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Results-based management is a cornerstone of reform in public administration, including the health field, and has become the basis for other innovations such as the institutionalization of management contracts and the use of professional incentives. This review article aims to introduce and discuss the use of such management contracts in the public health sector. Management by results has developed means and tools that highlight the importance of shared responsibility and mutual commitment between workers and management-level directors. Thus, preset goals are negotiated among all the stakeholders and are evaluated periodically in order to grant professional incentives. It is necessary to improve the mechanisms for control and observation, to more precisely determine the healthcare and management indicators and their patterns, to train stakeholders in designing the plan, and to improve the use of professional incentives in order to effectively increase accountability vis-à-vis the desired results.

Objective: The aim of this study was to evaluate the effectiveness of clinical criteria for the diagnosis of hyposalivation in hospitalized patients., Material and Methods: A clinical study was carried out on 145 subjects (48 males; 97 females; aged 20 to 90 years). Each subject was clinically examined, in the morning and in the afternoon, along 1 day. A focused anamnesis allowed identifying symptoms of hyposalivation, like xerostomia complaints (considered as a reference symptom), chewing difficulty, dysphagia and increased frequency of liquid intake. Afterwards, dryness of the mucosa of the cheeks and floor of the mouth, as well as salivary secretion during parotid gland stimulation were assessed during oral examination., Results: Results obtained with Chi-square tests showed that 71 patients (48.9%) presented xerostomia complaints, with a significant correlation with all hyposalivation symptoms (p <0.05). Furthermore, xerostomia was also significantly correlated with all data obtained during oral examination in both periods of evaluation (p<0.05)., Conclusion: Clinical diagnosis of hyposalivation in hospitalized patients is feasible and can provide an immediate and appropriate therapy avoiding further problems and improving their quality of life.

Objective: To identify racial inequities in oral health between groups of adults selfdeclared as white, black, or mixed in Brazil., Methods: Secondary data were obtained from the national oral health survey of the Brazilian population (SB-Brasil 2002-2003) database. Initially, a cross-sectional study was conducted to compare the following outcome variables: caries, tooth loss, pain of dental origin, and need for prostheses according to race/color in a sample of 12 811 adults of both sexes, aged 35 to 44 years. In the second stage, an ecologic study was carried out with data aggregated by Brazilian state to contextualize racial inequity in a population of 6 918 black individuals (black and mixed). For that, the oral health outcomes studied in the first stage were correlated with human development and income distribution indicators., Results: Significant differences were observed between the race/color groups for all oral health outcomes examined (P < 0.01). Correlations were found between oral health outcomes and indicators related to the human development profile, average family income, and income inequality by state for the group of Brazilian blacks., Conclusions: The results show racial inequity in oral health in Brazil for all the indicators analyzed (caries, tooth loss, pain, and need for prostheses), with greater vulnerability among the black population compared to whites. Contextual factors related to the human development profile, income distribution, and access to health care policies appear to play a key role in describing the vulnerability of populations to oral health problems.

This study investigated the association between oral and general health-related behaviors and socioeconomic status, and the relationship between health-related behaviors and toothbrushing among adolescents. The database used here was the National School-Based Health Survey (PeNSE), a cross-sectional population-based study in 2009 with students from 27 Brazilian State capitals. Socio-demographic and health-related behavior data were collected. The survey included 49,189 adolescents (47.5% males), the majority of whom were 14 years of age and enrolled in public schools. The associations between toothbrushing frequency and other health-related behaviors and socioeconomic status varied between boys and girls. Associations were observed between health-related habits and toothbrushing frequency in both sexes, but with variations according to socioeconomic status. Planning health promotion interventions for adolescents should take their individual characteristics and family and social context into account.

The evaluation of health promotion activities is a methodological and strategic challenge for establishing evidence to support health management processes. The use of adequate evaluation methods based on participatory analysis of local processes and contexts is essential to the success of interventions and policy formulation and implementation. Brazil's Policy for Oral Health Promotion and Surveillance explicitly states the need to improve evaluation strategies for oral health promotion activities conducted in the context of primary care, allowing to evaluate not only their results and impact, but also the political and social process for achieving the objectives. This article proposes to systematize the literature on the evaluation of effectiveness in health promotion strategies, define a theoretical model, and propose a matrix of descriptors, exploring the basic references for health promotion and practices with the potential to reduce situations of vulnerability in population groups, combat inequalities, and incorporate community participation in health management.

