Giardiose: realidade em Portugal e no mundo

Dissertação para obtenção do grau de Mestre no Instituto Superior de Ciências da Saúde Egas Moniz

O vírus do papiloma humano e a vacinação contra o cancro do colo do útero

Dissertação para obtenção do grau de Mestre no Instituto Superior de Ciências da Saúde Egas Moniz

Sistemas participativos online de monitorização de epidemias: avaliação do conhecimento e participação dos alunos finalistas dos cursos de ciências farmacêuticas da área de Lisboa

Dissertação para obtenção do grau de Mestre no Instituto Superior de Ciências da Saúde Egas Moniz

Avaliação do desempenho a longo prazo de pavimentos flexivéis : exploração da base de dados LTPP americana

A implementação de programas de LTPP – Long-Term Pavement Performance (avaliação do desempenho de pavimentos a longo prazo), ao criar um registo histórico sobre as características e a evolução do estado dos pavimentos da rede, revela-se uma ferramenta de valor acrescido no auxílio à tomada de decisões, no âmbito da conservação e da reabilitação de pavimentos, por parte das administrações das infraestruturas rodoviárias. O LTPP americano, dentre os existentes no mundo, é o projeto pioneiro e um dos que tem a maior quantidade de informação armazenada. Por isso, foi o escolhido no âmbito desta dissertação para estudar a evolução do estado dos pavimentos em várias secções classificadas no programa como SPS-5, incluídas no estudo de reabilitação de pavimentos betuminosos. A avaliação efetuada considera cerca de 15 anos de registos de dados, na Califórnia, no Texas e no Mississippi. Após uma breve apresentação de vários projetos LTPP existentes no mundo, descreve-se o modo como são recolhidos e estruturados os dados no LTPP americano, referindo os módulos, as tabelas e os campos considerados para estudo que se faz nesta dissertação. Os estados americanos escolhidos apresentam características climáticas que não reproduzem de forma muito próxima o que acontece em Portugal. Mesmo assim, procurou estabelecer-se um paralelo entre aquelas zonas, com base na temperatura do ar e na precipitação, de modo a poder inferir, de forma aproximada, tendências de evolução do estado dos pavimentos para Portugal Continental. A correspondência climática entre os estados americanos e as regiões portuguesas, resultou nos pares Califórnia/Beja, Texas/Lisboa e Mississippi/Porto. No que se refere ao desenvolvimento de patologias nos pavimentos, analisou-se a evolução do fendilhamento longitudinal, transversal, em bloco (ou malha) e por fadiga (ou pele de crocodilo), da desagregação superficial, do Índice de Irregularidade Internacional (IRI) e das rodeiras. O fendilhamento em bloco (ou malha) e a desagregação superficial não foram objeto de estudos estatísticos para determinação de modelos de previsão. A evolução do estado dos pavimentos, traduzida por indicadores relacionados com as patologias analisadas, foi apreciada em função de diversas variáveis associadas às técnicas de reabilitação, tais como a preparação da superfície de trabalho (realização de atividades de fresagem antes da nova camada), a espessura da camada de reforço (50 ou 125 mm) e o tipo de mistura utilizada (nova ou contendo cerca de 30% de material reciclado). Para as situações em que os dados existentes eram coerentes e em quantidade suficiente, apresentam-se análises de regressão multivariada, de modo a prever a evolução no tempo do estado dos pavimentos, tendo em conta um conjunto de variáveis explicativas relacionadas com as técnicas de reabilitação aplicadas e com o tráfego que solicitou os pavimentos. A análise agregada dos dados para cada um dos estados permitiu concluir que a preparação da superfície por fresagem, o aumento da espessura do reforço, e a utilização de misturas betuminosas novas ou com material reciclado, interferem na evolução das degradações. A influência daqueles fatores é variável em função dos diferentes tipos de patologias em análise.

