Percepção positiva e eficácia das meias de compressão na prevenção de edema em membros inferiores de gestantes

Background

Pregnancy is characterized by physiological changes that can contribute to development of varicose veins, venous insufficiency, and leg edema.

Objectives

To evaluate the effect of compression stocking on lower limb edema in pregnant women and their perceptions of wearing them.

Methods

This was a randomized, controlled, prospective, parallel, blinded clinical trial conducted with 60 pregnant women randomly distributed into two groups: an intervention group (n = 30) wearing compression stockings and a control group (n = 30). Standardized ankle and calf measurements were taken of all 120 lower limbs using a tape measure. At the end of the study, a questionnaire was administered to identify perceived difficulties and advantages related to wearing compression stockings.

Results

Pregnant women in the intervention group had a significantly smaller increase (p < 0.05) in calf and ankle diameters compared to those in the control group. The mean differences from the beginning to the end of gestation in the diameters of the right calf, left calf, right ankle, and left ankle respectively were 0.30 cm, 0.30 cm, 0.15, cm and 0.15 cm in the intervention group and 1.95 cm, 1.95 cm, 1.73 cm, and 1.87 cm in the control group. Most of the pregnant women had no difficulty wearing the compression stockings and all reported that they felt a difference in leg symptoms and would wear stockings again.

Conclusions

Compression stockings were effective for preventing lower limb edema in pregnant women, who had a positive perception of wearing them.

Compression stocking prevents increased venous retrograde flow time in the lower limbs of pregnant women

OBJECTIVES

To analyze the effect of graduated compression stockings on the venous reflux in the lower limbs of pregnant women.

METHOD

A controlled randomized clinical trial was performed with sixty women: intervention group (n = 30), who used compression stockings, and control group (n = 30). Using duplex-ultrasound, the reflux time and peak reflux velocity in the great saphenous vein and small saphenous vein were analyzed.

RESULTS

Great saphenous vein reflux times in the intervention group were 0.13 s at the beginning (initial) and 0.04 s at the end of pregnancy (final) in the right leg and 0.02 s and 0.34 s (p < 0.0001) in the control group. No patient in the intervention group experienced pathological reflux at the end of the pregnancy. There was a significant difference in the reflux time measured from both the great saphenous vein and small saphenous vein and peak reflux velocity between the groups.

CONCLUSION

Compression stockings prevent increased venous reflux in lower limbs of pregnant women.

Health surveillance: public water supply fluoridation in 40 municipalities of São Paulo, Brazil

Since fluoridation of water is an established public health measure for the prevention of dental caries and considering that monitoring of the method is crucial to its success, this study aimed to analyze the results of the analysis of the fluorine content of public water supply of 40 municipalities in the state of São Paulo, from November 2004 to December 2016. Samples were analyzed monthly using the potentiometric method. Of the 32,488 samples, 50.94% contained fluoride levels within the recommended range. In 2004, it was verified that 21 cities (52.50%) had mean levels within the recommended parameter, increasing to 32 cities (80.00%) in 2016. It was observed that 15 municipalities that initially had levels of fluoride below 0.55 mgF/L in their water supply adjusted to adequate levels during the project. In the first year of the study, 47.76% of the samples had values in the recommended range, which increased to 58.22% in 2016. Most of the municipalities adjusted the levels of fluoride in their waters over the years, evidencing the performance of heterocontrol programs as important strategies that assist in the monitoring of the method and have significant participation in the control of the water quality supplied to the population.

A OPERACIONALIZAÇÃO DO SUS NA PREVENÇÃO E CONDUÇÃO DE CASOS DE SUICÍDIOS: ANÁLISE DOCUMENTAL

Introdução: O suicídio é tido como um fenômeno complexo, multicausal, fruto da interação de fatores de ordem filosófica, biológica, antropológica, psicológica, e social, considerado nos dias de hoje um grave problema de saúde pública. Objetivo: realizar uma análise documental dos materiais lançados pelo SUS relacionados às medidas a serem adotadas em casos e tentativas de suicídio, bem como nos meios previni-las. Método: trata-se de um estudo descritivo, no qual foram verificadas as portarias e manuscritos do SUS relacionadas ao suicídio, tendo sido consultados oito documentos oficiais. Resultados: a primeira portaria a tratar especificamente do assunto, Portaria nº 1.876, foi lançada em 2006, e instituiu as Diretrizes Nacionais para Prevenção do Suicídio, norteando as estratégias do Ministério da Saúde para atuação e contenção do fenômeno. A partir dela, outros documentos foram instituídos, visando o aprimoramento do acesso, acolhimento, e tratamento aos indivíduos predispostos a desenvolverem depressão, ou que estão em situações de risco, além de garantir maiores esforços e investimentos para grupos específicos. Conclusões: as portarias estabelecidas garantem ao usuário do SUS acolhimento e acompanhamento, desde o nível de atenção básica até a atenção especializada.

Graduated compression stockings effects on chronic venous disease signs and symptoms during pregnancy

Objectives

To evaluate the effectiveness of compression stockings in controlling the varicose veins in pregnant women.

Method

A prospective controlled randomized clinical trial was performed, including 60 women: intervention group (n = 30), who used compression stockings, and control group (n = 30). Diameters of the great saphenous vein and small saphenous vein in the lower limbs of pregnant women in an orthostatic position were analyzed using Duplex-ultrasound. The symptomatology and CEAP were evaluated.

Results

Great saphenous vein diameters in the intervention group were 0.37 cm initial and 0.32 cm final (p < 0.0001) in the right leg and 0.28 cm and 0.38 cm (p < 0.0001) in the control group. CEAP classification presented worsening in the control group (p < 0.0001). The signs and symptoms in the control vs. intervention group: pain (86.67% vs. 23.33%; p < 0.0001), edema (70.00% vs. 33.33%; p = 0.0045), and leg heaviness (93.33% vs. 13.33%; p < 0.0001).

Conclusions

Compression stockings were effective in controlling the varicose veins related to pregnancy.

