Background: To improve health in the population, public health interventions must be successfully implemented within organisations, requiring behaviour change in health service providers as well as in the target population group. Such behavioural change is seldom easily achieved. The purpose of this study was to examine the outcomes of a child health promotion programme (The Salut Programme) on professionals' self-reported health promotion practices, and to investigate perceived facilitators and barriers for programme implementation. Methods: A before-and-after design was used to measure programme outcomes, and qualitative data on implementation facilitators and barriers were collected on two occasions during the implementation process. The sample included professionals in antenatal care, child health care, dental services and open pre-schools (n=144 pre-implementation) in 13 out of 15 municipalities in a Swedish county. Response rates ranged between 81% and 96% at the four measurement points. Results: Self-reported health promotion practices and collaboration were improved in all sectors at follow up. Significant changes included: 1) an increase in the extent to which midwives in antenatal care raised issues related to men's violence against women, 2) an increase in the extent to which several lifestyle topics were raised with parents/clients in child health care and dental services, 3) an increased use of motivational interviewing (MI) and separate 'fathers visits' in child health care 4) improvements in the supply of healthy snacks and beverages in open pre-schools and 5) increased collaboration between sectors. Main facilitators for programme implementation included cross-sectoral collaboration and sector-specific work manuals/questionnaires for use as support in everyday practice. Main barriers included high workload, and shortage of time and staff. Conclusion: This multisectoral programme for health promotion, based on sector-specific intervention packages developed and tested by end users, and introduced via interactive multisectoral seminars, shows potential for improving health promotion practices and collaboration across sectors. Consideration of the key facilitators and barriers for programme implementation as highlighted in this study can inform future improvement efforts.

The rhetoric of primary health care, health promotion and health service integration is ubiquitous in health policy development in post-apartheid South Africa. However the form in which oral health promotion elements have actually been incorporated into other areas of health care in South Africa and the extent to which they have been implemented, remains unclear. The central aim of this research was to critically analyse oral health promotion elements in health policies in South Africa and determine the extent to which they have been implemented. The study set out to test the hypothesis that oral health promotion is fully integrated into South African health policy and practice.

<p>The aim of this study was to compare the oral health status between well and malnourished children under five years old attending Mother and Child Health clinic in Queen Elizabeth II Hospital in Maseru, Lesotho.</p>

Thesis (Ph. D.)--University of Texas Health Science Center at Houston, School of Public Health, 2007. / Source: Dissertation Abstracts International, Volume: 68-10, Section: B, page: 6566. Adviser: Steven H. Kelder. Includes bibliographical references.

Diss. med. dent. Zürich. / Literaturverz.

Orientador: Orlando Saliba / Banca: Antônio Carlos Frias / Banca: Edgard Michel Crosato / Banca: Rogério Moreira Arcieri / Banca: Dóris Hissako Sumida / Resumo: O objetivo deste estudo foi analisar os aspectos epidemiologicos e os fatores associados as condicoes de saude bucal em residentes no municipio de Vere, Parana, Brasil, 2005. Para tanto foram analisados dados referentes a carie dentaria, a doenca periodontal, a perda dentaria e ao uso e a necessidade de protese. Realizaram-se exames epidemiologicos em 733 pessoas de diferentes faixas etarias, nas escolas e domicilios, de acordo com os criterios preconizados pela Organizacao Mundial da Saude e pelo Projeto SB2000. Utilizaram-se os testes Mann-Whitney e Exato de Fisher (a=5%). Na faixa etaria de 18 a 36 meses e aos 5 anos de idade a prevalencia de carie foi de 22,86% e de 80,99%, o ceo-d medio foi 1,34 