O Risco Percebido e Coberto pelas Seguradoras

Os Portugueses desde imemoráveis tempos gostam de partir à descoberta de mundos novos, fazemo-lo pelas mais variadas razões, no entanto, neste trabalho iremos apenas analisar os riscos associados ao turismo de lazer. Os atentados de Nova Iorque em 11 Setembro 2001, Síndrome Respiratório Grave em HongKong em Fevereiro de 2003, o Tsunami no oceano Indico em Dezembro 2004, a erupção vulcânica na Islândia em Abril de 2010 ou os atentados de Paris em 13 de Novembro 2015, estas datas ficaram marcadas para sempre, lemos e relemos inúmeros depoimentos de pessoas que se encontravam de férias nestas cidades e pensamos e se fossemos nós? Os primeiros registos da atividade seguradora datam do ano 5.000 A.C. inicialmente seguravam transportes de mercadorias, hoje em dia podem cobrir “qualquer coisa”. Com a perceção dos riscos que hoje em dia podem ocorrer numa viagem, será que as Seguradoras estão preparadas para minimizar os mesmos? E qual a perceção dos riscos para quem viaja. Para o efeito realizou-se um estudo exploratório por suporte a uma amostra de conveniência que reuniu 152 observações. Análises descritivas e testes não paramétricos foram aplicados para definir quais os riscos mais percebidos e quais os que os turistas portugueses pretendem ver cobertos. Concluiu-se que as pessoas que dão maior importância aos Risco de Saúde e Financeiro são os que efetuam seguros de viagem, já as que dão maior importância aos Risco Equipamento, Risco Politico, Risco Psicológico e Risco de Satisfação são as que optam por não fazer seguro.

Prevalência e fatores associados à morbidade materna: inquérito populacional em Natal/RN

INTRODUCTION: Severe maternal morbidity , also known as maternal near miss , has been used as an alternative to the study of maternal mortality , since being more frequent shares the same determinants and enables the implementati on of epidem iological surveillance of cases . Since then, hospital audits ha ve been carried out to determine the rates of maternal near miss, its mai n causes and associated factors . More recently, population surveys based on self - reported morbidity have als o been presented as vi able in identifying these cases . OBJECTIVE: The aim of this study was to determine the prevalence and associated factors of maternal near miss and complications during pregnancy and puerperal period in Natal/RN. METHODS: A cross - secti onal population - based study was conducted in Natal /RN , Brazil, which has as its target population women aged 15 to 49 years who were pregnant in the last five years. It was carried out a probabilistic sam pling design based on a multi - stage complex sample , in which 60 census tracts were selected from three strata (north , south - east and west). Afterwards, domiciles were visited in order to obtain a sample of the 908 eligible women in whom a questionnaire was applied. The descriptive analyzes and bivariate ass ociations were performed using the Chi - square test and the estimate of the prevalence ratio (PR ) with 95% confidence interval (CI) and considering the weights and design effects . The Poisson regression analysis , also with 5% significance and 95% CI, was us ed for analyzes of associated factors. RESULTS: 848 women were identified and interviewed after visits in 8.227 households corresponding to a response rate of 93 . 4 %. The prevalence of maternal near miss was 41 . 1 /1 000NV, being the Intensive Care Unity stay i ng (19 . 1 /1 000 LB ) and eclampsia (13 . 5/1000LB) the most important marker s . The prevalence of complications in the puerperal peri od was 21 . 2 %, and hemorrhage (10 . 7%) and urinary tract infection (10 . 7%) the most frequently reported clinical conditions and rema in ing in the hospital for over a week after delivery the mo st frequent intervention (5.4%) . Regarding associated factors , the bivariate analysis showed an association between the increased number of complications in women of black/brown race ( PR= 1 . 23; CI95 % : 1 . 04 - 1 . 46) and lower socioeconomic status ( PR= 1 . 33; CI95%: 1 . 12 - 1 . 58) in women who had pre natal care in public service ( PR= 1 . 42; CI95%: 1 . 16 to 1 . 72 ) and that were not advised during prenatal about where they should do the d elivery (PR= 1 . 24; CI95%: 1 . 05 - 1 . 46), made the del ivery in the public service (PR= 1 . 63; CI95%: 1 . 30 - 2 . 03), had to search for more than one hospital for delivery (PR=1 . 22; CI95%: 1 . 03 - 1 . 45) and had no companion during childbirth ( PR =1 . 19; CI95%: 1 . 01 - 1 . 41) or at all times of childbirth c are - before, during and after childbirth - ( PR= 1 . 25, CI95%: 1 . 05 - 1 . 48) . Moreover, the number of days postpartum hospitalization was higher in women who had more complications (P R= 1 . 59 ; CI95%: 1 . 36 - 1 . 86). In the final regression model for both birth place (P R= 1 . 21 ; CI 95% : 1 . 02 to 1 . 44 ) and socioeconomic status (PR = 1.54 ; CI95%: 1 . 25 - 1 . 90 ) the association remained. CONCLUSION : Conducting population surveys using the pragmatic definition of near miss is feasible and may add importa nt information about this ev ent . It was possible to find the expression of health inequalities related to maternal health in the analysis of both socioeconomic conditions and on the utilization of health services.

