O sistema de referência e contrarreferência na estaratégia saúde da família no município de Bauru: perpectivas dos gestores

Pós-graduação em Enfermagem (mestrado profissional) - FMB

O público e o privado nas universidades públicas: análise da fundação de apoio privada FADESP no gerenciamento dos recursos para a UFPA (2004 a 2008)

Este estudo tem como objetivo central analisar a parceria entre o público e o privado, estabelecida entre as universidades federais e as fundações de apoio privadas (FAP), no gerenciamento de recursos para a instituição apoiada, tendo como caso a relação entre a Universidade Federal do Pará (UFPA) e a Fundação de Amparo e Desenvolvimento da Pesquisa (FADESP), no período de 2004 a 2008, analisadas a partir dos relatórios de prestação de contas e documentos institucionais. Para compreender a realidade como resultado de processos históricos das relações humanas, partiu-se da premissa de que o esgotamento do modelo de gestão das universidades públicas no Brasil, financiadas exclusivamente com recursos do erário, acentuou-se a partir da década de 1990 com a Reforma do Estado no governo de Fernando Henrique Cardoso. Com a materialização das políticas de diminuição de recursos públicos introduziu a perspectiva de busca de vias alternativas de receitas para uma aparente manutenção das instituições públicas por entidades privadas como as FAP, políticas continuadas pelo governo de Luiz Inácio Lula da Silva. O estudo apontou que, apesar da introdução da lógica de mercado e da naturalização da parceria com o privado no interior das Instituições Federais de Ensino Superior (IFES), a relação entre público e privado é sustentada, essencialmente, com recursos públicos. Isso se reflete na expansão no número de FAP credenciadas junto às universidades federais, multiplicando-se em mais de 154% nos últimos 10 anos. Das 55 universidades públicas federais do Brasil, apenas cinco não possuem FAP credenciada, e as restantes apresentam 85 FAP gerenciando seus recursos. No caso da FADESP, no gerenciamento de recursos para a UFPA, abstraiu-se que: a) A FADESP atua há mais de 30 anos no interior da universidade e, embora seus relatórios de prestação de conta sejam apresentados de forma pública no conselho superior, isso se deu somente a partir de 2004 pela exigência do Decreto n° 5.204; b) Há ausência de observância da prestação de contas anual estabelecida pelo marco regulatório das FAP e o regimento da UFPA; c) Os Relatórios de Atividades são organizados diferentemente a cada ano, dificultando a compreensão dos mesmos por parte dos conselheiros da UFPA; d) A fundação apresenta no período investigado (2004-2008) um crescimento de 532,1% no volume de recursos gerenciados; e) Do total de recursos gerenciados pela fundação, em 2008, 94% representam recursos captados pela UFPA, especialmente por professores-pesquisadores, evidenciando uma nova identidade para a universidade pública, como produtora de conhecimento para valorização do capital, na qual a FAP é intermediadora dos processos administrativo-financeiros; t) O apoio real prestado pela fundação à UFPA, através da criação do Programa de Apoio (PROAP), é irrisório considerando o superávit da fundação que, em 2008, ultrapassou um milhão de reais; g) A FADESP atua com entendimento equivocado de Desenvolvimento Institucional, associando este como uma forma de prestação de serviço a outras instituições públicas e privadas, o que desvirtua a observância do marco regulatório das FAP e, por conseguinte, a missão institucional da UFPA.

Análise da qualidade da informação no setor de saneamento básico: em busca da inteligência estratégica

