Referred speech-language and hearing complaints in the western region of São Paulo, Brazil

OBJECTIVE: The aim of this study was to characterize the epidemiological profile of the population attending primary health care units in the western region of the city of São Paulo, Brazil, highlighting referred speech-language and hearing complaints. METHOD: This investigation was a cross-sectional observational study conducted in primary health care units. Household surveys were conducted and information was obtained from approximately 2602 individuals, including (but not limited to) data related to education, family income, health issues, access to public services and access to health services. The speech-language and hearing complaints were identified from specific questions. RESULTS: Our results revealed that the populations participating in the survey were heterogeneous in terms of their demographic and economic characteristics. The prevalence of referred speech-language and hearing complaints in this population was 10%, and only half the users of the public health system in the studied region who had complaints were monitored or received specific treatment. CONCLUSIONS: The results demonstrate the importance of using population surveys to identify speech-language and hearing complaints at the level of primary health care. Moreover, these findings highlight the need to reorganize the speech-language pathology and audiology service in the western region of São Paulo, as well as the need to improve the Family Health Strategy in areas that do not have a complete coverage, in order to expand and improve the territorial diagnostics and the speech-language pathology and audiology actions related to the prevention, identification, and rehabilitation of human communication disorders. .

Conditional factors for untreated caries in 12-year-old children in the city of Sao Paulo

The aim of the study was to analyze what sociodemographic and economic variables were associated with the presence of untreated caries in 12-year-old children in the city of São Paulo. This cross-sectional study had a complex sample design. It was based on secondary data generated by the Levantamento epidemiológico em saúde bucal (Epidemiological Oral Health Survey) in the city of São Paulo, conducted in 2008, whose sample comprised 4,246 12-year-old children from the public and private schools of all the administrative districts of the city. A questionnaire was applied and an epidemiological exam was performed in accordance with the World Health Organization's (WHO) recommendations. The variables of interest were categorized into a dependent variable of untreated dental caries (carious component of the DMFT index that corresponds to carious, missing and filled teeth) and independent variables related to the socioeconomic and demographic conditions of the children and their families, and to their access to dental services. The EPI-INFO 06 and STATA 10 programs were used for the analysis; the prevalence ratio and a confidence interval of 95% were applied to the population parameters. The Poisson regression model was used, adjusted for sampling of the complex type. Caries was associated with ethnicity (higher rate in black people, p = 0.042), attending public school (p = 0.000), lower average family income (p = 0.002), overcrowded dwellings (p = 0.000) and presence of pain (p = 0.000). Caries is a multifactorial disease influenced by social health determinants that intensify its risk.

Estudo de base populacional sobre as condições periodontais e determinantes socioeconômicos em adultos residentes no município de Guarulhos (SP), Brasil, 2006 / Population based study on periodontal conditions and socioeconomic determinants in adults in the city of Guarulhos (SP), Brazil, 2006

OBJETIVO: Este estudo descreveu a prevalência de condições periodontais e sua associação com variáveis demográficas, socioeconômicas e comportamentais em adultos de 35 a 44 anos residentes no município de Guarulhos, São Paulo, 2006. MÉTODOS: Foi realizado estudo transversal de base populacional com delineamento amostral por conglomerados. Os inquéritos e os exames foram realizados nos domicílios sorteados. Para avaliação da condição periodontal foi utilizado o índice Community Periodontal Index (CPI). Os dados foram apurados pelo programas EPIINFO 6 e STATA 10. Para o modelo de associação empregou-se a razão de prevalências (RP), calculada por meio de análise de regressão de Poisson, com correção para delineamento de amostras complexas e ponderação pelo peso populacional. RESULTADOS: Foram examinadas 263 pessoas em 237 domicílios. No estudo multivariado, com modelo ajustado para amostras complexas e ponderação populacional, a prevalência de sangramento gengival e cálculo dentário esteve associada significativamente ao fato de ser homem (RP=1,12, p=0,04), fumante (RP=1,11, p=0,01), ter menos de oito anos de estudo (RP=1,14, p=0,01) e não visitar o cirurgião-dentista (CD) há mais de dois anos (RP=1,19, p=0,00). Para a presença de bolsa periodontal, houve associação com adultos que relataram o hábito de fumar (RP=1,71, p=0,02) e apresentavam mais de dois anos sem frequentar o CD (RP=1,97, p=0,03). CONCLUSÃO: Houve maior prevalência (62,7 por cento) de indivíduos com sangramento gengival e cálculo dentário em relação à presença de bolsas periodontais rasas ou profundas (26,6 por cento); as primeiras, reversíveis, têm possibilidades de resolução por meio de procedimentos de atenção básica em saúde bucal.