Avaliação das condicionalidades em saúde do Programa Bolsa Família

The programs of conditional cash transfer are widespread in developing countries in Latin America with emphasis on Brazil as a new paradigm in social p olicies for poverty eradication . Consist of transferring monetary funds from the government directly to poor families by fulfilling the condition alities on education and health . In health, even wi th variations between countries , conditionality targeting public pregnant women and children with a view to improving health indic ators maternoinfantil as growth , infant mortality and prenatal care. The objectives of this study are to compare the transfer progr am conditional Brazilian income , the Family and similar programs in Latin A merica in relation to it s effects on growth in children , and to evaluate the effect of Bolsa Família in the prevalence of use of services ( conditionalities ) of prenatal care in Brazilian health services whose teams joined the Programa de Acesso e Melhoria da Qualidade da Atenção Básica (PMAQ - AB) . For the first objective a systematic review , we selec ted ten articles between 1007 ( one thousand and seven ) found in the databases Embase , PubMed, Scopus , Scielo and Lilacs databases was performed . Articles are ob servational epidemiological studies of transverse descriptive and analytical types of cohort and case - co ntrol. For the second objective, for it is a prevalence study , a statistical analysis using Poisson regression with robust variance was performed to i nvestigate how the prevalence of compliance with conditionalities on health was influenced b y various explanatory variables . Ratios , crude and adjusted prevalence , with their respective confidence i ntervals of 95 % were estimated . The family joined the sch olarship program was considered as the main expo sure variable . Confounding variables were: maternal age , race / color, paid employment , marital status and region of residence . In d ata analysis software R 3.0.1 (RDevelopment Core Team 2013 ) was used . Rega rding the comparison of the Bolsa Família with other programs in Latin America , the review found similar results regarding the positive effect of income transfer in the nutritional status o f beneficiary children programs , and these effects are more evident in children under two years old and belonging to familie s of lower socioeconomic status . For the prevalence of conditionalities entres different groups of users of the Bolsa Família and nonusers results showed no statistically significant difference betwe en respondents (with children under two years ) registered and not registered in PBF on issues relating to: me et at least six prenatal visits , meet and participate in health education activities . It follows from side to increase minimum income for families in extreme poverty showed positive impact on children's health in Brazil and Latin America. The o ther is not confirmed in Brazil , an increase in conditionality expressed in use of primary care by the user s of the Bolsa Família services.

