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Copyright of Revista de Atencao Primaria a Saude is the property of Revista de Atencao Primaria a Saude and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

No detailed analyses have been undertaken on the effects of Health Promoting Schools on oral health status. The objective of this study was to assess whether the oral health of 12-year-old children in supportive schools, where health promoting policies had been developed, was better than that of children in non-supportive schools. A sample of 1823 12-year-old children in 33 public (government-funded) schools were selected in deprived areas of Curitiba, Brazil. Principal component analysis, multiple regression, meta-analysis and meta-regression were used in the data analysis. Schools with a comprehensive curriculum were more likely to have a higher percentage of caries-free children (beta = 6.27, p = 0.02) and fewer children with dental trauma (beta = -5.04, p = 0.02). The commitment towards health and safety at school was strongly associated with dental trauma, as 9.7% fewer children had dental trauma (p = 0.00) in schools that demonstrated a commitment towards health and safety. At the school level, mother's education and family income were independently associated with children's caries experience and dental trauma, respectively. Children in supportive schools had better oral health than those in non-supportive schools. Our results suggest that some benefit can be obtained for the improvement of the oral health of children living in deprived areas if they attend supportive schools. [ABSTRACT FROM AUTHOR]

In the transition period from breastfeeding to the introduction of complementary feeding, the choice of food is extremely important for the child's development as many factors may be related. This study aims to investigate, through a systematic review and qualitative meta-synthesis, influence in the selection of foods in the introduction of complementary foods for children, including qualitative studies without language or publication period restrictions. Searches were performed in PubMed, LILACS, SciELO, Cinahl, Embase, Web of Science, and Scopus. Initially, 12,489 articles were selected for tittle reading, 13 were included in the review. Four analytical themes related to factors influencing complementary feeding were identified: family socioeconomic conditions, cultural and family aspects, guidance and advice from health professionals, and factors inherent to the infant. Economic factors, such as the opportunity to offer foods not consumed during the parents' childhood, were emphasized. The influence of grandmothers' opinions and community beliefs and traditions were considered. Trust in pediatricians and community health agents' advice, although considered, conflicted with cultural and family traditions. Mothers/caregivers often preferred to offer foods the child shows preference for, rather than introducing new flavors. The findings underscore the need for a better understanding of qualitative aspects., Competing Interests: Declaration of competing interest The authors declare that they have no conflicts of interest related to this research. There are no financial, personal, or professional relationships that could influence or be perceived to influence the work presented in this manuscript. This research is conducted with the utmost objectivity and transparency., (Copyright © 2024. Published by Elsevier Ltd.)

This study aimed to analyze the profile and level of satisfaction of users served in the dental specialty for patients with special healthcare needs (SHCN), based on the Brazilian Program for Improving Access and Quality ("PMAQ") of the Centers for Dental Specialties ("CEO"). This observational, quantitative study used a national secondary database in the public domain. Data were analyzed using the chi-squared test with Bonferroni correction, Student's t-test, and log-linear Poisson regression. Most users of the specialty "SHCN" interviewed were female (74.1% in 2014 and 68.8% in 2018), with a mean age of 41.7 (2014) and 44.9 (2018) years. For every 100 respondents who considered it regular or bad, 171 considered it good, and 199 considered it very good. Regarding satisfaction with the host of the "CEO," there were differences between the regions of Brazil (Midwest, Northeast, Southeast, and South). There has been an increase in the number of "CEO" that serve users with autism spectrum disorder. Generally, the "CEO" network provides humanized and welcoming services, presenting better performance in the second evaluation cycle, according to user perception.

Objective: To describe the sociodemographic and gestational profile of HIV-positive women in Curitiba-PR, years 2018-2020., Method: Observational, cross-sectional research, with data obtained from the Information System of Diseases of Notification of Pregnant Women. Data were analyzed for consistency exploration, description and analysis., Results: The sample consisted mostly of women aged 13-30 years, white and with incomplete elementary school. Prenatal care was performed by 93.8% of pregnant women, 66.1% of whom knew their serological status before prenatal care and 45% received notification in the first gestational trimester. Access to antiretroviral medication occurred for 82.4% of pregnant women and for 74.6% the pregnancy outcome was alive newborns. The statistical variables associated with prenatal care were pregnancy evolution, ART prophylaxis, type of delivery and ART at delivery (p<0.00)., Conclusion: The pregnant women in the sample presented desired gestational indicators. The collected data allowed describing the sample's profile and evaluating the performance of the health policy for pregnant women.

Background: Rapid demographic, epidemiological, technological, cultural/behavioural, and educational transitions, as they become more complex, demand new integrated and complementary professional skills and abilities. Interprofessional Education (IPE) is a promising alternative to deal with these changes, especially in courses in the health area. This systematic review was to explore the potentialities and limitations of IPE, from the perspective of undergraduate students, through a thematic synthesis of qualitative studies., Methods: A thematic synthesis of qualitative studies was conducted. The question elaborated for this review was: "What is the impact of interprofessional education on the teaching and learning of students in the health area inserted in Higher Education Institutions?". The search strategy was performed in the electronic databases PubMed, Latin American and Caribbean Literature in Health Sciences (LILACS), Cochrane Library, and Scientific Electronic Library Online (SciELO). In addition, searches were carried out in grey literature on the ERIC platforms, ProQuest Disserts and Theses, and Academic Google. The assessment of the quality of the studies was carried out using the Critical Appraisal Skills Programme tool. Data were summarized through thematic synthesis. From the databases, 8,793 studies were identified. After standardized filters procedures, critical summaries, and assessment of relevance to the eligibility criteria, 14 articles were included., Results: The synthesis of the studies revealed the potential of this teaching approach, arranged in three analytical themes: learning from each other and about them; the value of education and interprofessional practice; patient-centred health care. On the other hand, some limitations were also identified, such as barriers related to EIP; the difficulties related to teaching methodologies., Conclusion: Overcoming the identified limitations can enhance the results of the IPE, in view of its impact on the education of students and on the health care of the population., (© 2023. The Author(s).)

