Dissertations / Theses on the topic 'Community dental services Dental public health Dental Health Services Public Health Dentistry'

Introduktion: Under den tionde terminen av tandläkarprogrammet på Malmö högskola genomgår studenterna verksamhetsförlagd utbildning (VFU) sedan 2004. Detta sker i samarbete med Folktandvården Skåne och under 15 veckor arbetar studenterna en dag i veckan under handledning på folktandvårdens kliniker i närliggande område.Syfte: Att utvärdera erfarenheter efter genomgången VFU ur deltagarnas perspektiv.Metod: Alla tandläkarstudenter och handledare som genomgått VFU 2006 och 2015 tillfrågades om att besvara en utvärderingsenkät med numerisk bedömningsskala och utrymme för tillhörande kommentarer. Sex studenter och fem handledare som genomgått VFU år 2015 intervjuades även med en semistrukturerad intervjumetodik som sammanfördes genom en tematiserad innehållsanalys. Resultat: Enkät: Poängsättningen var genomgående hög för både 2006 och 2015. Studenterna poängsatte påstående 6 ”Det nuvarande upplägget med 15 veckor och en dags tjänstgöring i veckan är tillfredställande.” signifikant högre 2015 än 2006. Påstående 8 ”Det finns en samsyn avseende metoder och behandlingsval mellan skola och folktandvård.” poängsatte studenterna signifikant lägre än handledarna 2015. 2006 poängsatte studenterna påstående tre ”Sammansättningen av patienter var bra.” signifikant lägre än vad handledarna gjorde. Intervju: Studenter och handledare ansåg att VFU är fördelaktigt i utbildningssyfte och ger studenterna självsäkerhet och trygghet i ansvarstagande. Förslag på förbättringar förekom även under intervjuerna.Slutsats: Verksamhetsförlagd utbildning ger fördelaktigheter både för studenter och deras handledare. Studenter och handledare uttrycker uppskattning och är generellt nöjda efter VFU.<br>Introduction: The tenth semester of the dentistry program at Malmö university students undergoes an outreach program (internship) since 2004 and this is in collaboration with Folktandvården Skåne. During 15 weeks the students work at their assigned clinics one day a week under supervision from their tutors.Objective: To evaluate experiences after placement from the participants' perspective.Method: All dental students and tutors who have completed internship in 2006 and 2015 were asked to answer an evaluation questionnaire with numeric rating scale and scope for comments. Six students and five mentors who have completed internship in 2015 were interviewed with a semi-structured interview methodology, later analysed by content analysis method.Results: Questionnaire: rating was consistently high for both 2006 and 2015. The students scored significantly higher on question six “The set-up of one day of clinical work over 15 weeks were satisfying.” 2015 than in 2006. Students scored question eight“There is a consensus regarding methods and treatment options between the dental school and Folktandvården Skåne” significantly lower than their supervisors in 2015. In 2006 students scored question three “The composition of patients was good” significantly lower than the supervisors did. Interview: Students and tutors felt that the internship had been beneficial for training purposes, giving the students more self-esteem and confidence in taking responsibility. Improvements for the outreach program where proposed. Conclusion: The clinical training program is favourable, both for the students and their tutors. In general terms, the students and the supervisors were satisfied with the cooperation.

Many physical changes occur as one ages, including changes associated with the oral cavity. A review of the literature suggests that the provision of dental care to institutionalized elderly patients presents problems due to a variety of factors. The purpose of this study is to assess the level or dental care provided to residents of long-term care facilities located in Warren County, Kentucky. In addition, secondary objectives Include the ascertainment of who provides dental care to residents and the amount or in-service dental training made available to staff members of the facility. Each administrator of the long term care facilities located in Warren County participated in an *interview conducted by the author. During the interview, information was obtained for a 21 item questionnaire concerning the facility, the number and age range or the residents, and types of dental services provided within the facility. Results obtained from the questionnaire indicated that 77 percent or the residents in long-tern care facilities in Warren County are 70 years of age or older. No significant differences were noted in the types or dental services provided to residents. However, the dental services provided ranged from those that were obtained in a private dental office via transportation or the resident to outside dental facilities to routine oral hygiene measures carried out by staff members employed by the facility. The findings revealed significant differences in the dental status of the MRDD residents when compared to the nursing home residents. Other findings indicated that none of the long-term care facilities had dental operatories or dental radiographic equipment on the premises. Additional research would be required in order to address uncertainties discovered in the study. A followup to the questionnaire Interview with the consulting dentists may be included to determine to what capacity and to what extent they are utilized by the facilities. Other recommendations include the utilization of entrance dental examinations to determine if services offered do meet the needs of the residents and periodic dental examinations to aid in detection and thus reduce the prevalence of dental diseases in this population.

Background: Effective delivery of dental services must be based on reliable information regarding the prevalence and severity of disease in the target population. Evaluation of the various factors known to influence the severity and progression of disease is essential for health policy makers to promote oral health resources and address oral health needs. Objective: The overall aim of this research is to describe the situation of dental caries and investigate the associations of level of oral health knowledge, teeth irregularity, BMI and other life style variables (TV viewing, internet use, passive smoking and dietary habits) with dental caries, including the impact of socio-demographic factors amongst school children in Qatar. Materials and methods: A cross-sectional study was conducted in Qatar from October 2011 to March 2012. A total of 2,113 children aged 12-14 years were randomly selected from 16 schools from different areas. Clinical examination was conducted by three calibrated examiners using World Health Organization criteria for diagnosing dental caries. Teeth irregularity was determined clinically according to a method described by Björk et al (1964). A pre-tested and structured questionnaire was used to assess oral health knowledge and life style data. Data analyses were performed. Results: The mean decayed, missing and filled teeth index values was 4.62 (±3.2), 4.79 (±3.5), and 5.5 (±3.7), respectively, for the 12, 13 and 14 year old children. The caries prevalence was 85%. The mandibular incisors and canines were least likely to be affected by dental caries, while maxillary and mandibular molars were the most frequently attacked by dental caries. Of the total sample, only one quarter reported a high level of oral health knowledge. There were more incidences of teeth crowding (44.1%) than teeth spacing (9.5%). The overall prevalence of underweight, overweight, and obesity was 5%, 10%, and 5% respectively. Almost half of the children spent > two hours watching television and 46% spent > two hours using internet. Approximately 35.8% of children had exposure to passive smoking. Concerning dietary habits, 99.4% of children consumed sugar containing snacks in between meals. Approximately 65% consumed sugar containing snacks within one hour of bed time. Almost 49.1% skipped eating breakfast regularly and 22.7% skipped eating lunch regularly. Around 83.8% consumed diary snacks in between meals. Overall, 74.2% drank tea in-between meals and 80.1% chewed gum in-between meals. All variables were affected by socio-demographic factors, but significant differences were found in female children in that they were more at risk to dental caries than male children. Also, children who resided in semi-urban areas were more at risk to dental caries than children who resided in urban areas. The occurrence of dental caries is significantly associated with the level of oral health knowledge, teeth irregularity, and other life style variables. Conclusion: The need to reduce sedentary behaviors and to promote a more active and healthy lifestyle is becoming increasingly essential in Qatar. Implementation of a community-based preventive oral health programs on a healthy diet and practices of adequate oral hygiene should be promoted in schools through integration into the school curriculum and services to combat the growing problem of dental caries.

Background / Objective: Children under the age of 5 years bear a disproportionate burden of oral disease. The aim of this study is to investigate how child, family, and community determinants impact dental care utilization, and parental report of child’s oral health. Methods: Data for this study came from the 2011/2012 National Survey of Children’s Health for children aged 1 to 5 years old. Dependent variables evaluated were if the child had an oral health problem, been to a dentist in the past year, and parents description of the child’s teeth. Independent variables were selected from child, family, and community levels. Binary logistic methods were applied to each outcome and predictor variable. Stepwise logistic regression models were constructed for child, family, and community variables. Additionally the mediating effect of oral health services utilization in the association between child, family and community factors and parental perception of child’s oral health was evaluated. National results and Health Resource Service Area (HRSA) region IV results were compared. Results: In the national (n=24,875) and HRSA region IV sample (n=4,017) 9.7% and 10.2% of caregivers, reported that the child had an oral health problem in the past 12 months. Fewer than half (46.7%) of caregivers reported that their child had visited a dentist in the past 12 months. Absence of neighborhood cohesion, neighborhood amenities, and residence in metropolitan statistical area all had positive significant effects on children seeing a dentist. There was a mediating effect by utilization of oral health services between child with special health care needs (p=0.005), number of children (p=0.045) and adults (p=0.046) in the household, and tobacco use (p=0.018) and parents perception of oral health in the HRSA region IV population. Conclusion: This study identified several factors as correlates of poor oral health outcomes. Our results expand our knowledge of early childhood oral health by studying how oral health is impacted not only by child factors but also the family and community at large. Our results begin identifying the unique constellation of risk factors that contribute to early childhood oral health.

