Trees harbouring ants are better defended than con-generic and sympatric ant-free trees.

Plant strategies against herbivores are classically divided into chemical, physical, biotic defences. However, little is known about the relative importance of each type of plant defence, especially in the same species. Using the myrmecophyte Triplaris americana (both with and without ants), and the congeneric non-myrmecophyte T. gardneriana, we tested whether ant defence is more effective than other defences of naturally ant-free myrmecophytes and the non-myrmecophyte congeneric species, all spatially co-occurring. In addition, we investigated how plant traits vary among plant groups, and how these traits modulate herbivory. We sampled data on leaf area loss and plant traits from these tree groups in the Brazilian Pantanal floodplain, and found that herbivory is sixfold lower in plants with ants than in ant-free plants, supporting a major role of biotic defences against herbivory. Whereas ant-free plants had more physical defences (sclerophylly and trichomes), they had little effect on herbivory-only sclerophylly modulated herbivory, but with opposite effects depending on ants' presence and species identity. Despite little variation in the chemicals among plant groups, tannin concentrations and δ13C signatures negatively affected herbivory in T. americana plants with ants and in T. gardneriana, respectively. We showed that ant defence in myrmecophytic systems is the most effective against herbivory, as the studied plants could not fully compensate the lack of this biotic defence. We highlight the importance of positive insect-plant interactions in limiting herbivory, and therefore potentially plant fitness.

Social capital and dental service use in older Brazilians.

OBJECTIVES: To estimate the prevalence of dental services use and its association with social capital among Brazilian older adults. BACKGROUND: Health inequities can be explained by the social determinants of health, which are the social, environmental, cultural and behavioural factors that directly or indirectly affect people's health. Among these determinants is social capital, that seem to affect health behaviours, such as use of dental services among older adults. MATERIALS AND METHODS: This was a cross-sectional study using baseline data from the Longitudinal Study of the Health of the Brazilian Elderly, nationally representative of people aged 50 years or older. The baseline survey was carried out between 2015 and 2016, using structured questionnaires. The dependent variable was use of dental services in the last year. The main exposure variable was social capital, assessed through two dimensions: structural and cognitive. The covariates used were sex, skin colour, age, education, wealth, need for dental treatment, self-perception of oral health, tooth loss, type of dental services used, reason for dental care, smoking and alcohol consumption. Descriptive analyses and Poisson regression modelling were used. RESULTS: The sample consisted of 9323 individuals. The prevalence of dental services use was 32.6% (95% CI: 30.7-34.5). No associations were found between social capital and the use of dental services. CONCLUSION: This study did not find an association between structural and cognitive social capital and dental services use in Brazilian older adults. Further researches using instruments with different assessments of social capital are needed.

Using Voice Change as an Indicator of Dysphagia: A Systematic Review.

Voice change post-swallow, observed during a clinical swallow examination, is often used as a clinical indicator of dysphagia risk. However, there has been limited research that evaluated the level of agreement between voice change and swallow dysfunction reported to date. This systematic review aims to investigate existing evidence relating to the relationship between vocal change post-swallow and swallow deficits identified on a Videofluoroscopic Swallow Study (VFSS). The studies were selected by two independent evaluators for inclusion, without restriction on language or date of publication and the methodological quality and the risk of bias were assessed using QUADAS-2. Following the PRISMA recommendation, 271 articles were analyzed, of which 17 were included in the study. Of these, the methodology described in five studies employed voice analyses using only acoustic methods, seven others conducted only auditory-perceptual analyses, and five other studies used both. Across the studies there was no homogeneity in the voice quality parameters assessed, analytic methods used, and results obtained. Forty seven per cent of the studies presented a high risk of bias in the analysis of vocal quality due to lack of clarity and blinding of VFSS. There was no homogeneity in the choice of consistencies evaluated during swallowing, as well as standardization of the outcome investigated in VFSS without a vocal parameter attributable to accurate detection in each outcome. It is not possible to obtain a consensus regarding the recommendation of the use of vocal evaluation as an accurate method for identifying swallowing alterations due to heterogeneity of the vocal evaluation methods, the outcomes evaluated in the VFSS examination, heterogeneity in food and liquid consistencies, and the methodological quality of the studies.

Sealing of cavitated occlusal carious lesions in the dentine of deciduous molars: a two-year randomised controlled clinical trial.

