Thesis (M.S.)--University of Michigan, 1991.

Made available in DSpace on 2015-07-22T20:50:21Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-09-29 / Este trabalho busca correlacionar os indicadores de saúde Mortalidade Geral, Mortalidade Infantil, Materna e por Causas Externas com os indicadores macroeconômicos Inflação, Desemprego e Renda no Brasil durante o período de 1980-2009, contribuindo para a reflexão se as instabilidades ou recessões econômicas interferem na saúde dos indivíduos. A fundamentação teórica tem como base a literatura sobre condições macroeconômicas e saúde. Verificamos que existem diversos trabalhos relacionando a mortalidade com renda e desemprego, porém poucos que agregam a variável inflação, sendo que, dentre eles, nenhum especifica uma série histórica do Brasil. O método aplicado foi empírico-analítico de séries históricas dos Indicadores propostos, sendo que para os resultados das correlações utilizou-se a técnica de regressão linear simples, através do software STATA. Os resultados favoreceram a hipótese de Philips, ou seja, quanto existe queda da inflação, o desemprego aumenta e consequentemente a renda diminui; o que em tese temos piores condições de vida e saúde, consequentemente maiores taxas de mortalidade. Nas correlações entre mortalidade infantil, materna e externa, encontramos esse resultado; nas recessões econômicas as taxas de mortalidade aumentam. Acreditamos ser necessário certo grau de cautela na interpretação dos resultados, a fim de evitar a aceitação de associações definitivas sem considerar outras variáveis não analisadas nessa tese que podem sofrer variações por outros fatores. As análises de regressão efetuadas no presente trabalho sugerem que existe uma relação entre os indicadores de saúde e econômicos estudados, onde baixa inflação ocasiona aumento do desemprego e baixa renda, levando a pior condição de saúde e a elevadas taxas de mortalidade. / This work aims to correlate the health indicators General Mortality, Infant Mortality, Maternal and External Causes macroeconomic indicators with Inflation, Unemployment and Income in Brazil during the period 1980-2009, contributing to the debate if the instabilities or interfere in economic downturns health of individuals. The theoretical literature is based on macroeconomic conditions and health. We find that there are several studies relating mortality with income and unemployment, but few that add the variable inflation, and among them, none specifies a series of Brazil. The method was applied empirical-analytic time series of proposed indicators, and for the results of the correlations we used the technique of linear regression through the softwar STATA. The results favored the hypothesis of Philips, that is all that is fall in inflation, unemployment increases and income decreases accordingly, which supposedly have worse living conditions and health, hence higher rates of mortality. The correlations between child mortality, maternal and foreign, we find this result, economic downturns in mortality rates increase. We believe it is necessary degree of caution in interpreting the results in order to avoid outright acceptance of associations without considering other variables not analyzed in this thesis which may vary for other factors not considered. Regression analysis performed in this study suggest that a relationship exists between health indicators and economic studies, where low inflation leads to higher unemployment and low incomes, leading to poor health and high mortality rates. / TEDE / BV UNIFESP: Teses e dissertações

Este trabalho teve como objetivo desenvolver um modelo para mensuração do desempenho na gestão hospitalar por meio de indicadores chaves, desdobrados em boas práticas, elencados nas perspectivas do Balanced Scorecard visando delinear o enfoque estratégico organizacional. Após a delimitação das boas práticas, projetou-se a valoração da performance ideal esperada e diagnosticou-se a realizada, oportunizando a elaboração de um índice de desenvolvimento que foi submetido ao método de apoio a decisão multicritério ELECTRE II, resultando na ordenação para detecção e priorização das alternativas fragilizadas. Por meio de pesquisa bibliográfica, possibilitou-se