Health Professionals: Identifying and Reporting Child Physical Abuse-a Scoping Review

Health professionals play a significant role in identifying and reporting child physical abuse (CPA). However, several studies have pointed out non-reporting behavior among these professionals, evidencing difficulties identifying and reporting suspected cases. This review aimed to explore the frequency and possible barriers in identifying and reporting CPA by health professionals worldwide and to identify associated factors. This scoping review was conducted in the Pubmed, Web Of Science, Scopus, and SciELO databases between July 2019 and December 2020. Analytical and qualitative observational epidemiological studies were selected and published in English, Portuguese, and Spanish, with data on the identification and/or reporting of CPA by health professionals. Twenty studies fulfilled the criteria of this review. The studies were conducted with dentists, nurses, pediatricians, and general practitioners. The frequency of identification of CPA ranged from 50% to 89%, while the frequency of reporting ranged from 8% to 47%. This review revealed that health professionals had a low frequency of reporting of CPA, especially for dentists. In addition, several associated factors and barriers in the identification and reporting of CPA were identified in the studies. These were discussed in five main themes: training and continuing education in CPA, impact on professional practice, experiences and perceptions about child protection services, the threshold for suspicion of the professional, and the professional category.

Dentists' perceptions and attitudes towards emergency care for women in situations of violence: a scope review

The purpose of this study was to evaluate, through a scope review, studies that address the perceptions and attitudes of dentists regarding the care of women in situations of violence. Using the descriptors women violence, dentist attendance or dentist care, 473 articles were identified, of which 13 were included at the end of the selection process. Although the need for training was predominant, it was not sufficient. There is a weakness in understanding violence as a health problem, in understanding the role of the professional in solving this problem, and the factors that can contribute to its growth or its control. The results revealed that the dentist had greater difficulty than other professionals in coping with the issue and required extensive training. The recognition of these cases of abuse by the dentist requires the incorporation of educational measures that cause cultural changes, deconstruction of gender norms and the denaturalization of this social phenomenon.

Salutogenesis in oral health research in preschool children: A scoping review

BACKGROUND

Oral health research in children has focused both on identifying the risk factors for dental caries and on the impact the disease has on children's life.

AIM

Identifying studies that used the salutogenic theory to investigate positive aspects to promote a healthy condition in preschool children.

DESIGN

A literature scoping review was conducted to answer the question: 'What has been produced in scientific literature about children's oral health with a salutogenic theoretical reference?' The checklist preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews (PRISMA-ScR) was applied. The research was conducted on the databases PubMed, Scopus, and Web of Science with no language, design, country or date restrictions. Three independent reviewers selected the studies to be included in the research, extracted data, and assessed the studies' contribution to the review.

RESULTS

Among the 38 studies retained, 10 were included, those were published between 2009 and 2018: five in Brazil, two in the United States of America, and one in Canada, China and India, respectively. All articles were published in English language. Nine studies investigated the relation between the parents'/caretakers' sense of coherence and aspects related to the children's oral health condition. One study investigated health factors among the parents of caries-free children.

CONCLUSION

Salutogenic orientation must be included in oral health research, so that salutary and risk factors may coexist, contributing to a new perspective for oral health promotion among children.

The science of collective health in writing: contribution to studies in collective oral health

Celebrating the 25 years of existence of the Journal Ciência & Saúde Coletiva (C&SC), this paper analyzed 375 documents published between 2000-2019 as an integral part of the editorial of collective oral health. The production analysis aimed to understand how oral health core appears in publications and how it could have contributed to knowledge on the population's health-disease, specific public policies, education, and management of oral health services in the SUS. The process employed bibliometric and documental analysis. We could show the authors' territorial distribution, their extensive collaboration network, and the dimension of citations in publications, including the international plan. The Brazilian states most present in the publications were São Paulo and Minas Gerais, followed by authors from Pernambuco, Rio Grande do Sul, and Santa Catarina. Citations were more frequent in Brazil (85.14%), followed by the United States (2.31%), Portugal (1.34%), and Australia (1.34%). We concluded that, despite the limitations, the C&SC showed unequivocally a powerful instrument for the dissemination of scientific production from the perspective of collective oral health, enabling the exchange of information and facilitating the integration between researchers and enabling a path to its consolidation.

Facial Injuries and the Gender Issue: Expressions of Violence in a Metropolitan Region of Northeastern Brazil

The aims of this investigation were to describe the profile of men and women victims of violence and identify factors associated with the severity of facial trauma. A retrospective study was carried out from 762 records of victims attended at the Institute of Legal Medicine and Dentistry located in a metropolitan region of Northeastern Brazil. The dependent variable was type of facial trauma suffered by victims. Independent variables were the sociodemographic characteristics of victims, characteristics of aggressors and circumstances of violence. Descriptive, bivariate (c2 test) and multivariate statistics were made through logistic regression. Level of significance was set at p < 0.05. The mean age of victims was 29.78 years (SD=13.33). Based on the final regression model, male subjects [odds ratio (OR)=2.22, 95% CI=1.08-4.57, p=0.030], assaulted by other male subjects (OR=4.88; 95% CI=1.12-21.26; p=0.035) through instrument (OR=6.67; 95% CI=2.85-15.60; p<0,001) or mixed aggressions (OR=4.34; 95% CI=1.44-13.02; p=0.009) were more likely to exhibit facial bone fractures or dentoalveolar fractures. The findings highlight that men and women present important victimization differentials in relation to interpersonal violence and facial trauma. Victim's gender, aggressor's gender and mechanism of aggression may exert influence on facial trauma patterns.