In order to facilitate effective tobacco cessation services within dental school clinics, it is necessary to understand the perceived barriers encountered by dental students while providing these services. The aim of this study was to identify which factors fourth year dental students perceive to be associated with barriers to providing tobacco intervention services. A written survey was developed and completed by the incoming fourth year dental students at the University of Iowa College of Dentistry in 2008. The survey assessed the perceived barriers to providing tobacco intervention services and related factors. Descriptive, bivariate and logistic regression analyses were conducted. The response rate was 97 percent. Some of the most frequently reported barriers included: patient's resistance to tobacco intervention services (96%), inadequate time available for tobacco intervention services (96%) and forgetting to give tobacco intervention advice (91%). The following variables were significantly (p<0.05) related to greater perceived barriers in providing tobacco intervention services: lower "adequacy of tobacco intervention curriculum coverage of specific topics covered over the previous three years" and "perceived importance of incorporating objective structured clinical examination teaching method for learning tobacco intervention." Students could benefit from additional didactic training and enhanced clinical experience in order to facilitate effective intervention services in the dental school.

Background: Childsmile, the national oral health improvement programme for children in Scotland, aims to reduce oral health inequalities and improve access to dental services. Childsmile is delivered, in part, by a new category of lay or community-based worker known as a Dental Health Support Worker (DHSW) who supports families to improve oral health behaviours and attend a dental practice. Findings from Childsmile’s national process evaluation indicated there was widespread variation in delivery of the DHSW role and additional research was required to further understand and develop programme theory for the DHSW role; and clarify areas of variation which were adaptive and which were a risk to the programme meeting its desired objectives. Aims: The overarching aim was to gain further understanding of which factors and variants (contextual and those associated with programme delivery) impact on effectiveness of the DHSW role within Childsmile Practice. This research is a component study of the national Childsmile evaluation strategy. Findings will be fed back to the Childsmile programme to optimise delivery of the role and to enable future evaluation of the role’s impact. Methods: Learning and evidence generation was triangulated from two phases of research, comprising three component studies. Phase 1 comprised the sensitising study and comparative case studies: both provided learning from within Childsmile. The sensitising study was designed as a scoping exercise using qualitative data collection methods. The aim was to establish existing programme theory and explicate delivery of the DHSW role, while uncovering deviation (from programme theory) and variation within and between NHS boards. Findings were used to design three comparative case studies, comprising one DHSW and key stakeholders involved in delivery of the role from three NHS boards. The comparative case studies employed qualitative data collection methods; and were designed to address the overarching aim, and explore the casual links between context, delivery, and outcomes in delivery of the role using Realist-inspired analysis. Phase 2 comprised a Realist Review to provide learning from out with Childsmile. The aim was to gain an understanding of which components of child health interventions, delivered by lay health workers to parents, could influence ‘child health parenting behaviours’. Findings and Conclusions: Findings indicated that in terms of motivational readiness to engage with positive oral health parenting behaviours (POHPBs) there were three types of families referred to the DHSW for support: low, moderate, and high-risk. It was established that to address programme aims DHSWs ought to support moderate-high risk families, yet DHSWs only had capacity to support low-moderate risk families. Findings demonstrated that the Public Health Nurses/Health Visitors were best placed to triage families according to their needs and motivational readiness. The peer-ness of the DHSW role was found to positively influence parental engagement with the programme and facilitate person-centred support. However, an embedded ‘sweetie culture’ and health damaging environments were found to negatively impact on parents’ self-efficacy and perceived locus of control to engage with POHPBs. Learning indicated that: delivery over a prolonged period of time; incorporation of the programme into the Early Years Pathway and GIRFEC policy; and recent changes to the Children and Young Person (Scotland) Act (2014), served to embed Childsmile within the NHS boards and facilitated stakeholder buy-in, which positively impacted on delivery of the role. From the learning derived within and out with Childsmile the recommendations for the DHSW role included: (1) DHSW support should move away from a primarily information provision and facilitation of families into dental practice role, and incorporate socio-emotional and person-centred support; (2) The DHSW role should be redefined to support moderate-high risk families; and interpretation and application of referral criteria should be addressed to ensure continuity with who is referred for support; and (3) Programme theory for the DHSW role should be refined and future evaluative effort should concentrate on assessing impact.

The purpose of this study was to evaluate the effect of a school-based fluoride mouthrinse program in a fluoridated community. Such an evaluation is important because the effect of such programs may decrease over time due to the widespread use of fluoride. Two elementary schools were chosen. One had a fluoride mouthrinse program: the other did not. The subjects were children in grades one and six. Their caries experience was examined using dft. dfs. DFT, and DFS scores. There were no statistically significant differences between the two schools. The program had no significant effect in the community studied.

Even though the oral health of Americans has improved greatly in the last 50 years, some specific groups of the population have been left behind. Latinos, children and adults, bear a disproportionate burden of oral diseases. Latino children, the fastest growing minority group of children in the US, are affected disproportionately by oral diseases like dental caries compared to other groups. Understanding the difficulties and barriers that these children have to utilize dental care will help us in the future to develop effective programs to reduce health disparities in this segment of the population. The purpose of this study is to identify the factors that determine dental services access and utilization by children in the state of Iowa. Emphasis will be given to differences in utilization of dental services among different racial/ethnic groups. Additionally, the study will describe and compare difficulties in utilization of care among Latino children whose parents answered the survey in English (LE) and those who answered it in Spanish (LS). In order to address these objectives existing data from the Iowa Child and Family Household Health Survey 2005 (HHS) were analyzed. The dependent variable for the study was utilization of dental services. This outcome variable was dichotomized as whether or not the child had a dental visit in the last year. Characteristics of study subjects were first analyzed through descriptive statistics. Bivariate analyses were conducted to assess associations between the dependent variable and independent variables. Multiple logistic regression was used to identify factors associated with utilization of dental services in Iowa's children, and for each different racial and ethnic group. Seven factors were related to the time of the last dental visit for Iowa children: Having a regular source of dental care, dental insurance status, having a dental need in the past 12 months, brushing habits, the age of the children, and family income. The same seven factors were correlated to having a dental visit for white children. For African-American children, having a regular source of dental care, dental insurance status, and having a dental need in the last 12 months were the factors that were found associated to the time of the last dental check-up. For the Latino Spanish children, having a regular source of dental care and the age of the children were factors associated to dental utilization. Finally, for the Latino English children, the only factor associated with having a dental visit was having a regular source of dental care. Information from this research gives policy makers, public health workers, and clinicians an overview of oral health disparities affecting children in the state. For those agencies in Iowa interested in the improvement of access and utilization of dental services for minority children, this project gives important inside about the factors related to the use of services for different racial/ethnic groups in the state.

The aim of this study is to analyse and compare the delivery of oral health care services based on the prevailing curative paradigm and WHO-treatment norms for the school-going community of Mitchells Palin district in relation to selected alternative methods of dental care delivery. The optimal use of auxiliary personnel, purchasing care from private dental practitioners and intriducing water fluoridation was examined.