evidenciar que uma quantidade relevante de trabalhos converge ao indicar como eficiente a utilização do BSC aliado aos métodos de apoio a decisão multicritério, sendo verificados 43 indicadores chaves de desempenho comumente utilizados. Destes, 15 foram escolhidos e desdobrados em 57 boas práticas, tidas por sub-indicadores, para aplicação do método de mensuração do desempenho hospitalar. Os resultados do método proposto demonstraram-se satisfatórios pelo fato de direcionarem os pontos críticos que necessitam serem melhores desenvolvidos na organização, além de apoiarem os processos de tomadas de decisão e estarem de acordo com a missão, visão e valores da organização estudada. / This study aimed to develop a model for performance measurement in hospital management through key indicators, unfold into good practices listed in the Balanced Scorecard perspectives aiming to outline the organizational strategic focus. After the definition of best practices, designed to valuation of ideal performance expected and diagnosed to held, providing opportunities for the development of a development index which was subjected to the method of supporting multi-criteria decision ELECTRE II, resulting in order to detect and prioritization of vulnerable alternatives. Through literature, if allowed to evidence that a significant amount of work converges to indicate how effective the use of BSC ally methods of supporting multi-criteria decision being checked 43 key performance indicators commonly used. Of these, 15 were chosen and deployed in 57 good practices taken by sub-indicators for the application of hospital performance measurement method. The results of the proposed method proved to be satisfactory because steering plenty of critical points that need to be better developed in the organization, and support decision-making processes and be in accordance with the mission, vision and values of the organization studied.

Orientador: Maria da Luz Rosario de Sousa / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-05T16:23:03Z (GMT). No. of bitstreams: 1 Batista_SuzyPessanhaRangel_M.pdf: 371104 bytes, checksum: 3b67095dc2f1e7d66440ff57330dd2be (MD5) Previous issue date: 2005 / Resumo: Os objetivos deste trabalho foram: 1) analisar o sistema de informação na saúde bucal em Campos dos Goytacazes (RJ) em 2004; 2) comparar a relação do IDH (Índice de Desenvolvimento Humano) com a saúde bucal nos municípios do norte fluminense do Estado do Rio de Janeiro em 2004; 3) verificar a prevalência e severidade da cárie dentária, em pré-escolares e escolares da rede pública, nas idades de 06 e 12 anos, em Campos dos Goytacazes (RJ), no ano de 2002. Para se atingir o objetivo 1 foram coletados dados através de leitura de documentos oficiais e algumas dissertações; resgate do histórico do Sistema de Informação na Saúde, através de entrevista semi-estruturada e finalmente comparação dos indicadores de avaliação do sistema de informação em saúde bucal deste município, disponibilizados pelo Sistema de Informação SIA/SUS, em relação àqueles sugeridos por Narvai (1996). Para se atingir o objetivo 2 os dados do IDH (Índice de Desenvolvimento Humano) foram coletados no site do PNUD (Programa das Nações Unidas para o Desenvolvimento) e os dados de saúde bucal foram coletados no site do DATASUS (Departamento de Informação e Informática do Sistema Único de Saúde) no ano de 2004. Para atingir-se o terceiro objetivo realizou-se um levantamento epidemiológico e a amostra aleatória e sistemática, sendo realizados exames bucais de 528 escolares. Estes exames foram realizados segundo os critérios da Organização Mundial da Saúde (WHO, 1997), utilizando-se os índices ceod e CPOD para cárie dentária. Dos indicadores do modelo de atenção obteve-se 14,2% de procedimentos preventivos individuais, 23,4% de procedimentos coletivos, 3,9% de serviços especializados, atingindo uma média de 8 minutos por atendimento e com acesso à assistência de 31,2% à população, caracterizando uma ênfase restauradora e não mutiladora. No segundo capítulo a maioria dos municípios do Norte Fluminense do Estado do Rio de Janeiro apresentou seu IDH médio (entre 0,500 e 0,799) seguindo o parâmetro nacional e que o município com o mais