[Arterial Hypertension and work among teachers of basic education in the public-school system]

The scope of this paper was to investigate the relationship between Arterial Hypertension (AH) and the occupational profile of teachers of basic public education and present a theoretical model. A probabilistic sample was adopted by clusters, with AH as the dependent variable. The independent variables were grouped in thematic blocks (Sociodemographic Characteristics, Occupational Profile, Behaviors and Health Outcomes) that composed the theoretical model. The analyses were corrected by the sample design. Hierarchical logistic regression was conducted. The prevalence of AH was 25%, and 58% reported dissatisfaction with the work. There was a higher probability of AH among older teachers (OR = 3.7), without postgraduate qualification (OR = 1.4), who also worked in the private network (OR = 2.6), who had a higher salt intake (OR = 1.7), with a high waist-hip ratio (OR = 1.9) and hypercholesterolemia / hypertriglyceridemia (OR = 1, 5) and a lower chance among females (OR = 0.5), who had other work activity (OR = 0.6) and were dissatisfied with the work (OR = 0.6). Thus, the occupational profile of teachers had an influence on AH. The relationship between work and teacher health demands attention and care, with measures that preserve and promote the health and well-being of teachers.

Contextual and individual determinants of tooth loss in adults: a multilevel study

BACKGROUND

Tooth loss represents a known marker of health inequality. The association between tooth loss and unfavorable socioeconomic conditions is evident when analyzed at an individual level. However, the effects of contextual characteristics on tooth loss need to be better investigated and understood. The objective of this study was to analyze tooth loss among Brazilian adults (35-44 years of age), in accordance with individual and contextual social characteristics.

METHODS

This was a multilevel cross-sectional study with data from 9564 adult participants from the Brazilian Oral Health Survey - SBBrasil 2010. The dependent variable was the number of lost teeth and the independent variables were grouped into structural (socioeconomic & political context) and intermediary (socioeconomic position, behavioral & biological factors, and health services) determinants. Multilevel Hierarchical Negative Binomial Regression was conducted and the Mean Ratio (MR) was estimated.

RESULTS

Brazilian adults lost a mean of 7.57 (95% CI 7.1-8.1) teeth. Among the contextual variables, the number of teeth lost was higher among residents of municipalities with high and medium/low Municipal Human Development Index (MHDI) and in municipalities that did not have public water fluoridation. Among the individual variables, dental loss was higher among those who declared themselves yellow/black/brown/indigenous, were older, who had lower income, who had never visited a dentist, who had used dental services for more than a year and those whose most recent visit to the dentist was due to oral health problems. On the other hand, dental loss was lower among adults with higher education levels and males.

CONCLUSIONS

The number of missing teeth was associated with unfavorable contextual and individual conditions, which reinforces the need to reduce social inequality and guarantee regular, lifetime access to dental services.

Evaluation of secondary care in endodontics at a Dental Specialties Center (DSC)

This study aimed to evaluate secondary endodontic care at a Dental Specialties Center (DSC) in Belo Horizonte, MG. Data collection used two forms: (1) on endodontic treatment, completed by the endodontists (2) on the restorative treatment, with data from the medical records. The SPSS 22.0 program was used to analyze the results using frequency and percentiles. In total, 452 endodontic procedures were completed in adult patients. The patients had a median of 39 years of age, most were female (69.7%) and had a primary care referral order (96.2%). Most endodontic treatments were performed in upper premolars (23.7%) followed by lower molars (22.3%), using a mixed technique (74.1%) and in a single session (64.2%). The referral for restorative treatment was for the DSC in 81.2% of cases and finished in 24.1% (n = 109). The counter-referral following restorative treatment occurred in 58.7% of the completed cases. It is necessary to jointly plan the dental treatment between primary and secondary care and, within the latter, among the specialties, in addition to an adequate referral and counter-referral process aimed at ensuring comprehensive care and efficient and effective service.

Characteristics of Brazilian Offenders and Victims of Interpersonal Violence: An Exploratory Study

The aim of this study was to characterize the profile of Brazilian offenders and victims of interpersonal violence, following a medicolegal and forensic perspective. A cross-sectional and exploratory study was performed in a Center of Forensic Medicine and Dentistry. The sample was made up of 1,704 victims of nonlethal interpersonal violence with some type of trauma. The victims were subject to forensic examinations by a criminal investigative team that identified and recorded the extent of the injuries. For data collection, a specific form was designed consisting of four parts according to the information provided in the medicolegal and social records: sociodemographic data of the victims, offender's characteristics, aggression characteristics, and types of injuries. Descriptive and multivariate statistics using cluster analysis (CA) were performed. The two-step cluster method was used to characterize the profile of the victims and offenders. Most of the events occurred during the nighttime (50.9%) and on weekdays (66.3%). Soft tissue injuries were the most prevalent type (94.6%). Based on the CA results, two clusters for the victims and two for the offenders were identified. Victims: Cluster 1 was formed typically by women, aged 30 to 59 years, and married; Cluster 2 was composed of men, aged 20 to 29 years, and unmarried. Offenders: Cluster 1 was characterized by men, who perpetrated violence in a community environment. Cluster 2 was formed by men, who perpetrated violence in the familiar environment. These findings revealed different risk groups with distinct characteristics for both victims and offenders, allowing the planning of targeted measures of care, prevention, and health promotion. This study assesses the profile of violence through morbidity data and significantly contributes to building an integrated system of health surveillance in Brazil, as well as linking police stations, forensic services, and emergency hospitals.

The course from tooth loss to successful rehabilitation with denture: Feelings influenced by socioeconomic status

Objective:

This study evaluated the perception of users of complete dentures (successful cases) provided by the public health service throughout the course from tooth loss to rehabilitation.

Methods:

A total of 11 individuals who received their complete dentures through the public health service were interviewed according to a qualitative approach based on three pre-established topics: (1) tooth loss, (2) living without teeth, and (3) living with dentures. The obtained material was submitted to content analysis.

Results:

Individuals associated the socioeconomic status with lifelong oral health experiences and difficulty to access oral treatment. Tooth loss was the solution to pain and sometimes perceived as a natural event of life. Living without teeth was a negative surprise that resulted in physical and psychological impairments. The period of adaptation to dentures represented suffering and required psychological efforts to be successful.

