IntroductionThe objective was to analyze whether socioeconomic factors related to the context and those related to the model of care—specifically the coverage of primary care by the Family Health Strategy (ESF)—had an impact on hospitalizations due to heart failure (HF) and stroke, in the State of São Paulo/Brazil between 1998 and 2013.MethodsA longitudinal ecological study involving 645 municipalities was conducted in the state of São Paulo/Brazil from 1998 to 2013, using the Hospital Information System (SIH–DataSUS database). The hospitalizations for primary care sensitive conditions: Stroke and heart failure (HF) that correspond to the International Classification of Diseases (ICD 10): I50, I63 to I67; I69, G45 to G46 were analyzed longitudinally during the period indicated regarding the percentage of people covered by the Family Health Program (PSF) adjusted for confounders (population size, gross domestic product -GDP and human development index- HDI).ResultsThere was a significant decrease in the number of hospitalizations for heart failure and stroke per 10000 (inhabitants) in the period (p <0.0001), with a significant relationship with increased proportion of ESF (p <0.0001), and this remained significant even when possible confounders (population size, GDP and HDI) were included in the model (p <0.0001).ConclusionsGDP per capita was close to or higher than that if many European countries, which shows the relevance of the study. The health care model based on the Family Health Strategy positively impacted hospitalization indicators for heart failure and stroke, indicating that this model is effective in the prevention of primary care sensitive conditions.

Background The state of São Paulo recorded a significant reduction in infant mortality from 1990 to 2013, but the desired reduction in maternal mortality was not achieved. Knowledge of the factors with impact on these indicators would be of help in formulating public policies. The aims of this study were to evaluate the relations between socioeconomic and demographic factors, health care model and both infant mortality (considering the neonatal and post-neonatal dimensions) and maternal mortality in the state of São Paulo, Brazil. Methods In this ecological study, data from national official open sources were used to conduct a population-based study. The units analyzed were 645 municipalities in the state of São Paulo, Brazil. For each municipality, the infant mortality (in both neonatal and post-neonatal dimensions) and maternal mortality rates were calculated for every 1000 live births, referring to 2013. Subsequently, the association between these rates, socioeconomic variables, demographic models and the primary care organization model in the municipality were verified. For statistical analysis, we used the zero-inflated negative binomial model. Gross analysis was performed and then multiple regression models were estimated. For associations, we adopted “p” at 5%. Results The increase in the HDI of the city and proportion of Family Health Care Strategy implemented were significantly associated with the reduction in both infant mortality (neonatal + post-neonatal) and maternal mortality rates. In turn, the increase in birth and caesarean delivery rates were associated with the increase in infant and maternal mortality rates. Conclusions It was concluded that the Family Health Care Strategy was a Primary Care organization model that contributed to the reduction in infant (neonatal + post-neonatal) and maternal mortality rates, and so did actors such as HDI and cesarean section. Thus, public health managers should prefer this model when planning the organization of Primary Care services for the population.

RESUMO: Introdução: O câncer de boca e o câncer de orofaringe são doenças influenciadas por fatores socioeconômicos. O risco de desenvolver essas doenças aumenta com a idade, e a maioria dos casos ocorre em idosos, com elevadas taxas de mortalidade. O objetivo deste estudo foi analisar a influência dos índices socioeconômicos municipais nas taxas de mortalidade por câncer de boca (CB) e de orofaringe (CO) em idosos nas 645 cidades do estado de São Paulo, Brasil, nos anos de 2013 a 2015. Método: Dados secundários de óbitos foram obtidos pelo Sistema de Informações sobre Mortalidade (SIM) do Ministério da Saúde. O número de idosos e os valores da renda média per capita e do índice de desenvolvimento humano por município (IDH-M) foram obtidos a partir dos dados da Fundação SEADE. Realizou-se a análise descritiva e exploratória dos dados, seguida de modelos binomiais negativos descritos pelo procedimento PROC GENMOD e avaliados pelo critério de informação de Akaike corrigido (AICc), pelo grau de liberdade e pelo teste de Wald (α=0,05). Resultados: Cerca de 30% das cidades notificaram óbitos em 2013, 16,74% em 2014 e 18,61% em 2015. Astaxas médias de mortalidade por CB e CO foram, respectivamente, de 20,0 (± 30,9) e 10,7 (± 17,5) por 100milhabitantes. A renda média variou de R$ 434,20 a R$ 2.009,00 e o IDH-M, de 0,65 a 0,89. Houve decréscimo significativo (p < 0,05) nas taxas de mortalidade por CB e CO em idosos com o aumento dos valores das rendas médias e do IDH-M. Conclusão: As desigualdades socioeconômicas das cidades influenciam nas taxas de mortalidade por CB e CO em idosos.

