Spontaneous Demand Research Articles

User embracement and risk classification at obstetric emergency: evaluating operationalization in a maternity hospital school

Abstract Objective: To evaluate the functioning of a user embracement and risk classification service in a maternity hospital school in Recife, Pernambuco, Brazil. Method: Observational, cross-sectional, and analytical study with a quantitative approach, conducted at the "Amaury de Medeiros" Integrated Health Center of the University of Pernambuco (CISAM/UPE), in April and May 2015. The sample consisted of 377 female users and 6 nurses, with the application of Stork Network's user embracement and risk classification protocol. Results: The waiting time according to risk classification was 21.2 min; the duration time was 5 min; the waiting time according to the red priority was 3.5 min. The spontaneous demand showed that 56% of the users were classified as green priority, 60% of the users reported dissatisfaction, and 33% of the nurses received training. Conclusions: The service under analysis needs agreements and assessments to promote coping strategies.

Telenursing Intervention for Clean Intermittent Urinary Catheterization Patients: A Pilot Study.

Telenursing is a promising strategy to make nursing care feasible in different health situations, mainly to help patients with chronic illnesses. The aim in this study was to test the feasibility (acceptability and usability) of a telenursing intervention in care delivery to patients using clean intermittent urinary catheterization. This descriptive study focused on an intervention involving urology outpatients. The telenursing intervention was implemented synchronously by audio calls and chat and asynchronously by e-mail as part of a pilot study. The contact between nurse and patient was undertaken through an active search or on spontaneous demand, in which the patient contacted the nurse when necessary. During the 5 weeks of study, 21 telenursing care sessions took place, including 13 (61.9%) on spontaneous demand and eight (38.1%) on active demand. With regard to the technological resource used, 13 telenursing sessions (61.9%) took place by telephone call and eight (30.1%) by e-mail. The pilot study demonstrated the potential of the telenursing intervention to achieve important results, and as a complement to the patients' traditional health treatment. In addition, it revealed various barriers that need to be overcome for this type of care to take place effectively.

Funcionamento 24 horas para Unidades de Saúde da Família: uma solução para ampliação de acesso? Um ensaio sobre as “Upinhas” do Recife

A Atenção Primária à Saúde é via preferencial de acesso ao sistema de saúde, tendo em vista seu papel ordenador, os benefícios da continuidade do cuidado e resolutividade deste nível de atenção. Diversas barreiras de acesso, dentre eles o horário restrito de funcionamento, fazem com que esse primeiro contato não seja facilitado. No Recife, novos equipamentos de Atenção Primária à Saúde vêm sendo implantados desde o ano de 2013: as “Upinhas 24 horas”. O objetivo deste trabalho é analisar o modelo “Upinha” apresentado como uma solução para ampliação de acesso. Foi realizada uma revisão da literatura sobre diversas estratégias existentes de ampliação do acesso, a partir das quais se analisou criticamente o modelo “Upinha 24 horas” às lentes dos modelos vigentes. Horário estendido, acesso avançado e acolhimento à demanda espontânea foram os modelos de ampliação de acesso revisados para embasar a discussão. O impacto do horário estendido na ampliação do acesso pode ser minimizado se outras medidas, como mudanças no modelo de agendamento, priorizando o acesso avançado, não forem concomitantemente implantadas. O modelo “Upinha 24 horas”, da forma como se apresenta, parece ser baseado na concepção de uma Atenção Primária à Saúde que funciona como complemento para “desafogar” os serviços de atendimento às urgências já existentes e não como ordenadora do serviço de atenção às urgências. Apesar de apontar numa direção inicialmente acertada, a implantação das “Upinhas 24 horas” parece ainda ser uma proposta incipiente na garantia de acesso.

