reference guide from primary care (PR=2.95, 95 percent CI: 1.82;4.78) and coming from primary health care services (PR=3.13, 95 percent CI: 1.70;5.77) were more likely to achieve comprehensiveness in oral health care than other users. CONCLUSIONS: Users with better geographic accessibility, lower age and need of endodontic services were more likely to receive comprehensive health care. Implementation of Centers of Dental Specialists in cities where primary healthcare is not adequately structured is not recommended, because secondary health care would meet the free demand and perform basic procedures, thus not fulfilling the expected principle of comprehensiveness.

OBJETIVO: Analizar factores relacionados a la integración en la asistencia a la salud bucal en centros de especialidades odontológicas según los principios que guían la Política Nacional de Salud Bucal. MÉTODOS: Estudio exploratorio transversal basado en entrevista con 611 usuarios de cuatro centros de especialidades odontológicas de Bahia, Noreste de Brasil, en 2008. La variable dependiente fue descrita como "integración en la salud bucal", correspondiente a la realización de tratamiento odontológico básico antes del tratamiento especializado o concomitante a este. Las principales covariables se refirieron a cobertura de la estrategia salud de la familia en el municipio, características sociodemográficas de los usuarios, accesibilidad organizacional y geográfica al servicio, además del tipo de especialidad demandada. RESULTADOS: Residentes de ciudades donde el Programa Salud de la Familia tenía cobertura >50 por ciento tuvieron más chance de concluir el tratamiento odontológico (RP=2,03, IC 95 por ciento: 1,33;3,09) con relación a aquellas que estaban residenciados en localidades con cobertura menor. Quien buscó tratamiento endodóntico tuvo más chance de recibir asistencia integral a la salud bucal en comparación con los usuarios que buscan otras especialidades (RP=2,31, IC 95 por ciento: 1,67;3,19). Los usuarios con mayor facilidad en el acceso geográfico al servicio especializado (RP=1,22, IC 95 por ciento: 1,03;1,41), con ficha de referencia (RP=2,95, IC 95 por ciento: 1,82;4,78) y oriundos de la atención primaria (RP=3,13, IC 95 por ciento: 1,70;5,77) tuvieron más chance de alcanzar la integración en la asistencia a la salud bucal con relación a los demás usuarios. CONCLUSIONES: Usuarios con facilidad de acceso geográfico, más jóvenes y necesidad de servicios endodóntico tuvieron más chance de recibir asistencia integral. La implantación de centros de especialidades odontológicas en municipios donde la atención primaria a la salud no se encuentre adecuadamente estructurada no es recomendada, visto que la atención secundaria estaría atendiendo la libre demanda y ejecutando procedimientos básicos y, por lo tanto, no cumpliendo el principio de la integración pretendida.

Brazilian Oral Health Policy: factors associated with comprehensiveness in health care.

OBJECTIVE: To analyze the factors associated with comprehensiveness in oral health care in Centers of Dental Specialists, according to the guiding principles of the Brazilian Oral Health Policy. METHODS: An exploratory cross-sectional study, based on an interview with 611 users of four specialized dental care centers, was performed in the state of Bahia, Northeastern Brazil, in 2008. The dependent variable was described as "comprehensiveness in oral health care", corresponding to having a primary dental care performed before specialized treatment or concomitantly with it. The main covariables referred to the level of coverage of the family health strategy in the city, users' sociodemographic characteristics, and organizational and geographic accessibility to the service, in addition to the type of specialized care required. RESULTS: Residents of the cities where the Family Healthcare Program had a coverage >50% were more likely to conclude their dental treatment (PR=2.03, 95% CI: 1.33;3.09), compared to those who lived in places with lower coverage. Individuals who sought endodontic treatment were more likely to receive comprehensive oral health care than users who were seeking other types of specialized care (PR=2.31, 95% CI: 1.67;3.19). Users with better geographic accessibility to specialized services (PR=1.22, 95% CI: 1.03;1.41), with a reference guide from primary care (PR=2.95, 95% CI: 1.82;4.78) and coming from primary health care services (PR=3.13, 95% CI: 1.70;5.77) were more likely to achieve comprehensiveness in oral health care than other users. CONCLUSIONS: Users with better geographic accessibility, lower age and need of endodontic services were more likely to receive comprehensive health care. Implementation of Centers of Dental Specialists in cities where primary healthcare is not adequately structured is not recommended, because secondary health care would meet the free demand and perform basic procedures, thus not fulfilling the expected principle of comprehensiveness.

[The user's evaluation of the ophthalmologic service offered by SUS (Brazilian Unified Health System) in an urban center in the south of Brazil]. / Avaliação do usuário sobre o atendimento oftalmológico oferecido pelo SUS em um centro urbano no sul do Brasil.

