A organização da demanda em serviços públicos de saúde bucal: universalidade, eqüidade e integralidade em saúde bucal coletiva

RONCALLI, Angelo Giuseppe. A organização da demanda em serviços públicos de saúde bucal: universalidade, eqüidade e integralidade em Saúde Bucal Coletiva. raçatuba, 2000. 238p. Tese (Doutorado em Odontologia Preventiva e Social). Faculdade de Odontologia, Universidade Estadual Paulista “Júlio de Mesquita Filho”

Avaliação das concentrações hepáticas e séricas de retinol em bovinos e do consumo habitual de fígado por gestantes

The vitamin A is essential to animals because of its participation in a great number of biological functions. The investigation of this vitamin s concentrations is important to serve as reference to normality parameters. This study had as aim to analyse the serics and hepatics concentrations of vitamin A in two groups of bovines and to compare the hepatics concentrations to the present requeriments of vitamin A for pregnant women. It was also appraised the consume habit of bovine liver by pregnant women through of the alimentary frequency quest. Two groups of bovine were studied and the first was formad by Nelore bovine breed and the second by bovine without defined breed (WDB). It was analysed 120 samples: 60 of liver and 60 of serum. The method used to dose retinol was High Performance Liquid Cromatography (HPLC). The average (+ sd) of retinol concentrations in Nelore breed bovine and WDB liver were 16947,8 + 6866,9 and 5213,1 + 2517,2 µg of retinol/100g and at serum 39,6 + 17,9 e 28,6 + 9,4 µg of retinol/dL, respectively. No statistically significant correlation was found between hepatic and the serum retinol. The bovines in this study had adequate vitamin A levels. Independently of animal breed, the daily ingestion of bovine liver is not advised for pregnant women who show adequate support of vitamin A. The consume of bovine liver by pregnant women consulted on school maternity hospital Januário Cicco, UFRN, Natal RN, was considered high

A experiência da pré-eclâmpsia vivenciada por gestantes e profissionais de saúde

The aim of this study is to understand the perceptions of pregnant women, mothers and health professional about preeclampsia and the relation between professional and patient. A qualitative approach was chosen, together with semi-structured interviews, participative observation and Test of Free Association of Words (TFAW). The data were collected in February and June 2007 at Maternidade-Escola Januário Cicco (MEJC), Natal, RN, Brazil with 61 pregnant women and 87 professionals, 20 of each group were interviewed. An interpretative and understanding perspective was used similar to that of Gadamer s hermeneutics and with the construction of themes and empirical categories. The pregnant women showed fear preeclampsia and its consequences, and to know very little about the subject and also a desire to know more. The changes that occurred with the illness were more related to the emotional order than to the healthy lifestyle they have adopted. Some lack of preparation of the basic units was observed, in order to meet and guide the pregnant women to the reference unit. Professionals knew the customers characteristics, about their fear and about their little knowledge on this illness. Nevertheless, they did not include them in the treatment. It was observed the absence of conversation over the illness between professionals and patients and also the inability of the former to deal with emotional issues. A new way of looking into the preeclampsia assistance is necessary. A way that focuses on the collective construction of intervention and approach strategies; one which includes subjective aspects in an hermeneutic perspective of health

Formação em odontologia: um estudo sobre as clínicas integradas em cursos do Brasil

Dental education is going through important changes in preparing workers to meet the needs of the society and the labor market. For that reason, we studied the offering of comprehensive dental care clinics in Brazil with the aim of encouraging future curriculum changes focused on the training of general dental practitioners. An email questionnaire on educational organization and comprehensive care clinics of undergraduate programs was sent to each academic dental affairs dean. Sixty-seven (41.6%) dental schools agreed to participate. We observed that curriculum changes have contributed to modify the format of comprehensive care clinics. This was felt mainly (88,1%) with regards to workload and course offerings in different levels of the dental curriculum, thereby creating a favorable environment for generalist training. Most schools shared the following characteristics: clinical procedures were being prioritized according to level of complexity (95,5%), students were having the chance to attend courses in other programs (37,3%), and attempt to diversify teaching methods was being challenged (58,2%). Although progress in combining teaching and clinical services was reported by 83,6% of schools, most clinical procedures were still being performed intramurally (50,7%) in partnership with public service. There was also improvement in clinical mentorship due to the hiring of instructors qualified to work in comprehensive care clinics and with aptitude to supervise a wider range of dental procedures (58,2%). Further changes to Brazilian comprehensive care clinics should hence be encouraged and intensified to ensure appropriate generalist training for dental practitioners