The study aimed to analyze strategies for the implementation of the Brazilian National Oral Health Policy (PNSB) and its influence on oral health conditions in state capitals in the first decade of the 21st century. This is a policy assessment study. Data on oral health conditions were obtained from the databases of the Brazilian National Oral Health Surveys in 2003 and 2010 (SBBrasil 2003 and SBBrasil 2010), calculating the annual percent change in variables pertaining to oral health conditions as dependent variables for Brazilian state capitals. The PNSB was analyzed according to its conceptual foundations: oral healthcare model, organization of the supply of oral health services, implementation of oral health promotion strategies, and existence of fluoridation of the public water supply. Data were obtained from the national health databases and face-to-face interviews with oral health coordinators in 13 state capitals. The analyses were controlled and adjusted by the target population's socioeconomic conditions. An association was observed between the characteristics of oral health promotion, services supply, and model of care, indicating that the public services' dynamic is dependent on the management priorities and the policy's conduction. In conclusion, the PNSB is implemented differently in Brazil's state capitals according to the ways its guidelines are conducted in each capital and whether it favors best practices and strategies in oral healthcare. However, the influence of the PNSB is still not clear on the modification of oral health indicators from 2003 to 2010.

The aim of this study was to perform a cross-cultural adaptation of the Brazilian version of the Dental Neglect Scale (DNS). The process included (i) Translation; ii) Synthesis; iii) Back translation; (iv) Critical analysis by a committee of experts; (v) Pilot studies (n1=30 + n2=30); and (6) Evaluation and refinement of the instrument. The validated DNS presented a Content Validity Index (CVI) equal to 1.0 for the total score, as well as for each item. In the pilot studies, a minimum agreement level of 80% in understanding was achieved. DNS was properly adapted for Brazilian Portuguese, and it needs further study in a representative sample for reliability and construct validity assessment.

Aim: This systematic review was to explore the potentialities and limitations of Interprofessional Education (IPE), from the perspective of undergraduate students., Background: The increasing complexity in health increasingly demand professionals with the capacity to act in the face of new global challenges. Thus, this pedagogical approach presents itself as one of the most promising choices in facing these new obstacles., Design: A synthesis of quantitative studies and mixed methods., Methods: Studies involving quantitative analyzes were included, with no restriction on the date of publication and language. The search strategy was carried out in the electronic databases: PubMed, Latin American and Caribbean Literature in Health Sciences (LILACS), Cochrane Library and Scientific Electronic Library Online (SciELO). In addition, searches were carried out in gray literature on the ERIC platforms (ProQuest), ProQuest Disserts and Theses Full text and Academic Google. The assessment of the quality of the studies was carried out using the instrument by Downs and Black. The risks of bias in the studies were examined with the aid of the adapted version of the Cochrane Collaboration tool, with the domains of the Downs and Black instrument., Results: After standardized filter procedures, critical summaries and assessment of relevance to the eligibility criteria, 11 articles were included. The results showed that most students have a positive perception of IPE, with different factors influencing this research finding. The need to develop more robust assessment instruments is highlighted, in view of the insufficiency of tools with sufficient methodological rigor to measure real changes in attitudes among different groups of students., Conclusion: More consistent research is needed, which assesses, in a longitudinal way, the effects that the IPE has on the teaching and learning of undergraduate students and its impact after professional training., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

The organization of health systems in Health Care Networks (HCN) presents itself as a strategy to overcome the fragmentation of maternal and child health actions and services and to qualify care management. The objective of this study was to validate the Instrument for Evaluation of Maternal and Child Health Care Networks (IARAMI), adapted from the Evaluation Tool of Health Care Networks. The validation process comprised face and construct validation. The methodology used for face validation included the conceptual and semantic adaptation of the instrument and analysis by a panel of experts, through the modified consensus e-Delphi technique. After face validation, IARAMI was applied in a sample of 99 health managers of municipalities in the state of Paraná. The construct validation was conducted through the internal consistency analysis using Cronbach's alpha coefficient and factorial analysis. The factorial analysis technique was applied to each of the dimensions of the instrument, enabling the analysis of communalities. The results showed that IARAMI presented reliability and validity, proving to be a tool that can help managers and health workers in the planning, management, and evaluation of the degree of integration of the maternal and child care network.

Early childhood caries (ECC) is a global problem, disproportionately affecting disadvantaged populations. The aim of this study was to evaluate systematically the available scientific evidence on the effectiveness of methods for ECC prevention. Six electronic databases were searched. Two independent reviewers selected the publications and analysed the quality of the included systematic reviews. Thirteen studies were included. Overall, eight reviews were classified with methodological quality critically low using the AMSTAR 2, whereas five reviews achieved a high risk of bias using the ROBIS tool. The methods identified that were positively related to the prevention of ECC were as follows: preventive dental programmes for pregnant women; advice on diet and feeding; prenatal oral health care; integration of maternal and children's oral health promotion into nursing practice; maternal oral health programmes undertaken by non-dental health professionals; dental health education in combination with the use of fluoride for children; early preventive dental visits; and the use of fluoride varnish and toothpastes with more than 1000 ppm of fluoride. The currently available evidence supporting the effectiveness of methods for prevention of ECC, although suggesting some methods of greater potential, is still lacking due to the methodological quality of the systematic reviews and the included primary studies., (© 2021 BSPD, IAPD and John Wiley & Sons Ltd.)

This study explores associated factors and perceptions of oral health among crack users recruited in open drug scenes in Brazil. A mixed methods approach was used. The quantitative component analysed findings from a large ( N  =   7381), population-based survey. The outcomes under analysis were 'self-perception of oral health' and 'self-reporting of problems affecting the mouth, teeth and gingiva (gums)'. The qualitative component comprised a focus group, with 12 individuals recruited from a drug treatment clinic. Lower self-perception of oral health problems vis-à-vis a higher prevalence of problems affecting the mouth, teeth, and gingiva were found in users who had a lower level of education, used substances daily, had worse self-perception of physical health, did not receive health care and regularly used alcohol and/or tobacco. The results show an association between substance use and decline in oral health, as well as the lack of health services focusing on such issues. Oral health services should be emphasised as a gateway to the health system. So far, the putative cross-referral between services and professionals working in oral health and other health professionals working in the field of drug dependence has not been observed.