OBJECTIVES: This two-arm, parallel-group, tooth-randomised, controlled noninferiority clinical trial aimed to compare survival rates between the sealing and restoring of cavitated occlusal carious lesions in dentine [International Caries Detection and Assessment System (ICDAS) 5] of deciduous molars using resin-modified glass-ionomer cement (RMGIC) and to assess caries progression radiographically. MATERIALS AND METHODS: A total of 68 molars with ICDAS 5 occlusal lesions were randomly allocated into two groups, a sealing group (n = 31), in which RMGIC was placed directly over the carious lesion, and a restoration group (n = 37), in which a restoration with the same material was placed after selective caries removal. During the baseline and follow-up visits, dental caries was registered and caries activity was assessed according to a visuotactile criterion. At baseline, patient caries status (dmf-t) and cavity depth and extent (mesiodistal and buccolingual) were measured before RMGIC placement. An independent and blinded examiner evaluated the treated teeth using the USPHS criteria after one and two years. Standardised interproximal radiographs were taken for caries progression assessments. RESULTS: During the follow-up period, no lesion progression was observed radiographically. After one year (n = 60; 27 sealed and 33 restored) and two years (n = 48; 23 sealed and 25 restored) of follow-up, the treatment success rates were 78.8% and 76.0% in the restoration group and 59.3% and 47.8% in the sealing group, respectively. Multivariate Cox regression showed that lesions smaller than 2 mm in the mesiodistal extent were less prone to fail after one year (p = 0.03). However, survival curves (log-rank test) were statistically significantly different only after two years (p < 0.001). CONCLUSIONS: Sealing ICDAS 5 occlusal lesions of deciduous molars using RMGIC achieved lower survival rates than restorations. Both sealing and restoration effectively arrested caries progression for two years. Clinical relevance Sealing dentine carious lesions can be effective for treating lesions involving the inner and outer half of the dentine. Ultraconservative treatments can arrest carious lesions presenting obvious cavitation in primary molars. TRIAL REGISTRATION: ReBEC Register no. RBR-225n35.

Seasonal and habitat structure of an anuran assemblage in a semideciduous forest area in Southeast Brazil.

In this study, we evaluated the reproductive activity and the temporal and spatial distributions of anuran assemblages in three environments within a semideciduous forest in Southeast Brazil, located at Municipality of Barão de Monte Alto, State of Minas Gerais, Brazil. The field activities were carried out during three consecutive days, monthly throughout the rainy seasons of 2013-2014 and 2014-2015. We recorded 28 anurans species, distributed in eight families. We observed the spatial-temporal distribution of some species, and their associated reproductive behaviors through exploration of vocalizations at different sites. The spatial and temporal distribution of the species seems to adapt to abiotic and biotic factors of their environment.

Use of Dental Care Among Pregnant Women in the Brazilian Unified Health System.

PURPOSE: To assess the prevalence of and factors associated with the use of public Unified Health System-based dental services by pregnant women and recent mothers. MATERIALS AND METHODS: In this cross-sectional study, face to face interviews were conducted to collect data on the outcome of interest (prevalence of use of dental care) and independent variables (sociodemographic, pregnancy, and prenatal care data). A total of 302 pregnant women seen at public dental services in the municipality of Canoas, southern Brazil, were interviewed. Statistical analysis was performed using the chi-squared test and hierarchical Poisson regression with robust variance (p < 0.05). RESULTS: The prevalence of use of dental care among pregnant women was 50% (n = 151). Pregnant women who initiated prenatal care in the first trimester showed a 34% higher likelihood of using dental care (prevalence ratio [PR] 1.34; 95% confidence interval [95%CI] 1.27-1.61); this likelihood was 12% higher among multiparous women (PR 1.12; 95%CI 1.03-1.23), and 40% higher among women who received guidance to seek dental care (PR 1.40; 95%CI 1.30-1.51). CONCLUSION: The present findings suggest that starting prenatal care in the first trimester, being multiparous, and receiving guidance to seek dental care significantly contributed to the use of public dental services during pregnancy in the population assessed. These factors should be considered when planning public health policies for this population.

Distribution pattern of anurans from three mountain complexes in southeastern Brazil and their conservation implications.

