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Silva ÉT, Ferreira RC, Diniz FC, Gomes MR, Martins AMEDBL, Chalub LLFH, Senna MIB. Disparities in the protagonism of oral health teams in the work process of Primary Healthcare. Rev Saude Publica 2024; 58:14. [PMID: 38695443 PMCID: PMC11037909 DOI: 10.11606/s1518-8787.2024058005759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 11/08/2023] [Indexed: 05/05/2024] Open
Abstract
OBJECTIVE Evaluate and compare the protagonism of Oral Health teams (OHt) in the teamwork process in Primary Healthcare (PHC) over five years and estimate the magnitude of disparities between Brazilian macro-regions. METHODS Ecological study that used secondary data extracted from the Sistema de Informação em Saúde para a Atenção Básica (SISAB - Health Information System for Primary Healthcare) from 2018 to 2022. Indicators were selected from a previously validated evaluative matrix, calculated from records in the Collective Activity Form on the degree of OHt's protagonism in team meetings and its degree of organization concerning the meeting agendas. A descriptive and amplitude analysis of the indicators' variation over time was carried out, and the disparity index was also calculated to estimate and compare the magnitude of differences between macro-regions in 2022. RESULTS In Brazil, between 3.06% and 4.04% of team meetings were led by OHt professionals. The Northeast and South regions had the highest (3.71% to 4.88%) and lowest proportions (1.21% to 2.48%), respectively. From 2018 to 2022, there was a reduction in the indicator of the "degree of protagonism of the OHt" in Brazil and macro-regions. The most frequent topics in meetings under OHt's responsibility were the work process (54.71% to 70.64%) and diagnosis and monitoring of the territory (33.49% to 54.48%). The most significant disparities between regions were observed for the indicator "degree of organization of the OHt concerning case discussion and singular therapeutic projects". CONCLUSIONS The protagonism of the OHt in the teamwork process in PHC is incipient and presents regional disparities, which challenges managers and OHt to break isolation and lack of integration, aiming to offer comprehensive and quality healthcare to the user of the Unified Health System (SUS).
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Affiliation(s)
- Érika Talita Silva
- Universidade Federal de Minas GeraisFaculdade de OdontologiaBelo HorizonteMGBrasilUniversidade Federal de Minas Gerais. Faculdade de Odontologia. Belo Horizonte, MG, Brasil.
| | - Raquel Conceição Ferreira
- Universidade Federal de Minas GeraisFaculdade de OdontologiaDepartamento de Odontologia Social e PreventivaBelo HorizonteMGBrasilUniversidade Federal de Minas Gerais. Faculdade de Odontologia. Departamento de Odontologia Social e Preventiva. Belo Horizonte, MG, Brasil
| | - Fabiano Costa Diniz
- Universidade Federal de Minas GeraisFaculdade de OdontologiaBelo HorizonteMGBrasilUniversidade Federal de Minas Gerais. Faculdade de Odontologia. Belo Horizonte, MG, Brasil.
| | - Milena Ribeiro Gomes
- Universidade Federal de Minas GeraisFaculdade de OdontologiaBelo HorizonteMGBrasilUniversidade Federal de Minas Gerais. Faculdade de Odontologia. Belo Horizonte, MG, Brasil.
| | | | - Loliza Luiz Figueiredo Houri Chalub
- Universidade Federal de Minas GeraisFaculdade de OdontologiaDepartamento de Odontologia Social e PreventivaBelo HorizonteMGBrasilUniversidade Federal de Minas Gerais. Faculdade de Odontologia. Departamento de Odontologia Social e Preventiva. Belo Horizonte, MG, Brasil
| | - Maria Inês Barreiros Senna
- Universidade Federal de Minas GeraisFaculdade de OdontologiaDepartamento de Clínica, Patologia e Cirurgia OdontológicasBelo HorizonteMGBrasilUniversidade Federal de Minas Gerais. Faculdade de Odontologia. Departamento de Clínica, Patologia e Cirurgia Odontológicas. Belo Horizonte, MG, Brasil
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da Silva BC, Buzinaro GS, Cabral JAV, da Cunha IP, de Lacerda VR, Bomfim RA. Regulation of dental consultations in primary health care and performance of services in dental speciality centers. BMC Health Serv Res 2023; 23:609. [PMID: 37296441 DOI: 10.1186/s12913-023-09597-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 05/24/2023] [Indexed: 06/12/2023] Open
Abstract
OBJECTIVE This study analyzed the regulation of dental specialty centers (CEOs) coordinated exclusively by Primary Health Care (PHC) in four primary outcomes: access and dental consultation, reception services, bonding and responsibility, and social participation. METHODS A cross-sectional study was carried out using secondary data from the National Program for the Improvement of Access and Quality of Dental Specialty Centers (PMAQ-CEO): second cycle, using multilevel logistic regression to calculate the odds ratio (OR) and individual covariates. RESULTS The analytical sample consisted of 9,599 CEO users who had completed all the variables analyzed. Of these, 63.5% were referred to the CEO by PHC. Dental care regulated by PHC was related to better access (OR 1.36, CI 95% 1.10-1.68), better reception (OR 1.33, CI 95% 1.03-1.71), better bonding and responsibility (OR 1.36, CI 95% 0.91-2.04), and social participation (OR 1.13, CI 95% 0.93-1.35) compared to those not regulated by primary health care as the exclusive pathway. CONCLUSION The regulation of access to the CEO coordinated by PHC presented the best performance. It is suggested that this form of PHC regulation, as a route for dental specialty centers, can be established in the national oral health care policy for better service performance.
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Affiliation(s)
| | | | | | - Inara Pereira da Cunha
- School of Dentistry, Federal University of Mato Grosso do Sul, Campo Grande, Brazil
- Escola de Saúde Pública, Escola de Saúde Pública de Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
| | | | - Rafael Aiello Bomfim
- School of Dentistry, Federal University of Mato Grosso do Sul, Campo Grande, Brazil.
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de Miranda Vargas DG, da Cunha AR, Probst LF, Zafalon EJ, Pereira PZ, da Silva Tagliaferro EP, De-Carli AD. Characteristics and in-hospital morbidity trends associated with oral and oropharyngeal cancers in Brazil. BMC Oral Health 2022; 22:276. [PMID: 35794558 PMCID: PMC9261028 DOI: 10.1186/s12903-022-02312-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 06/23/2022] [Indexed: 12/24/2022] Open
Abstract
Background Brazil experienced an expansion of the population's access to oral health policies after the creation of the Unified Health System (SUS, Sistema Único de Saúde). Through public policies, the consolidation of Primary Health Care (PHC) and the incorporation of dental care into primary and hospital care took place. The objective of this study was to identify epidemiological aspects, including the temporal trend, of hospital morbidity from oral and oropharyngeal cancer in Brazil, considering hospitalizations for this neoplasm in a hospital network linked to the public care system. Methods Observational study based on information on hospital admissions for oral cancer throughout Brazil. The research used data from the Brazilian Cancer Registry Information System. For the temporal series analysis, generalized linear regression model was used with the Prais-Winsten method. Results Of the 121,971 patients hospitalized with oral and oropharyngeal cancers, 76.40% were male and 23.60% were female, resulting in a M:F ratio of 3.24:1. Regarding the anatomical region of involvement among hospitalized patients with oral cavity neoplastic lesions, there was a predominance in non-specific places in the mouth, such as the floor of the mouth, soft and hard palate, among others (32.68%), followed by lesions in the region of tongue (28.89%). In this population, the predominant age group was between the fifth decade (31.09%) and sixth decade of life (24.99%); men presented neoplastic lesions of oral and oropharyngeal cancers at an earlier age than women. In all regions of the country, the staging of cases diagnosed in the tertiary health network accredited to the José Alencar Gomes da Silva National Cancer Institute (INCA) was late, with higher tendency for metastasis. The temporal trend of the adjusted in-hospital morbidity rates showed to be increasing in the Northeast, South and Midwest regions for the male gender. For females, they were increasing in the Northeast and South regions. Conclusions It is concluded that the distribution of in-hospital morbidity rates of oral and oropharyngeal cancers in the country is irregular. There is a greater number of cases identified by the study in male patients and in the Southeast and South regions; with an increasing tendency of this coefficient in both genders.
