Oral Health Promotion Through an Online Training Program for Medical Students

The objective of this study was to compare the impact on knowledge and counseling skills of face-to-face and Internet-based oral health training programs on medical students. Participants consisted of 148 (82 percent) of the 180 invited students attending their fifth academic year at the Faculty of Medicine, University of Sao Paulo, Brasil, in 2007. The interventions took place during a three-month training period in the clinical Center for Health Promotion, which comprised part of a clerkship in Internal Medicine. The students were divided into four groups: 1) Control Group (Control), with basic intervention; 2) Brochure Group (Br), with basic intervention plus complete brochure with oral health themes; 3) Cybertutor Group (Cy), with basic intervention plus access to an Internet-based training program about oral health themes; and 4) Cybertutor + Contact Group (Cy+C), the same as Cy plus brief proactive contact with a tutor. The impact of these interventions on student knowledge was measured with pre- and post assessments, and student skills in asking and counseling about oral health were assessed with an objective structured clinical examination (OSCE). Multivariate logistic regression models were applied to identify the odds ratios of scoring above Control's medians on the final assessment and the OSCE. In the results, Cy+C performed significantly better than Control on both the final assessment (OR 9.4; 95% CI 2.7-32.8) and the OSCE (OR 5.6; 95% CI 1.9-16.3) and outperformed all the other groups. The Cy+C group showed the most significant increase in knowledge and the best skills in asking and counseling about oral health.

Friere`s Dialogic Concept Enables Family Health Program Teams to Incorporate Health Promotion

Objective The study analyzes the possibility of incorporating health promotion measures into the work processes of Family Health Program teams at a primary health care clinic in Brazil. Design and Sample We used the participatory research concept developed in 1968 by Freire. The study sample comprised the end-users of the health care system, together with 3 multidisciplinary teams. A total of 77 health care users and 55 health professionals participated in the study. Measures Culture circles composed of health care professionals, and users from different areas investigated generative topics, encoded/decoded topics, and engaged in critical probing for clarification. Topics affecting quality of life and health were heuristically evaluated. Results Although most topics were related to changing the focus of health care facilities, some were related to subsidizing community-based interventions, improving environmental strategies, individual skills, and public policies. Incorporating the novel health promotion measures and creating an expanded full-treatment clinic are important steps toward that goal. Conclusions Topics that can stimulate dialogue among the members of the culture circles include creating an environment of closer cultural contact, with repercussions for work processes, family health models, and general health models, as well as the inclusion of social aspects in the decision-making processes related to health issues that affect the living conditions of the population.

Oral health in Brazil - Part II: Dental Specialty Centers (CEOs)

The concepts of health promotion, self-care and community participation emerged during the 1970s and, since then, their application has grown rapidly in the developed world, showing evidence of effectiveness. In spite of this, a major part of the population in the developing countries still has no access to specialized dental care such as endodontic treatment, dental care for patients with special needs, minor oral surgery, periodontal treatment and oral diagnosis. This review focuses on a program of the Brazilian Federal Government named CEOs (Dental Specialty Centers), which is an attempt to solve the dental care deficit of a population that is suffering from oral diseases and whose oral health care needs have not been addressed by the regular programs offered by the SUS (Unified National Health System). Literature published from 2000 to the present day, using electronic searches by Medline, Scielo, Google and hand-searching was considered. The descriptors used were Brazil, Oral health, Health policy, Health programs, and Dental Specialty Centers. There are currently 640 CEOs in Brazil, distributed in 545 municipal districts, carrying out dental procedures with major complexity. Based on this data, it was possible to conclude that public actions on oral health must involve both preventive and curative procedures aiming to minimize the oral health distortions still prevailing in developing countries like Brazil.

Oral Health in Brazil - Part I: public oral health policies

This paper reviews the historical development of public health policies in Brazil and the insertion of oral health in this context. Since 1988, Brazil established a Unified National Health System ("Sistema ��nico de Sa��de" - SUS), which was conceived to assure access to health actions and services, including oral health. However, a history of lack of access to health services and the health problems faced by the Brazilian population make the process of building and consolidating the SUS extremely challenging. Since 2004, the Oral Health National Policy has proposed a reorientation of the health care model, supported by an adaptation of the working system of Oral Health teams so that they include actions of health promotion, protection and recovery. Human resources should be prepared to act in this system. The qualifying process must take in consideration knowledge evolution, changes in the work process and changes in demographical and epidemiological aspects, according to a perspective of maintaining a balance between technique and social relevance.