baixo IDH apresentou o maior percentual de exodontias por ações individuais e a menor cobertura de consulta odontológica e o município com o mais alto IDH apresentou o maior percentual de procedimentos coletivos. No terceiro capítulo aos 06 anos de idade, o ceod foi de 3,2, sendo que 28,0% eram livres de cárie e aos 12 anos de idade o CPOD foi de 3,1, sendo 23,1% livres de cárie / Abstract: The objectives of this work were: 1) to analyze the information system in the oral helth of Campos dos Goytacazes (RJ) in 2004; 2) to compare the relation of IDH (Human Development Index) with the oral health in the cities of the north ¿fluminense¿ in the state of Rio de Janeiro in 2004; 3) to verify the prevalence and severity of tooth decay, in schools and preschool of the public net, in the ages of six and twelve years old, in Campos dos Goytacazes (RJ), in the year of 2002. In order to reach the objective 1, the data were collected through the reading of official documents and some dissertations; the retrieval of the history of the Health Information System, through a semi-structured interview and finally, a comparison of the evaluation indicators of the information system in the oral health of this city, available through the Information System SIA/SUS, in relation to that suggested by Narvai (1996). To achieve the objective 2, the data of the the IDH (Index of Human Development) were collected in the site of the PNUD (United Nation Program for Development) and the data of oral health were collected in the site of the DATASUS (Information and Informatique Department of the Single Health System) in the year of 2004. To reach the third objective, it was done an epidemiological study and a systematic and random sample, and 528 oral examinations were made in schools. These examinations were realized according to the World Health Organization (WHO, 1997) criteria, using the dmft and DMFT criteria for tooth decay. From the indicators of the model, it was obtained 14,2% of individual preventive procedures, 23,4% of collective procedures, 3,9% of specialized services, reaching a mean of 8 minutes for each appointment and the access to the assistance was 31,2%, characterizing an emphasis to the restoration and no-mutilating. In the second chapter, the majority of the cities of the north ¿fluminense¿ of the state of Rio de Janeiro showed its mean IDH (between 0,500 and 0,799) following the national parameter and the city with the lowest IDH showed the greatest percentage of exodontics by individuals actions and the smallest coverage of dental visit and the city with the highest IDH showed the greatest percentage of collective procedures. In the third chapter at six years old, the dmft was 3,2; with 28% decay free and at twelve years old the DMFT was 3,1; with 23,1% decay free / Mestrado / Saude Coletiva / Mestre em Odontologia

Objetivo: Discutir criticamente, descrever e analisar os dados de óbitos infantis disponibilizados pelos serviços públicos da província de Cabinda-Angola. Método: Foram estudados nascimentos vivos em hospitais da província de Cabinda, e óbitos de menores de um ano de idade, nos anos 2007 e 2008. Como fonte de dados foram utilizados os registrados nos livros de registro dos hospitais municipais, d o hospital provincial e do escritório provincial da OMS de Cabinda. Os dados são contextualizados pela experiência do autor como habitante da região. Resultados: Os resultados deste trabalho mostram que em 2008 morreram mais crianças no primeiro dia de vida (109) que nos 11 meses restantes (97). Contudo, evidencia-se que 200 óbitos (54,64 por cento ) ocorreram em menores de 28 dias de idade em 2007 enquanto que para o mesmo período em 2008 morreram 178 crianças, Quanto às causas básicas de mortes infantis, a malária é destacada como principal causa. Isoladamente a malária responde aproximadamente por uma morte a cada três crianças falecidas. Dentre as doenças evitáveis por vacinação, o tétano responde por cerca de 5 por cento das mortes. Entre as doenças controláveis por saneamento básico, as diarréias ocupam posição de destaque 9,83 por cento em 2007 e 3,27 por cento em 2008. A redução de 65 para 40 óbitos por pneumonia entre as crianças inscreve-a como segunda ou terceira