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Affiliation(s)
| | - Amanda Ramos da Cunha
- Faculdade de Odontologia, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Livia Fernandes Probst
- Unidade de Avaliação de Tecnologias em Saúde, Hospital Alemão Oswaldo Cruz (HAOC), São Paulo, Brazil
| | - Edílson José Zafalon
- Faculdade de Odontologia, Universidade Federal de Mato Grosso do Sul (UFMS), Campo Grande, Brazil
| | - Paulo Zárate Pereira
- Faculdade de Odontologia, Universidade Federal de Mato Grosso do Sul (UFMS), Campo Grande, Brazil
| | | | - Alessandro Diogo De-Carli
- Programa de Pós-Graduação em Saúde da Família, Universidade Federal de Mato Grosso do Sul (UFMS), Campo Grande, Brazil.,Faculdade de Odontologia, Universidade Federal de Mato Grosso do Sul (UFMS), Campo Grande, Brazil
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Uchida TH, Suga USG, Garcia Rodrigues C, Umeda JE, Keboa MT, Terada RSS, Fujimaki M. Oral healthcare management practices in Brazil. BRAZILIAN JOURNAL OF ORAL SCIENCES 2022. [DOI: 10.20396/bjos.v21i00.8666252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Universal health coverage is a global target included in the United Nations Sustainable Development Goals agenda for 2030. Healthcare in Brazil has universal coverage through the Unified Health System (SUS), which guarantees health as basic right to the Brazilian population. Considering the principles of SUS, public oral healthcare management is a huge challenge. Aim: To identify good management practices for quality care adopted by local public oral healthcare managers and teams around Brazil. Methods: This study was registered with PROSPERO (CRD42017051639). Five databases (PubMed, Embase, Web of Science, Scopus and Lilacs) as well as the reference lists and citations of the included publications were searched according to PRISMA guidelines. Results: A total of 30,895 references were initially found, which were evaluated according to the defined eligibility criteria. Twenty qualitative studies, eight surveys and two mixed-model studies were selected. The practices (codes) were organized into three main groups (families), and the Frequency of the Effect Size (FES) of each code was calculated. Among the 20 codes identified, the most relevant ones were: Diagnosis and Health Planning (FES=80%) and Family Health Strategy (FES=66,7). The Intensity of the Effect Size of each study was also calculated to demonstrate the individual contribution of each study to the conclusions. Conclusion: The evidence emerging from this review showed that healthcare diagnosis, planning, and performance based on the family health strategy principles were the most relevant practices adopted by public oral healthcare managers in Brazil. The widespread adoption of these practices could lead to improved oral healthcare provision and management in Brazil.
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da Costa S, Araujo PG, Frichembruder K, Hugo FN. Brazilian Oral Health Policy: metasynthesis of studies on the Oral Health Network. Rev Saude Publica 2021; 55:105. [PMID: 34932695 PMCID: PMC8664239 DOI: 10.11606/s1518-8787.2021055003454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 04/06/2021] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Analyze the performance of the oriented oral health care network from its implementation, in 2004 to 2020, according to publications on the subject. METHODS This is a research with a methodological description of metasynthesis. RESULTS The searches resulted in 600 complete publications (586 in the first search and another 14 in the second search), according to the established criteria. 539 articles were excluded: 151 after duplication analysis, 236 after reading the title, 45 by type of publication and 107 after reading the abstract, as they did not fit the research theme. Thus, 61 original publications and another 29 publications in snowball sampling were selected and analyzed, totaling 90 publications. From this selection, we chose to use the model proposed by the Projeto de Avaliações de Desempenho de Sistemas de Saúde (PROADESS - Health Systems Performance Assessment Project). The study will use its guiding principles on the dimension "Health Services Performance". CONCLUSION The analyzed set allowed us to identify that the way the Brazilian State organizes and finances oral health care made it possible to expand access and the number of procedures performed, but not the creation of an effective comprehensive care network, after more than a decade of implementation of Brasil Sorridente (Smiling Brazil).
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Affiliation(s)
- Sylvio da Costa
- Secretaria Municipal SaúdeFlorianópolisSCBrasilSecretaria Municipal Saúde. Florianópolis, SC, Brasil
| | - Pierre Guedes Araujo
- Secretaria Municipal SaúdeFlorianópolisSCBrasilSecretaria Municipal Saúde. Florianópolis, SC, Brasil
| | - Karla Frichembruder
- Universidade Federal do Rio Grande do SulFaculdade de OdontologiaCentro de Pesquisas em Odontologia SocialPorto AlegreRSBrasilUniversidade Federal do Rio Grande do Sul. Faculdade de Odontologia. Centro de Pesquisas em Odontologia Social. Porto Alegre, RS, Brasil
| | - Fernando Neves Hugo
- Universidade Federal do Rio Grande do SulFaculdade de OdontologiaDepartamento de Odontologia Preventiva e SocialPorto AlegreRSBrasilUniversidade Federal do Rio Grande do Sul. Faculdade de Odontologia. Departamento de Odontologia Preventiva e Social. Porto Alegre, RS, Brasil
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de Lara JVI, Frazão P. Oral health guidelines in the primary care policies of five selected countries: An integrative review. HEALTH POLICY OPEN 2021. [DOI: 10.1016/j.hpopen.2021.100042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Vargas DGDM, Probst LF, da Cunha AR, Tagliaferro EPDS, Zafalon EJ, Zárate-Pereira P, De-Carli AD. Inclusion of oral health teams in primary health care promotes early diagnosis of oral and oropharyngeal cancers: a nationwide study. BMC Oral Health 2021; 21:312. [PMID: 34144686 PMCID: PMC8212463 DOI: 10.1186/s12903-021-01664-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 06/01/2021] [Indexed: 12/24/2022] Open
Abstract
Background Oral and oropharyngeal cancers are considered important public health problems worldwide. This study aims to analyze the association between late diagnosis of oral and oropharyngeal cancers in Brazil and the contextual indicators of socioeconomic variables and coverage of Primary Health Care (PHC), and to assess the temporal trend of late diagnosis. Methods In this cross-sectional observational study, secondary data were evaluated with a time series analysis. All Brazilian cities that reported at least one case of oral and oropharyngeal cancers each year in the period between 2000 and 2013 were included; and the staging was analyzed by calculating the ratio risk for late diagnosis for each municipality. The association between staging and socioeconomic variables and offer of PHC was calculated using multiple linear regression. The time trend of the risk ratio for late-stage diagnosis was calculated using the Prais–Winsten method. Results One hundred and sixty Brazilian municipalities had at least one annual case of oral and oropharyngeal cancers notified to the INCA hospital system between 2000 and 2013. The adjusted model showed that the higher the Gini value (greater social inequality) and the lower the HDI value (less human development) was, the higher was the number of tumors diagnosed at a late stage, considering the size of the tumor. A greater risk for late diagnosis was identified, as early as at the stage of lymph node involvement, when there was a higher level of social inequality and lower level of coverage by Oral Health Teams (OHT) in PHC. The greater the social inequality, the greater was the risk of late diagnosis, as early as in the stage of metastasis. Conclusions We concluded that, during the evaluated period, there was an increase in the number of cases diagnosed at the most advanced stage. Furthermore, there was association between higher levels of social inequality and an increase in the proportion of late diagnosis of oral and oropharyngeal cancers. In addition, the inclusion of Oral Health Teams in Primary Health Care promoted the early diagnosis of these types of cancers. Supplementary Information The online version contains supplementary material available at 10.1186/s12903-021-01664-3.