Dentists have traditionally been the sole gatekeepers to the delivery of primary care dental services. Direct Access, a measure that allows Dental Care Professionals to see patients without a referral from a Dentist, is a fundamental change to this long-standing principle. This thesis systematically explores the attitudes of stakeholders across the micro, meso and macro levels of dentistry towards Direct Access in two distinct health care systems, the Netherlands and the UK.Direct Access was introduced in the Netherlands in 2006 and subsequently introduced in the UK in 2013. This study uses a qualitative approach to explore the attitudes towards the introduction of Direct Access in both of these states. It presents the results of semi-structured interviews with 74 participants (individually or as part of a group) including Students, Dental Care Professionals and Dentists at the micro-level, representatives of Professional Associations, Insurers and Dental Schools at the meso-level and Policy Makers at the macro-level. The results of this study show a significant range of attitudes towards Direct Access, but reveal a degree of consensus within individual stakeholder groups towards the reform’s introduction and impact. Dental Care Professionals interpret the introduction of Direct Access as recognition of their capabilities and expect it to primarily benefit patients through access to care and expertise. Dentists were more likely to view the introduction of Direct Access in terms of competition or professional persecution, with the impacts considered from a professional or financial viewpoint. Policy Makers saw potential for Direct Access to realign dental workforces and services to contemporary care needs. Attitudes at the meso level demonstrated the greatest variety and were more influenced by the idiosyncrasies of their respective health care system. In comparing the attitudes towards Direct Access in the Netherlands and the UK there were several differences, such as in the support of the Direct Access by Principal Dentists, however many of these can be explained by differences in healthcare funding and the time difference between the two reforms. Despite these differences stakeholders in both states felt that while Direct Access had the potential to create significant impacts on a range of issues (including professional competition, patient access to care, the reduction of care costs to patients and the state, the redistribution of dental tasks and the remodelling of the dental workforce) it was unlikely to do so in either the Netherlands or the UK. Flaws in the Direct Access regulations, legal obstructions to crucial procedures and imbalances in street-level professional power were perceived to obstruct Direct Access. Rather than revolutionising dental services Direct Access has been implemented selectively in the interest of dental practices.

Orientador: Suzely Adas Saliba Moimaz<br>Banca: Rogério Nogueira de Oliveira<br>Banca: Luís Carlos Cavalcante Galvão<br>Resumo: O Sistema de Auditoria no setor saúde é fundamental, pois permite a avaliação da veracidade das informações e a resolubilidade da prestação de serviços, pressupondo o desenvolvimento de um modelo de atenção adequado. Nesta pesquisa, objetivou-se analisar as atividades da auditoria no Sistema Único de Saúde no serviço de saúde bucal do município de Aquidauana (MS); fazer o levantamento das principais justificativas de glosas e das perdas de produção; analisar as atividades desenvolvidas pelas equipes da Estratégia da Saúde da Família. É um estudo epidemiológico de série histórica retrospectiva, com abordagem quantitativa, entre os anos de 2001 a 2010. Foi realizada análise documental e revisão bibliográfica sobre os sistemas de auditoria e o papel do auditor no serviço odontológico. Para o levantamento dos dados de produção, perdas, justificativas de glosas e cumprimento de metas foram utilizadas respectivamente, o sistema de informação do DATASUS, relatórios realizados pelo Sistema Municipal de Auditoria do município de Aquidauana (MS), relatórios dos indicadores propostos pelos Decretos nº 11.684/2004 e nº 12.005/2005 da Secretaria Estadual de Saúde do Mato Grosso do Sul que estabelece mensalmente o mínimo de 10 visitas domiciliares, 26 tratamentos completados e uma atividade educativa. Os resultados mostraram que a atuação da auditoria é abrangente no gerenciamento do sistema, consistindo no controle, avaliação, supervisão e orientação, bem como na garantia da participação social e acesso aos serviços. Neste período foram apresentados 921.300 procedimentos odontológicos; sendo 223.226 (24,2%) procedimentos individuais e 698.074 (75,8%) coletivos. Ocorreram 23.881 glosas (2,6%), sendo 10.158 (42,5%) nos procedimentos coletivos e 13.723 (57,5%) nos individuais. Constatou-se que a ... (Resumo completo, clicar acesso eletrônico abaixo)<br>Abstract: Auditing system in public health is furthermost important, as it permits the evaluation of veracity of information and to access the accuracy in delivering services, assuming a model of adequate attention. The research objectives were to analyze auditing activities in oral health from the Single Health System within the municipality of Aquidauana (MS); to find the main justifications for glosses and losses in production; and to analyze activities developed by the strategic family health units. This is an epidemiological study of a retrospective historical series, with a quantitative approach, from 2001 to 2010, with a documental analysis and literature review about the auditing systems and the role of the auditor in odontological services. To compile the data from production, losses in procedures, and justifications for glosses as well as the achievement of targets, the database DATASUS was used, reports from the municipal system of auditing in the municipality of Aquidauana (MS) and reports and indicators from decrees 11,684/2004 and 12,005/2005 from the Health State Office of Mato Grosso do Sul- which establishes a minimum of 10 home visits monthly, 26 treatments completed and one education activity. Results show a broad range of activities from the auditing system in the system management, including activities for control, evaluation, supervision, orientation, and guarantee for social engagement and access to services. In this period there were 921,300 odontological procedures; from which 223,226 (24.2%) were individual procedures and 698,074 (75.8%) were collective procedures. There were 23,881 glosses (2.6%), from which 10,158 (42.5%) happened in collective procedures and 13,723 (57.5%) happened in individual procedures. It was found that the most frequent cause for glosses in individual procedures was the repetition in procedure to the ... (Complete abstract click electronic access below)<br>Mestre

Objectives: The objective of the quantitative research was to estimate the prevalence of Early Childhood Caries (ECC) and severe Early Childhood Caries (s-ECC) and the severity of Early Childhood Caries (ECC) in the primary dentition of young children in Ajman, UAE, and investigate their association with child and family characteristics, dietary habits, fluoride use, oral hygiene practices and dental services utilization. The purpose of the qualitative research was to obtain information that could explain some of the findings of the quantitative stage in order to progress towards determining a strategy to control ECC in this population. Methods: A two-stage cluster sample was used to randomly select children aged 5 or 6 years old who were enrolled in public or private schools in Ajman, UAE. Clinical examinations for caries were conducted by a single examiner using WHO criteria. Parents completed questionnaires seeking information on child and family characteristics, dietary habits, oral hygiene, fluoride use and dental service utilization. Bivariate and multivariate analyses were used to identify risk markers and risk indicators for caries experience. To complement the quantitative findings, the second (qualitative) stage of the research was conducted with six chosen groups of mothers from different educational backgrounds and different nationalities. Each group contained between six and ten mothers - some of whose children had been examined in the quantitative section of the project. The mothers were invited to comment on the significance for them of those risk indicators identified in the earlier section of the research. The manual thematic coding method of analysis was used. Problems concerning the dental health of children were identified based on the results of both stages. Results: The total number of children sampled was 1297. Dental examination and questionnaire data were obtained for 1036 (79.9%), of whom 50.0% were female. The prevalence of ECC in 5- and 6-year-old children was 72.9% (95% CI, 61.8, 83.9) and 80.0% (95% CI, 76.0, 84.4) respectively, with mean dmft scores of 4.0 (sd, 4.1) and 4.9 (sd, 4.3) respectively (P<0.05). The overall prevalence of s-ECC was 31.1% (95% CI, 23.6, 38.9). Multivariate analysis indicated that frequency of snacking between meals per day, snack consumption level and the frequency of brushing had a significant effect on the severity of ECC, while only the snack consumption level and the frequency of brushing had a significant effect on plaque score. There was a strong association between plaque score and the severity of ECC. The total number of mothers who contributed to the qualitative study was 42. The findings of the qualitative stage showed that some mothers had a negative perception toward the primary dentition and unhelpful attitudes towards their children�s diets (through promoting a high consumption of cariogenic food), while the use of fluoride (other than in toothpaste) was rare. However, many mothers were in favor of bottled water fluoridation once they understood the benefits of such a scheme and supported the idea of a dental preventive program beng provided through their children�s schools. Conclusions: The prevalence and severity of ECC in young children in Ajman is high, with child and family characteristics, dietary habits, oral hygiene practices and dental utilization being important determinants. Young children in Ajman would benefit from health promotion strategies directed towards appropriate dietary practices and oral hygiene measures framed within culturally specific guidelines.