A (bio)ética e a Odontologia: os (des)caminhos de uma formação humana

The present research carried out from three national dentistry magazines published in the period between 1990 and 2004, has as a goal to analyze how bioethics has been approached in this area, not only identifying the main concerns and tendencies, but also aiming to learn how this knowledge is produced and divulged in the dentistry circuit. We have articulated a quantitative-qualitative approach, studying 2995 articles. The articles were selected and assorted in twenty thematic categories, through their titles and key words. The analysis of the empiric material shows that, although there is a growth tendency of this discussion, little has been published about this theme (1,9%). Besides, it seems that there is an arrhythmia between the present bioethic approach in dentistry and the present life demands, where the deontology and legalist focuses are predominant, seeming to correspond to the inner aspects of the profession alone. In spite of this, through the qualitative approach it was possible to identify ways to build a more complex and integral odontological formation and practice. Within the conclusions, we still point out, that, this investigation, even face to its limitations, seems to offer subsidies for reflection and further studies about the theme, working as a parameter to keep up with the evolution of the bioethic thinking in the Odontology

Aleitamento e infecções por parasitas intestinais em gestantes adolescentes e seus filhos

The exclusive breastfeeding in the first six months of life practice is essential for the health and development of children. Studies show there is in human milk protective antibodies against intestinal parasites and a relationship between the absence of breastfeeding or weaning and parasitic infections. This work was a prospective cohort study involving 34 pregnant adolescents attended school in Maternity Januario Cicco / RN and their children, to assess the influence of breastfeeding on intestinal parasites in them. Thus, the parasitic infection was investigated by examination of feces parasitological and environmental factors by use of questionnaires. The average age of the mothers studied was 16.2 years. Of these 76.4% were infected and the most prevalent species of parasites were Entamoeba histolytica/dispar (76.9%), Giardia lamblia (19.2%) and Ascaris lumbricoides (11.5%). The infected children had an average age of 5.1 months and the frequency of parasites was 61.7%. The infection was earlier detecctada with 45 days of life. The most common parasites were Giardia lamblia (40%), Entamoeba histolytica/dispar (35%), Ascaris lumbricoides (5%) and Ancylostoma (5%). The average length of exclusive breastfeeding was 2.2 months. There was an association between increased duration of exclusive breastfeeding and increased time to detection of parasites in the feces of children. There was no statistically significant correlation between the socio-economic conditions and cultural and breastfeeding. The data reinforce the importance of breastfeeding to protect the children in its first year of life

Qualidade de vida em gestantes no contexto na Estratégia Saúde da Família

The pregnancy as a process in woman's life requires several biological, psychological, relational and socio-cultural changes for the preparation for motherhood. By modifying its capacity and, at the expense of these factors, it is observed that the physical, social and emotional problems experienced by women during pregnancy can affect their quality of life, especially related to health. It had as objectives of this research verifying the quality of life of women in the context of the Family Health Strategy in a municipality in Paraíba, in order to characterize the sociodemographic aspects, lifestyle habits, and obstetric care of pregnant women and to characterize the fields of quality of life of pregnant women according to the WHOQOL-bref. This is a descriptive exploratory study with cross-sectional and quantitative approach. The population consisted of 120 pregnant women in primary care in the municipality of Sousa-PB. Data collection occurred over a period of two months by the own master's degree student and two nursing students in applying a standard form about sociodemographic characteristics, and obstetric care and the WHOQOL-bref instrument. The data collected were organized into an electronic database of the Microsoft Excel application, coded, tabulated and presented in tables, charts and figures with their respective percentage distributions. Of the surveyed, the predominant were age group of 20 to 25 years, Catholic religion, with a steady partner, low education, no employment, wage income of 01 minimum wage. As for the data and obstetric care, almost all had never aborted and reported to the care received as excellent. The most frequent complaints were back pain and in lower abdomen. Regarding quality of life according to the WHOQOL-bref, dissatisfactions that predominated in the areas were in the physical pain and discomfort, sleep, rest, energy and fatigue. In the psychological domain, body image and appearance, memory, concentration and negative feelings. In the field of social relationships, sexual activity and the environment domain, the greatest dissatisfaction with facets scored: financial resources, leisure opportunities and transport. It is concluded that the quality of life of the users interviewed were deemed unsatisfactory for these facets, indicating that assistance to this target audience should be done comprehensively and holistically, in order to accommodate the affected facets to improve the quality of life pregnant women attended in primary care