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Affiliation(s)
- Deborah Gomes de Miranda Vargas
- Postgraduate Program in Family Health (PPGSF), Federal University of Mato Grosso Do Sul (UFMS), Campo Grande, Mato Grosso Do Sul, Brazil
| | - Livia Fernandes Probst
- Faculty of Dentistry (FAODO), Federal University of Mato Grosso Do Sul (UFMS), Campo Grande, Mato Grosso Do Sul, Brazil. .,Piracicaba Dental School (FOP), State University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil.
| | - Amanda Ramos da Cunha
- School of Dentistry, Faculty of Dentistry, Federal University of Rio Grande Do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil
| | | | - Edílson José Zafalon
- Faculty of Dentistry (FAODO), Federal University of Mato Grosso Do Sul (UFMS), Campo Grande, Mato Grosso Do Sul, Brazil
| | - Paulo Zárate-Pereira
- Faculty of Dentistry (FAODO), Federal University of Mato Grosso Do Sul (UFMS), Campo Grande, Mato Grosso Do Sul, Brazil
| | - Alessandro Diogo De-Carli
- Postgraduate Program in Family Health (PPGSF), Federal University of Mato Grosso Do Sul (UFMS), Campo Grande, Mato Grosso Do Sul, Brazil. .,Faculty of Dentistry (FAODO), Federal University of Mato Grosso Do Sul (UFMS), Campo Grande, Mato Grosso Do Sul, Brazil.
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Menezes LDS, Ceissler CAS, Cavalcanti YW, Figueiredo N, Lucena EHGD. Estudo comparativo entre indicadores assistenciais de saúde bucal na Atenção Básica em Recife, Pernambuco. SAÚDE EM DEBATE 2021. [DOI: 10.1590/0103-1104202112812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO A rede de atenção à Saúde Bucal (SB) se ampliou com a Política Nacional de Saúde Bucal, sendo os indicadores ferramentas para avaliar conquistas ou necessidade de mudanças. Este trabalho objetivou analisar indicadores de SB da Atenção Básica por tipo de organização das unidades de saúde em Recife, 2018. Trata-se de um estudo transversal, de natureza descritiva e analítica com base em dados secundários. Analisou-se a associação entre tipos de organização da Atenção Básica (Unidade de Saúde da Família - USF; Upinha e Unidade Básica Tradicional - UBT) e indicadores assistenciais de SB, através dos testes qui-quadrado e Kruskal-Wallis (p<0,05). A cobertura de primeira consulta odontológica e os procedimentos odontológicos per capita apresentaram mediana maior nas UBT, 31,8% (p=0,00) e 0,6 (p=0,127), respectivamente. A proporção de exodontia e procedimentos clínicos foi maior nas USF com mediana 8,2% (p=0,703). As USF foram as que realizaram o maior número de atividades coletivas de escovação dental supervisionada (45,3%, p=0,082) e aplicação de flúor (44,6%, p=0,174). Conclui-se que as UBT apresentaram melhores resultados nos indicadores relacionados ao acesso ao tratamento clínico e as USF realizaram mais ações coletivas de prevenção.
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Alves HFC, Collares PMC, Alves RDS, Brasil CCP, Carnaúba JP. Interprofissionalismo na Estratégia Saúde da Família: um olhar sobre as ações de promoção de saúde bucal. SAUDE E SOCIEDADE 2021. [DOI: 10.1590/s0104-12902021200648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo O trabalho interprofissional é necessário para a consolidação do modelo de atenção à saúde, porém o cirurgião-dentista encontra muitos desafios para trabalhar em equipe. Este estudo objetivou conhecer o interprofissionalismo, no âmbito da saúde bucal, entre os trabalhadores graduados da Estratégia Saúde da Família. Tratou-se de um estudo exploratório e transversal, com abordagem qualitativa, desenvolvido com 39 profissionais graduados da Atenção Básica do município de Icó, Ceará, Brasil. Os sujeitos pesquisados declararam uma deficiência na manutenção técnica nas unidades, a recorrente falta de insumos e a demanda excessiva de usuários como elementos que prejudicam o trabalho em equipe, assim como a inexistência de um plano de cargos, carreiras e salários, sendo um motivo de descontentamento entre os profissionais. Todos consideraram importante o trabalho interprofissional e sugeriram reuniões periódicas, atividades compartilhadas mais frequentes e capacitações como forma de intensificar essa ação. Apesar de o trabalho interprofissional ser reconhecido como fundamental para as ações de cuidado, é necessário mais comprometimento e apoio da gestão.
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Freire AR, Freire DEWG, de Araújo ECF, de Lucena EHG, Cavalcanti YW. Influence of Public Oral Health Services and Socioeconomic Indicators on the Frequency of Hospitalization and Deaths due to Oral Cancer in Brazil, between 2002-2017. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 18:E238. [PMID: 33396190 PMCID: PMC7795570 DOI: 10.3390/ijerph18010238] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/08/2020] [Accepted: 12/09/2020] [Indexed: 12/24/2022]
Abstract
Background: Oral cancer is a frequent neoplasm worldwide, and socioeconomic factors and access to health services may be associated with its risk. Aim: To analyze effect of socioeconomic variables and the influence of public oral health services availability on the frequency of new hospitalized cases and mortality of oral cancer in Brazil. Materials and Methods: This observational study analyzed all Brazilian cities with at least one hospitalized case of oral cancer in the National Cancer Institute database (2002-2017). For each city were collected: population size, Municipal Human Development Index (MHDI), Gini Coefficient, oral health coverage in primary care, number of Dental Specialized Centers (DSC) and absolute frequency of deaths after one year of the first treatment. The risk ratio was determined by COX regression, and the effect of the predictor variables on the incidence of cases was verified by the Hazard Ratio measure. Poisson regression was used to determine factors associated with higher mortality frequency. Results: Cities above 50,000 inhabitants, with high or very high MHDI, more unequal (Gini > 0.4), with less oral health coverage in primary care (<50%) and without DSC had a greater accumulated risk of having 1 or more cases (p < 0.001). Higher frequency of deaths was also associated with higher population size, higher MHDI, higher Gini and lower oral health coverage in primary care (p < 0.001). Conclusions: The number hospitalization and deaths due to oral cancer in Brazil was influenced by the cities' population size, the population's socioeconomic status and the availability of public dental services.