Perception on Oral Health and Recommendations for Improvement of Public Service Dental

A participação social é uma importante ferramenta para o aprimoramento do Sistema Único de Saúde (SUS), fortalece a instituição de processos de avaliação do desempenho e contribui para a ampliação do acesso e qualidade dos serviços prestados. O objetivo foi avaliar a percepção dos usuários sobre a saúde bucal e as recomendações para melhoria do serviço público odontológico. Trata-se de um estudo transversal, tipo inquérito, com 390 usuários do SUS. As variáveis analisadas foram: autoavaliação da saúde bucal; avaliação da equipe e do serviço odontológico prestado. Realizou-se análise qualitativa das questões discursivas e teste estatístico de associação Qui-Quadrado ou Teste G, ao nível de significância de 5%. A autoavaliação da saúde bucal foi categorizada em muito boa/boa, regular, ruim/muito ruim e os motivos identificados da classificação foram: presença de doença, cuidado com a saúde, dor, educação em saúde, negligência com a saúde, tempo e medo. Quanto à avaliação da equipe e do serviço foram feitas sugestões para a melhoria, relacionadas à: infraestrutura, acesso, humanização e educação em saúde. Constatou-se associação significativa entre o cuidado com a saúde e a percepção positiva da saúde bucal. A presença de doença, negligência, tempo e medo influenciaram negativamente na autoavaliação. Como recomendações para melhoria do atendimento, 15,4% dos entrevistados apontou a infraestrutura; 8,2% o acesso; 6,9% a humanização e 1% a educação em saúde. Conclui-se que o cuidado com a saúde foi o fator mais relacionado a uma boa saúde bucal. Houve poucas recomendações para o aprimoramento da qualidade e resolutividade do serviço prestado. Palavras-chave: Avaliação em Saúde. Autoavaliação. Saúde Bucal. Abstract Social participation is an important tool for the improvement of the Brazilian Unified Health System, strengthens the institution of performance evaluation processes and contributes to the expansion of access and quality of services provided. This study evaluated user’s perceptions on oral health and recommendations for improvement of public dental services. This is a cross-sectional study, type inquiry, with 390 users of the Brazilian Unified Health System. The analyzed variables were self-assessment of oral health, evaluation of the team and the dental service provided. A qualitative analysis of the discursive questions was performed and Chi-square or G-test statistical association test, at a significance level of 5%. The self-assessment of oral health was categorized as very good/good, regular, bad/very bad and the identified reasons for the classification were: presence of disease, health care, pain, health education, negligence in health, time and fear. As for team and service evaluation, suggestions for improvement concerning infrastructure, access, humanization and education in health were made. It was found a significant association between health care and positive perception of oral health. The presence of disease, neglect, time and fear  affected negatively the  self-assessment. The recommendations for service improvement, 15.4% interviewed users pointed to infrastructure; 8.2% access; 6.9% humanization and 1% education in health. It is concluded that healthcare was the most frequent factor associated with good oral health. There were few recommendations for quality improvement and outcome of service provided.Keywords: Health Evaluation. Self-Assessment. Oral Health.

Caries in children with lactose intolerance and cow's milk protein allergy

Dental caries in 5-to-8-year-old children with cow's milk protein allergy (CMPA) and lactose intolerance (LI), their treatment needs, and the consumption of milk-based products and milk derivatives by these patients were investigated. A cross-sectional study was undertaken with 200 children in southern Brazil in 2017. The clinical examination was based on the World Health Organization criteria and a questionnaire was sent to parents or legal guardians to collect information on the children's food intake, pre-existing systemic diseases, medication use, and CMPA and LI. Standardization was performed to verify concordance among examiners (kappa = 0.96). Caries prevalence was 67.50% in children with CMPA or LI, but 34.37% in those without these conditions. The mean dmft (decayed, missing, and filled teeth) index in children with CMPA or LI was 1.75 ± 1.84, significantly higher than among non-allergic or lactose-tolerant children (0.83 ± 1.60) (p < 0.001). In children with CMPA or LI, the mean for treatment needs was 1.58 ± 1.50. Lactose-free milk was the most frequently consumed food among allergic/intolerant children (65.00%), with a mean dmft of 2.00 ± 2.08, higher than that obtained for those without CMPA/LI (0.82 ± 0.87), showing no significant difference (p = 0.129). Although dental caries and treatment needs in primary dentition were associated with CMPA or LI, children's intake of replacement foods did not pose any risk for the development of carious lesions. Statistically significant differences were obtained for the prevalence and severity of dental caries. This shows the need for treatment of children with CMPA or LI, who had the worst caries prevalence and severity rates.

Discriminación y prejuicio. La influencia del VIH/SIDA y la Hepatitis B en la actitud de los académicos en odontología

Introducción: la Hepatitis B y el Síndrome de Inmunodeficiencia Adquirida (SIDA) son enfermedades virales de destaque en salud pública, debido a sus elevados índices epidemiológicos. La representación de ellas genera actitudes discriminatorias y prejuiciosas, principalmente en el acceso a servicios de salud. El objetivo es evaluar el conocimiento de las enfermedades y la existencia de actitudes discriminatorias de los académicos en odontología frente a la presencia del sida y Hepatitis B. Materiales y métodos: estudio exploratorio de corte transversal realizado en una facultad pública de odontología, con una muestra compuesta por 462 (88%) académicos que aceptaron participar de la investigación. Para recolectar los datos fue utilizado un cuestionario semiestructurado autoaplicable, creado para este estudio. Para analizar los datos se utilizó el test chi-cuadrado de proporciones, con nivel de significancia de 5%. Resultado: se verificó que, aunque la mayoría de los académicos a rma tener conocimiento sobre sida y Hepatitis B, apenas 58,9% y 55,8%, respectivamente, acertaron sus agentes etiológicos. Sobre las actitudes de los académicos frente al tratamiento odontológico de pacientes infectados por el Virus de Inmunodeficiencia Humana (VIH) y de la Hepatitis B (VHB) 85,3% y 91,8%, respectivamente, afirman atender; sin embargo, parte considerable de los alumnos piensa que existen diferencias en conductas clínicas a seguir. Conclusión: existen lagunas en el conocimiento de los graduados con relación al SIDA y la Hepatitis B. Las actitudes de los alumnos, en la atención odontológica de pacientes infectados, fueron consideradas discriminatorias, con mayor expresividad en el recelo en ser atendido por un profesional infectado, en lugar de tratar pacientes enfermos.

EXPECTATIVA E PRÁTICA MATERNA DO ALEITAMENTO EXCLUSIVO E A SAÚDE BUCAL DO BEBÊ

Introdução: O aleitamento materno exclusivo (AME) é fundamental para a saúde do bebê, entretanto o sucesso da sua prática nem sempre é alcançado, pois depende de diferentes determinantes. Objetivos: Verificar a expectativa das gestantes em relação ao AME e percepção sobre a importância do aleitamento e a sua relação com a saúde bucal do filho e posteriormente acompanhar a prática durante os seis primeiros meses de vida do bebê para realização de inquérito e exame bucal da mãe e do filho. Métodos: Foi realizado um estudo longitudinal com 74 pares de mães e bebês (n=148). No último trimestre de gestação, nas Unidades de Saúde da Família, as mulheres foram entrevistadas e visitadas nos domicílios, aos seis meses de idade do bebê. Resultados: Verificou-se que 95,95% das entrevistadas pretendiam amamentar seu filho; 74% queriam AME até o sexto mês de idade do bebê, entretanto, após seis meses, 63,51% das mães estavam amamentando e apenas 18% estavam em AME; 31,05% das mães tiveram dificuldades para amamentar. Com relação à saúde bucal 98,65% das gestantes pretendiam limpar a boca do bebê e levá-lo ao cirurgião-dentista; 36,49% levariam chupeta ao hospital e 29,73% achavam que amamentar não era importante para a saúde bucal do bebê. Após seis meses do nascimento do bebê; 63,51% limpavam a boca do bebê; 91,89% ainda não haviam levado seus bebês ao cirurgião-dentista e 25,68% levaram chupeta ao hospital. Em relação a saúde bucal, 32,72% das mães possuíam mancha branca. Do total de 74 bebês, 16 possuíam dentes aos seis meses de idade, três apresentavam manchas brancas e não estavam em AME. Conclusão:A expectativa de AME não se configurou totalmente na prática. A taxa de AME aos seis meses foi baixa, portanto a identificação das barreiras é importante para o estabelecimento de estratégias de promoção de saúde para superá-las. 

