Parents' sense of coherence in the use of dental services by children aged 12 years old in the city Manaus/AM

Aim The aim of this study was to evaluate the association between the sense of coherence (SOC) of parents/guardians and the use of dental services by children who are 12 years old. Methods This is a cross-sectional study conducted in the eastern zone of the city of Manaus, with 358 children enrolled in the 7th grade in the municipal public school system. Data collection was performed through self-administered questionnaires sent to parents/guardians, which contained questions about socioeconomic conditions, use of dental services by children and Antonovsky's SOC-13 scale. Data were examined by descriptive and bivariate analysis, using the Chi-square test, with a 5% significance level. Results Of the 358 children, 58.4% were female; in addition, 75.4% of the parents/guardians self-reported to be brown and 39.9% of them had a family income of ½ to 1 minimum wage. SOC was categorized as strong SOC and weak SOC by the median. The association between strong or weak SOC and the use of dental services in terms of frequency (p= 0.839) and reason for last visit (p= 0.384), was not significant. Conclusion It was concluded that SOC of parents/guardians and utilization of dental services by children were not associated.

Fluoride Concentration in Public Water Supply in a City in the Amazon Region

Abstract Objective: To analyze the fluoride concentration in the public water supply in Manaus, Brazil. Material and Methods: Water samples were collected in 50 mL polyethylene bottles, identified, and labeled. The collection was performed from September 2016 to August 2018. For the selection of collection points, all neighborhoods of the city of Manaus, divided into four health districts (North, South, East, and West), were mapped. From each district, 30 samples were collected, totaling 120 monthly samples. Water samples were analyzed using an ion analyzer, ORION 720-A, and a specific electrode, ORION 96-09. The ion analyzer and electrode were calibrated in standard solutions. The levels were classified in intervals based on technical consensus to guide the health surveillance agencies. Results: Of the 2,874 water samples, 50.3% were within the recommended range, and 49.7% were inadequate, with 31.6% considered above the parameters and 18.1% below. Among the districts, the North had the highest percentages of unsatisfactory samples, resulting in limited action to prevent tooth decay. During the 24 months of analysis, there were large oscillations in the values in all four districts of Manaus. Conclusion: Results reinforce the importance of heterocontrol for the city to guarantee the effectiveness of this public health measure.

Construção de um indicador multidimensional de saúde bucal para a população idosa da cidade de Manaus, AM / Construction of a multidimensional oral health indicator for the older population in the city of Manaus-Amazonas

Resumo Objetivo Produzir um indicador multidimensional de saúde bucal, a partir de variáveis dentárias e não dentárias, para a pessoa idosa da zona urbana do município de Manaus, AM, Brasil. Método Os dados utilizados são oriundos de um estudo transversal de base populacional conduzido no ano de 2008, com indivíduos de 65 a 74 anos de idade, aleatoriamente selecionados, residentes na cidade de Manaus. Para a produção do indicador proposto, consideraram-se as variáveis dentárias (CPO-D - Índice de Dentes Perdidos, Cariados e Obturados; CPI - Índice Periodontal Comunitário; PIP- Índice de Perda de Inserção Periodontal) e não dentárias (socioeconômicas e índice GOHAI - General Oral Health Assessment Index). Uma Análise Fatorial Exploratória sintetizou essas variáveis, facilitando a construção do indicador multidimensional. Resultados A análise gerou três fatores que, em conjunto, explicaram 72,9% da variância do modelo (KMO = 0,749 e p< 0,001 para o teste de esfericidade de Bartlett). Esses três fatores foram reduzidos à variável "soma", calculada a partir da soma dos escores fatoriais por indivíduo. A mediana dessa nova variável foi o valor de referência para categorização da condição de saúde bucal do indivíduo em "favorável" ou "desfavorável". Conclusão O indicador foi capaz de agregar diversas dimensões da saúde bucal em uma única medida, além de possibilitar sua reprodutibilidade para construção de outros indicadores de saúde.

Abstract Objective Produce a multidimensional indicator of oral health, based on dental and non-dental variables, for the older adult in the urban area of the city of Manaus-AM. Method The data used are from a cross-sectional population-based study conducted in 2008 with randomly selected individuals aged 65 to 74 years, residing in the city of Manaus. To produce the proposed indicator, the dental variables (DMFT- Decayed, Missing and Filled Teeth; CPI- Community Periodontal Index; PIP- Periodontal Insertion Loss Index) and non-dental (socioeconomic and index GOHAI- General Oral Health Assessment Index) were considered. An exploratory factor analysis synthesized these variables, facilitating the construction of the multidimensional indicator Results The analysis generated three factors that, together, explained 72.9% of the model's variance (KMO = 0.749 and p<0.001 for Bartlett's test of sphericity). These three factors were reduced to the "sum" variable, calculated from the sum of the factor scores per individual. The median of this new variable was the reference value for categorizing the individual's oral health condition into "favorable" or "unfavorable". Conclusion The indicator was able to aggregate several dimensions of oral health into a single measure, in addition to enabling its reproducibility for the construction of other health status indicators.

