Karine Laura Cortellazzi

Avaliação dos fatores de risco para distúrbios de voz em professores e análise acústica vocal como instrumento de avaliação epidemiológica

OBJETIVO: avaliar fatores de risco para disfonia em professores e associa-los compresenca de alteracao vocal. METODO: 102 professores(81 mulheres e 21 homens) selecionados aleatoriamente de 11 escolas do municipio de Piracicaba/SP, com media de idade de 42,48 anos. Um questionario sobre aspectos do ambiente e organizacao do trabalho, comportamento vocal, estilo de vida e sinais e sintomas de alteracoes vocais foi aplicado.Uma analise acustica da voz foi realizada e as variaveis avaliadas dependentes foram Frequencia Fundamental e a Intensidade media vocal. Foram realizadas associacoes entre as variaveis do questionario com a frequencia fundamental e a intensidade media e utilizaram-se os testes estatisticos: Qui-quadrado, Exato de Fisher e calculo do OddsRatio e este e um estudo clinico prospectivo. RESULTADOS: os individuos do sexo masculino tiveram menos chance de apresentarem frequencia fundamental da voz alterada do que o genero feminino (p<0,0001). As professoras que lecionavam para o ensino fundamental II e medio tiveram menos chance de apresentar alteracao da frequencia fundamental da voz do que aquelas que lecionavam para o ensino fundamental (p=0,04). O ruido ambiente teve associacao significante com a alteracao da intensidade media da voz (p=0,02). CONCLUSAO: fatores como o sexo feminino lecionar para o ensino primario e estar exposto ao ruido do ambiente de trabalho foram considerados indicadores de risco para disturbios da voz em professores.

Influência de variáveis socioeconômicas, clínicas e demográfica na experiência de cárie dentária em pré-escolares de Piracicaba, SP

OBJETIVO: Avaliar a influencia de variaveis socioeconomicas, clinicas e demografica na experiencia de carie em pre-escolares de 5 anos de idade da cidade de Piracicaba. METODOLOGIA: A amostra consistiu de 728 criancas matriculadas em 22 pre-escolas publicas (n = 428) e 18 pre-escolas privadas (n = 300). A carie dentaria foi avaliada pelos indices ceo-d e ceo-s e pela deteccao de lesao inicial (LI). Outras variaveis clinicas como gengivite, apinhamento, espacamento, fluorose e respiracao bucal tambem foram coletadas. As variaveis socioeconomicas (renda familiar mensal, numero de residentes na mesma casa, escolaridade do pai e da mae, habitacao e posse de automovel) foram obtidas por meio de um questionario semi-estruturado enviado aos pais. RESULTADOS: As medias (desvio-padrao) do ceo-d e ceo-s foram de 1,30 (2,47) e 3,08 (7,55), respectivamente, sendo que 62,2% da amostra estava livre de carie. As medias (desvio-padrao) do ceo-d+LI e ceo-s+LI foram 1,72 (3,36) e 3,45 (7,94), respectivamente e 59,7% estavam livres de caries. Por meio da analise de regressao logistica multipla, as criancas com fluorose (Odds Ratio-OR=0,40) ou de familias com renda superior a 4 salarios minimos (OR = 0,49) apresentaram menor probabilidade de ter experiencia de carie. Aquelas com gengivite (OR = 1,87) tiveram maior chance de ter a doenca. Para o criterio de diagnostico de carie com a inclusao de LI, as criancas com fluorose (OR = 0,39) ou de familias com renda superior a 4 salarios minimos (OR = 0,52) tiveram menor chance de ter carie. Aquelas com gengivite (OR=1,80), apinhamento (OR = 2,63 e OR = 1,01) ou respiracao bucal (OR = 1,37) apresentaram maior probabilidade de ter a doenca. CONCLUSAO: Os pre-escolares que apresentaram gengivite, apinhamento, respiracao bucal ou renda familiar mensal inferior a 4 salarios minimos tiveram maior probabilidade de ter experiencia de carie. Assim, o planejamento de acoes de prevencao e intervencao direcionadas a este publico seria essencial para o controle da doenca.

Geographic Information Systems (GIS) in Assessing Dental Health

The present study investigated the distribution profile of dental caries and its association with areas of social deprivation at the individual and contextual level. The cluster sample consisted of 1,002 12-year-old schoolchildren from Piracicaba, SP, Brazil. The DMFT Index was used for dental caries and the Care Index was used to determine access to dental services. On the individual level, variables were associated with a better oral status. On the contextual level, areas were not associated with oral status. However, maps enabled determining that the central districts have better social and oral conditions than the deprived outlying districts.