Ergonomia e Odontologia: determinantes da postura corporal dos estudantes da clínica-escola de uma Universidade Federal

Posture is one of the most worrying problems dentists face. That is because of the high incidence of low back pathologies regarding the professional activity, despite the development on the field of Dental Ergonomics. This work took place at the dental schoolclinic at a Federal University, and it was grounded on the Ergonomic Principles in the workplace. Its main objective was to analyze the determinants of inadequate posture adopted by students inasmuch as the adoption of non ergonomic methods at the school-clinic may influence them to develop inadequate postures in their working environment. The analysis of the activity showed us that it requires some complex procedures in the patient s mouth. Thus, when the students carry out the activity, they start to adopt, although unconsciously, inadequate postures which will make easier the visual accuracy and the access to the operation focus. In case there is no internal (body awareness) or external warning mechanisms (the professor s or the partner s counseling) regarding posture or possible risks which lead them to self-correction, the students become vulnerable to osteomuscle disorders. The time pressure, because the students are expected to perform their task in a predetermined clinical time. The facts related to each patient s variability as well as the stress caused by the expectations to get their work done in time make the students to advance it believing they will waste time if they help their partners or using an indirect view. We could also notice that there was no assistant to perform the job of minor ones, as well as there was no professor who could actually connect the knowledge on Ergonomics to its working practice. The conclusions of this work stand out the need of widen the discussion at the academic environment regarding health professionals in places such as universities. The ergonomic principles in the workplace aim a multidisciplinary analysis based on the experience of students, professors, staff members and janitors that can contribute to some reflection upon the issue and consequently actions which will bring positive changes at the working environment

Programa de odontologia para bebês: uma avaliação quantitativa e qualitativa

The objective of this study was to evaluate a baby dentistry program which has been in the city of Natal for five years. The research was based on two analysis: a quantitative one, which tried to check caries prevalence in 52 children supported by the program and a qualitative one, which, through interviews carried out with the mothers, using the focus group technique, tried to realize the effect of the program their attitudes related to the care of their children´s oral health. For the quantitative analyses of caries prevalence there was the use of def-s and knutson rates and the values obtained were shown in a descritive and analytical way.The results showed that 4.2% of babies ranging 24 to 36 months old presented carie disease. Children from 36 to 48 months old and above 48 months old presented 18.2% and 16.7% carie prevalence respectively.The def-s averages found in ages 24 to 36, 36 to 48 and 48 to 60 months old were 0.08; 0.40 and 1.16 respectively, considered as being equally low, going along with Knutson rates. The qualitative analyses showed a high level of the mothers` satisfaction, considering the access,practitioner-patient relationship and opportunity to keep the oral health. Children supported by the program showed a low carie prevalence and the program turned out to be effective under the mothers` point of view

Projetos políticos pedagógicos dos cursos de Odontologia do RN : formação profissional e a perspectiva da atenção à terceira idade