Agentes comunitários de saúde e o aleitamento materno: desafios relacionados ao conhecimento e à prática

RESUMO Objetivo: identificar o conhecimento de Agentes Comunitários de Saúde sobre as práticas e a promoção do aleitamento materno. Métodos: estudo transversal, descritivo, inquérito, quanti-qualitativo realizado com amostra de 148 agentes. A coleta de dados foi realizada por meio da aplicação de um questionário semiestruturado, com questões abertas e fechadas. Foram analisadas as variáveis: sociodemográficas, capacidade para orientação sobre o aleitamento, participação em treinamentos/cursos, conhecimentos sobre vantagens do aleitamento para mãe e bebê. Realizou-se análise estatística descritiva, foram empregados os testes Qui-quadrado, Exato de Fisher e G, ao nível de significância 5%. As questões abertas foram analisadas segundo a técnica de pesquisa qualitativa. Resultados: aproximadamente, 45,95% dos agentes não foram capacitados para realizar orientação prática das nutrizes sobre o aleitamento e 63,30% nunca participaram de cursos sobre amamentação. A maioria citou vantagens do aleitamento relacionadas, somente, ao bebê, emergindo as categorias: nutrição do bebê, imunológica, desenvolvimento/saúde do bebê, dentição/ossos. Houve associação estatisticamente significante entre capacidade de orientar as mães na amamentação e participação em treinamentos (p<0,001). Conclusão: os agentes não haviam participado de cursos de capacitação para acompanhar as nutrizes, apresentaram conhecimento limitado sobre a prática e a promoção do aleitamento, e as visitas domiciliares realizadas pós-parto ocorreram tardiamente.

ESTUDO DA CONCENTRAÇÃO DE FLÚOR NAS ÁGUAS DE ABASTECIMENTO PÚBLICO RELACIONADA ÀS VARIAÇÕES PLUVIAIS

Introdução: Quanto ao uso do flúor na odontologia, a fluoretação das águas de abastecimento público se constitui o método de maior abrangência, além de possuir um baixo custo e ser seguro, porém a análise periódica dos níveis do íon se faz necessária para que se obtenha o máximo benefício na prevenção de cárie e risco mínimo no desenvolvimento de fluorose dentária. Objetivo: analisar e comparar a concentração de flúor nas águas de abastecimento público nos períodos de chuva e seca, em fontes de captação onde o íon é natural, no intervalo de 5 anos. Metodologia: a coleta de água foi feita em pontos previamente estabelecidos de acordo com o número e localização das fontes de captação de água. As análises foram executadas com um analisador de íons acoplado a um eletrodo específico para flúor. A análise dos dados foi feita por estatística descritiva e utilizando-se o teste de Wilcoxon para a comparação entre os períodos de chuva e seca. Resultados: 81,03% das amostras dos poços profundos estavam acima dos teores de flúor recomendados, não estando então na classificação que ofereça o máximo benefício e risco mínimo. Os valores referentes à média, desvio padrão e valores máximos e mínimos foram semelhantes nos dois poços profundos onde o flúor contido é natural. Conclusão: Não houve diferenças estatisticamente significativas nos teores do íon flúor das águas provenientes de poços profundos na comparação dos períodos de chuva e seca.

Influence of oral health on quality of life in pregnant women

This study evaluated the relationships between oral conditions and oral health-related quality of life (OHRQoL), as well as related factors. A crosssectional study was performed on 119 postnatal women who had sought prenatal care during pregnancy in the public health system of São Paulo State, Brazil. The women received oral clinical exams and were interviewed using the questions on the OHIP14. A second survey with information about their socioeconomic status, pregnancy and health habits was administered. The highest OHIP14 scores were found in the area of physical pain, with an average score of 10.6. Average DMFT rate for the population was 12.2 (±6.1), with the majority having DMFT ≥4.5 (89.9%). Most of the women needed some type of dental prosthesis (59.7%), had some type of periodontal disease (90.8%), tooth decay (73.9%), missing teeth (64.7%) and were in need of oral treatment (68.1%). The OHIP14 scores were significantly associated with age (p=0.02), first pregnancy (p<0.001), need for dental prosthesis (p<0.001), presence of dental caries (p<0.001) and missing teeth (p=0.01). In the multivariate analysis, the worst OHRQoL was significantly associated with the presence of caries (p=0.03). The results suggest an association between the worst oral condition and poorer quality of life during pregnancy. This risk group should be prioritized in the health services in order to treat and recover the oral health of pregnant women, promoting better oral health conditions and better quality of life for their children.

Early Childhood Caries: Epidemiology, Severity and Sociobehavioural Determinants

PURPOSE

To investigate the association between sociobehavioural variables and the pattern and severity of early childhood caries in Brazilian infants and toddlers ages 0-3 years.

MATERIALS AND METHODS

This was a cross-sectional study with 768 children who attended 58 public nursery schools. Five previously calibrated teams (Kappa = 0.842) performed oral examinations, using the decayed, missing, filled teeth (dmft) index according to the WHO methodology. A pretested, self-administered questionnaire was given to the subjects' parents or guardians to obtain sociobehavioural information.

RESULTS

Caries was observed in 134 of the 768 (17%) children. Caries and rampant caries were significantly more prevalent in low-income families (p = 0.0121) and the incidence of caries was associated with access to dental services (p < 0.05). The percentages of children who were caries free in the age groups of 0-11 months, 12-23 months, 24-35 months and 36-47 months were 100%, 96%, 88% and 76%, respectively.

CONCLUSION

Programmes for prevention and oral health education should be instituted, preferably during the first year of life, especially for those in the most socioeconomically deprived groups.

