RESUMO
Introduction: Use of telehealth (TH) resources increased dramatically during the COVID-19 pandemic. This study set out to examine associations between the level of integration of TH resources and the level of Primary Health Care (PHC) structuring to deal with the COVID-19 pandemic in the State of Minas Gerais, Brazil. Methods: This work was a cross-sectional study conducted through the application of a semistructured questionnaire to a sample of 260 PHC Teams working in the state of Minas Gerais, Brazil, from September to December 2020. This study was approved by the Research Ethics Committee and logged under report number 44.294.637. Results: Two variables were created - Level of the PHC structuring to deal with the COVID-19 pandemic and Level of TH structuring. Variables were grouped into five categories (poor to excellent). Associations between variables were examined using the Tukey's test for multiple comparisons and the Spearman correlation coefficient. Variables associated with socioeconomic dimensions (human development index and Gini index) and health care were also analyzed. Levels of TH structuring in PHC ranged from poor (43%) to regular (40%) in most cases. Most PHC teams had regular (56%) or good (37%) levels of PHC structuring to deal with the pandemic. The greater the availability and use of TH resources at a given unit, the better the structure to face COVID-19 (0.45 - p < 0.001). Conclusion: PHC was structured to tackle the pandemic. However, there is a lot to be done before TH resources are effectively incorporated into PHC. Whenever incorporated, TH resources contributed to a more robust response to the COVID-19 pandemic.
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COVID-19 , Telemedicina , Humanos , Pandemias , Brasil/epidemiologia , Estudos Transversais , COVID-19/epidemiologia , Atenção Primária à SaúdeRESUMO
OBJECTIVE: To provide the prevalence and an overview of cleft lip and palate (CL/P) in the period of 2008 to 2017, as well as the profile of care provided for this condition in Brazil. DESIGN: Cross-sectional study of epidemiological character. SETTING: Brazilian government website. PARTICIPANTS: National Live Birth and Hospital Information System. INTERVENTION: Organization of the end databases and performance-based statistical analysis. MAIN OUTCOME MEASURE(S): Analysis of the prevalence of CL/P in newborns, sociodemographic condition of the mothers, surgical procedures and hospitalizations, and specialized hospitals in Brazil within a 10-year period. RESULTS: The average prevalence of CL/P in Brazil was â¼52 children per 100â 000 live births in the covered period, corresponding to 1 per 1924 newborns. The presence of cleft was associated with preterm birth, being underweight, and the male gender. The highest prevalence was found in the South region, while the lowest was found in the Northeast region, with increasing rates in the North region of Brazil. The states with the highest prevalence were not those with a great number of hospitalizations and surgical procedures for live births with CL/P. CONCLUSION: In the 10-year study period, the prevalence of CL/P was 0.52 newborns per 1000 live births, a result which differs among the states of Brazil. The need to reinforce the national monitoring of the prevalence and surgical procedures of cleft patients have also emphasized the need to improve public medical care for CL/P subjects.
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Fenda Labial , Fissura Palatina , Nascimento Prematuro , Gravidez , Feminino , Criança , Recém-Nascido , Humanos , Masculino , Fenda Labial/epidemiologia , Fenda Labial/cirurgia , Fissura Palatina/epidemiologia , Nascido Vivo/epidemiologia , Brasil/epidemiologia , Estudos Transversais , Seguimentos , PrevalênciaRESUMO
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.
Assuntos
Higienistas Dentários/organização & administração , Administração em Saúde Pública , Brasil , Estudos Transversais , Assistência Odontológica/organização & administração , Higienistas Dentários/estatística & dados numéricos , Indicadores Básicos de Saúde , Humanos , Saúde Bucal/estatística & dados numéricos , Administração em Saúde Pública/métodos , Administração em Saúde Pública/estatística & dados numéricos , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Studying the factors associated with the use of dental services can provide the necessary knowledge to understand the reasons why individuals seek out public healthcare services and the formulation of more appropriate public policies for the present-day reality. METHODS: This work was a cross-sectional epidemiological study consisting of a sample of adults found in a research databank concerning the conditions of the oral health of the population of the state of Minas Gerais, Brazil. This study examined both main oral health disorders and relevant socioeconomic aspects. The dependent variable was defined as the type of service used, categorized under public and private use. The independent variables were selected and grouped to be inserted in the analysis model according to an adaptation of the behavioral model described by Andersen and Davidson. A hierarchical model was used to analyze the data. The description of variables and bivariate analyses were performed in an attempt to verify possible associations. For each group of variables at each hierarchical level, the gross and adjusted odds ratios (OR) and the respective 95% confidence intervals (CI) were estimated by means of logistic regression. The Complex Samples model from the SPSS statistics program, version 19.0, was used to analyze the sample framework. RESULTS: In the final model, the factors associated with the use of public healthcare services by adults were directly related to the socioeconomic and demographic conditions of the individuals, including: being of a dark-skinned black race/color, belonging to families with more than four household residents and with a lower income level, residing in small towns, having more teeth that need treatment. CONCLUSIONS: According to the findings from this study, socioeconomic and demographic factors, as well as normative treatment needs, are associated with the use of public dental services.
