Exclusive breastfeeding intention among pregnant women and associated variables: a cross-sectional study in a Brazilian community / Intenção de amamentar entre gestantes e variáveis associadas: estudo transversal em uma comunidade brasileira

ABSTRACT Objective: To investigate exclusive breastfeeding (EBF) intention and associated variables among women in the third trimester of pregnancy. Methods: The data were collected with a questionnaire for the pregnant women (n=653), from December/2018 to November/2019. They answered the Infant Feeding Intentions (IFI) scale, translated and adapted to Brazilian Portuguese, and a questionnaire on sociodemographic, biological, family, pregnancy, breastfeeding, health care, and habits variables. Descriptive statistics and multiple logistic regression analyses were performed with a 5% significance level, following a multilevel hierarchical model that estimated the association between the dependent and independent variables. The outcome EBF intention measured by the IFI score was dichotomized by the median (<16 or =16). Results: Mean±standard deviation score for the IFI scale was 14.4±2.6 (score 0: very strong intention to not breastfeed at all; score 16: very strong EBF intention up to six months). The results from the regression analysis showed that pregnant women who had no intention to bottle feed (OR=4.33; 95%CI 2.79-6.72) or did not know (OR=1.85; 95%CI 1.21-2.82), those who planned the pregnancy (OR=1.52; 95%CI 1.09-2.12), those who believed they would have help to care for the baby (OR=3.60; 95%CI 1.51-8.56) or did not know (OR=3.97; 95%CI 1.26-12.51), and those who reported knowing the World Health Organization recommendations on breastfeeding (OR=1.73; 95%CI 1.13-2.64) were more likely to show a very strong EBF intention. Conclusions: Pregnant women in the third trimester of pregnancy presented a strong EBF intention. The higher EBF intention score was significantly associated with the structural, setting, and individual determinants.

RESUMO Objetivo: Investigar a intenção materna de amamentar exclusivamente (IMA) e variáveis associadas entre as mulheres no terceiro trimestre de gravidez. Métodos: A coleta de dados foi realizada por meio de entrevista e questionário semiestruturado e autoadministrado, entre dezembro/2018 e novembro/2019. As gestantes (n=653) responderam à escala Infant Feeding Intentions (IFI) testada, traduzida e adaptada para o português do Brasil e ao questionário contendo perguntas sobre variáveis sociodemográficas, biológicas e familiares, bem como relacionadas à gestação, ao aleitamento materno, à assistência à saúde e a hábitos. Foram realizadas análises estatísticas descritivas e de regressão logística múltipla hierarquizada, com nível de significância de 5%, para estimar a associação entre as variáveis independentes e o desfecho. A IMA, medida pela escala IFI, foi dicotomizada pela mediana (<16 ou =16). Resultados: A pontuação média±desvio padrão para a escala IFI foi de 14,4±2,6. Os resultados da análise de regressão mostraram que as gestantes que não tinham intenção de oferecer mamadeira (OR=4,33; IC95% 2,79-6,72) ou não sabiam (OR=1,85; IC95% 1,21-2,82), que planejaram a gestação (OR=1,52; IC95% 1,09-2,12), aquelas que acreditavam que teriam ajuda nos cuidados com o bebê (OR=3,60; IC95% 1,51-8,56) ou que não sabiam (OR=3,97; IC95% 1,26-12,51), bem como aquelas que relataram conhecer as recomendações da Organização Mundial de Saúde sobre amamentação (OR=1,73; IC95% 1.13-2.64) tinham mais chances de mostrar uma IMA muito forte. Conclusões: As gestantes no terceiro trimestre de gestação apresentaram forte IMA. A maior IMA esteve significativamente associada aos determinantes estruturais, contextuais e individuais.

Age and Type of Delivery as Risk Indicators for Maternal Mortality / Idade e tipo de parto como indicadores de risco para mortalidade materna

Abstract Objective: This study assessed maternal mortality (MM) and related factors in a large-sized municipality in the Southeastern region of Brazil (Campinas, São Paulo) during the period 2000-2015. Methods: This study consisted of two phases: 1. An analytical nested case-control phase that assessed the impact of individual and contextual variables on MM; and 2. an ecological phase designed to contextualize maternal deaths by means of spatial analysis. The case group consisted of all maternal deaths (n = 87) and the control group consisted of 348 women who gave birth during the same period. Data analysis included descriptive statistics, association, and multiple logistic regression (MLR) tests at p < 0.05 as well as spatial analysis. Results: Maternal Mortality Ratio was 37 deaths per 100.000 live births. Deaths were dispersed throughout the urban territory and no formation of cluster was observed. MLR showed that pregnant women aged > 35 years old (OR = 2.63) or those with cesarean delivery (OR = 2.51) were more prone to maternal death. Conclusion: Maternal deaths were distributed dispersedly among the different socioeconomic levels and more prone to occur among older women or those undergoing cesarean deliveries.