The SBBrasil 2010 Project (SBB10) was designed as a nationwide oral health epidemiological survey within a health surveillance strategy. This article discusses methodological aspects of the SBB10 Project that can potentially help expand and develop knowledge in the health field. This was a nationwide survey with stratified multi-stage cluster sampling. The sample domains were 27 State capitals and 150 rural municipalities (counties) from the country's five major geographic regions. The sampling units were census tracts and households for the State capitals and municipalities, census tracts, and households for the rural areas. Thirty census tracts were selected in the State capitals and 30 municipalities in the countryside. The precision considered the demographic domains grouped by density of the overall population and the internal variability of oral health indices. The study evaluated dental caries, periodontal disease, malocclusion, fluorosis, tooth loss, and dental trauma in five age groups (5, 12, 15-19, 35-44, and 65-74 years).

This article offers a critical review of the problem of inequalities in oral health and discusses strategies for disease prevention and oral health promotion. It shows that oral health is not merely a result of individual biological, psychological, and behavioral factors; rather, it is the sum of collective social conditions created when people interact with the social environment. Oral health status is directly related to socioeconomic position across the socioeconomic gradient in almost all populations. The main priority for dental interventions is that they be integrated collaboratively and enable research and policies that address the main proximal determinants of oral diseases, i.e., sugars, smoking, hygiene, and risk behaviors. Adopting a mixed approach, these interventions should also reduce inequality, focusing on the socioeconomic determinants, to change the slope of the social gradient. The cornerstone of this approach is the Integrated Common Risk Factor Approach (CRFA).

Objective: To evaluate the adequacy of fluoride levels in the public water system in Curitiba, state of Paraná, Brazil, as determined by two techniques (colorimetric and electrometric)., Methods: Data from independent measurements of fluoride in the public water system in Curitiba routinely performed by the city government were obtained for the period between January 2000 and July 2008. Mean levels of fluoride concentration were calculated for each of these years. After that, fluoride concentrations measured in 1 470 samples by the state water utility (SANEPAR) using the electrometric technique in 2006 and 2007 were compared with the corresponding levels measured by the city using the colorimetric method. The rate of samples meeting the standard for the city (0.8 ppmF), and below and above the standard, was calculated for both methods. Fluoride levels were compared between sanitary districts, months for the period between December 2007 and July 2008, and water treatment facilities., Results: The overall mean fluoride level between 2000 and 2008 was 0.7 ppmF based on the independent measurements. The comparison between techniques showed a higher mean fluoride level with the electrometric technique (0.743 ppmF ± 0.133) vs. the colorimetric technique (0.637 ppmF ± 0.164). The rate of samples meeting the ideal standard of 0.8 ppmF was 15.05% for the colorimetric and 63.97% for the electrometric technique; 62.03% and 22.85% of the samples were below that standard and 21.10% and 13.18% were above that standard, respectively. Fluoride levels were statistically significant (P < 0.001) for the comparison between sanitary districts and months., Conclusions: The choice of technique significantly influences the resulting levels of fluoride. Independent monitoring of fluoride levels should employ the same technique used by the water utility. Further studies should aim at defining which technique is the most adequate to determine fluoride concentration in public water systems.

An evaluation was made of the perception of oral health teams regarding Atraumatic Restorative Treatment (ART) as a primary oral healthcare strategy used by the Municipal Health Department of Curitiba, Paraná State. A study was made both of Health Units (HU) that operate using the Family Health Strategy (FHSHU) and those that do not (Basic Healthcare Units--BHU). The sample involved 191 oral health professionals proportionally (CI=95%, e=6%). A questionnaire was used to collect data. The information was analyzed using the SPSS 13.0 program. The response rate was 82%. Chi-square testing did not reveal a statistically significant difference between the FHSHU (83.1%) and the BHU (74.3%) with regard to knowledge about the technique (p>0.05). A difference was found as to training in ART among the different HU (p<0.01) and the use of the technique by the services (p<0.01). The length of training and the length of service of dental health professionals at the municipal health service were relevant in relation to knowledge of the technique and the taking of clinical decisions as to ART. The conclusion was reached that training on ART is needed at the primary healthcare level as a result of the different perceptions revealed.