Assuntos
Serviços de Saúde Bucal/estatística & dados numéricos , Setor Privado/estatística & dados numéricos , Setor Público/estatística & dados numéricos , Adulto , Atitude Frente a Saúde , População Negra/estatística & dados numéricos , Brasil , Estudos Transversais , Serviços de Saúde Bucal/economia , Escolaridade , Estudos Epidemiológicos , Etnicidade/estatística & dados numéricos , Características da Família , Feminino , Custos de Cuidados de Saúde , Humanos , Renda/estatística & dados numéricos , Cobertura do Seguro/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Masculino , Estado Civil , Avaliação das Necessidades/estatística & dados numéricos , Ocupações/estatística & dados numéricos , Setor Privado/economia , Setor Público/economia , População Rural/estatística & dados numéricos , Fatores Socioeconômicos , População Urbana/estatística & dados numéricosRESUMO
OBJECTIVE: To evaluate the in-lux examination method to assess the reliability of examiners for oral health surveys. METHODS: A calibration study involving 10 examiners and 27 patients was conducted, and high-quality photographs of dental epidemiological indices were projected. The latter refers to the in-lux examination method. Two groups, comprised of five examiners each, were trained to assess dental caries (DMFT index) and malocclusion (DAI). The first group carried out in vivo (clinical) and in-lux examinations in the same patients. The second group performed in-lux examinations only. The measurements were repeated to obtain intraexaminer weighted kappa coefficients. RESULTS: Interexaminer weighted kappa coefficients of the in vivo examination method for DMFT and DAI ranged from 0.597 to 0.851 and from 0.574 to 0.844, respectively. The values for in-lux examination were between 0.440 and 0.856 (DMFT) and between 0.524 and 0.783 (DAI). The intraexaminer kappa coefficients of the in vivo examination method ranged between 0.569 and 0.851 (DMFT) and between 0.644 and 0.834 (DAI). In the in-lux method, these values were between 0.426 and 0.831 (DMFT) and between 0.341 and 0.838 (DAI). Three examiners did not reach the minimum acceptable kappa value (k = 0.610) for DMFT, and one for DAI. Of these, one examiner managed to reach the minimum kappa coefficient for DMFT after additional training. The three others maintained the kappa coefficients at lower than acceptable limits. CONCLUSIONS: Calibration, using both in vivo and in-lux examination methods, was able to discriminate the examiners regarding their reliability to reproduce dental indices. The in-lux examination method was considered reliable and can replace the in vivo examination method. The in-lux method might be more feasible to evaluate the reliability of examiners when clinical calibration is unrealistic due to logistic issues and when a large number of examiners are involved in the survey.
Assuntos
Cárie Dentária , Humanos , Adolescente , Cárie Dentária/diagnóstico , Cárie Dentária/epidemiologia , Reprodutibilidade dos Testes , Inquéritos de Saúde Bucal , Estudos Epidemiológicos , Índice CPORESUMO
OBJECTIVE: The aim of this study was to investigate, at a national level, which individual factors of the work process/infrastructure are associated with the achievement of goals in the periodontics specialty in Brazilian Dental Specialty Centers (BDSC). METHODS: This was a quantitative, analytical, cross-sectional study. Secondary data from DATASUS and the external evaluation of the second cycle of the BDSC Access and Quality Improvement Program were used. Variable description was carried out in the first stage, and then the bivariate Poisson regression was performed to verify possible associations between the variables and the outcome (achievement of goals in Periodontics in the BDSC). In this analysis, the covariates that were associated with the outcome at the p <0.20 significance level were included in the next step of the analysis. Multivariate Poisson regression with a robust estimator was then performed with those that met the above criterion. The variables that showed a p value < 0.05 were considered in the final model. RESULTS: The outcome was achieved in more than seven months of the year (mean 7.03 months, SD 4.20). Most BDSC monitored the established goals (93.2%), had referral as the only way of access (61.7%), had only municipal coverage (68.4%), carried out planning and periodic evaluation of actions (89.2%). A minority has quotas of procedures by Oral Health teams (OHTs) in Primary Health Care (PHC) (18.8%). The presence of a specialist in periodontics was (on average) 1.16 per BDSC and the sum of the workload of dentists working in this specialty was 31.1 hours (SD = 23.9). CONCLUSION: It was concluded that the individual factors of the work process/infrastructure associated with the achievement of goals in periodontics in Brazilian BDSC are: monitoring of established goals, BDSC scope and number of professionals working in the specialty.
