Baldani Márcia Helena, Rocha Juliana Schaia, Fadel Cristina Berger, Nascimento Antonio Carlos, Antunes José Leopoldo Ferreira, Moysés Samuel Jorge
Faculdade de Odontologia, Universidade Estadual de Ponta Grossa, Ponta Grossa, Brasil.
Pontifícia Universidade Católica do Paraná, Curitiba, Brasil.
Cad Saude Publica. 2017 Nov 21;33(11):e00158116. doi: 10.1590/0102-311X00158116.
This cross-sectional study aimed to assess the association between the quality of primary health care (PHC) and the use of dental services by preschoolers served by the Family Health Strategy (FHS), controlling for socio-demographic determinants and perceived need. The sample encompassed 438 children aged 3-5 years, enrolled in 19 FHS facilities in Ponta Grossa, Paraná State, Brazil. Individual level variables were collected by interviewing parents or caregivers at home. They answered a questionnaire on socioeconomic conditions, oral hygiene habits and use of dental services. Parental perception of child's oral health related quality of life, as perceived need, was assessed by the Brazilian version of Early Childhood Oral Health Impact Scale (ECOHIS). Normative need was assessed by oral examinations, according to guidelines standardized by the World Health Organization. The contextual level factor was defined as the extent of implementation of PHC in the facilities. Managers responded to PCATool-Brazil, a validated questionnaire which measures the extent of PHC. Dentists answered to a version of PCATool, which was adapted and pretested for dental services. Multilevel analysis, based on Andersen's behavioral model, fitted the adjustment of "having ever consulted a dentist" to contextual and individual covariates. We observed high prevalence of dental caries. Almost half of the sample had had dental appointments in life. Social gradients were observed for the use of dental services. Although it was not able to eliminate the impact of adverse social conditions, higher levels of PHC attributes in dental services favored the effective use of such services by low-income children.
这项横断面研究旨在评估初级卫生保健（PHC）质量与家庭健康战略（FHS）所服务的学龄前儿童牙科服务利用之间的关联，同时控制社会人口学决定因素和感知需求。样本包括巴西巴拉那州庞塔格罗萨市19个FHS机构中登记的438名3至5岁儿童。通过在家中访谈父母或照顾者收集个体层面的变量。他们回答了一份关于社会经济状况、口腔卫生习惯和牙科服务利用情况的问卷。通过巴西版的幼儿口腔健康影响量表（ECOHIS）评估父母对儿童口腔健康相关生活质量的感知需求。根据世界卫生组织标准化指南，通过口腔检查评估规范需求。情境层面因素被定义为各机构中PHC的实施程度。管理人员回答了PCATool - 巴西版，这是一份经过验证的问卷，用于衡量PHC的实施程度。牙医回答了PCATool的一个版本，该版本针对牙科服务进行了改编和预测试。基于安徒生行为模型的多水平分析对“曾咨询过牙医”这一情况进行了情境和个体协变量的调整。我们观察到龋齿的高患病率。几乎一半的样本一生中曾有过牙科预约。在牙科服务利用方面观察到了社会梯度。尽管它无法消除不利社会状况的影响，但牙科服务中较高水平的PHC属性有利于低收入儿童有效利用此类服务。
