RESUMO
BACKGROUND: This study aimed to assess the trend in income-related inequalities in oral health services utilization by the Brazilian population from 1998 to 2013. This period represents a timeline that includes different stages of implementation of the National Oral Health Policy. METHODS: The design was based on repeated cross-sectional surveys using secondary data from household-based studies carried out in Brazil in 1998, 2003, 2008, and 2013. The dependent variable was "having access to a dentist appointment at least once in a lifetime (yes/no)." Monthly household per capita income, based on Brazil's minimum wage, was included as the main independent variable. To measure the inequalities in oral health access related to economic position, the following complex indexes based on regression were used: (a) the slope index of inequality (SII) and (b) the relative index of inequality (RII). RESULTS: There was a reduction in the percentage of individuals who never had a dentist appointment for all age groups and income classifications. In general, there was a reduction trend in absolute inequality for all age groups (p < 0.001). The relative inequality and reduction trend were different between the age groups studied. CONCLUSIONS: The National Oral Health Policy was very important for expanding free of charge, public access to dental appointment. However, despite policy implementation, there continues to be high levels of inequality in access to dental consultation. Assessing which strategies are necessary to overcome this challenge is discussed.
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Disparidades nos Níveis de Saúde , Saúde Bucal , Brasil , Estudos Transversais , Utilização de Instalações e Serviços , Política de Saúde , Disparidades em Assistência à Saúde , Humanos , Renda , Fatores SocioeconômicosRESUMO
OBJECTIVE: To investigate the impact of the family's socioeconomic trajectory on the oral health status of young people in the city of Sobral, Ceará, Brazil, and test the hypotheses of the life course theory. METHODS: This is a cohort study conducted in 2000, 2006, and 2012. In the third wave, 482 individuals between 17 and 21 years of age were examined and interviewed. The outcomes analyzed were the trajectory of tooth decay (decayed teeth in 2012 and cavity reoccurrence) and the trajectory of dental assistance (immediate dental assistance and untreated caries). The socioeconomic trajectory was measured by the mobility of the family's income between childhood and youth and the number of episodes of poverty throughout life. RESULTS: The risk of developing decayed teeth in 2012 was greater for those who had always remained poor. Young people who were never poor had fewer decayed teeth in 2012, but more cavity reoccurrence. Downward mobility resulted in less access to immediate dental assistance. More experience of poverty throughout life implied more decayed teeth in 2012 and less immediate dental assistance. CONCLUSION: The life course hypotheses regarding an influence of socioeconomic mobility and cumulative risk on oral health outcomes in youth were confirmed.
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Cárie Dentária/epidemiologia , Renda , Saúde Bucal , Pobreza , Adolescente , Brasil , Estudos de Coortes , Humanos , Adulto JovemRESUMO
Dental caries levels have declined in children since the 1970s in many countries. Most of the postulated main reasons for the decline are speculative and have not been rigorously evaluated. The objective of this study was to assess the relationship between some social factors and the decline in dental caries in Brazilian 12-year-old children from 1996 to 2010. Secondary analysis of national data was performed in 27 Brazilian state capitals. A panel data regression model with fixed effects and multiple linear regression were used to verify the relationship between the explanatory and the dependent variables and also the time-trend effect. The results showed that the DMFT (decayed, missing, and filled teeth) decreased by about 3% per year, and the percentage of caries-free children increased by 4.5% per year. For DMFT and percentage caries free, the results for the panel data regression showed a significant association for the Human Development Index (HDI) in the adjusted model (p = 0.010). When the overall changes over time were compared, the Gini index had a significant association with the overall change in DMFT in the final model of the multiple regression analysis (p = 0.033). Our results indicate that the maintenance of good levels of human development, which includes better education, income, and longevity, are important factors relating to improving levels of oral health in 12-year-old Brazilian children. However, to accelerate this process in cities with the worst caries situation, income inequality should be tackled.