Conclusion:

The dentures represented a reward for the suffering and recovered normal function, appearance, and socialization.

Mothers' perception about health education in brazilian primary health care: A qualitative study

BACKGROUND

Health education actions are strategic actions aimed at health promotion. Moreover, better health education practices have been linked to comprehensive care developed by primary health services.

AIM

To understand the perception of mothers about the health education developed by the Primary Health Care (PHC) services.

DESIGN

We adopted a qualitative research approach, conducted using semi-structured interviews, and assuming, as the theoretical reference, the attributes derived from PHC. Pregnant women and mothers of children under 1 year old attended by Brazilian Family Health teams were included.

RESULTS

Eight pregnant women and twelve mothers of children under 1 year of age participated in the study. These mothers perceive educational actions as necessary only for primiparous mothers. They value the guidance of informal networks and maternity hospitals to the detriment of primary services, and they do not adhere to care that conflicts with their previous knowledge. The evidence shows that the educational actions of the primary health services do not adequately respond to the attributes of community orientation, family focus, and cultural competence.

CONCLUSION

It is necessary to modify the educational practices in order to incorporate and value the existing knowledge in the territory, thereby adapting the care guidelines to the local context.

Exploring the effect of time and sex in family and community violence from 2008 to 2014

OBJECTIVE

To evaluate the effect of the time and the sex of victims and perpetrators on the rates of family and community physical violence in a Brazilian municipality over seven years (2008–2014).

METHODS

We made a census analysis from non-fatal victims attended in the Forensic Institute of the Scientific Civil Police. The monthly and annual violence rates were calculated based on the population size of the municipality. Time series was evaluated by negative binomial regression models, based on the number of cases with population offset and considering the effect of the sex of victims and perpetrators.

RESULTS

A total of 3,324 cases of family and 4,634 cases of community violence were analyzed. There was a significant increase in family violence rates for female victims and male perpetrators. Family violence rates were always higher for female victims than for male and it was always lower for female perpetrators than for male (p < 0.001). There was a lower risk of community violence for male victims after 2013 and a decrease of aggression perpetrated by men over time. Men and women were similarly affected by community violence; however, the perpetrators were more frequently men.

CONCLUSIONS

The results indicate a trend of increasing female victims in the family violence, mainly perpetrated by men. The reduction in community violence rates could be the result of policies to reduce crime.

Analysis of the asynchronous dental teleconsulting of Telehealth Brazil Networks in Minas Gerais

This cross-sectional study aimed to evaluate the asynchronous dental teleconsulting of Telehealth Brazil Networks Program in Minas Gerais. Data were collected from secondary databases of the Clinical Hospital of the Universidade Federal de Minas Gerais (CH/UFMG) and Medical School of UFMG (MS/UFMG), from July 2015 to July 2017. The variables analyzed were telehealth center, sex and profession, date and time questions and answers, response time in days, whether the issue was duly addressed, whether the teleconsulting was attended, post status, professional's satisfaction, conduct adopted after teleconsulting, dental specialty area, and type of issues. Sociodemographic data from the Intermediate Geographical Regions (IGR) of Minas Gerais, including the Municipal Human Development Index (MHDI) and Gini Index were also collected. The results were analyzed using SPSS v.22.0. In total, 3,920 teleconsulting were recorded, with increasing demand in the study period. Most were requested by dentists (93.3%) and female professionals (78.6%), during office hours (78.6%), and related to general conducts (72.1%). Almost all were attended (99.7%), with a maximum response time of two days (75.0%). A low feedback on satisfaction and resolution of issues (missing data of 57.2% and 70.2%, respectively) was recorded. Only 5.2% had information on whether patients were referred. The most common inquires were of issues about Pathology/Stomatology specialties (19.0%) and Pharmacology/Anesthesiology (18.8%). The response occurred within the expected time, with prevalent issues in basic dental areas and general conducts. Feedback from professionals must be encouraged to allow a better analysis and improvements of the program.

Patterns of Oral-Maxillofacial Trauma and Determinant Factors among Brazilian Victims of Physical Aggression: A 4-Year Study

PURPOSE

To determine the prevalence of oral-maxillofacial trauma among Brazilian victims of physical aggression and identify its associated factors from a medico-legal and forensic perspective.

MATERIALS AND METHODS

A cross-sectional study was carried out involving the analysis of complete medico-legal and social reports of 3668 victims of physical aggression treated at a centre of legal medicine and forensic dentistry over the course of four years. The dependent variable was the occurrence of oral-maxillofacial trauma. The independent variables were sociodemographic status and characteristics of physical aggression. Statistical analyses included the chi-squared test (p < 0.05) as well as univariate and multivariate logistic regression analyses.

RESULTS

Oral-maxillofacial trauma occurred in 1655 cases (45.1%). Individuals who lived in suburban areas (OR = 1.32; 95%CI = 1.11-1.58) and those who were victims of community violence (OR = 1.20; 95%CI = 1.03-1.40) perpetrated by someone known to them (OR = 1.24; 95%CI = 1.03-1.40) using physical force (OR = 2.31; 95%CI = 1.96-2.72) on weekends (OR = 1.19; 95%CI = 1.04-1.37) and during nighttime hours (OR = 1.23; 95%CI = 1.08-1.41) were more likely to exhibit oral-maxillofacial trauma.

CONCLUSION

The prevalence of oral-maxillofacial trauma was high and the associated factors were area of residence, type of violence, type of offender, mechanism of violence, day, and period of occurrence.

