Andréa Maria Duarte Vargas

Perda dentária e seu significado na qualidade de vida de adultos usuários de serviço público de saúde bucal do Centro de Saúde Boa Vista, em Belo Horizonte

Este trabalho objetivou estudar os problemas causados pela perda dentaria e a falta de acesso a protese na vida diaria da populacao adulta, usuaria de uma unidade de saude da Secretaria Municipal de Saude de Belo Horizonte (SMSBH). Trata-se de uma pesquisa qualitativa, realizada por meio de entrevistas abertas, semi-estruturadas, com 20 pacientes atendidos no Centro de Saude Boa Vista, pertencente a Regional Leste. Os resultados mostraram que os problemas vivenciados pelos pacientes foram tanto funcionais quanto psicossociais, e os sentimentos relatados com a perda dentaria, bastante negativos. Os pacientes apontaram as deficiencias do servico prestado ao adulto, revelando a sua pouca resolutividade, uma vez que so a atencao basica e ofertada, o que tem acarretado a extracao de dentes em condicoes de serem recuperados. Tal situacao e agravada pela nao oferta da protese dentaria para reabilitacao estetica e funcional. Concluiu-se que o Programa de Saude Bucal da Secretaria Municipal de Saude de Belo Horizonte, realizado no Centro de Saude Boa Vista, mostrou-se insuficiente e ineficaz para resolver a maioria das necessidades odontologicas que os usuarios adultos apresentam.

Prospective study of complier individuals under periodontal maintenance therapy: analysis of clinical periodontal parameters, risk predictors and the progression of periodontitis

AIM This prospective study aimed to evaluate the progression of periodontitis and the influence of risk variables among individuals attending a programme of periodontal maintenance treatment in an academic environment. MATERIAL AND METHODS A total of 150 individuals diagnosed with chronic moderate-advanced periodontitis, and who had finished active periodontal treatment, were incorporated into the periodontal maintenance therapy. Social, demographic and biological variables of interest from subjects were collected at quarterly recalls, over a 12-month period. The effect of variables of interest and confounding on the periodontal status and progression of periodontitis was tested by univariate and multivariate logistic analysis. RESULTS A total of 130 subjects (86.7%) showed stable periodontal status, whereas 20 subjects (13.3%) presented periodontitis progression. Twenty-eight subjects (18.66%) presented tooth loss that resulted in a total of 47 lost teeth (1.38%). Diabetes was not found to be associated with periodontitis progression (p=0.67). Smoking was significantly associated with a greater progression of periodontitis (OR=2.7, 95% CI 1.01-7.22). CONCLUSIONS Periodontal maintenance programmes in academic environment can stabilize the periodontal condition obtained after active periodontal therapy as well as control the action of risk variables for the progression of periodontitis.

Implications of edentulism on quality of life among elderly.

This study aimed was to test the association between quality of life and edentulism among elderly individuals in a city in southeastern Brazil. This cross-sectional study was carried out with 163 individuals aged 60 years or older, functionally independent and non-institutionalized. Data were collected with a questionnaire and oral examination. The edentulism was the dependent variable. The independent variables were sex, age, household income and quality of life (WHOQOL-Old) and their scores. To assess the association between the dependent variable and independent variables was used bivariate analysis (p < 0.10). Poisson regression model was performed, adjusting for age and sex. The average age of participants was 69 years (± 6.1), 68.7% were female and 52.8% were diagnosed as completely edentulous (90% CI: 0.33–1.24). When the independent variables were associated to the prevalence of edentulism, statistically significant associations were found for age (p = 0.03) and social participation dimension of the WHOQOL-Old (p = 0.08). In the Poisson regression, social participation remained statistically associated to edentulism {RP = 2.12 [90% CI (1.10–4.00)]}. The social participation proved to have a significant association to edentulism, thereby attesting to the negative effect of this condition on social aspects.