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Cárie Dentária/epidemiologia , Serviços de Saúde Bucal/estatística & dados numéricos , Saúde Bucal/estatística & dados numéricos , Fatores Socioeconômicos , Brasil/epidemiologia , Criança , Índice CPO , Cárie Dentária/terapia , Feminino , Fluoretos/uso terapêutico , Humanos , Longevidade , Masculino , Prevalência , Análise de Regressão , Fatores de TempoRESUMO
BACKGROUND: Brazil has severe socioeconomic inequalities, resulting in major oral health problems for the Brazilian elderly, such as tooth loss and, consequently, a need for oral rehabilitation. The aim of this study was to evaluate inequalities in complete denture need among older Brazilian adults in relation to social determinants at individual and contextual levels. METHODS: This retrospective study was based on data from the national oral health survey, SB Brasil 2010, in which 7,619 older adults aged 65-74 years participated. The dependent variable was complete denture need. The independent variables at the first level were age, sex, race, and socioeconomic status. The independent variables that were used to identify inequality at the contextual level were geographic region of Brazil, the population of the municipality where the subject lived, whether the subject lived in the state capital or not, and the Human Development Index. In order to describe the socioeconomic characteristics, a socioeconomic cluster variable was created using the multivariable cluster analysis technique. Prevalence ratios (PRs) with 95 % confidence intervals (CIs) were determined to evaluate the effect of each variable. Two-level multivariable modeling was performed to examine the individual and contextual effects. RESULTS: There was a high prevalence of complete denture need among older Brazilian adults. The main factors associated with the prevalence of complete denture need were individual socioeconomic status (PR: 1.81; 95 % CI: 1.65-1.99), and the city-level contextual effect (PR: 1.20; 95 % CI: 1.08-1.34). CONCLUSIONS: Consistently poor rates of oral health rehabilitation were found among older Brazilian adults, and were associated with significant social inequality. Complete denture need was strongly associated with individual socioeconomic position. It was also verified that the Human Development Index, the city-level contextual effect, was associated with complete denture need.
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Prótese Total , Disparidades em Assistência à Saúde , Saúde Bucal , Fatores Socioeconômicos , Idoso , Brasil , Estudos Transversais , Feminino , Humanos , Masculino , Estudos RetrospectivosRESUMO
BACKGROUND: The chronic cumulative nature of caries makes treatment needs a severe problem in adults. Despite the fact that oral diseases occur in social contexts, there are few studies using multilevel analyses focusing on treatment needs. Thus, considering the importance of context in explaining oral health related inequalities, this study aims to evaluate the social determinants of dental treatment needs in 35-44 year old Brazilian adults, assessing whether inequalities in needs are expressed at individual and contextual levels. METHODS: The dependent variables were based on the prevalence of normative dental treatment needs in adults: (a) restorative treatment; (b) tooth extraction and (c) prosthetic treatment. The independent variables at first level were household income, formal education level, sex and race. At second level, income, sanitation, infrastructure and house conditions. The city-level variables were the Human Development Index (HDI) and indicators related to health services. Exploratory analysis was performed evaluating the effect of each level through calculating Prevalence Ratios (PR). In addition, a three-level multilevel modelling was constructed for all outcomes to verify the effect of individual characteristics and also the influence of context. RESULTS: In relation to the need for restorative treatment, the main factors implicated were related to individual socioeconomic position, however the city-level contextual effect should also be considered. Regarding need for tooth extraction, the contextual effect does not seem to be important and, in relation to the needs for prosthetic treatment, the final model showed effect of individual-level and city-level. Variables related to health services did not show significant effects. CONCLUSIONS: Dental treatment needs related to primary care (restoration and tooth extraction) and secondary care (prosthesis) were strongly associated with individual socioeconomic position, mainly income and education, in Brazilian adults. In addition to this individual effect, a city-level contextual effect, represented by HDI, was also observed for need for restorations and prosthesis, but not for tooth extractions. These findings have important implications for the health policy especially for financing and planning, since the distribution of oral health resources must consider the inequalities in availability and affordability of dental care for all.
