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de Oliveira DB, Belotti L, Eshriqui I, Rebustini F, da Costa Palácio D, Bonfim D, Paresque MAC, Ribeiro DV, Barbieri W, Tedesco TK. Standardization of Dental Vulnerability Scale scores (EVO-BR). BMC Oral Health 2024; 24:791. [PMID: 39004710 PMCID: PMC11246572 DOI: 10.1186/s12903-024-04531-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 06/24/2024] [Indexed: 07/16/2024] Open
Abstract
BACKGROUND Dental Vulnerability Scale (EVO-BR) is an instrument developed to help identifying oral health-vulnerable individuals. This scale comprises 15 items distributed into 4 dimensions. It is the first instrument with the potential to guide clinical and managerial decisions in the oral health field. The aim is to validate a score to enable using EVO-BR in Primary Health Care (PHC). METHOD The investigated sample included PHC users in five Brazilian regions. Data were collected at two different stages: in 2019 (São Paulo) and in 2022 (Minas Gerais, Mato Grosso, Roraima, Pernambuco e Paraná). Exploratory descriptive study of this scale scores was carried out to create classification ranges. Subsequently, discriminant analysis was performed to assess the accuracy of the established classification. Boosting regression was carried out to check items' weight for the instrument score. RESULTS EVO-BR score ranged from 0 (highest vulnerability) to 15 (lowest vulnerability). Four (4) classification configurations were tested. Score equal to 12 points was the one presenting the best classification of the assessed individuals (100% were correctly classified). Boosting regression has evidenced that items 1 and 2 (Overall health domain) and 14 and 15 (Health Services domain) had the strongest influence on this instrument's score. CONCLUSION The process to standardize the EVO-BR score and, consequently, to develop assessment ranges, is an important step in the fight against health inequalities, since it provides a tool to help planning actions and interventions aimed at meeting specific needs of the population in the Primary Health Care context.
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Affiliation(s)
- Daniele Boina de Oliveira
- Graduate Program in Dentistry, Department of Odontology , Cruzeiro do Sul University, São Paulo (SP), Brazil
| | - Lorrayne Belotti
- Albert Einstein Center for Studies, Research and Practice in Primary Health Care (CEPPAR), Hospital Israelita Albert Einstein, São Paulo (SP), Brazil
| | - Ilana Eshriqui
- Albert Einstein Center for Studies, Research and Practice in Primary Health Care (CEPPAR), Hospital Israelita Albert Einstein, São Paulo (SP), Brazil
| | - Flávio Rebustini
- Graduate Program in Gerontology, The School of Arts, Sciences and Humanities, São Paulo University, São Paulo (SP), Brazil
| | - Danielle da Costa Palácio
- Albert Einstein Center for Studies, Research and Practice in Primary Health Care (CEPPAR), Hospital Israelita Albert Einstein, São Paulo (SP), Brazil.
| | - Daiana Bonfim
- Albert Einstein Center for Studies, Research and Practice in Primary Health Care (CEPPAR), Hospital Israelita Albert Einstein, São Paulo (SP), Brazil
| | - Marcio Anderson Cardozo Paresque
- Albert Einstein Center for Studies, Research and Practice in Primary Health Care (CEPPAR), Hospital Israelita Albert Einstein, São Paulo (SP), Brazil
| | - Danielle Viana Ribeiro
- Albert Einstein Center for Studies, Research and Practice in Primary Health Care (CEPPAR), Hospital Israelita Albert Einstein, São Paulo (SP), Brazil
| | - Wander Barbieri
- Albert Einstein Center for Studies, Research and Practice in Primary Health Care (CEPPAR), Hospital Israelita Albert Einstein, São Paulo (SP), Brazil
| | - Tamara Kerber Tedesco
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of São Paulo, São Paulo (SP), Brazil
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Bomfim RA, de Lucena EHG, Cavalcanti YW, Celeste RK. Racial inequality in complete dental prosthesis delivered: can public services reduce inequities? Clin Oral Investig 2023; 28:17. [PMID: 38135856 DOI: 10.1007/s00784-023-05432-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 11/20/2023] [Indexed: 12/24/2023]
Abstract
OBJECTIVES To investigate the association between access and delivery of complete dental prosthesis according to the proportion of the black population in Brazilian municipalities and to oral health policies. MATERIALS AND METHODS Ecological data from 2017 to 2021 relating to the delivery of complete dentures stratified by race was collected in all Brazilian cities. We calculated a racial inequality indicator by subtracting the percentage of the black population from the percentage of complete dental prostheses that were delivered to blacks in each municipality. Logistic and linear regression models were carried out. RESULTS We found that 49.2% (2737) of municipalities delivered complete prostheses. The service was more frequently available in municipalities where black individuals made up 20-80% (odds ratio [OR] = 1.45, 95% confidence interval [CI] 1.15; 1.81), those with dental specialty centers (DSC) (OR = 3.04, 95%CI 2.50; 3.68), and those with more oral health teams (OHTs) (OR = 3.43, 95%CI 2.81; 4.18). Where dental prostheses were available, racial inequities favored the white population by 7.7 percentage points (p < 0.01). Increased inequality was observed in municipalities with more OHTs and/or a higher proportion of black individuals (>80%). CONCLUSIONS Although municipalities with a DSC, and with more OHTs offer better access to complete dental prosthesis for blacks, racial inequality still impacts the delivery of the service. Primary and secondary healthcare services may even exacerbate this. CLINICAL RELEVANCE Policymakers should monitor racial inequities in healthcare services. The currently unmet needs of black people are critical, especially in cities with more OHTs and/or increased proportions of black people.