Epidemiologia e caracterização molecular dos vírus Dengue circulantes no Rio Grande do Norte, 2013-2014

Dengue is an acute infectious disease, usually transmitted by Aedes aegypti mosquitoes. The etiologic agents belong to the family Flaviviridae, genus Flavivirus, and occur as four antigenically related but distinct serotypes designated DENV-1, 2, 3, and 4. In Brazil, the disease represents a national public health problem. The purpose of the present study was to describe epidemiological aspects of dengue in the State of Rio Grande do Norte, from 2013 to 2014. A total of 483 blood or serum samples, collected from January 2013 to December 2014, were studied by RT-PCR for viral detection and typing. The infection was confirmed in 36.44% (176/483) of the cases studied. This study detected the circulation of three serotypes of dengue virus in Rio Grande do Norte, DENV-1, 2, and 4. The predominant serotype in 2013-2014 was the DENV-4, representing 83.51% (81/97) and 68.35% (54/79) of the positive cases, respectively. Regarding the spatial distribution, most of the cases occurred in Natal and Caicó, with 9.28% (9/97) and 18.99% (15/79), respectively. The months with the biggest viral circulation in RN were March 2013 and May 2014. The female gender was the most affected, representing 69.07% (67/97) in 2013 and 54.43% (43/79) in 2014. The most affected age groups were 21-30 years (2013) and 11-20 years (2014) with 25.77% (25/97) and 20.25% (16/79) positive cases, respectively. Phylogenetic analysis indicated that genotype V (DENV-1) and genotype II (DENV-4) circulated in the State. Our results provide information about the dynamics of DENV in the Rio Grande do Norte, important for the development of disease control strategies.

Mortalidade em idosos longevos e "mais jovens" no Brasil

The aim of the present study was to trace the mortality profile of the elderly in Brazil using two neighboring age groups: 60 to 69 years (young-old) and 80 years or more (oldest-old). To do this, we sought to characterize the trend and distinctions of different mortality profiles, as well as the quality of the data and associations with socioeconomic and sanitary conditions in the micro-regions of Brazil. Data was collected from the Mortality Information System (SIM) and the Brazilian Institute of Geography and Statistics (IBGE). Based on these data, the coefficients of mortality were calculated for the chapters of the International Disease Classification (ICD-10). A polynomial regression model was used to ascertain the trend of the main chapters. Non-hierarchical cluster analysis (K-Means) was used to obtain the profiles for different Brazilian micro-regions. Factorial analysis of the contextual variables was used to obtain the socio-economic and sanitary deprivation indices (IPSS). The trend of the CMId and of the ratio of its values in the two age groups confirmed a decrease in most of the indicators, particularly for badly-defined causes among the oldest-old. Among the young-old, the following profiles emerged: the Development Profile; the Modernity Profile; the Epidemiological Paradox Profile and the Ignorance Profile. Among the oldest-old, the latter three profiles were confirmed, in addition to the Low Mortality Rates Profile. When comparing the mean IPSS values in global terms, all of the groups were different in both of the age groups. The Ignorance Profile was compared with the other profiles using orthogonal contrasts. This profile differed from all of the others in isolation and in clusters. However, the mean IPSS was similar for the Low Mortality Rates Profile among the oldest-old. Furthermore, associations were found between the data quality indicators, the CMId for badly-defined causes, the general coefficient of mortality for each age group (CGMId) and the IPSS of the micro-regions. The worst rates were recorded in areas with the greatest socioeconomic and sanitary deprivation. The findings of the present study show that, despite the decrease in the mortality coefficients, there are notable differences in the profiles related to contextual conditions, including regional differences in data quality. These differences increase the vulnerability of the age groups studied and the health iniquities that are already present.

