Felipe Fagundes Soares

Características do acesso e utilização de serviços odontológicos em municípios de médio porte

Este estudo de corte transversal descreve as principais caracteristicas de acesso e utilizacao de servicos odontologicos basicos e especializados em dois municipios de medio porte da Bahia com 100% de cobertura da Estrategia de Saude da Familia. Realizou-se um inquerito com 2.539 individuos de idade acima de 15 anos em 952 domicilios. As principais variaveis analisadas foram a necessidade de saude bucal percebida, a procura pelo servico, a barreira de acesso organizacional e o tipo de servico e o procedimento utilizado. A utilizacao de servicos publicos odontologicos especializados foi de 11,7% e basicos de 26%. No municipio com maior utilizacao de servicos publicos odontologicos, foi menor o uso de servicos privados. A principal barreira de acesso situou-se na AP (Atencao Primaria), entre 5,0% e 15,2%. Observou-se pouca interface da atencao secundaria com a AP ja que apenas 16,6% dos usuarios retornaram a esse nivel de atencao. Pode-se concluir que a principal barreira de acesso, em municipios com realidades organizacionais e geograficas especificas parece se situar na AP. Acoes preventivas individuais foram pouco relatadas. Recomenda-se a reducao de barreiras de acesso na AP, bem como a instituicao de um protocolo que estimule a longitudinalidade do cuidado nesse nivel.

Local government and public dental health services: an analysis of inequality in use

The aim of this study was to identify factors associated with the use of primary and specialized public dental health services and private services. A population-based household survey was conducted in two cities of Bahia State, Brazil. Key informants provided data on socioeconomic variables and use of dental health services. Organization of the local public dental health service was ranked as worse versus better. Univariate and multivariate polytomous logistic regression was performed. Of the total of 1,290 individuals, 38.76% used private services, 33.80% used public primary care, and 17.29% used both primary care and the Center for Dental Specialties. Less use of both primary care and specialized public services was associated with lower education (OR = 1.47; 95%CI: 1.03-2.10) and worse organization of services (OR = 1.74; 95%CI: 1.22-2.48), when compared to the exclusive use of primary care. The study showed inequality in the use of dental services, even when comparing more homogeneous groups, namely users of public services.

Maternal risk behavior and caries incidence in children with sickle cell disease

The aim of this study was to analyze the incidence of caries, in relation to maternal risk behaviors and clinical conditions representing different levels of sickle cell disease severity. A total of 295 children aged 6 to 60 months participated in this cohort conducted from August 2007 to December 2008. They were diagnosed and monitored by the referral service of the state. Interviews were made with families to identify sociodemographic variables, and an oral exam was performed to determine dental caries. The SRQ (Self Report Questionnaire) scale was used to diagnose the presence of common mental disorders, and the CAGE (Cut down, Annoyed, Guilty and Eye opener) was applied to determine abusive use of alcohol. The absolute and relative frequencies of the variables of interest were analyzed by Chi-square and Mann-Whitney, with a 5% significance level. The incidence variables were analyzed according to the logistic regression model, with a confidence interval of 95%. Caries incidence (1.98; SD = 4.68) was higher in the HbSS genotype. There was a statistically significant association between caries incidence and both abusive use of alcohol (32.43%, RR = 1.99; 1.05-3.78; 95%CI) and common mental disorders (8.77% RR = 0.37; 0.15-0.93; 95%CI). There was also an association between caries incidence and maternal risk behavior, indicating that the care network should be expanded to include patients with sickle cell disease.