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Aguiar VR, Cabreira FDS, Ritter F, Celeste RK. [What aspects influence the prioritization of Primary Health Care by municipal managers in Rio Grande do Sul - Brazil?]. CIENCIA & SAUDE COLETIVA 2023; 28:197-208. [PMID: 36629564 DOI: 10.1590/1413-81232023281.00182022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 07/06/2022] [Indexed: 01/11/2023] Open
Abstract
Primary Health Care (PHC) is capable of achieving broad coverage and effectiveness. This study evaluated the factors associated with the prioritization that municipal health managers in the state of Rio Grande do Sul (RS) give to PHC. A cross-sectional analytical study was carried out between August 2017 and May 2019 using an online FormSUS questionnaire, consisting of 44 questions divided into 4 blocks, sent to 497 municipal health managers. Multiple logistic regression was performed to analyze factors associated with PHC prioritization. Out of 404 participants, 66.8% reported a maximum degree of prioritization. Managers with a postgraduate degree showed greater prioritization than those with elementary education (78.5% vs 58.8%, p<0.01). Regarding the postgraduate area, managers with training in public health prioritized PHC more than in other areas, or with no postgraduate studies, respectively with 84%, 77.1% and 61.8% (p<0.01). After adjusting for covariates, having a postgraduate degree in public health or in another area remained associated with greater chances of prioritization. The results may encourage initiatives that consider the level and area of education for this position focusing on technical, and not strictly political criteria.
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Affiliation(s)
- Violeta Rodrigues Aguiar
- Programa de Pós-Graduação em Odontologia, Universidade Federal do Rio Grande do Sul (UFRGS). R. Ramiro Barcelos 2492, Santa Cecília. 90035-003 Porto Alegre RS Brasil.
| | | | - Fernando Ritter
- Secretaria Municipal de Saúde de Porto Alegre. Porto Alegre RS Brasil
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Relationship between Professional Training of Dentists and Outpatient Clinical Production. BIOMED RESEARCH INTERNATIONAL 2022; 2022:5365363. [PMID: 35355824 PMCID: PMC8958072 DOI: 10.1155/2022/5365363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 03/02/2022] [Indexed: 11/18/2022]
Abstract
Background. The aim was to evaluate the association between the professional training of dentists and their outpatient production (OP) of clinical and collective/preventive procedures and the total number of procedures registered in a health information system. Methods. It included all 19,947 primary dental care units participating in the Program for Improvement of Access and Quality of Primary Care (PMAQ-AB 2nd cycle) and the number of clinical procedures (CP), collective/preventive procedures (PP), and total procedures (TP) registered in the ambulatory information system between November 2013 and July 2014 for each participant oral health team. The outcome was being above the national median of procedures. The main variables related to training were the dentists specialising in family health, the level of training, and participation in permanent education. Effect estimates were calculated by multiple logistic regression. Results. In the final model, controlled by contextual factor work process, family health specialists had higher chances (
, 95% CI: 1.00; 1.27) of producing above the national median of CP than nonspecialists,
(0.96; 1.18) for PP and
(1.08; 1.27) for TP. Dentists taking permanent education had higher chances than those not taking it of producing above the national median for CP, PP, and TT, respectively, with
(1.20; 1.62),
(1.09; 1.40), and
(1.18; 1.39). Conclusion. Training in family health performs more procedures in primary care settings than those without training. However, this OP is influenced by variables related to the municipality and the work process, especially for PP. If the highest production observed is a consequence of training, then public health managers can not only encourage training policies such as permanent education policies to expand the use of services.
