Paulo Sávio Angeiras de Góes

Aspectos metodológicos do Projeto SBBrasil 2010 de interesse para inquéritos nacionais de saúde

The SBBrasil 2010 Project (SBB10) was designed as a nationwide oral health epidemiological survey within a health surveillance strategy. This article discusses methodological aspects of the SBB10 Project that can potentially help expand and develop knowledge in the health field. This was a nationwide survey with stratified multi-stage cluster sampling. The sample domains were 27 State capitals and 150 rural municipalities (counties) from the countrys five major geographic regions. The sampling units were census tracts and households for the State capitals and municipalities, census tracts, and households for the rural areas. Thirty census tracts were selected in the State capitals and 30 municipalities in the countryside. The precision considered the demographic domains grouped by density of the overall population and the internal variability of oral health indices. The study evaluated dental caries, periodontal disease, malocclusion, fluorosis, tooth loss, and dental trauma in five age groups (5, 12, 15-19, 35-44, and 65-74 years).

Validation of the Portuguese version of the RDC/TMD Axis II questionnaire

The present paper aimed at evaluating the validity of the Portuguese version of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis II Questionnaire. The sample was comprised of 155 patients with signs and symptoms of Temporomandibular Disorders (TMD), evaluated at the Orofacial Pain Control Center, School of Dentistry, University of Pernambuco, Brazil, between July 2003 and February 2004. Data collection was performed with the following tools: the RDC/TMD Axis I (clinical evaluation and TMD classification), and Axis II (psychosocial evaluation), as well as specific questionnaires for evaluation of Oral Health Related Quality of Life, namely, Oral Impacts on Daily Performances and the Oral Health Impact Profile-14, considered to be gold standard criteria. Validity evaluation consisted of internal consistency evaluation by the Cronbach alfa reliability test, reliability and reproducibility estimated by the Kappa test and the Spearmans correlation, and concurring validation through Spearmans correlation. The Portuguese version of the RDC/TMD Axis II questionnaire was considered consistent (Cronbach alfa = 0.72), reproducible (Kappa values from 0.73 to 0.91, p < 0.01), and valid (p < 0.01). It was concluded that this version showed valid and reproducible results for the Brazilian population, thus paving the way for including Brazil in transcultural epidemiological studies on TMD.

Avaliação da atenção secundária em saúde bucal: uma investigação nos centros de especialidades do Brasil

This article discusses the evaluation of secondary care in the area of health surveillance. This was a descriptive and normative/evaluative study. Performance analysis drew on secondary data, based on a historical series of dental procedures conducted at the specialized dental clinics implemented in Brazil and recorded by the Outpatient Information System of the Unified National Health System (SIA/SUS) in 2007, as well as primary data from site visits to the clinics, based on questionnaires completed by clinic staff. Performance of the clinics was poor in most regions of the country, and the North of Brazil had the lowest percentage of specialty services implemented. The indicator Performance of Secondary Care in Oral Health was 64.4%. The type 3 specialty clinics showed better results in terms of performance and achievement of targets. The study showed the need to review the legal framework for implementing specialized dental clinics by adjusting the criteria and norms, as well as definition of new standards for achievement of goals in the evaluation and monitoring of these services.

Validation of the multimedia version of the RDC/TMD axis II questionnaire in Portuguese

Objective The aim of the study was to validate the multimedia version of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis II Questionnaire in Portuguese language. Material and methods The sample comprised 30 patients with signs and symptoms of temporomandibular disorders (TMD), evaluated at the Orofacial Pain Control Center of the Dental School of the University of Pernambuco, Brazil, between April and June 2006. Data collection was performed using the following instruments: Simplified Anamnestic Index (SAI) and RDC/TMD Axis II written version and multimedia version. The validation process consisted of analyzing the internal consistency of the scales. Concurrent and convergent validity were evaluated by the Spearman’s rank correlation. In addition, test and analysis of reproducibility by the Kappa weighted statistical test and Spearman´s rank correlation test were performed. Results The multimedia version of the RDC/TMD Axis II questionnaire in Portuguese was considered consistent (Crombrach alpha = 0.94), reproducible (Spearman 0.670 to 0.913, p<0.01) and valid (p<0.01). Conclusion The questionnaire showed valid and reproducible results, and represents an instrument of practical application in epidemiological studies of TMD in the Brazilian population

Epidemiological profile of emergency care for dental and oral injuries in Brazil, 2006-2007

Injuries resulting from accidents and violence occupy a key place in the current epidemiological scenario. The head and face are one of the main sites of lesions from external causes, especially dental and oral injuries. This article aims to present the epidemiological profile of emergency care for dental and oral lesions from external causes. The study used data from the Surveillance System for Violence and Accidents (VIVA) for the years 2006 and 2007. There were a total of 106,075 emergency visits involving external causes, of which 939 (~1%) presented dental and oral lesions. There were a majority or large proportions of males (65.5%), children < 10 years (44.3%), black individuals (66%), and individuals with low schooling (45.9%). High proportions of the injuries occurred at home (48.3%) or on public byways (30%). Frequent characteristics were cuts or puncture wounds (63.3%) and lesions resulting from falls (43%), traffic accidents (19.9%), and physical assault (13%).