Enrollment in Physical Education Is Associated With Health-Related Behavior Among High School Students

METHODS: A total of 4210 students attending public high schools in Pernambuco (northeast of Brazil) were selected using random 2-stage cluster sampling. Data were collected by using the Global School-based Student Health Survey. The independent variable was the frequency of participation in PE classes, whereas physical activity, television viewing, smoking, and alcohol, fruit, vegetables and soda consumption were dependent variables. Logistic regressions were carried out to perform crude and adjusted analysis of the association between enrollment in PE classes and health-related behaviors. RESULTS: Sixty-five percent of students do not take part in PE classes, with a significantly higher proportion among females (67.8%). It was observed that enrollment in PE classes was positively associated with physical activity, TV viewing, and fruit consumption, but was negatively associated with soda drinking. The likelihood of reporting being active and eating fruit on a daily basis was 27% and 45% higher, respectively, among those who participate in at least 2 classes per week in comparison with those who do not. Students who participate in PE classes had 28-30% higher likelihood of reporting lower TV viewing during week days. CONCLUSIONS: Findings suggest that higher levels of enrollment in PE classes could play a role in the promotion of health-related behaviors among high school students.

Identification of nurses` competencies in primary health care through a Delphi study in southern Brazil

Objective: This investigation aimed to identify and analyze the general and specific competencies of nurses in the primary health care practice of Brazil. Design: The Delphi Technique was used as the method of study. Sample: 2 groups of participants were selected: One contained primary health care nurses (n=52) and the other specialists (n=57), including public health nurses and public or community health faculty. Measurements: 3 questionnaires were developed for the study. The first asked participants to indicate general and specific competencies, which were compiled into a list for each group. A Likert scale of 1-5 was added to these 2 lists in the second and third questionnaires. A consensus criterion of 75% for score 4 or 5 was adopted. Results: In the nurses` group, 17 general and 8 specific competencies reached the consensus criterion; 19 general and 9 specific competencies reached the criterion in the specialists` group. These competencies were classified into 10 domains: professional values, communication, teamwork, management, community-oriented, health promotion, problem solving, health care, and education and basic public health sciences. Conclusions: These competencies reflect Brazilian health policy and constitute a reference for health professional practice and education.

Promoting health in families of children with type 1 diabetes mellitus

This paper presents a study of families of children with type 1 diabetes mellitus, emphasizing the identification of social supports and networks to strengthen interventions aimed at health promotion. The approach selected was a qualitative research, using a case study design. Four families of children with diabetes type 1 were studied, totalling seven participants. Data were collected between April and June 2007, through in-depth interviews and the construction of a genogram and an ecomap. The results presented the families` characterization and testimonies grouped in the following categories: social support, social networks and family roles. To promote care in practice, there is a need to identify the characteristics of each family and resources available that provide better living conditions. We concluded that identifying supports and social networks allows for more personalized care delivery to each family with a view to health promotion.

An ergonomic approach to reorganize parking inspection agents` work productivity, health and safety in Sao Paulo, Brazil

Objective: The Traffic Engineering Company of the City of Sao Paulo (Brazil) observed a decrease in productivity, and an increase in sick leave, accidents and psychological distress among their parking inspection agents. To document this situation, qualitative research was undertaken to obtain an in-depth comprehension of work activity. Participants: Workers, managers and health and safety professionals contributed to the documentation of the problem and to the proposal of possible solutions. Methods: Ergonomic work analysis focusing on real work activity, as well as interviews with individual or groups of stakeholders, were conducted. Results: This research revealed that political-economic factors gradually contributed to: 1) an increasing work load; 2) growing fatigue throughout the day, increasing the workers` vulnerability to incidents and accidents and their tendency to react inappropriately to violence experienced on the street; and 3) excessive individual responsibility to manage dangerous situations. Conclusions: Recommendations to ameliorate the situation are proposed. These suggestions are discussed in terms of feasibility given the impact of macro social factors upon micro work activity, and the associated potential expansion of the ergonomist`s role.

Barriers to interventions aimed at promoting the health of health care workers in Brazil

Objective. To search the literature for circumstances that impede injury and disease prevention and other activities intended to improve the health of the health care worker. Methods. The SciELO database was searched for articles published in 1967-2008. This was supplemented by a PubMed search for the period 1950-2008. The following key words were used to identify articles in English, Portuguese, and Spanish: work, health personnel, occupational, risks, diseases, ergonomics, work ability, quality of life, organization, accidents, work conditions, intervention, and administration. Articles on injury and disease prevention and occupational health in a health care setting in Latin America were selected, along with articles focused on health promotion in the health sector. Results. The following shortcomings were identified: activities lacked a sound theoretical foundation and were not integrated with the health services management; a failure to evaluate the effectiveness of the activity; health surveillance focused solely on a specific disease or injury; management not committed to the proposed activity; miscommunication; inability of workers to participate, or control the work environment; and, programs or efforts that were limited to changing the workers` behaviors. Conclusions. The literature shows that all the barriers identified by this study affect both the health care workers` health as well as their productivity.