Pregnancy can have important effects on oral health and pregnant women are a population group requiring special attention with regard to their oral health and their babies? health. International research shows that oral health care for pregnant women has been inadequate, especially in relation to education and health promotion and there is some evidence of disparities by SES and ethnicity. Improving oral health is one of the health priorities in the New Zealand Health Strategy (Ministry of Health, 2000) and the Ministry of Health (Ministry of Health, 2006a) has recently identified a need for more information on the oral health and behaviour of pre-natal women. The aims of this study were to gain an understanding of pregnant women?s oral health care practices, access to oral health care information and use of dental care services and to identify any difference by ethnicity and socio-economic position. A self-reported questionnaire was completed by 405 pregnant women (55% response rate) who attended antenatal classes in the Wellington region. The questionnaire was broadly divided into four parts: (1) care of the teeth when the woman was not pregnant; (2) care of the teeth and diet during the pregnancy; (3) sources of oral health information during pregnancy and; (4) demographic information . Data were analysed by age, ethnicity, education and income and odds ratios (OR) and 95% confidence intervals (95%CI) were calculated using logistic regression. The majority of women in this survey were pakeha (80.2%), compared to 19.7% „Others? (8.8% Maori, 1.9% Pacific, 8.6% other). Most of the subjects were aged 31-35 years (34.5%), of high SES (household income and education level). Half of the women reported having regular visits to the dentist previous pregnancy while a significant percentage of women saw a dentist basically when they had problems. The usual dental hygiene habits were maintained during pregnancy. However, during pregnancy more than 60% of women reported bleeding gums. Just 32% of women went to see the dentist during pregnancy and less than half had access to oral health information related to pregnancy. „Others? (OR 0.38, 95% CI 0.15-0.91) and low income (OR 0.27, 95% CI 0.10-0.76) groups were significantly less likely to report access to oral health information compared to pakeha and high income groups (respectively). Women who went to see the dentist during pregnancy were more likely to receive information on dental health. However, low income women were more likely to report the need to see a dentist (OR 2.55, CI 1.08-5.99). Information on dental health and access to oral care should be prioritised to low income women, Maori, Pacific and other ethnic groups. Little attention has previously been given to oral health for pregnant women in New Zealand and there is a need to increase awareness of the importance of this area amongst health practitioners particularly Lead Maternity Carers and Plunket and tamariki ora nurses.

Dental caries is the most common chronic disease in children, and prevalence rates are disproportionately higher in American Indian/Alaska Native (AI/AN) populations. The Association of State and Territorial Dental Directors (ASTDD) recommends annual oral health screening for children in Head Start programs using the Basic Screening Survey (BSS). The 2014 study was a follow-up to a 2010 national survey of AI/AN children ages five and under that assessed oral health outcomes such as untreated decay, decay experience, urgent need for treatment, presence of sealants and decayed, missing and filled deciduous teeth (dmft) scores, and investigated the changes in Early Childhood Caries (ECC) prevalence from 2010 to 2014 in the Indian Health Service (IHS) Nashville Area. A gap analysis was completed comparing current recommended practices among dental clinics that participated in the IHS ECC Collaborative ASTDD Framework to Prevent and Control Childhood Tooth Decay (ASTDD Framework). Due to historical mistreatment of AI/AN populations in research, and out of respect for the sovereignty of the Tribal Nations that participated in the study, there limited data was made available for this study. In 2010, 579 children were screened in the Nashville Area; 1231 children participated in 2014. While there was a statistically significant, yet clinically small 9.36% reduction of untreated decay from 2010 (30.33%) to 2014 (27.49%), the ECC Collaborative did not reach their objective of a 25% reduction. There was also a significant increase in urgent need for treatment (3.17% in 2010 to 4.35% in 2014), and in presence of sealants (4.54% in 2010 to 10.01% in 2014). Gaps in best practices identified were related to need for increased risk assessments and enhancing policy development. Based on study findings and the limited access to data on Tribal and Area levels, development of culturally appropriate policies that are unique to individual Tribal needs, and focus on perinatal care, is recommended. Individual Tribal programs also need to be evaluated and surveillance needs to be continued to establish trend data. All program evaluations and research should be conducted in an ethical manner that is community-based and considerate of the needs of the Tribe.

Made available in DSpace on 2014-06-11T19:27:45Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-02-14Bitstream added on 2014-06-13T19:35:53Z : No. of bitstreams: 1 aych_c_me_araca.pdf: 1102238 bytes, checksum: 39ecdde677c4bb89c50094d91a1d2eb4 (MD5)<br>O Sistema de Auditoria no setor saúde é fundamental, pois permite a avaliação da veracidade das informações e a resolubilidade da prestação de serviços, pressupondo o desenvolvimento de um modelo de atenção adequado. Nesta pesquisa, objetivou-se analisar as atividades da auditoria no Sistema Único de Saúde no serviço de saúde bucal do município de Aquidauana (MS); fazer o levantamento das principais justificativas de glosas e das perdas de produção; analisar as atividades desenvolvidas pelas equipes da Estratégia da Saúde da Família. É um estudo epidemiológico de série histórica retrospectiva, com abordagem quantitativa, entre os anos de 2001 a 2010. Foi realizada análise documental e revisão bibliográfica sobre os sistemas de auditoria e o papel do auditor no serviço odontológico. Para o levantamento dos dados de produção, perdas, justificativas de glosas e cumprimento de metas foram utilizadas respectivamente, o sistema de informação do DATASUS, relatórios realizados pelo Sistema Municipal de Auditoria do município de Aquidauana (MS), relatórios dos indicadores propostos pelos Decretos nº 11.684/2004 e nº 12.005/2005 da Secretaria Estadual de Saúde do Mato Grosso do Sul que estabelece mensalmente o mínimo de 10 visitas domiciliares, 26 tratamentos completados e uma atividade educativa. Os resultados mostraram que a atuação da auditoria é abrangente no gerenciamento do sistema, consistindo no controle, avaliação, supervisão e orientação, bem como na garantia da participação social e acesso aos serviços. Neste período foram apresentados 921.300 procedimentos odontológicos; sendo 223.226 (24,2%) procedimentos individuais e 698.074 (75,8%) coletivos. Ocorreram 23.881 glosas (2,6%), sendo 10.158 (42,5%) nos procedimentos coletivos e 13.723 (57,5%) nos individuais. Constatou-se que a...<br>Auditing system in public health is furthermost important, as it permits the evaluation of veracity of information and to access the accuracy in delivering services, assuming a model of adequate attention. The research objectives were to analyze auditing activities in oral health from the Single Health System within the municipality of Aquidauana (MS); to find the main justifications for glosses and losses in production; and to analyze activities developed by the strategic family health units. This is an epidemiological study of a retrospective historical series, with a quantitative approach, from 2001 to 2010, with a documental analysis and literature review about the auditing systems and the role of the auditor in odontological services. To compile the data from production, losses in procedures, and justifications for glosses as well as the achievement of targets, the database DATASUS was used, reports from the municipal system of auditing in the municipality of Aquidauana (MS) and reports and indicators from decrees 11,684/2004 and 12,005/2005 from the Health State Office of Mato Grosso do Sul- which establishes a minimum of 10 home visits monthly, 26 treatments completed and one education activity. Results show a broad range of activities from the auditing system in the system management, including activities for control, evaluation, supervision, orientation, and guarantee for social engagement and access to services. In this period there were 921,300 odontological procedures; from which 223,226 (24.2%) were individual procedures and 698,074 (75.8%) were collective procedures. There were 23,881 glosses (2.6%), from which 10,158 (42.5%) happened in collective procedures and 13,723 (57.5%) happened in individual procedures. It was found that the most frequent cause for glosses in individual procedures was the repetition in procedure to the ... (Complete abstract click electronic access below)