Persistência de hábitos de sucção não nutritiva: prevalência e fatores associados

OBJECTIVES: to identify the prevalence of nonnutritive sucking habits in preschoolers and verify factors associated with persistent habit. METHODS: a cross-sectional analytical study conducted in 17 public educational units of Recife/PE through questionnaire with 524 preschooler guardians. Dependent (digital and pacifier sucking) and independent variables, related to the children (sex, age, breastfeeding, bottle feeding, nocturnal enuresis, school period, caregiver, birth order, dentist visit) and to their mothers (schooling, age, familiar income, outside work, work shift, cohabitation, habits guidance), were associated by Pearson´s chi-square test, Fisher´s Exact test and Poisson´s regression. RESULTS: prevalence of nonnutritive sucking habits was 57%; 47,5% pacifier sucking, 5,7% digital sucking and 3,8% of both habits. After odds ratio adjustment, in a multivariate analysis, variables: breastfeeding and bottle feeding duration remained associated with pacifier sucking, while others variables as mother education, bottle feeding, and children´s age and sex were statistically significant with digital sucking. CONCLUSIONS: nonnutritive sucking habits showed high prevalence, being pacifier sucking most prevalent. Factors related to breastfeeding pattern (bottle feeding and breastfeeding duration) were explanatory factors to the habits persistence and psychosocial factors had relevant association.

Impact of breathing patterns on the quality of life of 9- to 10-year-old schoolchildren.

Background Mouth breathing can cause a set of changes in craniofacial growth and development, with esthetic, functional, and psychological repercussions. Objective To determine the impact of mouth breathing on the quality of life of schoolchildren. Methods A school-based, cross-sectional study was conducted with 1911 children ages 9 and 10 years in the city of Recife, Brazil. The children answered the Mouth Breather Quality of Life questionnaire and a questionnaire that addressed sociodemographic data and health-related aspects. Clinical examinations were performed by an examiner who had undergone a training and calibration process for the diagnosis of mouth breathing (kappa = 0.90). Descriptive statistics were conducted to characterize the sample. Statistical analysis involved the Students t-test and the F test (analysis of variance) (alpha = 5%). Results The prevalence of mouth breathing was 54.81%. Children with oral breathing demonstrated a poorer quality of life in comparison with children with nasal breathing (p < 0.001). The following variables were significantly associated with a poorer quality of life among the children with mouth breathing: a younger age (p < 0.001) and the use of medication (p = 0.002). Conclusion Based on the present findings, children with the mouth-breathing pattern experience a greater negative impact on quality of life in comparison with those with the nose-breathing pattern. Thus, the early diagnosis and treatment of this clinical condition are fundamental to minimizing the consequences of mouth breathing on the quality of life of schoolchildren with respiration disorders.

Development of a questionnaire for measuring health-related quality of life among children and adolescents with mouth breathing.

Background Mouth breathing can exert an influence on quality of life and should be evaluated within a multidimensional context. However, there is no specific questionnaire to measure the impact of mouth breathing on quality of life. Objective To develop and validate a questionnaire for measuring the impact of mouth breathing on quality of life among children and adolescents. Methods Thirty-six items were evaluated by six health care professionals, one parent and one child with mouth breathing. After a qualitative evaluation, a modified set of 32 items was developed. The modified Mouth Breather Quality of Life (MBQoL) questionnaire was submitted to a pretest with a sample of 30 children and adolescents diagnosed with mouth breathing to evaluate comprehension, the order of the items, and the form of administration. The MBQoL questionnaire was then administered to 60 children and adolescents (30 mouth breathers and 30 nose breathers) for the evaluation of construct validity, internal consistency, and reproducibility. All the participants answered the questionnaire, and 50% of each group answered the questionnaire a second time after a 1-week interval (test-retest). Results Higher MBQoL scores (which indicated poorer quality of life) were significantly associated with mouth breathing. The Cronbach a coefficient for the items of the questionnaire was 0.88, and the Spearman correlation coefficient for test-retest reliability demonstrated that the questionnaire was reproducible (r = 0.993; p < 0.01). Conclusion Through this validation study, the MBQoL questionnaire demonstrated a good performance in the evaluation of the quality of life of children and adolescents with mouth breathing and may be a useful tool in clinical studies as well as public health programs. However, further studies are needed to establish its applicability in other populations with respiration disorders.BACKGROUNDnMouth breathing can exert an influence on quality of life and should be evaluated within a multidimensional context. However, there is no specific questionnaire to measure the impact of mouth breathing on quality of life.nnnOBJECTIVEnTo develop and validate a questionnaire for measuring the impact of mouth breathing on quality of life among children and adolescents.nnnMETHODSnThirty-six items were evaluated by six health care professionals, one parent and one child with mouth breathing. After a qualitative evaluation, a modified set of 32 items was developed. The modified Mouth Breather Quality of Life (MBQoL) questionnaire was submitted to a pretest with a sample of 30 children and adolescents diagnosed with mouth breathing to evaluate comprehension, the order of the items, and the form of administration. The MBQoL questionnaire was then administered to 60 children and adolescents (30 mouth breathers and 30 nose breathers) for the evaluation of construct validity, internal consistency, and reproducibility. All the participants answered the questionnaire, and 50% of each group answered the questionnaire a second time after a 1-week interval (test-retest).nnnRESULTSnHigher MBQoL scores (which indicated poorer quality of life) were significantly associated with mouth breathing. The Cronbach α coefficient for the items of the questionnaire was 0.88, and the Spearman correlation coefficient for test-retest reliability demonstrated that the questionnaire was reproducible (r = 0.993; p < 0.01).nnnCONCLUSIONnThrough this validation study, the MBQoL questionnaire demonstrated a good performance in the evaluation of the quality of life of children and adolescents with mouth breathing and may be a useful tool in clinical studies as well as public health programs. However, further studies are needed to establish its applicability in other populations with respiration disorders.