Estudo da dimensão informacional do setor de saneamento básico, com o objetivo de analisar a qualidade da informação disponível em fontes de informação utilizadas no planejamento do setor. Para isso, foram analisadas as bases governamentais de informação, o Sistema Nacional de Informações sobre Saneamento 2009 (SNIS), a Pesquisa Nacional de Saneamento Básico 2008 (PNSB), a Pesquisa Nacional por Amostra de Domicílios 2009 (PNAD) e o Censo Demográfico 2010, no âmbito nacional, e o Serviço de Informação do Estado do Pará 2009 (SIE). A análise foi realizada por meio do Diagrama de Pareto, do Diagrama de causa e efeito de Ishikawa e dos atributos de informação de atualidade, abrangência, confiabilidade, precisão e pertinência, sendo, ainda, investigada a opinião de especialistas do setor. Nos 15 problemas evidenciados na redução da qualidade da informação em saneamento básico, cinco deles são considerados vitais e influenciam os demais problemas, sendo eles: a) falta de interação com outras áreas; b) periodicidade inadequada de disseminação das informações; c) falta de detalhamento da informação; d) forma de coleta inadequada; e) organização da informação inadequada. A partir da constatação das fragilidades na dimensão informacional em saneamento básico, foi analisada a informação utilizada em dois instrumentos de planejamento do setor, o Plano Nacional de Saneamento Básico (PLANSAB) e o Plano Plurianual 2008/2011, do estado do Pará (PPA 2008/2011). A conclusão desta tese é que, no momento, as informações disponibilizadas para o planejamento do setor são desatualizadas, incompletas, imprecisas, não pertinentes e não confiáveis. Com isso, foram recomendadas ações de inteligência estratégica para melhorar a qualidade da informação do setor, definindo-se o quê e onde coletar, como sistematizar, analisar, disseminar, avaliar e monitorar as informações, visando contribuir para o planejamento, definição de investimentos, prestação dos serviços, regulação, fiscalização e controle social, de acordo com as diretrizes da Política Nacional de Saneamento Básico, Lei 11.445/2007, que tem como um dos princípios fundamentais a universalização do acesso da população aos serviços de saneamento básico.

Construction of pediatric homogeneous phantoms for optimization of chest and skull radiographs

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Prevalência de infecções sexualmente transmissíveis e de alterações da microbiota vaginal e fatores associados em mulheres que fazem sexo com mulheres

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

HTLV-1/2 seroprevalence and coinfection rate in Brazilian first-time blood donors: an 11-year follow-up

The seroprevalence and geographic distribution of HTLV-1/2 among blood donors are extremely important to transfusion services. We evaluated the seroprevalence of HTLV-1/2 infection among first-time blood donor candidates in Ribeirão Preto city and region. From January 2000 to December 2010, 1,038,489 blood donations were obtained and 301,470 were first-time blood donations. All samples were screened with serological tests for HTLV-1/2 using enzyme immunoassay (EIA). In addition, the frequency of coinfection with hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV), Chagas disease (CD) and syphilis was also determined. In-house PCR was used as confirmatory test for HTLV-1/2. A total of 296 (0.1%) first-time donors were serologically reactive for HTLV-1/2. Confirmatory PCR of 63 samples showed that 28 were HTLV-1 positive, 13 HTLV-2 positive, 19 negative and three indeterminate. Regarding HTLV coinfection rates, the most prevalent was with HBV (51.3%) and HCV (35.9%), but coinfection with HIV, CD and syphilis was also detected. The real number of HTLV-infected individual and coinfection rate in the population is underestimated and epidemiological studies like ours are very informative.

Quality in emergency departments: a study on 3,285,440 admissions

INTRODUCTION: A multi-centre study has been conducted, during 2005, by means of a questionnaire posted on the Italian Society of Emergency Medicine (SIMEU) web page. Our intention was to carry out an organisational and functional analysis of Italian Emergency Departments (ED) in order to pick out some macro-indicators of the activities performed. Participation was good, in that 69 ED (3,285,440 admissions to emergency services) responded to the questionnaire. METHODS: The study was based on 18 questions: 3 regarding the personnel of the ED, 2 regarding organisational and functional aspects, 5 on the activity of the ED, 7 on triage and 1 on the assessment of the quality perceived by the users of the ED. RESULTS AND CONCLUSION: The replies revealed that 91.30% of the ED were equipped with data-processing software, which, in 96.83% of cases, tracked the entire itinerary of the patient. About 48,000 patients/year used the ED: 76.72% were discharged and 18.31% were hospitalised. Observation Units were active in 81.16% of the ED examined. Triage programmes were in place in 92.75% of ED: in 75.81% of these, triage was performed throughout the entire itinerary of the patient; in 16.13% it was performed only symptom-based, and in 8.06% only on-call. Of the patients arriving at the ED, 24.19% were assigned a non-urgent triage code, 60.01% a urgent code, 14.30% a emergent code and 1.49% a life-threatening code. Waiting times were: 52.39 min for non-urgent patients, 40.26 min for urgent, 12.08 for emergent, and 1.19 for life-threatening patients.