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Soares Filho AM, Vasconcelos CH, Dias AC, Souza ACCD, Merchan-Hamann E, Silva MRFD. Atenção Primária à Saúde no Norte e Nordeste do Brasil: mapeando disparidades na distribuição de equipes. CIENCIA & SAUDE COLETIVA 2022; 27:377-386. [DOI: 10.1590/1413-81232022271.39342020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 11/20/2020] [Indexed: 11/22/2022] Open
Abstract
Resumo Objetiva-se analisar o padrão espacial de implantação de equipes da Atenção Primária à Saúde (APS) no Norte e Nordeste do Brasil em 2017. Estudo ecológico das taxas de Agentes Comunitários de Saúde (ACS), equipes Saúde da Família (eSF), equipes Saúde Bucal (eSB) e Núcleo Ampliado de Saúde da Família (NASF), a partir de dados do Ministério da saúde (MS). A análise dos dados de área permitiu a identificação de padrões de dependência espacial dos municípios para as taxas, utilizando os índices e mapas de Moran para visualizar clusters de áreas críticas (95% de confiança). Os municípios do Norte (n=450) e Nordeste (n=1.794) apresentaram 132,2 mil ACS, 18,4 mil eSF, 13 mil eSB e 2,2 mil NASF. A proporção de municípios com taxas dentro do preconizado pelo MS: ACS (>1,33/mil) 96% no Norte e 98,5% no Nordeste; eSF (>2,9/10 mil) 54% e 80% nas respectivas regiões; eSB (>2,9/10 mil) 28% e 59% nestas respectivas regiões. Equipes NASF foram implantadas em 70% do Norte e 89% do Nordeste. Exceto ACS, a região Norte constituiu-se em área crítica de equipes, principalmente no Pará, Rondônia, Amazonas e Amapá. No Nordeste, essas áreas foram menores e concentradas a oeste da Bahia e leste do Maranhão. O Nordeste exibiu melhor composição de equipes e menor extensão de áreas críticas.
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Peres Neto J, Cortellazzi KL, Sousa MDLRD. [Organization of demand in oral health and family vulnerability]. CIENCIA & SAUDE COLETIVA 2021; 26:3623-3633. [PMID: 34468657 DOI: 10.1590/1413-81232021269.2.21852019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 11/18/2019] [Indexed: 11/22/2022] Open
Abstract
The scope of this study was to analyze the relationship of an instrument of family vulnerability with sociodemographic, dental, and spatial distribution in a given territory. The dependent variable was the classification of family vulnerability, proposed by Coelho and Savassi. The independent variables were selected on the basis of the theoretical model proposed by Andersen. Hierarchical multiple logistic regression models were estimated. Kernel density estimation was used for spatial analysis. Subjects who lived with more than 4 people (OR = 3.46; 95% CI), who were dissatisfied with their oral health (OR = 2.38; 95% CI), who were ashamed to smile and talk (OR = 3.03, 95% CI) were more likely to be "at risk" in the family. Spatial analysis enabled the visualization of an area of higher concentration of families "at risk". The relationship of the instrument of vulnerability analyzed with sociodemographic and dental factors, as well as the assistance in the visualization and identification of more vulnerable areas, are useful in the knowledge of the territory for the planning of actions in oral health, and the conclusion drawn is that the tool can be adopted for more equitable access by the oral health teams.
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Affiliation(s)
- João Peres Neto
- Hospital Israelita Albert Einstein. Av. Brigadeiro Faria Lima 1.188, Jardim Paulistano. 01451-001. São Paulo SP Brasil.
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Siqueira PM, Umeda JE, Terada RSS, Giozet AF, Leite JS, Paludetto Junior M, Lima CCB, Fujimaki M. Association of Oral Health Teams implantation with collective actions and extractions in Paraná State, Brazil. CIENCIA & SAUDE COLETIVA 2021; 26:3705-3714. [PMID: 34468664 DOI: 10.1590/1413-81232021269.2.37332019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 04/06/2020] [Indexed: 11/21/2022] Open
Abstract
This article aims to monitor the indicators of outpatient production of Dentistry and to evaluate the association of collective action and extraction indicators with the number of Oral Health Teams (OHT) between 2006 and 2015 in Paraná. In this longitudinal ecological study, consolidated secondary data were analyzed (collective actions of supervised brushing-SB, topical application of fluoride-TAF, fluoride mouthwash-FM, oral examination for epidemiological purposes-OE and extractions of permanent teeth-EX) from the Ambulatory Information System (SIA-SUS) and OHT numbers from the National Registry System of Health Establishments. Descriptive analyzes and Pearson's correlation were performed, with significance level of p<0.05. It was verified the increase of the OHT implantation over time and a strong positive correlation with collective procedures of SB (r=0.78; p=0.007) and FM (r=0.76; p=0.011) and moderate negative correlation with EX (r=-0.53). It was concluded that the evaluated indicators showed that the implementation of Oral Health Teams may have contributed to changes to the healthcare model, with an increase in preventive collective procedures and reduction of tooth loss in Paraná.
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Affiliation(s)
- Paula Mayumi Siqueira
- Departamento de Odontologia, Universidade Estadual de Maringá. Av. Mandacaru 1550, Parque das Laranjeiras. 87083-240 Maringá PR Brasil.
| | - Josely Emiko Umeda
- Departamento de Odontologia, Universidade Estadual de Maringá. Av. Mandacaru 1550, Parque das Laranjeiras. 87083-240 Maringá PR Brasil.
| | - Raquel Sano Suga Terada
- Departamento de Odontologia, Universidade Estadual de Maringá. Av. Mandacaru 1550, Parque das Laranjeiras. 87083-240 Maringá PR Brasil.
| | - Amanda Fonquete Giozet
- Departamento de Odontologia, Universidade Estadual de Maringá. Av. Mandacaru 1550, Parque das Laranjeiras. 87083-240 Maringá PR Brasil.
| | | | | | | | - Mitsue Fujimaki
- Departamento de Odontologia, Universidade Estadual de Maringá. Av. Mandacaru 1550, Parque das Laranjeiras. 87083-240 Maringá PR Brasil.