e 5,34 respectivamente. O ceo-d foi mais elevado em criancas de 18 a 36 meses nao brancas (p=0.0120) e nas de 5 anos nao brancas (p=0.0076) e ainda nas de classes economicas menos favorecidas (p=0.0256), residentes na area rural (p=0.0056) e em local sem fluoretacao das aguas de abastecimento publico. Foram fatores associados a carie dentaria a etnia na idade de 18 a 36 meses e a classificacao economica e localizacao geografica aos 5 anos. Nas idades de 12 e 15 a 19 anos, as prevalencias de carie foram 73,24% e 89,23% respectivamente. O CPO-D foi 2,70 e 5,16, sendo esse indice mais elevado aos 12 anos nas classes economicas menos favorecidas (p=0.0024), em residentes na area rural (p=0.0132) e em local sem agua fluoretada (p=0.0487). Nessa idade a classe economica foi fator associado a carie dentaria. Nos adolescentes de 15 a 19 anos o CPO-D foi mais elevado em pertencentes as classes economicas menos favorecidas (p=0.0041), residentes na area rural (p=0.0001) e em local sem fluoretacao das aguas de abastecimento (p=0.0003), sendo a localizacao geografica o unico fator associado a carie dentaria. O SiC Index demonstrou o fenomeno da polarizacao ...(Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Epidemiological aspects and study of factors related to oral conditions of residents in the city of Verê-Paraná. The aim of this study was to analyze the epidemiological aspects and factors related to oral conditions of residents in the city of Verê-Paraná, Brazil, 2005. The analyzed data were referent to dental caries, periodontal disease, dental loss, the use and need for prosthesis. Epidemiological exams were carried out in 733 people from different age groups, at school and at home, according to criteria recognized by the World Health Organization and SB2000 project. The Mann- Whitney's and Fisher Exact's tests were used (a=5%). In the age groups of 18 to 36 months old and 5 years of age, the caries prevalence was 22.86% and 80.99%; the dmf-t mean was 1.34 and 5.34 respectively. The dmf-t was higher in children between 18 and 36 months, not white (p=0.0120) and in 5 year-old children not white (p=0.0076) and still, in the ones belonging to low socioeconomic class (p=0.0256), rural area residents (p=0.0056) and at places without public water fluoridation. Factors related to dental caries in 18 to 36 months-old children were ethnics and economic classification, and geographic location for the 5 year-old groups. In the ages of 12 and 15 to 19, the caries prevalence was 73.24 and 89.23 respectively. The DMF-T was 2.70 and 5.16. This index was higher in the low socioeconomic group of 12 year-olds (p=0.0024), in rural area residents (p=0.0132) and at places without public water fluoridation (p=0.0487). The socioeconomic classification was the factor related to dental caries in this city. In the adolescents of 15 to 19 years of age the DMF-T was higher in individuals belonging to low socioeconomic class (p=0.0041), rural area residents (p=0.0001) and at places without public water fluoridation (p= 0.0003), geographic location was the only factor related to dental caries ...(Complete abstract click electronic access below) / Doutor

Made available in DSpace on 2015-07-22T20:50:38Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-06-30 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Introdução: No Brasil, o Instituto Nacional do Câncer (INCA) estima que haverá 14.120 novos casos de câncer bucal em 2010, sendo 10.330 em homens e 3.790 em mulheres. A maioria dos cânceres de boca infelizmente só é diagnosticada em fase tardia. O autoexame bucal, por representar uma estratégia simples e eficaz na identificação precoce das lesões cancerizáveis e do câncer bucal, deveria ser feito periodicamente, sobretudo por indivíduos do grupo de risco. Objetivo: Desenvolver e avaliar um website educacional no intuito de promover a prevenção e a identificação precoce das lesões cancerizáveis e do câncer bucal. Método: Foram desenvolvidos um website com conteúdo educacional sobre o câncer bucal, um questionário de conhecimento e um vídeo do autoexame bucal. A avaliação do website baseou-se em uma amostra n=100 dividida em dois grupos. O grupo G1 foi avaliado pré e pós navegação no website, e o grupo G2 não teve acesso ao conteúdo do website. Ambos os grupos executaram o autoexame bucal e registraram seus achados clínicos, que foram comparados