Contribution to the improvement of communication services in nanosatellite constellations using delay and disruption tolerant networking based architectures

Esta tesis se desarrolla dentro del marco de las comunicaciones satelitales en el innovador campo de los pequeños satélites también llamados nanosatélites o cubesats, llamados así por su forma cubica. Estos nanosatélites se caracterizan por su bajo costo debido a que usan componentes comerciales llamados COTS (commercial off-the-shelf) y su pequeño tamaño como los Cubesats 1U (10cm*10 cm*10 cm) con masa aproximada a 1 kg. Este trabajo de tesis tiene como base una iniciativa propuesta por el autor de la tesis para poner en órbita el primer satélite peruano en mi país llamado chasqui I, actualmente puesto en órbita desde la Estación Espacial Internacional. La experiencia de este trabajo de investigación me llevo a proponer una constelación de pequeños satélites llamada Waposat para dar servicio de monitoreo de sensores de calidad de agua a nivel global, escenario que es usado en esta tesis. Es ente entorno y dadas las características limitadas de los pequeños satélites, tanto en potencia como en velocidad de datos, es que propongo investigar una nueva arquitectura de comunicaciones que permita resolver en forma óptima la problemática planteada por los nanosatélites en órbita LEO debido a su carácter disruptivo en sus comunicaciones poniendo énfasis en las capas de enlace y aplicación. Esta tesis presenta y evalúa una nueva arquitectura de comunicaciones para proveer servicio a una red de sensores terrestres usando una solución basada en DTN (Delay/Disruption Tolerant Networking) para comunicaciones espaciales. Adicionalmente, propongo un nuevo protocolo de acceso múltiple que usa una extensión del protocolo ALOHA no ranurado, el cual toma en cuenta la prioridad del trafico del Gateway (ALOHAGP) con un mecanismo de contienda adaptativo. Utiliza la realimentación del satélite para implementar el control de la congestión y adapta dinámicamente el rendimiento efectivo del canal de una manera óptima. Asumimos un modelo de población de sensores finito y una condición de tráfico saturado en el que cada sensor tiene siempre tramas que transmitir. El desempeño de la red se evaluó en términos de rendimiento efectivo, retardo y la equidad del sistema. Además, se ha definido una capa de convergencia DTN (ALOHAGP-CL) como un subconjunto del estándar TCP-CL (Transmission Control Protocol-Convergency Layer). Esta tesis muestra que ALOHAGP/CL soporta adecuadamente el escenario DTN propuesto, sobre todo cuando se utiliza la fragmentación reactiva. Finalmente, esta tesis investiga una transferencia óptima de mensajes DTN (Bundles) utilizando estrategias de fragmentación proactivas para dar servicio a una red de sensores terrestres utilizando un enlace de comunicaciones satelitales que utiliza el mecanismo de acceso múltiple con prioridad en el tráfico de enlace descendente (ALOHAGP). El rendimiento efectivo ha sido optimizado mediante la adaptación de los parámetros del protocolo como una función del número actual de los sensores activos recibidos desde el satélite. También, actualmente no existe un método para advertir o negociar el tamaño máximo de un “bundle” que puede ser aceptado por un agente DTN “bundle” en las comunicaciones por satélite tanto para el almacenamiento y la entrega, por lo que los “bundles” que son demasiado grandes son eliminados o demasiado pequeños son ineficientes. He caracterizado este tipo de escenario obteniendo una distribución de probabilidad de la llegada de tramas al nanosatélite así como una distribución de probabilidad del tiempo de visibilidad del nanosatélite, los cuales proveen una fragmentación proactiva óptima de los DTN “bundles”. He encontrado que el rendimiento efectivo (goodput) de la fragmentación proactiva alcanza un valor ligeramente inferior al de la fragmentación reactiva. Esta contribución permite utilizar la fragmentación activa de forma óptima con todas sus ventajas tales como permitir implantar el modelo de seguridad de DTN y la simplicidad al implementarlo en equipos con muchas limitaciones de CPU y memoria. La implementación de estas contribuciones se han contemplado inicialmente como parte de la carga útil del nanosatélite QBito, que forma parte de la constelación de 50 nanosatélites que se está llevando a cabo dentro del proyecto QB50. ABSTRACT This thesis is developed within the framework of satellite communications in the innovative field of small satellites also known as nanosatellites (<10 kg) or CubeSats, so called from their cubic form. These nanosatellites are characterized by their low cost because they use commercial components called COTS (commercial off-the-shelf), and their small size and mass, such as 1U Cubesats (10cm * 10cm * 10cm) with approximately 1 kg mass. This thesis is based on a proposal made by the author of the thesis to put into orbit the first Peruvian satellite in his country called Chasqui I, which was successfully launched into orbit from the International Space Station in 2014. The experience of this research work led me to propose a constellation of small satellites named Waposat to provide water quality monitoring sensors worldwide, scenario that is used in this thesis. In this scenario and given the limited features of nanosatellites, both power and data rate, I propose to investigate a new communications architecture that allows solving in an optimal manner the problems of nanosatellites in orbit LEO due to the disruptive nature of their communications by putting emphasis on the link and application layers. This thesis presents and evaluates a new communications architecture to provide services to terrestrial sensor networks using a space Delay/Disruption Tolerant Networking (DTN) based solution. In addition, I propose a new multiple access mechanism protocol based on extended unslotted ALOHA that takes into account the priority of gateway traffic, which we call ALOHA multiple access with gateway priority (ALOHAGP) with an adaptive contention mechanism. It uses satellite feedback to implement the congestion control, and to dynamically adapt the channel effective throughput in an optimal way. We assume a finite sensor population model and a saturated traffic condition where every sensor always has frames to transmit. The performance was evaluated in terms of effective throughput, delay and system fairness. In addition, a DTN convergence layer (ALOHAGP-CL) has been defined as a subset of the standard TCP-CL (Transmission Control Protocol-Convergence Layer). This thesis reveals that ALOHAGP/CL adequately supports the proposed DTN scenario, mainly when reactive fragmentation is used. Finally, this thesis investigates an optimal DTN message (bundles) transfer using proactive fragmentation strategies to give service to a ground sensor network using a nanosatellite communications link which uses a multi-access mechanism with priority in downlink traffic (ALOHAGP). The effective throughput has been optimized by adapting the protocol parameters as a function of the current number of active sensors received from satellite. Also, there is currently no method for advertising or negotiating the maximum size of a bundle which can be accepted by a bundle agent in satellite communications for storage and delivery, so that bundles which are too large can be dropped or which are too small are inefficient. We have characterized this kind of scenario obtaining a probability distribution for frame arrivals to nanosatellite and visibility time distribution that provide an optimal proactive fragmentation of DTN bundles. We have found that the proactive effective throughput (goodput) reaches a value slightly lower than reactive fragmentation approach. This contribution allows to use the proactive fragmentation optimally with all its advantages such as the incorporation of the security model of DTN and simplicity in protocol implementation for computers with many CPU and memory limitations. The implementation of these contributions was initially contemplated as part of the payload of the nanosatellite QBito, which is part of the constellation of 50 nanosatellites envisaged under the QB50 project.