Social capital and self-rated health among adolescents in Brazil: an exploratory study

BackgroundSocial capital may influence health and the patterns of association differ according its dimension such as cognitive, behavioral, bridging or bonding. There is a few numbers of studies in Latin America which comprise these aspects of social capital and health. The aim of this study was to examine the association between social capital and self-rated health among youth, and distinguish between the different forms of social capital - cognitive versus behavioral, and bonding versus bridging.FindingsA cross-sectional study was conducted in 2009 among working adolescents supported by a Brazilian NGO. The sample comprised 363 individuals and data were collected using a validated structured questionnaire. The outcome, self-rated health, was measured as a dichotomous variable (poor/good health) and fourteen social capital indicators were investigated (cognitive, behavioral and bonding/bridging). Data were analyzed using multivariate logistic regression. Cognitive (social support and trust), behavioral (civic participation) and bridging social capital were associated with good self-rated health after adjustment of all the other social capital indicators and confounders (sex, age, skin color and educational background).ConclusionsSocial capital was associated with self-rated health and the patterns of association differed according its specific dimensions. Cognitive, behavioral and bridging social capitals were protective for adolescents health living in a developing country context..

Aging, Gender and Quality of Life (AGEQOL) study: factors associated with good quality of life in older Brazilian community-dwelling adults

BackgroundIn Brazil, a rapidly aging country suffering from large inequalities, the study of the quality of life (QOL) of aged people is important for the future health. The aim of this study was to examine the associations among QOL, gender, and physical and psychosocial health in older Brazilian community-dwelling adults to identify factors that are associated with better QOL.MethodsThe “Aging, Gender and Quality of Life (AGEQOL)” study, which included 2,052 respondents aged 60 or older, was conducted in Sete Lagoas, Brazil between January and July 2012. The respondents answered questions regarding their socioeconomic and demographic information, health and social situations, cognitive impairment, depressive symptoms and family satisfaction. The authors also applied the Brazilian version the World Health Organization Quality of Life QOL Assessment-Brief Instrument (WHOQOL-BREF) and the World Health Organization Quality of Life Instrument-Older Adults Module (WHOQOL-Old). Ordinal logistic regression with the Proportional-Odds and Logit function was used to test the association between QOL and physical and psychosocial health according to age and socioeconomic status.ResultsOlder adults of both genders with five or more years of education, good self-rated health, an absence of depressive symptoms, and no family dysfunction reported better QOL. Retired men had a better QOL compared to non-retired men (OR = 2.2; 95% CI = 1.4–3.2), but this association was not observed in females. Men living in mixed arrangements (OR = 0.5; p = 0.033) and women who did not practice physical activity (OR = 0.7; p = 0.022) tended to have poorer QOL.ConclusionsWe conclude that there are gender differences related to better QOL in this sample. Women with good physical and psychosocial health are more likely to have a better QOL. For men, the best QOL was associated with high socioeconomic conditions and good physical and psychosocial health.

Psychosocial work conditions and quality of life among primary health care employees: a cross sectional study