Resumo Objetivo: Esse estudo avaliou a mortalidade materna (MM) e fatores relacionados em um município de grande porte da região sudeste do Brasil (Campinas, São Paulo) no período de 2000-2015. Métodos: Esse estudo consistiu de duas fases: 1. Uma fase analítica de caso-controle que avaliou o impacto de variáveis individuais e contextuais na MM; 2. Uma fase ecológica delineada para contextualizar as mortes maternas por meio de análise espacial. O grupo caso consistiu de 87 mortes maternas e o grupo controle de 348 mulheres que tiveram bebês durante o mesmo período. Os dados foram analisados por estatística descritiva, testes de associação e regressão logística múltipla (RLM) (p < 0,05) assim como análise espacial. Resultados: A taxa de mortalidade materna foi de 37 mortes para cada 100.000 nascidos vivos. As mortes foram dispersas por todo o território urbano e não se observou formação de clusters. Na RLM observou-se que mulheres grávidas com idade > 35 anos (OR = 2,63) ou aquelas que passaram por cesárea (OR = 2,51) foram mais propensas à morte materna. Conclusão: As mortes maternas foram distribuídas dispersamente entre os diferentes níveis socioeconômicos e mais propensas a ocorrer entre mulheres > 35 anos de idade ou que passaram por cesárea.

A medicalização na prática de dentistas no SUS: um olhar qualitativo para os sentidos da prática / Dentistry medicalization at SUS: a qualitative practice-based perspective

Resumo Este artigo explora sentidos e significados do trabalho odontológico no SUS, no contexto da relação profissional-paciente. Pesquisa qualitativa com 20 cirurgiões-dentistas que atuavam em um município paulista de médio porte, abordada por meio de três grupos focais, com a pergunta disparadora "Qual é o sentido ou significado do seu trabalho, aqui na prefeitura, para você?". O material foi áudio-gravado, transcrito na íntegra e analisado pelo método de análise de conteúdo temática. Procedemos a realização de leitura flutuante, categorização e discussão dos achados junto aos pares de pesquisadores para validação final. Como resultados, aponta-se a construção das categorias 1) Estranheza às necessidades percebidas pelos pacientes e a consequente medicalização da vida, e 2) Poder e consumo como significados da prática. O trabalho do cirurgião dentista, nesse contexto, evidenciou as diferenças entre as necessidades percebidas pelo paciente e aquelas que o dentista considera. Além disso, revelou o poder que emana da assimetria entre paciente e profissional como dificultador da produção de autonomia do paciente. Tais significações parecem trazer sofrimento para esses profissionais no seu trabalho. Concluiu-se que há necessidade de reflexão sobre o trabalho em saúde como forma de se evitar sofrimento, e que a prática desses dentistas é carregada de sentidos e significados.

Abstract This study explores the senses and meanings attributed to dental work in the Brazilian National Health System (SUS) focusing on dentist-patient relations. A qualitative research was conducted with 20 dentists working in a medium-sized municipality in São Paulo, divided into three focus groups and asked the guiding question "What sense or meaning do you attribute to your work here in the city?" Data were audio-recorded, fully transcribed, and analyzed using thematic content analysis. Floating reading, categorization, and peer discussion of the findings were performed for the final validation, resulting in two categories: 1) Strangeness to patients' needs and the subsequent medicalization of life, and 2) Power and consumption as meanings of practice. In this context, the dental practices showed the differences between patients' needs and those considered relevant by dentists. It also showed the power imbalance between patients and professionals as a hindrance to patients' autonomy. Such meanings seem to cause suffering to these professionals. In conclusion, reflections on health work are paramount to avoid suffering and understand that the practice of these dentists bears many senses and meanings.

Assessment of quality of life and associated factors in nursing students / Avaliação da qualidade de vida e fatores associados em graduandos de Enfermagem

ABSTRACT Objective: To assess the quality of life of nursing undergraduate students and factors associated with socioeconomic variables and internship field. Methods: A cross-sectional study was conducted in an educational institution located in the northern region of the state of Ceará, Brazil, involving 309 nursing undergraduates from the 1st to the 10th semester. The WHOQOL-bref instrument was used to evaluate the quality of life. Each domain and total score of the instrument were considered as outcome variables. Results: 69.3% of the individuals were women, the mean age of the sample was 28 years, and 67.7% defined their quality of life as "good" or "very good." Undergraduates who consumed well water and those with lower income had a higher chance of presenting lower scores in the physical domain and environmental domain of quality of life, respectively (p < 0.05), and of having a lower total quality of life score. Conclusion: The students considered their quality of life to be good/very good, and sociodemographic factors influenced the lower quality of life score.

RESUMO Objetivo: Avaliar a qualidade de vida de graduandos de enfermagem e fatores associados a variáveis socioeconômicas e campo de estágio. Métodos: Estudo transversal realizado em uma instituição de ensino localizada na região norte do estado do Ceará, Brasil, envolvendo 309 graduandos de enfermagem do 1º ao 10º semestre. O instrumento WHOQOL-bref foi utilizado para avaliar a qualidade de vida. Cada domínio e escore total do instrumento foram considerados como variáveis de desfecho. Resultados: 69,3% dos indivíduos eram mulheres, a média de idade da amostra foi de 28 anos e 67,7% definiram sua qualidade de vida como "boa" ou "muito boa". Universitários que consumiam água de poço e aqueles com menor renda tiveram maior chance de apresentar menores escores no domínio físico e meio ambiente de qualidade de vida, respectivamente (p < 0,05), e de ter menor escore total de qualidade de vida. Conclusão: Os estudantes consideraram sua qualidade de vida boa/muito boa, e fatores sociodemográficos influenciaram o menor escore de qualidade de vida.