causa mais importante de óbito entre as crianças cabindenses, partilhando espaço com a asfixia neonatal (17,75 por cento em 2007 e 26,90 por cento em 2008). Apesar das dificuldades e limitantes da qualidade das informações encontradas durante a coleta de dados, buscou-se valorizar as existentes e que foram analisa das neste trabalho. Conclusões: Os resultados obtidos indicam que em Cabinda, melhorias na qualidade de assistência pré-natal, ao parto e ao recém-nascido de risco, poderiam reduzir ainda que parcialmente a Mortalidade Infantil. Fatores como condições inadequadas de abastecimento de água, falta de saneamento básico, dentre outros, revelaram ter papel importante como condicionantes da elevada Mortalidade Infantil observada em Cabinda. Apesar de ser atraente priorizar investimentos dos recursos em ações curativas, este trabalho reforça a perspectiva revisitar as políticas locais de Saúde e priorizar as atividades preventivas nos municípios da grande Cabinda. Assim, sugere-se a implantação de uma rede primária de assistência à saúde e um investimento permanente na melhoria da qualidade das informações de Saúde / Objective: To critically discuss, describe and analyze the infant deaths data available for public services in the province of Cabinda-Angola. Method: A total of live births in hospitals in the province of Cabinda, and deaths of children under one year of age, in years 2007 and 2008. The data source were used those recorded on the records of municipal hospitals, the provincial hospital and the provincial office of WHO in Cabinda. The data are contextualized by the author\'s experience as an inhabitant of the region. Results: The results of this study suggested that in 2008 more children died in the first days of life (109) than in the remaining 11 months (97). However, it is clear that 200 deaths (54.64 per cent ) occurred in children younger than 28 day- old in 2007 while for the same period in 2008 died 178 children. As the root causes of child deaths, malaria is highlighted as the main cause. Malaria alone accounts for approximately one death every three children who die. Among the vaccinepreventable diseases, tetanus accounts for about 5 per cent of deaths. Among the diseases controlled by sanitation, diarrhea, occupy a prominent position in 2007, 9.83 per cent and 3.27 per cent in 2008. The reduction from 65 to 40 deaths from pneumonia among children falls as the second or third most important cause of death among children Cabinda, sharing space with neonatal asphyxia (17.75 per cent in 2007 and 26.90 per cent in 2008). Despite the difficulties, limiting the quality of information found during the data collection, we sought to enhance existing ones, which were analyzed in this work. Conclusions: The results indicate that in Cabinda, improvements in quality of prenatal care, childbirth and the newborn at risk, even partially could reduce infant mortality. Factors such as inadequate water supply, poor sanitation, among others, were found to have important role as determinants of high infant mortality observed in Cabinda. Despite being attractive investments prioritize resources on curative actions, this work reinforces the perspective of revisit policies and prioritize local health preventive activities in the great area of Cabinda. Thus, we suggest the establishment of a network of primary health care and an ongoing investment to improve the quality of information on Health

The problem with which this study was concerned is that of developing an instrument for predicting the use of accident and health insurance. The purposes of the study were to translate selected theoretical descriptions of wellness into discrete components of behavior, to develop a valid and reliable self-report instrument, and to determine the correlation between wellness behaviors and a person's use of accident and health insurance. Content validity was established by a panel of judges, each of whom was selected on the basis of professional concern for the areas of interest in health contained in the instrument. The original instrument of fifty-five items was increased by three items resulting in a fifty-eight item instrument, which was then approved by each of five judges.