Dental fluorosis and its influence on children's life

This study verified the prevalence of dental fluorosis in 12-year-old children and its association with different fluoride levels in the public water supply, and evaluated the level of perception of dental fluorosis by the studied children. To assess fluorosis prevalence, clinical examinations were performed and a structured instrument was used to evaluate the self-perception of fluorosis. The water supply source in the children's area of residence since birth was used as the study criterion. In total, 496 children were included in the study. Fluorosis was diagnosed in 292 (58.9%) children; from these, 220 (44.4%) children were diagnosed with very mild fluorosis, 59 (11.9%) with mild fluorosis, 12 (2.4%) with moderate fluorosis, and 1 (0.2%) child with severe fluorosis. A significant association (p = 0.0004) was observed between the presence of fluorosis and areas with excessive fluoride in the water supply. Among the 292 children that showed fluorosis, 40% perceived the presence of spots in their teeth. The prevalence of fluorosis was slightly high, and the mildest levels were the most frequently observed. Although most of the children showed fluorosis to various degrees, the majority did not perceive these spots, suggesting that this alteration did not affect their quality of life.

Access of children to the oral health service

BACKGROUND

Dental caries still affect a considerable proportion of children, however the epidemiological profile of oral diseases is changing, social inequalities cause different disease patterns. The same problems occur for the use of services, which damage those who are more susceptible to oral diseases in numerous ways.

AIM

To verify the association between the variables: socioeconomic condition, oral health and access to dental services providing oral health care for preschool children.

METHODS

The study population consisted of 2,759 children up to 6 years-old. The clinical exams followed the World Health Organization (WHO) criteria. The data were collected using a self-applied questionnaire, answered by the carers of children, with questions about socioeconomic variables and access to dental services.

RESULTS

In terms of social class, a majority of the subjects came from the middle socioeconomic level (babies, 84.7%; children, 82.8%). Babies who had caries, 48.4% and 67.2% of the children that had decayed teeth had access to dental service. There was a association between the variables: the reason for the last dental appointment and the parent's perception of the treatment need of their children (babies p=0.0004 and children p < 0.0001); the parent's perception of the treatment need of their children and the oral health condition (babies p=0.0008 and children p < 0.0001); access to dental services and oral health condition (babies p=0.0021 and children p < 0.0001).

CONCLUSION

The majority of the population studied sought care from public dental service and was from the middle class.

Longitudinal study of habits leading to malocclusion development in childhood

BACKGROUND

The increased prevalence of malocclusions represents a secular trend attributed to the interaction of genetic and environmental factors. The analysis of factors related to the causes of these changes is essential for planning public health policies aimed at preventing and clinically intercepting malocclusion. This study investigated the sucking habits, nocturnal mouth breathing, as well as the relation of these factors with malocclusion.

METHODS

This is a longitudinal study in which 80 mother-child pairs were monitored from the beginning of pregnancy to the 30th month after childbirth. Home visits for interviews with the mothers were made on the 12th, 18th and 30th months of age. Finger sucking, pacifier sucking, bottle feeding, breastfeeding and nocturnal mouth breathing, were the variables studies. On the 30th month, clinical examinations were performed for overjet, overbite and posterior crossbite. A previously calibrated single examiner (Kappa coefficient = 0.92) was responsible for all examinations. Data were analyzed using the chi-squared or Fisher's exact tests, at a significance level of 5%.

RESULTS

Bottle feeding was the most prevalent habit at 12, 18 and 30 months (87.5%; 90% and 96.25%, respectively). Breastfeeding was 40%, 25% and 12.50% at 12, 18 and 30 months, respectively. Nearly 70% of the children in this study had some sort of malocclusion. Pacifier sucking habit at 12, 18 and 30 months of age was associated with overjet and open bite; and at 30 months, an association with overbite was also observed. Finger sucking habit and breastfeeding at 12, 18 and 30 months were also associated with overjet and open bite. The posterior crossbite was associated with bottle feeding at 12 and 30 months, and nocturnal mouth breathers at 12 and 18 months.

CONCLUSIONS

Sucking habits, low rates of breastfeeding, and nocturnal mouth breathing were risk factors for malocclusion.

Humanização na atenção básica de saúde na percepção de idosos

O objetivo deste estudo foi analisar a percepção do idoso quanto ao cuidado humanizado na atenção básica de saúde, com enfoque sobre os aspectos do atendimento ambulatorial que interferem na qualidade do atendimento. Para isso, realizou-se um estudo do tipo transversal, abrangendo todas as unidades básicas de saúde de um município do interior do Estado de São Paulo, por meio de entrevistas dirigidas aos idosos que frequentavam essas unidades. O instrumento utilizado foi desenvolvido pela Organização Mundial da Saúde (OMS), que, em busca de maior objetividade para a avaliação da qualidade do cuidado à saúde, propôs o conceito de responsividade, para referir-se aos elementos não diretamente ligados ao estado de saúde, e sim aos envolvidos no atendimento acolhedor e resolutivo com responsabilidade e vínculo. Dessa forma, os domínios de responsividade avaliados foram: pronta atenção, dignidade, comunicação, autonomia, escolha dos profissionais, confidencialidade e estrutura física e conforto. Os resultados foram analisados através do software Epi Info 3.5.2. Verificou-se que alguns domínios da atenção em saúde, altamente valorizados pelos idosos, tiveram desempenho bem inferior, como: Autonomia, em que apenas 54,4% tiveram liberdade para tomar decisões sobre sua saúde ou tratamento; e Comunicação, em que 67,6% não obtiveram informações sobre outros tipos de tratamentos ou exames e 79,2% não tiveram oportunidade para esclarecimentos quanto às dúvidas sobre o tratamento. Sugere-se, portanto, mudanças nos serviços de atenção básica à saúde prestados, principalmente quando se trata de idosos, uma população especial que necessita receber uma assistência diferenciada.

Water fluoridation in 40 Brazilian cities: 7 year analysis

Objectives:

Fluoride levels in the public water supplies of 40 Brazilian cities were analyzed and classified on the basis of risk/benefit balance.

Material and Methods:

Samples were collected monthly over a seven-year period from three sites for each water supply source. The samples were analyzed in duplicate in the laboratory of the Center for Research in Public Health - UNESP using an ion analyzer coupled to a fluoride-specific electrode.

Results:

A total of 19,533 samples were analyzed, of which 18,847 were artificially fluoridated and 686 were not artificially fluoridated. In samples from cities performing water fluoridation, 51.57% (n=9,720) had fluoride levels in the range of 0.55 to 0.84 mg F/L; 30.53% (n=5,754) were below 0.55 mg F/L and 17.90% (n=3,373) were above 0.84 mg F/L (maximum concentration=6.96 mg F/L). Most of the cities performing fluoridation that had a majority of samples with fluoride levels above the recommended parameter had deep wells and more than one source of water supply. There was some variability in the fluoride levels of samples from the same site and between collection sites in the same city.

Conclusions:

The majority of samples from cities performing fluoridation had fluoride levels within the range that provides the best combination of risks and benefits, minimizing the risk of dental fluorosis while preventing dental caries. The conduction of studies about water distribution systems is suggested in cities with high natural fluoride concentrations in order to optimize the use of natural fluoride for fluoridation costs and avoid the risk of dental fluorosis.