Objectives: To conduct a systematic review of coronavirus disease 2019 (COVID-19)-related biosafety guidelines for dental clinical practice in the early stage of the pandemic, focusing on quality assessment., Methods: Electronic (via PubMed, Scopus, Web of Science, Latin American and Caribbean Health Sciences Literature database, Brazilian Library in Dentistry, and Cochrane Library) and gray literature searches were performed for documents published up to May 12, 2020. Guidelines updated until April 17, 2021 were identified. Documents were included as guidelines if they (1) consisted of a set of statements, directions, or principles presenting current or future rules or policy; (2) were developed by government agencies, institutions, organizations, or expert panels; and (3) were related to the general conduct of healthcare activities rather a particular condition. Two researchers, using the Appraisal of Guidelines for Research & Evaluation II, independently extracted the recommendations and evaluated the quality of the guidelines., Results: Twenty-seven documents from 19 countries were included in the review. These documents presented 122 recommendations related to (1) professional biosafety; (2) patients'/companions' safety; (3) the organization and biosafety of the physical dental facility environment; and (4) the work process in dental care. Overall, the scientific quality of the guidelines was considered low. Some recommendations presented in these guidelines would require further research to establish their effectiveness., Conclusions: We found a wide variety of biosafety guidelines for dental practice regarding COVID-19 in the early months of the pandemic, but their quality was low. Biosafety recommendations should be frequently updated.

Background: People with disabilities tend to have greater oral health problems compared to those without disabilities. This may be due to barriers they come across in accessing dental services., Objectives: The objective of this systematic review was to provide a critical digest of the scientific literature concerning barriers and facilitators of access to oral health services for people with disabilities., Methods: The electronic databases PubMed, Scopus, Web of Science, Latin American and Caribbean Health Sciences Literature (LILACS), and Brazilian Library of Dentistry (BBO) were searched using keywords relevant to the subject. The search was not restricted to specific languages or years of publication; all relevant studies were translated and reviewed., Results: Sixteen studies including 14 articles, a doctoral thesis, and a monograph were selected, and their quality was analysed using the Downs and Black assessment tool. Barriers to dental services were divided into physical or nonphysical based on the dentist's perspective, as per the perception of parents/guardians or by the persons with disabilities. The barriers that emerged included the dentist's lack of preparation to assist people with disabilities, structural problems of access to dental offices, communication difficulties, and lack of awareness regarding the need for dental treatment for the disabled person., Conclusion: It is concluded that people with disabilities continue to run into complex physical, behavioural, or multidimensional barriers in accessing dental services. Improved training of dentists for the care of this population is hereby emphasized. The legal framework enabling access to dental care for people with disabilities must also be respected in each country., Competing Interests: The authors declare that they have no financial affiliation (e.g., employment, direct payment, stock holdings, retainers, consultantships, patent licensing arrangements, or honoraria) or involvement with any commercial organization with direct financial interest in the subject or materials discussed in this manuscript or any such arrangements existed in the past five years. No potential conflicts of interest relevant to the present article were reported., (Copyright © 2020 Saulo V. da Rosa et al.)

Objective: To present a genetic and protein interaction analysis associated with dental caries., Material and Methods: The first step was to conduct a systematic literature review (SLR) through an electronic database search. Case-controls that reported associations between genes and dental caries were the main type of study design used as inclusion criteria, retrieved from the PubMed and the Virtual Health Library databases, comprising the chronological range from 1982 to 2017. The SLR was guided by PRISMA protocol and the methodological quality of the studies was established through Newcastle-Ottawa Scale (NOS). In the second step, the String Protein Interaction (SPI) approach was used to analyze protein interaction (by esyN software) and also the Ingenuity Pathway Analysis (IPA) to check biological pathways associated with dental caries genes., Results: A total of 51 articles were included to perform this SLR, describing a number of 27 genes associated with dental caries development. At the genetic level, 23 genes have at least one other gene with which they interact. The genes TUFT1, VDR, TFIP11, LTF, HLA-DRB1, MMP2, MMP3 and MUC5B were shown to be connected in interactive networks by at least 10 other genes., Conclusion: It is essential to apprehend the multifactorial pattern of inheritance in human disease. This study presents pathways which may be directly correlated with several dental caries phenotype and this contributes to a better understanding of this disease, opening up a wider range of biotechnology options for its effective control in the future., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

It was investigated the perception of service users in relation to the professional practice of dentists, based on gender differences. The Primary Care Assessment Tool (PCATool) was applied to 900 users of the Public Service in Curitiba, PR, Brazil. Sixty clinics were selected using random sampling, divided between conventional Primary Health Care (PHC) Units and PHC with Family Health System Units. The attributes of PHC that compound the PCATool were analyzed. A question was added about user preference regarding the gender of the dental professional, thus generating four dyads derived from user gender/dentist gender (FF, FM, MM, MF). The attributes were linked to the dyads by applying the independent sample t test. Using logistic regression, the dyads were linked to 23 factors relating to scaled-up care in PHC. Many users showed a clear preference for being attended by female dentists. Users who prefer to be cared for by women tend to better evaluate PHC on issues related to "active listening", while those who prefer to be cared for by male dentists highlight the attributes of "care integration" and "community guidance". In other factors and attributes studied, there is no difference between the care given by men or women, regardless the unit.