Assuntos
Assistência Odontológica/estatística & dados numéricos , Cárie Dentária/epidemiologia , Necessidades e Demandas de Serviços de Saúde , Disparidades nos Níveis de Saúde , Adulto , Brasil/epidemiologia , Cárie Dentária/prevenção & controle , Feminino , Política de Saúde , Humanos , Masculino , Modelos Teóricos , Prevalência , Fatores SocioeconômicosRESUMO
This study aimed to analyze the prevalence of work-related musculoskeletal disorders (WMSD) and their association with individual and contextual factors in the Brazilian population. This quantitative cross-sectional study used secondary data from the Brazilian National Health Survey from August 2013 to February 2014. The dependent variable included WMSD, and independent variables were analyzed as individual and contextual factors. WMSD was mostly prevalent in females, individuals aged 43 to 59 years, with chronic physical or mental disorders, reporting frequent sleep disorders, and performing integrative and complementary health practices, physical exercise or sports, and heavy physical activity or housework. Regarding contextual factors, high social classes and proportion of individuals with formal work were associated with a high prevalence of WMSD, whereas a high Gini index was associated with a low prevalence. Thus, a high prevalence of WMSD in the Brazilian population was associated with individual and contextual factors, which should be the target of health professionals for actions of promotion, prevention, and intervention at individual or collective care levels.
Assuntos
Doenças Musculoesqueléticas , Doenças Profissionais , Humanos , Brasil/epidemiologia , Feminino , Masculino , Adulto , Pessoa de Meia-Idade , Doenças Musculoesqueléticas/epidemiologia , Estudos Transversais , Doenças Profissionais/epidemiologia , Prevalência , Adulto Jovem , Adolescente , Determinantes Sociais da Saúde , Inquéritos Epidemiológicos , Fatores SocioeconômicosRESUMO
OBJECTIVES: Constructing and validating a theoretical model of relationships between dental services use and socioeconomic characteristics, oral health status, primary care coverage, and public dental services. METHODS: The first stage of the study consisted of developing a theoretical-conceptual model to demonstrate the expected relationships between variables based on the literature. In the second stage, we tested the proposed theoretical model using the Partial Least Squares Structural Equation Modeling (PLS-SEM) technique, using data from the Brazilian National Health Survey conducted in 2019 with a sample of 41,664 individuals aged 15 or older. RESULTS: This study successfully defined a theoretical model that explains the systematic relationships involving public dental services utilization. Socioeconomic status was negatively associated with oral health status (ß = -0.376), enrollment in primary care facilities (ß = -0.254), and the use of public dental consultations (ß = -0.251). Being black, indigenous, or living in a rural area was directly associated with lower socioeconomic status and greater use of public dental services. CONCLUSIONS: The identified relationships, establishing a theoretical basis for further investigations, also provide evidence of a public access policy's effect on oral health services on equity, supporting the construction of more effective and equitable public policies.