Potentially inappropriate medications used by the elderly: prevalence and risk factors in Brazilian care homes

BACKGROUND

The use of potentially inappropriate medications (PIM) among the elderly is a serious public health problem because it is intrinsically linked to increased morbidity and mortality, causing high costs to public health systems. This study's objective was to verify the prevalence of and the factors associated with the use of PIMs by elderly Brazilians in institutional settings.

METHODS

We performed a transversal study, by consulting the case files of elderly people living in Long Term Care for the Elderly (LTC) in towns in the State of São Paulo, Brazil, as well as structured interviews with the nurses responsible for them.We identified PIMs using the list of recently updated Beers criteria developed by a group of specialists from the American Geriatrics Society (AGS), who reviewed the criteria based on studies with high scientific evidence levels. We defined the factors studied to evaluate the association with PIM use prior to the statistical analyses, which were the chi-square test and multiple logistic regression.

RESULTS

Among the elderly who used drugs daily, 82.6% were taking at least one PIM, with antipsychotics (26.5%) and analgesics (15.1%) being the most commonly used. Out of all the medications used, 32.4% were PIMs, with 29.7% of these being PIMs that the elderly should avoid independent of their condition, 1.1% being inappropriate medication for older adults with certain illnesses or syndromes, and 1.6% being medications that older adults should use with caution. In the multivariate analysis, the factors associated with PIM use were: polypharmacy (p = 0.0187), cerebrovascular disease (p = 0.0036), psychiatric disorders (p < 0.0001) and dependency (p = 0.0404).

CONCLUSIONS

The results of this study showed a high prevalence of PIM use in institutionalized elderly Brazilian patients. and the associated factors were polypharmacy, psychiatric disorders, cerebrovascular diseases and dependency.

A influência da prática do aleitamento materno na aquisição de hábitos de sucção não nutritivos e prevenção de oclusopatias

OBJETIVO: Neste estudo, objetivou-se verificar a associação entre prática do aleitamento materno, aquisição de hábitos de sucção não nutritivos e oclusopatias. MATERIAL E MÉTODO: Trata-se de uma pesquisa do tipo transversal, retrospectiva, na qual foram realizadas entrevistas com 330 mães de crianças de 3 a 6 anos de idade de Araçatuba-SP, após consentimento esclarecido, utilizando-se questionário semiestruturado, testado em estudo piloto. Exames clínicos foram realizados nas crianças (n = 306) para verificação de oclusopatias. Dois pesquisadores foram calibrados (Kappa = 0,91) para realização das entrevistas e exames. Os testes Qui-Quadrado (χ²) e Exato de Fischer foram utilizados para verificar associações, em nível de significância de 5% (p < 0,05). Os dados foram processados no programa EpiInfo e GraphPad®. RESULTADO: A maioria das mães (86,4%) amamentou seus filhos, entretanto, apenas 33,4% delas amamentaram exclusivamente no peito até seis meses de vida. As oclusopatias estiveram presentes em 54% das crianças e, entre estas, 83% não foram amamentadas no peito até seis meses de idade. Os hábitos de sucção não nutritivos estiveram presentes em 53,3% (176) das crianças, sendo o uso de chupeta (31,2%), o mais prevalente. Houve associação significante direta entre a falta de aleitamento materno total e as seguintes variáveis: presença de oclusopatias (p < 0,0001); mordida aberta (p = 0,0001); mordida cruzada anterior (p = 0,0346); hábitos de sucção não nutritivos (p < 0,0001), e uso de chupeta (p < 0,0001). A falta de aleitamento materno exclusivo esteve associada com uso de chupeta (p < 0,0001). CONCLUSÃO: O aleitamento materno, além de inúmeras vantagens, exerce papel preventivo na aquisição de hábitos de sucção não nutritivos e na prevalência de oclusopatias.

A participação do auxiliar em saúde bucal na equipe de saúde e o ambiente odontológico

INTRODUÇÃO: A composição da equipe de saúde bucal e as condições sanitárias e ergonômicas no ambiente de trabalho influenciam na qualidade do atendimento odontológico prestado ao paciente. OBJETIVO: Neste estudo observacional e transversal, objetivou-se verificar a participação do auxiliar na equipe odontológica do serviço público, bem como os itens relacionados com a legislação sanitária e a existência e a distribuição dos equipamentos no consultório. MATERIAL E MÉTODO: A coleta de dados foi realizada por meio de aplicação de questionários e observações nos locais de atendimento. Foram entrevistados 75 cirurgiões-dentistas de nove municípios do DRS XV - São José do Rio Preto-SP e avaliados 34 consultórios. RESULTADO: Do total de 75 cirurgiões-dentistas, 21 (28%) trabalhavam sozinhos, sendo seis (29%) em escolas e 15 (71%) em UBS. Dos 34 consultórios, dois (6%) não apresentavam qualquer equipamento de esterilização e, dos que possuíam, a autoclave era o meio mais utilizado, em número de 15 (44%). Dos consultórios analisados, 13 (38%) não possuíam lixeiras do lixo comum e, em 18 (53%), as existentes eram inadequadas. Quanto ao lixo contaminado, em 21 (62%), as lixeiras eram inadequadas e, em dois (6%), ausentes. Ou seja: em apenas 11 (32%), as lixeiras para este tipo de lixo eram adequadas. Notou‑se ainda que 13 (38%) não tinham lavatórios para mãos; em 23 (68%), havia toalheiro de papel; em 20 (59%), saboneteiras adequadas, e o compressor estava instalado dentro dos consultórios em cinco (15%) dos locais de atendimento. Quanto à adequação dos consultórios para o trabalho auxiliado, todos (n = 19) estavam insatisfatórios. CONCLUSÃO: A existência do ASB apresentou-se principalmente nos CEOs e nas Unidades de Saúde da Família por exigência legal e foram encontradas condições sanitárias e ergonômicas inadequadas, sugerindo a necessidade de reorganização no processo de trabalho e de gestão.

External control of the public water supply in 29 Brazilian cities

The fluoridation of public water supplies is considered the most efficient public health measure for dental caries prevention. However, fluoride levels in the public water supply must be kept constant and adequate for the population to gain preventive benefit. The aim of this study was to analyze fluoride levels in the public water supply of 29 Brazilian municipalities during a 48-month period from November 2004 to October 2008. Three collection sites were defined for each source of municipal public water supply. Water samples were collected monthly and analyzed at the Research Laboratory of the Nucleus for Public Health (NEPESCO), Public Health Postgraduate Program, Araçatuba Dental School (UNESP). Of the 6862 samples analyzed, the fluoride levels of 53.5% (n = 3671) were within the recommended parameters, those of 30.4% (n = 2084) were below these parameters, and those of 16.1% (n = 1107) were above recommended values. Samples from the same collection site showed temporal variability in fluoride levels. Variation was also observed among samples from collection sites with different sources within the same municipality. Although 53.5% of the samples contained the recommended fluoride levels, these findings reinforce the importance of monitoring to minimize the risk of dental fluorosis and to achieve the maximum benefit in the prevention of dental caries.