Factors associated with the non-wear of mandibular dentures in the Brazilian public primary health care

This study investigated factors that affect the use of complete conventional mandibular dentures (CCMD) by patients of the Brazilian Public Health Service. For this, two hundred and thirty one subjects who received CCMD in the Primary Health Care of the Public Health Service in Belo Horizonte - Brazil were evaluated and divided in Group 1 - irregular/non-wear; Group 2 - regular wear. Multivariate logistic regression analysis was used to create predictive models for CCMD non-wear and included socio-demographic and biological variables, technical quality of CCMD, and user satisfaction. The prevalence of CCMD non-wear was 41.10%. The mean score of CCMD quality was 54.97 (0-100). Not wearing the CCMD was significantly associated with user satisfaction and technical quality (p < 0.05). The lack of retention of the CCMD was the most important factor in the evaluation of satisfaction and quality. The final predictive model (specificity = 92.65%; AROC = 0.8759) for not wearing the CCMD retained the variables CCMD stability (OR = 0.888; 95%CI = 0.827-0.954), freeway space (OR = 0.916; 95%CI = 0.860-0.976), satisfaction with speech (OR = 0.694; 95%CI = 0.612-0.786), and irregular CCMD edges (OR = 3.185; 95%CI = 1.478-6.864). Socio-demographic and biological variables were not associated with patients not wearing the CCMD, whereas technical quality and user satisfaction were strongly associated.

Elementary and lower secondary school students' perceptions of the Health at School Programme: a case study in Belo Horizonte, Brazil

The Health at School Programme is a Brazilian inter-sector policy resulting from a partnership between the Ministries of Health and Education to expand health actions to public school students, with a view to the comprehensive education of primary and lower middle school students. This qualitative study was carried out in 2016 to investigate Brazilian schoolchildren's perceptions of activities under the Health at School Programme. Data were collected from schoolchildren eleven to fourteen years of age using the written report (essay) as the instrument. Analysis of the reports highlighted two themes: 1. the Health at School Programme as care, and 2. the Health at School Programme as benevolence. For some, the activities meant the possibility of health care, of identifying problems and arranging solutions, and the opportunity for gaining information and learning that may be beneficial in maintaining health - the offer was received passively, however; for others, they were a blessing, a favour, for which they showed their gratitude. The schoolchildren were passive and receptive, without being proactive enough to produce their own health. Co-responsibility seems to be a seed that is still germinating.

Dependence on others for oral hygiene and its association with hand deformities and functional impairment in elders with a history of leprosy

OBJECTIVE

To analyse the frequency of dependence on others for oral hygiene and its association with hand deformities, frailty and dependence on others for basic activities of daily living (BADL) among elders with a history of leprosy.

BACKGROUND

Dependence on others for oral hygiene has not been considered in multifunctional geriatric assessments.

MATERIAL AND METHODS

Edentulous elders with a history of leprosy who used complete dentures and resided in a former leprosy colony were classified as independent or partially/completely dependent on others for brushing their dentures or rinsing and for BADL, and as frail or robust. The presence of hand deformities was assessed by an occupational therapist.

RESULTS

28.4% and 14.9% were completely/partially dependent on others for brushing and rinsing, respectively. The dependence for BADL was observed in 21.6% and hand deformities in 17.6%. A higher odds of dependence for brushing/rinsing was found among elders who were dependent on others for BADL. Brushing dependence (61.5%) was more frequent among participants with hand deformities than those without this condition (21.3%) (OR: 6.8; 95% IC: 1.2-37.9; P = .028). There was no association between frailty and brushing (P = .068) or rinsing (P = .202) dependence.

CONCLUSION

Approximately one-third of elders have a dependence on others for brushing; a smaller proportion is dependent on others for rinsing. Older people who are dependent on others for BADL and who present hand deformities are more likely to be dependent on others for denture brushing and rinsing. Elders may perform oral self-care even when they present frailty.

Religiosity as a possible protective factor against "binge drinking" among 12-year-old students: a population-based study

Associated with positive impacts on health, religiosity has presented itself as a possible protection factor against alcohol consumption by teenagers. This study evaluated the prevalence of binge drinking and its association with religiosity among 12-year-old students, from Diamantina, State of Minas Gerais. Statistical analyses involved chi-square Pearson (p < 0,05) and Poisson regression with robust variance. The sample included a census of 588 students. Participation in religious activities was associated with no binge drinking (PR = 0,823; 95% CI: 0,717 - 0,945); and consumption of alcoholic beverages by the best friend was associated with binge drinking (PR = 1.554; 95% CI: 1,411-1,711). It was concluded that religiosity was associated with no consumption of alcoholic beverages in binge drinking sessions.

[Lack of access to information on oral health problems among adults: an approach based on the theoretical model for literacy in health]

This study sought to investigate factors associated with the lack of access to information on oral health among adults. It is a cross-sectional study, carried out among 831 adults (35-44 years of age). The dependent variable was access to information on how to avoid oral problems, and the independent variables were gathered into subgroups according to the theoretical model for literacy in health. Binary logistic regression was carried out, and results were corrected by the design effect. It was observed that 37.5% had no access to information about dental problems. The lack of access was higher among adults who had lower per capita income, were dissatisfied with the dental services provided, did not use dental floss, had unsatisfactory physical control of the quality of life, and self-perceived their oral health as fair/poor/very poor. The likelihood of not having access to information about dental problems among those dissatisfied with the dental services used was 3.28 times higher than for those satisfied with the dental services used. Thus, decreased access to information was related to unfavorable conditions among adults. Health services should ensure appropriate information to their users in order to increase health literacy levels and improve satisfaction and equity.

Alcohol intake among adolescent students and association with social capital and socioeconomic status

The aim was to evaluate the prevalence of alcohol consumption, binge drinking and their association with social capital and socioeconomic factors among Brazilian adolescents students. A cross-sectional study was carried out with a randomly selected representative sample of 936 adolescents aged 15 to 19 years. Information on alcohol consumption, social capital and socioeconomic status was collected using the Alcohol Use Disorders Identification Test, the Integrated Questionnaire for the Measurement of Social Capital and Social Vulnerability Index, respectively. The prevalence of alcohol consumption was 50.3% and binge drinking 36% the last year. Adolescents who reported believing that people in their community could help solve a collective problem (with the water supply) and those classified as having high social vulnerability had lower likelihood of binge drinking (PR = 0.776 [95%CI:0.620 to 0.971] and PR = 0.660 [95%CI:0.542 to 0.803], respectively). The prevalence of alcohol consumption and binge drinking the last year is high among participants. Those with higher socioeconomic status as well as lower perceptions of community capital social are more likely to display binge-drinking behavior.