BackgroundWorkers in Primary Health Care are often exposed to stressful conditions at work. This study investigated the association between adverse psychosocial work conditions and poor quality of life among Primary Health Care workers.MethodsThis cross-sectional study included all 797 Primary Health Care workers of a medium-sized city, Brazil: doctors, nurses, nursing technicians and nursing assistants, dentists, oral health technicians, and auxiliary oral hygienists, and community health workers. Data were collected by interviews. Quality of life was assessed using the WHOQOL-BREF; general quality of life, as well as the physical, psychological, social and environmental domains were considered, with scores from 0 to 100. Higher scores indicate a better quality of life. Poor quality of life was defined by the lowest quartiles of the WHOQOL score distributions for each of the domains. Adverse psychosocial work conditions were investigated by the Effort-Reward Imbalance model. Associations were verified using multiple logistic regression.ResultsPoor quality of life was observed in 117 (15.4%) workers. Workers with imbalanced effort-reward (high effort/low reward) had an increased probability of general poor quality of life (OR = 1.91; 1.07–3.42), and in the physical (OR = 1.62; 1.02–2.66), and environmental (OR = 2.39; 1.37–4.16) domains; those with low effort/low reward demonstrated a greater probability of poor quality of life in the social domain (OR = 1.82; 1.00–3.30). Workers with overcommitment at work had an increased likelihood of poor quality of life in the physical (OR = 1.55, 1.06–2.26) and environmental (OR = 1.69; 1.08–2.65) domains. These associations were independent of individual characteristics, job characteristics, lifestyle, perception of general health, or psychological and biological functions.ConclusionsThere is an association between adverse psychosocial work conditions and poor quality of life among Primary Health Care workers.ResumoIntroduçãoOs trabalhadores da Atenção Primária à Saúde estão frequentemente expostos a estresse no trabalho. Esse estudo avaliou a associação entre condições estressantes no trabalho e qualidade de vida ruim entre trabalhadores da Atenção Primária à Saúde, Minas Gerais, Brasil.MétodosTrata-se de um estudo transversal analítico, que incluiu os 797 trabalhadores da Atenção Primária à Saúde. A qualidade de vida foi medida pelo WHOQOL-bref; considerou-se a questão de ordem geral e os domínios físico, psicológico, social e ambiente, com escores de 0 a 100, quanto maior o escore melhor a qualidade de vida. Os trabalhadores foram considerados com qualidade de vida ruim quando apresentaram escores no menor quartil de cada um dos domínios. O modelo Effort-reward Imbalance foi empregado para avaliação de condições estressantes no trabalho; composto pelo componente extrínseco (esforço e recompensa) e intrínseco (comprometimento excessivo no trabalho). As associações foram verificadas por meio de regressão logística múltipla.ResultadosQualidade de vida ruim foi observada em 15.4% dos trabalhadores. Trabalhadores com desequilíbrio esforço/recompensa (alto esforço/baixa recompensa) apresentaram maior chance de qualidade de vida ruim geral (OR = 1.91; 1.07-3.42), nos domínios físico (OR = 1.62; 1.02-2.66) e ambiente (OR = 2.39; 1.37-4.16); aqueles com baixo esforço/baixa recompensa apresentaram maior chance de qualidade de vida ruim no domínio social (OR = 1.82; 1.00-3.30). Trabalhadores com alto comprometimento no trabalho apresentaram maior chance de qualidade de vida ruim nos domínios físico (OR = 1.55; 1.06-2.26) e ambiente (OR = 1.69; 1.08-2.65). Essas associações foram independentes de características individuais, relacionadas ao trabalho, do estilo de vida, da percepção de saúde geral, das funções psicológica e biológica.ConclusõesHá uma associação entre estresse no trabalho e a qualidade de vida entre os trabalhadores da Atenção Primária à Saúde.

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.OBJETIVO: Descrever a distribuicao de edentulismo e estimar a prevalencia de denticao funcional e arco dentario reduzido entre idosos. METODOS: Estudo epidemiologico populacional com 5.349 individuos de 65 a 74 anos do banco de dados do inquerito nacional de saude bucal do Ministerio da Saude/Coordenacao Nacional de Saude Bucal em 2002 e 2003. Foram avaliados perda dentaria; cumprimento a meta da Organizacao Mundial da Saude para a faixa etaria (50% com pelo menos 20 dentes); presenca de arco dental reduzido, numero de pares em oclusao posterior; sexo e macro-regiao da residencia. O teste qui-quadrado avaliou a associacao entre variaveis categoricas. Os testes Kruskal-Wallis e Mann-Whitney foram usados para determinar diferencas do numero medio de pares de dentes posteriores em oclusao, macro-regiao e sexo. RESULTADOS: Os idosos tinham, em media, 5,49 dentes (DP = 7,93) (mediana = 0). A porcentagem de individuos totalmente edentulos foi de 54,7%. O edentulismo foi de 18,2% no arco superior e 1,9% no inferior. A meta da Organizacao Mundial da Saude foi alcancada por 10% dos individuos; no entanto, 2,7% tinham a funcao mastigatoria e estetica aceitaveis (com pelo menos o arco dental reduzido). Entre esses, o numero medio de pares de oclusao posterior foi 6,94 (DP = 2,97). A presenca de arco dental reduzido foi mais frequente entre homens, assim como o alcance da meta da Organizacao Mundial da Saude. Tambem se observaram diferencas quanto ao arco dental reduzido entre as macro-regioes. CONCLUSOES: O levantamento epidemiologico de saude bucal brasileira apresentou alto percentual de edentulismo e baixo de arco dental reduzido, sugerindo o comprometimento funcional e estetico consideravel em todas as regioes do Pais, especialmente entre mulheres.

