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.

Proposta educacional on-line sobre úlcera por pressão para alunos e profissionais de enfermagem

OBJETIVOS: Desenvolver uma proposta educacional on-line sobre o tema úlcera por pressão para alunos e profissionais de enfermagem. MÉTODOS: Pesquisa aplicada, de produção tecnológica, composta pelas etapas de concepção/ planejamento e desenvolvimento, caracterizadas por um conjunto de procedimentos, documentação, digitalização de informações e de imagens. Foram utilizados recursos computacionais didáticos interativos como: o Cybertutor e o Homem Virtual. RESULTADOS: Desenvolvimento de uma proposta educacional virtual sobre úlcera por pressão (UP) dividida em módulos de aprendizagem, contendo lista de discussão, estudos de casos e recursos didáticos, tais como fotos e o Homem Virtual. CONCLUSÕES: Utilizou-se de novas tecnologias educacionais, com a finalidade de promover o aprendizado sobre UP a estudantes de graduação de enfermagem e possibilitar a educação continuada de enfermeiros, uma vez que as UP representam um desafio aos profissionais da saúde e aos serviços de saúde.

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.

Mudanças no Código Florestal e seu impacto na ecologia e diversidade dos mamíferos no Brasil

Os ecossistemas florestais do Brasil abrigam um dos mais altos níveis de diversidade de mamíferos da Terra, e boa parte dessa diversidade se encontra nas áreas legalmente protegidas em áreas de domínio privado. As reservas legais (RLs) e áreas de proteção permanente (APPs) representam estratégias importantes para a proteção e manutenção dessa diversidade. Mudanças propostas no Código Florestal certamente trarão efeitos irreversíveis para a diversidade de mamíferos no Brasil. Os mamíferos apresentam papéis-chave nos ecossistemas, atuando como polinizadores e dispersores de sementes. A extinção local de algumas espécies pode reduzir os serviços ecológicos nas RLs e APPs. Outra consequência grave da redução de áreas de vegetação nativa caso a mudança no Código Florestal seja aprovada será o aumento no risco de transmição de doenças, trazendo sério problemas a saúde pública no Brasil.

Epigean and subterranean ichthyofauna in Cordisburgo karst area, eastern Brazil

After an ichthyofaunistic survey conducted in May 2007 on surface (epigean) water bodies of Cordisburgo karst area, State of Minas Gerais, 13 species were recorded, mostly characiforms; in addition three non-troglomorphic (normally eyed and pigmented) and one troglomorphic catfish (siluriforms) species were recorded in two caves surveyed at different occasions, totaling 17 fish species for the area. All the nominal species herein reported for Cordisburgo area have been previously reported for the Rio das Velhas basin. None of the species observed in caves were found in epigean habitats and vice-versa. The four cave species are distributed throughout subterranean stream reaches, with individuals at different size/age classes. This, associated to the lack of conspicuous morphological differences in relation to epigean congeners, indicate that Trichomycterus brasiliensis, Gymnotus cf. carapo and Pimelodella cf. vittata are troglophiles (species encompassing individuals able to live and complete their life cycle either in the surface or in the subterranean environment) in the Morena Cave; the latter forms a large population and may be at the beginning of a differentiation process due to isolation in the subterranean habitat, as indicated by a slight reduction in eye size. Topographic isolation may be the cause for the incipient, but unmistakable troglomorphism of the Rhamdiopsis population found in the Salitre Cave, allowing for its classification as troglobite (exclusively subterranean species). The Cordisburgo area is subject to significant anthropic pressure, mainly represented by deforestation for agriculture, cattle raising and timbering. Tourism is an additional important threat for cave communities, calling for urgent protection measures.

Mamíferos não voadores (Mammalia) da Estação Ecológica Serra Geral do Tocantins

A comunidade de mamíferos terrestres foi amostrada em três localidades (1-Mateiros, TO; 2- Rio da Conceição, TO e 3- Formosa do Rio Preto, BA) no interior da Estação Ecológica Serra Geral do Tocantins. Para o registro dos marsupiais e pequenos roedores foram utilizadas armadilhas convencionais (5.396 armadilhas.noite) e armadilhas de queda (5.300 pitfalls.noite) nas diferentes fitofisionomias encontradas, entre elas: campo úmido, campo limpo, campo sujo, campo cerrado, cerrado sensu stricto, cerrado com afloramentos rochosos, mata de galeria e mata de galeria úmida. No caso dos mamíferos de médio e grande porte, foram obtidos registros casuais através de observação direta e evidências indiretas (rastros, fezes, crânios e carcaças de animais encontrados mortos). Foram amostradas 24 espécies de pequenos mamíferos e 17 espécies de mamíferos de médio e grande porte, totalizando 41 espécies para a região. Considerando-se os pequenos mamíferos, a comunidade foi representada por várias espécies raras e de abundância intermediária, e poucas espécies muito abundantes. Os roedores cricetídeos dominaram tanto em número de espécies (14) quanto em abundância (50% da comunidade). As espécies se distribuíram, basicamente, em dois tipos de fisionomias: um grupo esteve restrito aos ambientes florestais, e outro às formações abertas, demonstrando a grande seletividade de hábitats e a importância de se amostrar o mosaico de hábitats presente na região para uma melhor caracterização da diversidade deste grupo de mamíferos. Em termos biogeográficos, a fauna de pequenos mamíferos amostrada apresentou certa sobreposição com a fauna da Caatinga e da Amazônia, evidenciando a importância destes domínios para a composição de espécies das comunidades que habitam a porção norte do Cerrado, além da presença de espécies endêmicas e de distribuição geográfica restrita ao norte do domínio, caracterizando uma comunidade distinta de outras regiões do Cerrado. Em relação aos mamíferos de médio e grande porte, a presença de um elevado número de espécies ameaçadas de extinção (10) também ressalta a importância da preservação desta região.

