Magister Public Health - MPH (Public Health) / The oral health programme in Lesotho aims to offer curative, preventive, promotive and rehabilitative oral health services. However, observations as well as annual reports suggest that oral health service utilization is poor, as most patients only attend dental clinics with advanced stages of decayed teeth which can only be extracted. The reasons for this very undesirable late utilization of oral health services have not been systematically explored and understood in Lesotho. This makes it difficult for health planners to find solutions for improving access, utilizations and responsiveness of oral health services.

Made available in DSpace on 2014-12-17T15:32:31Z (GMT). No. of bitstreams: 1 ManoelAGN_tese.pdf: 5283581 bytes, checksum: 65511a1dd2487deff44e8db44d2a0cf5 (MD5) Previous issue date: 2006-08-18 / Conselho Nacional de Desenvolvimento Cient?fico e Tecnol?gico / The objective of this study was perform by the streptoavidin-biotin technique an immunohistochemical analysis of ?2?1, ?3?1e ?5?1 integrins in 11 normal oral mucosa (NOM), 16 oral inflammatory fibroepithelial hyperplasia (OIFH) and 25 oral epithelial dysplasia (OED) (16 mild, 2 moderates and 7 severe), to determine if exists qualitative alteration in the expression of these integrins and if this guard relation with the oral epithelial modifications. It was observed that for the ?2?1 integrin the majority of the sample showed a predominantly intense labeling diffusely distributed in the intercellular contacts and the cytoplasm of cells of the basal and suprabasal layers, without difference of this profile between the different types of specimens, however with a trend to weak or loss of expression in 21.1% of the OEDs, being all the specimens that had not expressed this heterodimer, severe OEDs. For the ?3?1 integrin the majority of the sample showed a weak or absent labeling in basal layer. The ?5?1 integrin showed a predominant strong diffuse labeling in the intercellular contacts and cytoplasm in the suprabasal layer, with difference only in the labeling intensity between the types of specimens, inhabiting this difference in the OEDs, where 12 (48%) specimens had shown a weak labeling. It was concluded that the evaluated integrins can be involved in the cell-cell, cell-ECM interactions modulating the cellular differentiation and maintenance of the epithelial structural arrangement. The variable expression of the ?5?1 integrin in the OEDs, could suggest, respectively, a role of this molecule in the cellular survival, with intention to perpetuate the modified phenotype in these lesions, or a suppressor role on the modified phenotype due to lack of interaction of this molecule with the fibronectina of the MEC / Este estudo se prop?s analisar atrav?s da t?cnica da estreptoavidina-biotina a express?o imuno-histoqu?mica das integrinas ?2?1, ?3?1e ?5?1 em 11 esp?cimes de mucosa oral normal (MON), 16 de hiperplasia fibroepitelial inflamat?ria oral (HFIO) e 25 de displasia epitelial oral (DEO) (16 leves, 2 moderadas e 7 graves), procurando determinar se existe altera??o qualitativa na express?o destas integrinas e se a mesma guarda rela??o com as modifica??es sofridas pelo epit?lio oral. Para a integrina ?2?1 a maioria dos esp?cimes exibiu uma marca??o predominantemente intensa e difusa nos contatos intercelulares e no citoplasma celular das camadas basal e suprabasal, sem diferen?a desse perfil entre os diferentes tipos de esp?cimes, por?m com uma tend?ncia a fraca ou perda da express?o em 21.1% das DEOs, sendo todos os esp?cimes que n?o expressaram marca??o para este heterod?mero DEOs graves. Para a integrina ?3?1 a maioria da amostra exibiu uma marca??o fraca ou ausente predominantemente em camada basal. A integrina ?5?1 exibiu uma forte marca??o difusa nos contatos intercelulares e citoplasm?tica na camada suprabasal, com diferen?a apenas na intensidade de marca??o entre os tipos de esp?cimes, residindo essa diferen?a nas DEOs, onde 12 (48%) esp?cimes exibiram uma fraca marca??o. Concluiu-se que as integrinas avaliadas podem estar envolvidas nas intera??es c?lula-c?lula e c?lula-MEC que garantem a diferencia??o celular e manuten??o do arranjo estrutural tecidual. A vari?vel express?o da integrina ?5?1 nas DEOs, poderia sugerir, respectivamente, um papel dessa mol?cula na sobrevida celular, com o intuito de perpetuar o fen?tipo alterado nessas les?es, ou uma a??o supressora desse fen?tipo devido ? falta de intera??o desta mol?cula com a fibronectina da MEC