Longitudinal study for dental caries calibration of dentists unexperienced in epidemiological surveys

Abstract This study aimed to make a longitudinal analysis of interexaminer calibration reproducibility in diagnosing dental caries in posterior teeth, by examiners without previous experience in epidemiological studies. A group of 11 inexperienced examiners underwent theoretical-practical training and calibration assessments, assisted by a standard examiner. An examiner who did not participate directly in the research selected 5-year-old children with and without caries. The D3 diagnostic threshold was used to evaluate dental caries, based on the World Health Organization (WHO) criteria. The initial calibration (baseline) was performed after the theoretical-practical training session, and consisted of examining 20 children; the second calibration occurred three months later, and involved evaluating another 18 children. The interexaminer agreement was obtained by kappa statistics, and by overall percentage agreement. The paired t-test was applied to compare the values for kappa means and overall percentage agreement between the time points studied. At baseline, the values for kappa (> 0.81) and overall percentage agreement (> 95.63%) were considered high. At the 3-month calibration assessment, all the examiners showed some decrease in both kappa (p < 0.0001) and overall percentage agreement (p = 0.0102). The calibration process currently proposed by the WHO is effective. However, reproducibility was not maintained over time for inexperienced examiners evaluating the posterior teeth of 5-year-old children, under epidemiological conditions.

Factors associated with oral health literacy among users of primary health care: a cross-sectional study

Aim To analyze associations between sociodemographic factors, self-perception, self-care practices in health with Oral Health Literacy (OHL) levels among users of Primary Health Care (PHC). Methods A cross-sectional and analytical study was performed in Piracicaba (São Paulo), Brazil, in 2018, with a convenience sample of users of PHC that were aged over 18 years. Data were collected with a questionnaire by a trained dentist in two Family Health Units. The outcome variable was OHL, measured by the OHLA-B instrument, which was dichotomized by median into low (≤8 point) and high (>8 point). The independent variables were sociodemographic conditions (age, sex, self-declared skin color, and education), self-perceived oral health and self-care practices in health (tooth brushing frequency, smoking habits, reason for the last visit to the dentist, and source of health information search). Unadjusted and adjusted analyses were performed between OHL and independent variables for multiple logistic regression model (p≤0.05). Results The sample consisted of 450 adults. A total of 54.7% had a low OHL. After adjusting for sex and age, OHL was associated with skin color (OR=0.57; 95%CI=0.37-085), educational level (OR=4.92; 95%CI=3.16-7.79), health information from health professionals (OR=2.40; 95%CI=1.42-4.16) and internet (OR=2.88; 95%CI=1.59-5.32), toothbrushing >1 time a day (OR=3.23; 95%CI=1.27-9.92) and smokers (OR=0.42; 95%CI=0.23-0.73). After adjusting for sex, age and income, OHL was associated with (OR=0.63; 95%CI=0.41-096), educational level (OR=4.06; 95%CI=2.57-6.51) and smokers (OR=0.48; 95%CI=0.26-0.84). Conclusions Low OHL was associated with socioeconomic factors, source of information and smoking. This fact highlights the importance of health professionals to promote OHL.

Health literacy and self-efficacy associations with non-adherence to dental treatment among young adults

Abstract: The aim of this study was to investigate associations of health literacy (HL), general self-efficacy (GSE), and sociodemographic variables with non-adherence to dental treatment among Brazilian young adults. This is a cross-sectional study based on a cohort study of 248 young adults aged 19 to 25 years followed up in an earlier study. The participants completed the perceived general self-efficacy scale (GSE), a questionnaire on socioeconomic and demographic variables and were examined for oral conditions. HL was measured using the Brazilian version of the health literacy questionnaire (HLQ-Br), which provides nine individual scores based on an average of the items within each of the nine scales. Dental treatment adherence was evaluated as the decision of young adults to seek a dentist to finish the recommended restorative treatment for dental caries. The effects of HL domains on the adherence to dental treatment were analyzed by logistic regression and the effect was adjusted for sex, age, family income, paternal and maternal education, type of housing, and self-efficacy. The results of the adjusted analysis showed associations among young adults who did not adhere to dental treatment with lower self-efficacy levels, living in non-owner-occupied homes, and lower HL levels in almost all of the HL domains (p < 0.05). Only the HLQ6 domain "Ability to actively engage with healthcare providers" was not associated with the outcome (p>0.05). Adherence to dental treatment in primary care among young adults was associated with their general self-efficacy levels, socioeconomic characteristics, and individual's lower HL aspects.

Analysis of the prevalence in sugar consumption in child care consultations / Análise da prevalência do consumo de açúcar em consultas de puericultura

Abstract Objectives: to analyze the prevalence of sugar consumption and associated factors in childcare consultations. Methods: cross-sectional study with 599 children > six months to < 24 months of age, assisted by the Family Health Units. Outcomes: daily consumption of sweetened beverages, sweets/candies, recorded in the Food and Nutrition Surveillance System; independent variables: sociodemographic data. Multiple logistic regression test was applied. Results: 62.10% of the children consume sugary drinks and 42.23%, sweets/candies. Consuming sugary drinks was associated with the age of 12-17 months and 29 days (OR=2.525; CI95%=1.68-3.78) and 18-17 months and 29 days (OR=2.90; CI95%=1.90-4.43); children living with more than four people at home (OR=1.59; CI95%=1.11-2.26), aged 12-17 months and 29 days (OR=2.05; CI95%=1.34-3.13) and 18-23 months and 29 days (OR=2.51; CI95%=1.62-3.87) were more likely to consume sweets/candies than younger children. Maternal aspects, such as age (OR=0.66; CI95%=0.46-0.93), marital status (OR=1.67; CI95%=1.06-2.6), schooling (OR=2.14; CI95%=1.12-4.08), and presence of government assistance (OR=2.03; CI95%=1.41-2.93), were conditions associated with the consumption of sweets. Conclusions: the prevalence of sugar in children's diet was high and was associated with sociodemographic aspects. Health education actions should be carried out in childcare, in order to promote healthy food, minimizing the consumption of sugar.