Violence against women in different stages of the life cycle in Brazil: an exploratory study

Objective:

The aim of this study was to describe the profile of violence against women in different life cycles, according to the sociodemographic characteristics of the victims and offenders.

Methods:

A cross-sectional and exploratory study was performed based on 1,388 police reports during a four-year period, in a metropolitan area of Northeast Brazil. The dependent variable was the type of aggression suffered by the victims. The independent variables were sociodemographic characteristics of the victims and offenders. Statistical analysis included the χ2 test (p < 0.05) and the decision tree analysis, through the Chi-squared Automatic Interaction Detector (CHAID) algorithm.

Results:

Cases of physical abuse (n = 644) were the most common, followed by threat (n = 415) and verbal aggression (n = 285). The violence profiles could be explained by the relationship between victims and offenders (p < 0.001) and age of the victims (p = 0.026 in Node 1; p = 0.019 in Node 3).

Conclusion:

It was observed that women in different stages of life are more exposed to different types of violence.

[The use of dental services on a regular basis in the population of Montes Claros in the State of Minas Gerais, Brazil]

The use of dental services on a regular basis by residents of Montes Claros (MG) was assessed, as well as related aspects. Cross-sectional study was conducted with a complex probabilistic sample by conglomerates. Logistic regression was used (OR/CI95%) with a significance level of 5. Of the 2582 study participants, 761 required and obtained access to the services for less than a year. Of these, 262 (35.8%) used the services in a regular/routine manner. The use of dental services on a regular basis was greatest among individuals in the age group "≥ 18 ≤ 37"; with schooling "equal to or greater than 9 years"; who classified their oral health, general health and appearance of teeth and gums as "excellent/good"; who reported no pain" on teeth and gums over the last six months; They reported that the "assistance provider had adequate skills"; that they "always/often" received information about oral hygiene and diet/nutrition. In addition, this use was lower among those who rated the time to ask questions about the dental problem or treatment as "regular/bad/terrible." The conclusion drawn is that the use of dental services on a regular basis was relatively low, being associated with personal traits, subjective health conditions and characteristics related to the services.

Impact of untreated dental caries on the daily activities of children

OBJECTIVES

Untreated dental caries can compromise oral health-related quality of life (OHRQoL). However, it is not clear which specific daily activities related to OHRQoL are compromised by the presence of this problem. Therefore, the purpose of this study was to identify which specific daily activities are affected by the presence of untreated dental caries using a representative sample of Brazilian children.

METHODS

A cross-sectional study using a representative sample of Brazilian children (12 years of age) was conducted. The presence of untreated dental caries was assessed using the "decayed - D" component of the DMFT (decayed, missing, and filled teeth) index. Clinical exams were conducted by trained and calibrated dentists. The daily activities were evaluated using the survey Oral Impacts on Daily Performance (OIDP), considering items and domains. Descriptive, bivariate, and multiple analyses were conducted (α = 0.05).

RESULTS

A total of 7,247 children were included, and 39.9 percent had at least one tooth with untreated dental caries, with 33.5 percent experiencing an impact on at least one of the OIDP activities. This study identified a greater chance of the presence of untreated dental caries in children having an impact on the psychological domain (P = 0.006), as well as on the "difficulty eating" (P = 0.007), and "difficulty sleeping" (P = 0.023) items.

CONCLUSION

The presence of untreated dental caries among Brazilian children was associated with an impact on specific daily activities (difficulty eating and sleeping) and the psychological domain of OHRQoL.

Risk of alcohol dependence: prevalence, related problems and socioeconomic factors

The present study evaluated the possible alcohol dependence and related problems among adolescents and determined possible associations with socioeconomic factors and gender. A cross-sectional study was conducted with a representative sample of 936 adolescents aged 15 to 19 years enrolled at public and private schools in the city of Belo Horizonte, Brazil. Data related to alcohol consumption and associated problems were collected using the Alcohol Use Disorder Identification Test (AUDIT). The Social Vulnerability Index (SVI), mother's schooling and type of school were used to assess socioeconomic factors. Statistical analysis involved the chi-square test (p < 0.05) and Poisson regression. The prevalence of possible dependence was 16.4%, 52.1% reported concern of a family member regarding the adolescent's alcohol consumption. Female adolescents were less likely to exhibit possible dependence in comparison to males. Participants with living in a low vulnerability area were more likely to consume alcohol in comparison to those living in underprivileged areas. The results of the present study demonstrate that possible dependence was significantly associated with the male gender and low social vulnerability.

Systematic review and meta-analysis to determine the proportion of maxillofacial trauma resulting from different etiologies among children and adolescents

PURPOSE

This study aimed to determine via systematic review and meta-analysis the proportion of maxillofacial trauma resulting from different etiologies among children and adolescents.

METHODS

A systematic review of articles published from 2006 to 2015 (10 years) in English language was performed. The following databases were used: PubMed/MEDLINE, Scopus, and Web of Science. Observational studies reporting the number of children and/or adolescents who suffered maxillofacial trauma resulting from different etiologies were included. Studies were selected by two independent reviewers (Kappa = 0.737). A proportion meta-analysis using random-effect models was performed to estimate the pooled prevalence and the 95% confidence intervals (CI) using Der-Simonian and Laird weights. Heterogeneity among studies was assessed using the I ² statistics.