Síndrome de Guillain-Barré: epidemiologia, prognóstico e fatores de risco

Introduction. Guillain-Barré syndrome (GBS) is an immune-mediated polyneuropathy and the principal cause of acute neuromuscular paralysis. The most prominent GBS subtypes are: acute inflammatory demyelinating polyneuropathy (AIDP), acute motor axonal neuropathy (AMAN), acute motor-sensory axonal neuropathy (AMSAN) and Fisher syndrome (FS). Differences in geographical distribution of variants have been reported. In Brazil, there are few studies describing the characteristics of GBS, but none on the frequency of GBS variants and their clinical manifestations. Infection-induced aberrant immune response resulting from molecular mimicry and formation of cross-reacting antibodies, contribute to complement activation. Functional biallelic polymorphism in immunoglobulin receptors that influence the affinity of IgG subclasses and the type of immune response have been described, suggesting genetic susceptibility to developing disease. It remains unclear whether individuals carrying different FCGR alleles have differential risk for GBS and⁄or disease severity. The goals of this study were: (1) To characterize GBS and describe the clinical findings in a cohort of patients with GBS from the state of Rio Grande do Norte, Brazil; (2) to determine whether polymorphism in FCGR were associated with development of GBS, and (3) to tease out whether the global gene expression studies could be a tool to identify pathways and transcriptional networks which could be regulated and decrease the time of disease. Methods. Clinical and laboratory data for 149 cases of GBS diagnosed from 1994 to 2013 were analyzed. Genomic DNA and total RNA were extracted from whole blood. Antigangliosides antibodies were determined in the sera. In addition, we also assessed whether FCGR polymorphism are present in GBS (n=141) and blood donors (n=364), and global gene expressions were determined for 12 participants with GBS. Blood samples were collected at the diagnosis and post-recovery. Results. AIDP was the most frequent variant (81.8%) of GBS, followed by AMAN (14.7%) and AMSAN (3.3%). The incidence of GBS was 0.3 ⁄ 100,000 people for the state of Rio Grande do Norte and cases occurred at a younger age. GBS was preceded by infections, with the axonal variant associated with episodes of diarrhea (P = 0.025). Proximal weakness was more frequent in AIDP, and distal weakness predominant in the axonal variant. Compared to 42.4% of cases with AIDP (P<0.0001), 84.6% of cases with the axonal variant had nadir in <10 days. Individuals with the axonal variant took longer to recover deambulation (P<0.0001). The mortality of GBS was 5.3%. A worse outcome was related to an axonal variant (OR17.063; P=0.03) and time required to improve one point in the Hughes functional scale (OR 1.028; P=0.03). The FCGR genotypes and allele frequencies did not differ significantly between the patients with GBS and the controls (FCGR2A p=0.367 and FCGR3A p=0.2430). Global gene expression using RNAseq showed variation in transcript coding for protein isoforms during acute phase of disease. Conclusions. The annual incidence of GBS was 0.3 per 100,00 and there was no seasonal pattern. A predominance of the AIDP variant was seen, and the incidence of the disease decreased with age. The distribution of weakness is a function of the clinical variants, and individuals with the axonal variant had a poorer prognosis. Early diagnosis and variant identification leads to proper intervention decreasing in long-term morbidity. FCGR polymorphisms do not seem to influence susceptibility to GBS in this population. This study found deregulated genes and signs of transcriptional network alterations during the acute and recovery phases in GBS. Identification of pathways altered during disease might be target for immune regulation and with potential to ameliorate symptoms.