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Rauber ED, Menegazzo GR, Knorst JK, Bolsson GB, Ardenghi TM. Pathways between toothache and children's oral health-related quality of life. Int J Paediatr Dent 2021; 31:558-564. [PMID: 32767803 DOI: 10.1111/ipd.12692] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 07/21/2020] [Accepted: 07/29/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Toothache is considered a multifactorial health problem that is associated with oral diseases and comorbidities. AIM Evaluate the direct and indirect pathways between toothache and children's oral health-related quality of life (COHRQoL). DESIGN This is a cross-sectional study conducted with a random sample of children from southern Brazil. The variables included demographic, socioeconomic, behavioral, and oral health characteristics. Toothache was collected through the question 'Have you had toothache in the last 12 months?'. COHRQoL was collected by the Child Perceptions Questionnaire 8-10 in his Brazilian version. The pathways between the associated variables, toothache, and COHRQoL were analyzed through structural equation modeling. RESULTS A total of 449 schoolchildren were evaluated. The prevalence of toothache was 50.1% (95% confidence interval: 45.4%-54.8%). The poorer COHRQoL was directly affected by the presence of toothache. Considering the indirect pathways, the low household income, high household crowding, low age, the use of public health service, and the untreated dental caries influenced indirectly in the worst COHRQoL via toothache. CONCLUSION This study determined that COHRQoL was directly influenced by toothache. Meanwhile, indirect pathways were observed. These findings justify initiatives that highlight the importance of the reduction of oral diseases that can lead to pain experiences.
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Affiliation(s)
| | | | - Jessica Klöckner Knorst
- Postgraduate Program in Dental Sciences, Federal University of Santa Maria, Santa Maria, Brazil
| | - Gabriela Bohrer Bolsson
- Postgraduate Program in Dental Sciences, Federal University of Santa Maria, Santa Maria, Brazil
| | - Thiago Machado Ardenghi
- School of Dentistry, Federal University of Santa Maria, Santa Maria, Brazil.,Postgraduate Program in Dental Sciences, Federal University of Santa Maria, Santa Maria, Brazil
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da Costa Palacio D, Rebustini F, de Oliveira DB, Neto JP, Barbieri W, Sanchez TP, Mafra ACCN, Bonfim D, Nascimento Monteiro C, Filho VVG, Ribeiro DV, Loschiavo LM, Miraglia JL, Pereira AC. Dental vulnerability scale in primary health care: evidence of content and structure internal validity. BMC Oral Health 2021; 21:421. [PMID: 34454449 PMCID: PMC8400751 DOI: 10.1186/s12903-021-01742-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 07/12/2021] [Indexed: 12/05/2022] Open
Abstract
Background Access to oral health services remains a challenge in the Brazilian healthcare system, especially in the primary health care setting, where the use of a risk stratification tool that could identify individuals with higher dental vulnerability would be extremely valuable. However, there literature on this theme is scarce, and there is no validated instrument in Brazil that is capable of measuring dental vulnerability. Hence, this psychometric study aimed at the development and evaluation of content and internal structure validity of the Dental Vulnerability Scale for Primary Health Care (PHC). Methods The items were developed based on a qualitative exploratory analysis. A total of 172 items were prepared and submitted to a panel of specialists, with content validity analyzed with the Content Validity Ratio (CVR), resulting in an the initial version of the instrument composed by 41 items. Internal structure validity was analyzed by Exploratory Factor Analysis (EFA), Confirmatory Factor Analysis (CFA), and by applying 3 reliability indicators (Cronbach’s Alpha, McDonald's Omega and Greatest Lower Bound – GBL), with a sample of 1227 individuals. Results The final configuration indicated a scale of 15 items divided into 4 dimensions (overall health, oral health, infrastructure, and healthcare services) with explained variance of 72.11%. The factor loads varied from 0.37 to 0.96. The model adjustment indices were set at × 2/df(51) = 3.23, NNFI = 0.95, CFI = 0.98, GFI = 0.96, AGFI = 0.97, RMSEA = 0.04 and RMSR = 0.03. Conclusion DVS presented satisfactory evidence of validity, indicating its suitability to be used by healthcare professionals, students and managers to plan oral health actions and services at PHC.