The user's evaluation is an important component of the quality of the health services. The goal of the present study was to evaluate the user's satisfaction with the ophthalmologic service provided by an accredited service of the Brazilian Unified Health System (SUS) in an urban center of the South of Brazil. It is a transversal study in which a questionnaire was applied about the user's socioeconomic and demographic profile, questions related to the quality of the service and suggestions and/or complaints regarding to the attendance and the service. The sample was calculated in the program EPINFO version 6.0, it had as its base 1200 monthly services, in a total of 355 users. The results showed that 77.1% of the users were satisfied with the medical service. However, 75.4% pointed deficiencies related to the time they had to wait in the place, to the duration of the consultation and at the interpersonal relationship with doctor and other attendants. It was verified that 36.3% considered the ophthalmologic service offered by SUS as terrible and regular. This way, it is fundamental to rethink the professional practices and to intervene on the form of organization of this service, seeking its improvement and the user's satisfaction.

Avaliação do usuário sobre o atendimento oftalmológico oferecido pelo SUS em um centro urbano no sul do Brasil / The user's evaluation of the ophthalmologic service offered by SUS (Brazilian Unified Health System) in an urban center in the south of Brazil

A avaliação do usuário é um importante componente da qualidade dos serviços em saúde. O objetivo deste estudo foi avaliar a satisfação do usuário quanto ao atendimento oftalmológico prestado por um serviço credenciado do SUS num centro urbano do Sul do Brasil. Trata-se de um estudo transversal, no qual se aplicou questionário sobre o perfil socioeconômico e demográfico do usuário, questões relacionadas à qualidade do atendimento e sugestões e/ou reclamações referentes ao atendimento e ao serviço. Calculou-se a amostra no programa EPINFO versão 6.0, tendo como base 1.200 atendimentos mensais, totalizando 355 usuários. Os resultados mostraram que 77,1 por cento dos usuários estavam satisfeitos com o atendimento médico. Entretanto, 75,4 por cento apontaram deficiências relacionadas ao tempo de espera no local, à duração da consulta e à relação interpessoal com médico e atendentes. Verificou-se que 36,3 por cento consideraram o serviço oftalmológico oferecido pelo SUS como péssimo e regular. Desta forma, é fundamental repensar as práticas profissionais e intervir sobre a forma de organização deste serviço, visando ao seu aperfeiçoamento e satisfação do usuário.

The user's evaluation is an important component of the quality of the health services. The goal of the present study was to evaluate the user's satisfaction with the ophthalmologic service provided by an accredited service of the Brazilian Unified Health System (SUS) in an urban center of the South of Brazil. It is a transversal study in which a questionnaire was applied about the user's socioeconomic and demographic profile, questions related to the quality of the service and suggestions and/or complaints regarding to the attendance and the service. The sample was calculated in the program EPINFO version 6.0, it had as its base 1200 monthly services, in a total of 355 users. The results showed that 77.1 percent of the users were satisfied with the medical service. However, 75.4 percent pointed deficiencies related to the time they had to wait in the place, to the duration of the consultation and at the interpersonal relationship with doctor and other attendants. It was verified that 36.3 percent considered the ophthalmologic service offered by SUS as terrible and regular. This way, it is fundamental to rethink the professional practices and to intervene on the form of organization of this service, seeking its improvement and the user's satisfaction.

[Access by hearing-disabled individuals to health services in a southern Brazilian city]. / Acesso de pessoas deficientes auditivas a serviços de saúde em cidade do Sul do Brasil.

This cross-sectional study aimed to compare access to health services and preventive measures by persons with hearing disability and those with normal hearing in Canoas, Rio Grande do Sul State, Brazil. The sample included 1,842 individuals 15 years or older (52.9% of whom were females). The most frequent income bracket was twice the minimum wage or more, or approximately U$360/month (42.7%). Individuals with hearing disability were more likely to have visited a physician in the previous two months (PR = 1.3, 95%CI: 1.10-1.51) and to have been hospitalized in the previous 12 months (PR = 2.1, 95%CI: 1.42-3.14). Regarding mental health, individuals with hearing disability showed 1.5 times greater probability of health care due to mental disorders and 4.2 times greater probability of psychiatric hospitalization as compared to those with normal hearing. Consistent with other studies, women with hearing disability performed less breast self-examination and had fewer Pap smears. The data indicate the need to invest in specific campaigns for this group of individuals with special needs.

