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Trans R Soc Trop Med Hyg ; 114(5): 323-331, 2020 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-32134492


BACKGROUND: Reducing TB mortality is a great challenge in Brazil due to its territorial extension, cultural variations and economic and political crises, which impact the health system. This study aimed to estimate in space and time the risk of TB mortality and test its relationship with social inequities. METHODS: This was an ecological study that included deaths from TB between 2006 and 2016 in Cuiabá, Brazilian Legal Amazon. Bayesian models based on the integrated nested Laplace approximation approach were used to estimate spatio-temporal RRs. RRs for TB mortality were obtained according to the covariables representative of social inequities. RESULTS: The risk of TB mortality was stable between 2006 and 2016 and high-risk areas were identified throughout the municipality studied. Regarding social inequities, income was an important factor associated with TB mortality risk, as an increase of 1 SD in income resulted in a 35.4% (RR 0.646; CI 95% 0.476 to 0.837) decrease in risk. CONCLUSIONS: The results provided evidence of areas with higher TB mortality risks that have persisted over time and are related to social inequities. Advancing social policies and protections in these areas will contribute to achieving the WHO's End TB strategy.

J Dent Educ ; 82(10): 1077-1083, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30275142


The aim of this study was to assess the performance of dental students for detecting in vitro occlusal carious lesions using the International Caries Detection and Assessment System (ICDAS) with different learning strategies. A convenience sample of all 64 fourth-year dental students at a dental school in Brazil who had no previous experience with ICDAS was selected for the study in 2015. First, students performed the in vitro examination of the occlusal surfaces of 80 teeth according to ICDAS. Two weeks later, students were randomly allocated to three groups: G1 (n=21), ICDAS e-learning; G2 (n=22), ICDAS e-learning + digital learning tool (DLT); G3 (n=21), no training (control group). All students reexamined the 80 teeth according to ICDAS two weeks later. Sensitivity, specificity, and area under the ROC curve (AUC) were calculated according to three thresholds. Of the 64 students, 59 completed all study phases, for a 92.2% participation rate. The intra-group comparison found significantly higher sensitivity and specificity values for G1 and G2 students. G3 students showed an increased sensitivity at the D2 threshold. G2 was the only training strategy that resulted in significant improvement for the AUC. In the comparison of groups at the same threshold, G1 showed higher specificity at D3 threshold (0.78) than G2 (0.72) and G3 (0.73). Regarding sensitivity, G1 showed a lower value at D2 (0.91) threshold than G2 (0.94) and G3 (0.94). In this study, both training strategies (ICDAS e-learning and ICDAS e-learning + DLT) improved the performance of dental students for the in vitro detection of occlusal carious lesions, mainly when the association of methods was used.

Instrução por Computador , Cárie Dentária/diagnóstico , Estudantes de Odontologia , Competência Clínica , Avaliação Educacional , Humanos , Sensibilidade e Especificidade
Int J Paediatr Dent ; 23(4): 266-73, 2013 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-23016995


BACKGROUND: Traumatic dental injury (TDI) has been considered a significant problem in youth, not only because of its consequences to the craniofacial structures but also for its potential impact on the quality of life of affected individuals. AIM: The aim of this study was to investigate the impact of TDI with treatment needs on the oral health-related quality of life (OHRQoL) of South Brazilian schoolchildren. DESIGN: A cross-sectional study was performed in Porto Alegre, Brazil, using a multistage probability sampling strategy. Of 1837 eligible 12-year-old schoolchildren attending public and private schools, 1528 were examined. OHRQoL was assessed by the Brazilian version of the Child Perceptions Questionnaire for 11-to 14-year-old children (CPQ11-14) - 16-item short form. Clinical examination was conducted to assess the presence of TDI in permanent incisors (Children's Dental Health Survey criteria), malocclusion, and dental caries. Parents/legal guardians answered questions on socioeconomic status. Statistical analyses were performed using Poisson regression models. RESULTS: The overall CPQ11-14 score was not associated with TDI. In the functional limitations domain, individuals presenting TDIs with treatment needs experienced significantly higher mean CPQ11-14 than individuals with no TDI or without treatment needs (RR = 1.21; 95% CI = 1.05-1.39), after adjusting for malocclusion, dental caries, gender, and socioeconomic status. No other domains were associated with TDI. CONCLUSIONS: This study revealed that TDI with treatment needs negatively affects the OHRQoL in this population of 12-year-old schoolchildren and that this impact is related to oral functions.

Necessidades e Demandas de Serviços de Saúde , Incisivo/lesões , Saúde Bucal , Qualidade de Vida , Atitude Frente a Saúde , Brasil , Criança , Estudos Transversais , Coroas/psicologia , Índice CPO , Cárie Dentária/psicologia , Esmalte Dentário/lesões , Exposição da Polpa Dentária/psicologia , Restauração Dentária Permanente/psicologia , Dentina/lesões , Prótese Parcial Removível/psicologia , Estética Dentária , Humanos , Índice de Necessidade de Tratamento Ortodôntico , Má Oclusão/psicologia , Tratamento do Canal Radicular/psicologia , Classe Social , Fraturas dos Dentes/psicologia , Perda de Dente/psicologia , Saúde da População Urbana
J Public Health Dent ; 71(4): 265-70, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-22320284


OBJECTIVES: The aim of the present study was to assess Public Health Service clinicians' treatment decisions about deep carious lesions in the city of Porto Alegre, Brazil. METHODS: Treatment decisions were assessed with a structured questionnaire (open/discursive and containing information about gender, university and year of college graduation, and college major) and three simulated clinical cases composed of teeth with primary deep carious lesion. All professionals working for the Public Health Service in the city were addressed. RESULTS: Out of 122 professionals, 54 participated in the study (response rate of 44 percent). There was no difference between respondents and non-respondents regarding gender, year of college graduation, or college major. The most commonly indicated procedure was direct complete excavation (71.1 percent), followed by stepwise excavation (17.6 percent), partial caries removal (8.8 percent), and pulp therapies (direct pulp capping, partial or complete pulpotomy, and endodontics) (2.5 percent). Year of college graduation was the only variable influencing treatment decision. Logistic regression analysis showed that professionals who had graduated after the year 2000 were significantly more likely to indicate a conservative treatment than were dentists who graduated through 1979 (odds ratio = 5.5). CONCLUSIONS: The most commonly proposed treatment is the one with the highest risk of pulp exposure, and consequently the poorest prognosis. Younger dentists tended to indicate more conservative approaches, compared with those indicated by older dentists.

Atitude do Pessoal de Saúde , Tomada de Decisões , Cárie Dentária/terapia , Odontólogos/psicologia , Fatores Etários , Brasil , Preparo da Cavidade Dentária/métodos , Capeamento da Polpa Dentária/métodos , Exposição da Polpa Dentária/prevenção & controle , Registros Odontológicos , Educação em Odontologia , Feminino , Humanos , Masculino , Projetos Piloto , Odontologia em Saúde Pública , Pulpotomia/métodos , Tratamento do Canal Radicular/métodos , Inquéritos e Questionários