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Affiliation(s)
- Danielle da Costa Palacio
- CEPPAR, Hospital Israelita Albert Einstein, Av. Albert Einstein 627, São Paulo, SP, Brazil. .,Faculdade de Odontologia de Piracicaba, Universidade Estadual de Campinas, Av. Limeira, 901 - Areião, Piracicaba, SP, Brazil.
| | - Flavio Rebustini
- Ciências e Humanidades - Rua Arlindo Béttio, Universidade de São Paulo - Escola de Artes, 1000 - Ermelino Matarazzo, São Paulo, SP, Brazil
| | | | - João Peres Neto
- CEPPAR, Hospital Israelita Albert Einstein, Av. Albert Einstein 627, São Paulo, SP, Brazil
| | - Wander Barbieri
- CEPPAR, Hospital Israelita Albert Einstein, Av. Albert Einstein 627, São Paulo, SP, Brazil
| | - Thais Paragis Sanchez
- CEPPAR, Hospital Israelita Albert Einstein, Av. Albert Einstein 627, São Paulo, SP, Brazil
| | | | - Daiana Bonfim
- CEPPAR, Hospital Israelita Albert Einstein, Av. Albert Einstein 627, São Paulo, SP, Brazil
| | | | | | - Danielle Viana Ribeiro
- CEPPAR, Hospital Israelita Albert Einstein, Av. Albert Einstein 627, São Paulo, SP, Brazil
| | | | - João Luiz Miraglia
- CEPPAR, Hospital Israelita Albert Einstein, Av. Albert Einstein 627, São Paulo, SP, Brazil
| | - Antonio Carlos Pereira
- Faculdade de Odontologia de Piracicaba, Universidade Estadual de Campinas, Av. Limeira, 901 - Areião, Piracicaba, SP, Brazil
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Galvão MHR, Roncalli AG. [Performance of Brazilian municipalities in the supply of specialized oral health services]. CAD SAUDE PUBLICA 2021; 37:e00184119. [PMID: 33440412 DOI: 10.1590/0102-311x00184119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 06/09/2020] [Indexed: 11/21/2022] Open
Abstract
The study aimed to analyze factors associated with the availability of specialized dental services in Brazilian municipalities. This was an ecological study with a sample of 776 municipalities that participated in the first cycle of the Program to Improve Access and Quality of Dental Specialization Centers (PMAQ-CEO, in Portuguese) survey held in 2014. The study's dependent variables consisted of a coefficient created with variables on the number of professionals and the workweek of dentists in the minimum set of specialties, per 10,000 inhabitants. Exploratory factor analysis was performed to create a score for the municipalities' performance with the availability of specialized dental services. Factors associated with the municipalities' performance were assessed with Pearson's chi-square test, with the following municipal indicators as independent variables, categorized in tertiles: per capita income, Municipal Human Development Index (HDI-M), resident population, total health spending per inhabitant, and Oral Health Teams per 10,000 inhabitants. Higher performance with the availability of specialized oral health services was associated with municipalities having smaller populations (67.3%; CI: 61.6-73.0; p < 0.001), lower HDI-M (41.9%; CI: 35.8-48.0; p < 0.001), lower per capita income (41.2%; CI: 35.2-47.3; p < 0.001), and higher mean number of oral health teams per 10,000 inhabitants (50.6%; CI: 46.0-58.4; p < 0.001). The results show positive impacts from the implementation of the National Oral Health Policy in Brazil, meeting the goal of expanding the supply of secondary care services according to the principle of equity in care.
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de Lucena EHG, de Lucena CDRX, Alemán JADS, Pucca GA, Pereira AC, Cavalcanti YW. Monitoring of oral health teams after National Primary Care Policy 2017. Rev Saude Publica 2020; 54:99. [PMID: 33206837 PMCID: PMC7593040 DOI: 10.11606/s1518-8787.2020054002075] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 12/06/2019] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To monitor the number of oral health teams implemented in the Family Health Strategy after National Primary Care Policy 2017. METHODS This is a study of quantitative, descriptive and analytical nature that used the data from the public reports of the history of oral health coverage available in the e-Manager platform of Primary Care of the Ministry of Health of all Brazilian municipalities (5,570). The survival rate of the municipalities that did not reduce the number of oral health teams was analyzed according to the region of the country, human development index, Gini inequality index and population size. Cox regression was used to analyze the factors associated with the decrease in the number of teams implanted after 1, 3, 6, 9, 12, 15, 18 and 21 months of publication of the 2017 national policy ordinance, considering the hazard ratio (HR) and p < 0.05. RESULTS After 21 months of publication of the policy, 6.7% of Brazilian municipalities reduced the number of oral health teams. This reduction was higher in the South (6.7%) and Northeast (4.8%), in municipalities with the highest human development index, i.e., greater than or equal to 0.7 (5.6%), more unequal in terms of income distribution (Gini index > 0.62) and larger population size (more than 100,000 inhabitants). Municipalities in the Northeast (HR = 1.220) and South (HR = 1.771) regions had a higher chance of reducing the number of teams compared with those in the North region. More unequal municipalities (HR = 6.405) and with larger population size (HR = 4.273) were also more likely to reduce the coverage of oral health teams. CONCLUSION The municipalities that reduced the number of oral health teams in the Family Health Strategy are from the South and Northeast regions, with greater social inequality and larger population size. This scenario can significantly affect the population's access to dental health services in the Unified Health System, especially among those in need.