Oral health in transition: the case of Indigenous peoples from Brazil

The objective of this paper is to summarise epidemiological information about the distribution of dental caries among Indigenous peoples in Brazil. The authors also present a case study of a specific group of Xavante Indians, one of the most numerous of Brazil`s Indigenous peoples, describing how their oral health has deteriorated over recent decades, and showing how an oral health programme is attempting to reverse the present trend of increase in caries. The programme at Etenheritipa Xavante village incorporated three principal components: educational, preventive, and clinical. From the beginning, the programme included epidemiological record keeping for monitoring the level of caries in the population. Transversal studies of the condition of oral health among the Xavante of Etenheritipa were undertaken in 1999, 2004, and 2007. In the period from 2004 to 2007 the DMFS values in the 11-15 age cohort had a significant reduction in caries experience. The mean DMFS score fell from 4.95 in 2004 to 2.39 in 2007 (p<0.01). An increase in the percent of individuals who were free from caries was also noted: in 1999, 20% of adolescents 11-15 had no caries; in 2007, the proportion had risen to 47%. The Xavante case is a prime example of the transition in oral health that is taking place among the Indigenous peoples of the Americas, and it highlights the importance of oral health promotion through preventive measures such as access to fluoridation and basic care in reducing the inequality between Indians and non-Indians.

Dental caries profile in Monte Negro, Amazonian state of Rond��nia, Brazil, in 2008

OBJECTIVE: This epidemiological survey assessed the dental caries profile in Monte Negro, a small town in the Amazonian state of Rond��nia, Brazil, and its relationship with the northern region, national and global goals for oral health in the years 2000 and 2020. MATERIAL AND METHODS: The groups randomly examined were composed of individuals aged 5, 12, 15 to 19, 35 to 44, 65 to 74 years, living in both rural and urban areas. RESULTS: The means dft (standard deviation) and DMFT (standard deviation) for the groups were, respectively, 3.15 (3.12), 3.41 (2.69), 5.96 (4.19), 16.00 (7.30) and 25.96 (9.82). Caries-free individuals were 34.42%, 14.81% and 8.16% in the preschoolchildren, schoolchildren and adolescent groups, respectively. The Significant Caries Index percentages applied to the two younger groups were 6.65 and 6.70, and they increased to 32.00 in the individuals aged 65 to 74 years. Care Index percentages for adolescents, adults and elderly groups were, respectively, 29.40, 25.00 and 1.41. The dental caries profile in Monte Negro in 2008 shows that, 8 years after the year 2000, no FDI/WHO goal for any age settled in 1982 has been achieved. Dental caries increased with age and the main dental problem of adult and elderly groups was tooth loss. CONCLUSION: Oral health promotion and prevention of oral disease policies are urgent needs. Setting of oral health goals and targets to people living in Monte Negro or Amazonia to be pursuit and achieved in a near future is an important action to do because of the culture, sanitary conditions and socioeconomic aspects of this particular population.

Educa����o e motiva����o em sa��de bucal: prevenindo doen��as e promovendo sa��de em pacientes sob tratamento ortod��ntico

INTRODU����O: os cirurgi��es-dentistas t��m a responsabilidade de prevenir doen��as, minimizar riscos e promover sa��de. Os pacientes tamb��m precisam ser despertados sobre o seu papel nos cuidados com a sa��de bucal. No caso de pacientes em tratamento ortod��ntico, �� particularmente dif��cil manter uma higiene bucal satisfat��ria devido �� presen��a de bandas, fios e ligaduras. Torna-se, ent��o, indispens��vel a institui����o de m��todos preventivos de motiva����o e orienta����o para o controle mec��nico da placa dent��ria. OBJETIVO: verificar os efeitos de a����es educativas, preventivas e motivacionais sobre a sa��de bucal de pacientes em tratamento ortod��ntico fixo. M��TODOS: os participantes receberam gratuitamente dentifr��cio e escova dental durante todo o estudo e instru����es sobre higiene bucal foram fornecidas e refor��adas no decorrer dos 6 meses da pesquisa. Foram realizados exames cl��nicos baseline e ap��s 6, 12 e 24 semanas, para verifica����o dos ��ndices de Placa, Gengival e Sangramento. RESULTADOS: as condi����es de sa��de bucal dos participantes, que inicialmente eram insatisfat��rias, melhoraram significativamente no decorrer do estudo, considerando-se todos os ��ndices. As a����es preventivas, educativas e motivacionais realizadas foram estatisticamente eficazes na melhora da sa��de bucal dos pacientes ortod��nticos. CONCLUS��ES: a promo����o de sa��de e a preven����o de doen��as devem fazer parte do atendimento que os ortodontistas direcionam aos seus pacientes, sendo que a orienta����o e motiva����o quanto aos cuidados com a sa��de bucal devem estar presentes antes e durante o tratamento.

