Dental caries experience in children attending an infant oral health program

Aim: To investigate: a) caries experience in 5 year-old children and its relationship to the caries risk evaluation made before 1 year of age; b) compliance of parents to an infant oral health program as well as the abandonment reasons. Methods: Group A (GA) - 242 children (60-71 months old) who stayed in the program and had been enrolled since their first year of life underwent a clinical examination according to the WHO's criteria; their parents/caregivers were interviewed to ascertain their compliance to the program. Group B (GB) - parents of 60 children, who had dropped out of the program, were interviewed to check the reasons of withdrawing. The caries risk classification was based on the file at the first appointment. Chi-square test was used (α=0.05) for statistical analyses. Results: Most of the children were free of caries (71.1%). Caries risk evaluation showed low sensibility (34.3%, 95% CI = 22.4-46.1) and high specificity (74.4%, 95% CI = 67.6-81.2) to caries experience. Sixty-two mothers (25.6%) reported difficulty to follow the guidelines. The main reason for dropping out was changing to similar health services (40.0%). Conclusions: Caries risk in the first year of life was not efficient to predict dental caries experience at 5 years of age. Educational practice should be improved to increase the compliance of the parents to the program.

Work conditions and occupational health of dentists in Brazilian public health system

Conselho Nacional de Desenvolvimento Ciêntífico e Tecnológico (CNPq)

Efeitos da idade e dos indicadores de obesidade na pressão arterial de trabalhadores

Os objetivos do estudo foram descrever a prevalência de hipertensão arterial (HA) e verificar os efeitos que a idade e indicadores de obesidade provocam na pressão arterial (PA) de trabalhadores de uma indústria de balas e gomas. Para tanto a PA sistólica (PAS), PA diastólica (PAD), as medidas de massa corporal (MC), estatura e circunferência de cintura (CC) foram obtidas de 348 trabalhadores voluntários (243 homens e 105 mulheres). A prevalência de HA na amostra foi 8,9% (31 casos) e mais comum nos homens do que nas mulheres (7,2% vs 1,7%). Entre os hipertensos a idade (PAS r=0,43) e a MC (PAD r=0,39) demonstraram correlação (r) positiva e significativa, apesar de baixa. Por sua vez entre os normotensos (317) e o grupo total (348), a idade e todos os indicadores de obesidade (MC, IMC, CC) apresentaram correlação baixa, porém significativa e positiva com os valores de PAS, PAD e PA média (PAM) (r=0,23 a r=0,47). Adicionalmente a análise estatística revelou que homens e mulheres com HA são mais velhos e obesos do que seus pares normotensos. Exceto para a idade e o sexo, que são fatores de risco não modificáveis, os indicadores de obesidade possuem forte associação com hábitos e comportamentos de risco e, portanto, passíveis de prevenção.

Avaliação das condições de trabalho dos servidores braçais de instituição pública

Descrevem-se as condições de trabalho dos servidores braçais da Prefeitura Municipal de Botucatu (PMB), Brasil, procurando identificar as condições mais freqüentes e mais graves de riscos ocupacionais. Foi analisada a morbidade registrada no ambulatório dos servidores municipais, no período de 17 de julho a 4 de dezembro de 1987; foram analisados os acidentes de trabalho sofridos e registrados pelos servidores municipais nos anos de 1984, 1985,1986 e 1987. A descrição dos setores braçais revelou que as tarefas executadas na PMB são, majoritariamente, executadas manualmente, sem tecnologia, evidenciando condições potenciais para gerar acidentes de trabalho e posições antiergonômicas como as condições de risco mais freqüentes. Os coeficientes de gravidade desses mesmos acidentes elevaram-se desde 1984, sendo o de 1987, 1,85 vezes maior que o de 1984. A análise da causa externa e natureza da lesão decorrentes dos ATs validam a descrição do processo de trabalho e das condições de risco ocupacionais observadas. Os agravos mais freqüentes registrados no ambulatório foram: hipertensão arterial, outras circunstâncias familiares não especificadas (problemas pessoais), lombalgia, gripe, alcoolismo crônico e gastroenterocolite aguda, sendo que todas essas doenças (exceto problemas pessoais) foram mais freqüentes nos servidores braçais do que nos administrativos. Propõe-se a implantação de um programa de saúde ocupacional voltado aos servidores municipais da PMB.