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Assistência Odontológica , Utilização de Instalações e Serviços , Humanos , População Negra , Brasil/epidemiologia , Assistência Odontológica/estatística & dados numéricos , Utilização de Instalações e Serviços/estatística & dados numéricos , Inquéritos Epidemiológicos , Modelos Teóricos , Fatores SocioeconômicosRESUMO
OBJECTIVES: The study aimed to examine individual and contextual factors associated with the frequency of dental service utilization among adolescents, adults and older adults Brazilians. METHODS: This cross-sectional study used secondary data from the Brazilian 2019 National Health Survey (94 114 individuals). The outcome 'when was your last dental appointment?' was categorized into three groups: up to 1 year, more than 1 year and never had a dental appointment. Andersen's behavioural model was used to select contextual and individual variables. Multinomial logistic regression analysis was performed to calculate the odds ratio (OR) and 95% confidence intervals (95% CI). RESULTS: The following variables showed increased probability to the outcome had the last dental appointment more than 1 year ago: older adult, illiterate or incomplete primary school, and without private dental insurance. The outcome never had a dental appointment was significantly associated with illiterate (OR 26.65; 95% CI 17.63-40.29), male (OR 2.38; 95% CI 2.17-2.61), without private dental insurance (OR 5.20; 95% CI 3.48-7.76), self-rated oral health as bad or very bad (OR 2.67; 95% CI 2.31-3.09), household not enrolled in primary care teams (OR 1.29; 95% CI 1.11-1.49), household in a rural area (OR 1.86; 95% CI 1.69-2.05), high household crowding (OR 1.08; 95% CI 1.04-1.14) and low household income per capita (OR 0.99; 95% CI 0.99-0.99). CONCLUSIONS: This study showed that contextual and individual factors induce inequity in dental appointments. Moreover, Andersen's behavioural model demonstrated inequitable access for dental services in Brazil, in which social structure and enabling characteristics, rather than the need for the service, determine who receives health care. Living in a household enrolled in primary care teams favoured regular dental appointments. Thus, these findings may help policymakers improve health access by expanding coverage of dental services in primary health care.
Assuntos
Aglomeração , Características da Família , Adolescente , Humanos , Masculino , Idoso , Brasil , Estudos Transversais , Assistência OdontológicaRESUMO
INTRODUCTION: Access to medicines is a challenge, especially in developing countries, highlighting the need of population-based research to evaluate access and related factors. OBJECTIVE: This study aimed to assess access to medicines and identify associated factors using data from the 2019 Brazilian National Health Survey (PNS). METHODS: This population-based cross-sectional study used data from the 2019 PNS and considered access to prescription medicines as the primary outcome. The sample included 24,753 individuals aged 15 years or older who looked for medical care in the last 15 days and received a medicine prescription. Andersen's behavioral model was used to select independent variables. After descriptive analysis, a multinomial logistic regression multilevel analysis was performed using the independent variables with a significance level lower than 0.20 in the bivariate analysis. RESULTS: The lowest chances of getting access to medicines were observed in individuals aged between 40 and 59 years, women, with complete middle and high school, with lower-income families, who attended public services, with worse self-assessed health, and those who looked for health care for disease prevention and health promotion. CONCLUSIONS: Access to medicines among the Brazilian population is associated with social, economic, and health perception factors. Our findings may update and guide the development of public policies on medication and pharmaceutical care, facilitating medication purchases by the care user and promoting health equity.
Assuntos
Acessibilidade aos Serviços de Saúde , Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Brasil , Estudos Transversais , Fatores Socioeconômicos , Inquéritos EpidemiológicosRESUMO
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
This study aimed to examine the influence of socioeconomic factors on inequality in the use of dental services within the Brazilian population. The methodology was based on a sectional study, using secondary data from the 2013 National Health Survey (PNS, in Portuguese). The database contains information on 60,202 individuals over 18 years of age. The dependent variables were "frequency of dental appointments" and "type of dental treatment performed in the last appointment". The independent variables were sex, age group, education, social class measured using the Brazil criterion, and geographic region. The odds-ratio of outcomes were evaluated in the multivariate analysis using a multinomial logistic regression model. It was noticed that the population subgroups comprising Blacks and those residing in the North/Northeast, with lower social class and education, had a greater chance of having irregular follow-up and never having been to the dentist. In addition, this population stratum also had a greater chance of undergoing surgical or emergency dental procedures in the last dental appointment. Data from the 2013 PNS reveal a picture of social inequality in access to dental services in Brazil.