Introduction: In Brazil, the undergraduate dental education still remains fragmented and dissociated from its social context, with emphasis on the individualistic and private aspects of dental health. This study aimed to analyze the training and development of university professors of dentistry in stricto sensu postgraduate programs in Brazil., Materials and Methods: Delphi electronic methodology was used within a qualitative-quantitative design to gather data from a panel of 58 experts. Discussions representing the analytic axis focused on: (i) the evaluative processes of higher education, in particular stricto sensu postgraduate programs, and their influence on academic activities in undergraduate dentistry courses and (ii) policies for training and developing university professors., Results: Of the experts, 30 participated in the first round, 24 in the second, and 19 in the third. They considered the training of university professors in dentistry to be highly specialized and technologically focused and indicated the review of political-pedagogic aspects of the educational sphere, as well as the social, economic, cultural, epidemiologic, and professional aspects of training and preparation prescribed by the National Curricular Guides for graduate courses in dentistry. An adequate process of evaluating the official organs and regulators of postgraduate stricto sensu programs, as well the programs themselves, should be implemented., Conclusion: The experts stated that changes to the university teaching system are necessary, even in the field of dentistry. Mechanisms for evaluating areas and professors were inadequate, and the training was overly specialized and not consistent with the social reality of the country., (© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: The gerontoism, a neologism adopted here, is a form of discrimination regarding age and can occur in rational, emotional, and behavioral contexts, and could be influenced by many factors. This study aimed to identify if the social support and the family functionality interfere in the self-perception of gerontoism., Methods: Participants were 376 elderly in good physical and mental condition. They participated in the Group Living organization in the Municipality of Curitiba, State of Paraná, Brazil, in 2012. Information was collected about sociodemographic profile using a structured questionnaire. The social support, the family functionality, and the self-perception of gerontoism were defined by the Medical Outcomes Study, the Family APGAR index, and Ageism Survey, respectively. The variables were analyzed by Pearson's correlation coefficient, One Way ANOVA, Tukey's HSD test, and the Student's t-test., Results: Most of the participants came from small cities from the interior (48.7%), were female (94.4%), with age ranging 60-69 yr-old (45.5%), whites (76.1%), widowers (47.1%), with children (93.9%), with low schooling (55.3%), with family income from 1-2 minimum wage (31.4%), and retirees not working (44.1%). It was not observed correlation between sociodemographic variables and self-perception of gerontoism. Statistical significance was observed between self-perception of gerontoism and social support ( r = -0.26, P =0.00), and between the self-perception and family functionality ( r = -0.28, P =0.00). Once the scores of self-perception of gerontoism increased, the ones from social support and family functionality, decreased., Conclusion: Lower self-perception of gerontoism was observed in elderly with higher social support and family functionality., Competing Interests: Conflict of interest The authors declare that there is no conflict of interest.

The idea that the Holocene is over and a new human-dominated geological epoch, the Anthropocene, is in progress has been widely discussed. The article aims to outline the published definitions and current patterns on the Anthropocene, highlighting an agenda of emerging risks, challenges and possibilities for the health of the world's population in this new era. We performed a review on the complexities of planetary health in the Anthropocene, which generated 42 initial references for full-text reading; we selected 25 of them and carried out analysis and interpretation. Anthropogenic activities have increasing impacts on the environment and a fundamental change in the relationship between humans and the terrestrial system, in many ways that exert intentional and unintentional influences on natural and social processes. The burgeoning literature on health promotion and global public health talks about the anthropogenic forces, claiming a solid critical theory of action to confront, modify and reduce the deleterious effects of such forces. For that reason, the 23rd IUHPE World Conference on Health Promotion, scheduled to be held in New Zealand in 2019, emphasizes the theme 'Promoting Planetary Health and Sustainable Development for All'. It recognizes that the current paradigm of economic unlimited growth and exploitation of limited natural resources is unfair and unsustainable, leading to geopopulational and temporal inequities between generations., (© The Author(s) 2019. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Objectives: To compare two different models of public oral health in primary care services, a so-called family health strategy (FHS), as opposed to non-FHS services designated as 'conventional' healthcare (CHC), regarding the presence and extent of the attributes of 'good' primary healthcare (PHC). The null hypothesis of this study is that the attributes do not differ between the FHS and CHC., Design: Cross-sectional., Setting: Public PHC services in Curitiba, the state capital of Paraná., Participants: PHC users of the public oral health network (n=900) and dentists active in this municipal network (n=203)., Primary and Secondary Outcome Measures: The Primary Care Assessment Tool (PCATool)-Dentists and PCATool-Users were used to analyse the primary outcomes ('essential' attributes) and secondary outcomes ('derived' attributes) in the PHC., Results: Overall, the primary care services in oral health were well evaluated, both by users and by dentists, with mean scores ascribed to PHC attributes mostly above the cut-off point (6.6). The exception for users were affiliation (6.36; 95% CI 6.11 to 6.60) and accessibility (5.83; 95% CI 5.78 to 5.89); and for dentists the accessibility (5.80; 95% CI 5.63 to 5.96). When comparing FHS and CHC, there was a superiority of the FHS model, which reached a general mean score of 7.53 (95% CI 7.48 to 7.58) among users and 7.56 (95% CI 7.45 to 7.67) among dentists; on the other hand, the CHC general mean score was of 6.61 (95% CI 6.49 to 6.73) and 6.68 (95% CI 6.56 to 6.80) respectively for users and dentists., Conclusions: The results reveal a reasonable level of attainment of PHC attributes in the services investigated. Nevertheless, public health managers should make efforts to reduce the difficulties faced by users in accessing dental care. The more positive results achieved by FHS services indicate that the provision of oral healthcare under this strategy should be expanded., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Imprisoned women represent a growing population worldwide with important health needs. In this study, we aimed to analyze the impact of oral health conditions on the quality of life of female inmates in a maximum security correctional facility. Participants were examined and answered the OHIP-14 questionnaire. A total of 305 inmates were included in the study. Prevalence of untreated caries was 84%. Worse quality of life was associated with dental caries, dental pain, deep periodontal pocket, prosthetic use, and age. Sociodental indicators should be incorporated into healthcare and health policies in order to promote wellbeing among this vulnerable population.