Submitted by Erika Demachki (erikademachki@gmail.com) on 2014-12-01T17:01:44Z No. of bitstreams: 2 Dissertação - Geovanna de Castro Morais Machado - 2013.pdf: 1533306 bytes, checksum: e16ca58206af7c3cd308d7a6b59f61f9 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5)<br>Approved for entry into archive by Erika Demachki (erikademachki@gmail.com) on 2014-12-01T17:02:04Z (GMT) No. of bitstreams: 2 Dissertação - Geovanna de Castro Morais Machado - 2013.pdf: 1533306 bytes, checksum: e16ca58206af7c3cd308d7a6b59f61f9 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5)<br>Made available in DSpace on 2014-12-01T17:02:04Z (GMT). No. of bitstreams: 2 Dissertação - Geovanna de Castro Morais Machado - 2013.pdf: 1533306 bytes, checksum: e16ca58206af7c3cd308d7a6b59f61f9 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2013-02-26<br>Aim: The aim of this study was to describe how the community centers from the the city of Goiania handled dental emergency care in children under 6 years during 2011. Methods: This quantitative study evaluated the dental charts of children under 6 years old of age focusing on emergent dental care and assessed dental emergency risk classification, child’s age and gender, chief complaint, involved teeth, clinical procedures performed, medications prescribed and referral. Data were recorded on forms for later descriptive analysis. Results: 1,108 children under 6 years old (4.0%) were treated, 556 male (50.2%), with a mean age of 3.7 years old (±1.4). The most reported chief complaints were toothache (47.9%, n=531) and dental trauma (20.0%, n=221). The most frequently performed clinical procedures were extraction (13.0%) and endodontic treatment (13.0%). No clinical procedures were performed in 58.5% of the cases (n=649). Conclusion: Emergency dental care for children under 6 years occurs mainly as a result of dental decay. It is necessary that emergency dental public services have a more effective management of these situations.<br>Objetivo: O objetivo desse estudo foi verificar o perfil do atendimento das urgências odontológicas em crianças menores de 6 anos nas Unidades de Saúde de Urgência da Secretaria Municipal de Saúde de Goiânia-Goiás. Material e Métodos: Neste estudo descritivo, foram analisadas as fichas de crianças menores de 6 anos atendidas nestes serviços de urgência, entre os meses de janeiro e dezembro de 2011. Foram observados: classificação de risco, idade e sexo da criança, queixa principal, procedimentos executados, dentes acometidos, prescrição de medicamentos e encaminhamentos. Resultados: Foram atendidas 1108 crianças menores de 6 anos (4.0% do total de atendimentos nos serviços de urgência), sendo que 556 eram meninos (50,2%). A idade média das crianças foi de 3,7 anos (DP ±1,4). As queixas mais descritas foram dor de dente (47,9%, n=531) e trauma dentário (20,0%, n=221). Os procedimentos clínicos mais executados foram a exodontia (13,0%) e intervenção pulpar (13,0%). Em 58,5% (n=649) dos casos de urgência não houve realização de procedimento clínico local. Conclusão: A urgência odontológica em crianças menores de 6 anos ocorre, principalmente, como consequência da cárie dentária. Os serviços públicos voltados à urgência/emergência em saúde necessitam de um manejo mais efetivo dessas situações.

RESUMO Introdução - O acesso à assistência odontológica pública é um dos principais problemas na área de saúde bucal. Nesta tese, se discute se os cuidados em saúde bucal são sentidos como necessidade por lideranças de movimentos populares de saúde e como estas lidam com o tema, aborda-se o potencial do capital social como referência teórica para analisar essa questão e apresenta-se um quadro da assistência odontológica na cidade de São Paulo. Objetivo - Analisar as representações sociais sobre saúde bucal e controle social entre lideranças da União de Movimentos Populares de Saúde de São Paulo (UMPS). Método - Pesquisa qualitativa, com orientação analítico-descritiva, mediante realização de grupos focais com lideranças da União de Movimentos Populares de Saúde de São Paulo (UMPS). Para a organização e apresentação dos dados, foi utilizado o procedimento metodológico do Discurso do Sujeito Coletivo (DSC). Além disso, fez-se revisão bibliográfica sobre capital social em periódicos brasileiros e utilizaram-se dados secundários para compor o quadro da assistência odontológica na capital paulista. Resultados O processo saúde-doença foi reconhecido como socialmente determinado. Em relação ao entendimento de saúde bucal como necessidade, houve antagonismo. A associação de saúde bucal à saúde geral foi apontada como razão de necessidade. A não identificação da saúde bucal como prioridade foi atribuída à população, aos fatores econômicos, aos governos e à falta de vinculação entre saúde bucal e saúde geral. O princípio da universalização na saúde bucal gerou discursos contraditórios, com forte presença da ideia de que a assistência odontológica deve ser dirigida para as crianças, com a presença de cirurgiões-dentistas nas escolas. As lideranças apontam que a assistência odontológica pública é insuficiente para garantir o acesso; não é resolutiva; tem problemas de infra-estrutura; e dispõe de profissionais que não atendem às exigências da comunidade. A organização da população é condição necessária para a implantação e manutenção de serviços assistenciais, por parte do Estado. Há um forte componente do conceito de saúde enquanto direito de cidadania, e de que a luta política e social é um vetor para a organização de redes assistenciais. Em relação à especificidade da saúde bucal no controle social, emergiram falas contraditórias. Os estudos realizados no Brasil corroboram a ambigüidade conceitual, dificuldade de operacionalização e aferição do conceito de capital social. Sobre a assistência odontológica na cidade de São Paulo registra-se, entre 2000 e 2009, um crescimento expressivo no número de beneficiários de planos odontológicos, que se elevou de cerca de 660 mil para aproximadamente 1,97 milhão, com a cobertura se expandindo de 6,3por cento para 17,9por cento da população paulistana. Por outro lado, é precário o acesso aos serviços públicos. Os indicadores Cobertura de Primeira Consulta Odontológica Programática e Cobertura Populacional Potencial registraram 3,8por cento e 8,2por cento em 2009. Conclusão As representações sociais das lideranças indicam sua visão de mundo e de sua inserção social, destacando-se a condição subalterna com que conseguem influenciar, em algum grau, o processo de decisões sobre as políticas públicas de interesse para a saúde. O capital social não se configura como referencial teórico suficientemente potente para a compreensão das contradições relacionadas à saúde bucal na cidade. Os serviços públicos odontológicos cobrem menos de 10por cento da população, expande-se a cobertura dos planos odontológicos (18por cento ) e se reproduz a transformação dos cuidados odontológicos em mercadorias, acessíveis apenas aos que podem comprá-la no mercado em saúde<br>ABSTRACT Introduction - Access to public dental care is a major problem in the field of oral health. In this thesis, it is discussed whether the oral health care is considered as a need for popular health movement leadership and how they deal with the topic, it is also discussed the potential of social capital as a theoretical reference for analyzing this issue and presents a picture of dental care in São Paulo. Objective - To analyze the social representations of oral health and social control among leadership of the Union of Popular Movements of Health of São Paulo (UMPS). Method - Qualitative research analytical-descriptive-oriented, by conducting focus groups with leadership of the Union of Popular Movements of Health of São Paulo (UMPS). For the organization and presentation of data, we used the methodological procedure of the Collective Subject Discourse (CSD). In addition, we reviewed the literature on social capital in Brazilian periodicals and secondary data was used to compose the picture of dental care in the state capital. Results - The health-disease process was recognized as socially determined. In relation to the understanding of oral health as a necessity, there was antagonism. The association among oral health to general health was cited as reason of need. The failure on prioritizing oral health was most appointed to the population, economic factors, governments and the lack of linkage among oral health and general health. The principle of universalization in oral health has generated contradictory discourses, with a strong presence of the idea that dental care should be directed toward children, with the presence of dentists in schools. The leadership points out that public dental care are insufficient to ensure access, it is not resolving, it has problems of infrastructure, and have professionals who do not meet the requirements of the community. The organization of the population is a prerequisite for the deployment and maintenance of healthcare services by the state. There is a strong component about the concept of health as a right of citizenship, and that the political and social struggle is a vector for the organization of health care networks. In relation to the specific oral health in social control, contradictory statements emerged. Studies conducted in Brazil reinforce the conceptual ambiguity, difficulty in operationalizing and measuring the concept of social capital. Dental care in São Paulo enroll between 2000 and 2009, significant growth in the number of dental plan, which amounted to about 660,000 to about 1.97 million, with coverage expanding from 6.3per cent to 17.9per cent of the population in Sao Paulo. On the other hand, the access to public services is poor. The indicators Coverage of First Outpatient Dental Program and Population Potential Coverage recorded 3.8per cent and 8.2per cent in 2009. Conclusion Leaderships social representation indicate their global vision and their social integration, emphasizing the subordinate status that can influence, to some degree, the decision process on public policies related to health. Social capital is not configured as a theoretical powerful enough to understand the contradictions related to oral health in the city. Public dental services cover less than 10per cent of the population expands the coverage of dental plans (18per cent) and reproduces the changing of dental care in goods, accessible only to those who can buy it on the health market

