Determinants of oral self-care in the Brazilian adult population: a national cross-sectional study

Role of community pharmacy and pharmacists in self-care in Brazil

Global healthcare systems, including the National Health System in Brazil - one of the largest public models in the world -, continue to evolve, as well as populations' health needs, currently shaped on individuals feeling a greater desire to manage their own health. Self-care practices are part of several public policies and clinical guidelines in Brazil including the National Policy on Complementary and Integrative Practices, the National AIDS Control Program, the National Policy for Women's Health, and the Guidelines for Care of People with Chronic Diseases. There are over 100,700 community pharmacies, in the country (89.2% privately owned) employing 234,300 pharmacists, representing an important delivery point for self-care, as they are the first point of access to care for most patients. Self-medication is a common practice in Brazil (prevalence rates of self-medication ranging from 16.1% to 35.0%), especially with non-prescription/over-the-counter medicinal products (65.0%). In fact, these products represent over 25% of volume marketed of medicines, summing revenues of USD 1.9 billion per year. Studies demonstrated a positive budget impact as important savings for the National Health System due to reductions of unnecessary medical appointments and loss of working days. In addition to minor ailments management, other self-care services provided by community pharmacies that are frequently sought by Brazilian citizens (20-25% of cases) are smoking cessation and weight management (costs per service ranging from around USD 5.00-12.00). However, pharmacy services are not yet as fully integrated in Brazil to the same extent as in other countries. Barriers such as standardization of processes (from services' design, implementation, and evaluation in practice), pharmacist remuneration for the provision of services and the amount to be charged for the service are still a matter of controversy. For more rapid and sustainable advances in these practices, communication among various stakeholders, professional practice and healthcare regulations, standardization of services and financing of self-care (both publicly and privately) are urgently needed. This paper provides an overview of some self-care services provided by community pharmacies in Brazil and call attention to the ongoing challenges to move the National Health system forward.

Incisor Molar Hypomineralization and Quality of Life: A Population-Based Study with Brazilian Schoolchildren

Aim

To assess the impact of incisor molar hypomineralization (MIH) on oral health-related quality of life (OHRQoL) according to the perception of students and their parents/caregivers.

Materials and Methods

This is a cross-sectional population-based study with 463 Brazilian students aged 11-14 years. OHRQoL was measured using the Child Perceptions Questionnaire (B-CPQ_11-14ISF: 16) applied to students and the short version of the Parental-Caregiver Perceptions Questionnaire (B-P-CPQ) applied to parents/caregivers. The diagnosis of MIH followed the European Academy of Paediatric Dentistry criteria modified in 2019. Caries experience (ICDAS II), malocclusion (DAI), and socioeconomic and demographic factors were assessed as confounding factors for impact on OHRQoL. Cluster analysis was carried out to dichotomize the negative impact into greater and lesser impact. The chi-square test and Poisson regression were performed (p < 0.05) to verify associations between quality of life and MIH, adjusted for confounding variables.

Results

The prevalence of MIH was 10.8%. Multivariate regression demonstrated that caries experience was the only oral disease that impacted OHRQoL according to students' self-perception in the functional limitation domain (PR = 1.82; 95% CI = 1.20-2.77) and in the total questionnaire score (PR = 1.59; 95% CI = 1.00-2.51). However, according to the perception of parents/caregivers, in addition to caries experience, which affected OHRQoL in the oral symptoms (PR = 3.57; 95% CI = 1.71-7.414) and emotional well-being domains (PR = 1.71; 95% CI = 1.08-2.69), as well as in the total B-P-CPQ score (PR = 1.67; 95% CI = 1.01-2.76), malocclusion also affected OHRQoL in the social well-being domain (PR = 1.50; 95% CI = 1.07-2.10) and in the total questionnaire score (PR = 1.54; 95% CI = 1.11-2.15).

Conclusion

According to students and their parents/caregivers' perception, incisor molar hypomineralization did not influence OHRQoL of the studied sample.

