The Role of Socioeconomic and Health Services Organizational Factors on Infection Control Structure Score, Brazil

This study aimed to analyze possible associations between the Infection Control Structure Score (ICSS), health services, and social characteristics of the municipalities in Brazil. Secondary data from the third cycle 2017-2018 of the Brazilian National Program for Improving Primary Care Access and Quality (PMAQ) was analyzed. Six independent variables - FIRJAN Index of Municipal Development, number of inhabitants, number of family health teams receiving a financial incentive from the federal government, healthcare expenditure per capita, and number of Oral Health Teams modalities 1 and 2 - were included to assess their influence on ICSS, measured for each Brazilian town. Data analysis used the Classification and Regression Tree model performed with IBM SPSS 25. A total of 4,900 municipalities were included, and the mean ICSS was 0.905 (±0.092). A positive relationship was observed between healthcare expenditure per capita, municipal development, and the outcome. Conversely, towns with a higher number of family health teams receiving a financial incentive from the federal government showed lower mean ICSS. The findings suggest that inequalities in the infection control structures exist within the country, and they were related to the health services and social characteristics of the municipalities.

A Description of Infection Control Structure in Primary Dental Health Care, Brazil

OBJECTIVE

This study is aimed at describing a score to assess infection control structures in Oral Health Teams (OHT) in Primary Health Care (PHC) in Brazil.

METHODS

Secondary data from a national external evaluation of PHC conducted in 2017 and 2018 were analyzed. The construction of the score used 14 variables, divided into the following: structural characteristics of the PHC, infection control equipment under conditions of use, and biosafety supplies in sufficient quantity. The questions were mostly dichotomous (yes/no). Descriptive analyses were carried out to characterize the OHT and factor analyses to reduce the number of observed variables to a specific number of factors.

RESULTS

Among 20,301 health units with OHT, 4,510 (22.2%) units did not have washable floors, ceilings, and walls; 8,406 (41.4%) did not have a sealer; 16,780 (82.7%) did not have taps with noncontact activation, and 4,663 (23.0%) units did not have rubber gloves. Regarding personal protective equipment (PPE), 1,618 (8.0%) units did not have a sufficient quantity of basic PPE. Three factors were defined to explain the 14 evaluated variables. The South region had the best score of infection control, while the North had the worst.

CONCLUSIONS

Regional inequalities in the failures in infection control structures identified in PHC with OHT were related to the physical structure, equipment, and supplies used for infection control and the absence of PPE for OHT.

A Survey About Dental Instruments at the Primary Health Care in Brazil

Abstract This study describes the structure of oral health services in primary health care in Brazil and the instruments available for the provision of oral health care and to compare the number of instruments according to organizational characteristics of health services and among the macroregions. Of the 23,251 oral health teams (OHTs) in the Public Health System, 17,513 (75.3%) participated in this study. Trained researchers observed the structures of the health services and determined the presence of and whether a sufficient quantity of 36 dental instruments existed. The score of each oral health service was determined by the sum of the number of dental instruments present in sufficient quantity (0 to 36). Central tendency measures were compared along with the variability in these scores according to the organizational characteristics of the services and according to the Brazilian macroregion. No instrument was found to be present in all evaluated services. Basic, surgical and restorative instruments were the most frequently found. Periodontal, endodontic and prosthetic instruments exhibited the lowest percentages. The mean and median numbers of dental instruments were higher for teams that operated over more shifts, those with an oral health technician and those in the South and Southeast regions. The oral health services were equipped with basic, surgical and restorative instruments. Instruments designed for periodontal diagnosis, emergency care and denture rehabilitation were less frequently found in these services. The worst infrastructure conditions existed in the OHTs with the worst forms of care organization and in regions with greater social issues.