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Affiliation(s)
| | | | | | | | - Yuri W. Cavalcanti
- Graduate Program in Dentistry, Department of Clinic and Social Dentistry, Federal University of Paraíba, University City, João Pessoa-PB 58046-600, Brazil; (A.R.F.); (D.E.W.G.F.); (E.C.F.d.A.); (E.H.G.d.L.)
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Gonçalves AJG, Pereira PHS, Monteiro V, Silva Junior MF, Baldani MH. Estrutura dos serviços de saúde bucal ofertados na Atenção Básica no Brasil: diferenças regionais. SAÚDE EM DEBATE 2020. [DOI: 10.1590/0103-1104202012610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Teve-se por objetivo analisar as condições de acessibilidade, estrutura e oferta de serviços odontológicos de Unidades Básicas de Saúde com Equipe de Saúde Bucal e compará-los entre as regiões geográficas brasileiras. O estudo quantitativo, analítico e transversal utilizou dados secundários referentes aos Módulo I, V e VI da Avaliação Externa do 2º Ciclo do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB) (2013-2014). A análise descritiva foi realizada por frequências absolutas (n) e relativas (%), e houve comparação entre regiões brasileiras pelo teste qui-quadrado com uso do Teste Z ajustado pelo método Bonferroni (p<0,05). A amostra foi constituída por 24.056 Unidades Básicas de Saúde, nas quais atuavam 29.778 Equipes de Atenção Básica; destas, 16.203 (67,3%) possuíam serviços odontológicos e abrigavam 18.119 Equipes de Saúde Bucal. De maneira geral, as Unidades Básicas de Saúde apresentavam boa estrutura física, porém, baixa acessibilidade para pessoas com deficiência. Os consultórios odontológicos apresentavam estrutura física adequada e equipamentos, instrumentos e insumos odontológicos suficientes. No entanto, exibiam alta proporção na oferta de serviço mutiladores em comparação a procedimentos que evitariam as extrações dentárias, e baixa oferta de referência especializada. Além disso, houve evidenciadas desigualdades regionais, favoráveis às regiões Sul e Sudeste.
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Lima JCS, Oliveira AGRDC, Noro LRA. Advances and challenges of training in the Unified Health System based on teachers' experience in the area of Public Health in Dentistry courses. CIENCIA & SAUDE COLETIVA 2020; 26:3323-3334. [PMID: 34378719 DOI: 10.1590/1413-81232021268.09952020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 06/08/2020] [Indexed: 11/22/2022] Open
Abstract
The training directed at the Unified Health System (SUS) has been one of the most challenging assumptions in the development of Dentistry courses in Brazil. In this regard, public health educated teachers play a fundamental role in the curricular proposition favoring such an approach. This study aimed to identify the possible advances achieved in Dentistry courses and the challenges in training for the SUS. This is a quantitative, cross-sectional research with a sample of 119 teachers employing the probabilistic Snowball technique. Participants responded to a validated criteria matrix, and an exploratory factor analysis was performed for data analysis, which defined five factors responsible for training for the SUS: Primary Care; Social Responsibility and Teamwork; Health Management; Information Systems, and Continuing Education/Humanization. The study allowed identifying significant advances in the perspective of greater adequacy of the training proposal aimed at the SUS. However, some challenges to teachers require expanding the prospect to face the barriers still imposed by traditional health training.
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Affiliation(s)
- Jônia Cybele Santos Lima
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal do Rio Grande do Norte. Av. Senador Salgado Filho 300, Lagoa Nova. 59078-900 Natal RN Brasil.
| | | | - Luiz Roberto Augusto Noro
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal do Rio Grande do Norte. Av. Senador Salgado Filho 300, Lagoa Nova. 59078-900 Natal RN Brasil.
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Public oral health services performance in Brazil: Influence of the work process and service structure. PLoS One 2020; 15:e0233604. [PMID: 32469941 PMCID: PMC7259635 DOI: 10.1371/journal.pone.0233604] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 05/08/2020] [Indexed: 11/19/2022] Open
Abstract
The quality of oral health care might be evaluated based on Donabedian’s structure-process-outcome model. This study assessed the association between the oral health public services structure and work process of oral health teams (OHT) and performance indicators (access and problem-solving capacity) in Brazil. Secondary data from a national program obtained through interviews and by observation in 2013/2014 were analyzed. The performance indicators were Coverage of First Scheduled Dental Appointment (FDA) (< or ≥ the mean) and Ratio between Completed Treatments and First Scheduled Dental Appointments (CT/FDA) (< 1 or ≥ 1). The structure was assessed by the sum of available instruments, equipment, and supplies. Latent class analyses were used to identify similar groups (consolidated, developing, and incipient) of OHT according to the work process (planning of actions, health promotion and intersectoral actions, and integral health care). Each OHT was also described regarding the number of the health team in which the OHT operates, whether the primary care unit receives students/teaches, frequency of care provided outside of OHT coverage, and participation in telehealth. Multiple logistic regression models were adjusted for each performance indicator. A total of 16189 (99,8%) and 16192 (99,9%) OHTs located in 4344 (78,0%) municipalities had complete data on the work process and structure. 91.92% of OHTs presenting CT/FDA ≥ 1 and 37.05% presenting FDA ≥ the mean. Consolidated planning of actions and better structural conditions were associated with better performance. A higher frequency of CT/FDA ≥ 1 was observed among OHTs with consolidated integral health care and those that performed telehealth. OHTs that served individuals outside of OHT coverage daily and that worked with two to nine Health Teams presented a higher frequency of FDA ≥ the mean. OHTs with better structural and work process conditions had better performance.
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Gabriel M, Cayetano MH, Chagas MM, Araujo MED, Dussault G, Pucca Junior GA, Almeida FCSD. Mecanismos de ingresso de dentistas no SUS: uma agenda prioritária para o fortalecimento do Brasil Sorridente. CIENCIA & SAUDE COLETIVA 2020; 25:859-868. [DOI: 10.1590/1413-81232020253.14532018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 07/20/2018] [Indexed: 11/21/2022] Open
Abstract
Resumo Este artigo objetiva i) descrever e analisar a expansão do provimento de dentistas no Sistema Único de Saúde (SUS); ii) identificar e analisar as características do vínculo trabalhista dos dentistas com o serviço; iii) caracterizar as vagas em concurso público, no que se refere aos requisitos, atribuições e remuneração. Neste estudo de caso, descritivo, foram consultados bancos de dados do Ministério da Saúde e editais de concurso público. Os achados apontam que 48% dos dentistas cadastrados no Cadastro Nacional dos Estabelecimentos de Saúde (CNES) realizam atendimento no SUS, em 13 anos observou-se um aumento de 118% dos municípios com equipes de saúde bucal (eSB) implantadas. A cobertura populacional estimada pelas eSB aumentou 10,46% entre os anos de 2007 e 2015. O principal mecanismo de ingresso nos Centros de Especialidades Odontológicas (CEO) foi o concurso público. O salário na atenção primária variou de 1,05 a 12,67 salários mínimos, para cargos de 40 horas semanais e nos CEOs de 3,35 a 7,05. Conclui-se que é necessário, entre outras medidas, o planejamento de estratégias voltadas aos recursos humanos em saúde. A continuidade dos êxitos alcançados demanda que medidas regulatórias dos contratos de trabalho e apoio aos gestores entrem na agenda das ações da política em saúde bucal.