The aim of this thesis was to describe inequalities in the use of different health care services according to socioeconomic position (SEP) in Catalonia, Spain and Europe. In addition, we intended to assess whether the public coverage of the services, in particular dental health care, has an influence on the magnitude of inequalities in the use of such services. Finally, we aimed to determine the influence of population-based female cancer screening programmes on the prevalence of screening and on the extent of inequality. To accomplish these objectives four studies were carried out. The sources of information of the four studies were, respectively: several editions of the Catalan Health general practitioner (GP) services are equitable or manual classes use them to a greater extent. However, there are marked SEP inequalities in the use of outpatient specialist services, especially in dental care. Socioeconomic inequalities in use of dental care services exist throughout Europe, but they are larger in countries in which dental care is not covered at all by the public health care system than in countries in which dental care is partially covered. In Europe, socioeconomic inequalities in breast and cervical cancer screening are not found in countries with population-based screening programmes but they are found in those countries with only regional or pilot programmes and in those countries with opportunistic screening.<br>L'objectiu d'aquesta tesi era descriure les desigualtats en l'ús de diferents serveis sanitaris segons la posició socioeconòmica a Catalunya, Espanya i a Europa. A més a més, es volia avaluar si la cobertura pública dels serveis, en particular la dels serveis dentals, infuencia la magnitud de les desigualtats socioeconòmiques en l'ús d'aquests serveis. Finalment, es va voler determinar la influència dels programes poblacionals de cribratge dels càncers de mama i cèrvix en la prevalença de cribratge i en la magnitud de les desigualtats. Per tal d'assolir aquests objectius es van dur a terme 4 estudis. Les fonts d'informació d'aquests estudis van ser, respectivament: diferents edicions de l'Enquesta de Salut de Catalunya (ESCA), diferents edicions de l'Enquesta Nacional de Salut d'Espanya (ENS), l'Enquesta de Salut, Envelliment i Jubilació a Europa (SHARE) 2006 i dades dels països europeus que van participar a l'Enquesta Mundial de la Salut de l'OMS l'any 2002. Els dos primers estudis eren estudis de tendències mentre que els dos últims van ser transversals. En tots els estudis les desigualtats socioeconòmiques es van mesurar mitjançant índexos relatius (RII) i absoluts (SII) de desigualtat. Els resultats d'aquests estudis mostren que a Catalunya i a Espanya els serveis d'atenció primària són equitatius o fins i tot les persones de classes manuals en presenten una major proporció d'ús. Tanmateix, hi ha marcades desigualtats en visites a l'especialista, en especial en les visites al dentista. Les desigualtats socioeconòmiques en la utilització dels serveis dentals existeixen a tota Europa, però són més grans en aquells països on l'atenció dental no està coberta pel sistema públic de salut que en aquells països on aquesta està parcialment coberta. A Europa, no es troben desigualtats socioeconòmiques en el cribratge dels càncers de mama i cèrvix en aquells països amb programes poblacionals de cribratge, però sí que es troben en aquells països amb programes pilot o regionals o amb només cribratge oportunista.

Nurse Practitioners (NPs) comprise a significant portion of the U.S. primary care workforce and play an essential role in patients' health awareness, prevention strategies, disease management, and in providing appropriate provider referrals. Nurse Practitioners receive education on the oral-systemic connection, yet there have been limited studies on the clinical practice of NPs assessing the oral cavity to evaluate the condition of the teeth and the oral tissues. The purpose of this study was to explore the nurse practitioners’ knowledge and practice habits of assessing the oral cavity for diseases or abnormalities in the mouth that can, in turn, affect overall health. A total of 66 NPs were included in the study, primarily female (91%) with master’s degrees (77%). While knowledge and education were not significantly associated, this research found significant associations between confidence and assessments, less than one-third (30.3%) were confident in their knowledge and ability to evaluate oral abnormalities.

Background: In 2005, the Västerbotten County Council launched a child health promotion programme, “the Salut Programme”, in response to an alarming prevalence of overweight and obesity, and trends of increased dental caries, among young county citizens. The programme, initially developed in four pilot areas, is built on multidisciplinary and cross-sectoral collaboration and aims to support and strengthen health promotion activities in health care, social services and school settings. It targets children and adolescents (0-18 years of age) and their parents, and starts during pregnancy. This thesis focuses on interventions provided by antenatal care, child health care, dental services, and open pre-schools, directed to expectant parents and families with children aged 0-1 ½ years. Within the programme context, the aim was to explore socio-demographic patterns of overweight and obesity in expectant parents (Paper I), firsttime parents’ experiences of health promotion and lifestyle change during pregnancy and early parenthood (Paper II), professionals’ experiences of factors influencing programme implementation and sustainability (Paper III and IV), and early programme outcomes on professionals’ health promotion practices and collaboration following countywide dissemination and implementation (Paper IV).   Methods and results: A population based cross-sectional study among expectant parents showed overweight and obesity in 29% of women (pre-pregnancy) and in 53% of men (n=4,352♀, 3,949♂). The likelihood for obesity was higher in expectant parents with lower levels of education, among those unemployed or on sick leave, and those living in rural areas. In 62% of couples, at least one of the partners was overweight or obese; a positive partner correlation was also found for BMI (I). An interview study with 24 first-time parents (n=12♀, 12♂) revealed that they primarily undertook lifestyle changes to secure the health of the fetus in pregnancy, and to provide a healthy environment in childhood. Parents described themselves as highly receptive to information about how their lifestyle could influence fetal health, and they frequently discussed pregnancy risks related to tobacco and alcohol, as well as toxins and infectious agents in foods. However, parents did not seem inclined to make lifestyle changes primarily to promote their own health. The antenatal and child health care services were perceived as being mainly directed towards women, and parents described a lack of a holistic view of the family which included experiences of fathers being treated as less important (II). An interview study undertaken with professionals (n=23) in the Salut Programme pilot areas indicated programme sustainability at most sites, two years after implementation, although less adherence was described within child health care. Factors influencing programme sustainability, as described by professionals, were identified at multiple organisational levels (III). A before-and-after survey among professionals (n=144) measured outcomes of the county-wide implementation of the Salut Programme in 13 out of 15 county municipalities. Results showed significant improvements in professionals’ health promotion practices and collaboration across sectors. A number of important implementation facilitators and barriers, acting at different organizational levels, were also identified via a survey comprised of open-ended questions (IV).   Conclusion: The Salut Programme, developed with high involvement of professionals, and strongly integrated in existing organisational structures and practices, shows potential for improving health promotion practices and cross-sectoral collaboration. The findings can inform further development of the Salut Programme.as well as new health promotion initiatives, and inform policy practice and future research. These aspects include approaches in health promotion and prevention, father involvement during pregnancy and early parenthood, and factors influencing implementation and sustainability of cross-sectoral health promotion programmes.<br>Bakgrund: År 2005 lanserade Västerbottens läns landsting en hälsofrämjande satsning “Salut” som svar på en oroande förekomst av övervikt och fetma samt trender till ökad förekomst av karies hos barn i länet. Satsningen, som initialt utvecklades i fyra pilotområden, bygger på tvärprofessionellt och verksamhetsövergripande samarbete och syftar till att stödja och stärka hälsofrämjande insatser inom landstinget och länets kommuner. Satsningen riktar sig till barn och unga (0-18 år) och deras föräldrar, med start under graviditeten. Denna avhandling fokuserar på insatser som erbjuds via mödrahälsovård, barnhälsovård, tandvård och öppen förskola riktade till blivande föräldrar och familjer med barn i åldern 0-1 ½ år. Med utgångspunkt från Salut-satsningen syftar avhandlingen till att undersöka socio-demografiska mönster av övervikt och fetma hos blivande föräldrar (I), förstagångsföräldrars upplevelser av hälsofrämjande insatser och förändrade levnadsvanor under graviditet och tidigt föräldraskap (II), personalens upplevelser av underlättande och hindrande faktorer för satsningens införande och uthållighet (III, IV), samt förändringar i arbetssätt och samarbete mellan verksamheterna efter den länstäckande spridningen av satsningen (IV).   Metod och resultat: En populationsbaserad tvärsnittsstudie bland blivande föräldrar visade på övervikt och fetma hos 29% av kvinnorna (vikt före graviditet) och hos 53% av männen (n=4352♀, 3949♂). Lägre utbildningsnivå, arbetslöshet och sjukskrivning samt att bo utanför städerna visade sig öka sannolikheten för fetma. Hos en övervägande del av paren (62%) fanns minst en partner med övervikt eller fetma och samband kunde även påvisas mellan kvinnans och mannens BMI (I). En intervjustudie med 24 förstagångsföräldrar (n=12♀, 12♂) visade att föräldrarna främst förändrade sina levnadsvanor för att säkra hälsan hos fostret under graviditeten och för att skapa en hälsosam miljö för barnet under uppväxten. Föräldrarna beskrev sig själva som mycket mottagliga för information om hur deras levnadsvanor kunde påverka fostrets hälsa och de diskuterade ofta graviditetsrisker i relation till tobak och alkohol samt gifter och smittoämnen i livsmedel. Föräldrarna var dock mindre angelägna att förändra sina levnadsvanor med tanke på sin egen hälsa. De upplevde att mödrahälsovårdens och barnhälsovårdens insatser i huvudsak riktades till kvinnor och beskrev en avsaknad av helhetssyn på familjen, vilket även avspeglades i upplevelser av att papporna behandlades som mindre viktiga (II). En intervjustudie med personal (n=23) inom pilotområdena, två år efter utveckling och införandet av Saluts insatser, indikerade god uthållighet av satsningen, även om en lägre följsamhet till insatserna beskrevs inom barnhälsovården. Faktorer som av personalen beskrevs påverka uthålligheten identifierades på flera organisatoriska nivåer (III). En före- och efterstudie bland personal (n=144) mätte effekter av den länstäckande spridningen av satsningen i 13 av länets 15 kommuner. Resultaten visade på flera signifikanta förbättringar av de hälsofrämjande arbetssätten och ett ökat samarbete mellan verksamheterna. En enkät med öppna frågor riktad till personalen belyste också faktorer på flera organisationsnivåer som ansågs underlätta respektive hindra införandeprocessen (IV).   Slutsats: Salut-satsningen, som är utvecklad i nära samarbete med verksamheternas personal och väl integrerad i redan existerande organisatoriska strukturer och arbetssätt, visar på potential att förbättra hälsofrämjande arbetssätt och samarbete mellan verksamheter. Aspekter som beskrivits och diskuterats kan vägleda satsningens fortsatta utveckling såväl som framtida nya initiativ. Resultaten och slutsatserna kan även användas i syfte att påverka policy, praxis och framtida forskning. Detta avser framförallt hälsofrämjande och sjukdomsförebyggande metoder, pappans roll under graviditet och tidigt föräldraskap samt kunskaper om faktorer som kan ha betydelse för genomförande och uthållighet av verksamhetsövergripande hälsofrämjande insatser.