This study is a situational analysis of the health care services for attending accidents and violence, in Curitiba, focusing the general conditions of infrastructure, planning and support at the pre-hospital assistance level, considering mobile and fixed emergency services dedicated to the victimized elderly. Positive points were evidenced as well as gaps and needs to meet the national guidelines. The investigation integrated quantitative and qualitative approaches and it was carried out on the grounds of the triangulation of methods. It is concluded that on the theme of accidents and violence against the elderly still there is room for important improvements in the actions developed by the researched services: (1) preventive actions are not part of the routine of the services; (2) most of the services does not develop specific services, addressed to the peculiar demands of the elderly; (3) the interviewees' experience reveals difficulties for obtaining hospital beds, either for referral or transfer/admission of patients. Facing the issue of accidents and violence against the elderly in Curitiba requires considering the organization of data, flows, training of professionals and planning in the development of prevention programs, attendance and rehabilitation to the elderly.

Background: The study presents a geographical analysis of dental trauma in a population of 12 and 15 year-old school-children, in the city of Curitiba, Brazil (n = 1581), using a database obtained in the period 2005-2006. The main focus is to analyze dental trauma using a geographic information system as a tool for integrating social, environmental and epidemiological data., Methods: Geostatistical analysis of the database and thematic maps were generated showing the distribution of dental trauma cases according to Curitiba's Health Districts and other variables of interest. Dental trauma spatial variation was assessed using a generalized additive model in order to identify and control the individual risk-factors and thus determine whether spatial variation is constant or not throughout the Health Districts and the place of residence of individuals. In addition, an analysis was made of the coverage of dental trauma cases taking the spatial distribution of Curitiba's primary healthcare centres., Results: The overall prevalence of dental trauma was 37.1%, with 53.1% in males and 46.7% in females. The spatial analysis confirms the hypothesis that there is significant variation in the occurrence of dental trauma, considering the place of residence in the population studied (Monte Carlo test, p = 0,006). Furthermore, 28.7% of cases had no coverage by the primary healthcare centres., Conclusions: The effect of the place of residence was highly significant in relation to the response variable. The delimitation of areas, as a basis for case density, enables the qualification of geographical territories where actions can be planned based on priority criteria. Promotion, control and rehabilitation actions, applied in regions of higher prevalence of dental trauma, can be more effective and efficient, thus providing healthcare refinement.

Objectives: To investigate social determinants of oral health, analysing the occurrence of associations between millennium development goals (MDG) indicators and oral health (OH) indicators., Methods: An ecological study was performed in two distinct phases. In Phase 1, MDG indicators and related covariates were obtained from the demographic census of the Brazilian Institute of Geography and Statistics, the Ministry of Health database and the 2000 Human Development Atlas, making up the whole set of independent variables. Principal component analysis was carried out for the independent variables showing the correlations among the variables comprising the main components, and generating a synthetic index allowing the performance of the cities to be known with regard to the MDG (MDG index). In Phase 2, the DMFT index (mean number of decay, missing or filled permanent teeth) and the CF index (prevalence of caries-free individuals), in 12 years old were obtained from the epidemiological survey undertaken in 2002-2003, in 49 cities in southern Brazil, and were analysed in relation to the MDG index using Spearman's correlation., Results:   A statistically significant correlation was found for the DMFT and CF indices, respectively, with: the MDG index (R(2)=0.49 and 0.48; P = 0.00); the socioeconomic status of the population (R(2)= 0.12 and 0.12; P = 0.02); the socioenvironmental characteristics (R(2)=0.41 and 0.46; P= 0.00)., Conclusions:   The MDG synthetic index of the cities analysed and the respective components relating to their socioeconomic and socioenvironmental status demonstrated a positive correlation with OH indicators. As such, intersectoral public policies based on population strategies that act on social determinants of general and oral health need to be integrated so as to impact on the MDG and OH outcomes., (© 2010 John Wiley & Sons A/S.)