Equity in the Accessibility to Specialized Care in Oral Health in Brazil: Analysis of PMAQ-CEO External Evaluation Data According to the User's Perspective

Objective: To analyze the distribution of Centers of Dental Specialties (CEO) implemented in Brazil until 2014 and identify the contextual and individual variables associated with the geographical accessibility, considering the user's perspective. Material and Methods: The study was conducted with data from the Improving Access and Quality of CEOs (AVE/PMAQ CEO) External Evaluation and contextual characteristics of states and municipalities. The AVE/PMAQ CEO was an evaluative research with cross-sectional observational character, performed in all CEOs in Brazil, with 932 services evaluated and 8,897 users interviewed. Data analysis was conducted in two stages, considering the study dimensions. Analyses were conducted on the availability of units by region, state, population size of the municipality and contextual variables. Then, the relationship between explanatory variables and the user's displacement time and with the intention to change the service location was evaluated using generalized linear regression analysis. Results: The 932 CEOs evaluated were located in 780 of the 5,570 municipalities of the country and the majority was located in the northeastern (38.3%) and southeastern regions (36.2%), with the northern and midwestern regions presenting the lowest absolute number of units. The average displacement time to the CEO was 28.4 minutes, while the intention to change CEO location due to the distance from home was reported by 7.8% of users. Lower geographical accessibility was reported in the northern region and for individuals who reported living in the rural area and in cities with larger populations. Conclusion: The availability of CEOs in the country is still low and not equitably distributed among states and regions.

Effect of Chewing Gum Containing CPP-ACP on Salivary Flow and Buffer Capacity: An in vivo Study

Objective: To evaluate salivary flow and buffer capacity by means of mechanical and chemical-mechanical stimuli, through the use of chewing gums. Material and Methods: The study was a cross-sectional study with 12 volunteers, divided into three groups, in three phases: Group A: paraffin gum; Group B: Chewing gum without sucrose, flavored (Trident®); Group C: Flavored chewing gum, without sucrose and amorphous calcium casein-phosphate phosphopeptide (Trident Total®). The stimulated total saliva was collected after 5 minutes of mastication of one of the products and the volume was expressed in mL / min. The same sample was submitted to pH measurement with the use of a digital potentiometer, where the results were classified in normal buffer capacity (final pH between 5.0 and 7.0) or low (final pH <4.0). The results were evaluated regarding the normality of the sample distribution (Shapiro-Wilk test), Analysis of Variance (ANOVA) and Tukey's test. Results: Chewing gums increased the salivary flow of the volunteers, when compared to the control group (paraffin) (1.53 mL / min), differing statistically from the group, although there was no difference between Trident® (2.09 mL / Min) and Trident Total® (2.06mL / min). Regarding the buffer capacity, the values obtained were 6.94 (paraffin), 6.99 (Trident®) and 6.93 (Trident Total®), with no difference between groups (p = 0.713). Conclusion: It was concluded that chewing gums, with and without CPP-ACP, increased the salivary flow in relation to the control group. In relation to buffer capacity the values obtained for chewing gums with and without CPP-ACP, are shown to be within the normal range.

External quality assessment in the voluntary counseling and testing centers in the Brazilian Amazon using dried tube specimens: results of an effectiveness evaluation

INTRODUCTION : In 2011, the Brazilian Ministry of Health rolled out a program for the external quality assessment of rapid human immunodeficiency virus (HIV) tests using the dried tube specimen (DTS) method (EQA-RT/DTS-HIV). Our objective was to evaluate the implementation of this program at 71 voluntary counseling and testing centers (VCTCs) in the Brazilian Legal Amazonian area one year after its introduction. METHODS : Quantitative and qualitative study that analyzed secondary data and interviews with healthcare workers (HCWs) (n=39) and VCTC coordinators (n=32) were performed. The assessment used 18 key indicators to evaluate the three dimensions of the program's logical framework: structure, process, and result. Each indicator was scored from 1-4, and the aggregate results corresponding to the dimensions were expressed as proportions. The results were compared to the perceptions of the HCWs and coordinators regarding the EQA-RT/DTS-HIV program. RESULTS: The aggregate scores for the three dimensions of structure, process, and result were 91.7%, 78.6%, and 95%, respectively. The lowest score in each dimension corresponded to a different indicator: access to Quali-TR online system 39% (structure), registration in Quali-TR online system 38.7% (process), and VCTC completed the full process in the program's first round 63.4% (result). Approximately 36% of the HCWs and 52% of the coordinators reported enhanced trust in the program for its rapid HIV testing performance. CONCLUSIONS: All three program dimensions exhibited satisfactory results (>75%). Nevertheless, the study findings highlight the need to improve certain program components. Additionally, long-term follow-ups is needed to provide a more thorough picture of the process for external quality assessment. .