Biogeographic tools support spatial distribution pattern hypotheses and help to determine priority areas for conservation. Our aim was to verify biogeographic patterns for anurans in three mountain complexes in southeastern Brazil, as well as to discuss the status of species conservation recorded and the biogeographical units evaluated. We selected 16 areas distributed in the Serra da Mantiqueira complex, south of Serra do Espinhaço and Serra da Canastra. We used the occurrence (geographic coordinates) of each species in the localities to determine areas of endemism applying the Endemicity Analysis method. We also tested whether similarity between areas was explained by geographic distance (Multiple Regression on distance Matrices-MRM). The Serra do Itatiaia, Serra da Canastra, Plateau of Poços de Caldas and Serra do Cipó were the areas that presented the highest number of species restricted to them. Through the Endemicity Analysis, we identified four areas of endemism with higher scores. The MRM revealed that the geographic distance explained 41% of species dissimilarity between areas. Most of the endemic species from these areas have inaccurate conservation statuses (data deficient or unevaluated). These results highlight the need for greater research efforts towards understanding species restricted by distribution, as well as the priority in conserving these endemic areas.

Perspectives of FTIR as Promising Tool for Pathogen Diagnosis, Sanitary and Welfare Monitoring in Animal Experimentation Models: A Review Based on Pertinent Literature.

Currently, there is a wide application in the literature of the use of the Fourier Transform Infrared Spectroscopy (FTIR) technique. This basic tool has also proven to be efficient for detecting molecules associated with hosts and pathogens in infections, as well as other molecules present in humans and animals' biological samples. However, there is a crisis in science data reproducibility. This crisis can also be observed in data from experimental animal models (EAMs). When it comes to rodents, a major challenge is to carry out sanitary monitoring, which is currently expensive and requires a large volume of biological samples, generating ethical, legal, and psychological conflicts for professionals and researchers. We carried out a survey of data from the relevant literature on the use of this technique in different diagnostic protocols and combined the data with the aim of presenting the technique as a promising tool for use in EAM. Since FTIR can detect molecules associated with different diseases and has advantages such as the low volume of samples required, low cost, sustainability, and provides diagnostic tests with high specificity and sensitivity, we believe that the technique is highly promising for the sanitary and stress and the detection of molecules of interest of infectious or non-infectious origin.

Impact of quality and transparency in scientific writing on the reduction of animal usage in experimental protocols: a review based in pertinent literature.

The irreproducibility in scientific research has become a critical issue. Despite the essential role of rigorous methodology in constructing a scientific article, more than half of publications, on average, are considered non-reproducible. The implications of this irreproducibility extend to reliability problems, hindering progress in technological production and resulting in substantial financial losses. In the context of laboratory animal research, this work emphasizes the importance of choosing an appropriate experimental model within the 3R's principle (Refine, Reduce, Replace). This study specifically addresses a deficiency in data specification in scientific articles, revealing inadequacies in the description of crucial details, such as environmental conditions, diet, and experimental procedures. For this purpose, 124 articles from journals with relevant impact factors were analyzed, conducting a survey of data considered important for the reproducibility of studies. Important flaws in the presentation of data were identified in most of the articles evaluated. The results of this study highlight the need to improve the description of essential information, standardizing studies, and ensuring the reproducibility of experiments in areas such as metabolism, immunity, hormones, stress, among others, to enhance the reliability and reproduction of experimental results, aligning with international guidelines such as ARRIVE and PREPARE.

Integrality, absenteeism and resolubility of specialized care for pediatric patients: a cross-sectional study.

Dental Specialties Centers (CEOs) are clinics representing part of the secondary oral health care system of the Brazilian Unified Health System (SUS). Pediatric dentistry is not a requirement for service accreditation. However, the CEO of the Federal University of Rio Grande do Sul (CEO-UFRGS) has provided dental care for children aged 3-11 years since 2017. The utilization rates of health services are influenced by absenteeism. Therefore, evaluation of absences for dental appointments is of primary importance. This study aimed to evaluate referral characteristics, absenteeism, and resolubility of pediatric dentistry appointments at the CEO-UFRGS. This retrospective cross-sectional study was conducted at the Dental Teaching Hospital of the university and analyzed secondary data from referrals and medical records. From August 2017 to December 2019, 167 referrals and 96 medical records were reviewed, from which data of individual variables related to the referral process and treatment were collected. Data were collected by a single trained examiner and analyzed using SPSS software. The main reasons for referral to secondary care were dental caries and pulpal or periapical diseases associated with difficult-to-manage behavior. An absenteeism rate of 28.1% at the first pediatric dental visit and a resolution rate of 65.6% were found. Binary logistic regression analysis indicated that each day of waiting for specialized care resulted in a 0.3% of higher chance of absence for appointment. This also increased the chance by 0.7% in child who attended the first visit to complete treatment, suggesting that the waiting time for attendance was associated with absenteeism and resolubility. Public policies that expand providing child dental care in secondary care are recommended to improve access to and resolubility of services.