Resumo Objetivos: analisar a prevalência do consumo de açúcar e fatores associados em consultas de puericultura. Métodos: estudo transversal com 599 crianças >seis a <24 meses de idade, assistidas por Unidades de Saúde da Família. Desfechos: consumo diário de bebidas adoçadas, doces/guloseimas, registrados no Sistema de Vigilância Alimentar e Nutricional; variáveis independentes: dados sociodemográficos. Aplicou-se teste de regressão logística múltipla. Resultados: 62,10% das crianças consomem bebidas açucaradas e 42,23% doces/guloseimas. Consumir bebidas açucaradas associou-se à idade de 12-17 meses e 29 dias (OR=2,525; IC95%=1,68-3,78) e 18-17 meses e 29 dias (OR=2,90; IC95%=1,90-4,43); crianças residirem com mais de quatro pessoas na casa (OR=1,59; IC95%:1,11-2,26), terem idade de 12-17 meses e 29 dias (OR=2,05; IC95%=1,34-3,13) e 18-23 meses e 29 dias (OR=2,51; IC95%=1,62-3,87) apresentaram maior chance de consumir doces/guloseimas que crianças mais novas. Aspectos maternos como idade (OR=0,66; IC95%=0,46-0,93), estado civil (OR=1,67; IC95%=1,06-2,6), escolaridade (OR=2,14; IC95%=1,12-4,08), e presença de auxílio do governo (OR=2,03;IC95%=1,41-2,93), foram condições associadas ao consumo de doces/guloseimas. Conclusão: foi alta a prevalência de açúcar na dieta das crianças e esteve associada a aspectos sociodemográficos. Ações de educação em saúde devem ser realizadas na puericultura, a fim de fomentar a alimentação saudável, minimizando o consumo de açúcar.

A cobertura da Atenção Básica interfere no controle da Tuberculose Pulmonar? / Does Primary Health Care coverage interfere with the control of Pulmonary Tuberculosis?

O objetivo deste estudo foi avaliar se a cobertura da Atenção Básica, em seus diferentes modelos de atenção, interferiu no número de casos notificados por tuberculose pulmonar, óbitos e cura da doença, no estado de São Paulo, no período de 2008 a 2016. Estudo do tipo ecológico, com dados secundários, analisados estatisticamente por Regressão de Poisson. Percebeu-se maior prevalência da doença em municípios com maior população, maior taxa de pobreza e menor cobertura de Estratégia de Saúde da Família. Verificou-se mais óbitos em municípios com maior população, melhores indicadores econômicos, menor cobertura de agentes comunitários e que possuem Atenção Básica do tipo tradicional. Maiores taxas de cura foram observadas nos municípios com piores indicadores econômicos e de desenvolvimento humano, com maiores coberturas de agentes comunitários e de Atenção Básica. Conclui-se que a cobertura de Atenção Básica, principalmente nos modelos de atenção que possuem Agentes Comunitários de Saúde, está associada a melhores indicadores de tuberculose pulmonar.

The objective of this study was to assess whether the Primary Health Care coverage, in different models, interfered with the number of reported cases of pulmonary tuberculosis, deaths and cure of the disease, in the state of São Paulo, from 2008 to 2016. This was an ecological study, with secondary data, statistically analyzed by Poisson regression. A higher prevalence of the disease was found in municipalities with a larger population, higher poverty rate and lower coverage of the Family Health Strategy. There were more deaths in municipalities with a larger population, better economic indicators, lower coverage of community health agents and with traditional Primary Health Care. Higher cure rates were observed in municipalities with worse economic and human development indicators, with higher coverage of community health agents and the Primary Health Care. The coverage of Primary Health Care, especially in models composed with community health agents, is associated with better indicators of pulmonary tuberculosis.

Quality of life and adherence to dental treatment in adolescents: a longitudinal analytical study

The study aimed to analyze the quality of life, oral health impact on daily activities and its association with adherence to dental treatment, and other factors, among vulnerable adolescents. It is a longitudinal analytical study performed with 15- to 19-year-old adolescents in the city of Piracicaba, São Paulo, from 2014 to 2015. The sample consisted of 476 adolescents referred for the treatment of caries and/or periodontal disease in family health units (initial phase). After 18 months, 325 individuals were assessed to investigate the dental treatment provided (final phase). The response variables considered in the final phase were the Quality of Life (WHOQOL-bref) and the Oral Impacts on Daily Performances (OIDP) questionnaires. The independent variables analyzed were sex, age, treatment adherence, and family cohesion and adaptability. A multiple regression model was used. The data on the physical (p<0.0001), social (p=0.0003), environmental (p<0.0001), and psychological (p<0.0001) domains of the WHOQOL collected in the initial phase had a positive relationship with the same domains assessed in the final phase. The WHOQOL data of the initial phase were associated with the WHOQOL data of the final phase (p=0.0341). The OIDP data of the initial phase were associated with the OIDP data of the final phase (p<0.0001). The OIDP of volunteers who did not adhere to dental treatment showed a higher impact (p=0.0234). The quality of life and impacts on daily performances of adolescents improved between the evaluation periods.