Vigilância à saúde bucal: a construção de um modelo integrado

Although Brazil has a tradition of conducting nationwide epidemiological surveys such as the oral health surveys in 1986, 1996, and 2003, it was only in 2006 that the country created a specific policy for including oral health surveillance as a crucial component of both the National Oral Health Policy (PNSB) and the Ministry of Health’s overall health surveillance policy. In this context, it is imperative to establish a theoretical framework based on the field of surveillance and to determine the interfaces for building an oral health surveillance model, integrated with the prevailing health surveillance policy. Based on the essentially chronic nature of most oral health diseases, the model should attempt to integrate the various approaches. The first step is to adopt a surveillance model for chronic diseases, necessarily from the oral health perspective. This requires adopting new ways of measuring oral lesions and sequelae not only physically, but also in terms of their impact on quality of life. The new model should also focus on common risk factors, representing the principal information needed by countries, regions, and local health authorities for planning health promotion and primary prevention. This approach should also be considered in the construction of a future oral health information system. The surveillance system for chronic non-communicable diseases includes: (a) mapping trends and analyzing social, economic, behavioral, and political determinants to back health promotion policies and strategies; (b) reducing the level of individual and population exposure to the most common risk factors; (c) strengthening the health system for patient management; and (d) strengthening the respective local, regional, national, and international networks and partnerships. In December 2006, under Ministry Health Ruling SAS/MS 939/2006, Brazil created a national committee with various functions, including, in Article 4, advising the Oral Health Division of the Ministry in setting guidelines and strategies for oral health surveillance, based on epidemiological characteristics and organization of health services at the National, State, and Municipal levels, and proposing criteria for data validation in the information systems under the Unified National Health System (SUS), as well as strategies for institutionalization of monitoring and surveillance in oral health. Due to the relevance of chronic non-transmissible diseases as part of the epidemiological profile of the Brazilian population, the Ministry of Health, through the Health Surveillance Secretariat, has formed various partnerships between academic research institutions, States, and Municipalities to develop overall surveys for monitoring risk and protective factors and health problems and conditions. This Supplement discusses some of these surveys (e.g. VIGITEL, VIVA, and PENSE) that have already included issues related to oral health, besides the specific survey on the oral health conditions of the Brazilian population (SB-2010), highlighting the importance of consolidating the current initiative to structure the oral health surveillance component of the PNSB by extending this action to the State and Municipal levels. Oral health surveillance: building an integrated model

Relações contratuais e perfil dos cirurgiões-dentistas em centros de especialidades odontológicas de baixo e alto desempenho no Brasil

Introducao: No Brasil, a partir da decada de 1990, quando foram implementadas novas modalidades contratuais flexiveis na administracao publica, tem se destacado o debate sobre as relacoes de trabalho. Esse movimento de mudancas tem repercutido no sistema publico de saude pela tendencia a instabilidade dos vinculos laborais e a desprotecao social. Objetivo: Investigar o perfil profissional de cirurgioes-dentistas dos centros de especialidades odontologicas e analisar a natureza das relacoes de trabalho em vigor nos contratos firmados entre esses profissionais e os municipios. Metodologia:O estudo, de natureza exploratoria, foi realizado a partir de entrevistas semiestruturadas com 289 profissionais alocados em 59 centros de especialidades odontologicas das 5 macrorregioes do pais, selecionados entre os 10% com melhor e pior desempenho na producao de procedimentos. Resultados:Entre os profissionais investigados, a maioria era do sexo feminino (55,0%). Quanto a qualificacao profissional, 72,7% do total dos entrevistados afirmaram ter cursado ou estar cursando pos-graduacao no momento da entrevista. A presenca de vinculos precarios e a instabilidade laboral sobressaem nas entrevistas, o que evidencia algumas distincoes entre as macrorregioes do pais. Conclusoes:Ao ressaltar o debate sobre o conceito de trabalho precario, os autores reafirmam que essa condicao se faz presente no espaco da Politica Nacional de Saude Bucal implementada por estados e municipios.