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Affiliation(s)
- Edson Hilan Gomes de Lucena
- Universidade Federal da ParaíbaCentro de Ciências da SaúdeDepartamento de Clínica e Odontologia SocialJoão PessoaPBBrasil Universidade Federal da Paraíba . Centro de Ciências da Saúde . Departamento de Clínica e Odontologia Social . João Pessoa , PB , Brasil
| | - Carolina Dantas Rocha Xavier de Lucena
- Fundação Oswaldo CruzInstituto Aggeu MagalhãesPrograma de Pós-Graduação em Saúde PúblicaPernambucoPEBrasil Fundação Oswaldo Cruz . Instituto Aggeu Magalhães . Programa de Pós-Graduação em Saúde Pública . Pernambuco , PE , Brasil
| | - Josiane Aparecida de Souza Alemán
- Universidade Federal da ParaíbaCentro de Ciências da SaúdeNúcleo de Estudo e Pesquisas Interdisciplinares em BiomateriaisJoão PessoaPBBrasil Universidade Federal da Paraíba . Centro de Ciências da Saúde . Núcleo de Estudo e Pesquisas Interdisciplinares em Biomateriais . João Pessoa , PB , Brasil
| | - Gilberto Alfredo Pucca
- Universidade de BrasíliaFaculdade de Ciências da SaúdeDepartamento de OdontologiaBrasíliaDFBrasil Universidade de Brasília . Faculdade de Ciências da Saúde . Departamento de Odontologia . Brasília , DF , Brasil
| | - Antônio Carlos Pereira
- Universidade Estadual de CampinasFaculdade de Odontologia de PiracicabaDepartamento de Odontologia SocialCampinasSPBrasil Universidade Estadual de Campinas . Faculdade de Odontologia de Piracicaba . Departamento de Odontologia Social . Campinas , SP , Brasil
| | - Yuri Wanderley Cavalcanti
- Universidade Federal da ParaíbaCentro de Ciências da SaúdeDepartamento de Clínica e Odontologia SocialJoão PessoaPBBrasil Universidade Federal da Paraíba . Centro de Ciências da Saúde . Departamento de Clínica e Odontologia Social . João Pessoa , PB , Brasil
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Da Penha ES, Rezende TLGD, Rezende TLGD, Guênes GMT, Guênes GMT, Medeiros LADMD, Medeiros LADMD, Figueiredo CHMDC, Figueiredo CHMDC. Profile of Public Dentistry Contests in the Southeast Region of Brazil. JOURNAL OF HEALTH SCIENCES 2019. [DOI: 10.17921/2447-8938.2019v21n5p483-488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
AbstractPublic contest is one of the best ways for health professionals to enter the Family Health Strategy (FHS) and other public health services. The objective of this study was to verify the profile of Dentistry public examinations in the southeast region, as well as to analyze the coherence between the proposal of FHS and the content on the professionals selection for this position. The examinations were retrieved by means of research of the sites: PCI Concursos and Folha Dirigida and sites of companies of greater representativeness in the competitive bidding in the states of the southeast region. From the entire southeastern region, 266 competitive examinations were obtained for the position of dental surgeon, from 2001 to 2017. For the data analysis,, three categories were created: QG, for the questions that included the general questions present in the tests; QT, individual technical questions that balance the requirements related to specific knowledge; and QC, corresponding to the questions related to collective character. In all the tests analyzed, the specific knowledge (QC and QT) had a higher prevalence among the contents charged. Among the areas that involved the individual technical questions, the subjects of Surgery, Dentistry, Stomatology and Pathology were the ones with the highest prevalence. Through the results, it can be seen that the public examinations for dental surgeons who want to work in the FHS in the states of the southeast region, most of them deal with knowledge of clinical dentistry specialties. Keywords: Dentists. Health Personnel. Examination Question. Resumo O concurso público é uma das melhores formas de inserção dos profissionais de saúde na Estratégia Saúde da Família (ESF) e em outros serviços de saúde pública. O objetivo deste estudo foi verificar o perfil de provas de concursos públicos de Odontologia da região sudeste, bem como analisar a coerência entre a proposta da ESF e o conteúdo da seleção de profissionais para este cargo. Os exames foram recuperados por meio de pesquisa em dois sites bastante acessados que disponibilizam provas de concurso público no Brasil: PCI Concursos e Folha Dirigida e em sites de empresas de maior representatividade nas licitações de concurso nos estados da região sudeste. De toda a região foram obtidas 266 provas de concursos para o cargo de cirurgião dentista, no período de 2001 a 2017. Para análise dos dados foram criadas três categorias: QG, para os quesitos que englobaram as questões gerais presentes nas provas; QT, questões técnicas individuais que equivalem aos quesitos relacionados aos conhecimentos específicos; e QC, correpondendo aos quesitos relacionados ao caráter coletivo. Em todas as provas analisadas, os conhecimentos específicos (QC e QT) tiveram maior prevalência entre os conteúdos cobrados. Dentre as áreas que envolveram os quesitos técnicos individuais, as disciplinas de Cirurgia, Dentística, Estomatologia e Patologia foram as de maior prevalência. Através dos resultados, percebe-se que os concursos públicos para os cirurgiões dentistas que querem atuar na ESF nos estados da região sudeste, abordam em sua maioria conhecimentos de especialidades clínicas da Odontologia. Palavras-chave: Odontólogos. Pessoal da Saúde. Questão de Prova.