Assuntos
Saúde Bucal , Atenção Primária à Saúde , Brasil , Estudos Transversais , Atenção Secundária à SaúdeRESUMO
OBJECTIVES: To assess which factors were associated with the achievement of endodontic goals. METHODS: Cross-sectional study using secondary data from the second cycle of the Program for the Improvement of Access and Quality in the dental speciality centres-in Portuguese PMAQ-CEO. The independent variables extracted from this database were related to dental speciality centres (CEO in Portuguese). In addition, variables referring to the CEO host city were incorporated into the model. The outcome variable was the number of endodontic goals achieved calculated from the production of the CEO available in the Ambulatory Health Information System in 2018. Descriptive analyses and multilevel Poisson regression were performed with the software SPSS 23.0 and STATA 14.0. RESULTS: CEOs with more than 20% of patients' absenteeism were 26% less likely to reach the goals of the endodontics specialty; CEOs with availability of endodontists for more than 40 hours a week were two times more likely to reach the goals than those with less than 40 hours in endodontics specialty. CEOs with a waiting time for endodontic procedures greater than 45 days achieved a number of goals 31% lower than those with a waiting time up to 45 days. CEO type I and CEO type II showed 2.10 and 1.20 higher likelihood to reach the number of goals of the endodontics specialty than CEO type III. The number of endodontic instruments in sufficient number was positively associated with the achievement of goals. CEOs located in municipalities that reached more than 5% in the supervised brushing indicator had 2.26 greater likelihood to achieve the goals than those that did not reach this percentage. CONCLUSION: Contextual and local determinants are associated with the achievement of goals in the endodontic specialty in the dental speciality centres in Brazil.
Assuntos
Endodontia , Objetivos , Brasil , Estudos Transversais , Humanos , Análise MultinívelRESUMO
AIM: To examine the relationship between contextual and individual determinants with the need for endodontic treatment in Brazilian adults. METHODS: Individual-level data from 6897 adults aged 35-44 years living in the Brazilian state capitals who participated in the Brazilian Oral Health Survey (SBBrasil 2010 Project) were combined with city-level data. Individual- and city-level variables were selected to represent the structural and intermediate determinants of health according to the WHO model of social determinants of health. The association of independent variables with one or more teeth in need of endodontic treatment was evaluated using multilevel logistic regression to estimate the odds ratio (OR) and 95% confidence intervals (CI). RESULTS: The prevalence of the need for endodontic treatment was 7.7%. Adults living in cities with better contextual socioeconomic conditions (OR 0.82; 95% CI = 0.72-0.93) and better specialized dental services (OR 0.85; 95% CI = 0.77-0.95) were less likely to need endodontic treatment. Younger age, greater schooling and use of private dental services reduced the odds of need for endodontic treatment. Number of people per room, type of dental service and reason for the last dental visit were also associated with need of endodontic treatment. CONCLUSION: Contextual and individual factors were relevant determinants of endodontic treatment needs in adults.
Assuntos
Inquéritos de Saúde Bucal , Adulto , Brasil/epidemiologia , Cidades , Estudos Transversais , Humanos , Análise Multinível , Fatores SocioeconômicosRESUMO
The aim of this study was to assess the factors associated with dental pain in adolescents from the state of Minas Gerais, Brazil. Individual data on adolescents aged 15 to 19 years were collected from the SB Minas survey secondary database. Dental pain over the past 6 months, assessed by a questionnaire, was used as the dependent variable. Sex, income, skin color, prevalence of untreated dental caries, periodontal health, dental treatment needs, and time of last dental appointment were analyzed as individual covariates. Allocation factor, Human Development Index (HDI), Gini coefficient, illiteracy rate, unemployment, 50% and 25% of the Brazilian monthly minimum wage, primary healthcare coverage, oral health team coverage, access to individual healthcare, and supervised toothbrushing average rate were the analyzed contextual variables. A multilevel analysis was conducted for the individual and contextual variables. Statistical analyses used hierarchical linear and nonlinear modeling to infer an association between the different levels. Male adolescents had a lower prevalence of dental pain (OR = 0.53; 95%CI = 0.37-0.75). There was an association between dental pain and low income (OR = 1.58; 95%CI = 1.07-2.33), prevalence of untreated dental caries (OR = 1.25; 95%CI = 1.11-1.40), periodontal health (OR = 1.80; 95%CI = 1.04-3.09), and dental treatment needs (OR = 6.93; 95%CI = 3.96-12.14). Sociodemographic and clinical factors at the individual level were associated with the outcome but not with contextual variables. These findings reinforce the need to address these factors for effective community health actions.
Assuntos
Cárie Dentária , Adolescente , Brasil/epidemiologia , Estudos Transversais , Cárie Dentária/epidemiologia , Humanos , Masculino , Saúde Bucal , Dor , Fatores SocioeconômicosRESUMO
OBJECTIVE: to evaluate factors related to the dissatisfaction of users of the specialized dental care centers (CEO) in Brazil. METHODS: this was a cross-sectional study with data from the Dental Specialty Center Access and Quality Improvement Program; the study was conducted in 2014 and included a non-probabilistic sample of users; those who answered that the service received was regular, poor or very poor were classified as dissatisfied. RESULTS: a total of 8,730 users were included, 4.8% reported dissatisfaction; longer time taken to get to the service (OR=1.38 - 95%CI1.10;1.74), and longer waiting time until treatment (OR=1.37 - 95%CI1.07;1.75), were positively associated with dissatisfaction, whereas negative association was found with attention received (OR=0.12 - 95%CI0.09;0.16), the possibility of asking questions about treatment (OR=0.37 - 95%CI0.24;0.58), and receiving advice during treatment (OR=0.33 - 95%CI0.25;0.44). CONCLUSION: prevalence of user dissatisfaction was low and was associated with factors related to service organization and receipt of information and support.