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Computing and Oral Health: Mobile Solution for Collecting, Data Analysis, Managing and Reproducing Epidemiological Research in Population Groups. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17031076. [PMID: 32046266 PMCID: PMC7036884 DOI: 10.3390/ijerph17031076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 01/23/2020] [Accepted: 01/24/2020] [Indexed: 11/17/2022]
Abstract
Epidemiological inquiries study and evaluate the health status of the population. For dental caries, the World Health Organization (WHO) recommends the DMFT and DMFS indexes, which represent the sum of the decayed, missing and filled teeth, divided by the population studied. Traditionally these surveys are conducted using cellulose paper sheet. This study describes the development and presents the field performance of NutriOdonto, a software created for an Oral Health Survey carried out in 2018 and 2019 involving 2578 students from the municipal schools of Palmas/TO, located in the Brazilian Amazon region. This is a descriptive, applied research on the development of a software for the collecting, analysis, management and reproducibility of oral health epidemiological research. A software applied to the collecting, analysis and formation of the database was developed through the information obtained from the questionnaires applied to the participants of the study and the completion of the electronic oral examination form. Recent Information and Communication Technologies (ICT) are intelligently configured to create models and mobile applications (Apps) that can be useful to manage health issues, thus broadening the perspective of service provision in this sector. Some of these mobile devices, tablets and smartphones are being developed to generate information, for collection, recording, storage and analysis of oral health epidemiological research data. NutriOdonto contributed to the rapid collection, recording and storage of information, in the construction of the database and its analysis. Replacing paper forms with electronic forms minimized possible typos, reduced the use of cellulose paper and the financial costs, among other things. This software can contribute to decision making by managers and professionals and to improving the planning and implementation of actions in health promotion and oral disease prevention.
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Cunha ARD, Prass TS, Hugo FN. Mortality from oral and oropharyngeal cancer in Brazil: impact of the National Oral Health Policy. CAD SAUDE PUBLICA 2019; 35:e00014319. [PMID: 31800779 DOI: 10.1590/0102-311x00014319] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 06/03/2019] [Indexed: 11/22/2022] Open
Abstract
The objective was to investigate if there is an association between the mortality rates due to oral and oropharyngeal cancer in Brazil and the expansion of access to public primary and specialized dental care services that resulted from the implementation of the National Oral Health Policy, between 2000 and 2013. The mortality data were obtained from the records of the Mortality Information System and the exposure variables were obtained from databases of the Brazilian Ministry of Health and the Brazilian Institute of Geography and Statistics. The main exposures investigated were "coverage of primary dental care" and "number of specialized dental care centers". Additional covariates included "Gini index of household income", "average number of years of study", "proportion of unemployed people" and "proportion of smokers". For the statistical analysis, a random coefficient model was used. There was a statistically significant association between the mortality rates by oral and oropharyngeal cancer with coverage by primary dental care and the number of specialized dental care centers with males. This study found that the expansion of the coverage of primary dental care and the number of specialized dental care centers are associated with the reduction of mortality rates due to oral and oropharyngeal cancer in Brazil. There is plausibility for the association found, which needs to be confirmed by implementation studies.
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De Almeida Lima C, Souto Moreira K, Silva Barbosa BC, De Souza Junior RL, De Quadros Coelho Pinto M, De Melo Costa S. Atenção integral à comunidade: autoavaliação das equipes de saúde da família. AVANCES EN ENFERMERÍA 2019. [DOI: 10.15446/av.enferm.v37n3.76998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Objetivo: analisar a autoavaliação das equipes de saúde da família quanto à atenção integral à saúde da comunidade.Método: pesquisa transversal analítica, em cidade polo do estado de Minas Gerais, Brasil. Todas as 75 equipes existentes na cidade, no período de coleta dos dados, estavam aderidas ao programa de avaliação. As equipes com ausência de informações nos 35 padrões de qualidade analisados foram excluídas. Analisaram-se 35 itens da subdimensão atenção integral, da “Autoavaliação para Melhoria do Acesso e da Qualidade da Atenção Básica”, instrumento validado pelo Ministério da Saúde brasileiro. Foram processadas análises estatísticas descritivas e bivariadas pelos testes Likelihood ratio, Anova e correlação de Pearson, para comparar a autoavaliação segundo localização (urbana e rural) e profissionais componentes das equipes.Resultados: entre as equipes, 38 (54,28 %) ficaram no nível satisfatório e sete (10 %) no insatisfatório. Houve melhor classificação para aquelas da área urbana (p = 0,010). As categorias profissionais técnico em enfermagem (p = 0,030), médico (p = 0,018), cirurgião-dentista (p = < 0,001) e auxiliar/técnico em odontologia (p = 0,001) se correlacionaram positivamente com maior pontuação.Conclusões: evidenciou-se necessidade de aprimoramento da performance das equipes. Os achados trazem implicações para gestores e profissionais com impacto no cuidado e na atuação do enfermeiro.
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Silva-Oliveira F, Andrade CI, Guimarães MO, Ferreira RC, Ferreira EF, Zarzar PM. Recognition of child physical abuse by a group of Brazilian primary care health professionals. Int J Paediatr Dent 2019; 29:624-634. [PMID: 31071237 DOI: 10.1111/ipd.12506] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 04/16/2019] [Accepted: 05/02/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Child maltreatment is a complex social and public health problem. AIM To evaluate the frequency of the recognition by Brazilian health professionals in primary care of child physical abuse (CPA) and associated factors. DESIGN A representative cross-sectional study was conducted with dentists, nurses, family physicians, and pediatricians who participated in the network of the Family Health Strategy in the city of Belo Horizonte, Brazil. Data collection involved in the administration of a questionnaire validated for use in Brazil. Data were collected from 181 dentists, 235 nurses, 203 family physicians, and 96 pediatricians. RESULTS Among the 715 health professionals, 499 (69.8%) had some type of postgraduate degree and 414 (57.9%) recognized suspected or proved cases of CPA. The recognition was associated with occupation, as pediatricians recognized 14.11-fold [OR = 14.11 (95% CI: 3.73 to 53.43)] more cases of CPA compared with dentists. The recognition was also associated with a longer period of time working in the city [OR = 2.79 (95% CI: 1.24 to 6.29)]. CONCLUSION The recognition of cases was positively associated with the longer working time in the municipal network and with pediatricians. The dentist was the category that was least associated with the recognition of CPA.