Brazil has been undergoing major demographic change.According to IBGE, the next 20 years the country's elderly population may reach over 30 million people. This tariff provides specifics regarding the process of health / disease. It is essential that higher education institutions are committed to this demand in view of the integrated training of health needs of society. The aim of this study is to analyze the Pedagogical Political Projects (PPP) of courses in dentistry in Rio Grande do Norte (RN), according to the national curriculum guidelines (DCNS) and training from the perspective of health care for the elderly. This is an exploratory study with a qualitative approach: with records and interviews. The study subjects were an Assistant Professor in the development of PPPs for each institution. The scenario in this study were dental training institutions in the newborns. Initially, the analysis of the PPP was by using the Alceste 4.9 software. The interpretation of the contents of interviews with teachers was done through content analysis of Bardin (2010). The PPPs are based on the DCNS, meet the characteristics of regional and seek a generalist, but still strongly directed to technical and scientific aspects of professional practice. Efforts and institutional approaches, involving teachers and students of the courses are being mobilized for training with more articulated network of health services. However, the emphasis on content pertaining to the health care of the elderly, is still limited when compared to those targeted content inherent in children and adolescents in all three curricular structures. It is reasonable to conclude that the historical, political, scientific, cultural and social, present in society, influence the formation of the dental professional RN. The greater participation of society in the process of vocational training in dentistry is needed. This can be done from the involvement of universities with health councils, bodies representing the dental profession and other segments of civil society in order to induce changes that generate ideas and educational practices integrative and interdisciplinary, with emphasis on continuing education for teachers, servants, employees and students. Containing conduct this process inherent flexibility of curriculum, teaching-service integration and coordination abilities and professional skills that are essential to understanding the human being and its complexities

Atividades preventivas realizadas pelos cirurgiões-dentistas do PSF de Natal-RN

Family Health Program (FHP) presents itself as a restructured model on basic cares besides having prevention practices and promotion in health as essential parts. According to that, the purpose of this study is to perceive which prevention practices in oral health are accomplished by the dentists from the FHP of Natal-RN as well as the way they have been developed, the knowledge basis to execute the procedure and the use of evaluation instruments by the dentists and by the Oral Health Co-Ordinator. A list of dentists participating on the FHP of Natal in March, 2006 (n= 91) was obtained so it was possible to formulate a structured interview. After excluding those with less than six months attending to the program, and considering the loss, eighty dentists got to be interviewed. It had questions about individual and group preventive procedures, sources of basement to develop the activities and to verify the impact and evaluation instruments. Besides that, an interview was made with the Oral Health Co-Ordinator about the evaluating process and the existence of a protocol as well as about document analysis in the Ambulatory Informations System Unique Health System (AIS-UHS), Information of Basic Care System and Pact of Recorder. The main individual activities consist on Oral Hygiene Orientation (87,5%) and Fluoridization (95%). Group activities remain at scholar groups acts(91,25%) being fluoridization done by 91,25% and educative activities by 86,25% mainly through speeches (61,25%).Orientations about oral cancer were detached on the aged group (39,96%)and hypertensive and diabetic group (19,51%), as well as integration with the health team was respectively 21,93% and 39,02%. Speeches and talk rounds are the main activities for aged, hypertensive and diabetics, and are also expressive to pregnant women. For pregnant women and babies group predominate hygiene and diet orientation. About the evaluation instruments 73,75% of the dentists do not consider their existence, despite 73,75% consider that actions have impact specially due to a increase of hygiene and decrease of caries index on the children. The main sources of basement are clinical experience (42,5%) and preparative courses (33,75%), only 7,5% mentioned population need and local reality. The Oral Health Co-Ordinator related the Attention Pact Recorder and records from the AIS - UHS as evaluation source but also detached the lack of epidemiologic surveying. She mentioned the increase of supervised brushing as a positive result and detached the hardness of the professional to act inside the family and as a team. The AIS-UHS records showed that fluoridization is more used individually and the supervised brushing is predominant as a group action, besides that educative activities at the Health Establishment predominate due to actions at the community. Facing the results, it was verified the act in different groups, special attention given to scholars, as well as focus the activities on caries giving less emphasis to other oral problems. Despite that, there was no epidemiologic instruments or data of the local reality to guide the actions and to be part of the planning and evaluation process

Bioética e odontologia: um perfil dos problemas éticos vividos por cirurgiões-dentistas

