Analyses of cataract surgery performed by the Unified Health System in Brazil, 2006-2007

Objective. Estimate cataract surgical rates (CSR) for Brazil and each federal unit in 2006 and 2007 based on the number of surgeries performed by the Unified Health System to help plan a comprehensive ophthalmology network in order to eliminate cataract blindness in compliance with the target set by the World Health Organization (WHO) of 3 000 cataract surgeries per million inhabitants per year. Methods. This descriptive study calculates CSR by using the number of cataract surgeries carried out by the Brazilian Unified Health System for each federal unit and estimates the need for cataract surgery in Brazil for 2006-2007, with official population data provided by the Brazilian Institute of Geography and Statistics. The number of cataract surgeries was compared with the WHO target. Results. To reach the WHO goal for eliminating age-related cataract blindness in Brazil, 560 312 cataract surgeries in 2006 and 568 006 surgeries in 2007 needed to be done. In 2006, 179 121 cataract surgeries were done by the Unified Health System, corresponding to a CSR of 959 per million population; in 2007, 223 317 were performed, with a CSR of 1 179. With the Brazilian Council of Ophthalmology estimation of 165 000 surgeries each year by the non-public services, the CSR for Brazil would be 1 842 for 2006 and 2 051 for 2007. The proportions needed to achieve the proposed target were 38.6% in 2006 and 31.6% in 2007. Conclusions. Human resources, technical expertise, and equipment are crucial to reach the WHO goal. Brazil has enough ophthalmologists but needs improved planning and infrastructure in order to eliminate the problem, aspects that require greater financial investment and stronger political commitment.

Oral health conditions among the elderly in Southeastern São Paulo State

OBJECTIVE: This study aimed to asses oral health conditions in a population aged 60 years and over living in Botucatu, Southeastern Brazil. A cross-sectional population-based study was carried out using a random sample (N=372) of the urban population aged 60 years and over from the city of Botucatu, in 2005. World Health Organization criteria and codes for oral health epidemiological surveys were used. Re-examination was carried out in 10% of individuals aiming to evaluate intra-examiner agreement. Statistical analysis was performed by one-way ANOVA or Kruskal-Wallis ANOVA, as applicable. Also, the t-test was used in the absence of homoscedasticity. Fisher's exact test was used for situations where the categories with less than five units were observed. Adjusted residuals and multiple-comparison analysis were conducted to identify associations between variable categories and subgroups. The intra-examiner agreement was 98% and Kappa statistics result was 0.95. Loss component represented 90.68% of DMF-T index, which was 29.85. The prevalence of edentulism was 63.17%. Upper and lower dentures were found in 80% and 58% respectively, with complete denture as the most commonly used. In those studied, 15% required upper and 38% lower dentures. There was more need for complete denture in both jaws. Approximately 20% had soft tissue alterations. For periodontal conditions, most sextants were excluded (81.81%). Periodontal pockets (4 - 5 mm) were seen in 11.29% of the examined individuals. The oral health status of the elderly population in Botucatu is poor, as well as in other Brazilian cities. The results of this study may help planning collective health actions, giving an accurate description of the oral problems among the elderly.

Evolução temporal da dengue no município de Ribeirão Preto, São Paulo, 1994 a 2003

Este estudo caracteriza-se epidemiológico-descritivo com objetivo de descrever a evolução temporal dos casos de dengue em Ribeirão Preto, São Paulo, no período de 1994 a 2003, segundo mês de ocorrência e sexo. Os dados foram obtidos junto às fichas de notificação compulsória fornecidas pela Vigilância Epidemiológica da Secretaria Municipal de Saúde do município. Foram obtidos os coeficientes de incidência por 100.000 habitantes, segundo estimativas populacionais do Instituto Brasileiro de Geografia e Estatística. O município viveu uma epidemia de dengue no ano de 2001, quando o coeficiente de incidência chegou a 619,65 casos/100.000 habitantes, sendo que dentre os 5.553 casos encontrados no período estudado, 0,07% ocorreram no ano de 1994, 3,68% em 1995, 4,52% em 1996, 2,40% em 1997, 1,82% em 1998, 5,73% em 1999, 3,75% em 2000, 57,37% em 2001, 6,25% em 2002 e, 14,39% em 2003 . Os meses do ano de maior ocorrência da doença foram de janeiro a maio. Em relação à variável sexo, a proporção entre o número de casos foi de aproximadamente 1:1, mostrando pequenas flutuações de casos de dengue entre homens e mulheres, para todo período estudado. Os resultados apontam a necessidade do desenvolvimento de estudos sobre a temática e reforçam o papel das instituições de ensino na questão da dengue no nosso país.

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 Único de Saúde" - 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.