RESULTS

A total of 27 studies remained after qualitative analysis including 402,339 patients. The male/female ratio ranged from 1.5:1 to 3.5:1. Road traffic accidents corresponded to the main etiology agent of maxillofacial trauma (34%; 95% CI, 25-44), followed by falls (31%; 95% CI, 25-37), violence (11%; 95% CI, 4-19), sports (4%; 95% CI, 3-5), and others (5%; 95% CI, 2-8). Heterogeneity among studies was high, even stratifying by world region. The adapted version of the Newcastle-Ottawa scale for observational studies showed an intermediate score for most of the included studies.

CONCLUSIONS

Results suggest that road traffic accidents represent the main cause of maxillofacial trauma among children and adolescents. However, results should be interpreted with caution due to the high heterogeneity.

Dissatisfaction with the dental services and associated factors among adults

This study aimed to identify factors associated with dissatisfaction with dental services among adults. It analyzed 830 adult participants of an epidemiological survey of oral health. The dependent variable was dissatisfaction with the dental service, and the independent ones were selected according to the theoretical model set forth by Andersen and Davidson (1997). Estimates were corrected by the sample design effect, and Binary Logistic Regression was carried out. It was found that about 11% of adults were dissatisfied with the dental service. In the final model, dissatisfaction with dental services was lower among older adults (OR = 0.559) and among smokers (OR = 0.332). On the other hand, it was higher among adults who self-perceived their chewing as negative (OR = 2,804), who self-perceived some discomfort in the mouth and head and neck region (OR = 2.065), and among those who did not have access to information on how to avoid oral problems (OR = 3.020). Therefore, the services need to access the perceptions and expectations expressed by users, and provide information in appropriate quantity and quality, in the context of "health literacy" in order to achieve greater satisfaction among its users.

Healthy aging profile in octogenarians in Brazil

OBJECTIVE

to identify the healthy aging profile in octogenarians in Brazil.

METHOD

this population-based epidemiological study was conducted using household interviews of 335 octogenarians in a Brazilian municipality. The decision-tree model was used to assess the healthy aging profile in relation to the socioeconomic characteristics evaluated at baseline. All of the tests used a p-value < 0.05.

RESULTS

the majority of the 335 participating older adults were women (62.1%), were aged between 80 and 84 years (50.4%), were widowed (53.4%), were illiterate (59.1%), had a monthly income of less than one minimum wage (59.1%), were retired (85.7%), lived with their spouse (63.8%), did not have a caregiver (60.3%), had two or more children (82.7%), and had two or more grandchildren (78.8%). The results indicate three age groups with a healthier aging profile: older adults aged 80 to 84 years (55.6%), older adults aged 85 years and older who are married (64.9%), and older adults aged 85 and older who do not have a partner or a caregiver (54.2%).

CONCLUSION

the healthy aging profile of octogenarians can be explained by age group, marital status, and the presence of a caregiver.

[Adult tooth loss profile in accordance with social capital and demographic and socioeconomic characteristics]

Demographic and socioeconomic conditions play an important role in tooth loss in the population, however, there is little scientific evidence regarding the influence of social capital on this outcome. The scope of this study was to describe the tooth loss profile of adults aged 35-44, who are residents of the surrounding area of the city of Belo Horizonte in the state of Minas Gerais. This cross-sectional exploratory study comprised a sample of 1,013 adults. The dependent variable was tooth loss. Exploratory variables were social capital, demographic and socioeconomic characteristics. The Chi-squared Automatic Interaction Detector (CHAID) was used to map the adult tooth loss profile which was explained by low levels of social capital (47.0%; p < 0.001), more elderly adults (60.2%; p < 0.001), and low education levels (66.3%; p = 0.022). In the high social capital group, age was the determinant factor of tooth loss, irrespective of educational level or per capita income. The conclusion, at the individual level, is that social capital as well as demographic and socio economic characteristics explained the adult tooth loss profile. Individual social capital may have attenuated the negative influence of socioeconomic factors in the population under scrutiny.

[Binge drinking among 12-year-old adolescent schoolchildren and its association with sex, socioeconomic factors and alcohol consumption by best friends and family members]

This is a cross-sectional study with a convenience sample of 101 twelve-year-old adolescents enrolled in public and private schools in the city of Diamantina in the State of Minas Gerais. The scope was to evaluate the prevalence of binge drinking among 12-year-old schoolchildren and its association with gender, socioeconomic status and alcohol consumption by family members and best friends. The participants completed a self-administered questionnaire entitled the Alcohol Use Disorders Identification Test (AUDIT-C) and the consumption of alcoholic beverages by friends and family. Parents/guardians answered the form on sociodemographic questions. Descriptive analyses and association tests were performed (p < 0.05). The prevalence of binge drinking was 24.8%. Alcoholic beverage consumption began at the age of 10 (16.8%), though sex was not associated with binge drinking by adolescents. However, attending a public school (0.005) and alcohol consumption by best friends (p < 000.1) were associated with binge drinking by adolescents in the bivariate analysis. The prevalence of binge drinking was high and was associated with low socioeconomic status and alcohol consumption by the best friend. No association between sex and alcohol consumption by the family members of adolescents was detected.

Facial trauma among victims of terrestrial transport accidents

Introduction

In developing countries, terrestrial transport accidents – TTA, especially those involving automobiles and motorcycles – are a major cause of facial trauma, surpassing urban violence.

Objective

This cross-sectional census study attempted to determine facial trauma occurrence with terrestrial transport accidents etiology, involving cars, motorcycles, or accidents with pedestrians in the northeastern region of Brazil, and examine victims’ socio-demographic characteristics.

Methods

Morbidity data from forensic service reports of victims who sought care from January to December 2012 were analyzed.

Results

Altogether, 2379 reports were evaluated, of which 673 were related to terrestrial transport accidents and 103 involved facial trauma. Three previously trained and calibrated researchers collected data using a specific form. Facial trauma occurrence rate was 15.3% (n = 103). The most affected age group was 20–29 years (48.3%), and more men than women were affected (2.81:1). Motorcycles were involved in the majority of accidents resulting in facial trauma (66.3%).