Assuntos
Assistência Odontológica , Clínicas Odontológicas , Satisfação do Paciente , Brasil , Estudos Transversais , Assistência Odontológica/organização & administração , Clínicas Odontológicas/estatística & dados numéricos , Humanos , Satisfação do Paciente/estatística & dados numéricosRESUMO
This study aimed to assess time trends in production and performance indicators in secondary dental care services in the Brazilian Unified National Health System (SUS) from 2008 to 2018. A time series study was conducted, based on production data from the Specialized Dental Clinics (CEOs in Portuguese) obtained from the Ambulatory Information System of the SUS. The monitoring indicator was assessed as the proportion of clinics that met the monthly target set for each specialty (primary care, endodontics, surgery, periodontics). Dental services' performance was defined as poor for those that met only one or no targets in the four dental specialties. The time series were analyzed by the decomposition method, considering the components trend, seasonal variation, and random variation. All the analyses were performed for Brazil as a whole and for each of the country's five major geographic regions. A decline was seen in Brazil as a whole in the proportion of clinics that met the primary care targets. There were upward trends in the proportion of compliance with the targets for surgery and periodontics in Brazil as a whole. Important differences were seen between the regions of Brazil in the proportion of compliance with the targets, with the worst performance for the clinics in the North and Northeast regions. Time trends showed an improvement in the services for Brazil as a whole, while emphasizing the importance of assessing the country's regions and the need for constant monitoring of these indicators.
Este trabalho teve o objetivo de avaliar a tendência temporal dos indicadores de monitoramento de produção e desempenho dos serviços de atenção secundária em saúde bucal do Sistema Único de Saúde (SUS), no período de 2008 a 2018. Realizou-se um estudo de séries temporais com base nos dados de produção dos Centros de Especialidades Odontológicas (CEOs) obtidos junto ao Sistema de Informações Ambulatoriais do SUS. O indicador de monitoramento foi avaliado segundo a proporção de CEOs que cumpriram a meta mensal estabelecida para cada especialidade (atenção básica, endodontia, cirurgia, periodontia). O desempenho dos serviços foi definido como ruim para aqueles que não cumpriram nenhuma ou apenas uma das metas estipuladas para as quatro especialidades odontológicas. As séries temporais construídas foram analisadas pelo método da decomposição, considerando os componentes de tendência, variação sazonal e variação aleatória. Todas as análises foram feitas para o Brasil e cada uma das cinco macrorregiões. Verificou-se o declínio da proporção de CEOs que cumpriram as metas da atenção básica no país como um todo. As tendências da proporção de cumprimento de metas para a área de cirurgia e periodontia foram crescentes para o Brasil. Observou-se diferenças importantes na proporção de cumprimento de metas entre as regiões brasileiras, com o pior desempenho dos CEOs nas regiões Norte e Nordeste. As tendências temporais demostraram uma melhora dos serviços para o Brasil como um todo, mas destacam a importância de avaliação das regiões do país e necessidade de monitoramento constante desses indicadores.
El objetivo de este estudio fue evaluar la tendencia temporal de los indicadores de monitoreo de producción y desempeño de los servicios de atención secundaria en salud bucal del Sistema Único de Salud (SUS), durante el período de 2008 a 2018. Se realizó un estudio de series temporales, basado en los datos de producción de los Centros de Especialidades Odontológicas (CEOs), obtenidos mediante el Sistema de Información Ambulatoria del SUS. El indicador de monitoreo se evaluó según la proporción de CEOs que cumplieron la meta mensual establecida para cada especialidad (atención básica, endodoncia, cirugía, periodoncia). El desempeño de los servicios se definió como malo para aquellos que no cumplieron ninguna o solo una de las metas estipuladas para las cuatro especialidades odontológicas. Las series temporales construidas se analizaron mediante el método de descomposición, considerando los componentes de tendencia, variación estacional y variación aleatoria. Todos los análisis fueron realizados respecto a Brasil y cada una de sus cinco macrorregiones. Se verificó un decremento en la proporción de CEOs que cumplieron las metas de la atención básica en todo el país. Las tendencias de la proporción de cumplimiento de metas para el área de cirugía y periodoncia fueron crecientes en el caso de Brasil. Se observaron diferencias importantes en la proporción de cumplimiento de metas entre las regiones brasileñas, con un peor desempeño de los CEOs en las regiones Norte y Nordeste. Las tendencias temporales demostraron una mejora de los servicios para todo Brasil, pero destacan la importancia de la evaluación de las regiones del país y la necesidad de un monitoreo constante de estos indicadores.