Enquanto lesões cutâneas do líquen plano (LP) são autolimitantes, suas manifestações orais (LPO) têm comportamento crônico, raramente apresentam remissão espontânea, e podem sofrer transformação maligna, embora subsista controvérsia sobre esta ultima questão. A este respeito, alguns autores têm dado ênfase ao envolvimento da Candida spp. na malignização LPO devido à capacidade deste fungo em produzir enzima carcinogênica N-nitrobenzilmetilamina e sua relativa freqüência em lesões LPO. Adicionalmente, foi investigada a xerostomia que, além de ocorrer com maior freqüência em indivíduos da faixa etária em que o LPO é mais prevalente, é considerado fator predisponente à candidose. Portanto, a correlação entre xerostomia e colonização por Candida spp. apresente relevância de ser investigada. O presente estudo objetivou comparar a prevalência de Candida spp. e xerostomia em 37 pacientes com lesões LPO (grupo LPO) com a de 26 pacientes com lesões inflamatórias não-LPO (grupo não-LPO) e com a de 28 indivíduos sem lesões orais (grupo controle-saudável). Pacientes LPO foram predominantemente indivíduos do sexo feminino com média idade de 50 anos. Presença de xerostomia foi evidenciada em 35,1% dos pacientes do grupo LPO, em 38,5% do grupo não-LPO e em 25% do grupo controle-saudável, não havendo diferença estatisticamente significante entre os três grupos (p > 0,05). Nos três grupos, medicação sistêmica e presença de distúrbios emocionais (ansiedade e depressão) não foram estatisticamente significante associados como fatores ao desenvolvimento de xerostomia (p > 0,05). A presença de xerostomia não foi fator estatisticamente significante de predisposição à colonização por Candida spp. nos três grupos. Colonização por Candida spp foi maior no grupo controle-saudável (53,5%) que nos outros grupos (29,7% no LPO e 26,9% no não-LPO), porém, não houve diferença estatisticamente significante (p > 0,05). Formas clínicas do LPO não foram fatores de predisposição à colonização por Candida spp. Espécie mais freqüentemente isolada nos três grupos foi Candida albicans. Formas não-albicans, especificamente a C. dubliniensis, foram encontradas em três indivíduos do grupo controle-saudável. / While cutaneous lesions of lichen planus (LP) are self-limiting, its counterpart oral manifestations (OLP) are chronic, hardly ever undergo spontaneous remission, and may suffer malignant transformation, though this latter issue still bears some controversy. In this respect, some authors have believed that Candida spp. might play a part in the OLP process of malignant transformation since this fungi has the ability to produce carcinogenic N-nitrobenzilmetilamina enzyme and has been found in OLP lesions. Apart that, xerostomia is considered a predisposing factor to candidosis and occurs more frequently in individuals at an aging in which OLP is more prevalent. Therefore, the correlation between xerostomia and candidosis may be worth it investigating. This study aimed at comparing the prevalence of Candida spp. and xerostomia in 37 patients with OLP lesions (OLP group) with that of 26 patients with inflammatory non-OLP disease (non-OLP group) and with that of 28 subjects without oral mucosal lesions (healthy-control group). OLP patients occurred predominantly in females at a mean age of 50 years. Presence of xerostomia was seen in 35.1% of patients in the OLP group, in 38.5% of the non-OLP and in 25% of the healthy-control group with no statistically significant difference among the three groups (p > 0.05). In all the groups, systemic medication and the presence of psychological disorder (anxiety and depression) were not statistically significant factors associated with the development of xerostomia. The presence of xerostomia was not a statistically significant factor at predisposing the colonization by Candida spp. in the three groups (p > 0.05). Colonization by Candida species was higher in healthy-control group (53.5%) than in other groups (29.7% in OLP and 26.9% in non- LPO), but the difference among them did not reach a statistical significance (p > 0. 05). Clinical forms of OLP were not predisposing factors to the colonization by Candida spp. The most frequently isolated species in the three groups were Candida albicans. Non-albicans forms, specifically C. dubliniensis, was found in three patients in the healthy-control group.