Este trabalho teve por objetivo analisar a influência de fatores socioeconômicos na desigualdade de utilização de serviços odontológicos na população brasileira. A metodologia baseou-se em um estudo seccional, com uso de dados secundários provenientes da Pesquisa Nacional de Saúde (PNS) 2013. O banco de dados utilizado contém informações sobre 60.202 indivíduos maiores de 18 anos. As variáveis dependentes avaliadas foram "frequência de consulta odontológica" e "tipo de tratamento odontológico realizado na última consulta. As variáveis independentes avaliadas foram sexo, faixa etária, escolaridade, classe social mensurada através do critério Brasil e região geográfica. Na análise multivariada, foram avaliadas as odds-ratio dos desfechos a partir de um modelo de regressão logística multinominal. Percebeu-se que a população de cor/raça negra, residente na região Norte/Nordeste, de menor classe social e escolaridade apresentou maior chance de realizar acompanhamento irregular e nunca ter ido ao dentista. Além disso, este estrato populacional também apresentou maior chance de realizar procedimentos odontológicos cirúrgicos ou de urgência na última consulta odontológica. Os dados da PNS 2013 demonstram um quadro de desigualdade social no acesso a serviços odontológicos no Brasil.
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Assistência Odontológica , Classe Social , Adolescente , Adulto , Brasil/epidemiologia , Escolaridade , Humanos , Fatores SocioeconômicosRESUMO
Introduction: Knee pain can impact the performance of activities and sports participation in children. Dynamic knee valgus is a movement pattern commonly related to health conditions that may be associated with sex and foot kinematics in children. Objective: To assess the prevalence of dynamic knee valgus and its relationship with foot mobility, sex, and knee pain in children. Method: A cross-sectional observational study was carried out with 144 children (10-18 years old). The pain level was investigated using the Visual Analog Pain Scale and categorized into no pain/minor pain (≤2 cm), moderate pain (3-4,9 cm), and severe pain (≥5.0 cm). Foot mobility was assessed using the adapted navicular drop test and categorized into poor/adequate foot mobility (0.0 cm-0.9 cm) and greater foot mobility (≥1.0 cm). The dynamic knee valgus presence was checked using the step-down test. The association analysis was performed using simple tabulation considering the cluster effect. The Prevalence Ratios and the respective confidence intervals (95%) were estimated from Multiple Poisson Regression with robust variance. A significance level of 5% was adopted. Results: The dynamic knee valgus prevalence was 26.3% and 26.9% in the right and left lower limbs, respectively. Females presented greater dynamic knee valgus frequency in the left lower limb than males. The dynamic knee valgus presence in males was associated with foot mobility in right (p = 0.001) (Prevalence Ratio: 9.33 Confidence Interval: 2.93-29.72) and left lower limbs (p = 0.003) (Prevalence Ratio: 6.25 Confidence Interval: 1.7-22.62). Conclusion: Male and female children showed different relationships of the analyzed factors, suggesting that characteristics related to sex may impact the aspects linked to dynamic knee in children.
RESUMO
The aim of this study was to develop a methodological proposal for the assessment of food and nutritional insecurity (FNiS) in adults and older adults (Vigi-FNiS). The proposal was developed using data from the BRAZUCA Natal survey, a cross-sectional study with 411 people living in Natal in the state of Rio Grande do Norte, Brazil. The association between sociodemographic, health and nutrition variables and food insecurity (FI) was tested using Poisson multiple regression. Overall prevalence of FI was 42.1% (37.4%-46.9%) and was higher in women (47.5%), adults (48.2%) and black people (52.7%). The following variables were included in the Vigi-FNiS: people aged <18 years living in the household (A) (AdjPR=1.3; 1.1-1.6); family income (B) in quintiles (Q1: AdjPR=5, 4; 2.5-11.7; Q2: AdjPR=4.8; 2.2-10.5; Q3: AdjPR=3.8; 1.8-8.5; Q4 AdjPR=2.2; 1.0-5.1); inadequate treatment of drinking water (C) (AdjPR=1.3; 1.1-1.5); presence of chronic non-communicable diseases (D) (AdjPR=1.3; 1.1-1.7); not eating fruit for breakfast (E) (AdjPR=1.7; 1.3-2.5);eating meals on the couch or in bed (F) (AdjPR=1.3; 1.1-1.6); and skipping either lunch or dinner or dinner (G) (AdjPR=1.4; 1.2-1.7). A cutoff point for FNiS of 2.3 was adopted (Kappa=0.47; sensitivity=0.82; specificity=0.67; PPV=0.64; NPV=0.83).