Oral health conditions among pregnant women attended to at a health care center in Manaus, Amazonas, Brazil / Condições de saúde bucal de gestantes atendidas em uma unidade de saúde em Manaus, Amazonas, Brasil

PURPOSE: To evaluate the oral health conditions of pregnant women enrolled in the Prenatal and Birth Humanization Program of the Theomário Pinto Costa primary healthcare unit in the south-central zone of Manaus, Amazonas METHODS: The population comprised 50 pregnant women, independent of pregnancy trimester. To assess the prevalence of dental caries, we used the DMFT Index, and for gingivitis, we used the Plaque Index and Gingival Bleeding Index. A questionnaire was used to investigate socioeconomic conditions, access to dental services and self-perception regarding oral health. RESULTS: One hundred percent of the population presented with caries; the mean DMFT score was 10.0, and the M component (missing teeth) was predominant (4.28). Among the pregnant women examined, 62% presented with moderate gingival inflammation, and 64% presented with at least some plaque. With regard to educational level, 10% of the population had completed an elementary education, 20% had not completed an elementary education, 34% had completed a high school education, and 6% had not completed a university-level education. CONCLUSION: Considering the results, it can be seen that the oral health status of the population was unfavorable, although a majority considered their oral health to be normal or good.

OBJETIVO: Avaliar as condições de saúde bucal de gestantes cadastradas no Programa de Humanização no Pré-natal e Nascimento (PHPN) na Unidade Básica de Saúde "Theomário Pinto Costa, situada na zona centro-sul de Manaus-AM". METODOLOGIA: A população estudada foi composta por 50 gestantes, independente do trimestre de gravidez. Para medir a prevalência de cárie utilizou-se o índice CPO-D e para gengivite foram utilizados Índices de Placa e Sangramento Gengival. Por meio de um questionário estruturado foram investigadas as condições socioeconômicas, o acesso aos serviços odontológicos e a autopercepção em saúde bucal. RESULTADOS: A população estudada apresentou 100% de prevalência de cárie com CPO-D médio de 10,0 sendo o componente P (dentes perdidos) predominante na composição do índice (4,28). Das gestantes examinadas, 62% apresentaram inflamação gengival moderada e 64% apresentaram placa mínima. O grau de escolaridade apresentou a seguinte distribuição: 10% ensino fundamental completo; 20% ensino fundamental incompleto; 34% ensino médio completo; 6% ensino superior incompleto. CONCLUSÕES: Diante dos resultados obtidos, pôde-se constatar que as condições de saúde na população de gestantes estudadas foram desfavoráveis; entretanto, a maioria a considerou regular ou boa.

Análise da atenção básica em cinco municípios da amazônia ocidental, com ênfase no programa saúde da família / Analysis of primary care in five municipalities of western amazonia, with emphasis on family health program

O objetivo deste artigo é analisar o processo de gestão da atenção básica, aí incluído o Programa de Saúde da Família (PSF), em cinco municípios da Amazônia Ocidental. A descentralização, entendida como meio de aprimoramento da gestão local, também foi investigada. Trata-se de um estudo qualitativo, que explorou o plano político-institucional dos sistemas de saúde dos municípios, através das dimensões projeto de governo, capacidade de governo e governabilidade. A coleta de dados foi realizada por meio de técnicas combinadas: análise da documentação oficial dos sistemas municipais de saúde; realização de entrevistas semiestruturadas junto aos gestores municipais de saúde e gerentes intermediários da atenção básica, do PSF e da direção de unidades de saúde (PSF e não PSF) para subsidiar estudo sobre o modelo de gestão e atenção à saúde, e consulta aos sistemas nacionais e municipais de informação. Os resultados mostraram baixa capacidade gestora, dificuldade em definir prioridades para a saúde, inexistência ou incipiência de ações intersetoriais, limitação na autonomia financeira e uma base de apoio político precária; limitada formação técnica dos gestores e de suas equipes, com carência de aperfeiçoamento profissional; quadro técnico dos profissionais da rede de serviços insuficiente em número e em qualificação para efetuar uma gerência qualificada de serviços de atenção primária à saúde.