Acesso de pessoas deficientes auditivas a serviços de saúde em cidade do Sul do Brasil / Access by hearing-disabled individuals to health services in a southern Brazilian city

Este estudo transversal, de base populacional, tem como objetivo comparar o acesso dos portadores de deficiência auditiva incapacitante a serviços assistenciais e de prevenção com os ouvintes de Canoas, Rio Grande do Sul, Brasil. A amostra incluiu 1.842 pessoas com 15 anos ou mais, sendo a maioria mulheres (52,9 por cento). A renda individual de dois salários mínimos ou mais foi a mais freqüente (42,7 por cento). As pessoas com deficiência auditiva incapacitante tiveram 30 por cento maior probabilidade de ter consultado nos dois meses anteriores à entrevista (RP = 1,3, IC95 por cento: 1,10-1,51) e ter sido internado nos 12 meses anteriores à entrevista (RP = 2,1, IC95 por cento: 1,42-3,14). Nas variáveis relativas à saúde mental, os deficientes auditivos tiveram 1,5 mais probabilidade de terem consultado para problemas de nervos (IC95 por cento: 1,18-1,95) e 4,2 mais probabilidades de terem sido internados em hospital psiquiátrico que os ouvintes (IC95 por cento: 2,17-8,16). Assim como encontrado na literatura, as mulheres deficientes auditivas realizaram menos auto-exame das mamas e exame citopatológico de colo uterino. Os dados encontrados indicam a necessidade de investir em educação em saúde e campanhas específicas para o grupo de pessoas investigado.

This cross-sectional study aimed to compare access to health services and preventive measures by persons with hearing disability and those with normal hearing in Canoas, Rio Grande do Sul State, Brazil. The sample included 1,842 individuals 15 years or older (52.9 percent of whom were females). The most frequent income bracket was twice the minimum wage or more, or approximately U$360/month (42.7 percent). Individuals with hearing disability were more likely to have visited a physician in the previous two months (PR = 1.3, 95 percentCI: 1.10-1.51) and to have been hospitalized in the previous 12 months (PR = 2.1, 95 percentCI: 1.42-3.14). Regarding mental health, individuals with hearing disability showed 1.5 times greater probability of health care due to mental disorders and 4.2 times greater probability of psychiatric hospitalization as compared to those with normal hearing. Consistent with other studies, women with hearing disability performed less breast self-examination and had fewer Pap smears. The data indicate the need to invest in specific campaigns for this group of individuals with special needs.

[Physical violence and associated factors: a population-based study in Southern Brazil]. / Violência física e fatores associados: estudo de base populacional no sul do Brasil.

OBJECTIVE: To estimate the prevalence of physical violence and its association with sociodemographic aspects, stressful life events, and the use of health services due to emotional problems. METHODS: A cross-sectional population-based study was conducted with a sample of 1,954 14-year-old or older inhabitants of the city of Canoas (Southern Brazil). They were selected by means of conglomerate sampling according to a pre-established system. Data were obtained in visits to households by means of a confidential semi-structured questionnaire. A bivariate analysis was carried out through multinomial logistic regression, and the multivariate analysis by polytomous logistic regression, categorizing the outcome by age group. RESULTS: The findings show a prevalence of 9.7% (CI 95%: 8.37;11.03) and association with: women 20 years old and older (OR=2.74; CI 95%: 1.52;4.94); higher schooling rate (p<0.03); higher experience of stressful life events at 20 years of age or more (OR=6.61; CI 95%: 2.71;16.1); and doctors' appointments due to emotional problems as of 10 years of age (p>0.001). CONCLUSIONS: The prevalence of physical violence in the population was significant, resulting in important emotional consequences and impact on health services, requiring capacity building of the professionals in the field.

Violência física e fatores associados: estudo de base populacional no sul do Brasil / Physical violence and associated factors: a population-based study in Southern Brazil / Violencia física y factores asociados: estudio de base poblacional en el sur de Brasil

OBJETIVO: Estimar a prevalência de violência física e sua associação com aspectos sociodemográficos, eventos estressantes e utilização de serviços de saúde por problemas emocionais. MÉTODOS: Estudo transversal de base populacional realizado em amostra de 1.954 sujeitos com 14 anos ou mais, residentes em Canoas, RS, 2002-2003. A amostragem por conglomerados seguiu sistemática pré-estabelecida. Os dados foram coletados em visitas domiciliares com questionário semi-estruturado e confidencial. Foram realizadas as análises: bivariada, por meio de regressão logística multinomial e multivariada, por regressão politômica, categorizando o desfecho por faixa etária. RESULTADOS: Foi encontrada prevalência de 9,7 por cento (IC 95 por cento: 8,37;11,03) e associação com: sexo feminino a partir dos 20 anos de idade (OR=2,74; IC 95 por cento: 1,52;4,94), maior escolaridade (p<0,03), maior vivência de eventos estressantes com 20 anos ou mais (OR=6,61; IC 95 por cento: 2,71;16,1) e consulta por problemas emocionais a partir dos 10 anos de idade (p>0,001). CONCLUSÕES: A prevalência da violência física na população foi significativa, com conseqüências emocionais e impacto nos serviços de saúde, requerendo capacitação dos profissionais da área.