Caries experience in children under 5 years old in the Xingu indigenous park in Brazil

Aim: The present study sought to investigate dental caries experience and its association with sociodemographic, postnatal and breastfeeding variables in children in the agerange from 6 to 71 months of age, in the Xingu Indigenous Park, Mato Grosso, Brazil. Methods: This was an analytical cross-sectional study that used secondary data pertaining to 402 indigenous children of the Low, Middle and Eastern Xingu regions, who participated in the Oral Health Epidemiological Survey in 2013. The dependent variable was dental caries, dichotomized by the median (dmf-t≤1 and dmf-t>1). The data of independent variables were obtained by means of instruments of the Local Health Information System of the Xingu Indigenous Special Sanitary District (DSEI). Raw analyses were performed to test the association of the independent variables with the dependent variable. The variables were tested in the multiple logistic regression model. Results: The mean value of the dmf-t index was 2.60 and the prevalence of affected children was 51%. In the multiple analysis, only children older than 36 months (OR: 6.64; CI95%: 4.11 to 10.73) and those that were breastfed for a longer period of time (OR: 1.88; CI95%: 1.16 to 3.02) showed significant association with the dmf-t>1 index. Conclusion: Childhood dental caries among indigenous children was associated with age and breastfeeding prolonged for over 26 months, therefore, pointing out the need to offer dental follow-up care at earlier ages

Association of clinical, social and environmental variables with dental caries prevalence in adolescents from a Brazilian municipality supplied with fluoridated water / Associação de variáveis clínicas, sociais e ambientais sobre a cárie dentária em adolescentes de um município brasileiro com água fluoretada

Abstract Background Although a trend towards dental caries reduction has been observed, further investigations on its pattern and development are still needed. Objective To investigate the influence of clinical, social and environmental variables on dental caries prevalence in adolescents from a Brazilian municipality supplied with fluoridated water in 2018. Method This study was conducted with a non-probabilistic sample of 277 adolescents aged 12 years of public schools in Nova Friburgo, state of Rio de Janeiro, Brazil. Clinical examinations were carried out by calibrated examiners to assess caries, periodontal disease, and fluorosis according to criteria of the World Health Organization (WHO). Semi-structured questionnaires were applied to record socio-environmental information. Results Individuals living in regions supplied with fluoridated water below the minimum required levels (OR=3.60, p=0.0006), with low income (OR=1.90, p=0.0444), presence of gingivitis (OR=3.36; p=0.0016), and whose reason for visiting the dentist was dental treatment (OR=2.41; p=0.0203) were more likely to have dental caries. A significant reduction (p<0.0001) in dental caries indexes was observed between 2012 and 2018. Conclusion Fluoridation of public water supply at unsuitable levels, as well as other social and clinical variables can influence the caries pattern in adolescents.

Resumo Introdução A tendência de redução da cárie dentária tem sido constatada, apesar de maiores investigações sobre seu padrão e desenvolvimento serem ainda necessárias. Objetivo investigar a influência de variáveis clínicas, sociais e ambientais sobre a cárie em adolescentes de um município brasileiro com água fluoretada, no ano de 2018. Método Empregou-se uma amostra não probabilística de 277 adolescentes de 12 anos, de escolas públicas de Nova Friburgo, Rio de Janeiro, Brasil. Exames clínicos foram realizados por examinadores calibrados, para avaliação de cárie, doença periodontal e fluorose, sob critérios da Organização Mundial da Saúde (OMS). Questionários semiestruturados foram aplicados para coletar informações socioambientais. Resultados Indivíduos residentes em regiões com flúor na água em subdoses (OR=3,60, p=0,0006), e aqueles com baixa renda (OR =1,90, p=0,0444), com presença de gengivite (OR = 3,36; p = 0,0016) e cuja razão para a visita ao dentista foi para tratamento dentário (OR=2,41; 0,0203), apresentaram mais chances de terem cárie. Uma redução significativa (p<0,0001) nos índices de cárie foi observada entre 2012 (primeiro levantamento epidemiológico) e 2018. Conclusão A fluoretação das águas de abastecimento público, quando em níveis não adequados, assim como outras variáveis sociais e clínicas, podem influenciar o padrão de cárie nos adolescentes.

Repercussões da epidemia de COVID-19 nos atendimentos odontológicos de urgência do Sistema Único de Saúde em Piracicaba, 2020 / Repercusiones de la epidemia de COVID-19 en la atención odontológica de emergencia del Sistema Único de Salud en Piracicaba, Brasil, 2020 / Repercussions of the COVID-19 epidemic on Brazilian National Health System urgent dental care in Piracicaba, Brazil, 2020

Objetivo: Avaliar as repercussões da pandemia de COVID-19 nos procedimentos realizados por um serviço público odontológico de urgência (SPOU). Métodos: Estudo transversal, utilizando-se dados do SPOU de Piracicaba, SP, Brasil, relativos a dois períodos, anterior (fevereiro e março de 2020) e durante a pandemia (março e abril de 2020). Diferenças no perfil de atendimentos, entre os períodos pré-COVID-19 e COVID-19 selecionados, de acordo com sexo, idade e procedimentos odontológicos, foram analisadas pelo teste qui-quadrado de Pearson. Também foi calculado o tamanho do efeito Cramer's V. Resultados: Houve redução de 51% no número de atendimentos, entre o período anterior (n=824) e o período da pandemia de COVID-19 observado (n=404). O percentual de exodontias reduziu-se, de 14,7 para 8,9%, enquanto o de selamento provisório de cavidades aumentou de 22,9 para 33,2%, entre ambos períodos. Conclusão: A pandemia de COVID-19 repercutiu na quantidade e no padrão de procedimentos realizados pelo serviço odontológico de urgência do município.