This study sought to explore the intersectoral actions developed by the oral health teams of Curitiba, Paraná State, and to analyze the local managers' perception about intersectoral approach. A cross-sectional study with quantitative and qualitative methodology was used, with data collection by a self-response questionnaire and focal group technique. The results showed that most health promotion actions carried out by the teams are interdisciplinary and when other sectors are involved it is in turning physical spaces available, without jointed and integrated perspectives. The managers' perception reinforces in the concept the teams' practices. It was observed that the Family Health Strategy facilitate intersectoral actions and the intersectorality is a challenging way of work, but possible to become reality.

Indicators and analyses that used the database from SB Brazil 2003 (the most recent nationwide oral health survey) have been criticized as unreliable due to sampling problems. The current study countered that this critique was based solely on statistical concepts, unsupported by empirical evidence. The critique's essentially epistemic approach leads to peremptory reductionism that denies other forms of knowledge and fails to recognize the multidisciplinary nature of epidemiology. The current study retrieves information on the implementation of the oral health survey and its impact on knowledge output in the field. The article draws an analogy between science and art, demonstrating the multifaceted images obtained by both. Thus, recognition of validity requires a full grasp of the field and appropriate use of value criteria. The current article concludes that use of the SB Brazil 2003 database is a reliable and relevant application of epidemiology to oral health.

Introduction: Ameloblastomas are benign asymptomatic intraosseous lesions that affect the bones of the maxillomandibular complex, interfering both in function and facial esthetic appearance. A 14-year-4-month-old girl was referred by her clinician complaining her anterior teeth were crooked and inclined forward. The lower left mandibular tooth presented with increased pericoronal space compatible with dentigerous cyst., Methods and Results: The aim of this report is to relate a case of unicystic ameloblastoma with conservative treatment and with indication for orthodontic treatment. The conservative therapy was performed and the lesion had been completely removed. The need for radiographic and clinical follow-up for up to 10 years, initially performed every 6 months during the first 2 years and afterwards annually, in addition to the risk of late recurrence were explained for patient and her guardian., Conclusion: The histopathologic exam of the surgical tissue provided the final diagnosis of ameloblastoma, as the lesion had not presented in its classical form and in atypical locations, as in this case involving a tooth that had not yet erupted., (2010 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.)

Objective: The present study evaluated the association between lactotransferrin (LTF) gene polymorphism (exon 2, A/G, Lys/Arg) and dental caries., Material and Methods: A convenience sample of 110 individuals, 12 years old, was divided into: group 1, 48 individuals without caries experience (DMFT=0), and group 2, 62 subjects with caries experience (DMFT>or=1). DNA was obtained from a mouthwash with 3% glucose solution, followed by a scrapping of the oral mucosa. After DNA purification, polymerase chain reaction (PCR), single strand conformation polymorphism (SSCP) was performed to access the study polymorphism. The LTF A/G (Lys/Arg) polymorphism had been previously reported as located in exon 1., Results: Allele 1 of the study polymorphism was associated with low DMFT index and showed a protective effect against caries experience (OR=0.16, IC=0.03-0.76, p=0.01)., Conclusions: Lactotransferrin A/G (exon 2, Lys/Arg) polymorphism was associated with susceptibility to dental caries in 12-year-old students.

This study aims to identify patterns in maternal and fetal characteristics in the prediction of infant mortality by incorporating innovative techniques like data mining, with proven relevance for public health. A database was developed with infant deaths from 2000 to 2004 analyzed by the Committees for the Prevention of Infant Mortality, based on integration of the Information System on Live Births (SINASC), Mortality Information System, and Investigation of Infant Mortality in the State of Paraná. The data mining software was WEKA (open source). The data mining conducts a database search and provides rules to be analyzed to transform the data into useful information. After mining, 4,230 rules were selected: teenage pregnancy plus birth weight < 2,500 g, or post-term birth plus teenage mother with a previous child or intercurrent conditions increase the risk of neonatal death. The results highlight the need for greater attention to teenage mothers, newborns with birth weight < 2,500 g, post-term neonates, and infants of mothers with intercurrent conditions, thus corroborating other studies.