OBJECTIVE: To estimate the prevalence of physical violence and its association with sociodemographic aspects, stressful life events, and the use of health services due to emotional problems. METHODS: A cross-sectional population-based study was conducted with a sample of 1,954 14-year-old or older inhabitants of the city of Canoas (Southern Brazil). They were selected by means of conglomerate sampling according to a pre-established system. Data were obtained in visits to households by means of a confidential semi-structured questionnaire. A bivariate analysis was carried out through multinomial logistic regression, and the multivariate analysis by polytomous logistic regression, categorizing the outcome by age group. RESULTS: The findings show a prevalence of 9.7 percent (CI 95 percent: 8.37;11.03) and association with: women 20 years old and older (OR=2.74; CI 95 percent: 1.52;4.94); higher schooling rate (p<0.03); higher experience of stressful life events at 20 years of age or more (OR=6.61; CI 95 percent: 2.71;16.1); and doctors' appointments due to emotional problems as of 10 years of age (p>0.001). CONCLUSIONS: The prevalence of physical violence in the population was significant, resulting in important emotional consequences and impact on health services, requiring capacity building of the professionals in the field.

OBJETIVO: Estimar la prevalencia de violencia física y sua asociacion con aspectos sociodemográfcos, eventos estresantes y utilizacion de servicios de salud por problemas emocionales. MÉTODOS: Estudio transversal de base poblacional realizado en muestra de 1.954 sujetos con 14 anos o mas, residentes en Canoas, sur de Brasil, 2002-2003. La muestra por conglomerados siguio sistemática pré-estabelecida. Los datos fueron tomados en visitas domiciliarias con cuestionário semi-estructurado y confidencial. Fueron realizadas las analisis: bivariada, por meio de regresión logística multinomial y multivariada, por regresión politómica, según grupo etario. RESULTADOS: Fue encontrada prevalencia de 9,7 por ciento (IC 95 por ciento: 8,37;11,03) y asociación con: sexo feminino a partir dos 20 anos de edad (OR=2,74; IC 95 por ciento: 1,52;4,94), mayor escolaridade (p<0,03), mas vivencia de eventos estresantes con 20 anos o mas (OR=6,61; IC 95 por ciento: 2,71;16,1) y consulta por problemas emocionales a partir de los 10 anos de edad (p>0,001). CONCLUSÕES: La prevalencia de la violencia física en la poblacion fue significativa, con consecuencias emocionales e impacto en los servicios de salud, requiriendo capacitación de los profesionales del área.

Hearing impairment and socioeconomic factors: a population-based survey of an urban locality in southern Brazil.

OBJECTIVE: To provide the first population-based data on deafness and hearing impairment in Brazil. METHODS: In 2003, a cross-sectional household survey was conducted of 2,427 persons 4 years old and over. The study population was composed of 1,040 systematically chosen households in 40 randomly selected census tracts (dwelling clusters) in the city of Canoas, which is in the state of Rio Grande do Sul, in southern Brazil. Hearing function was evaluated in all subjects by both pure-tone audiometry and physical examination, using the World Health Organization Ear and Hearing Disorders Survey Protocol and definitions of hearing levels. The socioeconomic data that were gathered included the amount of schooling of all individuals tested and the income of the head of the household. RESULTS: It was found that 26.1% of the population studied showed some level of hearing impairment, and 6.8% (95% confidence interval (CI) = 5.5%-8.1%) were classified in the disabling hearing impairment group. The prevalence of moderate hearing loss was 5.4% (95% CI = 4.4%-6.4%); for severe hearing loss, 1.2% (95% CI = 0.7%-1.7%); and for profound hearing loss, 0.2% (95% CI = 0.03%-0.33%). The groups at higher risk for hearing loss were men (odds ratio (OR) = 1.54; 95% CI = 1.06-2.23); participants 60 years of age and over (OR = 12.55; 95% CI = 8.38-18.79); those with fewer years of formal schooling (OR = 3.92; 95% CI = 2.14-7.16); and those with lower income (OR = 1.56; 95% CI = 1.06-2.27). CONCLUSIONS: These results support advocacy by health policy planners and care providers for the prevention of deafness and hearing impairment. The findings could help build awareness in the community, in universities, and in government agencies of the health care needs that hearing problems create.