Objetivo: Evaluar el impacto de la pandemia COVID-19 en los procedimientos realizados por un servicio de odontología pública de emergencia (SOPE). Métodos: Estudio transversal, utilizando datos del SOPE de Piracicaba, SP, Brasil, para los períodos anteriores (febrero y marzo 2020) y durante la pandemia (marzo y abril 2020). Las diferencias en el perfil de atención entre los períodos Pre-COVID-19 y COVID-19, según sexo, edad y procedimientos dentales, se analizaron mediante la prueba Chi-cuadrado de Pearson. También se calculó el tamaño del efecto de Cramer V. Resultados: Hubo una reducción del 51% en el número de visitas entre el período anterior (n=824) y el período de la pandemia de COVID-19 (n=404). El porcentaje de extracciones se redujo del 14,7% al 8,9%, mientras que el porcentaje de sellado provisional de cavidades aumentó del 22,9% al 33,2%, entre estos períodos. Conclusión: La pandemia de COVID-19 afectó la cantidad y patrón de procedimientos realizados en el servicio de odontología de emergencia de la ciudad.

Objective: To evaluate the repercussions of the COVID-19 pandemic on procedures performed by a public urgent dental care service (PUDS). Methods: This was a cross-sectional study, using data from the PUDS in Piracicaba, SP, Brazil, prior to the pandemic (February-March 2020) and during the pandemic (March-April 2020). Differences in the care profile between the pre-COVID-19 period and the COVID-19 period, according to sex, age and dental procedures were analyzed using Pearson's Chi-square test. Effect size was also measured using Cramer's V. Results: There was a 51% reduction in the number of visits between the pre-COVID-19 period (n=824) and the COVID-19 period (n=404). The percentage of extractions reduced from 14.7% to 8.9%, while the percentage of temporary cavity fillings increased from 22.9% to 33.2%, between the two periods. Conclusion: The COVID-19 pandemic had repercussions on the amount and pattern of procedures performed at the city's urgent dental care service.

Ultra-processed foods consumption among children and associated socioeconomic and demographic factors / Consumo de alimentos ultraprocessados por crianças e fatores socioeconômicos e demográficos associados

ABSTRACT Objective To evaluate the consumption of ultra-processed foods among children, and to investigate associations with socioeconomic and demographic factors. Methods An analytical cross-sectional study with 599 children aged 6 months to 2 years, and listed as users of Family Health Units, in a medium-size city. Mothers were approached at home by researchers and community health workers from the Family Health Units, for data collection. Two questionnaires were used: the socioeconomic and demographic questionnaire, and the form Sistema de Vigilância Alimentar e Nutricional of Ministério da Saúde do Brasil , for children aged 6 months to 2 years. Ultra-processed food consumption and socioeconomic and demographic factors were defined as dependent and independent variables, respectively. Multiple regression analysis with a significance level of 5% was used to test associations between ultra-processed food consumption and socioeconomic and demographic variables. Results Ultra-processed food consumption was associated with child age between 1 and 2 years (OR=3.89; 95%CI: 2.32-6.50 and OR=3.33; 95%CI: 2.00-5.56, respectively), number of people living in the same household (OR=1.94; 95%CI: 1.23-3.05), and recipients of government benefits (OR=1.88; 95%CI: 1.15-3.04). Conclusion Ultra-processed food consumption among children undergoing complementary feeding may be influenced by socioeconomic and demographic factors.

RESUMO Objetivo Avaliar a ingestão de alimentos ultraprocessados em crianças, e verificar se há associação com o contexto socioeconômico e demográfico. Métodos Trata-se de estudo analítico, do tipo transversal, com 599 crianças entre 6 meses e 2 anos de idade, cadastradas em Unidades de Saúde da Família, de um município de médio porte. Para a realização da coleta, as mães das crianças foram abordadas em seus domicílios pelas pesquisadoras e por um Agente Comunitário de Saúde da Unidade Saúde da Família e responderam dois questionários, o socioeconômico e demográfico e o marcador do Sistema de Vigilância Alimentar e Nutricional do Ministério da Saúde do Brasil para crianças entre 6 meses e 2 anos. A variável dependente do estudo foi a ingestão de alimentos ultraprocessados pela criança e as independentes foram as socioeconômicas e demográficas. Foi realizada análise de regressão múltipla, no nível de significância de 5%, para testar a associação entre a ingestão de alimentos ultraprocessados com as variáveis socioeconômicas e demográficas. Resultados A ingestão de ultraprocessados esteve associada com a idade da criança entre 1 e 2 anos (RC=3,89; IC95%: 2,32-6,50 e RC=3,33; IC95%: 2,00-5,56, respectivamente), com o número de pessoas que residiam na mesma casa (RC=1,94; IC95%: 1,23-3,05) e com as famílias que recebiam auxílio do governo (RC=1,88; IC95%: 1,15-3,04). Conclusão A ingestão de alimentos ultraprocessados por crianças no período da alimentação complementar pode ser influenciada por fatores socioeconômicos e demográficos.