A longitudinal study of the association between breast-feeding and harmful oral habits

PURPOSE

The purpose of this paper was to study the pattern of breast-feeding and harmful sucking habits (pacifier- and thumb-sucking) from birth to 12-months-old.

METHODS

A prospective cohort study with 80 newborn infants and their mothers was conducted. A semi-structured questionnaire on breast-feeding and pacifier- and thumb-sucking behavior was administered during monthly household visits. Data were analyzed using the chi-square test.

RESULTS

Exclusive breast-feeding occurred in 50% of infants from birth while 69% of participants were completely weaned by 12-months-old. Pacifier-sucking was more prevalent than thumb-sucking and was maintained at a higher rate than thumb-sucking throughout the study. The incidence of thumb-sucking was highest between the third and sixth month of life. There was a significant association between a low rate of breast-feeding and pacifier-sucking at the 12-month visit (chi-square=5.29; P<.05). Thumb-sucking did not significantly correlate with breast-feeding behavior.

CONCLUSION

The rate of exclusive breast-feeding was lower than that recommended by the World Health Organization. More than half the infants had a pacifier- and / or thumb-sucking habit during the study, and the incidence of breast-feeding was lower in those who used a pacifier.

Fluoride concentration in public water supply: 72 months of analysis

Known as one of the ten most important advances on Public Health in the 20th century, fluoridation of public water supply is a measure of wide population coverage, which is effective on caries control. The city of Araçatuba, in the Northwest region of the São Paulo state, Brazil, started public water supply fluoridation in 1972 and, based on the average annual highest temperature, has kept the fluoride concentration between 0.6 to 0.8 mgF/L. The purpose of this study was to analyze monthly the fluoride concentration in public water supply in the city of Araçatuba during 72 months. Water samples were collected monthly on weekdays, directly from the water distribution network, on pre-established locations and analyzed in duplicate between November 2004 and October 2010 at the Research Laboratory of the Nucleus for Public Health (NEPESCO) of the Public Health Graduate Program from Araçatuba Dental School/UNESP, Brazil, using an fluoride-specific electrode connected to an ion analyzer. From the total of samples (n=591), 67.2% (n=397) presented fluoride concentration between 0.6 and 0.8 mgF/L; 20.6% (n=122) below 0.6 mgF/L; 11.5% (n=68) between 0.8 and 1.2 mgF/L and 0.7% (n=4) above 1.2 mgF/L. Most samples showed fluoride levels within the recommended parameters. Minimal variation was observed among the analyzed collection locations, showing that the city has been able to control the fluoride levels in the public water supply and reinforcing the importance of surveillance and constant monitoring to assure the quality of the water delivered to the population.

Relação entre aleitamento materno e hábitos de sucção não nutritivos

Este estudo objetivou identificar o tipo e o período de tempo de aleitamento recebido por crianças e verificar a associação com hábitos de sucção não nutritivos. Trata-se de um estudo transversal, retrospectivo, no qual foi aplicado um questionário em 330 mães ou responsáveis por crianças de 3 a 6 anos matriculadas em pré-escolas de Araçatuba (SP), após consentimento livre e esclarecido. Observou-se que 86,4% das mães amamentaram seus filhos. Quanto ao período de tempo, apenas 33,4% delas amamentaram exclusivamente no peito após seis meses de vida. O tempo médio de amamentação materna exclusiva recebida foi 3,84 meses e o de aleitamento complementar foi de 11,68 meses. Do total, 53,3% relataram que os filhos apresentavam hábitos de sucção não nutritivos, e destes 70,45% não foram amamentados exclusivamente no peito durante os seis primeiros meses de vida, existindo associação significativa entre os dois (p<0,05). O uso de chupeta foi o hábito mais frequente (44,4%), apresentando associação estatisticamente significante com o tempo de aleitamento (p<0,0001). Conclui-se que o aleitamento materno foi praticado, porém, por período de tempo inferior ao período considerado indispensável ao desenvolvimento do bebê, existindo associação entre tempo e tipo do aleitamento e hábitos de sucção não nutritivos.

Perda dentária em uma população rural e as metas estabelecidas pela Organização Mundial de Saúde

Este estudo teve como objetivo relatar a perda dentária em uma população rural, avaliando a contribuição de variáveis socioeconômicas e comportamentais e comparando os resultados com as metas da Organização Mundial da Saúde (OMS) para 2000 e 2010. Foram examinados 473 moradores, utilizando a metodologia, códigos e critérios propostos pela OMS. Os resultados foram processados no programa Epibuco e o teste qui-quadrado (p<0.05) foi utilizado para comparar o número de dentes perdidos com as variáveis estudadas. Do total de examinados, 17,8% são edêntulos totais, assim como 8% e 50,9% dos examinados pertencentes aos grupos etários de 35 a 44 e 65 a 74 anos, respectivamente. Iniciando precocemente nesta população, a perda dentária avançou consideravelmente com a idade, estando a situação muito aquém das metas estabelecidas pela OMS para 2010. O teste qui-quadrado revelou diferenças estatisticamente significantes quanto ao número de dentes perdidos pelos entrevistados com 35 anos de idade ou mais em relação à escolaridade, tipo de moradia e autopercepção da qualidade da fala. Torna-se necessário o desenvolvimento de programas de atenção à saúde bucal, a fim de diminuir os danos causados e prevenir a continuidade da tendência à mutilação.

Práticas de ensino-aprendizagem com base em cenários reais

O processo ensino-pesquisa-extensão realizado com a imersão dos sujeitos em cenários reais possibilita a integração universidade-comunidade, ampliando a inserção social. O objetivo deste trabalho foi apresentar a experiência de um projeto conduzido em cinco municípios brasileiros, com a participação de docentes, pós-graduandos e acadêmicos, em parceria com prefeituras municipais e trabalhadores de saúde como cenário de ensino-pesquisa no SUS. Foram realizadas oficinas e cursos de capacitação com as equipes de saúde, gestores e conselheiros de saúde, visitas técnicas aos municípios para avaliação situacional e supervisão das atividades, avaliação da satisfação dos usuários e formação de lideranças populares. Observou-se a melhoria na organização dos serviços e estímulo ao fortalecimento do vínculo entre os usuários e prestadores de serviços. Essa experiência serviu como laboratório de aprendizagem e pesquisa, fazendo-se ciência a partir da vivência in loco da realidade do SUS e contribuindo para uma formação professional mais humanitária baseada em cenários reais.