com os achados clínicos dos dentistas. Resultados: O website desenvolvido foi intitulado “Website Educacional da Prevenção do Câncer Bucal”. A análise estatística mostrou que os grupos G1 e G2 eram homogêneos quanto ao conhecimento prévio sobre o câncer bucal. Entretanto, o G1 mostrou diferença significante (p<0,01) sobre o conhecimento pós navegação no website. Já a análise de concordância entre os grupos versus dentistas apresentou alta concordância para o G1 e fraca concordância para o G2. Conclusões: O website desenvolvido mostrou-se uma eficiente ferramenta educacional quanto ao ganho de conhecimento sobre o câncer bucal e propiciou eficaz reprodutibilidade do autoexame bucal. / Introduction: In Brazil, the National Cancer Institute (INCA) estimates there will be 14,120 new cases of oral cancer in 2010, with 10,330 men and 3,790 women. Unfortunately, most mouth cancers are only diagnosed in late stage. The oral self-examination represents a simple and effective strategy for early identification of precancerous lesions and oral cancer, and should be done periodically, especially for individuals in risk groups. Objective: To develop and evaluate an educational website aimed at promoting prevention and early detection of cancerous lesions and oral cancer. Method: A website with educational content on oral cancer, a survey of knowledge and a video of oral self-examination have been developed. The website evaluation was based on a sample n = 100, divided into two groups. Group 1(G1) was evaluated before and after browsing the website, and the group 2(G2) did not have access to the website content. Both groups performed the oral self-examination and recorded their clinical findings, which were compared with dentists clinical findings. Results: The developed website was named "Educational Website for Oral Cancer Prevention." Statistical analysis showed that G1 and G2 were homogeneous with respect to prior knowledge about oral cancer. However, G1 showed a significant difference (p <0.01) on knowledge after browsing the website. However, analyzing the agreement between the groups versus dentists, it was found high concordance for G1 and poor agreement for G2. Conclusions: The website proved to be an effective educational tool for gain of knowledge about oral cancer and provided effective reliability of oral self-examination. / TEDE / BV UNIFESP: Teses e dissertações

INTRODUÇÃO: Mudanças nas políticas de saúde e educação promoveram avanços na reorientação da educação dos profissionais da saúde e das práticas de atenção à saúde no Brasil. A odontologia acompanhou esse movimento e a formação de dentistas no país foi reorganizada nas Instituições de Ensino Superior buscando um perfil de egressos aptos a atuar no Sistema Único de Saúde. Para responder ao desafio da formação e para alcançar a integralidade do cuidado, a clínica odontológica também precisa ser ‘ampliada’ no sentido de possibilitar que outros aspectos do sujeito, que não apenas o físico, possam e devam ser compreendidos e trabalhados pelos profissionais da saúde bucal. OBJETIVO: Analisar os sentidos atribuídos às práticas clínicas por dentistas da Atenção Primária à Saúde (APS) na produção do cuidado. METODOLOGIA: Trata-se de uma pesquisa qualitativa de base fenomenológica (estudo de caso), realizado nas Unidades do Serviço de Saúde Comunitária do Grupo Hospitalar Conceição, no município de Porto Alegre, Rio Grande do Sul. A coleta de dados envolveu a realização de entrevistas semiestruturadas guiadas por um roteiro de questões norteadoras com dentistas que atuam na APS e a observação não estruturada da rotina clínica desses profissionais com registros em diário de campo. A amostra foi intencional seguindo o critério da saturação teórica e da densidade do material textual produzido (n=11). O material textual das entrevistas e do diário de campo foram interpretados pela análise de conteúdo de Bardin, com o apoio do software ATLAS.ti (Visual Qualitative Data Analysis). Cada categoria emergente foi discutida tendo por base os conceitos de tecnologias leves do cuidado em saúde, clínica ampliada, atenção centrada no paciente e das Políticas Nacionais de Atenção Básica, Saúde Bucal e Humanização. A pesquisa foi aprovada pelos Comitês de Ética em Pesquisa da UFRGS e do GHC. RESULTADOS: Os resultados mostraram dentistas com práticas clínicas capazes de produzir