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OBJECTIVE:To assess the association between the prevalence of malocclusion in Brazilian 12 years-olds with individual and contextual variables. METHODS:A cross-sectional, analytical study was conducted with data from the Brazilian Oral Health Survey -SBBrazil 2010. The outcome studied was malocclusion, categorized as absent, set, severe and very severe. The independent variables were classifi ed as individual and contextual. Data were analyzed using a multilevel model with a 5% signifi cance level. RESULTS:It was found that the prevalence of severe and very severe malocclusion in 12-year-olds did not differ between the Brazilian regions, although variation between the cities was signifi cant (p < 0.001). Male children (p = 0.033), those on lower income (p = 0.051), those who had visited a dentist (p = 0.009), with lower levels of satisfaction with mouth and teeth (p < 0.001) and embarrassed to smile (p < 0.001) had more severe malocclusion. The characteristics of the cities also affected the severity of malocclusion; cities with more families on social benefi ts per 1,000 inhabitants, with lower scores on the health care system performance index and lower gross domestic product per capita were signifi cantly associated with malocclusion. CONCLUSION:Signifi cant associations between the presence and severity of malocclusion were observed at the individual and contextual level. The epidemiological profi le of oral health problems has changed, especially in children aged 12. In Brazil, tooth decay has shown a decrease in the DMFT index (decayed, missing and fi lled teeth) from 6.7 in 1986 to 2.07 in 2010 and, currently, a signifi cant number of those children are free of caries (43.5%). a Therefore, other problems related to the oral cavity have begun to receive attention, among them, occlusal changes stand out. DESCRIPTORS:14 Due to its high prevalence, the World Health Organization (WHO) now considers malocclusion to be the third largest public health problem in dentistry. 9,10 National data relating to malocclusion indicate a prevalence of 40.0% for the index age of 12 years. For severe, and very severe malocclusion, the prevalence is 10.4% and 7.1% respectively.a In many cases, malocclusion can impact on the quality of life of this part of the population. It can produce aesthetic deviations in the teeth and/or face and functional disturbances of occlusion, chewing, swallowing, pronunciation and breathing. It can also cause psychosocial disorders with potential repercussions on the self-esteem and interpersonal relationships of severely affected individuals. 5In the face of this reality, there is a need for a clearer picture in order to understand the disease process in relation to malocclusion. Thus, in addition to individual factors, other factors, called modifi ers or modulators (social, economic, cultural, ethnic/racial, psychological and behavioral factors), are related to the health of the population. Currently, these factors are known as social determinants of health.

INTRODUCTION: The aim of this study was to identify factors associated with the prevalence of anterior open bite among five-year-old Brazilian children. METHODS: A cross-sectional study was undertaken using data from the National Survey of Oral Health (SB Brazil 2010). The outcome variable was anterior open bite classified as present or absent. The independent variables were classified by individual, sociodemographic and clinical factors. Data were analyzed through bivariate and multivariate analysis using SPSS statistical software (version 18.0) with a 95% level of significance. RESULTS: The prevalence of anterior open bite was 12.1%. Multivariate analysis showed that preschool children living in Southern Brazil had an increased chance of 1.8 more times of having anterior open bite (CI 95%: 1.16 - 3.02). Children identified with alterations in overjet had 14.6 times greater chances of having anterior open bite (CI 95%: 8.98 - 24.03). CONCLUSION: There was a significant association between anterior open bite and the region of Brazil where the children lived, the presence of altered overjet and the prevalence of posterior crossbite.

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The aim of this study was to investigate the relationship between root fillings and the presence of apical periodontitis in studies with samples containing elderly patients. The data were obtained by means of a systematic review of studies that evaluated the quality of root fillings and their relationship with periapical health. 1,376 potentially relevant articles were selected, of which 667 were repeated and 16 were duplicates. 693 abstracts were analyzed, with 608 of these being excluded and 85 selected for reading in full. Fourteen (14) articles were included, totaling data of 135,566 teeth. Of these, 13,704 (10.1%) had endodontic fillings, with 6,455 (47.1%) being considered adequate and 7,249 (52.9%) inadequate. Among the teeth with apical periodontitis, 2,084 (32.3%) had adequate endodontic fillings and 3,749 (51.6%) had inadequate fillings. There was a significant correlation between the quality of endodontic fillings considered adequate and lower frequency of apical periodontitis in elderly patients.