Dental caries prevalence in children up to 36 months of age attending daycare centers in municipalities with different water fluoride content

This study determined the prevalence of cavitated caries lesions (CCL) and early childhood caries (ECC), and the contribution of some variables in children up to 36 months of age attending daycare centers in municipalities with different fluoride levels in the water supply: AFC (adequate fluoride content) and LFC (low fluoride content). After approval of the Ethics Committee, the parents were interviewed. The children were clinically examined using the same codes and criteria established by the WHO (World Health Organization) and the ADA (American Dental Association). Fisher's exact test (p<0.05) was applied for statistical analysis of data. The dmft indices calculated in the LFC and AFC municipalities were 0.57 and 0.68, respectively. Considering all children examined, 17.6% presented CCL and 33.8% ECC. The economic classification, mother's education level and duration of breastfeeding were considered statistically significant with regards to CCL prevalence. The age group, duration of the habit of drinking milk before bedtime and age at which oral hygiene started were considered statistically significant with regards to ECC prevalence.

Fluoride intake from meals served in daycare centres in municipalities with different fluoride concentrations in the water supply

PURPOSE

The aim of this study was (1) to determine the fluoride content in the meals served to children aged up to 36 months in daycare centres of two municipalities with different levels of fluoride in the water supply, (2) to calculate the mean fluoride ingested daily by the children when consuming those meals and (3) to analyse the contribution of this consumption to the development of dental fluorosis.

MATERIALS AND METHODS

Samples of the meals served to the children were collected during a whole week. The fluoride content of the samples of solid foods and milk was analysed using an ion-specific electrode combined with reference electrode after diffusion facilitated by hexamethyldisiloxane. Samples of beverages were buffered with an equal volume of total ionic strength adjustment buffer and analysed using a combined electrode. The results were compared using the Mann-Whitney test.

RESULTS

Mean fluoride contents of the meals were of 0.204 +/- 0.179 and 0.322 +/- 0.242 microg F/mL (P < 0.05), respectively, in the municipalities with low and adequate fluoride content. Daily fluoride intake in the former was 0.013 +/- 0.003 mg/kg body weight/day and in the latter was 0.012 +/- 0.001 mg/kg body weight/day (P > 0.05).

CONCLUSIONS

The children were not exposed to dental fluorosis in the daycare centres. However, the risk cannot be ignored, considering the meals and the use of fluoridated dentifrices at home may also contribute to fluoride intake.

Smoking and periodontal disease: clinical evidence for an association

PURPOSE

The aim of the present study was to assess the periodontal condition and smoking status, according to dose and duration information, and to estimate the percentage of subjects with periodontitis attributable to cigarette smoking in a representative adult rural population in southern Brazil.

MATERIALS AND METHODS

Bivariate statistical analysis was used to evaluate the association of smoking status with periodontitis in a cross-sectional study comprising 165 dentate individuals, aged 35 to 66 years, subjected to oral clinical examination of six sites per tooth in all sextants.

RESULTS

The prevalence of periodontitis (having > or = 1 pocket of > or = 4 mm around the index teeth) in the population was 35.2%. Overall, 13.9% had a cumulative loss of attachment > 4 mm; 35.7% of subjects were current smokers, classified as heavy (average 25.3 pack years), moderate (average 14.6 pack years) and light smokers (average 3.1 pack years). Statistical analysis showed that current smokers had an 11 times (95% confidence interval [CI] = 4.69 to 26.62) and former smokers had a nine times (95% CI = 3.29 to 25.96) greater probability of having established periodontitis compared with non-smokers. The number of pack years (P = 0.0004) and years of smoking exposure (P = 0.0013) were associated with an increased prevalence of periodontitis. The number of current smokers with periodontitis might be reduced by 80%, had they not smoked cigarettes. Of the subjects with periodontitis, 64% could be prevented among current smokers by eliminating tobacco consumption.

CONCLUSIONS

Cigarette smoking was strongly associated with periodontitis, and there was a relationship with dose and duration of smoking. These findings contributed to the evidence of smoking as a risk factor for periodontal disease and support the importance of dose-response analysis on determining the strength of this association.

Freqüência e variáveis associadas ao aleitamento materno em crianças com até 12 meses de idade no município de Araçatuba, São Paulo, Brazil

OBJETIVOS: avaliar a prevalência do aleitamento materno em crianças assistidas em Araçatuba, São Paulo, Brasil; verificar a associação com variáveis materno-infantis e o conhecimento das mães sobre a relação da amamentação com saúde bucal. MÉTODOS: estudo transversal. Os dados foram coletados durante a Campanha Nacional de Vacinação, em 2005. Foram entrevistadas 100 mães de crianças com até 12 meses de idade. A freqüência do aleitamento foi estimada por meio da análise de sobrevivência, e foram realizadas análises estatísticas para verificação da associação entre aleitamento e variáveis independentes. RESULTADOS: a prevalência do aleitamento aos 6 e 12 meses foi de 22,2% (exclusivo) e 65% (total). A duração mediana da amamentação exclusiva foi de 3,65 meses. As variáveis associadas ao desmame foram uso de mamadeira (χ2=9,537; p=0,002) e chupeta (χ2= 14,667; p=0,001). Poucas mães (33) demonstraram saber a influência do aleitamento sobre a saúde bucal de seus filhos, sendo o cirurgião-dentista o profissional mais citado como responsável por essa informação. CONCLUSÕES: a prevalência da amamentação foi satisfatória, porém foram baixas as taxas de aleitamento exclusivo, e como fatores determinantes destacaram-se o uso de mamadeiras e chupetas associado ao desmame. É dever de órgãos governamentais, meios de comunicação e profissionais de saúde compactuarem ações efetivas em prol do aleitamento.

Association between breast-feeding practices and sucking habits: a cross-sectional study of children in their first year of life

In addition to providing nutrition and immunological protection, breast-feeding has positive effects on the development of the infant's oral cavity. The aim of the present study is to assess breast-feeding patterns and to analyze the influence of breast-feeding practices and maternal sociodemographic variables on the prevalence of non-nutritive sucking habits in a sample of Brazilian infants. This cross-sectional study was carried out in Southern Brazil. A random sample of 100 mothers of infants up to 12 months of age was interviewed during the National Vaccination Campaign Day. The prevalence and median duration of breast-feeding were assessed. Breast-feeding practice, the exposure factor, was categorized as exclusive breast-feeding, predominant breast-feeding, complementary breast-feeding, or weaning. Maternal sociodemographic variables included age, race, marital status, educational level, profession, and family income. The outcome investigated was the prevalence of sucking habits (pacifier use and thumb sucking). We used two-sample tests, the chi-square test and FISHER'S EXACT TEST for statistical analyses of the data. The study revealed that 75% of infants were being breast-fed. Pacifier use and thumb sucking were common in 55%. Bottle-feeding was prevalent in 74% of infants. Breast-feeding was negatively correlated with pacifier use and thumb sucking (OR=0.11; 95% CI: 0.03 to 0.4). Bottle-feeding was strongly associated with weaning (p=0.0003). Among the sociodemographic variables, only marital status showed a statistical association with sucking habits (p=0.04). These findings suggest that breast-feeding can prevent the occurrence of sucking habits. Although we could not evaluate causality assessment, malocclusion prevention seems to be yet one more reason for promoting breast-feeding practices.