Aim: This study aimed to investigate the associations between human development and the demographic ratio of dentists with the prevalence of dental caries at 12 years of age in large Brazilian cities., Materials and Methods: Data were collected from 27 state capitals, Secondary databases were used: the municipal human development index (MDHI); the ratio of dentists qualified to exercise their profession according to the number of inhabitants; and the decayed, missing or filled teeth index (DMFT). Pearson correlation coefficient analysis and multiple logarithmic regression analysis were performed., Results: The MDHI showed a strong correlation with DMFT and explained 48.1% of the variation in the cities. The ratio of dentists to the number of inhabitants displayed an insignificant, weak correlation with the variations in the DMFT., Conclusion: Social factors strongly influence the oral health/ disease process in Brazilian capitals, thus actions are needed for the promotion of health at more distal, or structural levels that modify the environment, thus enabling healthier choices for individuals. These results challenge traditional beliefs that only the ratio of professional dentists to inhabitants and the provision of dental services have beneficial effects on the prevention and control of oral health problems., Clinical Significance: The prevalence of dental caries is strongly correlated with social factors, as the MDHI.

Some barriers to dental treatment during pregnancy are poorly understood, especially those related to psychosocial factors, which are better explored in qualitative studies. The aim of this systematic review was to explore the barriers and facilitators to dental care during pregnancy through a thematic synthesis of qualitative studies. Qualitative or mixed-methods studies published in English, Portuguese, Spanish and French, from 2000 to 2016, were included. The search strategies were conducted in PubMed, Scopus, Web of Science, LILACS, BBO and CINAHL. To evaluate the quality of the studies, we used the Critical Appraisal Skills Programme tool. Thematic synthesis was performed in order to interpret and summarize the results. From 2,581 screened studies, ten were included in the synthesis. We found 14 analytical themes related to barriers and facilitators to dental care during pregnancy that interacted in complex ways: physiological conditions, low importance of oral health, negative stigma regarding dentistry, fear of/anxiety toward dental treatment, mobility and safety, financial barriers, employment, time constraints, social support, lack of information, health professionals' barriers, family and friends' advice, beliefs and myths about the safety of dental treatment. Myths and beliefs about oral health and dental treatment during pregnancy appear to be the most frequent barriers, both to pregnant women and to dentists or other health professionals. The findings of this review may support new studies, especially to test intervention protocols and to guide effective public policies for the promotion of oral health during pregnancy.

Objective: To identify the impact of MUC5B polymorphisms on dental caries., Methods: A case-control study was performed with patients recruited at Pontifícia Universidade Católica do Paraná. These individuals were aged 12 years old or more. Dental caries was diagnosed using the International Caries Detection and Assessment System, and the effects of socioeconomic, dietary, and hygiene factors on dental caries were investigated. Furthermore, buccal cells were collected, and their DNA was extracted and amplified using PCR. Uni-, bi-, and multivariate analyses were performed., Results: Two hundred patients were recruited, 100 were assigned to the case group and 100 to the control group. In the bivariate analysis, the following variables showed significant results: ethnicity (p = .008), biofilm (p < .001), and gingivitis (p < .001). The MUC5B gene affected dental caries with the markers rs2735733 (p < .001), rs2249073 (p < .001), and rs2857476 (p < .001). In the multivariate analysis, the biofilm variable remained significant (p = .026), as did the following markers from the MUC5B gene: rs2735733 (p = .019), rs2249073 (p < .025), and rs2857476 (p < .005)., Conclusion: Genetic variations in the MUC5B gene can influence dental caries., (© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd. All rights reserved.)

Despite the fact that dental care attendance during pregnancy has been recommended by guidelines and institutions, the demand for dental services is still low among pregnant women. The aim of this study was to identify and analyze the determinants of dental care attendance during pregnancy. We performed a systematic literature search in the electronic databases PubMed, Scopus, Web of Science, Latin American and Caribbean Health Sciences Literature, Brazilian Library in Dentistry, Cumulative Index to Nursing and Allied Health Literature, and Medline using relevant keywords. Studies were filtered by publication year (2000-2016) and language (English, Portuguese, Spanish, and French). The included studies were assessed for quality. Their characteristics and statistically significant factors were reported. Fourteen papers were included in the review. The prevalence of dental service usage during pregnancy ranged from 16 to 83%. Demographic factors included women's age, marital status, parity, and nationality. The socioeconomic factors were income, educational level, and type of health insurance. Many psychological and behavioral factors played a role, including oral health practices, oral health and pregnancy beliefs, and health care maintenance. Referred symptoms of gingivitis, dental pain, or dental problems were perceived need. Demographic, socioeconomic, psychological, behavioral factors and perceived need were associated with the utilization of dental services during pregnancy. More well-designed studies with reliable outcomes are required to confirm the framework described in this review., (© 2018 S. Karger AG, Basel.)

This cross-sectional study aimed to assess the association between the quality of primary health care (PHC) and the use of dental services by preschoolers served by the Family Health Strategy (FHS), controlling for socio-demographic determinants and perceived need. The sample encompassed 438 children aged 3-5 years, enrolled in 19 FHS facilities in Ponta Grossa, Paraná State, Brazil. Individual level variables were collected by interviewing parents or caregivers at home. They answered a questionnaire on socioeconomic conditions, oral hygiene habits and use of dental services. Parental perception of child's oral health related quality of life, as perceived need, was assessed by the Brazilian version of Early Childhood Oral Health Impact Scale (ECOHIS). Normative need was assessed by oral examinations, according to guidelines standardized by the World Health Organization. The contextual level factor was defined as the extent of implementation of PHC in the facilities. Managers responded to PCATool-Brazil, a validated questionnaire which measures the extent of PHC. Dentists answered to a version of PCATool, which was adapted and pretested for dental services. Multilevel analysis, based on Andersen's behavioral model, fitted the adjustment of "having ever consulted a dentist" to contextual and individual covariates. We observed high prevalence of dental caries. Almost half of the sample had had dental appointments in life. Social gradients were observed for the use of dental services. Although it was not able to eliminate the impact of adverse social conditions, higher levels of PHC attributes in dental services favored the effective use of such services by low-income children.