Made available in DSpace on 2015-03-05T20:05:14Z (GMT). No. of bitstreams: 0 Previous issue date: 25 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / A dentição funcional possui importante papel na manutenção da capacidade mastigatória, a qual está intimamente relacionada com o número de dentes presentes na boca. Para manter tal funcionalidade é necessária a presença mínima de 20 dentes bem distribuídos nos arcos dentários superior e inferior. O objetivo deste estudo foi investigar o efeito de aspectos individuais e contextuais na ausência de dentição funcional de adultos do Estado do Rio Grande do Sul, Brasil. / Oral functionality has important role in maintaining masticatory capacity. This can be achieved with the presence of at least 20 functional teeth in mouth. The objective of this study was to investigate the effect of individual and contextual factors on the functional dentition status of Brazilian adults.

Made available in DSpace on 2016-04-27T18:12:43Z (GMT). No. of bitstreams: 1 Dissertacao Camila Cardoso Pereira.pdf: 1282416 bytes, checksum: 4ace715fa04c649060485bb12a062a4e (MD5) Previous issue date: 2005-08-23 / This study had the aim to investigate the importance, on the speech therapy, of the comprehension of life s story from patients that present the finger suction. Therefore, was used the clinic-qualitativy methodology, with the presentation of fragments of the therapeutic process from an eleven years old patient who abode with this habit for a long time, cutting off during the treatment. This analysis of this empiric material reflected the change of clinic attitude from the therapist, who abstained from focus only on specific procedures and started to valorize topics brought from patient on the therapeutic context, trying to heed their suffering and allowing the manifestation of its subjectivity. The conclusion of this study allows the area of speech therapy and also the whole team-work involved, consider the peculiarity of the patients in the constitution of a new work field, understood, as unique, distinct and individual / Dentro da atuação fonoaudiológica, no campo da Motricidade Oral, o paciente portador do hábito de sucção digital vem recebendo tratamentos relacionados aos intrincados processos de manifestações clínicas. Partindo da necessidade de atender e compreender as demandas que este hábito deletério incide sobre o tratamento fonoaudiológico, este estudo tem como objetivo investigar a importância, na terapia fonoaudiológica, de compreender a história de vida dos pacientes que apresentam este hábito oral deletério. Para alcançar este objetivo, recorremos à metodologia clínico-qualitativa, relatando o processo terapêutico de uma paciente que perdurou com o hábito de sucção por um longo tempo, interrompendo-o durante o tratamento fonoaudiológico, partindo da descrição e análise de fragmentos das sessões terapêuticas. Os resultados analisados circunscreveram além dos procedimentos específicos fonoaudiológicos, a trajetória desse hábito oral escoltado em sua história de vida, retratando, contudo, a mudança de postura clínica do terapeuta, foco da análise. A conclusão desse estudo leva tanto o fonoaudiólogo quanto a equipe multidisciplinar envolvida com este paciente, considerar o sujeito e suas manifestações clínicas além das alterações orofaciais, visando uma atuação que contemple a singularidade do paciente, refletindo, entretanto, a importância deste tipo de abordagem na área da Motricidade Oral

Poor oral care is detrimental to the overall health of the population. In the United States, oral health diseases affect millions of individuals, especially children and adolescents. Guided by the health belief model, the purpose of this study was to identify parents' perceived barriers to oral health care access among their 5- to 10-year-old children. A phenomenological approach was used to gather data and thematically analyze interview data from 20 parents who were recruited from a health center in the northeastern United States. All participants had at least one child between 5-10 years old and all identified as under-served. Data were coded and analyzed for emerging themes, with the assistance of Nvivo software. The findings demonstrated that lack of time, the location of dental facilities, and the lack of sensitivity of dental providers were issues for parents in managing their children's oral health. This study might be beneficial in eliciting positive social change at the individual and organizational levels by illuminating the constraints faced by the underserved population in Massachusetts.