Untreated caries and serum vitamin D levels in children and youth of the United States: NHANES 2013-2014.

This study aimed to investigate the association between serum vitamin D levels and untreated caries and determining factors in children and youth. METHODOLOGY: This cross-sectional study used data from the National Health and Nutrition Examination Survey (2013-2014). In total, 3,072 participants with ages ranging from 1 to 19 years were included in our sample. The main dependent variable, untreated caries, was defined as having at least one untreated carious surface in any tooth. Serum concentration of 25-hydroxyvitamin D [25(OH)D] was categorized into four groups: ≥75 nmol/ml, 50-74.9 nmol/ml, 25-49.9 nmol/ml, and <25 nmol/ml. Data were analyzed using a binary logistic regression. RESULTS: For children aged 1-5 years, age (OR = 1.68, 95% confidence intervals (95% CI) 1.38-2.04) and low levels of vitamin D (25-49.9 nmol/ml, and <25 nmol/ml: OR = 2.55, 95% CI 1.06-6.13) were associated with untreated caries. For children aged 6-11 years, low levels of vitamin D (50-74.9 nmol/ml: OR=1.45, 95% CI 1.16-1.82) remained associated with untreated caries. No associations were found in those between 12 and 19 years of age. CONCLUSION: Our findings show an association between low levels of 25(OH)D and untreated caries in children between 1 and 11 years of age, suggesting that this nutrient might interfere in the caries process.

[The use of dental services in the past year in the brazilian population: a systematic review with meta-analysis]. / O uso dos serviços odontológicos no último ano na população brasileira: revisão sistemática com metanálise.

The scope of this study was to analyze the factors associated with the use of dental services in Brazil. The review strategy included PubMed, SciELO, LILACS, BBO, EMBASE, Scopus, WOS and Google Scholar databases, in addition to repositories and databases of dissertations and theses. Studies were selected using the PEO (Population/Exposure/Outcomes) strategy. The outcome of this study was the use of dental services in the last year by the Brazilian population, treated as dichotomous variables for the following analyses: ≤ 1 year and > 1 year. Mantel-Haenszel random effect meta-analysis was performed, estimating Prevalence Ratios (PR) and 95% confidence intervals (95%CI). A total of 94 studies were selected. The majority (98%) had a cross-sectional design, with 63% derived from primary data. For the meta-analysis, 25 studies were included. The use of oral health services in the last year was associated with higher education (≥ 8 years of schooling) (PR = 0.49, (95%CI: 0.39-0.60)); higher family income (≥ 2 minimum wages) (RP = 0.79, (95%CI: 0.74-0.84)); and living in urban areas (RP = 0.79, (95%CI: 0.64-0.97)). The availability of dental services in the Unified Health System needs to be made readily accessible to people with lower income, less education and those living in rural areas.

O objetivo foi analisar os fatores associados ao uso dos serviços odontológicos no Brasil. A estratégia de revisão incluiu as bases PubMed, SciELO, LILACS, BBO, EMBASE, Scopus, WOS e Google Scholar, além de repositórios e bancos de dissertações e teses. Os estudos foram selecionados ​​usando a estratégia PEO (população/exposição/desfechos). O desfecho deste estudo foi o uso dos serviços odontológicos no último ano pela população brasileira, tratado como variáveis dicotômicas para as análises: ≤ 1 ano e > 1 ano. Foi realizada uma metanálise de efeito randômico de Mantel-Haenszel, estimando-se razões de prevalência (RP) e intervalos de confiança de 95% (IC95%). Foram selecionados 94 estudos. A maioria (98%) tinha delineamento transversal, sendo 63% oriundos de dados primários. Para a metanálise, 25 estudos foram incluídos. O uso dos serviços odontológicos no último ano esteve associado com maior escolaridade (≥ 8 anos de estudo) (RP = 0,49, (IC95%: 0,39-0,60)); maior renda familiar (≥ 2 salários-mínimos) (RP = 0,79, (IC95%: 0,74-0,84)); e residir na zona urbana (RP = 0,79, (IC95%: 0,64-0,97)). A oferta de serviços odontológicos no Sistema Único de Saúde precisa ser ampliada entre pessoas com menor renda, menor escolaridade e moradores da zona rural.