Introduction With the significant increase of women in dentistry, the profile of the dental professional has been altered.Aim To investigate the discourses of future dental surgeons, of both genders, from public and private universities of Curitiba, Paraná, Brazil, to detect whether gender profile differences can influence training and intended future practice.Methods The problem is approached using a qualitative design, with the strategy of collective interviews in focus groups followed by a discourse analysis.Results Women choose dentistry mainly because they like working with people and want to have formal employment in the future. Male discourses show a desire for professional status, worthy business prospects, and the flexibility of being self-employed. The analysis of the university education process revealed that men desire learning that is more technical, besides knowledge on business management, whereas women still complain of current prejudices in the personal relationships that exist with teaching staff and colleagues.Conclusion The teaching process, based on the technique-driven biomedical model, has not reached an ideal standard for the female gender in terms of training, which would be a model based on empathy and good relationships with human beings.

Objective:: To evaluate the potential effectiveness of strategies of Oral Health Promotion (OHP), which are carried out by teams in primary health care (PHC) in Brazilian capitals and regions., Methods:: A sample of 1,848 dentists were interviewed (1,819 valid responses) working in the PHC of 26 capitals and the Federal District. The Effectiveness of the Assessment Tool for the Promotion of Oral Health Strategies was used. It is composed of 23 indicators grouped into three dimensions: oral health, health public policies, and human and social development. The answers were arranged in a Likert scale (1-5), and the final score obtained for each sample unit can range from 23 to 115. Higher score values indicate greater potential for the strategy to promote oral health., Results:: Statistically significant differences were identified among the analyzed geopopulation units considering the study object. The Southeast and South regions had better performance for the OHP strategies in comparison to the other regions of Brazil (p ≤ 0.01)., Conclusions:: The OHP strategies identified in the study were heterogeneous, with better results favoring the Southeast regions, with disadvantages for people living in capitals from the Central-North-Northeast of Brazil. Efforts should be undertaken aiming to qualify the PHC teams, especially for those in disadvantageous regions. Therefore, an alignment of PSB strategies to the principles and values of health promotion is required, addressed to the social health determinants (SHDs) and in order to fight the inequalities in oral health.

Objective: To explore high-risk behaviors and experiences with traffic law among night drivers in Curitiba, Brazil., Method: Data from 398 drivers on sociodemographic parameters, high-risk behaviors, experiences with traffic law, and traffic law violations were collected through interviews conducted at sobriety checkpoints. Exploratory-descriptive and analytical statistics were used., Results: The mean age of the participants was 32.6±11.2 years (range, 18 to 75 years). Half of the drivers reported having driven after drinking in the last year, predominantly single men aged 18 to 29 years who drive cars and drink alcohol frequently. Only 55% of the drivers who had driven after drinking in the last year self-reported some concern about being detected in a police operation., Conclusions: A significant association was found between sociodemographic variables and behavior, which can help tailor public interventions to a specific group of drivers: young men who exhibit high-risk behaviors in traffic, such as driving after drinking alcohol, some of whom report heavy alcohol consumption. This group represents a challenge for educational and enforcement interventions, particularly because they admit to violating current laws and have a low perception of punishment due to the low risk of being detected by the police.

The aim of this study was to investigate the association between sociodemographic, socioeconomic, psychosocial, and behavioral variables and oral health as assessed using the 14-question short version of the Oral Health Impact Profile (OHIP-14). A cross-sectional study was performed with 1095 adult residents from 38 census tracts in the municipality of São Leopoldo, State of Rio Grande do Sul, Brazil. Responses to the OHIP-14 were dichotomized, and bivariate (Chi-square) and multivariate analysis (logistic regression and Wald's test) were performed. In the bivariate analysis, the worse effects were reported by female individuals, the elderly, those with low family income, less schooling, those reporting a lower quality of life and social support, and smokers. In the multivariate analysis the following variables maintained their statistical significance: gender (female), age (50-59 years), family income (low), quality of life (low), social support (low, moderate), and smoking (smokers). Individuals' self-perception of their oral health was related to sociodemographic, socioeconomic, psychosocial, and behavioral variables, thus confirming that emphasis should be placed on social factors when addressing oral health problems.

Introduction: The combination of drinking and driving is globally understood as a risk factor for road traffic crashes and disastrous outcomes such as injury and disability or death. However, the magnitude of the problem may not always be known in many countries, particularly where there are legislative loopholes. In Brazil, until December 2012, verification by breathalyzer of drinking and driving was dependent on drivers' acceptance of the tests after being stopped by the police., Objective: To describe the epidemiological profile of drinking and driving behaviors of a sample of drivers from Curitiba, Brazil, and explore the sociodemographic characteristics of those interviewed at police sobriety checkpoints., Methods: Drivers were selected and interviewed at police checkpoints on public roads in Curitiba. The local police, after informed consent, applied breathalyzer tests to check the drivers' blood alcohol content and the results were compared with data previously collected through interviews containing self-reports of drinking and driving. Data were collected between March and November 2012., Results: Of the 511 drivers asked to participate in the study, 398 (77.9%) agreed to give a roadside interview. Most respondents were single men between the ages of 18 and 29 years, with 8.3% of interviewed drivers self-reporting alcohol consumption in the last 6 h before driving. On the other hand, only 46.2% of the whole sample accepted the breathalyzer testing. Among those breathalyzed by the police, 2.7% tested positive for alcohol., Discussion: This study, conducted on public roads in Curitiba, shows a noticeable proportion of drivers voluntarily self-reporting drinking and driving. However, a smaller percentage was confirmed to have positive blood alcohol content, likely due to the high breathalyzer refusal rate.

The aim of this study was to evaluate the association between individual and contextual variables related to self-perception in oral health among residents in the municipality of São Leopoldo, Rio Grande do Sul State, Brazil. The cross-sectional design involved 1,100 adults in 38 census tracts. The self-perception was evaluated using the Oral Health Impact Profile (OHIP-14) tool. A logistic multilevel analysis was performed. The multivariate analysis revealed that those who are of the female gender, older, with lower scores of quality of life and less social support, with poor healthy eating habits, smokers and those living in low-income census tracts presented higher odds of reporting worse oral health self-perception (OHIP-1). We concluded that individual and contextual variables are associated with oral health self-perception. This is essential information for planning health services wishing to meet the health needs of the population.