Relação entre condição gengival e fatores sociodemográficos de adolescentes residentes em uma região brasileira

O objetivo deste artigo é relacionar as condições gengival e socioeconômica e distribuição demográfica de adolescentes residentes em uma região desfavorecida brasileira. O estudo transversal foi realizado com amostra probabilística de 450 adolescentes (15-19 anos) em 13 municípios sorteados no Vale do Jequitinhonha (MG). A condição gengival foi avaliada por um examinador calibrado (Kappa ≥ 0,85) e baseado Índice Periodontal Comunitário (CPI). Foram calculadas as frequências para indivíduos e sextantes com posterior Análise de Correspondência Múltipla (Anacor) que explorou relações entre o CPI e as características sociodemográficas. Como resultados: 16 (3,6%) apresentaram-se sem alterações gengivais, 235 (52,2%) com sangramento, 36 (8,0%) com cálculo dental e 163 (36,2%) com sangramento e cálculo. A Anacor identificou dois grupos que guardavam semelhanças entre si em relação à doença periodontal. O grupo 1 reuniu os adolescentes com CPI sadio, 19 anos de idade, que trabalham e têm maior renda familiar. No grupo de CPI com sangramento, tem-se os adolescentes com 15 e 16 anos de idade, de ambos os sexos, cursando o ensino fundamental, menor renda familiar e que se autodeclararam pardos ou negros. A gengivite foi relacionada às condições socioeconômicas e demográficas de adolescentes da região.

Utilização dos serviços de atendimento odontológico hospitalar sob sedação e/ou anestesia geral por pessoas com necessidades especiais no SUS-MG, Brasil

O presente estudo identificou as características demográficas dos indivíduos e assistenciais do tratamento odontológico sob sedação e/ou anestesia geral em ambiente hospitalar no SUS-MG. Foram avaliadas todas as Autorizações de Internações Hospitalares (AIH) para o procedimento Tratamento Odontológico para Pacientes com Necessidades Especiais, de julho de 2011 a junho de 2012. Foram mensuradas variáveis demográficas e assistenciais dos atendimentos. Foram calculadas as taxas de internações por 10.000 habitantes e a cobertura assistencial realizada no estado de Minas Gerais e em cada uma das Regiões Ampliadas de Saúde. A análise descritiva das variáveis foi feita por meio de cálculo da frequência e medidas de tendência central e variabilidade. Foram avaliadas todas as 1.063 AIH pagas no período estudado, que representaram uma taxa de 0,54 internações por 10.000 habitantes. A maioria dos indivíduos era adulta, do sexo masculino, com diagnóstico de transtornos mentais ou comportamentais e residente em 27,7% dos municípios de Minas Gerais. Os procedimentos foram realizados em 39 municípios e a cobertura assistencial foi igual a 1,58%. O estudo revelou um perfil clássico do paciente atendido. Dificuldades em se estabelecer uma rede de atenção à saúde bucal foram identificadas.

[Socioeconomic indicators and oral health services in an underprivileged area of Brazil]

OBJECTIVE

To evaluate the association between the proportion of tooth extractions, socioeconomic indicators, and the availability of oral health services in an underprivileged area of Brazil.

METHODS

An ecological study was carried out in 52 municipalities in the state of Minas Gerais, Brazil. The socioeconomic indicators employed were criteria for health care resources allocation, municipal human development index, Theil index, Gini coefficient, and sanitation conditions. Concerning the availability of oral health services, the following were considered: number of inhabitants, number of dental surgeons living in the city, number of dentists working in the public services, and number of municipal oral health care teams. The utilization of oral health services was evaluated using the indicators recommended by the Health Ministry's Basic Care Package (Pacto da Atencão Básica in Portuguese) and the number of procedures carried out in the primary care setting. The 17 variables assessed were grouped into factorial components, which were then analyzed in terms of their relationship with the dependent variable, tooth extractions.

RESULTS

The following six components explained 73.5% of the overall variance: socioeconomic conditions, social inequality, Basic Care Package indicators, number of procedures carried out, ratio of dentists to inhabitants, and coverage of the Family Health Strategy. Inequalities in income distribution (P = 0.031) and coverage by the Family Health Strategy (P = 0.015) contributed significantly to explain the difference in the proportion of tooth extractions in the different municipalities under study.

CONCLUSIONS

The dental loss observed in the region is largely explained by socioeconomic factors and aspects related to the organization of oral health services.