subjetividades e vínculo, caracterizadas por um acolhimento de escuta e diálogo com o usuário e pela pactuação de um plano terapêutico compartilhado e em constante reconstrução, contrário a uma assistência com foco essencialmente dentário voltado a necessidades diagnosticadas exclusivamente pelo profissional. O usuário foi reconhecido como um sujeito de experimentação e interação social, cujas necessidades do corpo vivido vão além das de um corpo físico. Os dentistas apontaram que, para além da formação na graduação e pós-graduação, as suas formas de trabalhar foram tecidas em ato, no trabalho em equipe no cotidiano da APS. CONSIDERAÇÕES FINAIS: Propostas de inovação pedagógica nos currículos da área da saúde devem trazer bases teóricas e atividades práticas que incluam as subjetividades como uma das dimensões do modo de produção do cuidado em saúde e as tecnologias relacionais. / INTRODUCTION: Changes in health and education policies have promoted advances in the reorientation of education of health professionals and health care practices in Brazil. Dentistry followed this movement and the formation of dentists in the country was reorganized in Higher Education Institutions seeking a profile of graduates able to work in the SUS. To respond to the challenge of training and to achieve integral care, the dental clinic also needs to be 'expanded' in order to enable other aspects of the subject, other than just the physical, can and should be understood and worked by oral health professionals. OBJECTIVE: To analyze the sense attributed to clinical practices of Primary Care (PC) dentists in the care health production. METHODOLOGY: This is a phenomenological qualitative research (case study) conducted at the Units of Primary Care of SSC/GHC, Porto Alegre, Rio Grande do Sul. Data collection involved semi-structured interviews guided by a script of guiding questions with dentists who work in PC and the unstructured observation of the clinical routine of these professionals with records in field diaries. The sample was intentional following the criterion of theoretical saturation and the density of the textual material produced (n = 11). The textual material from the interviews and the field diary were interpreted by Bardin content analysis, supported by the ATLAS.ti (Visual Qualitative Data Analysis) software. Each emerging category was discussed based on the concepts of light technologies of health care, expanded clinical practice, patient-centered attention and the National Policies of Basic Attention, Oral Health and Humanization. The research was approved by the Research Ethics Committees of UFRGS and GHC. RESULTS: Results showed dentists with clinical practices capable of producing subjectivity and connection, characterized by a listening and dialogue with the user and by the agreement of a shared therapeutic plan and in constant reconstruction, contrary to an essentially dental-based care, from needs diagnosed exclusively by the professional. The user has been recognized as a subject of experimentation and social interaction, whose needs of the lived body go beyond those of a physical body. Dentists pointed out that, in addition to undergraduate and postgraduate training, their ways of working were produced in act, in teamwork in the everyday life of PC. CONCLUSIONS: Proposals for pedagogical innovation in health curricula should provide theoretical bases and practical activities that include subjectivities as one of the dimensions of the way of production of health care and the health relational technologies.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The use of dental care services has been associated with contextual factors and time-related variations. However, there is a lack of studies assessing the association between contextual variables and the use of dental care services as well as the trends of oral health care utilization in preeschoolers. This dissertation aimed to assess the association between individual and contextual socioeconomic factors with the use of dental health services in Brazilian preschool children. As well, assess the trend in the use of dental health care, type of service and reasons for dental care utilization considering time-related variations of age, period and cohort ( Age-Period- Cohort effect ). A representative sample of 1,765 preschool children from Santa Maria-RS, Brazil, was collected