When adolescents forgo oral health treatment, factors that hinder them from obtaining these services put them at risk of detrimental consequences in their oral and overall health. The purpose of this qualitative phenomenological study was to identify the various barriers that adolescents encounter causing them to defer oral treatment. Through this study, public health officials, school health care providers, the state, and parents could be made aware of these factors and work together to implement programs and supplemental aid to help adolescents become more knowledgeable of the importance of oral care and encourage them to desire and seek treatment. The oral health and behavioral conceptual models provided foundations for the development of the research questions, and they highlighted the selection of risk factors on the deferment process. Twenty adolescents who had oral health treatment/services in the past 12 months participated in the study. Interviews were transcribed verbatim and analyzed thematically. The results of this study show that oral health beliefs, as well as personal, behavioral, and environmental factors, shaped adolescents' decision to forgo oral health treatment. Financial barriers, dental fear, and transportation obstructed their capacity to seek care for themselves. The positive social change implications of this study include increasing the proportion of adolescents receiving oral health treatment yearly through the development of targeted interventions (such as school programs) that are designed to increase the adolescents' access to and use of dental care services. Such efforts would support the strategies implemented to achieve Healthy People 2020 objectives.

No description available.

The past few decades have witnessed an increased focus on the importance of oral health on the social, psychological and developmental well-being in children. Although effective and advanced dental prevention measures and treatment options are increasingly available, dental decay remains one of the most common chronic childhood diseases in the United States and around the world. Recently, the World Health Organization Assembly called attention to the significant burden oral disease has maintained in all countries around the world. Additionally, multiple studies have described disparities in oral health with a disproportionate amount of dental disease concentrated in children with special health care needs, those that live with poor families or that live in isolated or rural communities. In response to this issue there has been renewed focus on combating access to oral health care issues. One approach that has been suggested is the utilization of non-dental health professionals in assessing oral health, performing basic preventive steps and referral of high-caries risk children for further care. These non-dental professionals are often in a better position to evaluate children at an early age, are more likely to see poor children early and to provide care for them on a continuing basis when compared to dentists. However, several barriers have been mentioned in the literature that prevent or deter these non-dental health professionals from taking on a more active role in this access to care issue. Of which has been a reported lack in oral care education and training for medical care professionals. Additionally, collectively few studies have specifically identified the importance of different suggested influencing factors. In our present study, three main analyses were conducted. The first analysis assessed the oral-health knowledge, practices, and factors influencing the ability and willingness of Iowa pediatricians' to assess and refer high caries-risk children. In which, a 22-item survey was mailed to all licensed pediatricians in Iowa. Chi-square statistics and logistic regression models were used to analyze data. On questions regarding comfort levels when performing oral-health related practices on children under 3, physicians reported high levels of comfort with all specified issues. The majority of respondents routinely gave the name of a dentist to the caregiver when referring, where as only 4% made use of local care coordination services and only 9% actually made the dental appointment. Sixty-five percent referred all children 12 months or older to a dentist in accordance with AAPD and AAP guidelines. The ability to locate a dentist willing to accept Medicaid or uninsured children was noted as the major referral barrier. Bivariate and multivariate logistic regression analyses indicated that pediatricians who had higher frequency of seeing oral-health problems (p=0. 