Autopercep����o da sa��de bucal em idosos e fatores associados em Campinas, SP, 2008-2009

OBJETIVO: Descrever a autopercep����o de sa��de bucal em idosos e analisar fatores sociodemogr��ficos e cl��nicos associados. M��TODOS: Estudo transversal com 876 participantes em amostra representativa de idosos (65 anos ou mais) de Campinas, SP, em 2008-2009. Os exames odontol��gicos seguiram crit��rios padronizados pela Organiza����o Mundial da Sa��de para levantamentos epidemiol��gicos de sa��de bucal. A autopercep����o da sa��de bucal foi avaliada pelo ��ndice Geriatric Oral Health Assessment Index (GOHAI). Os indiv��duos foram classificados segundo caracter��sticas sociodemogr��ficas, odontol��gicas e preval��ncia de fragilidade biol��gica. O estudo de associa����es utilizou an��lise de regress��o de Poisson; a an��lise considerou os pesos amostrais e a estrutura complexa da amostra por conglomerados. RESULTADOS: A m��dia de idade dos indiv��duos foi de 72,8 anos; 70,1% eram mulheres. A propor����o de indiv��duos com mais de 20 dentes presentes foi 17,2%; 38,2% usavam pr��tese dent��ria total em ambos os arcos; 8,5% necessitavam desse recurso em ao menos um arco dent��rio. Em m��dia, o ��ndice GOHAI foi elevado: 33,9 (m��ximo poss��vel 36,0). Manter 20 dentes ou mais, usar pr��tese total nos dois arcos, n��o necessitar desse tratamento, n��o apresentar altera����es de mucosa oral e n��o apresentar fragilidade biol��gica foram os fatores significantemente associados com melhor autopercep����o de sa��de bucal (p < 0,05). CONCLUS��ES: A avalia����o de autopercep����o em sa��de bucal permitiu identificar os principais fatores associados a esse desfecho. Esse instrumento pode contribuir para o planejamento de servi��os odontol��gicos, orientando estrat��gias de promo����o em sa��de voltadas �� melhora da qualidade de vida das pessoas desse grupo et��rio.

Fatores associados �� capacidade para o trabalho de trabalhadores do Setor El��trico

O Setor El��trico passou por recente processo de reestrutura����o produtiva com reflexos nas condi����es e organiza����o do trabalho, podendo comprometer a capacidade para o trabalho. Este estudo objetivou avaliar fatores associados �� capacidade para o trabalho junto a 475 trabalhadores de uma empresa do Setor El��trico no Estado de S��o Paulo, Brasil. Neste estudo transversal foi realizada an��lise descritiva e an��lise de regress��o linear m��ltipla. A m��dia do ��ndice de Capacidade para o Trabalho (ICT) foi de 41,8 pontos (escala de 7,0 a 49,0 pontos). A an��lise m��ltipla mostrou que os fatores que melhor explicaram a variabilidade do ICT foram estresse no trabalho (p < 0,001) e sa��de f��sica (p < 0,001 em todas as dimens��es). Em outra an��lise, exclu��das as dimens��es da sa��de, as vari��veis associadas ao ICT foram estresse no trabalho (p < 0,001), local de trabalho (p = 0,022), pr��tica de atividade f��sica (p = 0,001), consumo de ��lcool (p = 0,012) e ��ndice de massa corporal (p < 0,001). Os resultados identificaram aspectos a serem considerados no desenvolvimento de medidas visando a preserva����o da capacidade para o trabalho, com ��nfase no controle do estresse no trabalho e na promo����o da sa��de.

A alimenta����o saud��vel na ��tica dos adolescentes: percep����es e barreiras �� sua implementa����o e caracter��sticas esperadas em materiais educativos

Este estudo visou avaliar percep����es, barreiras e caracter��sticas de materiais educativos de promo����o de alimenta����o saud��vel descritas por adolescentes. Realizaram-se quatro grupos focais com 25 adolescentes com perguntas sobre: percep����o e motiva����o para modificar a dieta; conceito de alimenta����o saud��vel e barreiras para sua ado����o; e caracter��sticas de impressos para a promo����o de pr��ticas alimentares saud��veis. Observou-se uma freq��ente indecis��o quanto a classificar a dieta como saud��vel. Os adolescentes referiram n��o se sentir confiantes para modificar a dieta, mas relataram conceitos adequados sobre alimenta����o saud��vel. As principais barreiras citadas foram focadas em aspectos pessoais e sociais, como: a tenta����o, o sabor dos alimentos, a influ��ncia dos pais e a falta de tempo e de op����es de lanches saud��veis na escola. Para os jovens, materiais educativos de promo����o de alimenta����o saud��vel devem refor��ar seus benef��cios imediatos e destacar mensagens alarmantes sobre os riscos �� sa��de advindos de uma alimenta����o inadequada.