from 3 oral health surveys performed in 2008, 2010 and 2013. Data from these surveys were used to assess the trend in the use of dental health services among preschool children considering the influence of Age- Period-Cohort effect. A total of 639 participants from the second period of data collection (2010) were used to assess the influence of contextual factors in the use of dental care. Contextual social determinants included the presence of worker s associations and the number of dentists in thethe neighborhood in which the child was living. Data analysis used multilevel Poisson regression models to assess the association between predictors and the outcomes in both studies. The chi-square for trends was also used to assess the the prevalence of each outcome considering time-related changes. Presence of wokers association in the neighborhood favors preschool children to use dental health services. Children who lived in a neighborhood with workers association visited the dentist 65% more than their counterparts. There is a time-related vartion (Age-Period-Cohort effect) in the useof dental health services along the years of study; age influenced straightly the dental visits prevalence, and period and cohort effects influenced significantly the type of service used and the reasons for dental seek. There is a significant association between individual and contextual social determinants and the use of dental care services in preschool children. The study also found a significant age-period-cohort effect in the use of dental care service which may be considered when planning public health strategies that facilitate dental acess for this population. / O uso de serviços odontológicos pode ser influenciado por fatores contextuais e sua prevalência, por efeitos temporais. Entretanto, há pouca evidencia da associação entre diferentes fatores contextuais e uso de serviços, ademais, não existem estudos avaliando a tendência do uso de serviços odontológicos em pré-escolares brasileiros. O objetivo desta dissertação foi avaliar a associação entre fatores socioeconômicos individuais e contextuais e o uso de serviços odontológicos em pré-escolares. Como também, avaliar a tendência no uso de serviços odontológicos, tipo de serviço e motivo da consulta, levando em consideração os efeitos temporais de idade, período e coorte (Age-period-cohort effect). Uma amostra representativa de 1765 pré-escolares de Santa Maria-RS, Brasil, foi obtida a partir de 3 levantamentos realizados nos anos de 2008, 2010 e 2013. Os dados dos 3 levantamentos epidemiológicos foram utilizados para verificar a tendência na utilização de serviços odontológicos por pré-escolares considerando Age-period-cohort effect. Ademais, foram verificadas possíveis alterações nas associações de fatores individuais com o uso de serviços odontológicos por pré-escolares considerando esses efeitos temporais. Para verificar a associação de fatores contextuais com o uso de serviço, foram utilizados dados do levantamento realizado em 2010 composto por 639 pré-escolares. As variáveis contextuais consideradas foram: número de dentistas do bairro e a presença de associação de trabalhadores. Os dados foram analisados utilizando Modelos Multiníveis de Regressão de Poisson, para avaliar a associação das variáveis preditoras e os desfechos em ambos os estudos. No estudo de tendência também foi realizado o teste qui-quadrado para tendências para verificar a mudança nas prevalências de cada desfecho, de acordo com cada efeito temporal. A presença de associações de trabalhadores no bairro favoreceu o uso de serviços odontológicos por pré-escolares. Os pré escolares residentes em bairros com associação de trabalhadores tiveram uma prevalência 65% maior de terem visitado o dentista em comparação a quem não morava. No estudo de tendências, verificamos uma influência dos efeitos temporais (Age-period-cohort effect) na tendência de uso por préescolares brasileiros. O efeito idade, influenciou diretamente o uso de serviços odontológicos por pré-escolares, já o tipo de serviço e o motivo da consulta foi influenciado pelos efeitos período e coorte de forma significativa. Conclui-se que variáveis individuais e contextuais devem ser levadas em consideração, assim como os efeitos temporais que modulam o uso de serviços odontológicos, no planejamento e organização de políticas públicas de saúde bucal.