Objective: To identify and summarize the findings of studies describing interventions aimed at reducing road traffic injuries., Methods: An integrative systematic review without meta-analysis was performed. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were used to synthesize the findings of the articles reviewed. The keywords "traffic accidents", "review" and "public policy" were used in isolation or combined with boolean operator "And" to search PubMed, Web of Science, SciELO, and LILACS for the period between 2006 and 2011 RESULTS: Twenty-two studies were included in the systematic review. Of these, two described engineering strategies, two described other road safety policies, three described education strategies, and 15 described law enforcement policies. Law enforcement had the most effective immediate results. Engineering strategies proved important to promote a safe environment. Finally, education strategies had an informative role and served to support other strategies, but did not seem sufficient to promote cultural changes regarding road safety., Conclusions: Law enforcement seems to be the most effective strategy to change the behavior of drivers, especially regarding speed limits and drinking and driving.

Identify and analyze cases of child and adolescent abuse and neglect in Curitiba, Brazil. This is an exploratory descriptive study that takes a quantitative approach. Secondary data from the reporting registry of the Network for the Protection of Children and Adolescents at Risk for Violence in Curitiba, Brazil, dating from 2004 to 2009, were analyzed. Variables included the victims' sociodemographic profile, place of notification, type, nature and severity of abuse, information about the author of the aggression or abuse, and physical lesions. The frequency distribution and associations between the variables were analyzed using the Chi-square test at a 5% significance level. The analysis of 19,316 records showed that domestic violence, abuse and neglect directed against children and adolescents were the most frequently recorded situation, with 17,082 cases (88.4%) distributed in the following manner: neglect, with 9742 reports (57.0%); physical violence, with 1341 reports (7.9%); sexual violence, with 796 reports (4.7%); psychological violence, with 574 reports (3.4%); and abandonment, with 190 reports (1.1%). Of the total, 43.9% were considered severe cases. The most affected age group was between 5 and 14 years of age, with balance between genders. In the majority of cases, the mother was registered as the author of the abuse or neglect. Physical sequelae (20.2%) mostly affected the head and upper and lower limbs, with consequent lesions manifesting as bruises, cuts, and fractures. An increase in the visibility of domestic violence and children and adolescents abuse and neglect has been observed in the city during the last few years, suggesting the effectiveness of the reporting strategies proposed by the protection network. It is important to increase social security and public welfare policies to prevent child and adolescent abuse and neglect, focusing on family support., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

The aim of this study was to identify and analyze inequities in the access to specialized services in the municipalities of the metropolitan area of Curitiba, Paraná, Brazil. This is an ecological study. In its preparatory stage, this study focused on the socioeconomic, epidemiologic, healthcare network and sectoral financing network profiles of the 26 municipalities comprising this area. Factor analysis was employed to obtain the six principal components, and a synthetic index was calculated from them, allowing municipalities to be ranked according to living conditions and health situation. Primary data was collected from 24 municipalities, regarding their capacity, directed and repressed demand of specialized healthcare services. The context analysis revealed accentuated intermunicipal inequities. The synthetic index allowed municipalities to be classified in four relatively homogeneous groups regarding living and health conditions. Municipalities located in Vale do Ribeira obtained the worse outcomes for the Living Conditions and Health Situation Synthetic Index, as well as the higher repressed demand for specialized healthcare services. The geographical distance from the capital showed to contribute to worse living and health conditions and greater difficulties in access to healthcare services.

Objective: To assess the correlation between the social determinants of oral health (SDOH) index and social indicators, indicators of oral health, and intermediary social determinants expressed by the indicators of the Government of Brazil's National Oral Health Policy., Methods: This ecological study included 5 915 adults aged 35 to 44 years from 27 Brazilian capitals. Indicators of oral health outcomes-tooth loss, restored teeth, and dental care index (DCI)-were extracted from the 2010 National Oral Health Survey. Social indicators (structural social determinants) and indicators of the National Oral Health Policy were obtained from census data and from the Ministry of Health., Results: A moderate Pearson correlation (r) was observed between SDOH and DCI (r = 0.580), restored teeth (r = 0.545), and tooth loss (r = - 0.490). The social equity component was strongly correlated to DCI (r = 0.856), restored teeth (r = 0.822), and tooth loss (r = - 0.665). These oral health outcomes were not statistically associated with the components related to primary and secondary oral health care. The social equity component explained 44% of the variance in tooth loss, 68% of the variance in the number of restored teeth, and 73% of the variance in DCI., Conclusions: A significant correlation was observed between SDOH and the social equity component with oral health outcomes in adults in Brazilian capitals. Therefore, equity policies should prioritize actions focused on the SDOH, such as increased sanitation coverage and water fluoridation, and on reducing poverty and regional inequities.

The scope of this article is to outline the construction of the regionalized health network, focusing on oral health care and identifying the problems and the progress in its implementation. The context was the proposed national network model in the policies that underpin the Unified Health System. This is a descriptive-exploratory study with a qualitative approach methodologically supported by Grounded Theory. Interviews were conducted with managers, health professionals and teachers graduated in Dentistry, forming three sample groups. The core category was named "Enhancing the interaction of oral health care in the health network in the regionalization process." In the proposed theoretical model, the enhancement of interaction arises from conditions such as: the characterization of oral health care in the regionalized health network; the identification of difficulties in the implementation process; and the analysis of the operation of the oral health care network. The inclusion of oral health in the network is at an early stage, sometimes detached from the set of relations that constitutes the health network, which is also being consolidated. Evidence gathered in this study indicates the structuring of the regionalized health care network as a prerequisite to raise oral health care and assistance to a new level.