Assuntos
Clínicas Odontológicas , Atenção Primária à Saúde , Brasil , HumanosRESUMO
This study evaluated the individual and contextual factors associated with the specialised dental treatment needs of a population of adults aged 35 to 44 years old in the state of Minas Gerais. The individual variables were obtained from the database of the SB Minas Gerais project - a survey of oral health status of the population of Minas Gerais, Brazil. The variables at the municipal level were derived from any available public databases related to oral health services. A multilevel analysis was performed to evaluate the association of independent individuals and contextual variables with or without dental treatment needs in the secondary care of the oral health network. Individuals with a higher income (OR 0.53; CI95% 0.31-0.93) and with greater access to oral health care (OR 0.94; CI95% 0.90-0.99) had less secondary care treatment needs. Income and access to oral health care are related to the needs of specialised dental treatment in Minas Gerais.
Assuntos
Renda , Saúde Bucal , Adulto , Brasil , Estudos Transversais , Assistência Odontológica , HumanosRESUMO
RESUMO O presente artigo tem o objetivo de avaliar indicadores sociais e de saúde de municípios conforme a tipologia rural-urbano. Trata-se de estudo ecológico que utilizou dados oficiais de acesso público dos 853 municípios do estado de Minas Gerais, Brasil. Foram conduzidas análises descritivas e bivariadas através da Regressão de Poisson e Teste de Kruskal-Wallis. Do total de municípios, 547 (64,12%) são rurais. A maior média do Índice de Desenvolvimento Humano Municipal (IDH-M) foi observada entre os municípios urbanos. A maior média de cobertura da Estratégia Saúde da Família (ESF) foi verificada entre os municípios rurais, nos quais também foram demonstrados os melhores resultados para os indicadores de mortalidades infantil, prematura e por causas evitáveis, homogeneidade vacinal e prevalência de desnutrição. Os achados deste estudo evidenciam que uma maior cobertura da ESF está associada à ocorrência de melhores condições gerais de vida e de saúde das populações atendidas em municípios de tipologia rural. Recomenda-se aos gestores de saúde o fomento à consolidação da ESF em comunidades com contextos socioeconômicos e culturais desfavoráveis, como localidades rurais remotas e aglomerados urbanos, e o estabelecimento de ações intersetoriais com impacto positivo na saúde.
ABSTRACT This article aims to evaluate social and health indicators of municipalities according to the rural-urban typology. This is an ecological study that used official publicly accessible data from the 853 municipalities in the state of Minas Gerais, Brazil. Descriptive and bivariate analysis were carried out using Poisson Regression and Kruskal-Wallis Test. 547 (64.12%) are rural municipalities. The highest average of the Municipal Human Development Index (MHDI) was observed among urban municipalities. The highest average coverage of the Family Health Strategy (FHS) was found among rural municipalities. In these municipalities, the best results were shown for the indicators of infant mortality, premature mortality and mortality from preventable causes, vaccine homogeneity and prevalence of malnutrition. The findings of this study show that greater FHS coverage is associated with the occurrence of better general living and health conditions in the populations served in rural municipalities. It is recommended that health managers encourage the consolidation of the FHS in communities with unfavorable socioeconomic and cultural contexts, such as remote rural locations and urban agglomerations, and the establishment of intersectoral actions with a positive impact on health.
RESUMO
BACKGROUND: It is important to assess context to explain inequalities in oral health, particularly with regard to the type of service used; thus, this study aimed to identify the social determinants of public dental service use by adults and to assess whether, beyond the level individual, existing inequalities are also expressed in the context in which individuals are embedded. METHODS: A multilevel analysis with three levels of aggregation of variables was performed. The individual variables were derived from the database of the SB Minas Gerais project-a survey of oral health status of the population of Minas Gerais, a state of the Brazilian Southeast region. The variable at the neighborhood level came from the Census of 2010. The variables at the municipal level were obtained from available public databases relating to oral health services. At the municipal level, the Human Development Index (HDI) variable was chosen to represent quality of life in the municipalities. RESULTS: In the final model, the following individual variables were associated with greater use of public dental services: lower income (PR = 1.98, 95% CI = 1.53; 2.58), higher number of residents at home (PR = 1.37, 95% CI = 1.11; 1.68) and higher number of teeth requiring treatment (PR = 1.49, 95% CI = 1.20; 1.84). With regard to context variables, a poorer infrastructure (PR = 0.62, 95% CI = 0.40; 0.96) leads to a lower use of public services. CONCLUSION: The use of public services is associated with family income, how this income is divided in households, the need for treatment presented by the individual and the organization of the existing oral health service infrastructure in the municipality.