Made available in DSpace on 2014-06-11T19:33:00Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-08-19Bitstream added on 2014-06-13T21:05:36Z : No. of bitstreams: 1 costa_aco_dr_araca.pdf: 434039 bytes, checksum: 5a80adc9f83140fd3b9d2ea2ecdbf039 (MD5)<br>Avaliar os serviços de saúde é fundamental para garantir a qualidade na prestação de serviços. O objetivo deste estudo foi conhecer as condições de trabalho, relacionadas ao trabalho no Sistema Único de Saúde, por meio da percepção do cirurgião-dentista, avaliando: a satisfação profissional com o emprego público e remuneração, as condições ergonômicas e sanitárias do ambiente de trabalho e a qualidade de vida e saúde dos profissionais relacionadas ao ambiente de trabalho. Realizou-se uma pesquisa transversal, tipo inquérito e observacional. A coleta de dados foi feita por meio de entrevistas com 83 cirurgiões-dentistas, atuantes em 12 municípios paulistas. As informações foram processadas no software Epi Info 2000 versão 3.2.2. As variáveis analisadas foram: tipo de ingresso, regime de trabalho, carga horária, remuneração percebida, existência de plano de carreira, satisfação com o emprego público, aspectos sanitários e ergonômicos relacionados à distribuição de equipamentos no consultório odontológico, presença da auxiliar na equipe, satisfação com o trabalho efetuado e com o ambiente físico odontológico, segurança, saúde, lazer e renda. Os resultados apontam que 19% dos entrevistados não prestaram concurso público para ingressar no sistema público. O regime de trabalho estatutário foi mais adotado 47(57%). Notaram-se jornadas de trabalho distintas: 47(57%) de 20h, 7(8%) de 30h e 29(35%) de 40h. Estavam insatisfeitos com a remuneração 55(66%) profissionais, notando-se, ainda, a ausência do plano de carreira em 11municípios; 70(84%) profissionais afirmaram estar “satisfeito” e “muito satisfeito” com o emprego público. Observou-se que 21(28%) profissionais trabalhavam sozinhos; nos 34 consultórios, autoclave foi o meio mais utilizado 15(44%); 31(91%) lixeiras de lixo comum e 23(68%) de lixo contaminado eram inadequadas; 13(38%)...<br>The evaluation of the health service is fundamental to ensure the quality of the realization of the services. The aim of this study was to examine the working conditions related to the employment at the Brazilian Public health Service, by means of the perception of the Dental Surgeon, evaluating: professional satisfaction with the public employment and remuneration. The sanitary and ergonomic conditions at workplace environment and the quality of life and health of the professionals related to work environment. A cross-sectioned inquiry and observational type study was performed. Data collection was made through interviews, realized on 83 dental surgeons operative in 12 municipalities of the state of Sao Paulo. Information was processed on Epi Info 2000 software, version 3.2.2. The analyzed variables were: type of income, labor regime, workload, perceived remuneration, career plan existence, satisfaction with public employment, sanitary and ergonomic aspects related to the equipment distribution at the dental office, presence of an assistant in the team, satisfaction with realized work and with physical environment, safety, health, leisure and earnings. The results showed that 19% of the interviewed did not apply for public contest to enter the public service. Statutory work regime was the most adopted 47(57%). Different workdays were noticed: 47 (57%) of 20h, 7(8%) of 30h and 29(35%) of 40h; 55(66%) professionals were unsatisfied with the remuneration and, furthermore, the absence of a career plan was observed in 11 municipalities. 70 (84%) professionals affirmed to be “satisfied” and “very satisfied” with public employment. It was observed that 21(28%) professionals worked alone; at the 34 dental offices, autoclave was the most used method 15(44%); 31(91%) common waste bins and 23(68%) bins of contaminated material were inadequate; 13(38%) had no hand washbasins, 23(68%) ...(Complete abstract click electronic access below)

Bibliography: p. 320-341.<br>xvii, 341 p. : ill. ; 30 cm.<br>Title page, contents and abstract only. The complete thesis in print form is available from the University Library.<br>Addresses the documented variation in dental service rates and the questions of appropriateness of care arising from this variation. Examines the association of services provided with dentists, practice and patient factors. Based on a survey pf private general practice dentists who provided a data log for one typical day.<br>Thesis (Ph.D.)--University of Adelaide, Dept. of Dentistry, 2000