Conclusion

The occurrence of facial trauma in terrestrial transport accident victims tends to affect a greater proportion of young and male subjects, and the most prevalent accidents involve motorcycles.

[The inclusion of the oral health team in the Brazilian Family Health Strategy: barriers, advances and challenges]

This scope of this article is to discuss the inclusion of oral health in the Brazilian Family Health Strategy in municipalities of a micro-region of southeastern Brazil, from the standpoint of human resources. Questionnaires were distributed to members of the oral health service: dentists, assistants and managers. The instrument included three dimensions: how and why they adopted the new model; how the service is being reorganized; and what advances were perceived by professionals. The most common reason mentioned by managers for the inclusion of Oral Health was the possibility of changing the technical care model. When asked about their motivation, dentists and assistants also considered the possibility of change in practices to be a priority. It was also seen that there are critical bottlenecks in the hiring and training of human resources to work in the oral health team and in integration among health professionals. Indeed, access is enhanced either by the organization or by the expansion of the teams. The municipalities of the micro-region still encounter difficulties for the functioning of the oral health service, after Family Health, to show actual progress in care practices. However, advances exist and these need to be bolstered to consolidate the health system and improve the quality of life of the population.

[The judicialization of health care: a case study of three state courts in Brazil]

The scope of this study was to describe and compare records of the results of lawsuits filed in three Brazilian courts in cases involving the Unified Health System. A survey was made of the judgments listed on electronic sites of Courts of Justice in the states of Pernambuco, Rio Grande do Sul and Minas Gerais using a specific script. A total of 558 judgments was analyzed. There was a greater frequency of ordinary lawsuits (73.1%). In the majority of cases, it was not possible to identify the economic situation of the plaintiff or the legal representative of the defendant (54.5%). In cases where such identification was possible, a public defender was the most common (71.5%). The cases were predominantly individual in all three states. There was a large number of requests for injunctions (83.8%), which were almost always granted (91.2%), with the allegation of urgency/emergency in almost all cases (98.8%). The majority of decisions were favorable to the users of the public healthcare system (97.8%). The decisions studied showed that the users sought to ensure their right to health individually, using the public authorities to file their lawsuit, but there is a perceived difference in posture between legal courts evaluated. There is a strong tendency of the judiciary to accept these requests.

Impact of aesthetic restorative treatment on anterior teeth with fluorosis among residents of an endemic area in Brazil: intervention study

BACKGROUND

Endemic dental fluorosis has already been described in some regions of the world. The aim of this study was to evaluate the functional and psychosocial impact of direct aesthetic restorative treatments in endemic fluorosis patients in the northern state of Minas Gerais, Brazil. Was a quasi-experimental intervention study.

METHODS

The reference population consisted of individuals between 9 and 27 years of age that were served by a project intended to recover the smiles of patients with severe fluorosis. The questionnaires were administered on two occasions, 24 months apart (before and after dental treatment). Initially, descriptive analyses were conducted. Prevalence and severity, as well as the extent of the functional and psychosocial impact of oral disorders were estimated based on the Oral Health Impact Profile instrument (OHIP-14). Comparisons between baseline and follow-up and between treatment techniques were carried out using the McNemar, Wilcoxon, and Mann-Whitney tests.

RESULTS

The study involved 53 individuals, with a mean age of 15.9 years, treated with microabrasion, dental composite, or a combination of both techniques. The treatments performed proved to be competent for reducing the functional and psychosocial impact of oral disorders as measured by the OHIP-14, pointing to the possibility of establishing protocols to be used in programs aimed at restoring the aesthetics and functionality of the anterior teeth in large populations.

CONCLUSIONS

After performing the direct aesthetic restorative treatments in patients with endemic fluorosis, a significant improvement was observed in the prevalence and severity, as well as the extent of the functional and psychosocial impact of oral disorders.

Epigenetic regulation of matrix metalloproteinase expression in ameloblastoma

BACKGROUND

An ameloblastoma is a benign odontogenic neoplasm with aggressive behaviour and high recurrence rates. The increased expression of matrix metalloproteinases (MMPs) has been reported in ameloblastomas. In the present study, we hypothesised that epigenetic alterations may regulate MMP expression in ameloblastomas.

METHODS

We investigated the methylation status of the genes MMP-2 and MMP-9 in addition to mRNA transcription and protein expression in ameloblastomas. Methylation analysis was performed by both methylation-specific polymerase chain reaction (MSP-PCR) and restriction enzyme digestion to evaluate the methylation profile of MMP-2 and MMP-9 in 12 ameloblastoma samples and 12 healthy gingiva fragments, which were included as controls. Furthermore, we investigated the transcription levels of the genes by quantitative reverse-transcription PCR (qRT-PCR). Zymography was performed to verify protein expression in ameloblastomas.

RESULTS

The ameloblastomas showed a high frequency of unmethylated MMP-2 and MMP-9, whereas the healthy gingival samples presented a sharp prevalence of methylated MMPs. Higher expression levels of MMP-9 were found in ameloblastomas compared to healthy gingiva. However, no significant differences in the MMP-2 mRNA expression between groups was found. All ameloblastomas showed positive expression of MMP-2 and MMP-9 proteins.

CONCLUSIONS

Our findings suggest that expression of MMP-9 is increased in ameloblastomas and is possibly modulated by unmethylation of the gene.

Edentulism and shortened dental arch in Brazilian elderly from the National Survey of Oral Health 2003

OBJECTIVE

To describe the distribution of edentulism and estimate the prevalence of functional dentition and shortened dental arch among elderly population.