O objetivo deste artigo é desenvolver uma proposta metodológica para avaliar a insegurança alimentar e nutricional (INSAN) em adultos e idosos. A proposta metodológica Vigi-INSAN foi elaborada com dados do Brazuca Natal, um estudo transversal com 411 residentes de Natal-RN. O modelo preditivo foi desenvolvido por regressão múltipla de Poisson, analisando-se as variáveis sociodemográficas, de saúde e nutrição, e a insegurança alimentar (IA). A prevalência de IA foi 42,1% (37,4%-46,9%), sendo maior em mulheres (47,5%), adultos (48,2%) e pessoas de cor/raça preta (52,7%). O Vigi-INSAN foi composto por: presença de <18 anos no domicílio (A) (RPaj=1,3; 1,1-1,6), renda familiar (B) (em quintis) (Q1: RPaj=5,4; 2,5-11,7; Q2: RPaj=4,8; 2,2-10,5; Q3: RPaj=3,8; 1,8-8,5; Q4 RPaj=2,2; 1,0-5,1), tratamento inadequado da água de beber (C) (RPaj=1,3; 1,1-1,5), presença de DCNT (D) (RPaj=1,3; 1,1-1,7), não comer frutas no café da manhã (E) (RPaj=1,7; 1,3-2,5), realizar refeições no sofá da sala ou na cama (F) (RPaj=1,3; 1,1-1,6) e pular pelo menos o almoço ou o jantar (G) (RPaj=1,4; 1,2-1,7). Foi adotado o ponto de corte 2,3 (Kappa=0,47; Sensibilidade=0,82; Especificidade=0,67; VPP=0,64; VPN=0,83).
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Desjejum , Refeições , Idoso , Estudos Transversais , Feminino , Insegurança Alimentar , Abastecimento de Alimentos , Humanos , Estado NutricionalRESUMO
This study analyzed the delay in the primary surgical treatment of patients with cleft lip and palate in Brazil performed under the Unified Health System (SUS), and the effect of the sociodemographic context and municipal socioeconomic indicators on access to this treatment (2009-2013). Data from the Decentralized Hospital Information System relating to all hospital authorization forms paid for primary cleft lip and/or palate surgeries and socioeconomic data (2010) was used. The ages recommended by the American Cleft Palate-Craniofacial Association (12 months for lip surgeries and 18 months for palate surgeries) were used as parameters. The prevalence of delay observed in primary lip surgeries was 66.4% and in palate surgeries was 71.2%. The North and Northeast regions had the worst percentages of delay. Non-whites had a greater prevalence of delay in cleft lip surgeries with PR = 1.40 (1.30-1.50) and cleft palate surgeries with PR = 1.27 (1.21-1.33). The multilevel analysis identified the influence of self-reported skin color and Human Development Index (HDI) on the delay of primary lip surgery, and of HDI on the delay of palate surgery. The importance of social determination on the access to primary cleft lip and palate surgeries was evident.
Investigou-se o atraso no tratamento cirúrgico primário de fissuras labiopalatinas no âmbito do Sistema Único de Saúde (SUS) do Brasil e o efeito do contexto sociodemográfico e de indicadores socioeconômicos municipais no acesso a esse tratamento (2009-2013). Utilizaram-se informações das autorizações de internação hospitalar pagas para cirurgias primárias de lábio e de palato e variáveis socioeconômicas municipais (2010). Aplicaram-se os parâmetros adotados pela American Cleft Palate-Craniofacial Association: cirurgia de fissura de lábio (FL) aos 12 meses e de fissura de palato (FP) aos18 meses. Observou-se uma prevalência de 66,4% de atraso para cirurgias de lábio e 71,2% para cirurgias de palato, com piores percentuais nas regiões Norte (83,8% para FL e 86,6% para FP) e Nordeste (69% para FL e 75,2% para FP). Não brancos apresentaram maior prevalência de atraso nas cirurgias de fissuras de lábio, com RP = 1,40 (IC 95%: 1,30-1,50), e de fissuras palatinas, com RP = 1,27 (IC 95%: 1,21-1,33). A análise multinível identificou influência da cor autorreferida e do Índice de Desenvolvimento Humano Municipal (IDH-M) nos atrasos da queiloplastia primária e do IDH-M nos atrasos da cirurgia de palato. Ficou evidente a determinação social e o efeito de contexto no acesso a essas cirurgias no Brasil.