Relationship between oral health and its impact on quality of life among adolescents

The aim of this study was to assess oral health status and its relationship with quality of life. A household population, cross-sectional study was carried out; participants were between 15 and 17 years of age (n = 247) and were examined by two calibrated dentists. Socio-economic status was classified according to ANEP-ABIPEME criteria. Clinical examinations to observe DMFT, CPI and Dean indices were performed as per WHO criteria. The Significant Caries Index (SiC) was used to evaluate polarization of the occurrence of caries among participants of the tercile with higher DMF-T. The OHIP instrument was used to measure quality of life. The Spearman and Mann-Whitney tests were used for assessing correlations (5% significance level). Examinations were carried out in 117 (47.37%) females and in 130 (52.63%) males. Of the examined participants, 45.75% were classified as belonging to socio-economic class C. Caries occurrence was observed in 218 subjects (88.26%); the mean DMFT was 5.40. The SiC index was 9.97. Almost half (47.77%) of the participants examined did not present sextants affected by periodontal disease. Of the participants examined, 80.16% presented absence of fluorosis. The mean OHIP was 3.95. The following correlations were observed: a positive and statistically significant correlation between the highest score in the OHIP and decayed teeth; a positive correlation with threshold significance between OHIP and DMFT; an inverse correlation between intact teeth and OHIP; and a positive and non statistically significant correlation between SiC and OHIP (correlation coefficient = 0.13, p = 0.245). Association between the mean OHIP and the terciles was not significant (p = 0.146); there were also no associations between periodontal condition and OHIP nor were there associations between the presence of fluorosis and mean OHIP.

Differences in responses to the Oral Health Impact Profile (OHIP14) used as a questionnaire or in an interview

The objective of this study was to compare the completion rates and performance of the Brazilian version of the Oral Health Impact Profile (OHIP14) when applied as an interview or in its original self-reported form. A convenience sample of 74 adult patients was selected in a Dental Clinic (University of Araras, Brazil). One examiner administered the instrument in both formats to participants with an interval of 2 weeks between each administration. Data about dental health condition and socioeconomic status were collected and associated with total OHIP14 scores in both formats using linear regression analyses. No differences were found in the total scores and in each subscale of the OHIP14 according to the form of administration. Higher values of completion were found in the interview format. More severe impacts were recorded in the interview format than in the questionnaire format. Higher values of total OHIP-14 scores in both formats were related to the presence of dental caries. Total OHIP14 scores were not influenced by the method of administration. However, the use of the OHIP14 in the questionnaire format may result in lower completion rates and loss of data.

Overview of the taxonomy and of the major secondary metabolites and their biological activities related to human health of the Laurencia complex (Ceramiales, Rhodophyta) from Brazil

In Brazil, the Laurencia complex is represented by twenty taxa: Laurencia s.s. with twelve species, Palisada with four species (including Chondrophycus furcatus now that the proposal of its transference to Palisada is in process), and Osmundea and Yuzurua with two species each. The majority of the Brazilian species of the Laurencia complex have been phylogenetically analyzed by 54 rbcL sequences, including five other Rhodomelacean species as outgroups. The analysis showed that the Laurencia complex is monophyletic with high posterior probability value. The complex was separated into five clades, corresponding to the genera: Chondrophycus, Laurencia, Osmundea, Palisada, and Yuzurua. A bibliographical survey of the terpenoids produced by Brazilian species showed that only six species of Laurencia and five of Palisada (including C. furcatcus) have been submitted to chemical analysis with 48 terpenoids (47 sesquiterpenes and one triterpene) isolated. No diterpenes were found. Of the total, 23 sesquiterpenes belong to the bisabolane class and eighteen to the chamigrene type, whose biochemical precursor is bisabolane, two are derived from lauranes and four are triquinols. Despite the considerable number of known terpenes and their ecological and pharmacological importance, few experimental biological studies have been performed. In this review, only bioactivities related to human health were considered.

Inbreeding levels in Northeast Brazil: strategies for the prospecting of new genetic disorders

A new autosomal recessive genetic condition, the SPOAN syndrome (an acronym for spastic paraplegia, optic atrophy and neuropathy syndrome), was recently discovered in an isolated region of the State of Rio Grande do Norte in Northeast Brazil, in a population that was identified by the IBGE (Brazilian Institute of Geography and Statistics) as belonging to the Brazilian communities with the highest rates of "deficiencies" (Neri, 2003), a term used to describe diseases, malformations, and handicaps in general. This prompted us to conduct a study of consanguinity levels in five of its municipal districts by directly interviewing their inhabitants. Information on 7,639 couples (corresponding to about 40% of the whole population of the studied districts) was obtained. The research disclosed the existence of very high frequencies of consanguineous marriages, which varied from about 9% to 32%, suggesting the presence of a direct association between genetic diseases such as the SPOAN syndrome, genetic drift and inbreeding levels. This fact calls for the introduction of educational programs for the local populations, as well as for further studies aiming to identify and characterize other genetic conditions. Epidemiological strategies developed to collect inbreeding data, with the collaboration of health systems available in the region, might be very successful in the prospecting of genetic disorders.