The influence of the Brazilian school health program on the oral-health-related quality of life of adolescents

Abstract The aim of this study was to evaluate the influence of the Brazilian School Health Program (SHP) on dental clinical disorders such as caries, gingivitis, and dental trauma as well as on the oral-health-related quality of life (OHRQoL) of adolescents in Nova Friburgo, RJ, Brazil. The study consisted of a non-probabilistic (convenience) sample comprising 319 12-year-old adolescents, both participants and non-participants of the SHP, for at least two years. Socio-demographic and OHRQoL questionnaires (CPQ11-14, the Child Perceptions Questionnaire) were applied as well as clinical examinations for caries, periodontal disease, and dental trauma following the World Health Organization (WHO) criteria by calibrated researchers. Mann-Whitney, chi-square tests, and multiple logistic regression models were used for the data analysis. Statistically significant differences were observed between the groups covered and not covered by the SHP for gingivitis (p = 0.0373) and OHRQoL on the social welfare subscale (p = 0.0265) and total scale (p = 0.0449) of CPQ11-14. Multivariate analysis showed that female adolescents were 1.74 times more likely to present a lower OHRQoL (OR = 1.74, 95%IC = 1.10-2.77, p = 0.0183) than males. In addition, non-SHP subjects were 1.56 times more likely to have poor OHRQoL (OR = 1.56, 95%IC = 0.94-2.59, p = 0.0873) than program participants. In conclusion, SHP positively influenced the OHRQoL of adolescents. However, follow-up studies are needed to verify the continued effectiveness of this Brazilian SHP in improving the oral health levels and quality of life of adolescents.

Senso de coerência e fatores associados ao desempenho escolar de adolescentes / Sense of coherence and factors associated with school performance of adolescents

Resumo O desempenho escolar é um aspecto fundamental para o futuro sucesso profissional e social. O objetivo do presente estudo foi investigar os fatores associados ao desempenho escolar dos adolescentes, incluindo o Senso de Coerência (SOC) e o estado de saúde bucal. Foram incluídos, no estudo, 381 escolares entre 15 e 18 anos de idade da cidade de Campo Grande, Mato Grosso do Sul, Brasil. O desfecho foi o desempenho escolar avaliado por meio das notas finais das disciplinas de Português e Matemática em 2013. As variáveis independentes foram dados sociodemográficos, autopercepção de saúde bucal, uso de serviços odontológicos e Senso de Coerência, obtidos por um questionário autoaplicado. Além disso, avaliou-se o número de dentes cariados, perdidos e obturados (índice de CPO-D). Análises de regressão logística foram realizadas, com base em um modelo hierárquico. A idade média dos alunos foi de 16 anos; valor médio do CPO-D 4,1 e SOC 44,5. No ajuste final, os indivíduos do sexo masculino (p = 0,0021); aqueles com o maior número de pessoas que moravam em casa (p = 0,0021) e o SOC fraco (p = 0,0005) mostraram associação com o menor desempenho escolar. Em conclusão, o desempenho escolar é um fenômeno complexo, associado ao SOC e às características bucais.

Abstract School performance is a key aspect for future professional and social success. The objective of the present study was to investigate factors associated with adolescents' school performance including sense of coherence (SOC) and oral health status. Three hundred eighty one schoolchildren between 15 and 18 years of age from the city of Campo Grande, Mato Grosso do Sul, Brazil, participated in the study. The outcome variable was school performance, assessed through the final grades of the Portuguese and Mathematics disciplines in 2013. Independent variables were sociodemographic data, self-perception of oral health, use of dental services and sense of coherence, obtained through a self-applied questionnaire. In addition, in a clinical assessment, the number of decayed, missing and filled teeth (DMFT index) was evaluated. Logistic regression analyses were performed, based on a hierarchical model. The mean age of students was 16 years; mean DMFT value 4.1, and SOC 44.5. In the final adjustment, the male subjects (p = 0.0021); those with the largest number of people residing at home (p = 0.0021) and weak SOC (p = 0.0005) showed an association with poorer school performance. In conclusion, school performance is a complex phenomenon associated with SOC and oral characteristics.

Malocclusion and dental appearance in underprivileged Brazilian adolescents

Abstract Satisfaction with dental aesthetics is a subjective indicator used in epidemiological studies and is related to health behaviours. Little is known about the factors that influence this indicator, particularly among adolescents who live in a situation of social vulnerability. The aim of this study was to investigate the relationship between malocclusion and dental appearance in underprivileged Brazilian adolescents. This analytical cross-sectional study was conducted in Piracicaba, Brazil, and evaluated 884 adolescents from 13 to 19 years of age. The dependent variable was satisfaction with dental appearance, and the independent variables were classified as individual (components of the Dental Aesthetic Index - DAI, sex and age) and contextual (social exclusion index). For statistical analysis, multilevel regression models were estimated. The individual variables were considered Level 1, and the contextual variable was considered Level 2, with a level of significance of 5%. The mean age of the adolescents was 15.3 years. Female adolescents more frequently affirmed that they were satisfied with their dental appearance than did male individuals. There was an increase in dissatisfaction with oral health with the increase in anterior maxillary overjet, midline diastema, larger anterior irregularity in the maxilla, larger anterior irregularity in the mandible, anterior open bite and antero-posterior molar relation. Satisfaction with dental appearance was associated with individual factors such as sex and DAI components.

