Social determinants of dental treatment needs in Brazilian adults

Background The chronic cumulative nature of caries makes treatment needs a severe problem in adults. Despite the fact that oral diseases occur in social contexts, there are few studies using multilevel analyses focusing on treatment needs. Thus, considering the importance of context in explaining oral health related inequalities, this study aims to evaluate the social determinants of dental treatment needs in 35–44 year old Brazilian adults, assessing whether inequalities in needs are expressed at individual and contextual levels. Methods The dependent variables were based on the prevalence of normative dental treatment needs in adults: (a) restorative treatment; (b) tooth extraction and (c) prosthetic treatment. The independent variables at first level were household income, formal education level, sex and race. At second level, income, sanitation, infrastructure and house conditions. The city-level variables were the Human Development Index (HDI) and indicators related to health services. Exploratory analysis was performed evaluating the effect of each level through calculating Prevalence Ratios (PR). In addition, a three-level multilevel modelling was constructed for all outcomes to verify the effect of individual characteristics and also the influence of context. Results In relation to the need for restorative treatment, the main factors implicated were related to individual socioeconomic position, however the city-level contextual effect should also be considered. Regarding need for tooth extraction, the contextual effect does not seem to be important and, in relation to the needs for prosthetic treatment, the final model showed effect of individual-level and city-level. Variables related to health services did not show significant effects. Conclusions Dental treatment needs related to primary care (restoration and tooth extraction) and secondary care (prosthesis) were strongly associated with individual socioeconomic position, mainly income and education, in Brazilian adults. In addition to this individual effect, a city-level contextual effect, represented by HDI, was also observed for need for restorations and prosthesis, but not for tooth extractions. These findings have important implications for the health policy especially for financing and planning, since the distribution of oral health resources must consider the inequalities in availability and affordability of dental care for all.

Saúde da família: uma estratégia de mudança no processo de produção dos serviços de saúde

The purpose of this study is to analyze, from the point of view of nurses, changes that took place in the process of providing health services after the introduction of the Family Health Program (FHP). It is na investigation of qualitative nature that uses semi-structured interviews as a main empirical approach tool. Six nurses from the city of Caicó, Rio Grande do Norte, who were working with basic care before the introduction of the FHP, within basic care, were: adscription and ties with the community; hospitality and the humanizacion of care-giving; decrease in cases of inpatient treatment; strengthening of the prevention of injuries and health promotion; improvemente of health indicatiors, finally, actions that point towads meeting the principles of wholeness, equity and universality as a declaration of the Brazilian National Health Care System (SUS). Nevertheless, in spite of all recognizable positive aspects, the FHP has some weaknesses, such as: the difficulty posed by colletive work; the mismatch between professional education and the demands of the current health standard; a poor physical infrastructure of the Basic Health Units; a high heath staff turnover and precarious work conditions. In addition to this, some strategies that can be used to help improve the process of providing health services have been pointed out, such as, coordination between sectors, continuous education, making work conditions less precarious and improving the means whereby heathy service management is conveyed,Tthus, finally, we understand that the FHP does bring forward meaningful changes to the process of provinding health services to strengthen the Brasilian National Health Care System (SUS), in spite of the fact that it lies within a scenario of adversities that can be overcome through the collective endeavor of the several social actors

Sistema de gestão ambiental na produção de água mineral

It s more and more evident the subject of the shortage of water, worsened by the accelerated urbanization, growth of the population, increase of the demand and of the costs of its treatment, factors that are also tied up to the increase of the consumption of mineral waters, whose chemical composition or physical-chemistries characteristics do with that are considered beneficial to the health. The growth accelerated all over the world in its consumption aims the concern with the waters quality, the health and the incentive to the consumption of natural products. However, in spite of quite valuable, that resource is explored, most of the time, without optimization of production or actions that avoid wastefulness. This research is justified for the need of minimizing the negative environmental impacts caused by the mineral water s production, mainly in what it say about the generation of effluents and wastes in the productive process, through the study, development and application of cleaner production tools for the environmental management, pertinent for that section. The applicability of Environmental Management System was determined by means of the characterization of the environmental aspects of productive process in a company of the section, in the state of Rio Grande do Norte and of the discussion of the panoramas that demonstrate the tendency for a sustainable development. Actions as a reforestation, optimization of energy and water uses, recycle of solid residues and water reuse were applied during the research, resulting in the considerable reduction of wastes of raw materials and inputs and consequent environmental and economic won. A specific methodology was proposed with concepts of Environmental Management, integrating with Quality Management. As foundations for the elaboration of the methodology, it was realized a similarity analysis among the systems and, mainly, an analysis of the experiences observed in the case study, including specificities, needs and difficulties of the company. With these results, the implantation of a EMS as a company strategy has environmental, economic and social benefits, and this research can be applied and adequate to others companies and sectors