Assuntos
Serviços de Saúde/estatística & dados numéricos , Análise Multinível/métodos , Saúde Bucal/estatística & dados numéricos , Determinantes Sociais da Saúde/estatística & dados numéricos , Adulto , Brasil/epidemiologia , Índice CPO , Assistência Odontológica/estatística & dados numéricos , Cárie Dentária/epidemiologia , Inquéritos Epidemiológicos/métodos , Inquéritos Epidemiológicos/estatística & dados numéricos , Humanos , Renda/estatística & dados numéricos , Análise de Componente Principal , Saúde Pública/métodos , Saúde Pública/estatística & dados numéricos , Fatores SocioeconômicosRESUMO
Abstract The aim of this study was to assess the factors associated with dental pain in adolescents from the state of Minas Gerais, Brazil. Individual data on adolescents aged 15 to 19 years were collected from the SB Minas survey secondary database. Dental pain over the past 6 months, assessed by a questionnaire, was used as the dependent variable. Sex, income, skin color, prevalence of untreated dental caries, periodontal health, dental treatment needs, and time of last dental appointment were analyzed as individual covariates. Allocation factor, Human Development Index (HDI), Gini coefficient, illiteracy rate, unemployment, 50% and 25% of the Brazilian monthly minimum wage, primary healthcare coverage, oral health team coverage, access to individual healthcare, and supervised toothbrushing average rate were the analyzed contextual variables. A multilevel analysis was conducted for the individual and contextual variables. Statistical analyses used hierarchical linear and nonlinear modeling to infer an association between the different levels. Male adolescents had a lower prevalence of dental pain (OR = 0.53; 95%CI = 0.37-0.75). There was an association between dental pain and low income (OR = 1.58; 95%CI = 1.07-2.33), prevalence of untreated dental caries (OR = 1.25; 95%CI = 1.11-1.40), periodontal health (OR = 1.80; 95%CI = 1.04-3.09), and dental treatment needs (OR = 6.93; 95%CI = 3.96-12.14). Sociodemographic and clinical factors at the individual level were associated with the outcome but not with contextual variables. These findings reinforce the need to address these factors for effective community health actions.
RESUMO
Objetivo: avaliar os fatores associados à insatisfação dos usuários dos centros de especialidades odontológicas (CEOs) do Brasil. Métodos: estudo transversal, com dados do Programa de Melhoria do Acesso e da Qualidade dos CEOs; realizado em 2014, o estudo incluiu amostra não probabilística de usuários; foram classificados como insatisfeitos aqueles que responderam ser o atendimento por eles recebido regular, ruim ou muito ruim. Resultados: foram incluídos 8.730 usuários, dos quais 4,8% relataram insatisfação; maior tempo de deslocamento até o serviço (OR=1,38 - IC95% 1,10;1,74) e maior tempo de espera (OR=1,37 - IC95% 1,07;1,75) associaram-se positivamente à insatisfação; encontrou-se associação negativa com o acolhimento (OR=0,12 - IC95% 0,09;0,16), a possibilidade de tirar dúvidas (OR=0,37 IC95% 0,24;0,58) e o recebimento de orientações (OR=0,33 - IC95% 0,25;0,44). Conclusão: a insatisfação dos usuários teve baixa prevalência e foi associada a fatores relativos à organização dos serviços e ao recebimento de informação e apoio.
Objetivo: evaluar los factores asociados con la insatisfacción de los usuarios de los centros de especialidades dentales (CEO) de Brasil. Métodos: estudio transversal con datos del Programa de Mejoramiento de Acceso y Calidad de los Centros de Especialidad Dental de 2014, que incluyó una muestra no probabilística de usuarios; los que respondieron que el servicio recibido era regular, malo o muy malo fueron clasificados como insatisfechos. Resultados: se incluyeron 8.730 usuarios, 4,8% reportaron insatisfacción; mayor tiempo de viaje (OR=1,38 - IC95% 1,10;1,74) y espera (OR=1,37 - IC95% 1,07;1,75) se asociaron positivamente con la insatisfacción; hubo asociación negativa con la recepción (OR=0,12 - IC95% 0,09;0,16), la posibilidad de despejar dudas (OR=0,37 - IC95% 0,24;0,58) y recibir orientación (OR=0,33 - IC95% 0,25;0,44). Conclusión: la prevalencia de insatisfacción fue baja y se asoció con factores relacionados con la organización de los servicios y la recepción de información y apoyo.
Objective: to evaluate factors related to the dissatisfaction of users of the specialized dental care centers (CEO) in Brazil. Methods: this was a cross-sectional study with data from the Dental Specialty Center Access and Quality Improvement Program; the study was conducted in 2014 and included a non-probabilistic sample of users; those who answered that the service received was regular, poor or very poor were classified as dissatisfied. Results: a total of 8,730 users were included, 4.8% reported dissatisfaction; longer time taken to get to the service (OR=1.38 - 95%CI1.10;1.74), and longer waiting time until treatment (OR=1.37 - 95%CI1.07;1.75), were positively associated with dissatisfaction, whereas negative association was found with attention received (OR=0.12 - 95%CI0.09;0.16), the possibility of asking questions about treatment (OR=0.37 - 95%CI0.24;0.58), and receiving advice during treatment (OR=0.33 - 95%CI0.25;0.44). Conclusion: prevalence of user dissatisfaction was low and was associated with factors related to service organization and receipt of information and support.