Qualidade de vida, coesão e adaptabilidade em famílias beneficiárias do Programa Bolsa Família / Quality of life, cohesion and adaptability in beneficiary families of the "Bolsa Família" Program

Resumo Avaliou-se a associação entre qualidade de vida, coesão familiar e fatores sociodemográficos de famílias beneficiárias do Programa Bolsa Família (PBF). Estudo transversal, analítico e de caráter exploratório com amostra representativa de 385 entrevistados. A variável dependente foi a qualidade de vida (WHOQOL-BREF), e as variáveis independentes quantificadas em características sociodemográficas, autopercepção sobre saúde, coesão e adaptabilidade familiar (FACES III). A melhor qualidade de vida associou-se com idade menor ou igual a 36 anos (OR = 2,15), maior nível educacional (OR = 1,54), boa/muito boa saúde (OR = 6,39), não ter problema de saúde atual (OR = 5,68), sem tratamento (OR = 1,76), moderada (OR = 3,39) e alta (OR = 3,66) coesão familiar e moderada adaptabilidade (OR = 2,23). Indivíduos provenientes de famílias com moderada e alta coesão familiar tiveram mais chance de ter uma melhor qualidade de vida do que aqueles vindos de famílias com baixa coesão. Os voluntários do sexo masculino tiveram 3,54 vezes mais chance de apresentar uma melhor qualidade de vida. Concluiu-se que níveis moderados e altos de coesão podem impactar positivamente uma melhor qualidade de vida das pessoas beneficiárias do PBF, indicando que as ações sociais devem buscar o fortalecimento dessa dinâmica.

Abstract We evaluated the association between quality of life, family cohesion and sociodemographic factors of beneficiary families of the BolsaFamília Program (PBF). This was an analytical, cross-sectional study with exploratory methodology. The sample was composed of 385 respondents. The dependent variable was the quality of life (WHOQOL-BREF), and the independent variables were sociodemographic characteristics, self-rated health, family cohesion and adaptability (FACES III). The best quality of life was associated with an age younger than or equal to 36 years (OR = 2.15), higher educational level (OR = 1.54), good/very good health (OR = 6.39), not having current health problem (OR = 5.68), no treatment (OR = 1.76), moderate (OR = 3.39) and high (OR = 3.66) family cohesion and moderate adaptability (OR = 2.23). Individuals from families with moderate and high family cohesion were more likely to have a better quality of life than those from families with low cohesion. The male volunteers were 3.54 times more likely to have a better quality of life. It was concluded that moderate and high levels of cohesion may impact positively to the quality of life of persons receiving the PBF, indicating that social programs should seek to strengthen these dynamics.

Associação entre o tipo de aleitamento na alta hospitalar do recém-nascido e aos seis meses de vida / Association between type of breastfeeding of newborns at hospital discharge and at six months of age

Resumo Introdução Os índices de aleitamento materno no Brasil permanecem muito abaixo dos considerados ideais, fazendo-se necessário o entendimento das variáveis envolvidas na fragmentação do aleitamento ao longo dos meses de vida da criança. Objetivo Objetivou-se, neste estudo, verificar a associação entre o tipo de aleitamento no momento da alta hospitalar do recém-nascido e a prática da amamentação aos seis meses de vida. Método Estudo transversal, com dados coletados do prontuário clínico de 301 crianças participantes de um programa de incentivo ao aleitamento materno. Foram considerados os fatores de risco e de proteção ao aleitamento, tais como: idade dos pais, presença do companheiro, paridade, renda familiar, permanência em alojamento conjunto, tempo decorrido do nascimento até a primeira mamada, tempo de hospitalização, tipo de amamentação na alta hospitalar e uso de chupeta ao longo dos seis meses de vida. Resultados Os resultados mostraram haver associação significativa entre aleitamento materno exclusivo na alta hospitalar e aos seis meses de idade (p=0,0205). Conclusão A observação desses dados permite concluir que é importante que, ao deixar a maternidade, o bebê esteja em amamentação exclusiva, pois, dessa forma, terá 2,5 vezes mais chances de manter esse tipo de aleitamento até os seis meses de vida.

Abstract Introduction Breastfeeding rates in Brazil remain far below those considered ideal, making it necessary understanding the variables involved in the fragmentation of this process over the months of a child's life. Objective The objective of this study was to investigate the association between type of breastfeeding of newborns at hospital discharge and at six months of age. Method A cross-sectional study with data collected from the medical records of 301 children participating in a program to encourage exclusive breastfeeding. The study considered risk and protection factors to breastfeeding such as age of parents, presence of mate, parity, family income, stay in room, time elapsed from birth to first breastfeeding, hospitalization time, type of breastfeeding at hospital discharge, and use of pacifier until the age of six months. Results The results revealed significant correlation between exclusive breastfeeding at hospital discharge and at six months of age (p=0.0205). Conclusion Observation of data enabled the following conclusion: it is important that newborns undergo exclusive breastfeeding after hospital discharge because, this way, they will be 2.5 times more likely to maintain this type of feeding until the age of six months.

Factors associated with preventable infant death: a multiple logistic regression

ABSTRACT OBJECTIVE To identify and analyze factors associated with preventable child deaths. METHODS This analytical cross-sectional study had preventable child mortality as dependent variable. From a population of 34,284 live births, we have selected a systematic sample of 4,402 children who did not die compared to 272 children who died from preventable causes during the period studied. The independent variables were analyzed in four hierarchical blocks: sociodemographic factors, the characteristics of the mother, prenatal and delivery care, and health conditions of the patient and neonatal care. We performed a descriptive statistical analysis and estimated multiple hierarchical logistic regression models. RESULTS Approximatelly 35.3% of the deaths could have been prevented with the early diagnosis and treatment of diseases during pregnancy and 26.8% of them could have been prevented with better care conditions for pregnant women. CONCLUSIONS The following characteristics of the mother are determinant for the higher mortality of children before the first year of life: living in neighborhoods with an average family income lower than four minimum wages, being aged ≤ 19 years, having one or more alive children, having a child with low APGAR level at the fifth minute of life, and having a child with low birth weight.