The objective of this paper was to analyze the primary healthcare management process, including the Programa Saúde da Família (PSF - Family Health Program), in five municipalities located in the western part of the Amazon region. Decentralization, understood as a means of improving the local management, was also investigated. This was a qualitative study that explored the political-institutional level of the municipalities' healthcare systems through the dimensions of government project, government capacity and governability. Data collection was accomplished by means of combined techniques: analysis of official documentation from the municipal healthcare systems; conduction of semi-structured interviews with municipal healthcare managers, managers of the primary healthcare services, of PSF and of the administration of healthcare units (both PSF and non-PSF) to subsidize a study on the healthcare provision and management model; and consultation of the national and municipal information systems. The results showed low management capacity, difficulty in defining healthcare priorities, nonexistent or incipient intersectoral actions, limited financial autonomy and a precarious political support base; limited technical training of managers and their team; insufficient and low-qualified technical staff of the services network, which prevent them from performing a skilled management of primary healthcare.

Caries experience in adolescents from a metropolitan region of the Brazilian Amazon / Experiência de cárie em adolescentes de uma região metropolitana da Amazônia brasileira

Purpose: To estimate the prevalence of dental caries among adolescents from a poor metropolitan region of the Brazilian Amazon, and to identify the independent socioeconomic variables of access to dental services, oral hygiene habits, and self-perception of oral health. Method: The sample comprised 178 adolescents aged from 15 to 19 year-old, enrolled in schools in the Eastern zone of the city of Manaus, AM, Brazil. Primary data were collected using a standardized questionnaire and clinical examination. Result: The prevalence of dental caries was 92.7%, and the mean DMF-T index was 5.16 (SD: 0.28). The average number of decayed, missing, and filled teeth was 4.4, 0.87, and 0.75, respectively. No statistically significant differences were found between DMF-T index and per capita household income. Most adolescents declared that they had had an appointment with a dentist at least once in their lifetime, had sought the public service, and that pain was the predominant reason for consultation. The perception of oral health of the majority was good/excellent. Conclusion: The data suggest lack of restorative dental treatment and high prevalence of dental caries in this socially disadvantaged sample, which evidences the need to implement strategies to improve delivery of oral health care.

Objetivo: Estimar a prevalência de cárie em adolescentes, escolares de uma região metropolitana de Manaus, Brasil, identificando variáveis independentes socioeconômicas, de acesso a serviço odontológico, hábitos de higiene oral e autopercepção da saúde bucal. Metodologia: Foram investigados 178 escolares de 15 a 19 anos, matriculados nas escolas da zona leste da cidade de Manaus, AM, Brasil. Foram coletados dados primários por meio de questionário e exame clínico. Resultado: A prevalência de cárie foi 92,7% e a média do índice CPO-D foi de 5,16 (desvio-padrão: 0,28). A média de dentes cariados, perdidos e obturados foi de 4,4; 0,87 e 0,75, respectivamente. Não foram encontradas diferenças estatisticamente significantes entre CPO-D e renda domiciliar per capita. A maioria dos adolescentes declarou já ter ido ao dentista pelo menos uma vez na vida e ter procurado o serviço público, sendo a dor o motivo predominante para a consulta. A percepção da saúde bucal da maioria foi boa/ótima. Conclusão: Os dados obtidos sugerem carência de tratamento odontológico restaurador e prevalência preocupante sobre dentes perdidos por cárie dentária, evidenciando necessidade de implantação de estratégias de atenção à saúde bucal, considerando a realidade desta população em desvantagem socioeconômica.

Dental caries and gingivitis among 15 to 19 year-old students in Manaus, AM, Brazil

In the light of the scarcity of epidemiological studies on the oral health of the general population within the context of the Amazon region, this study aimed to estimate the prevalence of dental caries and gingivitis, as well as to evaluate the need for restorative treatment, among school students aged 15 to 19 years in the city of Manaus, AM, Brazil. A cross-sectional study was carried out on a sample of 889 students from within city limits who were enrolled in 26 public and private schools. Dental examinations were performed to obtain the DMFT index (decayed, missing and filled teeth) as well as to determine the treatments needed. The gingival index (Lõe & Silness) was used to classify gingivitis. The intra-examiner diagnostic concordance was 94 percent and the Kappa statistic was 0.91. The DMFT index found was 4.65 (± 0.12), without significant difference between the sexes or skin color groups. The prevalence of dental caries was 87.4 percent. Restoration of a dental surface was the greatest need (59.3 percent). Slight gingival inflammation was present in 78.5 percent and gingival bleeding following probing occurred in 53.3 percent. Although the DMFT index was lower than that observed for the northern region of Brazil, restorative dental services are lacking for this population. Additional studies are suggested to better understand the differences found.