0.0488), greater mean total number of children seen per week (p=0.0431), and believed that children should have their 1st dental visit no later than 12 months of age (p=0.0196) were more likely to make frequent referrals to a dentist compared to their counterparts. The second analyses assessed Saudi medical interns' oral-health knowledge, and other factors influencing their ability and willingness to perform oral-health related practices for high caries-risk children. In which, a 15-item survey was emailed to all eligible graduating fifth year medical students at King Khalid University Hospital to address these areas of interest. Chi-square statistics and logistic regression models were used to analyze data. Similar to our first study physicians noted high levels of comfort with all specified oral health practices. However, students generally rated their medical training fair or poor in preparing them for oral-health assessments compared. Additionally, although 90% of respondents noted that the role of primary physicians in counseling/referring children with oral health was important; 60% did not agree with the AAPD and AAP guidelines that state that all children should be referred to a dentist by 12 months of age. Multivariate logistic regression analyses revealed several statistically significant variables that predict the likelihood of performing various oral-health related practices. The choice of public-health oriented future clinical goals, the level of oral-health knowledge, how interns rated their oral health training in medical school, and the average number of children seen per week, all - to varying degrees - proved important predicator variables for the likelihood of performing them once in practice. In our third study focus was placed on assessing the effectiveness of an electronic educational intervention on improving primary care practitioners' knowledge, willingness, and comfort levels in identifying children who are at high risk for developing dental caries. Following the educational program, a 16-item survey was emailed to all participants to address the areas of interest. Bivariate correlation and linear regression were used to analyze data. Respondents gave a higher percentage of correct responses to the knowledge questions post-intervention compared to pre-intervention with an average increase of 63%. Additionally, nearly all respondents agreed with the statement that all children 12 months and older should be seen by a dentist in accordance the AAP & AAPD. Furthermore, physicians noted improved levels of comfort with all specified oral health practices. Most notable, following the educational intervention, 91% of respondents rated them-selves as comfortable in counseling, compared to only 25.6% that did so before the educational program. The only exception on comfort issues pertained to performing emergency treatments on young children with a majority of interns (92%) still considering themselves as neutral or uncomfortable in doing so. Multiple linear regression analyses revealed several statistically significant variables that predict the likelihood of performing various oral-health related practices. Increased oral health knowledge, higher self-perceived comfort levels and seeing oral-health problems more frequently all proved important predicator variables for the likelihood of performing oral-health related services. Collectively, these three analyses lead us to several main conclusions and future education recommendations. Educating medical practitioners and students about basic oral health recommendations and referral guidelines provides an excellent opportunity to alert medical professionals about the importance and timing of these dental referrals. Ultimately, earlier referrals by physicians can help improve dental utilization among high risk children, especially among lower income and rural families. Additionally, providing these medical professionals with experience opportunities in assessing the oral health of young children may improve both physician willingness and likelihood to perform various oral health practices for young children. Overall, increasing both knowledge and personal experience of training physicians' could lead to greater comfort levels in dealing with oral health issues affecting young children. Furthermore, establishing effective care coordinator services to assist in linking various health care professionals more directly; may also increase physician willingness to assess and refer high-caries-risk children by making the referral process easier for physician offices. This step helps in saving time and effort, two deterrents noted by physicians.

<p>&nbsp / </p> <p align="left">Oral ulcers and oral thrush could be indicative of serious illnesses such as oral cancer, HIV and other sexually transmitted infections (STIs), among others. There are many different health care workers that can be approached for advice and/or treatment for oral ulcers and oral thrush (sometimes referred to as mouth sores by patients), including pharmacists. In fact, the mild and intermittent nature of oral ulcers and oral thrush may most likely lead the patient to present to a pharmacist for immediate treatment. In addition, certain aspects of access are exempt at a pharmacy such as long queues and waiting times, the need to make an appointment and the cost for consultation. Thus pharmacies may serve as a reservoir of undetected cases of oral cancer, HIV and other STIs. <b><font face="Times New Roman">Aim</font></b><font face="TimesNewRomanPSMT" size="3"><font face="TimesNewRomanPSMT" size="3"><font face="Times New Roman">: To determine how community pharmacists in the Western Cape manage </font>oral ulcers and oral thrush.</font></font></p>