The experience of a nationwide Community of Practice to set up Regional Prevention Plans in Italy

BackgroundIn 2010, the Italian Ministry of Health decided to start the planning process to elaborate the National Plan of Prevention 2010–2012 jointly with the 21 Regions. The National Institute of Health was responsible for supporting regional planners (RPs) by an original participatory approach of a web-based Community of Practice (CoP) to set up their own Regional Plans of Prevention. In this paper, we summarise the theoretical framework adopted, the main phases characterising the lifecycle of the nationwide CoP, the evaluation approach adopted and its findings.MethodsFollowing the CoP theoretical framework from Wenger, an initial group of RPs were trained on Project Cycle Management as a planning method and thereafter they started interacting on a web-based Moodle platform for 8 months. The CoP evaluation mainly took into account aspects of ‘immediate value’, such as members interactions within the website, and several quantitative and qualitative tools were used to monitor changes over time. Data were retrieved from Moodle statistics or directly from the RPs by the means of a Knowledge, Attitude and Practice survey, a reaction survey, SWOT analysis and focus groups.ResultsThe level of individual RPs knowledge increased after the initial course from 55.7% to 75%, attitudes and competence perception about the planning process method also showed an overall favourable change. During the CoP life span, the number of members increased from the original 98 RPs to include up to 600 new members on the basis of spontaneous demand. From April 2010 to January 2011, the ‘vital signs’ of the CoP were monitored, including RP logins (13,450 total logins and 3744 unique logins), views (27,522) and posts (1606) distributed in 326 forum discussion threads. Data and information retrieved from quantitative and qualitative evaluation approaches proved to be useful for the management and follow-up of the CoP.ConclusionsThe CoP experience was successful as 19 out of 20 Regions submitted their Regional Preventive Plan to their Ministry of Health within the due deadline. The CoP has proved to be an approach able to optimise resources and expertise, capitalising and generating new knowledge. However, more efforts should be deployed to define innovative ways to evaluate its values, tangible and intangible, as well as the return of investment.

Percepções de usuários atendidos em um pronto atendimento: olhar sobre a atenção primária à saúde

Objetivou-se compreender os motivos que levam os usuários a buscar as Unidades de Pronto Atendimento (UPA) quando o problema de saúde poderia ser resolvido no âmbito da Atenção Primária à Saúde (APS). Estudo descritivo, qualitativo, com 24 usuários da UPA de município do Sul do país, coleta de dados em fevereiro/março de 2015, por entrevista semiestruturada, e analisados pela análise de conteúdo. Dos resultados emanaram três categorias: descompasso entre a visão médico-centrada e a inadequação das equipes de saúde da APS para atenção à demanda espontânea; o acolhimento deficitário na APS gera dificuldades de acesso e baixa resolutividade da equipe de saúde; e desarticulação entre UPA e APS: necessidade de estruturação da coordenação do cuidado. Conclui-se que as UPAs são vistas pela população como mais resolutivas, havendo necessidade de ordenar fluxos de atendimento e educar/informar a população sobre seu funcionamento.

Profile of spontaneous demand for services among infants younger than 30 days old at a children's tertiary care hospital.

In recent years, admission of critical newborn infants (NBIs) to the neonatal intensive care unit of Hospital Garrahan (HG) has been limited due to the hospitalization of infants younger than 30 days old through spontaneous demand for services. This is probably a multifactorial situation, and one of its causes is a lack of regionalization, which results in an inadequate use of resources or a distorted use of resources intended for more complex care. To establish the profile of NBIs who make a spontaneous demand for services at HG and to assess the level of care required based on their medical condition. Cross-sectional study. All infants < 30 days old who sought care at HG in a period of 12 months were assessed. The analysis included clinical characteristics of NBIs, prior visits, parental reason for consultation at HG, and whether NBIs could have been seen at a primary or secondary care facility. A total of 307 consultations were analyzed; NBI age was 18 days ± 7.6. Of these, 78% required hospitalization. The most common reason for hospitalization was acute respiratory tract infection. Thirty-five percent had health insurance coverage; 54% had sought care more than once at a different facility. Only 15% of NBIs had a highly complex condition that should have actually been solved at HG. Based on the analysis of NBIs seen at HG through spontaneous demand for services, a high requirement of hospitalization for low and medium complexity pathologies was observed.