[Epidemiological profile of domestic violence: complaints of aggression filed in a city in São Paulo State, Brazil, from 2001 to 2005]

The aim of this study was to analyze complaints of household physical aggression filed in Araçatuba, São Paulo, Brazil, from 2001 to 2005. The study described the social characteristics of aggressors and victims, their family relationship, locale, time of day, day of week, causes of aggression, kind of injuries, and use of alcohol/drugs by aggressor. Of 7,750 complaints of aggression, 1,844 involved domestic violence: 81.1% involved the spouse or partner (group A), 11.6% parents/guardians and children (group B); and 7.3% other family members (group C). In the three groups, the aggressions occurred mainly at home, and the aggressors were mostly males. In group A, aggressions occurred mainly on weekends (38.9%), with jealousy as the most frequently reported cause (21.5%). In group B, children/adolescents constituted 68.1% of the victims, mostly girls, while 5.2% of victims were 60 years old. All three groups involved mostly minor injuries like bruises and excoriations to the head and upper limbs. Aggressors were frequently under the influence of alcohol: 26.8% (group A), 21.6% (group B), 17.1% (group C). Drug use was probably underestimated in the three groups (2.2%, 1.8%, and 4.5%, respectively).

Responsabilidade do profissional de saúde sobre a notificação de casos de violência doméstica

A notificação da violência doméstica pelos profissionais de saúde contribui para o dimensionamento epidemiológico do problema, permitindo o desenvolvimento de programas e ações específicas. O objetivo do trabalho foi verificar a responsabilidade desses profissionais em notificar a violência, especialmente a doméstica e as possíveis implicações legais e éticas a que estão sujeitos. Assim, foi realizada pesquisa na legislação brasileira e códigos de ética da medicina, odontologia, enfermagem e psicologia. Quanto à legislação, as sanções estão dispostas na Lei das Contravenções Penais, Estatuto da Criança e Adolescente, Estatuto do Idoso e na lei que trata da notificação compulsória de violência contra a mulher. Também existem penalidades em todos os códigos de ética analisados. Conclui-se que o profissional de saúde tem o dever de notificar os casos de violência que tiver conhecimento, podendo inclusive responder pela omissão.

Analysis of fluoride concentration in mother's milk substitutes

The aim of the present study was to determine the fluoride concentration in some brands of mother's milk substitutes and evaluate the possibility of developing dental fluorosis by consuming these products. The products, all powdered, were divided into 3 groups: infant formulae (group I, n = 7), milk-based (group M, n = 8) and soy-based (group S, n = 3). Samples from 3 cans of different batches of each brand were reconstituted in deionized water and analyzed using the specific electrode method, after hexamethyldisiloxane (HMDS) facilitated diffusion. The fluoride content (mg F/L) of the products ranged from 0.044 to 0.326 (I), 0.014 to 0.045 (M) and 0.253 to 0.702 (S). There was significant difference in the fluoride content of cans from distinct batches (p < 0.05) in most of the brands. The reconstitution of all products in water with optimal fluoride concentration for consumption during the mineralization phase of the primary teeth could result in daily fluoride intake above 0.07 mg F/kg body weight/day. Therefore, the consumption of these products, especially when reconstituted with optimally fluoridated water, could increase the risk of developing dental fluorosis.

Declínio da cárie em um município da região noroeste do Estado de São Paulo, Brasil, no período de 1998 a 2004

O objetivo do estudo foi analisar os índices CPOD, ceod, SiC Index e a porcentagem de crianças livres de cárie, em escolares de 5 a 12 anos da rede pública do Município de Bilac, São Paulo, Brasil, em estudos realizados nos anos de 1998, 2000, 2002 e 2004. Utilizou-se a mesma metodologia (OMS-1997) em todos os levantamentos. O teste estatístico kappa foi calculado a cada estudo, obtendo-se o valor de concordância interexaminadores mínimo de 0,86 e máximo de 0,89, e intra-examinador mínimo de 0,91. O índice ceod diminuiu pouco nos anos de 1998 e 2004. Houve uma redução contínua do índice CPOD aos 12 anos, passando de 5,28 em 1998 para 4,11 em 2000, 3,47 em 2002 e 2,62 em 2004, e o fenômeno da polarização. Na proporção inversa, a porcentagem de crianças com 5 anos livres de cárie aumentou de 37,9% em 1998 para 40% em 2000 e 2002, e 45,3% em 2004. Conclui-se que está ocorrendo a redução da cárie dentária na faixa etária de 12 anos entre escolares do ensino público do município.

A saúde bucal em pauta: análise de registros dos Conselhos Municipais de Saúde de municípios pertencentes à 17ª Regional de Saúde do Estado do Paraná, Brasil

O presente estudo teve como objetivo a análise das intervenções em saúde bucal, registradas em atas de reuniões, de 15 Conselhos Municipais de Saúde, próprios de municípios pertencentes à 17ª Regional de Saúde do Estado do Paraná. A análise documental deu-se a partir da identificação das temáticas em saúde, com ênfase na categorização por assunto das intervenções em saúde bucal. Os resultados evidenciaram os registros relativos à programação e organização da prestação de serviços, seguida pelo orçamento em saúde, como sendo os mais freqüentes do conjunto de temáticas analisadas. Pôde-se identificar, em 90 atas das 591 estudadas, o total de 134 registros de intervenções em saúde bucal. Por meio da análise desses últimos, percebeu-se que as intervenções em saúde bucal eram relatos de ações já concretizadas, desprovidas de características propositivas quando analisadas sob a dimensão do planejamento em saúde. Sinaliza-se para a necessidade da categoria odontológica de adquirir um maior padrão de representatividade nesses espaços, de forma a possibilitar vínculos importantes no processo de planejamento e de fortalecimento da saúde bucal enquanto direito de cidadania.

[Evaluate of popular knowledge and everyday practices in oral health]

OBJECTIVE

To evaluate the popular knowledge and everyday practices in oral health of public services' users.

METHODS

The target population was selected from a stratified sample and included users seeking medical care in health care units in Santa Maria - RS. The data were collected using a semi-structured interview and organized into descriptive categories groups, allowing the distribution in a frequency table.

RESULTS

It was verified the predominance of the age group between 21 to 40 years old and females. The socioeconomic pattern is characterized by low schooling and family income. The search for oral diseases control are due to individual awareness of the need of oral hygiene and dental care; fluoride in toothpaste and drinking water and its benefits were not known by the population.

CONCLUSIONS

The health programs offered to the population must take into account the knowledge and practices in oral health care to make it possible an improvement of oral health according to their reality. In addition there is a need to promote the collective awareness on health promotion in every level of the society.