METHODS

A population-based epidemiological study was carried out with a sample of 5,349 respondents aged 65 to 74 years obtained from the 2002 and 2003 Brazilian Ministry of Health/Division of Oral Health survey database. The following variables were studied: gender; macroregion of residence; missing teeth; percentage that met the World Health Organization goal for oral health in the age group 65 to 74 years (50% having at least 20 natural teeth); presence of shortened dental arch; number of posterior occluding pairs of teeth. The Chi-square test assessed the association between categorical variables. The Kruskal-Wallis and Mann-Whitney tests were used to assess differences of mean between number of posterior occluding pairs teeth, macro-region and gender.

RESULTS

The elderly population had an average of 5.49 teeth (SD: 7.93) with a median of 0. The proportion of completely edentulous respondents was 54.7%. Complete edentulism was 18.2% in the upper arch and 1.9% in the lower arch. The World Health Organization goal was achieved in 10% of all respondents studied. However, only 2.7% had acceptable masticatory function and aesthetics (having at least shortened dental arch) and a mean number of posterior occluding pairs of 6.94 (SD=2.97). There were significant differences of the percentage of respondents that met the World Health Organization goal and presence of shortened dental arch between men and women. There were differences in shortened dental arch between macroregions.

CONCLUSIONS

The Brazilian epidemiological oral health survey showed high rate of edentulism and low rate of shortened dental arch in the elderly population studied, thus suggesting significant functional and aesthetic impairment in all Brazilian macroregions especially among women.

Prevalence of dental trauma and associated factors among 1- to 4-year-old children

PURPOSE

The purpose of this study was to estimate the prevalence of dental trauma among 1- to 4-year-old children and test the association between dental trauma and demographic, socioeconomic, and clinical factors.

METHODS

Five calibrated researchers (intra- and interexaminer kappa values=0.89 and 0.81, respectively) examined a representative sample of 407 children in the city of Matozinhos, Minas Gerais, Brazil, during the 2008 national vaccination campaign. Statistical analysis was performed via descriptive analysis, chi-square test (P<.05), and logistic regression.

RESULTS

The prevalence of dental trauma was 47%; among the 407 children examined, 187 had suffered dental trauma. The most prevalent type of alteration due to dental trauma was enamel fracture (85%), followed by enamel-dentin fracture without pulp exposure (11%) and enamel-dentin fracture with pulp exposure (3%). The main location where the trauma occurred was at home (89%), with the cause reported by parents as accidents while running, playing, or crawling (79%). After adjusting for the variables, the child's age (P>.01) and number of siblings (P>.01) remained associated with the outcome.

CONCLUSION

Results indicate the need for public health policies that include dental trauma as one of the priorities directed at young children.

Periodontitis in individuals with diabetes treated in the public health system of Belo Horizonte, Brazil

OBJECTIVE

The aim of the present study was to investigate the prevalence of periodontitis among individuals with diabetes who use the public health system in the city of Belo Horizonte-Minas Gerais, Brazil, and the association of this condition with socioeconomic, behavioral and clinical variables.

METHODS

A cross-sectional study was carried out on a calculated sample of 300 individuals with diabetes. Periodontitis was defined as clinical attachment loss (CAL) > 3 mm in two or more non-adjacent teeth or those that exhibited CAL > 5 mm in 30.0% of teeth. All subjects were over 30 years of age and underwent a periodontal examination. Socioeconomic and behavioral characteristics as well as medical history and dental history were obtained from a structured interview. Multivariate analysis was conducted using Poisson regression.

RESULTS

Among the individuals with diabetes, 6.7% exhibited good periodontal health, 68.0% exhibited gingivitis and 25.3% exhibited periodontitis. The following variables were associated with periodontitis after adjustment: male (PR 1.67 95% CI 1.12, 2.49), individuals with diabetes for more than eight years (PR 1.63 95% CI 1.63, 2.38), smokers (PR 1.71 95% CI 1.10, 2.65); individuals with more than 12 missing teeth (PR 2.67 95% CI 1.73, 4.15)

CONCLUSIONS

Multiple determinants are associated with the prevalence of periodontitis among patients with diabetes.

[Dental loss and prosthetic replacement expectation: qualitative study]

This qualitative research analyses the repercussions of total dental loss on people's quality of life. The Oral Health Impact Profile short-form (OHIP14) was applied to 50 volunteers, and after analyzing the results, 13 out of those 50, were selected to be individually interviewed in an opened questions script. The criteria to select these 13 people were: perception of the impact of mouth condition on quality of life measured by the score reached on OHIP. We tried to comprise the sample with a good variety, according to the profile of the initial sample. After analyzing people's statements, it was possible to verify that dental loss had strong negative consequences on people's life, like shame, difficulty to eat, impact on social relationship and feeling of not being complete. The possibility of having their teeth replaced generates some anxiety. Although being aware that wearing total prosthesis represents some sacrifices, people considered it worthwhile because the possibility of regaining the social pattern and the self-image is renewed.

Beliefs and attitudes about endemic dental fluorosis among adolescents in rural Brazil

OBJECTIVE: To understand beliefs and attitudes about fluorosis among young people living in a rural area. METHODOLOGICAL PROCEDURES: Qualitative study consisting of semi-structured interviews with 23 adolescents with dental fluorosis, 14 teachers and three health authorities in the city of São Francisco, Southeastern Brazil, in 2002. Content analysis and social representation theory were applied. ANALYSIS OF RESULTS: The organoleptic characteristics of carbonates that affect groundwater (salty flavor, whitish coloration, and turbidity) associated with negative aspects of household use of this water are considered a cause of mottled enamel. Even after contact with researchers who investigated this phenomenon and helped find a solution for this condition, the local population is still unwilling to accept fluoride as the cause of the problem and does not fully agree to use water from other sources because they are afraid of the quality of water. CONCLUSIONS: Misperceptions of the causes of dental fluorosis and water treatment costs compromise the implementation of uncontaminated surface water supplies. Health education strategies are required in parallel with solutions for securing water supply in drought-ravaged areas.