Philosophiae Doctor - PhD<br>In order to manage public dental services, information is required about what work is being performed by the staff at the various clinics. Tally sheets have been used in the past to record treatment procedures but this is not an effective method of recording the amount of work done by staff at public dental clinics. But tally sheets are inaccurate, open to abuse, and fail to provide the necessary information for managers. Nor is it of any real value for providing feedback to staff on their performance. This inhibits a core aspect of job satisfaction for the staff, which is feedback. The staff just persevere, continue doing the same thing and feel frustrated. This contributes to poor work performance. Instead of using a tally sheet, 4 digit treatment codes are used for all treatment procedures (as used in the private sector for billing purposes) and additional codes were developed for services such as brushing programmes for which billing codes do not exist. These are recorded for each patient, together with a code for the patient category. A relative value unit (RVU) has been developed for each treatment code that has been weighted according to policy guidelines and the amount of time and effort required to provide the service. This was done for clinical treatment procedures as well as for community-based preventive activities. A computer program has been developed that captures the treatment codes which are saved in a number of databases that are linked to Excel pivot tables. The data can therefore be easily manipulated by the user to obtain the required information in the form of counts of procedures, monetary cost of the same clinical services in the private sector (useful with the proposed advent of National Health Insurance) and also in the form of relative value units. iii This is available for the current reporting period as well as for previous periods, allowing a detailed analysis of services rendered and staff performance over a period of time to show trends. Use is also made of an Objectives Matrix where the performance of each staff member can be measured according to seven objectives (Key Performance Areas) (five in the case of oral hygienists) to produce an overall Performance Index – which is a score out of ten. This enables performance appraisal to be carried out much easier than by comparing performance based on a number of diverse treatments provided. The data for all the public dental clinics in the Western Cape Province has been analysed for the period 1994 to 2012 using this system, and it has been shown that the system is sensitive enough to highlight problem areas as well as provide a balanced overall view of the service, as measured by a number of variables. The system is “low tech” in that it runs on a “stand alone” personal computer, but it could easily be applied to an integrated, networked information system provided the latter contained the treatment codes, and certain other patient, staff and clinic identifiers. It is therefore suitable for developing countries, such as South Africa, that may later develop a comprehensive Health Information System based on an electronic medical record. The emphasis is not on the information technology, it is focussed on the concepts behind the processing of the data into meaningful information for managing public dental services.

Thesis (Master of Public Health)--University of North Texas Health Science Center at Fort Worth, 1997.<br>eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references.

Magister Scientiae Dentium - MSc(Dent)<br>‘A satisfied worker is a happy worker’, this statement by Robbins (1998), sums up the importance of job satisfaction. Locke (1976), defined job satisfaction as the ‘positive emotional state resulting from the appraisal of one’s job and job experiences’. The Northern Cape province is the largest province in South Africa, by area. Oral health mainly focuses on primary health care and pain relief. Dental staff in the public sector are employed at district level, and not at sub-district level. This scenario requires dental staff (dentists, dental therapists, oral hygienists and dental assistants) to travel to rural areas that have working conditions that are not always optimal for dental treatment. Faced with numerous work-related challenges, it is believed that staff morale and motivation is particularly low in the province, as in the rest of South Africa in the public health sector (Howse, 2000). This research assessed the job satisfaction of dental staff in the public sector in the Northern Cape, and aims to make management aware of the need and the importance of oral health services, for staff and patients. The study found that the majority of the dental staff appear to enjoy their working environment (60%), love what their job entails (76%), and would like to continue their job in the long run (74%). Eighty percent of the participants reported that they experienced teamwork and 71% appreciated the support of their staff, which are very positive findings. However, it appears that the staff are not totally happy or satisfied with their work environment, and have identified various factors that need to be addressed to improve their job satisfaction. Seventy-four percent of the staff listed resources (human, financial, physical) as the major work-related factors that need to be addressed to improve their job satisfaction. iii The majority of the dental staff reported that the staff shortage, the poor communication with their administrator, the inadequate quantity and quality of equipment, the limited services being offered to patients, the lack of opportunities to make use of and improve their clinical skills, and their salary, are factors that need to be addressed to improve their job satisfaction. Just over half of the participants also stated that the salary they earn is not as important as the satisfaction gained from serving the public, and 80% of the participants felt that their job allows them to make a contribution to their community. Having a significant proportion of staff who feel that the salary they earn is not as important as serving their community is both interesting and praiseworthy. The dental staff seem to be giving of their best despite their current work environment, but expressed a need and willingness to deliver a more comprehensive oral health service that makes full use of their clinical skills, and that is not constrained by a lack of finances or limited treatment options. This is a positive foundation that needs to be built on to improve a service that clearly needs improving. The Department of Health of South Africa should provide adequate oral health services to the public, and should ensure that the dental staff are satisfied with their jobs. By identifying areas of concern that affect job satisfaction, these specific areas can be improved (Shugars et al, 1990). By increasing the dental staff’s job satisfaction, the staff morale can be improved. This will lead to increased productivity and quality of care (Harris et al 2008; Syptak et al, 1999). Satisfied practitioners are particularly important for a successful dental practice and the well-being of patients (Puriene et al, 2008a).

Indiana University-Purdue University Indianapolis (IUPUI)<br>Oral health is crucial to overall health and a focus of the U.S. Health Center program, which provides preventive dental services in medically underserved communities. Dental hygiene is an oral health profession whose practice is focused on dental disease prevention and oral health promotion. Variations in the practice and regulation of dental hygiene has been demonstrated to influence access to dental care at a state level; restrictive policies are associated lower rates of access to care. Understanding whether and to what extent policy variations affect availability and access to dental care and the oral health of medically underserved communities served by grantees of the U.S. Health Center program is the focus of this study. This longitudinal study examines dental service utilization at 1,135 health center grantees that received community health center funding from 2004 to 2011. The Dental Hygiene Professional Practice Index (DHPPI) was used as an indicator of the state policy environment. The influence of grantee and state level characteristics are also considered. Mixed effects models were used to account for correlations introduced by the multiple hierarchical structure of the data. Key findings of this study demonstrate that state policy environment is a predictor of the availability and access to dental care and the oral health status of medically underserved communities that received care at a grantee of the U.S. Health Center program. Grantees located in states with highly restrictive policy environments were 73% less likely to deliver dental services and, those that do, provided care to 7% fewer patients than those grantees located in states with the most supportive policy environments. Population’s served by grantees from the most restrictive states received less preventive care and had greater restorative and emergency dental care needs. State policy environment is a predictor of availability and access to dental care and the oral health status of medically underserved communities. This study has important implications for policy at the federal, state, and local levels. Findings demonstrate the need for policy and advocacy efforts at all levels, especially within states with restrictive policy environments.

INTRODUCTION Les partenariats université communauté (PUC) sont bien étudiés en médecine, mais peu d’études existent en médecine dentaire. C’est ainsi que notre étude explore l’expérience des partenaires d’un PUC entre une faculté de médecine dentaire et une école primaire. MÉTHODES Une étude qualitative descriptive a été effectuée avec entrevues semi-structurées et une analyse thématique. Tous les partenaires clés du partenariat ont été interviewés ainsi que deux étudiants de médecine dentaire et quatre parents d’élèves pour un total de 12 participants. RESULTATS Bien que les partenaires aient vécu des expériences positives, ils ont éprouvé plusieurs difficultés. D’un côté, la communauté a senti que ses besoins n’étaient pas bien compris par la faculté et a vécu des difficultés organisationnelles. De l’autre côté, la faculté a eu de la difficulté à coordonner les horaires cliniques et a trouvé que l’école était mal équipée. De plus, les parents n’étaient pas bien informés des détails des traitements avant qu’ils ne soient effectués. CONCLUSION La faculté a pris le contrôle du leadership du partenariat. Elle a placé ses besoins avant ceux de la communauté. Les dentistes cliniciens ont valorisé l’enseignement d’interventions techniques plutôt que l’enseignement de la dentisterie communautaire et sociale, alors que cela aurait pu être une bonne opportunité de le faire. Nous recommandons que les universités effectuent une analyse des besoins de la communauté avant de commencer un projet en PUC et de les impliquer dans les décisions. Nous proposons aussi d’encadrer les PUC avec un projet de recherche action participatif.<br>INTRODUCTION Community University Partnerships have been widely studied in medicine; however, much is unknown in dentistry. This research explores the experience of the different partners of a partnership between a faculty of dentistry and an elementary school. METHODS A qualitative descriptive research was undertaken using semi structured interviews and a thematic analysis. All of the partners were interviewed along with two dentistry students and four parents, for a total of 12 participants. RESULTS Although the partners had some good experiences, the partnership experienced many challenges. The Community felt its needs were not well understood by the Faculty and experienced organizational difficulties. On the other hand, the Faculty had scheduling difficulties with the School and found the local premises ill-equipped. Moreover, the parents were not well informed of the work that was being done on their children. CONCLUSION The Faculty took over the leadership of the partnership. As such, it placed its needs ahead of the Community’s needs which it did not make enough attempts to understand. Also, being clinicians, the Faculty members valued teaching the technical details of interventions, and an opportunity was missed in teaching the students about community and social dentistry. For future partnerships we recommend either assessing the communities’ needs before starting a project and involving the community in its funding and steering process, or adding to the partnership a participatory research-action project.