M.Tech. (Radiography) / Cervical cancer is the most frequently diagnosed cancer among women in Zambia. More recently, improved cure rates have been obtained with the concomitant use of radiotherapy and chemotherapy in locally advanced cancer of the cervix. However, the side effects associated with the treatment have a major impact on the quality of life (QoL) of these women. Prior to this study, QoL in Zambian women treated for cervical cancer with chemo-radiation had not been assessed thus creating a gap in the literature and hampering an attempt to improve QoL in this cohort of patients. The aim of this study was therefore to evaluate the impact of chemo-radiation treatment on QoL and to determine what socioeconomic and demographic factors are closely related with QoL decrements in Zambian women treated for cervical cancer at Cancer Diseases Hospital. This would then facilitate the introduction of intervention programmes aimed at improving QoL in these patients. The study was prospective and explored the phenomenon of QoL with the use of the European Organization for Research and Treatment of Cancer (EORTC) questionnaire and a demographics questionnaire answered by 45 women treated for cervical cancer with chemo-radiotherapy at Cancer Diseases Hospital. The use of the EORTC quality of life questionnaire added validity and reliability to the study as it is used extensively to measure health-related quality of life in cancer survivors worldwide. Analysis of the data indicates that patients with advanced cervical cancer treated with chemo-radiotherapy generally experienced a favourable QoL, and treatment was considered worthwhile by the majority of patients. However, women described problems with sexuality and marital relationships. Low education and living without a partner were depicted as risk factors for the development of the reported problems. To improve QoL in survivors, interventions focusing on more social support, education to improve patients’ understanding of their disease and treatment effects as well as physical rehabilitation through exercise interventions are recommended as mandatory.

Coronary heart disease takes a large toll of middle-aged males thereby reducing the overall occupational fitness and potential of the workforce. Most of the risk factors for CHD (and other diseases) are self-determined and/or the result of preventable behaviour or alterable environment. The Multiple Risk Factor Hypothesis and the CHD risk factors are reviewed in detail in Chapter 2. It is more the interaction among risk factors within supposedly "normal" limits, rather than abnormally high levels of one or a few factors which results in the development of CHD, a phenomenon which obscures the issue of causation. It is hypothesized that the imbalance between the collective pathogenic effects of risk factors and the ability of the body to resist and/or repair such effects cause CHD. States such as sedentariness and obesity in which most of the risk factors tend to be clustered are important risk indicators. Moreover, since the overall risk profile is improved with reversal of these two states through regular aerobic activity and weight loss, the latter two are key interventions in CHD prevention. Risk factor screening to identify those at risk and subsequent modification of the risk status are useful manoeuvers for the prevention of CHD. As well as being secondary to the ravages of such diseases as CHD, occupational productivity is also reduced by poor levels of employee physical fitness. The recognition by employers of the potential success of CHD prevention programs and the increased productivity of the fit employee has led to the emergence of employer-sponsored occupational fitness programs. Such programs are based on a wholistic health-enhancement approach with regular aerobic physical activity as the core. The operative principles, contents (including the what and how of the all important assessment component) and benefits of such programs are reviewed in Chapter 3. A review of the state of health and fitness in the Canadian Forces and the experimental portion of the thesis make up Chapter 4. In spite of policies, orders and programs to ensure the health and fitness of Canadian Forces' personnel, the CF remains a fairly high-risk population. The cross-sectional study on the health and fitness of 2 83 CF personnel at National Defence Headquarters shows that Other Ranks constitute a higher-risk rank grouping than Officers, as do lower ranks in both of these two major rank groupings. Volunteers appear to be a self-selected sub-population which is healthier and fitter than average. Aerobic fitness (VO₂ max), obesity and resting heart rate emerge as the three key indicators of health and CHD risk status. Chapter 5 summarizes the thesis and contains conclusions and recommendations to the CF for future actions which are also applicable to most occupational settings. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