Analysis of access and care among PMAQ-AB results and users satisfaction of emergency department: similarities and differences

The objective was to identify similarities and differences about user satisfaction with Primary Health Care (PHC) in the dimensions of access and care from non-urgent care in emergency care (EC) in Ribeirão Preto-SP with the National Program Evaluation Improving Access and Quality of Primary Care (PMAQ-AB), whose evaluation in Ribeirão Preto happened in same period. It was a quantitative study in the PA units of the five Health Districts.The study included 514 users who received at least one appointment in the PHC in the six months preceding the survey. We used the EUROPEP instrument - European Task Force on Patient Evaluation of General Practice Care and diary as data sources. It was based on the results of the dimensions of access and host PMAQ assessment to identify similarities and differences between what users of this study reported. During recruitment of users we realized that many did not receive medical care in PHC in the last six months justifying the difficulty in getting vaccancy and when they get sick and need to look for EC. We have that 12.7% were treated on the same day that sought to PHC. Of the 87.3% that have not met the same day, the average waiting time between the day of marking and the day of appointment on the PHC was 58 days, 42.4% of users answered "bad" about the ease in making an appointment. The results converge with PMAQ-AB results signaled underperforming to host the spontaneous demand. However, the good evaluation of PMAQ-AB in the category marking appointment diverged with the results of this study it was constant complaint by the delay in scheduling appointments. We conclude that users seen in EC in Ribeirão Preto-SP not recognize PHC as a regular source of care, which may interfere with non-adherence to these continuous service, resulting in the search for urgent and emergency services to treat injuries that could be resolved in the PHC

Comparison between Central and Brachial Blood Pressure in Hypertensive Elderly Women and Men.

Aim To compare the values of central and brachial systemic blood pressure (SBP) between women and men over 60 years of age with systemic arterial hypertension. Methods This study was a quantitative, descriptive, cross-sectional study with elderly patients admitted to and selected from spontaneous and scheduled demand at basic health units in Uberlândia, Minas Gerais, Brazil, between March 2013 and March 2014. We included 69 study participants and compared central and brachial SBP using a Sphygmocor® XCEL device (AtCor Medical, Sydney, Australia). Results Significant differences were found in the blood pressure values of the whole population in the central versus brachial systolic blood pressure (SP) [140(21) versus 153(23) mmHg] and in the central versus brachial pulse pressure (PP) [55(18) versus 70(18) mmHg]. Additionally, females exhibited higher blood pressure levels than males [central SP 144(23) versus 134(16) mmHg and brachial SP 161(26) versus 148(18) mmHg and central PP 62(17) versus 45(14) mmHg and brachial PP 80(21) versus 63(15) mmHg, resp.]. Conclusion Elderly women exhibited higher blood pressure values than elderly hypertensive men.

Perception of Dentists about the Functioning of Emergency Public Dental Services

Objective: To know the perception of dentists about the functioning of emergency public dental services (PEDS). Material and Methods: Cross-sectional exploratory study performed in Goiania, a large municipality in the mid-west of Brazil. Participated as subjects the dentists of all ten municipal PEDS. The perception was measured by Likert scale ranging from 1 to 5, where value 5 represented maximum agreement with assertions contained in a questionnaire about the functioning of the services. Results: The final sample consisted of 44 dentists (Response rate=70%.) The perception of the professionals, measured by average agreement with the assertions, ranged from 3.54 and 4.68 in a maximum score of 5.00. Conclusion: For all items discussed there was a favorable perception of the participants. In the perception of the professionals, emergency public dental services meet a spontaneous demand, commonly of endodontic emergencies, with performance of non-conclusive procedures and dental extraction. The professionals recognize that there is a need to improve the embracement of patients, as well as to adopt clinical protocols for the treatment, yet there are flaws in the system of reference of patients, in continuing education of professionals and in the conditions of provision of the services to the population.

MANCHESTER TRIAGE SYSTEM IN PRIMARY HEALTH CARE: AMBIGUITIES AND CHALLENGES RELATED TO ACCESS

ABSTRACT Objective: understanding ambiguities and challenges related to access after implementing the Manchester Triage System in primary health care. Method: a qualitative study developed through semi-structured interviews with nurses, doctors and nursing technicians, totaling 22 professionals. The data were analyzed using the thematic content analysis method. Results: the Manchester Triage System antagonistically interfered with access. In one aspect, an increase in waiting time, difficulty of the user being attended and scheduling of cases that are not classified as acute can be observed. In another aspect, service guarantee, open door service, receiving service in order of arrival and organizing spontaneous demand can be emphasized. Conclusion: the study highlights the need to broaden discussions on the legitimacy of the Manchester Triage System in primary health care in view of its ambiguities and challenges regarding a guarantee of access in this area of care production.

