Barriers to the access of people with disabilities to health services: a scoping review / Barreiras ao acesso das pessoas com deficiência aos serviços de saúde: uma revisão de escopo

ABSTRACT OBJECTIVE To analyze the scientific evidence regarding barriers to the access of people with disabilities to health services. METHODS A scoping review was carried out from the main question: "What are the main barriers that people with disabilities face in accessing health services?" The articles were surveyed in July 2019 in six scientific literature databases. Of the 1,155 documents identified in the searches, after selection by title and abstract, 170 publications were read in full and, thus, 96 articles were included and categorized according to the theoretical framework. RESULTS The main barriers indicated by the users of the service were: communication failure between professionals and patient/caregiver; financial limitations; attitudinal/behavioral issues; scarce service provision; organizational and transport barriers. The main barriers presented by service providers were: lack of training to professionals; failure of the health system; physical barriers; lack of resources/technology; and language barriers. CONCLUSIONS It was evident that people with disabilities face several barriers when trying to access the health services they need and that users and health professionals have distinct and complementary views on difficulties.

RESUMO OBJETIVO Analisar as evidências científicas relativas às barreiras para o acesso de pessoas com deficiência aos serviços de saúde. MÉTODOS Realizou-se uma revisão de escopo estabelecendo-se a perguntanorteadora: "Quais são as principais barreiras que as pessoas com deficiência enfrentam no acesso a serviços de saúde?" O levantamento dos artigos foi realizado em julho de 2019, em seis bases de dados de literatura científica. Dos 1.155 documentos identificados nas buscas, após seleção por título e resumo, foram lidas na íntegra 170 publicações e, após leitura, 96 artigos foram incluídos e categorizados conforme referencial teórico. RESULTADOS As principais barreiras indicadas pelos usuários do serviço foram: comunicação falha entre profissionais e paciente/cuidador; limitações financeiras; questões atitudinais/comportamentais; oferta de serviços escassa; barreiras organizacionais e de transporte. As principais barreiras apresentadas pelos prestadores de serviços foram: falta de treinamento/capacitação aos profissionais; falha do sistema de saúde; barreiras físicas; falta de recursos/tecnologia e barreiras de idioma. CONCLUSÕES Ficou evidente que as pessoas com deficiência enfrentam diversas barreiras ao tentarem acesso aos serviços de saúde de que necessitam e que usuários e profissionais de saúde têm visões distintas e complementares sobre as dificuldades.

Mothers of a Child with Cerebral Palsy: Perception on the Diagnosis Moment and the Child's General and Oral Health

ABSTRACT Objective: To analyze the perception of mothers of children with Cerebral Palsy (CP) on the diagnosis moment and the child's health. Material and Methods: Research with a qualitative approach, carried out with 19 mothers of children with CP, in a public higher education institution, in the state of Minas Gerais, Brazil. For data collection, the interview was used and for data interpretation, content analysis. Results: Mothers reported that the diagnosis of a child with CP resulted in major changes in the family's daily life, increasing their responsibility and demands. After the diagnosis, mothers revealed oscillating feelings, with progressively replaced by her motherly ability to take care, reestablishing the psychic balance. The health associated with the absence of disease and curative practices was frequently observed. Mothers reported a great concern with oral hygiene habits and frequent visits to the dentist. Conclusion: The diagnosis of a child with CP led to changes in the family's priorities and routine. After the moment of anguish, uncertainty and fear, the mothers accepted the reality. The biomedical principle significantly influenced the mother´s perception of health, being health perceived as the absence of disease and curative practices. In relation to oral health, practices widely spread and recommended by the media and health services, such as correct tooth brushing, showed an orientation of patients to maintain oral health.

Social, Educational and Dental Profiles of Brazilian Patients with Special Needs Attended at a Center for Dental Specialties

Objective: To identify the profiles of patients with special needs attended at a Center for Dental Specialties. Material and Methods: This was a cross-sectional and quantitative study using an inductive approach, and a comparative and statistical procedure for analysis of the patients with special needs. Information concerning socioeconomic, medical and dental conditions was collected. The data were analyzed using IBM SPSS, adopting a significance level of 5%. Results: It was observed that 58.6% of the users were males, single (54.7%), in the age group from 19 to 59 years (41.1%), being 97.4% without schooling. The most frequent clinical diagnoses were: deviations in intelligence (18.4%), behavioral deviations (18.4%) and physical defects (17.9%). We observed for oral health the presence of gingivitis (33.0%), and healthy gums (47.8%); the presence of caries (64.9%), with restored teeth (28.5%), and edentulism (12.3%). Dental intervention procedures were initiated with emphasis on: fluoride applications (39.7%) and subgingival scraping (34.9%). Topical fluoride applications (p=0.010) and prophylaxis (p=0.010) were realized in patients without autism. Also, prophylaxis (p=0.007) was more frequently performed and gingival alterations were more often verified (p=0.020) in patients without Down's syndrome. Conclusion: The users of the patients with special needs dental service can be generally described as male, single, aged between 19 and 54 years, with the special conditions of intelligence and behavioral deviation.

Oral Health Status and Treatment Needs for Children with Special Needs: A Cross-Sectional Study

Abstract Objective: To determine the oral health status along with the treatment need among Arabian children with special health care needs. Material and Methods: Fifty-seven special health care needs children aged 17 or younger, studying at RAK-RCD were recruited for the study. In addition to demographic data, the subjects were screened for the type of disability, oral health status, dental caries, occlusion abnormalities, and type of treatment required. Dental caries was recorded according to the WHO oral health survey criteria and methods. Oral hygiene status was recorded as good, fair, or poor according to the Simplified Oral Hygiene Index (S-OHI). Occlusion anomalies were categorized using Angle's classification of occlusion Results: Fifty-four subjects aged 3-17year old, comprising 70.4% males and 29.6% females participated in the study. There were 7 (13%) subjects in the 3-5 years age group, 23 (42.6%) in the 6-10 years age group, and 24 (44.4%) in the 11-17 years age group. Twenty-two (26%) subjects had Down Syndrome (DS), 14 (25.9%) Mental Disability, 9 (16.7%) Autism, 5 (9.3%) deafness and hearing loss and 4 (7.4%) multiple disabilities. Forty-six (85.2%) had dental caries with a mean dmft/DMFT score of (5.67± 4.69). Only eight (14.8%) were caries-free. Thirty-five (64.8%) had good oral hygiene, 25.9% fair oral hygiene and 9.3% poor oral hygiene, with statically insignificant differences across gender (p=0.43), age groups (p=0.11). Nevertheless, there was a significant difference between oral hygiene and the types of disabilities (p=0.0004). Up to 41% of the subjects required oral prophylaxis, 89% restorations, 13% extractions, 20% orthodontic treatment, and 11% dental prosthesis Conclusion: There was a high prevalence of dental caries and periodontal diseases among the subjects. The study highly recommends the education of the children's parents and caregivers on the need for diet modification, meticulous oral hygiene, and regular dental visits. Furthermore, there is a great deal of oral health program the RAK Rehabilitation Center for Disabled need to achieve.