Impact on human health of particulate matter emitted from burnings in the Brazilian Amazon region

OBJECTIVE: To analyze the impact on human health of exposure to particulate matter emitted from burnings in the Brazilian Amazon region. METHODS: This was an ecological study using an environmental exposure indicator presented as the percentage of annual hours (AH%) of PM2.5 above 80 μg/m3. The outcome variables were the rates of hospitalization due to respiratory disease among children, the elderly and the intermediate age group, and due to childbirth. Data were obtained from the National Space Research Institute and the Ministry of Health for all of the microregions of the Brazilian Amazon region, for the years 2004 and 2005. Multiple regression models for the outcome variables in relation to the predictive variable AH% of PM2.5 above 80 μg/m3 were analyzed. The Human Development Index (HDI) and mean number of complete blood counts per 100 inhabitants in the Brazilian Amazon region were the control variables in the regression analyses. RESULTS: The association of the exposure indicator (AH%) was higher for the elderly than for other age groups (β = 0.10). For each 1% increase in the exposure indicator there was an increase of 8% in child hospitalization, 10% in hospitalization of the elderly, and 5% for the intermediate age group, even after controlling for HDI and mean number of complete blood counts. No association was found between the AH% and hospitalization due to childbirth. CONCLUSIONS: The indicator of atmospheric pollution showed an association with occurrences of respiratory diseases in the Brazilian Amazon region, especially in the more vulnerable age groups. This indicator may be used to assess the effects of forest burning on human health.

Health Related Quality of Life Assessment questionnaire for children aged 5 to 11 years with HIV/AIDS: cross-cultural adaptation for the Portuguese language

The objective of this study is to describe preliminary results from the cross-cultural adaptation of the Quality of Life Assessment Questionnaire, used to measure health related quality of life (HRQL) in Brazilian children aged between 5 and 11 with HIV/AIDS. The cross-cultural model evaluated the Concept, Item, Semantic and Measurement Equivalences (internal consistency and intra-observer reliability). Evaluation of the conceptual, item, semantic equivalences showed that the Portuguese version is pertinent for the Brazilian context. Four of seven domains showed internal consistency above 0.70 (α: 0.76-0.90) and five of seven revealed intra-observer reliability (ricc: 0.41-0.70). This first Portuguese version of the HRQL questionnaire can be understood as a valuable tool for assessing children's HRQL, but further studies with large samples and more robust analyses are recommended before use in the Brazilian context.

Inequalities in access and utilization of dental services: a cross-sectional study in an area covered by the Family Health Strategy

This cross-sectional study aimed to investigate the presence of inequalities in the access and use of dental services for people living in the coverage area of the Family Health Strategy (FHS) in Ponta Grossa, Paraná State, Brazil, and to assess individual determinants related to them. The sample consisted of 747 individuals who answered a pre-tested questionnaire. Data analysis was performed by chi-square test and Poisson regression analysis, obtaining explanatory models for recent use and, by limiting the analysis to those who sought dental care, for effective access. Results showed that 41% of the sample had recent dental visits. The lowest visit rates were observed among preschoolers and elderly people. The subjects who most identified the FHS as a regular source of dental care were children. Besides age, better socioeconomic conditions and the presence of a regular source of dental care were positively associated to recent dental visits. We identified inequalities in use and access to dental care, reinforcing the need to promote incentives to improve access for underserved populations.

Social inequalities in health among the elderly

The aim of the present study was to assess social inequalities in health status, health behavior and the use of health services based on education level. A population-based cross-sectional study was carried out involving 1,518 elderly residents of Campinas, São Paulo State, Brazil. Significant demographic and social differences were found between schooling strata. Elderly individuals with a higher degree of schooling are in greater proportion alcohol drinkers, physically active, have healthier diets and a lower prevalence of hypertension, diabetes, dizziness, headaches, back pain, visual impairment and denture use, and better self-rated health. But, there were no differences in the use of health services in the previous two weeks, in hospitalizations or surgeries in the previous year, nor in medicine intake over the previous three days. Among elderly people with hypertension and diabetes, there were no differences in the regular use of health services and medication. The results demonstrate social inequalities in different health indicators, along with equity in access to some health service components.

Analysis of the prevalence of and factors associated with urinary incontinence among elderly people in the Municipality of São Paulo, Brazil: SABE Study (Health, Wellbeing and Aging)

To investigate the prevalence of urinary incontinence among elderly people living in São Paulo, Brazil and their associated risk factors. The Pan-American Health Organization and World Health Organization coordinated a multicenter study named Health, Wellbeing and Aging (SABE Study) in elderly people (over 60 years old) living in seven countries in Latin America and the Caribbean. In Brazil, the study was carried out in São Paulo in the year 2000. The total Brazilian sample included 2,143 people. The prevalence of self reported urinary incontinence was 11.8% among men and 26.2% for women. It was verified that among those reporting urinary incontinence, 37% also reported stroke and 34% depression. It was found that the greater the dependence that the elderly people presented, the greater the prevalence of urinary incontinence. The associated factors found were depression (odds ratio = 2.49), female (2.42), advanced age (2.35), important functional limitation (2.01). Urinary incontinence is a highly prevalent symptom among the elderly population of the municipality of São Paulo, especially among women. The adoption of preventive measures can reduce the negative effects of urinary incontinence.