Programa Saúde da Família: a experiência de equipe multiprofissional

OBJETIVO: O Programa Saúde da Família propõe uma nova dinâmica para estruturação dos serviços de saúde, assim como para a relação com a comunidade e para diversos níveis de assistência. O objetivo do estudo foi analisar o significado da experiência do trabalho em equipe para os profissionais do Programa Saúde da Família. MÉTODOS: O estudo foi realizado no município de Conchas, Estado de São Paulo no ano de 2004. A abordagem utilizada foi qualitativa, na vertente da fenomenologia, buscando a essência da realidade vivenciada por oito profissionais de duas equipes do Programa Saúde da Família. RESULTADOS: Os temas revelaram que o trabalho em equipe se caracteriza por dedicação durante as atividades diárias. É necessário haver interação entre todos os membros para ações integrais, embora haja diferenças de ideologias e condutas entre os profissionais. O contato próximo com as famílias permitiu melhor intervenção nos problemas e o trabalho integrado é fundamental para atuação eficaz e de qualidade. CONCLUSÕES: O fenômeno desvelado engendra nova perspectiva de atuação para os profissionais e possibilita a compreensão do trabalho em equipe multiprofissional.

Programa de saúde vocal para educadores: ações e resultados

TEMA: a voz do professor tem sido foco de estudos nas últimas duas décadas devido à alta ocorrência de alterações vocais nesta classe profissional, assim, reforçou-se a necessidade dos professores participarem de ações para garantir saúde vocal. Poucos são os estudos na literatura que descrevem programas e seus resultados. PROCEDIMENTOS: Descrever um Programa de Saúde Vocal desenvolvido no período 2002 a 2005, para educadores de ensino público (infantil e fundamental) do interior do Estado de São Paulo, composto por grupos básicos de voz oferecendo conhecimento teórico prático de cuidados vocais, com triagem da qualidade da voz dos participantes; grupos avançados buscando reorganização dos processos de fonação e do uso vocal em sala de aula. RESULTADOS: em média 56% dos educadores inscritos frequentaram as ações; 62,9% das vozes apresentavam distúrbios na triagem vocal com maioria em grau discreto; no início dos grupos avançados 100% dos educadores participantes referiram mais de 3 sintomas associados ao uso vocal, e após, somente 45% deles ainda de 4 a 13 sintomas; os dados de autopercepção vocal revelaram baixos escores de impacto da voz nas atividades profissionais. CONCLUSÃO: a descrição revelou a necessidade de ajustes constantes do programa para alcançar seus objetivos. A baixa participação às ações pode estar relacionada à presença de impacto discreto da voz nas atividades profissionais, fato a ser mais bem investigado no futuro, e o benefício constatado objetivamente da participação dos educadores nos grupos avançados de voz foi a diminuição na quantidade de sintomas vocais.

Diagnostic de sécurité d’une entreprise brésilienne à partir de l’analyse des accidents du travail par la méthode de l’arbre des causes

We present here the results of a study of 21 work-related accidents that occurred in a Brazilian manufacturing company. The aim was to assess the safety level of the company to improve its work accident prevention policy. In the last 6 months of 1992 and 1993, all accidents resulting in 15 days' absence from work, reported for social security purposes, were analyzed using the INRS causal tree method (ADC) and a questionnaire completed on site. Potential risk factors for accidents were identified based on the specific factors highlighted by the ADC. More universal trees were also compiled for the safety assessment. Three hundred and thirty specific accident factors were recorded (mean of 15.71 per accident). This is consistent with there being multiple causes of accidents rather than the assertion of Brazilian business safety departments that accidents are due to dangerous or unsafe behavior. Introducing the idea of culpability into accidents prevents the implementation of an appropriate information feedback process, essential for effective prevention. However, the large number of accidents related to material (78%) and environment (70%) indicates that working conditions are poor. This shows that the technical risks, mostly due to unsafe machinery and equipment are not being dealt with. Seventy-five potential accident factors were identified. Of these, 35% were organizational, a high proportion for the company studied. Improvisation occurs at all levels, particularly at the organizational level. This is thus a major determinant for entire series of, if not most, accident situations. The poor condition of equipment also plays a major role in accidents. The effects of poor equipment on safety exacerbate the organizational shortcomings. The company's safety intervention policy should improve the management of human resources (rules designating particular workers for particular workstations; instructions for the safe operation of machines and equipment; training of operators, etc.) and introduce programs to detect risks and to improve the safety of machines and equipment. We also recommend the establishment of a program to follow the results of any preventive measures adopted.