Orientador: Eliana Martorano Amaral / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-27T18:20:39Z (GMT). No. of bitstreams: 1 Christoforo_Fatima_D.pdf: 2258975 bytes, checksum: 26eb43ac3e7fb395496704555db4a6f1 (MD5) Previous issue date: 2015 / Resumo: Objetivos: Estudar os indicadores de saúde materna e perinatal, e socioeconômicos de 19 municípios e avaliar as rotinas da assistência aos partos da Região Metropolitana de Campinas (RMC). Sujeitos e Métodos: Trata-se de estudo transversal, associado a um estudo de casos de rotinas do cuidado na assistência ao parto em 16 maternidades públicas. Coletaram-se as informações referentes aos indicadores municipais a partir do DATASUS, da Fundação Seade e do censo de 2010. Para conhecer as intervenções realizadas nas 16 maternidades em entrevistas com médicos ou enfermeiros responsáveis, utilizaram-se o "Instrumento de avaliação de implantação das boas práticas na atenção à mulher e ao recém-nascido no parto" (Ministério da Saúde) e um questionário complementar próprio para o estudo. A coleta de dados ocorreu de dezembro de 2013 a outubro/2014. Utilizou-se análise descritiva para as práticas hospitalares e coeficientes de correlação de Pearson e Spearman para avaliar possíveis associações entre características socioeconômicos e demográficas e resultados obstétricos e perinatais. Resultados: As porcentagens de mães adolescentes, de renda ? 1 salário-mínimo (SM) e a taxa de analfabetismo se correlacionaram positivamente com a número de consultas pré-natais e com a taxa de mortalidade perinatal, porém inversamente com partos cesáreos. A renda média domiciliar per capita e o Índice de Desenvolvimento Humano Municipal foram correlacionados diretamente com partos cesáreos e inversamente com número de consultas pré-natais e com a taxa de mortalidade perinatal. A porcentagem de mães adolescentes e de escolaridade ? 8 anos e a taxa de analfabetismo se correlacionaram positivamente com a taxa de mortalidade neonatal precoce, taxa de prematuridade e baixo peso ao nascer. Em relação às rotinas das 16 maternidades públicas da RMC, treze hospitais utilizavam partograma, 10 utilizavam frequentemente a ocitocina para a condução do trabalho de parto, nove executavam a episiotomia frequentemente e 14 realizavam o manejo ativo do terceiro período do parto. A presença de acompanhante durante o trabalho de parto e parto foi rotineira para 9 e 14 hospitais, respectivamente. Todos os hospitais forneceram rastreamento para HIV e sífilis. Doze hospitais realizavam indução em gestação prolongada e 13 em ruptura prematura de membranas, enquanto 15 tinham protocolos de conduta para hipertensão arterial severa e profilaxia de sepse neonatal precoce por Streptococcus do grupo B. Cinco hospitais não utilizavam antibióticos para cesarianas. Produtos derivados de sangue não estavam disponíveis em quatro hospitais e oito não poderiam cuidar de gestantes em situação clínica grave. Quinze hospitais relataram ter profissional treinado para atendimento neonatal. Conclusão: A taxa de mortalidade perinatal foi o indicador que melhor refletiu os indicadores socioeconômicos na região. A adolescência foi um indicador social de grande risco perinatal, frequentemente associada com ausência de parceiro. A taxa de cesárea retratou os municípios com maior poder aquisitivo na região. As práticas qualificadas de assistência ao parto estavam disponíveis em quase todos os hospitais. No entanto, algumas delas parecem excessivas, como condução de parto e episiotomia, enquanto outras precisam ser melhoradas, como uso de antibióticos para todos os partos cesáreos e disponibilidade de sangue e cuidado de emergência. Os resultados destacam a inequidade da assistência e a importância de rever as rotinas hospitalares, mesmo em uma região com amplo acesso a recursos materiais e humanos e oportunidades de educação continuada / Abstract: Objectives: To study maternal and perinatal health, and socioeconomic indicators of 19 municipalities, and assess the routines of care during childbirth in the metropolitan region of Campinas (RMC). Subjects and Methods: Cross-sectional study, coupled with a case study of 16 public hospitals on clinical routines applied for labour and delivery. The information on health and socioeconomic indicators derived from the DATASUS, the Seade Foundation and 2010 census. Routines were assessed by through the "Assessment Tool of Good Practice Caring for Women and Newborns during Childbirth" (Ministry of Health) and a complementary questionnaire, for interviews with responsible doctors or nurses in 16 hospitals. Data collection occurred from December / 2013 to October / 2014. Descriptive analysis was applied to report routine practices in hospitals, and Pearson and Spearman correlation coefficients were used to evaluate possible associations between socioeconomic, obstetric, and perinatal outcomes. Results: The proportion of teenage mothers and income ? 