Morcegos (Mammalia: Chiroptera) da Estação Ecológica Serra Geral do Tocantins: composição específica e considerações taxonômicas

Registramos 39 espécies de quirópteros na Estação Ecológica Serra Geral do Tocantins e áreas adjacentes, nordeste do estado do Tocantins, durante 28 dias de trabalho de campo nos anos de 2003 e 2008 e na estação chuvosa. Este estudo da quiropterofauna é um dos primeiros para o estado do Tocantins, aumentando o número de espécies conhecido para esta região, com 29 espécies registradas pela primeira vez no estado. As espécies mais abundantes foram P. lineatus e C. perspicillata, com 23,5 e 15,4% do total de capturas. A diversidade no nível de família também foi alta: Phyllostomidae (26 espécies), Vespertilionidae (5), Molossidae (3), Emballonuridae (2), Mormoopidae (1), Noctilionidae (1) e Thyropteridae (1). A maioria das áreas mésicas e de cerrado (s.s.) não estão incluídas em unidades de conservação, representando uma ameaça para espécies restritas a estes tipos de hábitats, como T. devivoi que foi capturada apenas em áreas de veredas com Heliconiacea. Além disso, a região vem sendo alterada devido ao rápido avanço da agricultura e pastagens e do turismo crescente. Assim, a elevada diversidade de morcegos registrada na região, além dos diversos papéis ecológicos que estas espécies desempenham, somadas às ameaças acima relatadas, aumentam as prioridades em se estabelecer estratégias de conservação para este grupo de mamíferos nas regiões adjacentes à Estação Ecológica Serra Geral do Tocantins. Dentre as espécies com interesse taxonômico, biogeográfico e de conservação destacam-se Lonchophylla dekeyseri, Glyphonycteris behnii, Micronycteris sanborni, Artibeus anderseni, Sturnira tildae e a recém-descrita Thyroptera devivoi.

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.

Religiosidade, juventude e sexualidade: entre a autonomia e a rigidez

Este artigo descreve como jovens religiosos e autoridades religiosas das respectivas comunidades compreendem a sexualidade, considerando suas experiências pessoais e como membros de comunidades religiosas. A análise pretende contribuir para que políticas públicas dedicadas à promoção da saúde sexual da juventude considerem a religiosidade no contexto de um Estado laico e da promoção do direito à prevenção. Foram realizadas 26 entrevistas abertas e semidirigidas em diferentes comunidades da região metropolitana da cidade de São Paulo (comunidade Católica, de Umbanda, do Candomblé e de diferentes denominações Evangélicas) sobre iniciação sexual, casamento, gravidez, contracepção e prevenção das DSTs/aids, homossexualidade, aborto e direitos humanos. Observou-se como jovens e autoridades religiosas convivem com a tensão entre tradição e modernidade e os distintos discursos sobre a sexualidade. Como sujeitos religiosos (do discurso religioso) e sujeitos sexuais (de discursos sobre sexualidade), devem ser incorporados pelos programas como sujeitos de direito nos termos de sua religiosidade.

Scripts em cena: HIV e mercado sexual no contexto turístico

A atividade turística tem impacto também na saúde das populações de comunidades anfitriãs. Com base em estudo etnográfico e em 14 entrevistas com monitores(as) de turismo ambiental, o objetivo deste artigo é analisar como o cenário sexual no contexto do turismo e seus scripts sexuais constroem a vulnerabilidade de caiçaras às DSTs/HIV e ao mercado sexual. Scripts sexuais tradicionais operacionalizados num cenário de "curtição", "prazer", "desinibição sexual", evidenciaram desigualdades sociais entre caiçaras e turistas que ampliam a vulnerabilidade dos jovens às DSTs/HIV e à mercantilização de sua sexualidade. Os scripts sexuais femininos (passividade/ingenuidade) dificultavam a negociação do preservativo nas cenas sexuais coletadas; os "mais pró-ativos" eram interpretados como disponibilidade para "programas". Os scripts "não negar fogo", "catar as turistas" também ampliavam a vulnerabilidade dos rapazes. O contexto turístico constrói um cenário sexual singular e atravessa as trajetórias socioafetivas dos moradores. Seu impacto deve ser considerado por políticas e programas de saúde locais.