Education-Related Inequalities in Dental Services Use among Older Adults in 23 Countries

This study aimed to measure the magnitude of education-related inequalities in the use of dental services among older adults (aged 50 y or older) from a sizable multicountry sample of 23 upper-middle- and high-income countries. This study used cross-sectional data from nationally representative surveys of people aged 50 y and over. Countries included in the Health and Retirement Study surveys were the following: Brazil, China, South Korea, Mexico, United States, Austria, Belgium, Croatia, Czech Republic, Denmark, Estonia, France, Germany, Greece, Italy, Israel, Luxembourg, Poland, Portugal, Slovenia, Spain, Sweden, and Switzerland. The dependent variable was the use of dental services, based on the self-report of having had a dental visit within the previous year, except for the United States and South Korea, which used 2-y recall periods. Educational level was used as the measure of socioeconomic position and was standardized across countries. Multivariate logistic regression modeling was used to evaluate the factors associated with the use of dental services, and the magnitude of education inequalities in the use of dental services was assessed using the slope index of inequality (SII) to measure absolute inequalities and the relative index of inequality for relative inequalities. The pooled prevalence of the use of dental services was 31.7% and ranged from 18.7% in China to 81.2% in Sweden. In the overall sample, the absolute difference in the prevalence of use between the lowest and highest educational groups was 20 percentage points. SII was significant for all countries except Portugal. Relative educational inequalities were significant for all countries and ranged from 3.2 in Poland to 1.2 in Sweden. There were significant education-related inequalities in the use of dental care by older adults in all countries. Monitoring these inequalities is critical to the planning and delivery of dental services.

Implicações da saúde bucal na esfera funcional de idosos brasileiros

Resumo Objetivo Objetivou-se, por meio do estudo da Pesquisa Nacional de Saúde (PNS-2013), identificar fatores com alto grau de associação com quadros de dificuldade funcional (DF) em idosos brasileiros. Material e método Estudo transversal, quantitativo, com fonte de dados provenientes da PNS-2013, considerando a amostra total de indivíduos com 60 ou mais anos (n=23.815). Para a análise, foram consideradas duas variáveis dependentes nomeadas de: Atividades Básicas de Vida Diária e Atividades Instrumentais de Vida Diária, e 30 variáveis independentes, relacionadas a condições sociodemográficas e de saúde bucal. O software Waikato Environment for Knowledge Analysis foi utilizado para realizar as análises. Inicialmente, realizou-se o balanceamento do conjunto de dados e, na sequência, foi realizado o teste de redução de dimensionalidade, por intermédio do método de validação cruzada de 10 Fold. Finalmente, as variáveis relacionadas com as variáveis dependentes foram avaliadas por meio da regressão logística. Resultado Os resultados apontam a direta associação de DF de idosos com aspectos etários, principalmente para octogenários (ABVD OR=2,19 e AIVD OR=2,82), seguidos de idosos sem escolaridade (AIVD OR=1,96), aqueles que não convivem com cônjuge ou companheiro (AIVD OR=1,65) e aspectos de saúde bucal, como: presença de dificuldade para se alimentar decorrente de problemas com dentes ou próteses (ABVD OR=1,73 e AIVD OR=1,59), não realização de consulta com cirurgião-dentista ao longo da vida (ABVD OR=1,69) e ausência de dentes naturais (AIVD OR=1,64). Conclusão Com base nos achados, ressalta-se a importância do fortalecimento de estratégias preventivas voltadas à parcela de indivíduos com 60 ou mais anos, incluindo a saúde bucal.

Association of Self-Perceived Oral Health and Function with Clinically Determined Oral Health Status among Adults Aged 35⁻54 Years: A Cross-Sectional Study

This study aimed to analyse the association of self-perceived oral health status (OHS) and functions with clinical OHS in Korean adults aged 35–54 years. The study was designed as a cross-sectional study using data from the Fourth Korea National Health and Nutrition Examination Survey (2007–2009). A total of 6605 subjects aged 35–54 years who completed the oral examination and questionnaires were included. An association of self-perceived OHS and functions with clinically determined OHS was confirmed by a complex-samples general linear model. Data on socioeconomic variables, i.e., household income and education level, self-perceived OHS and functions, such as chewing and speaking, were collected by trained interviewers. The clinical OHS was determined by trained dentists and included the number of untreated decayed teeth (DT); decayed, missing, and filled teeth (DMFT); prosthetic and periodontal status. The combined score was estimated as the sum of self-perceived OHS and functions. Based on the estimation coefficient, the clinical variables that were most strongly associated with self-perceived OHS and functions were, in order, periodontal status, prosthetic status, DT, and DMFT. In addition, the combined score for self-perceived OHS and functions was associated with household income, education, and clinically determined OHS.