OBJECTIVE: This study described the prevalence of periodontal conditions and assessed its association with social, economical and behavioral variables in adults aged 35 to 44 years old, residents in the city of Guarulhos, State of Sao Paulo, 2006. METHODS: This study was a population based survey with cluster sampling. Data collecting and exams were done at houses drew at random. The Community Periodontal Index was used to assess the periodontal condition. Data analysis used EPIINFO 6 and STATA 10 softwares. The assessment of association used the prevalence ratio (PR), as calculated by Poisson regression models with complex sampling and weighted sample adjustments. RESULTS: The total number of people was 263 in 237 domiciles. In the multivariate model, the prevalence of gingival bleeding and dental calculus was significantly associated to being male (PR=1.12, p=0.04), smoking (PR=1.11, p=0.01), school level of less than eight years of study (PR=1.14, p=0.01), and who have not received dental care for more than two years (PR=1.19, p<0.01). As for the presence of periodontal pocket, associated factors were smoking (PR=1.71, p=0.02) and who have not received dental care for more than 2 years (PR=1.97, p=0.03). CONCLUSION: We observed a higher prevalence (62.7 percent) of individuals with gingival bleeding and dental calculus in relation to the presence of shallow or deep periodontal pockets (26,6 percent). As shallow pockets are reversible, their treatment may be resolute in programs of primary dental care.

Oral Health in Brazil - Part I: public oral health policies

This paper reviews the historical development of public health policies in Brazil and the insertion of oral health in this context. Since 1988, Brazil established a Unified National Health System ("Sistema Único de Saúde" - SUS), which was conceived to assure access to health actions and services, including oral health. However, a history of lack of access to health services and the health problems faced by the Brazilian population make the process of building and consolidating the SUS extremely challenging. Since 2004, the Oral Health National Policy has proposed a reorientation of the health care model, supported by an adaptation of the working system of Oral Health teams so that they include actions of health promotion, protection and recovery. Human resources should be prepared to act in this system. The qualifying process must take in consideration knowledge evolution, changes in the work process and changes in demographical and epidemiological aspects, according to a perspective of maintaining a balance between technique and social relevance.

Determinantes individuais e contextuais da prevalência de cárie dentária não tratada no Brasil / Individual and contextual determinants of the prevalence of untreated caries in Brazil

OBJETIVO: Descrever a prevalência de cárie dentária não tratada em adolescentes no Brasil e analisar a associação da cárie com fatores individuais e contextuais nos municípios onde esses adolescentes residem. MÉTODOS: Utilizou-se um banco de dados gerado pelo Ministério da Saúde (projeto SB-Brasil) que inclui informações de 16 833 adolescentes (15 a 19 anos). A presença de ao menos um dente permanente com cárie não tratada foi a variável de estudo. As variáveis explicativas, em nível individual, foram: sexo, grupo étnico, local de residência e situação escolar. As variáveis referentes ao município foram: índice de desenvolvimento humano municipal (IDH-M), proporção de domicílios com ligação de água e presença de flúor na água de abastecimento há 5 anos ou mais. Para ajustar o desfecho às condições individuais e municipais de interesse, foi realizada uma análise multinível para estimação em modelos multivariados de regressão logística. RESULTADOS: Ser negro ou pardo (razão de chances ajustada, ORajust = 1,79; 1,68 a 1,92) e residir em área rural (ORajust = 1,31; 1,19 a 1,45) foram determinantes individuais de maior probabilidade de apresentar cárie não tratada. Ser estudante foi identificado como fator de proteção (ORajust = 0,67; 0,62 a 0,73). As variáveis de segundo nível, IDH-M (coeficiente ajustado beta = -0,213), flúor na rede de água (beta = -0,201) e proporção de domicílios com ligação de água (beta = -0,197) foram identificadas como determinantes contextuais de cárie. CONCLUSÃO: Os resultados mostram que existe desigualdade na distribuição dos serviços de saúde nas diferentes regiões brasileiras e sugerem que pode haver desigualdade também na efetividade dos serviços prestados. Políticas de expansão do acesso à água fluoretada e inclusão escolar podem contribuir para evitar a doença cárie em adolescentes.