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Fenda Labial , Fissura Palatina , Brasil/epidemiologia , Fenda Labial/epidemiologia , Fenda Labial/cirurgia , Fissura Palatina/epidemiologia , Fissura Palatina/cirurgia , Humanos , Lactente , Análise Multinível , Estudos Retrospectivos , Estados UnidosRESUMO
OBJECTIVE: To perform a survival analysis of individuals diagnosed with COVID-19 identified by health information systems, analyzing the factors associated with the highest risk of death. METHODS: Survival analysis of individuals notified with COVID-19 in Rio Grande do Norte State using data from the Health Information Systems for the surveillance of cases of and deaths from COVID-19. The dependent variable was the period until the outcome occurrence. The independent variables were sex, self-reported skin color, age group, residence in the capital, and the presence of comorbidities. For data analysis the Kaplan-Meyer method and Cox-time-dependent Regression Model for multivariate analysis were used, with the covariable "period since the event notification recorded in days". RESULTS: Highest risk of death were observed in individuals aged 80 or older (HR = 8.06; p < 0.001), male (HR = 1.45, p < 0.001), non-white skin color (HR = 1.13; p < 0.033) or with no information (HR = 1.29; p < 0.001), with comorbidities (HR = 10.44; p < 0.001) or presence of comorbidities not reported (HR = 10.87; p < 0.001). CONCLUSION: The highest risk of occurrence of deaths from COVID-19 was observed in older adults, especially those over 80, patients who have comorbidities, men, and of non-white skin color. From the identification of the profile of patients with a higher risk of death with the identification by the health system, specific strategies of health care must be taken to prevent the evolution to death in these cases.
OBJETIVO: Realizar uma análise de sobrevivência de indivíduos diagnosticados com COVID-19 identificados pelos sistemas de informação em saúde, analisando os fatores associados ao maior risco de ocorrência de óbitos. MÉTODOS: Análise de sobrevivência de indivíduos notificados por COVID-19 no estado do Rio Grande do Norte até o dia 24 de agosto de 2020, utilizando dados dos sistemas de informação em saúde. A variável dependente foi o tempo até a ocorrência do desfecho. As variáveis independentes foram sexo, cor da pele, faixa etária, residir ou não na capital e presença de comorbidades. Para análise de dados, utilizou-se o método de Kaplan-Meyer e, na análise multivariada, utilizou-se o modelo de regressão de Cox tempo-dependente, utilizando a covariável "tempo desde a notificação do evento em dias". RESULTADOS: Apresentaram maiores riscos de ocorrência de óbitos por COVID-19 os indivíduos com 80 anos ou mais de idade (HR = 8,06; p < 0,001), do sexo masculino (HR = 1,45; p < 0,001), com cor de pele não branca (HR = 1,13; p < 0,033) ou sem informação (HR = 1,29; p < 0,001), que tinham comorbidades (HR = 10,44; p < 0,001) ou que a presença de comorbidades não foi informada (HR = 10,87; p < 0,001). CONCLUSÃO: O maior risco de ocorrência de óbitos por COVID-19 foi observado em indivíduos idosos, sobretudo os com idade acima de 80 anos, pacientes com comorbidades, homens e com cor de pele não branca. Com base na identificação desse perfil, estratégias e linhas de cuidado específicas devem ser tomadas para prevenir a evolução ao óbito nesses casos pela identificação desses indivíduos no sistema de saúde.