Exploring the coating of 3D-printed insulating substrates with conductive composites: a simple, cheap and versatile strategy to prepare customized high-performance electrochemical sensors.

The development of 3D-printed electrochemical sensors by fused deposition modeling (FDM) has been increasing exponentially in the last five years. In this context, commercial conductive filaments composed of a blend of carbon particles (e.g., graphene or carbon black (CB)) and insulating thermoplastic polymers (e.g., polylactic acid (PLA) or acrylonitrile butadiene styrene (ABS)) have been widely used for electrode fabrication. However, such materials may be expensive and the electrodes when used "as-printed" exhibit poor electrochemical performance as a function of the low content of conductive particles in the composition (∼10 to 20 wt%), which requires one or more post-treatment steps (e.g. polishing, chemical, electrochemical, and photochemical) to reach good electrochemical performance. In this technical note a less used approach to produce "ready-to-use" electrochemical platforms based on 3D printing is explored, which consists of the coating of 3D-printed insulating substrates with homemade conductive composites. To demonstrate the potentiality of this alternative protocol, 3D-printed ABS insulating substrates at two geometries were coated in a highly loaded graphite (55 wt%) homemade composite (G-ABS) and evaluated for the detection of the ferri/ferrocyanide redox probe and model analytes in stationary and hydrodynamic 3D-printed systems (nitrite in micro-flow injection analysis/µFIA and paracetamol in batch injection analysis/BIA, respectively). The analytical parameters acquired with the coated electrodes were comparable to those obtained using conventional electrodes (glassy carbon, boron-doped diamond and carbon screen-printed) and 3D-printed sensors fabricated with commercial filaments. Moreover, the inclusion of carbon black in the fluid conductive composite was demonstrated as a perspective to obtain modified coated 3D-printed surfaces easily for the first time. This alternative "do it yourself" strategy is promising for the large-scale production of very cheap (US$ 0.08) and high-performance electrodes based on FDM 3D printing. Moreover, this approach dispenses the acquisition of commercial conductive filaments and the laborious development of homemade filaments.

Dental Pain in Homeless Adults in Porto Alegre, Brazil.

OBJECTIVE: To evaluate the association of dental pain with time living on the street in a sample of homeless people in the city of Porto Alegre, Brazil. METHODS: A cross-sectional study was carried out with homeless people who accessed social services in 2017. A questionnaire was administered covering socioeconomic variables and including questions about general health, use of tobacco/alcohol/drugs, use of dental services and history of dental pain. The decayed, missing, and filled teeth (DMFT) index was calculated in an oral examination. The association between socioeconomic characteristics, health status, time of homelessness and dental pain was evaluated using chi-square, t-, and Mann-Whitney tests. RESULTS: A total sample of 214 homeless people was surveyed. Most were male (76.2%), had a low level of education (67.6%) and experienced many episodes of dental pain during life (91.0%). The last episode of pain was moderate or intense (79.7%) and do-it-yourself measures for pain relief were preferred (62.3%). Individuals who were homeless for longer than 1 year had more dental pain in the past (P < 0.001), more frequency of a recent episode of dental pain (P = 0.03), and sought a dentist or healthcare service to relieve pain less frequently (P = 0.03). CONCLUSIONS: Dental pain is frequent in the context of homelessness and does not necessarily result in seeking dental services, even where there is universal oral health care.

Efficacy of 1.23% acidulated phosphate fluoride gel on non-cavitated enamel lesions: a randomized clinical trial.