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Stein C, Santos KWD, Condessa AM, Celeste RK, Hilgert JB, Hugo FN. [Presence of Specialized Dentistry Centers and the relationship with dental extractions in the oral healthcare network in Brazil]. CAD SAUDE PUBLICA 2019; 36:e00054819. [PMID: 31939546 DOI: 10.1590/0102-311x00054819] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 06/03/2019] [Indexed: 11/21/2022] Open
Abstract
This study aimed to assess the association between the presence of Specialized Dentistry Centers and dental extractions as a proportion of all dental procedures in public services in Brazil. This was an ecological study that assessed sociodemographic data, oral health services, and outpatient production in 5,333 municipalities in 2000-2001 and 2015-2016. The principal exposure variable was the presence of Specialized Dentistry Centers, and the outcome was the mean national proportion of dental extractions in relation to all preventive and curative dental procedures. Interaction and multiple regression analyses were performed using a binomial model with log link function. The mean national proportions of dental extractions in relation to preventive and curative dental procedures were 27.07% and 15.11% in 2000-2001 and 2015-2016, respectively. In the analysis of interaction between the presence of Specialized Dentistry Centers and coverage greater than 80% by the oral health teams, there were lower proportions of dental extractions in relation to preventive and curative dental procedures (OR = 0.71; 95%CI: 0.71-0.72). In the multiple regression analysis, municipalities with Human Development Index of 0.6-0.7 (OR = 0.77; 95%CI: 0.77-0.77), annual per capita GDP greater than BRL 20,000 (OR = 0.45; 95%CI: 0.45-045), and proportionally higher urban populations (OR = 0.72; 95%CI: 0.72-0.72) showed fewer dental extractions as a proportion of all preventive and curative dental procedures in 2015-2016. In conclusion, there were lower proportions of tooth extractions in municipalities with at least one Specialized Dentistry Center and with a coverage of greater than 80% by the oral health teams, highlighting that municipalities with a consolidated Oral Health Care Network present better performance in the supply of dental care.
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Affiliation(s)
- Caroline Stein
- Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil
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Thum MA, Baldisserotto J, Celeste RK. [e-SUS AB use and factors associated with recording primary care procedures and consultations in Brazilian municipalities]. CAD SAUDE PUBLICA 2019; 35:e00029418. [PMID: 30758452 DOI: 10.1590/0102-311x00029418] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 10/22/2018] [Indexed: 11/22/2022] Open
Abstract
This article sought to evaluate e-SUS AB's impact on procedure and consultation notification in the Outpatient Information System of the Brazilian Unified National Health System (SIA/SUS) in Brazilian municipalities. This is an ecological study with longitudinal comparisons before, during and after the e-SUS AB implementation period (June 2013 to May 2015) and, during implementation, cross-sectional comparison between municipalities in completed, intermediary and initial implementation stages. Rates were described using means and standard deviations and analyzed through negative binomial regression. Municipalities where e-SUS AB had been implemented in November 2014 were small, with lower Municipal Human Development Index (HDI-M), lower per capita income, higher rates of nurses, high Family Health Strategy - (FHS) coverage (> 80%). We did not observe differences in rates of procedures or consultations between municipalities according to implementation stage and there was no increase over time. Municipalities with 100% FHS coverage had higher rates of procedures (rate ratio [RR] = 1.44; 95%CI: 1.29-1.62) and consultations (RR = 1.26; 95%CI: 1.15-1.39); municipalities with more than 100 thousand inhabitants had lower rates of procedures (RR = 0.68; 95%CI: 0.57-0.81) and consultations (RR = 0.54; 95%CI: 0.47-0.63). We found lower procedure rates in all regions when compared with the Northern Region, with the Northeastern RR of 0.34 (95%CI: 0.30-0.40) lower and the Southern Region RR of 0.35 (95%CI: 0.30-0.41) lower than the Northern Region. Further analyses of system use and its implications in teams' work processes should be carried out in order to support managers in using and maintaining the system.