OBJECTIVE: To describe the prevalence of untreated caries among adolescents in Brazil and to analyze the association between caries and individual and contextual factors in the municipalities where these adolescents live. METHODS: A Ministry of Health database (projeto SB-Brasil) provided health records on 16 833 adolescents from 15-19 years of age. The study variable used was the presence of at least one permanent tooth having been lost to caries. The individual variables considered were: sex, ethnic group, living in an urban versus a rural area, and being a student or not. Contextual variables related to the municipality were: municipal human development index (MHDI), proportion of households connected to the water system, and water fluoridation for 5 years or more. Multilevel logistic regression analysis was carried out to adjust the outcome to the individual and contextual variables. RESULTS: Individual determinants related to a higher probability of untreated caries were: the ethnic group described as "black or brown," (adjusted odds ratio, ORadjust = 1.79; 1.68 to 1.92); and living in a rural area (ORadjust = 1.31; 1.19 to 1.45). Being a student was identified as a protective factor (ORadjust = 0.67; 0.62 to 0.73). Secondary variables identified as contextual determinants of caries were MHDI (adjusted coefficient beta = -0.213), water fluoridation (beta = -0.201), and households connected to the water system (beta = -0.197). CONCLUSIONS: The results show inequalities in the distribution of health services in the various Brazilian regions, and suggest that inequalities may also be present in the effectiveness of the services provided. Policies to increase access to fluoride-treated water and school enrollment may contribute to preventing caries in adolescents.

The association between socioeconomic development at the town level and the distribution of dental caries in Brazilian children / La asociación entre el desarrollo socioeconómico local y la distribución de caries dental en niños brasileños

OBJECTIVE: To investigate the association between dental caries among children in the state of Säo Paulo, Brazil, and town-level indices of socioeconomic development. METHODS: We examined 15 385 oral-examination records from children aged 5 or 6 years old from 129 towns and cities in the state of Säo Paulo. We studied two outcomes: (1) the mean number of decayed, missing, and filled deciduous teeth (dmft index) and (2) the care index, which is the proportion of decayed teeth that have already been filled. The explanatory variables were the child development index, human development index, illiteracy rate among subjects older than 20 years, household income, Gini coefficient, insufficient income, fluoridated water supply, number of dentists per 10 000 inhabitants, number of dentists in the public service per 10 000 inhabitants, and number of weekly hours of dentist work in the public service per 10 000 inhabitants. Multiple linear regression models were fitted to the two outcome variables (dmft index and care index). RESULTS: The multiple linear regression analysis showed that a higher dmft index was associated with a low child development index, a high illiteracy rate, and an unfluoridated water supply. The child development index was significantly associated with the care index, and the number of dentists in the public service per 10 000 inhabitants showed borderline statistical significance. CONCLUSIONS: Our results indicate that town-level indices of socioeconomic status are significantly correlated with caries indices. Our results also emphasize the beneficial effect that fluoridating water has on reducing the prevalence of dental caries and the fact that strategies for treating and preventing oral diseases should be emphasized within the context of overall health promotion for children

Objetivo. Investigar la asociación entre la caries dental en niños del estado de São Paulo, Brasil, y los índices de desarrollo socioeconómico en el nivel local. Métodos. Examinamos 15 385 registros con los resultados de exámenes bucales de niños de 5 y 6 años de edad provenientes de 129 pueblos y ciudades del estado de São Paulo. Fueron dos los resultados examinados: 1) el número medio de dientes cariados, perdidos y obturados en la dentadura decídua (índice CPOD) y 2) el índice de atención, que es la proporción de dientes deteriorados que han sido empastados. Las variables explicativas fueron el índice de desarrollo infantil, el índice de desarrollo humano, la tasa de analfabetismo entre personas mayores de 20 años, el ingreso domiciliario, el coeficiente de Gini, la escasez de ingresos, el abastecimiento con agua fluorurada, el número de dentistas por 10 000 habitantes, el número de dentistas en el sistema público de atención por 10 000 habitantes y el número de horas semanales dedicadas a trabajos de tipo dental en el sistema público de atención por 10 000 habitantes. Se ajustaron modelos de regresión lineal múltiple a las dos variables dependientes de interés (el índice CPOD y el índice de atención). Resultados. El análisis de regresión lineal múltiple mostró que un índice CPOD más elevado se asocia con un índice bajo de desarrollo infantil, un índice elevado de analfabetismo y la ausencia de un abastecimiento de agua fluorurada. El índice de desarrollo infantil mostró una asociación significativa con el índice de atención, y el número de dentistas en el servicio público de atención por 10 000 habitantes mostró una asociación marginalmente significativa con ese mismo índice. Conclusiones. Nuestros resultados indican que los indicadores de nivel socioeconómico aplicables en el nivel local se correlacionan en grado significativo con los índices de caries dental. También resaltan el efecto beneficioso de la fluoruración del agua en lo que respecta a la reducción de la prevalencia de caries dental y el hecho de que las estrategias encaminadas a tratar y prevenir las afecciones bucales deben ser objeto de especial atención en el contexto de la promoción de la salud infantil