Grasiela Piuvezam

A dor e a perda dentária: representações sociais do cuidado à saúde bucal

The objective of this study was identify the social representations of the oral care on daily activities to understand how the common sense works with the oral health, we realized the research with Brazilian northeast people. Thirty residents of Cidade da Esperanca District, Natal, RN, Brazil were analyzed. The data was obtained from a semi-structured interview. The interviews were analyzed by Technique of Content Analysis (Bardin1) as well as by Alceste 4.5 software. The categories were Toothache and Tooth Loss. The Toothache shows how the public health service is restrict. The Tooth Loss shows how the dentistry practice resolved the toothache, and how the prosthetics is limited by the social condition. The Social Representations of the oral care on daily activities show the negative consequences of the dentistry practice and the necessity of the new paradigm to the organization of the public health service taking into consideration the common sense about the oral care on daily activities.

Self-perceived oral health status in institutionalized elderly in Brazil.

This study aims to identify self-perceived oral health status in institutionalized elderly in Brazil, using the Geriatric Oral Health Assessment Index (GOHAI) and to seek associations with objective and subjective conditions and behavior related to oral health, individual traits, and environmental factors. A cross-sectional study using census with institutionalized elderly in Brazil. A total of 1192 individuals were evaluated, and 587 (49.2%) responded to the GOHAI. A questionnaire and an epidemiological survey were applied. The Mann-Whitney, Kruskal-Wallis, Fishers exact, chi-square, and multiple logistic regression tests were performed. Mean age was 74.98 ± 9.5 years, 51.4% (302) were male. The mean DMFT-index (DMFT=decayed, missing, filled teeth) was 28.8 ± 5.5 and 54.5% (320) of the elderly were toothless. Categorized GOHAI showed that 75% (440) of the individuals had positive self-perception of oral health status. Multiple logistic regression demonstrated that the last visit to the dentist (adjusted prevalence ratio=PR=4.058; confidence interval=CI=1.526-10.789), presence of gingival problems (adjusted PR=5.703; CI=1.754-18.544), and self-rating of teeth, gums, or prosthesis (adjusted PR=19.514; CI=5.075-75.041) remained significant in the model. Predominance of positive self-perception of oral health status was observed despite poor oral conditions. Thus, for the institutionalized population, the present study recommends epidemiological and self-perception surveys to ensure adequate planning of oral health strategies.

Factors associated with missing teeth in the Brazilian elderly institutionalised population

OBJECTIVE Identify factors associated with missing teeth in the elderly institutionalised population in Brazil. METHODOLOGY Cross-sectional study of elderly institutionalised Brazilians with 1192 subjects. A questionnaire was applied as well as an epidemiological survey of oral health conditions in accordance with WHO. Factorial analysis was carried out with variables related to missing teeth, as well as the Fishers exact test, chi-squared test and multiple logistic regression. RESULTS Mean age was 76.3 (± 9.8), 53.5% (638) of subjects were women and 717 (60.2) were dependent. Mean of Decayed Missing and Filled Teeth Index (DMFT index) was 29.4 (± 4.9). The subjects that did not use upper and lower dentures were 61.5% (732) and 79.2% (944), respectively. Median number of missing teeth per person was 27.88 (± 6.8) with a mean of 4 (± 6.6) teeth present and 2.4 (± 4.5) caries-free teeth. Factors associated with missing teeth following multivariate analysis were: age, sex, self-assessment of oral health, access to health services, type of institution and area of the country. CONCLUSIONS High level of tooth loss and low level of rehabilitation demonstrate precarious oral health. It is therefore necessary to improve institutional access mechanisms to public health facilities for the institutionalised elderly.

Mortality from Cardiovascular Diseases in the Elderly: Comparative Analysis of Two Five-year Periods.