1SM, and the illiteracy rate were positively correlated with number of prenatal visits and perinatal mortality rate, and inversely with caesarean deliveries. The average household income per capita and the Municipal Human Development Index (MHDI) correlated directly with caesarean deliveries and inversely with number of prenatal consultations and perinatal mortality rate. The percentages of teenage mothers and education ? 8 years, and the illiteracy rate correlated positively with the early neonatal mortality rate, prematurity and low birth weight. Regarding routine practices during deliveries into 16 public maternities, thirteen hospitals used partograph, 10 frequently used oxytocin for labour augmentation, nine frequently performed episiotomy and 14 informed active management of the third stage of labour. The presence of a companion during labour and delivery was a routine for nine and 14 hospitals, respectively. All hospitals provided screening for HIV and syphilis. Twelve hospitals performed induction in prolonged gestation and 13 in premature rupture of membranes. Fifteen had clinical protocol for severe hypertension and for group B Streptococcus early neonatal sepsis prophylaxis. Five hospitals did not use antibiotics for caesarean sections. Blood products were not available in four hospitals and eight could not take emergency care for severe ill women. Fifteen hospitals reported trained professional providing neonatal care. Conclusion: The perinatal mortality rate proved to best indicator reflecting socioeconomic indicators in the region. The caesarean rate pictured the municipalities with higher income. Qualified health practices were available in most hospitals. However, augmentation with oxytocin and episiotomy sounded excessive, while others need improvement, as antibiotics for all C-sections and availability of blood and emergency care. The results highlight the health care inequity and the importance of reviewing hospital care routines, even in a region with ample access to material and human resources, and continuing education opportunities / Doutorado / Saúde Materna e Perinatal / Doutora em Ciências da Saúde

Indiana University-Purdue University Indianapolis (IUPUI) / Indices to assess malocclusion have been developed to serve a multitude of functions, from rating 'severity of malocclusion', to prioritizing orthodontic treatment for patients. These indices have been established and used, but many with significant inadequacies in their methods. Very few indices quantitatively look at characteristics of a patient to objectively assess treatment difficulty. No current published index uses all of the pretreatment diagnostic records in its assessment. A complete index of malocclusion with the objective analysis of all pretreatment records is needed to accurately quantify treatment need. Recently, an index of malocclusion was developed and validated at IUSD that evaluates a complete set of diagnostic records. Initially this index was found to be a valid measure of patients of non-Hispanic white descent in the permanent dentition. Later it was validated to patients of both mixed and permanent dentitions of various racial profiles. In the present study, pretreatment records (dental casts, intra-oral photographs, extra-oral photographs, panoramic radiograph, and a cephalogram) of 100 patients (48 mixed dentition, 52 permanent dentition) from the Indiana University Graduate Orthodontic Department were evaluated. The patients were selected from a group of completed cases that had been previously scored with the discrepancy index (DI). This data was used to select a group of patients that, as closely as possible, represented a comprehensive range of severity. Thirty-six measurements were scored and combined into a total score representing the new index for the permanent dentition. Thirty-three characteristics were totaled in a similar fashion for patients in the mixed dentition. The scores of the new index were compared to the average examiner scores of four experienced orthodontists. Statistical analysis showed significant correlations of the new index to the average examiner scores, as well as to the DI scores. It is the conclusion of this study that the new IUSD index is a valid measure of severity of malocclusion that correlates well with DI and reflects the rankings of experienced orthodontists.