Estimate of DMFT index using teeth most affected by dental caries in twelve-year-old children

The objective of the study was to develop regression models to describe the epidemiological profile of dental caries in 12-year-old children in an area of low prevalence of caries. Two distinct random probabilistic samples of schoolchildren (n=1,763) attending public and private schools in Piracicaba, Southeastern Brazil, were studied. Regression models were estimated as a function of the most affected teeth using data collected in 2005 and were validated using a 2001 database. The mean (SD) DMFT index was 1.7 (2.08) in 2001 and the regression equations estimated a DMFT index of 1.67 (1.98), which corresponds to 98.2% of the DMFT index in 2001. The study provided detailed data on the caries profile in 12-year-old children by using an updated analytical approach. Regression models can be an accurate and feasible method that can provide valuable information for the planning and evaluation of oral health services.O objetivo do estudo foi desenvolver modelos de regressao para delinear o perfil epidemiologico da carie dentaria em localidade com baixa prevalencia de carie aos 12 anos de idade. Foram examinadas duas amostras probabilisticas (n=1.763) de individuos de escolas publicas e privadas de Piracicaba,(SP). Dados sobre os dentes mais afetados foram coletados em 2005 e validados utilizando um banco de dados (2001). A media (dp) do CPOD foi de 1,7 (2,08) em 2001 e os modelos de regressao desenvolvidos estimaram um CPOD de 1,67 (1,98) em 2005, o qual representa 98,2% do CPOD em 2001. Os resultados apresentaram detalhes do perfil da carie dentaria aos 12 anos, usando uma abordagem analitica atual. Os modelos de regressao poderiam ser considerados como uma forma acurada e factivel no auxilio do planejamento e avaliacao dos servicos em saude bucal.

Individual and contextual factors related to dental caries in underprivileged Brazilian adolescents

BackgroundInvestigate the individual and contextual variables related to caries in underprivileged adolescents, and the disparity in distribution of the disease.MethodsCross-sectional analytical study, conducted in the city of Piracicaba, SP, Brazil, in 2012. The probabilistic sample was composed of 1,179 adolescents from 15–19 years of age, randomly selected from 21 state schools and 34 Primary Health Units – Family Health (PHU-FH). The dependent variables studied were number of decayed teeth and caries experience (DMFT). The independent variables were classified into individual (clinical, sociodemographic, psychosocial, self-perception, impact on oral health, access to services, and quality of life) and contextual (social exclusion index, total number of residents in suburb, literacy rate, and the following variables given in percentages: residences in the home ownership category, provision of domestic sewerage, trash collection, families with income of over 1 minimum wage per month, and families without monthly income) variables. The multilevel regression model was estimated by the PROC GLIMMIX (Generalized Linear Models-Mixed) procedure, considering the individual variables as Level 1 and the contextual variables of the suburbs as Level 2. Adjustment of the model was evaluated by -2 Res Log Likelihood with α = 0.05.ResultsAs regards the individual variables, adolescents who declared having a prison inmate in the Family and resided in homes with a larger number of persons, showed a higher number of decayed teeth. There were a larger number of decayed teeth, a higher DMFT value, and worse self-perception as regards the health of their teeth and mouth. Other variables, such as being of the female gender, age and time since last visit to the dentist were related to the DMFT index. As regards the contextual variables, the DMFT was lower in suburbs with greater access to domestic sewage, and the number of decayed teeth was higher in suburbs with the worst social exclusion indices.ConclusionIndividual and contextual variables were associated with the presence of caries and DMFT index in underprivileged adolescents, indicating that they must be taken into consideration in the formulation of policies directed towards oral health promotion and prevention activities in this group.

Informações da atenção secundária em Odontologia para avaliação dos modelos de atenção à saúde

Introduction: secondary care may reflect the care-solving capacity of primary care, considering the principle of integrality and the construction of health care networks in the Unique System of Heatlh (USH), supporting the organization of activities and oral health services in the context of medium complexity. Objective: to evaluate models of primary care in oral health in the municipality of Marilia / SP using information related to secondary care in dentistry, according to the principle of integrity. Methodology: This is a retrospective study with a randomly selected sample of 6 Basic Health Units (BHU), characterized by the traditional model of care, and 11 Family Health Units (FHU) working with the perspective of the Family Health Model. Secondary data were collected in two places: a) Department of Evaluation, Control and Auditing, which reported the number of referrals scheduled for specialties, and b) Center for Dental Specialties (CDS) that pointed out the number of missing patients in the initial consultation and the number of patients who abandoned specialized treatment. The Department of Oral Health Coordination reported unmet demand specialty endodontics. CDS operation from 2007 to 2009 was considered for collecting data. We conducted exploratory data analysis, and Student t and Mann-Whitney tests were performed. Result: The highest number of referrals for endodontics was coming from BHU. The percentage of absense in the initial consultation, treatment dropout and care-solving capacity in the specialty showed no statistical difference in relation to the organizational model of primary care. Conclusion: We conclude that results from both organizational models are similar, except for endodontic indication for endodontic treatment, suggesting future studies, analysis of other variables mainly related to the user.