Avaliação do acolhimento nas Unidades de Atenção Básica do Paraná

Objetivou-se verificar a efetividade no acolhimento desenvolvido nas Unidades de Atenção Básicas do Paraná, cadastradas no Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica. O estudo realizado foi descritivo e quantitativo, a partir do banco de dados fornecido pelo Departamento de Atenção Básica/Ministério da Saúde, que continham informações de 998 profissionais entrevistados, no segundo semestre de 2012. Destacou-se que 78,3% dos entrevistados afirmaram que esse processo existe e está implantado na Unidade de Atenção Básica e 51,8% informaram ter recebido capacitação para realizar o acolhimento, sendo que 68,2% realizam o atendimento de acolhimento à demanda espontânea com avaliação e classificação de risco e vulnerabilidade e 74,3% dos enfermeiros estão envolvidos na atividade do acolhimento. Verificou-se que o acolhimento é uma prática habitual no processo de trabalho da Atenção Básica à Saúde no estado do Paraná, destacando-se o profissional enfermeiro nesta atividade. É importante considerar a necessidade de educação permanente que envolva todos os profissionais da atenção básica com o propósito de obter resultados mais expressivos, para o acesso aos serviços e à saúde da população paranaense.

Oral health assessment from the perspective of the municipal manager

ABSTRACT Objective: The aim of this study was to conduct a situational diagnosis related to the organization of oral health services in 40 municipalities of São Paulo State, Brazil. Methods: This is a cross-sectional, quantitative and qualitative, descriptive study performed through document analysis and application of a semi-structured questionnaire to oral health coordinators, in 2014. The following items were defined: dental infrastructure, access and regulation, work organization and assessment strategies. Although the Basic Health Unit is the main gateway to the system, dental care was also conducted in schools; the main service access of the population was the spontaneous demand and there have been production data inconsistencies in the information systems. Results: It was observed that, 60% answered that the health planning process included oral health; 47.5% performed risk assessment; 47.5% did not perform evaluation and monitoring of results. Conclusion: It is concluded that municipalities present different moments in the structuring of the service and that managers should improve the access organization, the work process and service evaluation in order to consolidate the universality and comprehensiveness of health care.

Coronary disease risk assessment in men: Comparison between ASCVD Risk versus Framingham

IntroductionThis study evaluated the risk of men developing coronary heart disease and its determinant variables, comparing these results through two validated coronary risk scales. MethodsA cross sectional epidemiological analytical study in which data were collected by spontaneous demand, through a semi-structured questionnaire, clinical examination, and blood collection. The Chi-square test, logistic regression and Kappa for statistical analysis were performed. ResultsThe study included 637 men. Age was a determining factor (p<0.05) in blood pressure (BP) changes, central obesity, BMI, glycemia, total cholesterol, LDL and triglycerides. From this group of 637, 252 presented BP above the recommended values. It was found that 34.54% of men had high total cholesterol, 19.94% had high LDL, 46.78% presented HDL below normal values and 36.42% had elevated triglycerides. Metabolic syndrome was found in 24.96% of the men. With the Framingham scale, 637 men were evaluated, 12.56% were at intermediate-risk and 5.49% elevated risk, while on the ASCVD Risk scale 553 men were evaluated, and 7.05% had moderate risk and none had high coronary risk. In this study, 50.43% of men still had no previous diagnosis for any disease that increases the risk factors. ConclusionsThe determinant clinical variables were age, blood pressure, smoking, central obesity, race and education. The Framingham scale allowed the assessment of cardiac risk of all men in the study, with no age restriction or cholesterol value, so in population studies it shows advantages over the ASCVD Risk due to its comprehensive feature of including all individuals.