Assuntos
Humanos , Saúde Bucal/estatística & dados numéricos , Satisfação do Paciente/estatística & dados numéricos , Serviços de Saúde Bucal/organização & administração , Especialidades Odontológicas , Atenção Secundária à Saúde , Brasil , Estudos TransversaisRESUMO
Este trabalho teve o objetivo de avaliar a tendência temporal dos indicadores de monitoramento de produção e desempenho dos serviços de atenção secundária em saúde bucal do Sistema Único de Saúde (SUS), no período de 2008 a 2018. Realizou-se um estudo de séries temporais com base nos dados de produção dos Centros de Especialidades Odontológicas (CEOs) obtidos junto ao Sistema de Informações Ambulatoriais do SUS. O indicador de monitoramento foi avaliado segundo a proporção de CEOs que cumpriram a meta mensal estabelecida para cada especialidade (atenção básica, endodontia, cirurgia, periodontia). O desempenho dos serviços foi definido como ruim para aqueles que não cumpriram nenhuma ou apenas uma das metas estipuladas para as quatro especialidades odontológicas. As séries temporais construídas foram analisadas pelo método da decomposição, considerando os componentes de tendência, variação sazonal e variação aleatória. Todas as análises foram feitas para o Brasil e cada uma das cinco macrorregiões. Verificou-se o declínio da proporção de CEOs que cumpriram as metas da atenção básica no país como um todo. As tendências da proporção de cumprimento de metas para a área de cirurgia e periodontia foram crescentes para o Brasil. Observou-se diferenças importantes na proporção de cumprimento de metas entre as regiões brasileiras, com o pior desempenho dos CEOs nas regiões Norte e Nordeste. As tendências temporais demostraram uma melhora dos serviços para o Brasil como um todo, mas destacam a importância de avaliação das regiões do país e necessidade de monitoramento constante desses indicadores.
This study aimed to assess time trends in production and performance indicators in secondary dental care services in the Brazilian Unified National Health System (SUS) from 2008 to 2018. A time series study was conducted, based on production data from the Specialized Dental Clinics (CEOs in Portuguese) obtained from the Ambulatory Information System of the SUS. The monitoring indicator was assessed as the proportion of clinics that met the monthly target set for each specialty (primary care, endodontics, surgery, periodontics). Dental services' performance was defined as poor for those that met only one or no targets in the four dental specialties. The time series were analyzed by the decomposition method, considering the components trend, seasonal variation, and random variation. All the analyses were performed for Brazil as a whole and for each of the country's five major geographic regions. A decline was seen in Brazil as a whole in the proportion of clinics that met the primary care targets. There were upward trends in the proportion of compliance with the targets for surgery and periodontics in Brazil as a whole. Important differences were seen between the regions of Brazil in the proportion of compliance with the targets, with the worst performance for the clinics in the North and Northeast regions. Time trends showed an improvement in the services for Brazil as a whole, while emphasizing the importance of assessing the country's regions and the need for constant monitoring of these indicators.
El objetivo de este estudio fue evaluar la tendencia temporal de los indicadores de monitoreo de producción y desempeño de los servicios de atención secundaria en salud bucal del Sistema Único de Salud (SUS), durante el período de 2008 a 2018. Se realizó un estudio de series temporales, basado en los datos de producción de los Centros de Especialidades Odontológicas (CEOs), obtenidos mediante el Sistema de Información Ambulatoria del SUS. El indicador de monitoreo se evaluó según la proporción de CEOs que cumplieron la meta mensual establecida para cada especialidad (atención básica, endodoncia, cirugía, periodoncia). El desempeño de los servicios se definió como malo para aquellos que no cumplieron ninguna o solo una de las metas estipuladas para las cuatro especialidades odontológicas. Las series temporales construidas se analizaron mediante el método de descomposición, considerando los componentes de tendencia, variación estacional y variación aleatoria. Todos los análisis fueron realizados respecto a Brasil y cada una de sus cinco macrorregiones. Se verificó un decremento en la proporción de CEOs que cumplieron las metas de la atención básica en todo el país. Las tendencias de la proporción de cumplimiento de metas para el área de cirugía y periodoncia fueron crecientes en el caso de Brasil. Se observaron diferencias importantes en la proporción de cumplimiento de metas entre las regiones brasileñas, con un peor desempeño de los CEOs en las regiones Norte y Nordeste. Las tendencias temporales demostraron una mejora de los servicios para todo Brasil, pero destacan la importancia de la evaluación de las regiones del país y la necesidad de un monitoreo constante de estos indicadores.
Assuntos
Humanos , Atenção Primária à Saúde , Clínicas Odontológicas , BrasilRESUMO
Abstract Objective: To analyze the association between water sanitation and living conditions and dental caries in Brazilian schoolchildren. Material and Methods: A list containing names of children enrolled in 18 urban public schools was obtained. Then, data registered by community health agents from the family health strategy were consulted, aiming to obtain information about socio-environmental variables such as house type, number of rooms in the house, water supply, water treatment, waste, feces and urine disposal. For sample calculation, 95% confidence level, 80% test power and 5% error rate were used A total of 199 5-year-old and 137 12-year-old schoolchildren participated in the research. For examinations, World Health Organization recommendations for epidemiological surveys of dental caries were followed. Results: For 5-year-old children, dental caries prevalence was related to municipality of origin, water supply system and sewage system. For 12-year-old children, untreated water and waste collection were related to higher dental caries rates. Conclusion: Dental caries was associated to house type and water sanitation.
Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Qualidade de Vida , Abastecimento de Água , Fluoretação , Saúde Pública , Cárie Dentária/prevenção & controle , Instituições Acadêmicas , Brasil/epidemiologia , Distribuição de Qui-Quadrado , Estudos Transversais/métodos , Inquéritos e Questionários , Inquéritos Epidemiológicos/métodos , Estatísticas não ParamétricasRESUMO
Objetivo: Analisar fatores associados ao uso e à necessidade de prótese dentária em adultos e idosos do estado de Minas Gerais. Métodos: Estudo transversal foi realizado com amostra de 2.404 adultos e idosos. Regressão logística, estimativas de odds ratio e respectivos intervalos de confiança foram realizados. Resultados: Dos 2.404 indivíduos avaliados, 59,9% tinham necessidade de prótese pela ausência de prótese ou presença de prótese insatisfatória e 41,9% usavam prótese. Idosos tiveram 10,22 vezes mais chances de usar prótese comparados aos adultos. Indivíduos de menor escolaridade (< 2 anos de estudo) apresentaram 2,18 vezes mais chances de usar prótese do que indivíduos de maior escolaridade (> 11 anos de estudo). Indivíduos que usaram o serviço público na última consulta odontológica tiveram menos chance de usar prótese do que indivíduos que usaram o serviço privado. Conclusão:A necessidade e o uso de prótese dentária foram associados a fatores sociodemográficos.
Aim: To analyze factors associated with the need and use of dental prostheses in adults and the elderly in Minas Gerais, Brazil. Methods: This research conducted a cross-sectional study with 2,404 adult and elderly individuals. Logistic regression, odds ratio estimates, and respective confidence intervals were performed. Results:Among the 2,404 individuals evaluated in this study, 59.9% needed prosthesis due to a lack of a prosthesis or the use of an unsatisfactory prosthesis, while 41.9% used satisfactory prostheses. The elderly individuals were 10.22 times more likely to use prostheses w hen compared to adults. Individuals with a lower educational level (< 2 years of education) were 2.18 times more likely to use a prosthesis than were individuals with a higher educational level (> 11 years of education). Individuals who used the public dental services for their last dental appointment were less likely to use a prosthesis than were individuals who used private dental services. Conclusion: The need and use of dental prostheses were associated with sociodemographic factors.
Assuntos
Adulto , Pessoa de Meia-Idade , Idoso , Fatores Socioeconômicos , Idoso , Inquéritos e Questionários , Perda de Dente , Prótese Dentária , Adulto , Atenção Primária à Saúde , Estudos Transversais , Necessidades e Demandas de Serviços de SaúdeRESUMO
Introdução A definição de parâmetros assistenciais é de relevância para a execução de ações de saúde pública. Objetivo Descrever um percurso para elaboração de parâmetros de produção e de cobertura para endodontia e periodontia. Método Parâmetros de cobertura foram calculados a partir das necessidades normativas identificadas no levantamento epidemiológico de saúde bucal em Minas Gerais. Parâmetros de produção per capita foram calculados a partir das necessidades normativas, dos dados de produção do SIA/SUS e da capacidade instalada nos serviços. A análise foi desenvolvida no módulo Complex Samples do Programa SPSS. Resultados 6,2% (IC 95% 5,2%-7,3%) e 2,9% (IC 95% 2,2%-3,9%) dos indivíduos apresentavam, pelo menos, uma necessidade de tratamento endodôntico e periodontal, respectivamente. Em relação à produção, tanto a capacidade potencial de produção dos serviços especializados quanto a produção média registrada no SIA/SUS são muito inferiores às necessidades normativas globais da população. Conclusão A endodontia apresentou cobertura populacional e média de procedimentos maiores do que a periodontia. Os parâmetros de cobertura populacional podem ser utilizados para a organização dos serviços.
Background The definition of care parameters is relevant to the implementation of public health actions. Objective Describe a methodologic route for the elaboration of parameters on population coverage and production in endodontics and periodontics. Method Coverage parameters were calculated from the normative needs identified in the epidemiological survey of oral health in Minas Gerais. Production parameters were calculated based on normative requirements, SIA/SUS production data and installed capacity in the services. The analysis was developed in the Complex Samples module of the SPSS Program. Results 6.2% (95% CI 5.2%-7.3%) and 2.9% (CI 95% 2.2%-3.9%) needed endodontic and periodontal treatment, respectively. Both the potential production capacity of the specialized services and the average production recorded in the SIA/SUS were much lower than the overall normative needs of the population. Conclusion Endodontics presented a population coverage and average of procedures greater than that of periodontics. Population coverage parameters can be used to organize services.