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Affiliation(s)
| | | | | | - Raquel Conceição Ferreira
- Department of Social and Preventive Dentistry, Faculty of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Efigênia Ferreira Ferreira
- Department of Social and Preventive Dentistry, Faculty of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Patrícia Maria Zarzar
- Department of Pediatric Dentistry and Orthodontics, Faculty of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Cruz ACPDS, Lucas SD, Zina LG, Pinto RDS, Senna MIB. Factors associated with the inclusion of oral health technicians into the public health service in Brazil. HUMAN RESOURCES FOR HEALTH 2019; 17:35. [PMID: 31126300 PMCID: PMC6534839 DOI: 10.1186/s12960-019-0371-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 05/02/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND The number of oral health technicians (OHT) in the public health service in Brazil is lower than the number of training school graduates. Thus, the objective of this study was to investigate possible factors associated with the inclusion of OHT in the public health service in Minas Gerais, Brazil, and its implications on oral health indicators. METHODS This cross-sectional ecological study used a database (Excel) composed of 122 municipalities that participated in an OHT training course that took place between 2012 and 2013. Municipal contextual variables, including oral health indicators and sociodemographic indicators, related to the organization of health services were incorporated before and after the course. The dependent variable was the entry of graduates into the public health service according to a self-report survey conducted in 2015. A descriptive analysis of the variables was carried out, followed by bivariate analyses between the independent variables and the dependent variable using Pearson's chi-square test. The independent variables selected for multivariate logistic regression were statistically significant at p < 0.20. In the final model, significant effects were identified for variables with p < 0.05. The statistical software SPSS 18.0 for Windows was used. RESULTS After the course, the variable of the public service organization and the two variables of oral health indicators were associated with the outcome. The organization services variable "presence of oral health team modality II" and the variable "indicator of coverage of first dental programmatic consultation" presented an association tendency with the entry of OHT in the multivariate logistic regression model, but these associations were not statistically significant because they had significance levels of p = 0.075 and p = 0.191, respectively. The variable "collective action indicator supervised dental brushing" was associated with the entry of egress (p = 0.045) remaining in the final model. CONCLUSION The model of organization of the oral health service formed through the implementation of modality II oral health teams positively influenced the inclusion of OHT in the public health service in Minas Gerais, with improvement in the oral health indicators of the municipalities.
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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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Rossi TRA, Chaves SCL, Almeida AMFDL, Santos CML, Santana SFD. O financiamento federal da política de saúde bucal no Brasil entre 2003 e 2017. SAÚDE EM DEBATE 2018. [DOI: 10.1590/0103-1104201811903] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Este estudo descreveu e analisou os repasses financeiros federais para a Política Nacional de Saúde bucal (PNSB) no período 2003-2017. Realizou-se análise retrospectiva do financiamento federal da PNSB com dados coletados da base do Fundo Nacional de Saúde, nas rubricas relacionadas com a saúde bucal com correção de valores pelo Índice de Preços ao Consumidor (IPCA) até 2017. A série histórica dos repasses para a atenção em saúde bucal no período 2003-2017 mostrou um gasto federal crescente até 2012, com queda no início de 2013, manutenção de valores de 2013 a 2016 e discreta redução em 2017, chegando a R$ 1.059.555.548,48 neste último ano. Isso significou que o percentual de repasse do governo federal para a saúde bucal em relação ao repasse total passou de 0,62% em 2003 para 1,63% em 2017. Observou-se um aumento da participação percentual do financiamento da Atenção Especializada, principalmente a partir de 2013, passando de 2,3% em 2008 para 21,6% em 2017. A Atenção Básica recebia 97,3% do financiamento federal em 2003 e apenas 78,3% em 2017. Medidas de austeridade fiscal e mudanças nos blocos de financiamento podem indicar um caminho institucionalizado de redução dos repasses federais na saúde que poderão impactar nessa política setorial específica.
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Contribuição para uma agenda política estratégica para a Atenção Primária à Saúde no SUS. SAÚDE EM DEBATE 2018. [DOI: 10.1590/0103-11042018s128] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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Carreiro DL, Souza JGS, Coutinho WLM, Ferreira RC, Ferreira EFE, Martins AMEDBL. [The use of dental services on a regular basis in the population of Montes Claros in the State of Minas Gerais, Brazil]. CIENCIA & SAUDE COLETIVA 2017; 22:4135-4150. [PMID: 29267730 DOI: 10.1590/1413-812320172212.04492016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 05/09/2016] [Indexed: 11/22/2022] Open
Abstract
The use of dental services on a regular basis by residents of Montes Claros (MG) was assessed, as well as related aspects. Cross-sectional study was conducted with a complex probabilistic sample by conglomerates. Logistic regression was used (OR/CI95%) with a significance level of 5. Of the 2582 study participants, 761 required and obtained access to the services for less than a year. Of these, 262 (35.8%) used the services in a regular/routine manner. The use of dental services on a regular basis was greatest among individuals in the age group "≥ 18 ≤ 37"; with schooling "equal to or greater than 9 years"; who classified their oral health, general health and appearance of teeth and gums as "excellent/good"; who reported no pain" on teeth and gums over the last six months; They reported that the "assistance provider had adequate skills"; that they "always/often" received information about oral hygiene and diet/nutrition. In addition, this use was lower among those who rated the time to ask questions about the dental problem or treatment as "regular/bad/terrible." The conclusion drawn is that the use of dental services on a regular basis was relatively low, being associated with personal traits, subjective health conditions and characteristics related to the services.
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Affiliation(s)
- Danilo Lima Carreiro
- Instituto Federal de Educação, Ciência e Tecnologia do Norte de Minas. R. Cel. Luís Píres 202, Centro. 39400-106 Montes Claros MG Brasil.
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Rocha TAH, Thomaz EBAF, da Silva NC, de Sousa Queiroz RC, de Souza MR, Barbosa ACQ, Thumé E, Rocha JVM, Alvares V, de Almeida DG, Vissoci JRN, Staton CA, Facchini LA. Oral primary care: an analysis of its impact on the incidence and mortality rates of oral cancer. BMC Cancer 2017; 17:706. [PMID: 29084516 PMCID: PMC5661925 DOI: 10.1186/s12885-017-3700-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 10/22/2017] [Indexed: 02/07/2023] Open
Abstract
Background Oral cancer is a potentially fatal disease, especially when diagnosed in advanced stages. In Brazil, the primary health care (PHC) system is responsible for promoting oral health in order to prevent oral diseases. However, there is insufficient evidence to assess whether actions of the PHC system have some effect on the morbidity and mortality from oral cancer. The purpose of this study was to analyze the effect of PHC structure and work processes on the incidence and mortality rates of oral cancer after adjusting for contextual variables. Methods An ecological, longitudinal and analytical study was carried out. Data were obtained from different secondary data sources, including three surveys that were nationally representative of Brazilian PHC and carried out over the course of 10 years (2002–2012). Data were aggregated at the state level at different times. Oral cancer incidence and mortality rates, standardized by age and gender, served as the dependent variables. Covariables (sociodemographic, structure of basic health units, and work process in oral health) were entered in the regression models using a hierarchical approach based on a theoretical model. Analysis of mixed effects with random intercept model was also conducted (alpha = 5%). Results The oral cancer incidence rate was positively association with the proportion of of adults over 60 years (β = 0.59; p = 0.010) and adult smokers (β = 0.29; p = 0.010). The oral cancer related mortality rate was positively associated with the proportion of of adults over 60 years (β = 0.24; p < 0.001) and the performance of preventative and diagnostic actions for oral cancer (β = 0.02; p = 0.002). Mortality was inversely associated with the coverage of primary care teams (β = −0.01; p < 0.006) and PHC financing (β = −0.52−9; p = 0.014). Conclusions In Brazil, the PHC structure and work processes have been shown to help reduce the mortality rate of oral cancer, but not the incidence rate of the disease. We recommend expanding investments in PHC in order to prevent oral cancer related deaths. Electronic supplementary material The online version of this article (10.1186/s12885-017-3700-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Thiago Augusto Hernandes Rocha
- Federal University of Minas Gerais, School of Economics, Center of post-graduate and Research in Administration, Belo Horizonte, Minas Gerais, Brazil. .,Business Administration Department - Observatory of human resources for health, Universidade Federal de Minas Gerais, Antonio Carlos, avenue, 6627, Belo Horizonte, Minas Gerais, Brazil.