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Affiliation(s)
- Moara Ailane Thum
- Programa de Pós-graduação em Avaliação de Tecnologias para o Sistema Único de Saúde, Grupo Hospitalar Conceição, Porto Alegre, Brasil
| | - Julio Baldisserotto
- Programa de Pós-graduação em Avaliação de Tecnologias para o Sistema Único de Saúde, Grupo Hospitalar Conceição, Porto Alegre, Brasil.,Faculdade de Odontologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil
| | - Roger Keller Celeste
- Faculdade de Odontologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil
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de Sousa Queiroz RC, Ribeiro AGA, Tonello AS, Pinheiro ACM, Júnior JA, Rocha TAH, da Silva NC, Costa EM, Vissoci JRN, Staton C, Facchini LA, Thomaz EBAF. Is there a fair distribution of the structure of dental services in the capitals of the Brazilian Federative Units? Int J Equity Health 2019; 18:5. [PMID: 30621709 PMCID: PMC6325759 DOI: 10.1186/s12939-018-0899-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 11/28/2018] [Indexed: 11/10/2022] Open
Abstract
Background Brazilian Primary Care Facilities (PCF) provide primary care and must offer dental services for diagnosis, prevention, and treatment of diseases. According to a logic of promoting equity, PCF should be better structured in less developed places and with higher need for oral health services. Objective To analyze the structure of dental caries services in the capitals of the Brazilian Federative Units and identify whether socioeconomic factors and caries (need) are predictors of the oral health services structure. Methods This is an ecological study with variables retrieved from different secondary databases, clustered for the level of the federative capitals. Descriptive thematic maps were prepared, and structural equations were analyzed to identify oral health service structure’s predictors (Alpha = 5%). Four models with different outcomes related to dental caries treatment were tested: 1) % of PCF with a fully equipped office; 2) % of PCF with sufficient instruments, and 3) % of PCF with sufficient supplies; 4) % of PCF with total structure. Results 21.6% of the PCF of the Brazilian capitals had a fully equipped office; 46.9% had sufficient instruments, and 30.0% had sufficient supplies for caries prevention and treatment. The four models evidenced proper fit indexes. A correlation between socioeconomic factors and the structure of oral health services was only noted in model 3. The worse the socioeconomic conditions, the lower the availability of dental supplies (standard factor loading: 0.92, P = 0.012). Estimates of total, direct and indirect effects showed that dental caries experience observed in the Brazilian population by SB-Brasil in 2010 did not affect the outcomes investigated. Conclusion Material resources are not equitably distributed according to the socioeconomic conditions and oral health needs of the population of the Brazilian capitals, thus contributing to persistent oral health inequities in the country.
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Affiliation(s)
| | | | | | | | - José Aquino Júnior
- Department of Public Health, Postgraduate Program in Environmental Health, Federal University of Maranhão, São Luís, Maranhão, Brazil
| | - Thiago Augusto Hernandes Rocha
- Pan American Health Organization, Brasilia Federal District Brazil, Brasília, Brazil.,Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Núbia Cristina da Silva
- Center for Graduate Studies and Research in Administration (CEPEAD), Faculty of Economic Sciences (FACE), Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.,Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Elisa Miranda Costa
- Graduate Program in Public Health, Federal University of Maranhão, São Luís, Maranhão, Brazil
| | | | | | - Luiz Augusto Facchini
- Department of Social Medicine, Postgraduate Programs in Epidemiology and Nursing, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Erika Bárbara Abreu Fonseca Thomaz
- Department of Public Health, Postgraduate Program in Public Health, Postgraduate Program in Dentistry, Federal University of Maranhão, São Luís, Maranhão, Brazil
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Chaves SCL, Almeida AMFDL, Reis CSD, Rossi TRA, Barros SGD. Política de Saúde Bucal no Brasil: as transformações no período 2015-2017. SAÚDE EM DEBATE 2018. [DOI: 10.1590/0103-11042018s206] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Este estudo analisou a implementação da Política de Saúde Bucal no Brasil entre 2015 e 2017 em quatro componentes: ações institucionais, implantação, financiamento e resultados. Foram realizados acompanhamento dos sites do Ministério da Saúde (MS) e coleta de dados secundários sobre ações institucionais do MS, implantação dos serviços de Atenção Básica e Atenção Especializada, resultados alcançados (cobertura da primeira consulta odontológica, média de ação coletiva de escovação supervisionada e tratamentos especializados) e financiamento. Entre 2015 e 2017, houve aumento de 5,8% no número de Equipes de Saúde Bucal e de 6,4% no número de Centros de Especialidades Odontológicas. A cobertura de primeira consulta odontológica programática decresceu no período de 14,6% em 2015, para 10,5% em 2016 e 8,3% em 2017. Houve redução discreta do financiamento federal no ano de 2017, quando comparado a 2016. Verificou-se, em 2016, um cenário político restritivo para a saúde bucal na menor implantação de novos serviços, com mudanças sucessivas na coordenação nacional da política. É necessário aprofundar o estudo sobre o financiamento da política, visto que o aporte financeiro de 2016-2017 não está coerente com o pouco avanço na implantação e tendência de manutenção de resultados, com queda de indicadores específicos, como o de primeira consulta odontológica programática.
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