Parasitos de importância para a caprinocultura e a ovinocultura potiguar

The goat and sheep industry shows up as an agricultural activity of great importance for the semiarid Northeast. However, the sheep and goats production is made with various difficulties. Among them, parasitic infections, particularly helminth infections of the gastrointestinal tract, the eimeriosis and toxoplasmosis; this one related to problems in reproduction. For this reason, the aim of this study is to to make a survey of the occurrence and some determinants of parasitic diseases that affect small ruminant flocks of the microregions Natal, Macaíba, Litoral Sul, Angicos, Vale do Açu and Borborema Potiguar. Thereunto, epidemiological tools were applied with producers, keepers or guardians of herds and also held collections of blood and feces of animals in eight properties located in seven municipalities of these microregions. The parasite load of the animals was determined through eggs and oocysts counting per gram of feces EPG and OPG, respectively. In addition, the recovery of infective larvae was made. Blood samples were used to measure the globular cell volume and the search for anti-Toxoplasma gondii IgG in sheep serum, by Enzyme Linked Immune Sorbent Assay (ELISA). For categorical variables, the statistical analysis was performed using Poisson regression, with significance level of 0.05. The analysis of the instruments showed that ivermectin is the anthelmintic used in 85,71% of properties. From the total of feces samples of the sheep (n = 179), 53,07% were positive for helminth eggs and 48,04% were positive for oocysts of Eimeria. From the samples of faeces of goats (n = 133), 72,18% were positive for helminth eggs and 96,99% for oocysts of Eimeria. The lowest EPG and OPG count was observed in the micro region of Angicos. Most of the EPG count was found in the micro region Litoral Sul and the OPG count in the micro-region Borborema Potiguar. Both cases the difference was statistically significant(p- value0,000)The most prevalent helminth genus found was Haemonchus, present in 49,87% of the sheep and 80,42% of goats. The average of hematocrit ranged from 22,91 to 33,25 in sheep and from 22,62 to 28,25 in goats. The prevalence of anti-Toxoplasma gondii IgG ranged from 63,33% to 100,00%. The goats showed to be more susceptible to infections by parasites of the gastrointestinal tract than the sheep. In all the properties was observed high prevalence of infection by T. gondii, with the lowest percentages recorded in the micro regions Angicos and Borborema Potiguar.

Condições de trabalho e saúde psíquica de servidores técnico-administrativos da UFRN

Unfavorable working conditions constitute one of the factors that may contribute to cause psychic suffering and behavioral disorders in workers. This research aimed to characterize the working conditions public servant technical- administrative , specifically the auxiliaries and assistants in administration of the Federal University of Rio Grande do Norte – UFRN, Natal, Brasil, as well to identify the incidence of psychic suffering in this group of public servants. As a strategy, we chose a case study of multi-method type, descriptive with quantitative and qualitative sequential steps. For this, it initially performed desk research by surveying epidemiological data for these public servants working in central campus, to identify the major diseases presented in the period from January 2011 to June 2014. Then, we proceeded to diagnostic step of the aspects related to work, by applying online and in loco of Working Conditions Survey (already validated by Borges et al., 2013a) in 11 sectors selected according to the following criteria: high number of workers public servants and major and minor percentage of absences for health care for ICD-F (according to records of Sector of Workers Health Care - DAS). In the treatment of the data the spreadsheet editor software Microsoft Office Excel and statistical SPSS Statistical Package for Social Sciences were used and made qualifying type of content analysis of open questions. Applied to this study 174 public servants and the results show a predominance of absenteeism due to mental or behavioral disorders (ICD F), musculoskeletal diseases (ICD M) and respiratory system (ICD J). Among the factors that were significant are the working hours (contractual and legal); Physical Effort (M = 2.59) and workspace (M = 2.58) - physical and material conditions; encouraging collaboration (M = 3.5) - processes and characteristics of the work; and participation (M = 1.78) - social-management environment. Therefore, it infers the existence of a relationship between these factors and some of the reasons for absenteeism reported by participants. It is suggested the expansion of this research with studies involving other professionals (including scholarship workers and contractors) and specific sectors.

Prevalência e fatores associados ao Near Miss Materno: inquérito populacional em uma capital do Nordeste Brasileiro

The scope of this study was to determine the prevalence of near misses and complications during pregnancy and the puerperal period, identifying the main clinical and intervention markers and socioeconomic and demographic factors associated with near misses. It involved a cross-sectional, population-based and probabilistic study with multi-stage complex sampling design conducted in Natal, State of Rio Grande do Norte, Brazil. A validated questionnaire was given to 848 women aged 15 to 49 identified in 8,227 households in 60 census sectors. In theanalysis of associations, the Chi-square test applied and calculated the prevalence ratio (PR) with Confidence Interval (CI) of 95% and 5% significance. The prevalence of maternal near misses was 41.1/1000LB, with hospitalization in an Intensive Care Unit (19.1/1000LB) and eclampsia (13.5/1000LB) being the most important markers. The prevalence of complications during pregnancy and the puerperal period was 21.2%. The highest prevalence of near misses was observed in older women, of black/brown race and low socioeconomic status. Conducting population surveys is feasible and may add important information to the study of near misses and the markers highlight the need for enhancing maternal care to reduce health inequality.