A randomized controlled parallel clinical trial was conducted to evaluate the efficacy of the association of 1.23% topical professional acidulated phosphate fluoride (APF) gel with oral hygiene and dietary instructions on the arrest of active non-cavitated lesions in permanent, mixed, and temporary dentition in children between 3 and 12 years of age. Ninety-eight caries-active children were randomly divided into two groups: a fluoride gel group (n = 49) and a non-fluoridated gel group (n = 49). Each group received up to eight weekly applications of gel, weekly professional toothbrushing with oral hygiene instructions and dietary counselling. Caries lesions were assessed qualitatively through visual-tactile criteria performed in three stages: initial, intermediate, and final. Regression models were applied to identify risk indicators for caries control. Between-group comparison regarding the time taken to arrest the lesions was performed using Chi-squared and Fisher's exact tests. Seventeen children did not receive the allocated intervention, and one was lost to follow-up (n = 80). There was no difference between the control and placebo groups regarding the time to the arrest of the lesion (p >.05). The treatments showed similar results without significant statistical difference (p = 0.33; 95%CI: 0.32-1.48). No adverse effects were observed. It can be concluded that no additional effect of the association of 1.23% APF gel with oral hygiene using fluoride dentifrice and dietary instructions on the arrest of active non-cavitated lesions could be established. We can also confirm the importance of toothbrushing frequency and, consequently, the visible plaque reduction in the control of caries activity. RBR-37V5S3.

Development of highly sensitive electrochemical sensor using new graphite/acrylonitrile butadiene styrene conductive composite and 3D printing-based alternative fabrication protocol.

Here, a novel electrically conductive thermoplastic material composed of graphite/acrylonitrile butadiene styrene (G/ABS) is reported for the first time. This material was explored on the production of 3D printing-based electrochemical sensors with enhanced sensitivity using a novel fabrication approach. The developed G/ABS electrodes showed lower charge transfer resistance (157 vs. 3279 Ω), higher electroactive area (0.61 vs. 0.19 cm2) and peak currents ca. 69% higher when compared with electrodes fabricated using carbon black/polylactic acid (CB/PLA) commercial filament, which has been widely explored in recent literature. Moreover, the G/ABS sensor provided satisfactory repeatability, reproducibility and stability (relative standard deviations (RSDs) were 1.14%, 6.81% and 10.62%, respectively). This improved performance can be attributed to the fabrication protocol developed here, which allows the incorporation of greater amounts of conductive material in the polymeric matrix. The G/ABS electrode also required a simpler and quicker protocol for activation when compared to CB/PLA. As proof of concept, the G/ABS sensor was employed for electroanalytical quantification of paracetamol (PAR) in pharmaceutical products. The linear concentration range was observed from 0.20 to 30 µmol L-1 and the limit of detection achieved was 54 nmol L-1, much lower than several recent studies dealing with the same analyte. The sensitivity of the G/ABS electrode regarding PAR was also far better when compared to CB/PLA sensor (0.50 µA/µmol L-1 vs. 0.12 µA/µmol L-1). Analyses in commercial pill samples showed good accuracy (recoveries ca. 108%) and precision (RSDs < 5%), suggesting great potential for use of this novel conductive thermoplastic in electroanalytical applications based on 3D printing.

Analysis of referrals to the stomatology service in a Southern Brazilian hospital: a retrospective study.

This paper intends to describe the demand for referrals to the stomatology service requested by the medical teams for inpatients in a reference hospital in the south of Brazil. This research is a retrospective cross-sectional descriptive study focusing on data collection and assessment of information about referrals to the stomatology unit carried out from January 2008 to December 2018. All information was obtained from the hospital management software database, then transferred and analyzed individually for descriptive statistics. A total of 4433 cases were referred to the stomatology team, with an average of 403 cases by year. Hematology/hemato-oncology (37.3%) was the specialty asking for the majority of the referrals, followed by Oncology (20.4%) and Pneumology (8.2%). The mean patients' profile was males (55.5%), receiving a diagnosis of oral mucositis (43.5%), and with the first and second decades of life being the most prevalent ones (34.9%), with a mean age of 34.8±22.3 years. The most common treatment performed by the stomatology team was the photobiomodulation therapy (44.8%). This retrospective study demonstrated the important profile of the stomatological care in hospitalized patients from a specific hospital, especially referred by the hematology/hemato-oncology team. These results evidenced the importance of the stomatology specialty in the hospital environment.

Barriers to and facilitators of communication to care for people with sensory disabilities in primary health care: a multilevel study. / Barreiras e facilitadores à comunicação no atendimento de pessoas com deficiência sensorial na atenção primária à saúde: estudo multinível.