O serviço de psicologia no pré-natal de adolescentes

A adolescência é uma fase transformadora com desenvolvimento biopsicossocial. A gestação carrega consigo características transformadoras, com vivências únicas e subjetivas a cada gestante. É um momento caracterizado por profundos conflitos e emoções, pois afeta diretamente a identidade da mulher. Estar grávida na adolescência é um fator que intensifica a vivência de conflitos emocionais, acarretando sentimentos de impotência, ansiedade, raiva e culpa. Apresentar o trabalho realizado pela psicologia em um Pré-Natal de Adolescentes. O Pré-Natal de Adolescentes (PNA), do Hospital da Mulher - CAISM/UNICAMP é composto por uma equipe multiprofissional e oferece atendimento as gestantes de até 18 anos de idade. Os atendimentos psicológicos ocorrem através de demanda espontânea ou por encaminhamentos dos profissionais da saúde de forma individual e se necessário realizados também com a família e/ou acompanhante da gestante. O auxílio psicológico no PNA mostra-se como uma medida preventiva da saúde mental, de preparo à paciente para uma mudança significativa em sua vida, é necessário um olhar educador e acolhedor da psicologia, que favoreça na adolescente recursos e mecanismos internos para diminuir sentimentos e angustias que podem proporcionar sofrimento. O trabalho da psicologia com as adolescentes gestantes é essencial como auxiliar na ressignificação quanto a este momento de intensas transformações. A escuta ativa e o acolhimento, são formas de fortalecimento do ego materno, por meio da expressão de sentimentos relacionados à gestação e a compreensão da vivência gestacional na adolescência, o que pode facilitar o amadurecimento e o vínculo mãe-bebê.

ACOLHIMENTO COM CLASSIFICAÇÃO DE RISCO: CARACTERIZAÇÃO DA DEMANDA EM UNIDADE DE PRONTO ATENDIMENTO

Objetivou-se caracterizar o atendimento dos usuários com a diretriz de Acolhimento com Classificação de Risco, em uma Unidade de Pronto Atendimento do interior do Paraná. Pesquisa de campo, descritivo-exploratória, quantitativa, cuja fonte de informação consistiu em 500 fichas de pacientes atendidos entre janeiro e maio de 2014, obtidas em amostragem aleatória simples. Foram coletados dados demográficos, clínicos, relacionadas à rede de atenção e à classificação de risco; submetidos à estatística descritiva. A maioria era mulher, de 20 a 29 anos, de demanda espontânea; encaminhados por enfermeiros e Unidades Básicas de Saúde. Sobre a classificação de risco, quatro (0,8%) eram de emergência, 175 (35%) de urgência maior, 245 (49%) de urgência menor e 68 (13,6%) não urgentes; sendo o técnico de enfermagem o principal triador e a alta o principal desfecho. Há necessidade de melhoria dos registros e revisão do processo de classificação para esclarecimento de falhas pontuais.

From blueprint to action: The transformation of the planning paradigm for desakota in China

With a case study of Chaonan in Guangdong Province, this study examines China's desakota and its planning paradigm. After three decades of high-speed growth, the marginal areas of Guangdong Province — the lab of China's market-oriented reform and open door policy, are still fraught with desakotas, semi-urbanized areas of mixed landscape, economic and administrative systems. Chaonan faces a number of challenges, such as economic slowdown, poor infrastructure, environmental pollution, and so on. We found that China's desakota is driven by decades of rural industrialization, and this is now becoming a major challenge to master planning, the paradigm of which mainly comes from the rational theories of early western countries. As the traditional paradigm emphasizes the overall blueprint, there is a mismatch between planning orientation and spontaneous investment demand. Planning implementation thus is almost impossible. As such, we take the master plan of Chaonan as a case to integrate both blueprints and actions. To turn traditional blueprint-led planning into action-led planning, we highlight both recent and long-term actions, to make practical improvements to various facets, socio-economic upgrading, socio-spatial transformation, and environmental sustainability. Above all, we argue that action-led planning is the key to the transformation of desakotas in China.

Abstract P5-09-12: The importance of education for adherence to mammographic screening in the Brazilian public health services