Individual and contextual factors associated with malocclusion in Brazilian children

OBJECTIVE To assess the association between the prevalence of malocclusion in Brazilian 12 years-olds with individual and contextual variables. METHODS A cross-sectional, analytical study was conducted with data from the Brazilian Oral Health Survey - SBBrazil 2010. The outcome studied was malocclusion, categorized as absent, set, severe and very severe. The independent variables were classified as individual and contextual. Data were analyzed using a multilevel model with a 5% significance level. RESULTS It was found that the prevalence of severe and very severe malocclusion in 12-year-olds did not differ between the Brazilian regions, although variation between the cities was significant (p < 0.001). Male children (p = 0.033), those on lower income (p = 0.051), those who had visited a dentist (p = 0.009), with lower levels of satisfaction with mouth and teeth (p < 0.001) and embarrassed to smile (p < 0.001) had more severe malocclusion. The characteristics of the cities also affected the severity of malocclusion; cities with more families on social benefits per 1,000 inhabitants, with lower scores on the health care system performance index and lower gross domestic product per capita were significantly associated with malocclusion. CONCLUSION Significant associations between the presence and severity of malocclusion were observed at the individual and contextual level.OBJETIVO: Avaliar a associacao entre a prevalencia de ma oclusao em criancas aos 12 anos de idade com variaveis individuais e contextuais. METODOS: Foi realizado um estudo transversal analitico com dados da Pesquisa Nacional de Saude Bucal – SBBrasil 2010. O desfecho estudado foi a ma oclusao, categorizada em ausente, definida, severa e muito severa. As variaveis independentes foram classificadas em individuais e contextuais. Os dados foram analisados por meio de modelo multinivel, considerando nivel de 5% de significância. RESULTADOS: A prevalencia de ma oclusao severa e muito severa nas criancas com 12 anos de idade nao diferiu entre as regioes brasileiras, mas sim entre as cidades (p < 0,001). Criancas do sexo masculino (p = 0,033), de menor renda (p = 0,051), que consultaram o dentista (p = 0,009), com menor satisfacao com a boca e os dentes (p < 0,001) e com vergonha de sorrir (p < 0,001) apresentaram ma oclusao de maior gravidade. As caracteristicas das cidades tambem afetaram a gravidade da ma oclusao; cidades com mais familias com beneficio social por 1.000 habitantes, com menores notas do indice de desempenho do sistema de saude e menor renda per capita foram estatisticamente associadas com a ma oclusao. CONCLUSOES: Associacoes significativas entre a presenca e gravidade da ma oclusao foram observadas em nivel individual e contextual.

Fatores individuais e contextuais associados à má oclusão em crianças brasileiras