Prevalência e fatores associados ao Near Miss Materno: inquérito populacional em uma capital do Nordeste Brasileiro

The scope of this study was to determine the prevalence of near misses and complications during pregnancy and the puerperal period, identifying the main clinical and intervention markers and socioeconomic and demographic factors associated with near misses. It involved a cross-sectional, population-based and probabilistic study with multi-stage complex sampling design conducted in Natal, State of Rio Grande do Norte, Brazil. A validated questionnaire was given to 848 women aged 15 to 49 identified in 8,227 households in 60 census sectors. In theanalysis of associations, the Chi-square test applied and calculated the prevalence ratio (PR) with Confidence Interval (CI) of 95% and 5% significance. The prevalence of maternal near misses was 41.1/1000LB, with hospitalization in an Intensive Care Unit (19.1/1000LB) and eclampsia (13.5/1000LB) being the most important markers. The prevalence of complications during pregnancy and the puerperal period was 21.2%. The highest prevalence of near misses was observed in older women, of black/brown race and low socioeconomic status. Conducting population surveys is feasible and may add important information to the study of near misses and the markers highlight the need for enhancing maternal care to reduce health inequality.

Reflexões metodológicas sobre prevalência da fluorose dentária nos inquéritos de saúde bucal

OBJETIVO: Analizar limitaciones del estudio de fluorosis dentaria en pesquisas transversales. MÉTODOS: Se utilizaron datos de estudios de de Condiciones de Salud Bucal de la Población Brasileña (SBBrasil 2003) y de la Investigación Nacional de la Salud Bucal (SBBrasil 2010). La estimativa de tendencia epidemiológica de la fluorosis en la población de 12 años, aspectos de la confiabilidad de los datos, así como la precisión de las estimativas, fueron evaluadas en estas dos investigaciones. La distribución de la prevalencia de la fluorosis fue hecha de acuerdo con los dominios de estudio (capitales y regiones) y el año estudiado. Se expresaron también los intervalos de confianza (IC95%) para la prevalencia simple (sin considerar las fases de la gravedad). RESULTADOS: La prevalencia de la fluorosis dentaria presentó una variación considerable, de 0 a 61% en 2003 y de 0 a 59% en 2010. Se observaron inconsistencias en los datos en términos individuales (por año y por dominio) y en el comportamiento de la tendencia. Considerando la expectativa de prevalencia y los datos disponibles en las dos investigaciones, el tamaño mínimo de la muestra debería ser de 1.500 individuos para obtener intervalos de 3,4% y 6,6% de confianza, considerando un coeficiente de variación mínimo de 15%. Dada la subjetividad en la naturaleza de su clasificación, exámenes de fluorosis dentaria pueden presentar más variación de los realizados para otras condiciones de salud bucal. El poder para establecer diferencias entre los dominios del estudio con la muestra de SBBrasil 2010 es bastante limitado. CONCLUSIONES: No fue posible analizar la tendencia de la fluorosis dentaria en Brasil con base en los estudios de 2003 y 2010; esos datos son sólo indicadores exploratorios de la prevalencia de la fluorosis. La comparación se hace imposible por el hecho de haber sido utilizado modelos de análisis diferentes en las dos pesquisas. La investigación de la fluorosis dentaria en pesquisas de base poblacional no es viable técnica y económicamente, la realización de estudios epidemiológicos localizados con plan de muestreo es más adecuada.