OBJECTIVE: Communication barriers are the main obstacle for people with sensory disabilities (visual and hearing) to access health services. This study aims to describe the presence of facilitators of communication of basic health units in Brazil and to verify its associated factors. METHODS: Cross-sectional multilevel study, of 38,811 health units in 5,543 municipalities between 2012 and 2013, collected in the National Program for Improving Access and Quality in Primary Care (Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica - PMAQ-AB). The outcome was defined by grouping facilitators of communication (braille material; hearing resources; visual communication; accessible list of service; professionals to welcome users with sensory disabilities). The two levels were structured, using the variables: level I (contextual): macro region, population size, and GDP per capita; and level II (service): extended professional team (psychologist/social worker); service shifts; welcoming room; publishing of service hours; presence of physical access facilitators. Multilevel Poisson regression with hierarchical modeling was used in both stages. RESULTS: The presence of facilitators of communication is small in Brazilian health units (32.1%). It is more frequent in the municipalities with a higher GDP (RP = 1.02, 95%CI 0.92 - 1.12) and population size (RP = 1.25, 95%CI 1.02 - 1.52). CONCLUSION: Welcoming users is the main access facilitator and should be the focus of initiatives to improve health care for disabled persons. Universal access with adequate services, removal of communication barriers and encouragement to properly welcome users must be promoted.

[Primary dental healthcare in Brazil: the work process of oral health teams]. / Atenção primária à saúde bucal no Brasil: processo de trabalho das equipes de saúde bucal.

Ensuring access to dental care services requires the development of healthsurveillance practices to ensure comprehensive health care. The objective of this study was toinvestigate the association between social and economic indicators of Brazilian municipalities, work process characteristics, and performance of a list of curative dental procedures by oral health teams. It involved an exploratory, cross-sectional study withmulticenter data collection from 11,374 oral health teams assessed by the National Program for Improvement of Access to and Quality of Primary Healthcare. Multilevel Poisson regression was used to obtain the prevalence of curative dental procedures, which was 69.51%. The social/economic and work variables that remained associated with the outcome included municipalities in which the proportion of primary care-sensitive admissions was below 28% and that of tooth extractions below 8%; and oral health teams classified as type II (including oral health assistant and technician) that had different materials available and better work processes. This multilevel analysis, which took into consideration the performance of curative dental care in Brazil, reveals a worrying oral healthcare scenario.

A garantia de atenção odontológica passa pelo desenvolvimento de práticas pautadas na vigilância em saúde, a fim de concretizar a integralidade. Objetivou-se avaliar a associação entre aspectos contextuais dos municípios brasileiros, características do processo de trabalho e a realização de um rol de procedimentos odontológicos curativos pelas equipes de saúde bucal (ESB). Trata-se de estudo exploratório transversal cuja coleta multicêntrica de dados se deu em 11.374 ESB avaliadas pelo Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica. Foi empregada regressão de Poisson multinível para obtenção da prevalência de realização de procedimentos odontológicos curativos, que foi de 69,51%. As variáveis contextuais e da equipe de saúde que se mantiveram associadas ao desfecho incluíram municípios cuja proporção de internações sensíveis à atenção básica foi menor que 28% e cuja proporção de exodontias foi menor que 8%; bem como ESB de modalidade II que tinham à disposição materiais, insumos e melhores processos de trabalho. Esta análise multinível, que considera o desempenho da atenção odontológica curativa no Brasil, aponta para um cenário de atenção odontológica preocupante.

Dental care for early childhood in Brazil: from the public policy to evidence.

OBJECTIVE: To evaluate whether characteristics of health services, oral health team and dental surgeon are associated with provision of dental care for children up to five years old in Brazilian Primary Health Care. METHODS: A cross-sectional study was conducted with data from 18,114 oral health teams in Brazil, evaluated in 2014 by the National Program for Access and Quality Improvement in Primary Care. The study outcome was the proven performance of dental procedures on children up to five years old. Statistical analysis was performed by Poisson regression based on a hierarchical model, where the first level was composed of service organization variables, the intermediate level composed of unit planning characteristics, and the proximal level composed of variables related to dental surgeon characteristics. RESULTS: Prevalence of dental care performed by oral health teams was 80.9% (n = 14,239). Scheduled appointments and activities of education in health were positively associated with the outcome, as well as planning and programming activities for the population and monitoring and analysis of oral health indicators. Complementary training in public health, continuing education activities and career plan were variables related to dental surgeons associated with the service provision. CONCLUSIONS: One fifth of health units in Brazil do not provide dental care for children in early childhood. Health units' well-structured organization and planning protocols are associated with the provision of this service, as well as better employment relationship and graduate activities for dental surgeons.