OBJECTIVE To assess the association between the prevalence of malocclusion in Brazilian 12 years-olds with individual and contextual variables. METHODS A cross-sectional, analytical study was conducted with data from the Brazilian Oral Health Survey - SBBrazil 2010. The outcome studied was malocclusion, categorized as absent, set, severe and very severe. The independent variables were classified as individual and contextual. Data were analyzed using a multilevel model with a 5% significance level. RESULTS It was found that the prevalence of severe and very severe malocclusion in 12-year-olds did not differ between the Brazilian regions, although variation between the cities was significant (p < 0.001). Male children (p = 0.033), those on lower income (p = 0.051), those who had visited a dentist (p = 0.009), with lower levels of satisfaction with mouth and teeth (p < 0.001) and embarrassed to smile (p < 0.001) had more severe malocclusion. The characteristics of the cities also affected the severity of malocclusion; cities with more families on social benefits per 1,000 inhabitants, with lower scores on the health care system performance index and lower gross domestic product per capita were significantly associated with malocclusion. CONCLUSION Significant associations between the presence and severity of malocclusion were observed at the individual and contextual level.OBJETIVO: Avaliar a associacao entre a prevalencia de ma oclusao em criancas aos 12 anos de idade com variaveis individuais e contextuais. METODOS: Foi realizado um estudo transversal analitico com dados da Pesquisa Nacional de Saude Bucal – SBBrasil 2010. O desfecho estudado foi a ma oclusao, categorizada em ausente, definida, severa e muito severa. As variaveis independentes foram classificadas em individuais e contextuais. Os dados foram analisados por meio de modelo multinivel, considerando nivel de 5% de significância. RESULTADOS: A prevalencia de ma oclusao severa e muito severa nas criancas com 12 anos de idade nao diferiu entre as regioes brasileiras, mas sim entre as cidades (p < 0,001). Criancas do sexo masculino (p = 0,033), de menor renda (p = 0,051), que consultaram o dentista (p = 0,009), com menor satisfacao com a boca e os dentes (p < 0,001) e com vergonha de sorrir (p < 0,001) apresentaram ma oclusao de maior gravidade. As caracteristicas das cidades tambem afetaram a gravidade da ma oclusao; cidades com mais familias com beneficio social por 1.000 habitantes, com menores notas do indice de desempenho do sistema de saude e menor renda per capita foram estatisticamente associadas com a ma oclusao. CONCLUSOES: Associacoes significativas entre a presenca e gravidade da ma oclusao foram observadas em nivel individual e contextual.

Variables associated with the performance of Centers for Dental Specialties in Brazil

The aim of this study was to evaluate the performance of the Centers for Dental Specialties (CDS) in the country and associations with sociodemographic indicators of the municipalities, structural variables of services and primary health care organization in the years 2004-2009. The study used secondary data from procedures performed in the CDS to the specialties of periodontics, endodontics, surgery and primary care. Bivariate analysis by χ2 test was used to test the association between the dependent variable (performance of the CDS) with the independents. Then, Poisson regression analysis was performed. With regard to the overall achievement of targets, it was observed that the majority of CDS (69.25%) performance was considered poor/regular. The independent factors associated with poor/regular performance of CDS were: municipalities belonging to the Northeast, South and Southeast regions, with lower Human Development Index (HDI), lower population density, and reduced time to deployment. HDI and population density are important for the performance of the CDS in Brazil. Similarly, the peculiarities related to less populated areas as well as regional location and time of service implementation CDS should be taken into account in the planning of these services.

Variáveis de impacto na queda da mortalidade infantil no Estado de São Paulo, Brasil, no período de 1998 a 2008

This is an ecological, analytical and retrospective study comprising the 645 municipalities in the State of Sao Paulo, the scope of which was to determine the relationship between socioeconomic, demographic variables and the model of care in relation to infant mortality rates in the period from 1998 to 2008. The ratio of average annual change for each indicator per stratum coverage was calculated. Infant mortality was analyzed according to the model for repeated measures over time, adjusted for the following correction variables: the citys population, proportion of Family Health Programs (PSFs) deployed, proportion of Growth Acceleration Programs (PACs) deployed, per capita GDP and SPSRI (Sao Paulo social responsibility index). The analysis was performed by generalized linear models, considering the gamma distribution. Multiple comparisons were performed with the likelihood ratio with chi-square approximate distribution, considering a significance level of 5%. There was a decrease in infant mortality over the years (p 0.05). The proportion of PSFs deployed (p < 0.0001) and per capita GDP (p < 0.0001) were significant in the model. The decline of infant mortality in this period was influenced by the growth of per capita GDP and PSFs.This is an ecological, analytical and retrospective study comprising the 645 municipalities in the State of São Paulo, the scope of which was to determine the relationship between socioeconomic, demographic variables and the model of care in relation to infant mortality rates in the period from 1998 to 2008. The ratio of average annual change for each indicator per stratum coverage was calculated. Infant mortality was analyzed according to the model for repeated measures over time, adjusted for the following correction variables: the citys population, proportion of Family Health Programs (PSFs) deployed, proportion of Growth Acceleration Programs (PACs) deployed, per capita GDP and SPSRI (São Paulo social responsibility index). The analysis was performed by generalized linear models, considering the gamma distribution. Multiple comparisons were performed with the likelihood ratio with chi-square approximate distribution, considering a significance level of 5%. There was a decrease in infant mortality over the years (p < 0.05), with no significant difference from 2004 to 2008 (p > 0.05). The proportion of PSFs deployed (p < 0.0001) and per capita GDP (p < 0.0001) were significant in the model. The decline of infant mortality in this period was influenced by the growth of per capita GDP and PSFs.