| | | | | | | | | | - Allan Claudius Queiroz Barbosa
- Faculty of Economics, Department of Administrative Sciences, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Elaine Thumé
- Faculty of Nursing, Department of Collective Health, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | | | - Viviane Alvares
- National School of Public Health, Nova University of Lisbon, Lisboa, Portugal
| | | | - João Ricardo Nickenig Vissoci
- Duke Division of Emergency Medicine, Duke University Health System, Duke Global Health Institute, Duke University, Durham, USA
| | - Catherine Ann Staton
- Duke Division of Emergency Medicine, Duke University Health System, Duke Global Health Institute, Duke University, Durham, USA
| | - Luiz Augusto Facchini
- Faculty of Medicine, Department of Social Medicine, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
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Lima AMC, Garbin CAS, Garbin AJÍ, Aragão ERVF, Lima BMC, Canuto OMC, Moimaz SAS. INSERÇÃO DO TÉCNICO EM SAÚDE BUCAL NO SISTEMA ÚNICO DE SAÚDE: A INSTABILIDADE DOS VÍNCULOS DE TRABALHO E A DESVALORIZAÇÃO PROFISSIONAL. TRABALHO, EDUCAÇÃO E SAÚDE 2016. [DOI: 10.1590/1981-7746-sol00029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo A Política Nacional de Saúde Bucal destaca a importância da formação de pessoal auxiliar para a sua consolidação. Este estudo avaliou a inserção de técnicos em saúde bucal formados pela Escola de Saúde Pública do Ceará no Sistema Único de Saúde. Trata-se de estudo descritivo com abordagem qualitativa, desenvolvido em duas etapas. Na primeira, traçou-se o perfil profissional de 573 técnicos em saúde bucal ex-alunos da Escola. Na segunda, foram realizados grupos focais e utilizada a técnica de análise de conteúdo, na modalidade temática. A pergunta direcionadora foi: que aspectos influenciam na inserção dos técnicos em saúde bucal no Sistema Único de Saúde? Verificou-se que 73,3% estavam no Cadastro Nacional de Estabelecimentos de Saúde. Destes, 20,7% estavam cadastrados como técnico em saúde bucal e 67,9% como auxiliar de saúde bucal. Nos grupos focais, foram identificadas três categorias temáticas: interesse dos gestores; tipo de vínculo de trabalho; e valorização profissional. Concluiu-se que a maioria estava inserida no Sistema Único de Saúde, mas como auxiliar de saúde bucal. Na visão dos egressos, faltam interesse por parte dos gestores para contratação de técnicos em saúde bucal, vínculos de trabalho mais estáveis e maior valorização profissional.
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Costa CPS, Aires BTC, Thomaz EBAF, Souza SDFC. Dental care provided to sickle cell anemia patients stratified by age: A population-based study in Northeastern Brazil. Eur J Dent 2016; 10:356-360. [PMID: 27403053 PMCID: PMC4926588 DOI: 10.4103/1305-7456.184149] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Objective: To assess differences in the dental care provided to sickle cell anemia (SCA) patients depending on age. This retrospective study used secondary data from the dental records of the Center of Hematology and Hemotherapy in Maranhão (HEMOMAR). Materials and Methods: Data were obtained from 574 dental records of patients with SCA treated or under treatment in the Dental Department of HEMOMAR from 2000 to 2011. Data on the gender, age, duration of dental treatment, number of patients submitted to periodontal treatment (PT), number of filled teeth (FT), teeth extracted (EX), endodontically treated teeth (ET), and reason for the dental procedures were collected. The Kruskal–Wallis test together with Dunn's post hoc test, Chi-square test, and Spearman's correlation was used for statistical analysis. An alpha error of 5% was considered acceptable. Results: Significant differences were found for FT, EX (P < 0.05), ET and PT (P < 0.001) between the age groups. There were fewer FT in children compared to other age groups (P < 0.001). The most common reasons for restorations and endodontic treatment were dental caries (100%) and irreversible pulpitis (55.6%), respectively. The main reasons for teeth extractions were residual roots (21.3%), chronic apical periodontitis (19.7%), and crown destruction (19.3%). There were positive correlations between age and EX (r = 0.93; P = 0.025) and ET (r = 0.92; P = 0.028). Conclusions: FT, ET, EX, and PT procedures become more common in older patients. Tooth decay is the main reason for dental treatment in SCA patients.
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Fonseca LLV, Nehmy RMQ, Mota JAC. [The social value of teeth and access to dental health services]. CIENCIA & SAUDE COLETIVA 2015; 20:3129-38. [PMID: 26465855 DOI: 10.1590/1413-812320152010.00172015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Accepted: 05/06/2015] [Indexed: 11/22/2022] Open
Abstract
Oral healthcare provided by the Unified Health System (SUS) faces the challenge of attending the epidemiological profile of Brazil's adult population. Qualitative research using semi-structured interviews was conducted to understand the experiences, expectations and perception of SUS users to services in Diamantina, State of Minas Gerais, and content analysis was used to assess the data. Discussion of the results was based on dialogue between the symbolic interactionism of Goffman and Bourdieu's concept of habitus. The results show that the users did not give importance to dental care during childhood and adolescence because care was unknown to them. There was no offer of treatment besides dental extraction. Today, they value teeth and suffer the embarrassment caused by rotten teeth. However, access to dental restoration via SUS is not possible. For their children, they perceive better access to information and care, but for specialized procedures there are barriers. They express resignation both in relation to the poor state of the teeth and the difficulties of access to dental care, which can be understood by the constant exclusion experienced by them in the past, shaping their actions in the present. It was concluded that oral health in SUS should incorporate the social value and the aesthetic dimension of teeth as a social right.
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Affiliation(s)
- Luciara Leão Viana Fonseca
- Departamento de Odontologia, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, MG, Brasil,
| | - Rosa Maria Quadros Nehmy
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade Federal de Minas Gerais, Brasil
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Aquilante AG, Aciole GG. [Building a "Smiling Brazil"? Implementation of the Brazilian National Oral Health Policy in a health region in the State of São Paulo]. CAD SAUDE PUBLICA 2015; 31:82-96. [PMID: 25715294 DOI: 10.1590/0102-311x00193313] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 08/29/2014] [Indexed: 11/22/2022] Open
Abstract
This paper is a case study on the implementation of the Brazilian National Oral Health Policy (PNSB), known as "Smiling Brazil", in the cities of the Regional Health Department of Araraquara (DRS III) in São Paulo State. A structured questionnaire was given to the municipal oral health coordinators, an interview with oral health care professionals and managers was conducted, and the official data provided by the Brazilian Ministry of Health were coded to assess the policy's scope: (i) expansion and qualification of actions; (ii) work conditions; (iii) care; (iv) access; and (v) planning and management. The quantitative and qualitative analyses were linked by methods triangulation. In terms of PNSB implementation, the majority of the cities (52.6%) were classified as "good", with 42.1% classified as "bad". Approximately 10 years after launching the PNSB, despite strides in oral health care and access to different levels of care, the cities still experience difficulties in implementing the policy's principles.