Objective: To evaluate public health dentistry practices of two different family health models., Methods: Qualitative study conducted with data obtained from focus groups consisting of 58 dentists working in the Family Health Strategy for at least three years between August-October, 2006. The Paideia Family Health Approach was used in the city of Campinas and the Oral Health Initiative as part of the Family Health Strategy was implemented in the city of Curitiba, Southeastern and Southern Brazil, respectively. Data was analyzed using the hermeneutic-dialectic method. Analysis indicators were employed to indicate backwardness, stagnation or progress in oral health practices effective from the implementation of the strategies referred. The indicators used were: work process; interdisciplinary approach; territorialization; capacity building of human resources; health promotion practices; and responsiveness to users' demands., Results: There was progress in user access to services, humanization of health care, patient welcoming and patient-provider relationship. The results related to health promotion practices, territorialization, interdisciplinary approach and resource capacity building indicated a need for technical and operational enhancements in both cities., Conclusions: Both models have brought about important advances in terms of increased access to services and humanization of health care. Universal access to oral health at all levels of complexity was not achieved in both cities studied. Local health managers and oral health program coordinators must bring more weight to bear in the arena that defines public policy priorities.

The purpose of this study was to build epidemiological indicators on the experience of dental trauma in 12-year-old schoolchildren in the city of Curitiba, Brazil, exploring its geographical and population distributions. A geographic information system (GIS) was used, built by means of ArcView GIS 3.2 software and geographical databases of streets and districts defined within the boundaries of the city of Curitiba, provided by Curitiba's Institute of Research and Public Planning (IPPUC). The database used in the study was compiled based on an epidemiological survey undertaken in 1998 on a sample of 2126 schoolchildren 12 years old, residing in outlying urban suburbs distributed over 29 micro-areas in the city of Curitiba. The cases selected for this study were those with a history of dental trauma, thereby comprising a subsample of 327 schoolchildren. The spatial location of the schoolchildren's homes enabled the events to be visualized on a cartographic basis. The variables of gender, aetiology of the trauma and areas of substandard living conditions were included in the analysis and construction of thematic maps, thus making possible a descriptive analysis of the spatial distribution of dental trauma in the city. Intra-urban differentials were identified in the prevalence of dental trauma in 12-year-old schoolchildren in Curitiba. A greater concentration of occurrences was observed in the eastern region of the city, especially in areas of substandard living conditions. It was possible to conclude that socio-environmental and geophysical factors are associated with the determination of dental trauma in the city of Curitiba, pointing to the need for the development of public policies especially aimed at areas and populations at greater risk.

Background: The literature is scarce on the social and geographic inequalities in the access to and implementation of the fluoridation of public water supplies. This study adds knowledge to the Brazilian experience of the chronic privation of water and wastewater policies, access to potable water and fluoridation in the country. Thus, the aim of this study was to verify possible inequalities in the population's access to fluoridated drinking water in 246 Brazilian municipalities., Methods: The information on the process of water fluoridation in the municipalities and in the macro region in which each municipality is located was obtained from the national epidemiological survey which was concluded in 2003. The data relating to the human development index at municipal level (HDI-M) and access to mains water came from the Brazilian Human Development Atlas, whilst the size of the population was obtained from a governmental source. The Fisher exact test (P < 0.05) was employed to identify significant associations between the explanatory variables and their ability to predict the principal outcomes of interest to this study, namely the presence or absence of the water fluoridation process in the municipalities as well as the length of time during which this measure has been implemented. Linear regression was used to observe the associations between the relevant variables in a multivariate environment., Results: The results clearly showed that there is a relationship between municipalities with larger populations, located in more socio-economically advantaged regions and with better HDI-M, and where fluoridation is both present and has been implemented for a longer period of time (started before 1990)., Conclusion: The findings suggest that the aim of treating water with fluoride may not be being adequately achieved, requiring more effective strategies so that access to this measure can be expanded equitably.