Made available in DSpace on 2014-06-11T19:33:00Z (GMT). No. of bitstreams: 0 Previous issue date: 2006-07-27Bitstream added on 2014-06-13T19:22:57Z : No. of bitstreams: 1 presta_aa_dr_araca.pdf: 844622 bytes, checksum: 20bd8daf3f16411f965c07ec163994c3 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / O objetivo deste estudo foi analisar os aspectos epidemiologicos e os fatores associados as condicoes de saude bucal em residentes no municipio de Vere, Parana, Brasil, 2005. Para tanto foram analisados dados referentes a carie dentaria, a doenca periodontal, a perda dentaria e ao uso e a necessidade de protese. Realizaram-se exames epidemiologicos em 733 pessoas de diferentes faixas etarias, nas escolas e domicilios, de acordo com os criterios preconizados pela Organizacao Mundial da Saude e pelo Projeto SB2000. Utilizaram-se os testes Mann-Whitney e Exato de Fisher (a=5%). Na faixa etaria de 18 a 36 meses e aos 5 anos de idade a prevalencia de carie foi de 22,86% e de 80,99%, o ceo-d medio foi 1,34 e 5,34 respectivamente. O ceo-d foi mais elevado em criancas de 18 a 36 meses nao brancas (p=0.0120) e nas de 5 anos nao brancas (p=0.0076) e ainda nas de classes economicas menos favorecidas (p=0.0256), residentes na area rural (p=0.0056) e em local sem fluoretacao das aguas de abastecimento publico. Foram fatores associados a carie dentaria a etnia na idade de 18 a 36 meses e a classificacao economica e localizacao geografica aos 5 anos. Nas idades de 12 e 15 a 19 anos, as prevalencias de carie foram 73,24% e 89,23% respectivamente. O CPO-D foi 2,70 e 5,16, sendo esse indice mais elevado aos 12 anos nas classes economicas menos favorecidas (p=0.0024), em residentes na area rural (p=0.0132) e em local sem agua fluoretada (p=0.0487). Nessa idade a classe economica foi fator associado a carie dentaria. Nos adolescentes de 15 a 19 anos o CPO-D foi mais elevado em pertencentes as classes economicas menos favorecidas (p=0.0041), residentes na area rural (p=0.0001) e em local sem fluoretacao das aguas de abastecimento (p=0.0003), sendo a localizacao geografica o unico fator associado a carie dentaria. O SiC Index demonstrou o fenomeno da polarizacao... / Epidemiological aspects and study of factors related to oral conditions of residents in the city of Verê-Paraná. The aim of this study was to analyze the epidemiological aspects and factors related to oral conditions of residents in the city of Verê-Paraná, Brazil, 2005. The analyzed data were referent to dental caries, periodontal disease, dental loss, the use and need for prosthesis. Epidemiological exams were carried out in 733 people from different age groups, at school and at home, according to criteria recognized by the World Health Organization and SB2000 project. The Mann- Whitney's and Fisher Exact's tests were used (a=5%). In the age groups of 18 to 36 months old and 5 years of age, the caries prevalence was 22.86% and 80.99%; the dmf-t mean was 1.34 and 5.34 respectively. The dmf-t was higher in children between 18 and 36 months, not white (p=0.0120) and in 5 year-old children not white (p=0.0076) and still, in the ones belonging to low socioeconomic class (p=0.0256), rural area residents (p=0.0056) and at places without public water fluoridation. Factors related to dental caries in 18 to 36 months-old children were ethnics and economic classification, and geographic location for the 5 year-old groups. In the ages of 12 and 15 to 19, the caries prevalence was 73.24 and 89.23 respectively. The DMF-T was 2.70 and 5.16. This index was higher in the low socioeconomic group of 12 year-olds (p=0.0024), in rural area residents (p=0.0132) and at places without public water fluoridation (p=0.0487). The socioeconomic classification was the factor related to dental caries in this city. In the adolescents of 15 to 19 years of age the DMF-T was higher in individuals belonging to low socioeconomic class (p=0.0041), rural area residents (p=0.0001) and at places without public water fluoridation (p= 0.0003), geographic location was the only factor related to dental caries ...(Complete abstract click electronic access below)