Barriers and facilitators to effective coverage of Intimate Partner Violence services for immigrant women in Spain

Objective: To explore service providers’ perceptions in order to identify barriers and facilitators to effective coverage of Intimate Partner Violence (IPV) services for immigrant women in Spain, according to the different categories proposed in Tanahashi's model of effective coverage. Methods: A qualitative study based on 29 in-depth personal interviews and four group interviews with a total of 43 professionals working in public services (social and health-care services, women's refuges, the police force, the judiciary) and NGOs in Barcelona, Madrid, Valencia and Alicante (Spain) in 2011. Findings: Current IPV services in Spain partially fail in their coverage of abused immigrant women due to barriers of (i) availability, such as the inexistence of culturally appropriate services; (ii) accessibility, as having a residence permit is a prerequisite for women's access to different services and rights; (iii) acceptability, such as women's lack of confidence in the effectiveness of services; and (iv) effectiveness, for example, lack of specific training among professionals on the issues of IPV and immigration. However, interviewees also identified facilitators, such as the enabling environment promoted by the Spanish Law on Gender-Based Violence (1/2004), and the impetus it has provided for the development of other specific legislative tools to address IPV in immigrant populations in Spain (availability, accessibility and effectiveness). Conclusion: Whilst not dismissing cultural barriers, aspects related to service structure are identified by providers as the main barriers and facilitators to immigrant women use of IPV services. Despite noteworthy achievements, improvements are still required in terms of mainstreaming assistance tailored to immigrant women's needs in IPV policies and services.