Objective: To analyze the limitations of studying dental fluorosis in cross-sectional studies., Methods: Data from the Oral Health of the Brazilian Population (SBBrasil 2003) and the Brazilian Oral Health Survey (SBBrasil 2010) were used. Epidemiological trends for fluorosis in 12-year-old Brazilians, aspects of the reliability of the data as well as the accuracy of the estimates are assessed for these two studies. The distribution of prevalence of fluorosis was carried out according to the domains of the study (state capitals and regions) and the year in which the study took place. The confidence intervals (95%CI) were also shown for simple prevalence (without taking into account level of severity)., Results: The prevalence of dental fluorosis showed considerable variation, between 0% and 61% in 2003 and 0% and 59% in 2010. Inconsistencies were observed in the data in individual terms (for year and for domain) and in the behavior of the trend. Considering the expected prevalence and the data available in the two studies, the minimum sample size should be 1,500 individuals in order to obtain 3.4% and 6.6% confidence intervals, considering the minimum coefficient of variation to be 15%. Given the subjectivity in its classification, examinations for dental fluorosis may show more variation than those for other oral health conditions. The power to establish differences between the domains of the study with the sample of the SBBrasil 2010 is quite limited., Conclusions: Based on the 2003 and 2010 studies, it was not possible to analyze patterns of dental fluorosis in Brazil; these data are merely exploratory indicators of the prevalence of dental fluorosis. It was impossible to make comparisons due to different analysis models being used in the two surveys. Investigating dental fluorosis in population-based surveys is not even an economically viable technique, using localized epidemiological studies with a sampling plan would be more suitable [corrected].

Objective: To analyze the Final Report of the VIII Health Conference and the São José dos Pinhais City Health Program for 2010-2013 and investigate whether these documents addressed the themes of sustainability, governance, and equity and the interfaces between these themes--government policies, power balance, and inclusive processes/impacting results--that make up the Concept Model for Human Development and Health Promotion developed by the authors., Method: This case study analyzed 331 proposals approved for incorporation in the City Health Program. The six thematical categories of the Concept Model were analyzed using ATLAS Ti 5.0 software. The proposals were classified according to the number of themes and interfaces of the Concept Model: full health proposals contained all six categories; partial proposals contained three categories; and incipient proposals contained one category., Results: Of 331 proposals approved, 162 (49%) contemplated the six thematical categories and were classified as full health promotion proposals. Ninety-five (29%) contemplated three categories (partial health promotion). Of these, 38 (12%) addressed Governance, Sustainability, and Government Policies, 33 (10%) addressed Governance, Power Balance, and Equity and 24 (7%) addressed Equity, Inclusive Processes/Impact Results, and Sustainability. Finally, 74 (22%) proposals contemplated only one category and were classified as incipient: 36 (11%) addressed Governance, 27 (8%) addressed sustainability, and 11 (3%) addressed equity., Conclusions: Based on the fact that 49% of the proposals approved were classified as full health promotion, it is considered that the effectiveness of social control and popular participation in the construction of health policies at the local level contritute to the promotion of health in the city.

This comprehensive critical review, carried out in a descriptive-discursive style, presents the oral health surveillance policy currently in force in Brazil. Based on an appraisal of the national and international literature on the subject of health surveillance, it examines the formulation of a scientific and political agenda for oral health surveillance, which is anchored in the institutions of the Brazilian Public Health System. The accomplishment of this agenda is exemplified by the presentation of the most recent Brazilian Oral Health survey (SBBrasil 2010). A conclusive summary is presented on the search for a theoretical and methodological convergence of both the identification of the obstacles and weaknesses still detectable in this policy, and the recognition of its virtues already confirmed by important advances and achievements.

This article presents an integrative literature review that analyses the advances and challenges in oral health care of the Brazilian primary health care system, based on a political agenda that envisages re-organising the unified health system (SistemaÚnico de Saúde - SUS). It is presumed that the actions suggested by the Alma-Ata Conference of 1978 are still up-to-date and relevant when adapted to the situation in Brazil. Several studies and policies are reviewed, including works demonstrating the importance of primary care as an organising platform in an integrated health-care network, Brazil's strategy for reorganising the primary care network known as the Family Health Strategy, and the National Oral Health Policy. This review discusses results obtained over the last twenty years, with special attention paid to changes in oral health-care practices, as well as the funding of action programmes and assistance cover. The conclusion is that oral healthcare in the Brazilian primary health care system has advanced over the past decades; however, serious obstacles have been experienced, especially with regard to the guarantee of universal access to services and funding. The continuous efforts of public managers and society should focus on the goal of achieving universal coverage for all Brazilians., (© 2013 FDI World Dental Federation.)

Objective: To systematically evaluate the literature to investigate associations between social, demographic, economic, psychosocial, and behavioral factors and the self-perception of oral health measured using the Oral Health Impact Profile (OHIP)., Methods: In this systematic review of the literature, the Preferred Reporting Items for Systematic Reviews (PRISMA) were adapted for the performance of a qualitative metasummary, without meta-analysis. Articles about oral health and associated factors with implications for quality of life were selected, with a focus on the tool for self-rating of the oral health-disease process, the OHIP. Pubmed/National Library of Medicine (NLM) and the Virtual Health Library (Biblioteca Virtual em Saúde - BVS/BIREME) were searched. Articles published between 2001 and 2011 were included. The following Medical Subject Headings (MeSH) were employed: oral health, quality of life, sickness impact profile, and socioeconomic factors., Results: Of 57 articles identified, 20 met the inclusion criteria. The metasummary revealed that a poor self-perception of oral health was associated with unfavorable social, economic, demographic, and psychosocial factors, as well as with undesirable habits and poor clinical oral conditions., Conclusions: There is consensus in the literature about the influence of the investigated factors on the self-perception of oral health and on quality of life. The OHIP is an important aid for determining oral health needs and for developing strategies to control/reduce disease and promote oral health, with a consequent positive impact on quality of life.

The scope of this study was to analyze the normative measures issued about the Health in the School Program in order to ascertain the contribution and participation of the health and education sectors in the creation and implementation of the Program, since its success was based upon intersectoral action between them. The technique of content analysis proposed by Bardin, associated with ATLAS TI 5.2 software was used to conduct the research. The study revealed that the participation of the health and education sectors in the Health in the School Program is not well-balanced, pointing to the predominant role of health in areas such as financing and the centralization of the adhesion and coordination process of the Intersectoral Commission on Education and Health in the School.