Subnotificação de acidentes do trabalho não fatais em Botucatu, SP, 2002

Objective: The implementation of work-related injury prevention policies has been hindered by underreporting of incidents among formal workers, and substantial underreporting among informal workforce. This study aimed at estimating the underreporting of work-related injury in a median-sized city. Methods: A random survey was carried out among residences in the urban area of Brazil. Residents were interviewed about the occurrence of work-related injury to people aged more than nine years in the last 90 days. All incidents reported were double checked in the National Social Security Institute (INSS) records. Results: There were 9,626 residences visited. It was estimated 79.5% (CI 95%: 78.8%-80.3%) of underreporting of work-related injury. Conclusions: Work-related injury reporting is poor in the study location and this may be occurring in other cities. Data suggest the need to build up information systems on Brazilian workers' health. It should incorporate methods, materials and human recourses necessary to recognize, store, analyze, and spread information support injury prevention policies and promote workers' health programs.

Stressful life events and occupational accidents

Objective: The purpose of this study was to examine the association between stressful life events and occupational accidents. Methods: This was a population-based case-control study, carried out in the city of Botucatu, in southeast Brazil. The cases consisted of 108 workers who had recently experienced occupational accidents. Each case was matched with three controls. The cases and controls answered a questionnaire about recent exposure to stressful life events. Results: Reporting of environmental problems, being a victim of assault, not having enough food at home and nonoccupational fatigue were found to be risk factors for work-related accidents with estimated incidence rate ratios of 1.4 [95% confidence interval (95% CI) 1.1-1.7], 1.3 (95% CI 1.1 1-1.7), 1.3 (95% CI 1.1-1.6), and 1.4 (95% CI 1.2-1.7) respectively. Conclusions: The findings of the study suggested that nonwork variables contribute to occupational accidents, thus broadening the understanding of these phenomena, which can support new approaches to the prevention of occupational accidents.

Social disparity and oral health

There is a clear reported association between social disparity and oral health, for example, between dental caries and malnutrition in children. This fact is detected in several studies, and also found amongst the Brazilian population. However, several efforts have been made to improve the quality of life of the population and to achieve the 2015 Millennium Development Goals. Oral health is a branch to be improved among these goals. The Brazilian experience has been drawing the attention of authorities, insofar as there have been direct improvements in oral health through state oral health programs, and also indirect results by improving the quality of life of the population. Included within the Brazilian oral health programs are the Family Health Program and Smiling Brazil Program. The former is a global healthcare program which involves primary oral healthcare, while the latter is a specialized oral care program. Among the social programs that would indirectly improve oral health are Family Stipend and the Edmond and Lily Safra International Institute of Neuroscience of Natal (ELS-IINN). In conclusion, although oral health problems are related to socioeconomic factors, the implementation of primary oral health programs and programs to improve the population's quality of life may directly or indirectly improve the oral health scenario. This fact is being observed in Brazil, where the oral health policies have changed, and social programs have been implemented.

A saúde bucal no contexto da saúde do trabalhador: análise dos modelos de atenção

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Between the processes of strengthening and weakening of the Family Health Strategy

This was a qualitative study with the purpose of designing a meta-model for the work process of the Family Health Strategy (FHS) team. It was based on the experience of six sample groups, composed of their members (physicians, professional nurses, dentists, dental assistants, licensed technical nurses and community health agents) in a city in São Paulo state, Brazil, totaling 54 subjects. Six theoretical models emerged from non-directive interviews. These were analyzed according to Grounded Theory and submitted to the meta-synthesis strategy, which produced the meta-model between the processes of strengthening and weakening of the FHS model: professional-team-community reciprocity as an intervening component. When analyzed in light of the Theory of Complexity (TC), it showed to be a work with a vertical and authoritarian tendency, which is largely hegemonic in the tradition of public health care policies.

Os desafios para a implantação da política de Saúde do Trabalhador no SUS: o caso da região de Franca-SP

This article offers theoretical and practical elements for an analysis of the Worker's Health Care Program developed by the Brazilian Unified Health System (SUS). From a determined locus, the region of Franca, State of São Paulo, it aims at identifying the challenges for implementation of the National Occupational Health Policy, due to the particularities of the work/health relationship within the sugarcane agro-industry. It is based on group interviews involving health workers, specifically sanitary inspectors and the worker's health interlocutors. The results showed that health care professionals must be better prepared, from the technical point of view, to be able to perform actions related to workers' health. These results also indicated the need for a greater integration between health services, particularly when damage notification and workers' health surveillance are concerned.