Assessment of retail and wholesale market competition in the Illinois electric industry /

In this report, the Commission examines developments relevant to the competitiveness of the retail and wholesale markets. In the retail market, two key indicators of activity are examined: The first indicator is the rate of customer switching from bundled services to "delivery services." Customers taking delivery services are either purchasing power and energy from ARES or are purchasing power and energy from the host utility on an "unbundled" basis under the utility's delivery services tariffs. Currently, bundled power sales mainly consist of sales to customers under the Sec. 16-110 "Power Purchase Option" (PPO). The second indicator of retail activity presented in this report is the number of suppliers active in the State's nine service territories.

The use of online health techniques to assist with the delivery of specialist paediatric diabetes services in Queensland

We have tested an alternative method of delivering health services to regional areas of Queensland. By integrating telepaediatrics into an existing outreach programme for children with diabetes and endocrine conditions, we were able to reduce travel for specialist hospital staff while maintaining (and sometimes increasing) the contact patients had with the specialist team. In the first 28 months, we facilitated 160 patient consultations and 10 education sessions via videoconference through the telepaediatric service. By the end of the study, site visits were taking place annually and routine videoconference clinics were scheduled quarterly for the review of new patients and follow-up. Telepaediatric services in endocrinology and diabetes were established at three levels: the coordination of routine specialist clinics via videoconference; ad hoc patient consultations for collaborative management during acute presentations and at times of urgent clinical need; and the delivery of education to staff and patients throughout the state. The net result was improved access to specialist services from rural and remote areas of Queensland.

Evaluation of the Heart of Birmingham teaching Primary Care Trust (HoBtPCT): My Choice Weight Management Programme:report commissioned by Heart of Birmingham teaching Primary Care Trust

This report details an evaluation of the My Choice Weight Management Programme undertaken by a research team from the School of Pharmacy at Aston University. The My Choice Weight Management Programme is delivered through community pharmacies and general practitioners (GPs) contracted to provide services by the Heart of Birmingham teaching Primary Care Trust. It is designed to support individuals who are ‘ready to change’ by enabling the individual to work with a trained healthcare worker (for example, a healthcare assistant, practice nurse or pharmacy assistant) to develop a care plan designed to enable the individual to lose 5-10% of their current weight. The Programme aims to reduce adult obesity levels; improve access to overweight and obesity management services in primary care; improve diet and nutrition; promote healthy weight and increased levels of physical activity in overweight or obese patients; and support patients to make lifestyle changes to enable them to lose weight. The Programme is available for obese patients over 18 years old who have a Body Mass Index (BMI) greater than 30 kg/m2 (greater than 25 kg/m2 in Asian patients) or greater than 28 kg/m2 (greater than 23.5 kg/m2 in Asian patients) in patients with co-morbidities (diabetes, high blood pressure, cardiovascular disease). Each participant attends weekly consultations over a twelve session period (the final iteration of these weekly sessions is referred to as ‘session twelve’ in this report). They are then offered up to three follow up appointments for up to six months at two monthly intervals (the final of these follow ups, taking place at approximately nine months post recruitment, is referred to as ‘session fifteen’ in this report). A review of the literature highlights the dearth of published research on the effectiveness of primary care- or community-based weight management interventions. This report may help to address this knowledge deficit. A total of 451 individuals were recruited on to the My Choice Weight Management Programme. More participants were recruited at GP surgeries (n=268) than at community pharmacies (n=183). In total, 204 participants (GP n=102; pharmacy n=102) attended session twelve and 82 participants (GP n=22; pharmacy 60) attended session fifteen. The unique demographic characteristics of My Choice Weight Management Programme participants – participants were recruited from areas with high levels of socioeconomic deprivation and over four-fifths of participants were from Black and Minority Ethnic groups; populations which are traditionally underserved by healthcare interventions – make the achievements of the Programme particularly notable. The mean weight loss at session 12 was 3.8 kg (equivalent to a reduction of 4.0% of initial weight) among GP surgery participants and 2.4 kg (2.8%) among pharmacy participants. At session 15 mean weight loss was 2.3 kg (2.2%) among GP surgery participants and 3.4 kg (4.0%) among pharmacy participants. The My Choice Weight Management Programme improved the general health status of participants between recruitment and session twelve as measured by the validated SF-12 questionnaire. While cost data is presented in this report, it is unclear which provider type delivered the Programme more cost-effectively. Attendance rates on the Programme were consistently better among pharmacy participants than among GP participants. The opinions of programme participants (both those who attended regularly and those who failed to attend as expected) and programme providers were explored via semi-structured interviews and, in the case of the participants, a selfcompletion postal questionnaire. These data suggest that the Programme was almost uniformly popular with both the deliverers of the Programme and participants on the Programme with 83% of questionnaire respondents indicating that they would be happy to recommend the Programme to other people looking to lose weight. Our recommendations, based on the evidence provided in this report, include: a. Any consideration of an extension to the study also giving comparable consideration to an extension of the Programme evaluation. The feasibility of assigning participants to a pharmacy provider or a GP provider via a central allocation system should also be examined. This would address imbalances in participant recruitment levels between provider type and allow for more accurate comparison of the effectiveness in the delivery of the Programme between GP surgeries and community pharmacies by increasing the homogeneity of participants at each type of site and increasing the number of Programme participants overall. b. Widespread dissemination of the findings from this review of the My Choice Weight Management Project should be undertaken through a variety of channels. c. Consideration of the inclusion of the following key aspects of the My Choice Weight Management Project in any extension to the Programme: i. The provision of training to staff in GP surgeries and community pharmacies responsible for delivery of the Programme prior to patient recruitment. ii. Maintaining the level of healthcare staff input to the Programme. iii. The regular schedule of appointments with Programme participants. iv. The provision of an increased variety of printed material. d. A simplification of the data collection method used by the Programme commissioners at the individual Programme delivery sites.