Bioethics studies human behavior in the fields ofbiological sciences and health care. Tt strives for humanization in health services along with promoting the rights of patients. In view of the lack of dental research dealing with this topic, the present study was undertaken to identify, from the viewpoint of dental surgeons, ethical problems experienced in dental practice,understand how they occur and how professionals deal with them. It is a descriptive exploratory investigation within a qualitative approach. Empirical material was collected through semi-structured interviews performed with 15 dental surgeons who work both in private and public practice in the state of Rio Grande do Norte, Brazil. The content of the interviews was systemized and organized, resulting in the identification of topics, from which were grouped the ethical problems reported by the participants. The resu1ts indicate that many of the ethical problems coincide with infringements of the norms and mIes of the Dental Code of Ethics, confirming a dental ethic acquired during professional formation and therefore, inadequate for solving the problems that emerge in professional practice. Other questions stand out such as low salaries, competition and poor working conditions. Associated to these problems are lack of commitment and professional responsibility with the patients. Concem with maintaining user autonomy, guaranteeing access to specialized services, and the need for performing only procedures for which they are technically qualified arise in the responses, leading to difficulties in consolidating the principIes proclaimed by bioethics: autonomy, justice, nonmaleficence and beneficence. We concluded that the ethical problems identified in professional practice need to be understood beyond the dental dimension, towards a human approach. It is therefore necessary to incorporate health care management technologies into health practices, including dentistry, which implies recognizing the difTerent dimensions that surround individuaIs, that is, social, economic, political and cultural

Avaliação dos níveis de proteína C-reativa ultra-sensível em pacientes com periodontite crônica severa generalizada e sem periodontite

INTRODUCTION: The high sensitivity C-reactive protein (hsCRP) constitutes an inflammatory mediator used as predictor of cardiovascular risk that comes being researched as indicative relation factor between cardiovascular and periodontal diseases. PROPOSITION: To compare serumals levels of C-reactive protein between patients with and without generalized severe chronic periodontitis. METHODOLOGY: A seccional study was realized using a sample with 62 patients, being 31 participants carriers of periodontal diseases (Group I) and 31 without periodontal diseases (Group II), grouped to the pairs by age and sex. As inclusion criterio were selected patients with diagnosis of generalized severe chronic periodontitis, being preculeds, individuals which presented systemic disease, recent infection history, historical of CVA or stroke, smokers, pregnants and lactants. The research consisted of two stages, a clinc and other biochemist. The clinical stage is constituted of periodontal examination and the biochemist stage, of the peripheral blood collection for determination hsCRP levels and a hemogram to inquire any panel which could suggest infectious and/or inflammatory process. RESULTS: Periodontal disease group presented a average of 0,36mg/dL, while the group without disease presented 0,17 mg/dL, do not existing significant difference statistically between the averages (p = 0,061). The cardiovascular risk for the group I was classified high for 27,6% of participants and low for 72,4% of them. In the group II, 6,45% presented high risk e 93,5% low risk, being this significant relation statistically gotten for Fisher s Test (p = 0,042) presenting OR = 5,33; IC = 95% (1,02 27,4). The independets variables reseacred do not presented significant association statistically with the levels of hsCRP. CONCLUSION: The study indicated that despite of carriers patients of periodontal diseases do not present differents serumals levels of hsCRP from the other group, the periodontal disease was considered as risk factor for hsCRP plasmatic levels elevation

Condição peri-implantar e fatores associados às doenças peri-implantares em pacientes reabilitados no serviço odontológico da faculdade de odontologia da UFRN