Background Cardiovascular diseases are the leading cause of death in Brazil. The better understanding of the spatial and temporal distribution of mortality from cardiovascular diseases in the Brazilian elderly population is essential to support more appropriate health actions for each region of the country. Objective To describe and to compare geospatially the rates of mortality from cardiovascular disease in elderly individuals living in Brazil by gender in two 5-year periods: 1996 to 2000 and 2006 to 2010. Methods This is an ecological study, for which rates of mortality were obtained from DATASUS and the population rates from the Brazilian Institute of Geography and Statistics (Instituto Brasileiro de Geografia e Estatística). An average mortality rate for cardiovascular disease in elderly by gender was calculated for each period. The spatial autocorrelation was evaluated by TerraView 4.2.0 through global Moran index and the formation of clusters by the index of local Moran-LISA. Results There was an increase, in the second 5-year period, in the mortality rates in the Northeast and North regions, parallel to a decrease in the South, South-East and Midwest regions. Moreover, there was the formation of clusters with high mortality rates in the second period in Roraima among females, and in Ceará, Pernambuco and Roraima among males. Conclusion The increase in mortality rates in the North and Northeast regions is probably related to the changing profile of mortality and improvement in the quality of information, a result of the increase in surveillance and health care measures in these regions.

Equivalência semântica, conceitual e de itens do Observable Indicators of Nursing Home Care Quality Instrument

Long-term care facilities (LTCFs) for the elderly are an important health care alternative in the world, though Brazil does not yet have a valid instrument to monitor the quality of these institutions. This study sought to describe the initial stages of the cross-cultural adaptation of the Observable Indicators of Nursing Home Care Quality (OIQ) instrument used to assess the quality of care in LTCFs. Conceptual equivalence was conducted to assess the relevance and feasibility of the OIQ within the Brazilian context, using the Content Validity Index (CVI). The operational, idiomatic and semantic equivalence was then performed. This item consisted of 5 phases: (1) two translations; (2) the respective back translations; (3) formal appraisal; (4) review; and (5) application of the pre-test in three LTCFs. Significant changes were made to ensure the validity of the OIQ. The CVI instrument for the Brazilian contextwas 94.3% (viability) and 95.3% (relevance). The OIQ proved to be easy to understand and apply in the pre-test. Cross-cultural adaptation of the OIQ contributes to assessing and improving quality in Brazilian LTCFs, though the findings should be complemented by a psychometric evaluation of the instrument.

A qualitative study analyzing access to physical rehabilitation for traffic accident victims with severe disability in Brazil

Abstract Purpose To identify access barriers to physical rehabilitation for traffic accident (TA) victims with severe disability and build a theoretical model to provide guidance towards the improvement of these services. Methods Qualitative research carried out in the city of Natal (Northeast Brazil), with semi-structured interviews with 120 subjects (19 key informer health professionals and 101 TA victims) identified in a database made available by the emergency hospital. The interviews were analyzed using Alceste software, version 4.9. Results The main barriers present in the interviews were: (1) related to services: bureaucratic administrative practises, low offer of rehabilitation services, insufficient information on rehabilitation, lack of guidelines that integrate hospital and ambulatory care and (2) related to patients: financial difficulties, functional limitations, geographic distance, little information on health, association with low education levels and disbelief in the system and in rehabilitation. Conclusion The numerous access barriers were presented in a theoretical model with causes related to organizational structure, processes of care, professionals and patients. This model must be tested by health policy-makers and managers to improve the quality of physical rehabilitation and avoid unnecessary prolongation of the suffering and disability experienced by TA survivors. Implications for rehabilitation Traffic accidents (TAs) are a global health dilemma that demands integrality of preventive actions, pre-hospital and hospital care and physical rehabilitation (PR). This study lays the foundation for improving access to PR for TA survivors, an issue of quality of care that results in preventable disabilities. The words of the patients interviewed reveal the suffering of victims, which is often invisible to society and given low priority by health policies that relegate PR to a second plan ahead of prevention and urgent care. A theoretical model of the causes of the problem of access to PR was built. The identified barriers are potentially preventable through the intervention of health policy-makers, managers, regulators and rehabilitation professionals, and by encouraging the participation of patients. Addressing timely access barriers involves the expansion of the supply of services and rehabilitation professionals, regulation and standardization of referencing practises and encouraging the provision of information to patients about continuity of care and their health needs.