Factors associated to endemic dental fluorosis in Brazilian rural communities.

The present paper examines the relationship between hydrochemical characteristics and endemic dental fluorosis, controlling for variables with information on an individual level. An epidemiological survey was carried out in seven rural communities in two municipalities in the state of Minas Gerais, Brazil. The Thystrup & Fejerskov index was employed by a single examiner for the diagnosis of dental fluorosis. A sampling campaign of deep groundwater in the rural communities of interest was carried out concomitantly to the epidemiological survey for the determination of physiochemical parameters. Multilevel modeling of 276 individuals from seven rural communities was achieved using the non-linear logit link function. Parameters were estimated using the restricted maximum likelihood method. Analysis was carried out considering two response variables: presence (TF 1 to 9) or absence (TF = 0) of any degree of dental fluorosis; and presence (TF ≥ 5—with loss of enamel structure) or absence of severe dental fluorosis (TF ≤ 4—with no loss of enamel structure). Hydrogeological analyses revealed that dental fluorosis is influenced by the concentration of fluoride (OR = 2.59 CI95% 1.07–6.27; p = 0.073) and bicarbonate (OR = 1.02 CI95% 1.01–1.03; p = 0.060) in the water of deep wells. No other variable was associated with this prevalence (p > 0.05). More severe dental fluorosis (TF ≥ 5) was only associated with age group (p < 0.05). No other variable was associated to the severe dental fluorosis (p > 0.05). Dental fluorosis was found to be highly prevalent and severe. A chemical element besides fluoride was found to be associated (p > 0.05) to the prevalence of dental fluorosis, although this last finding should be interpreted with caution due to its p value.

A integralidade da atenção em diabéticos com doença periodontal

The aim of this study was to evaluate the periodontal conditions of individuals with diabetes and to analyze how SUS has contributed to the health attention of these people in Belo Horizonte, Minas Gerais State. For that, a sample of 300 individuals was selected and interviews with diabetics and health unit managers were conducted. From those, 55% presented gingivitis, 35.3% periodontitis and 9.7% were healthy. As for the integral attention for diabetics in SUS, it was observed that despite the fact that most of them were under medical supervision, only 27.3% were under dental treatment in basic health care units, 3.6% had specialized dental care and only 3.4% were seen by other health workers. Interdisciplinary care and attention in all levels of the system are essential factors for the integrality of health actions.

Gender differences in predictors of self-rated health among older adults in Brazil and Chile

BackgroundThe determinants of self-rated health (SRH) have been widely investigated to explain social differences and gender differences in health. This study aimed to investigate the gender differences in predictors of SRH among Brazilian and Chilean older adults.MethodsWe used two samples of older people: 2052 Brazilian community-dwelling participants (1226 women and 862 men) and 1301 Chilean community-dwelling participants (855 women and 446 men). Sequential logistic regression analysis was used to examine the relationships between SRH and potential predictors in a hierarchical model.ResultsOverall, 35.5% and 52.1% of individuals in Chile and Brazil, respectively, reported good SRH. There was a gradient association between good SRH and chronic diseases in both countries. Chilean men without chronic disease or with one had a higher chance of good SRH, compared to two or more diseases. For Brazilian men, no or one chronic disease was associated with good SRH. For women, the set of independent predictors for good SRH included no chronic diseases or one chronic disease, and no activities of daily living limitation. For men, the set also included instrumental activities limitation. For Brazilian adults of both genders, depression demonstrated the strongest independent association with good SRH.ConclusionsWe conclude that when examining gender differences in predictors of SRH, the similarities are greater than the differences between Brazilian and Chilean older adults. In both countries, physical health was the most important predictor of SRH. In addition, absence of depression was the strongest predictor of good health in older Brazilian adults.