A introdução dos implantes dentários osseointegrados como uma ferramenta na reabilitação oral de pacientes edêntulos e parcialmente edêntulos é uma realidade no cotidiano do cirurgião-dentista. Estudos reportam uma alta taxa de sucesso da utilização de implantes no tratamento reabilitador. Entretanto, outras investigações têm mostrado a perda desses implantes devido a infecções peri-implantares, como a mucosite e a peri-implantite. O objetivo deste trabalho foi avaliar a frequência das doenças peri-implantares e seus fatores associados em pacientes com implantes dentais em função reabilitados no serviço odontológico da Faculdade de Odontologia da UFRN. Foram examinados 155 indivíduos portadores de 523 implantes e 2718 dentes. Dentes e implantes foram avaliados por meio de sondagem periodontal, observando-se a profundidade de sondagem, retração gengival, bem como foram avaliados índices de placa visível (IPV) e sangramento gengival (ISG) e presença de supuração. Os dados foram armazenados em fichas clínicas e avaliados estatisticamente por meio da estatística descritiva e inferencial. A idade média dos pacientes foi de 54,05 (± 12,61) anos, sendo 79,4% do sexo feminino. As frequências da mucosite, peri-implantite e periodontite em indivíduos foram 54%, 28% e 50%, respectivamente. Dos 523 implantes avaliados, 43% tinham mucosite, 14% peri-implantite e 43% saúde. Os testes Qui-quadrado de Pearson e Exato de Fisher mostraram que as doenças peri-implantares estão associadas as doenças periodontais, uso de medicação, alterações sistêmicas número de implantes, IPV, ISG, ao tempo de função das próteses, região do implante, número de roscas expostas e faixa de mucosa queratinizada (p<0,05). A análise de regressão múltipla, através da regressão binária logística, constatou que indivíduos que faziam uso de medicação (OR = 1,784), com um ISG > 10% (OR = 1,742), com implantes instalados na maxila (OR = 2,654), onde a prótese sobre o implante tinham mais de 2 anos em função (OR = 3,144) e que radiograficamente apresentavam uma perda óssea atingindo a terceira rosca do implante (OR = 4,701) mostram uma associação positiva com as doenças peri-implantares de maneira que esses indivíduos têm mais chances de ter essas doenças. Os resultados sugerem que a frequência das doenças peri-implantares na população em estudo foi de 82% dos pacientes e que estas doenças estão associadas a fatores relacionados aos indivíduos como: a presença da doença periodontal, piores IPV e IS, alterações sistêmicas, uso de medicação e maior número de implantes; e a fatores locais relacionados aos implantes como: ausência ou faixa de mucosa menor que 2mm, implantes na maxila e na região anterior, perda óssea atingindo a terceira rosca do implante e a um tempo de reabilitação prótetica maior que 2 anos

Prevalência da disfunção temporomandibular em estudantes de odontologia por meio de diferentes índices

The epidemiology of temporomandibular disorders varies widely in the literature. The aim of this study was to determine the prevalence of TMD in dental students of the Federal University of Rio Grande do Norte assessed by different indexes. The sample consisted of 101 individuals selected by a randomized process, whose general outline was systematic sampling. For evaluation of the signs and symptoms of TMD, an anamnestic index, Fonseca s protocol, and two clinical indexes, the RDC/TMD (Research Diagnostic Criteria for Temporomandibular Disorders), or standard index, and the Helkimo s Clinical Dysfunction Index were applied. Data were analyzed using the chi-square test and kappa, besides verifying the sensitivity and specificity (5% significance). The diagnosis of TMD by different indexes showed a variation in the prevalence between 72.3% (Helkimo s Clinical index), 64.4% (Fonseca s anamnestic index) and 35.6% (RDC/TMD). There was no statistical difference between the sexes for the RDC/TMD, although this difference was found for Fonseca s and Helkimo s indexes (p<0.05). The most frequent type of TMD were joint disorders (Groups II and III), and the subtypes disc displacement with reduction (17.8%) and arthralgia (15.8%). Most individuals showed a mild TMD (45.5%) for both indexes, Fonseca and Helkimo. When comparing the types of diagnoses, RDC/TMD with Fonseca and Helkimo, low agreement was found (k=0.17 and k= 0.35, respectively). A moderate correlation between the severity of TMD was obtained (kw= 0.53) for Fonseca s protocol and Helkimo s index. High sensitivity and low specificity were seen for both diagnoses compared to standard, resulting in excessive false positives. Within the limitations of the study, it was concluded that the prevalence of TMD can vary widely, depending on the index used for its diagnosis