Estudo Comparativo do Perfil de Saúde Bucal em Idosos Institucionalizados no Brasil e em Barcelona, Espanha

1 Universidade do Estado do Rio Grande do Norte, Departamento de Odontologia. Caicó, Rio Grande do Norte, Brasil. 2 Agència de Salut Pública de Barcelona. Centro de Investigación Biomédica en Red (CIBER) Epidemiología y Salud Pública (CIBERESP). Barcelona, Espanha. 3 Centro de Investigación Biomédica en Red (CIBER) Epidemiología y Salud Pública (CIBERESP). Agència de Salut Pública de Barcelona, Espanha. 4 Universitdade do Chile, Facultdade de Odontologia. Santiago, Chile. Agència de Salut Pública de Barcelona. Barcelona, Espanha. 5 Universidade Federal do Rio Grande do Norte (UFRN), Departamento de Saúde Coletiva. Natal, Rio Grande do Norte, Brasil.Objective: To compare the oral health profile of institutionalized elderly persons in Brazil and in Barcelona, Spain, by gender and country of residence. Methods: A cross-sectional study was performed of individuals aged 65 years and above (n=1,440), resident in the health region of Barcelona and in Brazil. Two surveys and exams relating to the oral health status of institutionalized elderly persons in Brazil (in 2008) and in Barcelona, Spain (in 2009) were carried out. Periodontal disease, tooth loss and dental caries were analyzed, considering age and cognitive ability. The sample was stratified by gender and country. Bivariate and multivariate Robust Poisson Regression models were used to obtain adjusted Prevalence Ratios (aPR), and a 95% confidence interval (95%CI) was employed. Results: In Barcelona, men and women had a higher prevalence of periodontal illness: Men - calculus (aPR:1.5; CI:1.08-2.19) and pocket (aPR:2.05; CI:1.43-2.93) results. Women - calculus (aPR:2.4; CI:1.77-3.24) and pocket (aPR:3.2; CI:2.29-4.53) results. In Barcelona there was a lower prevalence of edentulism (aPR:0.49; CI:0.37-0.65) and functional edentulism (aPR:0.49; CI:0.40-0.60) among men. The same results were found among women with a lower prevalence of edentulism (aPR:0.49; CI: 0.41-0.58) and functional edentulism (aPR:0.42; CI: 0.30-0.49). Conclusions: A poor state of oral health of men and women was observed in both countries, with the elderly from Barcelona having worse periodontal health and the elderly from Brazil having greater tooth loss.

Multidimensional Assessment Of Institutionalized Elderly: The Reality Of A Brazilian Institution

Background: The population aging in Brazil is characterized by the accumulation of progressive disabilities in their functional activities and daily life. To consider the elderlies in his/her multiple dimensions turns out to be a critical issue to improvetheir assistance to an institu-tionalized level, improving their health and quality of life. To perform a mini-overall evaluation of institutionalized elderly person to trace their profile in relation to the socio-demographic, functional capacity, nutritional status and cognition. Methods: Descriptive study, with a cross-sectional design and quan-titative approach performed in a long - stay institution for the elderly in Natal, RN. The research was approved by the Research Ethics Com-mittee of the Federal University of Rio Grande do Norte, under opinion number 164/2011.Results: 63.3% of the elderly were female, with ages varying from 61 to 103 years. 60.0% were single; 56.7% were literate. 66.7% had no children and 55% lived with their families before the institutio-nalization. As for the institutionalization time, 63.3% resided in the institution for four years. As what concerns the aspects of health, 73.3% of the elderly presented hearing difficulties, 90% make use of medicines predominantly to diabetes and hypertension. There is clear evidence that the institutionalization has been harmful to the elderly as with regards basic activities of daily living, nutritional status and cognitive aspects. Conclusion: The progressive disability in functional activities of daily life interferes directly in the quality of life, increasing dependency and minimizing the autonomy of these individuals. It is necessary to effec-tive implementation of public policies directed to the institutionalized elderly from the perspective of effective actions for improved attention and assistance.

Fatores associados ao custo das internações hospitalares por doenças infecciosas em idosos em hospital de referência na cidade do Natal, Rio Grande do Norte

This study examined the factors associated with direct cost of hospitalizations for infectious diseases in the elderly. We conducted a case study of the costs of hospitalization in elderly patients with 60 or more years admitted in a reference hospital in the city of Natal, state of Rio Grande do Norte, during the period from January 2005 to December 2009. The Multiple Linear Regression model (log-linear) was applied to analyze the factors associated with hospitalization costs. The results of the regression model showed that each additional day of hospitalization determined a 3% increase in average spending and admissions of elderly who died produced a 71.6% increase in costs relative to admissions of patients discharged.