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De-Carli AD, Santos MLDMD, Souza ASD, Kodjaoglanian VL, Batiston AP. Visita domiciliar e cuidado domiciliar na Atenção Básica: um olhar sobre a saúde bucal. SAÚDE EM DEBATE 2015. [DOI: 10.1590/0103-110420151050002012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
O objetivo do presente trabalho foi analisar o processo de atenção domiciliar nas Equipes de Atenção Básica que aderiram ao Programa Nacional de Melhoria do Acesso e da Qualidade. Realizou-se um estudo a partir do banco de dados do programa relativos à dimensão que avaliou a realização de visita domiciliar e cuidado domiciliar, com ênfase nas práticas das Equipes de Saúde Bucal. Quase 100% das Equipes de Saúde da Família avaliadas realizam visita domiciliar. O cuidado no domicílio é realizado por mais de 90% dos profissionais da equipe mínima, e por aproximadamente 50% dos profissionais da saúde bucal. A saúde bucal tem desafios a superar em direção a novas práticas na Atenção Básica.
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Reis WG, Scherer MDDA, Carcereri DL. O trabalho do Cirurgião-Dentista na Atenção Primária à Saúde: entre o prescrito e o real. SAÚDE EM DEBATE 2015. [DOI: 10.1590/0103-110420151040608] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
No cenário mundial, o Cirurgião-Dentista atua, sobretudo, no setor privado. No Brasil, esta realidade começa a mudar com a inclusão desse profissional na Estratégia Saúde da Família (ESF). Este estudo de caso realizado no Centro-Oeste do Brasil busca compreender o trabalho do dentista nesse contexto, através de análise documental, observação do trabalho e entrevistas. Da análise temática de conteúdo emergiram duas categorias: condições para o trabalho na ESF e modo de trabalho na ESF. A influência histórica do modelo de atenção individual, o contexto adverso do trabalho, as concepções de ESF dos profissionais e a autonomia que lhes é conferida restringem sua atuação.
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Aquilante AG, Aciole GG. Oral health care after the National Policy on Oral Health - "Smiling Brazil": a case study. CIENCIA & SAUDE COLETIVA 2015; 20:239-48. [PMID: 25650618 DOI: 10.1590/1413-81232014201.21192013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 03/21/2014] [Indexed: 11/22/2022] Open
Abstract
In 2004, the National Oral Health Policy (PNSB) - Smiling Brazil was launched. Its guidelines seek to qualify Primary Health Care, ensure comprehensive actions, work on the basis of health surveillance, plan actions in accordance with the epidemiology and information available on the territory, financing and scheduling the research agenda so that the work can be based on scientific evidence. The purpose of this case study was to investigate the perspectives of health care professionals and managers on oral health care after launching the PNSB. For the gathering of information, an oral interview was conducted with health care professionals and managers and direct observation of oral health services. The interpretation of meaning method was used for analysis of the interviews. Approximately 10 years after launching the PNSB, even though the care and the oral health actions have been amplified and qualified, the cities still find it difficult to implement their basic premises.
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Affiliation(s)
- Aline Guerra Aquilante
- Programa de Pós-Graduação em Saúde Coletiva, Departamento de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil,
| | - Geovani Gurgel Aciole
- Programa de Pós-Graduação em Saúde Coletiva, Departamento de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil,
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Nunes Neto TDA, Thomaz EBAF, Ferreira MC, Santos AMD, Queiroz RCDS. [Dental spacing problems and associated factors among Brazilian adolescents]. CIENCIA & SAUDE COLETIVA 2014; 19:4555-68. [PMID: 25351321 DOI: 10.1590/1413-812320141911.15932013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2013] [Accepted: 08/27/2013] [Indexed: 11/22/2022] Open
Abstract
The scope of this study was to estimate the prevalence of dental spacing problems and associated factors among adolescents using data from the SB Brazil 2010 survey. The outcomes evaluated were dental spacing problems: space deficit (crowding and misalignment) and excess space (diastema and spacing) obtained using the DAI index. The association of independent variables with outcomes was assessed using a hierarchical model with four levels: contextual, socioeconomic and demographic characteristics, access to services and dental morbidity. Statistical analysis was performed using the chi-square test and univariate and multivariate Poisson distribution to estimate prevalence ratios (PR). The overall prevalence of space problems was 71.43%, with misalignment being the most common type (56.4%). The following aspects were significantly associated with excess space: age of 16, 18 and 19 years; being non-Caucasian (PR = 1.75), perception of speech problems (PR = 1.72) and periodontal pockets 4-5mm (RP = 1.56). For space deficit: family income up to 3 minimum wages, dental visit 1 year or more previously (PR = 1.19) and having one or more decayed teeth on average (PR = 1.32). There was a prevalence of spacing problems, especially with socioeconomic and demographic variables and morbidity as potential risk factors.
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Lourenço EDC, Guerra LM, Tuon RA, Vidal e Silva SMC, Ambrosano GMB, Corrente JE, Cortellazzi KL, Vazquez FDL, Meneghim MDC, Pereira AC. Variáveis de impacto na queda da mortalidade infantil no Estado de São Paulo, Brasil, no período de 1998 a 2008. CIENCIA & SAUDE COLETIVA 2014; 19:2055-62. [DOI: 10.1590/1413-81232014197.18822013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Accepted: 11/01/2013] [Indexed: 11/22/2022] Open
Abstract
Trata-se de estudo ecológico analítico, retrospectivo, composto pelos 645 municípios do Estado de São Paulo, cujo objetivo foi verificar a relação entre variáveis socioeconômicas, demográficas e modelo de atenção, em relação ao coeficiente de mortalidade infantil, no período de 1998 a 2008. Foi calculada a proporção de variação média anual para cada indicador por estrato de cobertura. A mortalidade infantil foi analisada segundo modelo de medidas repetidas no tempo, ajustado para as variáveis de correção: população do município, proporção de PSF implantado, proporção de PACS implantado, PIB per capita e IPRS (índice paulista de responsabilidade social). A análise foi realizada por modelos lineares generalizados, considerando a distribuição gama. Comparações múltiplas foram realizadas pela razão de verossimilhança com distribuição aproximada qui-quadrado, considerando-se nível de significância de 5%. Houve diminuição da mortalidade infantil no decorrer dos anos (p < 0,05), não havendo diferença significativa de 2004 a 2008 (p > 0,05). A proporção de PSF implantado (p < 0,0001) e o PIB per capita (p < 0,0001) foram significativos no modelo. A queda da mortalidade infantil no período analisado foi influenciada pelo crescimento do PIB per capita e pelo modelo Saúde da Família.
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