Objectives: The aim of this study was to investigate the associations between the Human Development Index at city level (HDI-M) in the state of Paraná, Brazil, and the length of time of population exposure to water fluoridation (time span) with the respective mean decayed, missing and filled teeth (DMF-T) of schoolchildren in the state, looking at possible inequalities in these associations., Methods: The HDI-M of 323 cities in the state of Paraná, Brazil, was correlated to the duration of exposure to water fluoridation, calculated in number of days. Correlation between the HDI-M and the DMF-T indexes for 12-year-old children was also performed., Results: Correlations were statistically significant, showing that in the cities with a better HDI-M, water fluoridation had been implemented earlier (squared coefficient correlation of 22%). The fluoridation time span accounted for around 11% of the variance in the DMF-T indexes of the cities. The correlation indicated that locations with a better HDI-M had a better DMF-T, owing to the probable mediating effect of receiving fluoridation earlier. Furthermore, the cost of water fluoridation to benefit the population that has access to this public health measure has been estimated at USD 0.15 per capita/year., Conclusions: It is possible to conclude that this low-cost measure is able to improve oral health status in general. Nevertheless, in the Brazilian areas studied, fluoridation seems to reflect existing social development inequalities, as it was first made available in more socially developed areas, thus bearing an influence on their higher DMF-T performance to date.

Social capital refers to those features of social organization that enable participants to act together and more effectively pursue common goals. A growing body of evidence suggests that societies with high levels of social capital have lower morbidity and mortality rates and higher life expectancy and are less violent. The main goal of this article is to review the relationship between social capital and health. First, the main concepts and criticisms of social capital theory are discussed. Next, commonly used assessment tools are elucidated. Then, the relationship between social capital and health is analyzed. Finally, the article comments on the theory's application to Brazilian reality. If scientific rigor is applied to social capital research, recognizing theoretical and methodological difficulties, it can expand the research agenda and contribute to a better understanding of how to effectively deal with health inequalities.

This paper is concerned with developing methods for assessing the potential impact of healthy public policies on health outcomes, particularly on dental trauma. The hypothesis is that in deprived areas of Curitiba, Brazil, there would be a lower prevalence of dental trauma in 12-year-old schoolchildren related to different degrees of implementation of healthy public policies. Fourteen socio-environmental variables gathered from 29 deprived areas were factor-analysed and three principal components (PCA) extracted: physical environment, public social policies, and social cohesion. Individual clinical data on dental trauma were collected for 2,126 children from public schools in the areas. Rank correlation indicated that the relationship between components' scores and dental trauma was statistically significant. The PCA scores explained 42% of the variance for dental trauma.

Objective: To review the scientific literature concerning dental fluorosis and to evaluate its occurrence among children attending public schools in the city of Curitiba, which is in the state of Paraná in Brazil., Methods: We reviewed the international literature on fluorosis that was published between 1998 and 2001, focusing on systematic critical reviews that were listed in such electronic bibliographical sources as MEDLINE, LILACS, the Cochrane Library, and Sci-ELO Public Health. In addition, in 2000 we carried out a cross-sectional study with 12-year old schoolchildren (n = 1,494) in Curitiba., Results: Our literature review found that there is still much controversy regarding the benefits associated with fluoride supplementation and the impact of fluorosis. In our cross-sectional study with the Curitiba schoolchildren, we found a fluorosis prevalence of 23% for grade 2, 3, 4, or 5 on the Dean index. The observed fluorosis had little impact on the biopsychosocial health of the children studied, as shown by the multivariate logistic regression analysis. The analysis showed that the presence of fluorosis was not significantly associated with dissatisfaction with tooth color. However, there was an association between the independent variable of place of residence (sanitary district within Curitiba) and fluorosis (P = 0.00), in both the bivariate and multivariate analyses., Conclusions: Based on our results, we concluded that dental fluorosis is not now a crucial epidemiological problem for the population studied in Curitiba. Any initiatives to control fluorosis should take into account the population's perception of the problem. Nevertheless, it is still extremely important to monitor the levels of fluoride in drinking water.