Abstract Introduction: A third of the registration of new cases of breast cancer in Brazil corresponds to locally advanced or late diagnosed disease. The benefits of screening in this sense become evident and measurable in terms of their temporal extent and adherence of the target population to its recommendations. Unlike the organized mammographic screening where there is call, breast health education, monitoring and enforcement of the intervals between examinations, in the opportunistic model, individuals are subject to the recommendations from the spontaneous demand by health services. Objective: To determine the influence of education in breast cancer for adherence to mammographic screening in brazilian public health services. Methods: This is a cross-sectional, descriptive and comparative study between two groups of women with (group A, n=136) and without (group B, n=128) knowledge about breast cancer, who appeared in the Center of Detection, Diagnosis and Monitoring (CDDM) for organized screening. For this were interviewed 264 women in relation to the realization of previous mammograms in the last three years. The repetition of examinations, respecting the range of 24 months was defined as criteria to classify participants in adherent or not to screening. Results: Both groups of women had a similar mean age (50.2 ± 9.2 and 49.5 ± 9.5 years; p&amp;gt;0.05). Of the respondents, 77.2% (n=204) reported mammographic screening before joining the CDDS, however highest proportion was registered in group A (64.8%). Sixty women denied conducting prior mammography with predominance in the Group B (93.4% vs 6.6%, p&amp;lt;0.05). One hundred forty-four women were adherent to screening, 90.2% (n=130) of these belonged to group A. The remaining variables (education, occupation, family income, distance between place of residence and mammography center and personal / family history of breast cancer) were not associated with adherence to screening (p&amp;gt;0.05). Conclusion: The decrease in the adherence to conducting periodic mammography observed in group B reflects the opportunistic character of the screening in the country, where it loses the chance to sensitize women through education to improve their effective adhesion. Acknowledgements to the Brazilian Ministry of Health for their support to the study. Citation Format: Blanco EC, Ribeiro IM, Nascimento CCP, da Silva CA, Abrah㯀 CF, Borges MM. The importance of education for adherence to mammographic screening in the Brazilian public health services. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P5-09-12.

RECEPTION: STRATEGIC POINT FOR USER ACCESS TO THE UNIFIED HEALTH SYSTEM

ABSTRACT This study investigated to understand how user embracement of users with acute illness or chronic worsened works, which has no scheduled service (spontaneous demand) from the perspective of workers of the reception service of health centers in a municipality in the southern region of Brazil. Descriptive exploratory qualitative study conducted in ten health centers in a municipality of Santa Catarina, Brazil. In data collection 17 workers from the reception of these health services were interviewed between January and March 2014. Thematic content analysis was performed. The results showed that user access does not occur as recommended by the Ministry of Health, due to weaknesses in the work process. Therefore, it is necessary to reorganize the work process, considering the reception as a strategic point in order to qualify the access of users to the Unified Health System.

Oral health assessment protocol in primary care

Objective: The aim of this study was to analyze the oral health service performance in a certain municipality and also to develop a diagnostic evaluation protocol of Oral Health in Primary Care. Methods: This is a descriptive, quantitative and qualitative research. The research site chosen was in the city of Pereira Barreto, State of São Paulo Brazil, since it makes use of the Family Health Strategy as the structuring care model of the Health Care System in 100% of the population as well as oral health teams implemented and oral health secondary care. Data were obtained through interviews with the manager, six dentists, six oral health assistants and six community health workers. Document analysis of the Municipal Health Plan was also conducted along with the Dental Health Agenda and on-site observation of the dental structure. Results: The city Health Plan presents a detailed description of the municipality general situation, the oral health agenda recommends, in its implementation phase, the three main areas as a core in Family Health Strategy as follows: health unit, family and community.The survey found that the main form of access of the population to services was the spontaneous demand and there were only two Family Health teams without focus on oral health. Conclusion: The analysis of the service performed; made possible to develop a protocol with specific Oral Health dimensions to support the manager in defining intervention strategies

Prevalence of permanent teeth avulsion in a brazilian trauma center: a 12 years retrospective study

Objective: The aim of this study is to perform a retrospective study of cases of avulsion of permanent teeth in patients from 12 years of the Oraldental Trauma Center (CENTRAU) of the School of Dentistry of Faculty of Pharmacy, Dentistry and Nursing in Federal University of Ceara. Material and Methods: A retrospective transversal study characterized by direct observation of dental records was performed of a spontaneous demand sample of dental trauma victims who presented to the Oraldental Trauma Center of UFC (CENTRAU) during the period from May 2001 to May 2013 was conducted. Results: The analisys was done on 1,104 records,which 66 patients reported having been victims of avulsion with 88 avulsed permanent teeth with ages ranging between 6 and 30 years Among the 88 avulsed teeth, 59 (67.04%) were replanted. Only in 9 (15.5%) cases replantation was immediately. The storage medium that was the most widely used was the oral cavity by 8 (30.7%) patients. In 26 (39.4 %) cases, the cause of avulsion was falling to the ground. Conclusion: In this study, it was clear that cases of avulsion in CENTRAU corresponded to a low occurrence of all cases seen in the center.