A cloud-based farm management system:architecture and implementation

Recent technological advances have paved the way for developing and offering advanced services for the stakeholders in the agricultural sector. A paradigm shift is underway from proprietary and monolithic tools to Internet-based, cloud hosted, open systems that will enable more effective collaboration between stakeholders. This new paradigm includes the technological support of application developers to create specialized services that will seamlessly interoperate, thus creating a sophisticated and customisable working environment for the end users. We present the implementation of an open architecture that instantiates such an approach, based on a set of domain independent software tools called "generic enablers" that have been developed in the context of the FI-WARE project. The implementation is used to validate a number of innovative concepts for the agricultural sector such as the notion of a services' market place and the system's adaptation to network failures. During the design and implementation phase, the system has been evaluated by end users, offering us valuable feedback. The results of the evaluation process validate the acceptance of such a system and the need of farmers to have access to sophisticated services at affordable prices. A summary of this evaluation process is also presented in this paper. © 2013 Elsevier B.V.

Uncertainty propagation in the model web:a case study with e-Habitat

eHabitat is a Web Processing Service (WPS) designed to compute the likelihood of finding ecosystems with equal properties. Inputs to the WPS, typically thematic geospatial "layers", can be discovered using standardised catalogues, and the outputs tailored to specific end user needs. Because these layers can range from geophysical data captured through remote sensing to socio-economical indicators, eHabitat is exposed to a broad range of different types and levels of uncertainties. Potentially chained to other services to perform ecological forecasting, for example, eHabitat would be an additional component further propagating uncertainties from a potentially long chain of model services. This integration of complex resources increases the challenges in dealing with uncertainty. For such a system, as envisaged by initiatives such as the "Model Web" from the Group on Earth Observations, to be used for policy or decision making, users must be provided with information on the quality of the outputs since all system components will be subject to uncertainty. UncertWeb will create the Uncertainty-Enabled Model Web by promoting interoperability between data and models with quantified uncertainty, building on existing open, international standards. It is the objective of this paper to illustrate a few key ideas behind UncertWeb using eHabitat to discuss the main types of uncertainties the WPS has to deal with and to present the benefits of the use of the UncertWeb framework.

Social determinants of dental treatment needs in Brazilian adults

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