Assuntos
COVID-19/mortalidade , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Comorbidade , Feminino , Humanos , Masculino , Grupos Raciais , Fatores de Risco , Fatores SexuaisRESUMO
The study aimed to analyze factors associated with the availability of specialized dental services in Brazilian municipalities. This was an ecological study with a sample of 776 municipalities that participated in the first cycle of the Program to Improve Access and Quality of Dental Specialization Centers (PMAQ-CEO, in Portuguese) survey held in 2014. The study's dependent variables consisted of a coefficient created with variables on the number of professionals and the workweek of dentists in the minimum set of specialties, per 10,000 inhabitants. Exploratory factor analysis was performed to create a score for the municipalities' performance with the availability of specialized dental services. Factors associated with the municipalities' performance were assessed with Pearson's chi-square test, with the following municipal indicators as independent variables, categorized in tertiles: per capita income, Municipal Human Development Index (HDI-M), resident population, total health spending per inhabitant, and Oral Health Teams per 10,000 inhabitants. Higher performance with the availability of specialized oral health services was associated with municipalities having smaller populations (67.3%; CI: 61.6-73.0; p < 0.001), lower HDI-M (41.9%; CI: 35.8-48.0; p < 0.001), lower per capita income (41.2%; CI: 35.2-47.3; p < 0.001), and higher mean number of oral health teams per 10,000 inhabitants (50.6%; CI: 46.0-58.4; p < 0.001). The results show positive impacts from the implementation of the National Oral Health Policy in Brazil, meeting the goal of expanding the supply of secondary care services according to the principle of equity in care.
Objetivou-se analisar em nível nacional os fatores associados à disponibilidade de serviços odontológicos especializados nos municípios brasileiros. É um estudo ecológico, com amostra de 776 municípios que participaram do 1º ciclo do Programa de Melhoria do Acesso e da Qualidade dos Centros de Especialidades Odontológicas (PMAQ-CEO) realizado em 2014. As variáveis dependentes do estudo consistiram em um coeficiente criado com base nas variáveis de número de profissionais e carga horária semanal de cirurgiões-dentistas atuando nas especialidades mínimas por 10 mil habitantes. Realizou-se uma análise fatorial exploratória para a criação de um escore que mensura o desempenho dos municípios quanto à disponibilidade de serviços odontológicos especializados. A fim de avaliar os fatores associados ao desempenho dos municípios utilizou-se o teste do qui-quadrado de Pearson, tendo como variáveis independentes os seguintes indicadores municipais categorizados em tercis: renda per capita, Índice de Desenvolvimento Humano Municipal (IDH-M), população residente, despesa total com saúde por habitante e equipes de saúde bucal por 10 mil habitantes. O maior desempenho quanto à disponibilidade de serviços especializados em saúde bucal esteve associado a municípios com menor porte populacional (67,3%; IC: 61,6-73,0; p < 0,001), com menor IDH-M (41,9%; IC: 35,8-48,0; p < 0,001) e com menor renda per capita (41,2%; IC: 35,2-47,3; p < 0,001) e maior média de equipes de saúde bucal por 10 mil habitantes (50,6%; IC: 46,0-58,4; p < 0,001). Os resultados demonstram impactos positivos da implantação da Política Nacional de Saúde Bucal no país, como o cumprimento do objetivo de ampliação da oferta dos serviços de atenção secundária sob o princípio da equidade na assistência.
El objetivo fue analizar nacionalmente los factores asociados con la disponibilidad de servicios odontológicos especializados en municipios brasileños. Se trata de un estudio ecológico, con una muestra de 776 municipios que participaron en el 1er ciclo del Programa para Mejorar el Acceso y la Calidad de los Centros de Especialización Odontológicas (PMAQ-CEO, en Portugués), realizado en 2014. Las variables dependientes del estudio consistieron en un coeficiente creado a partir de las variables de número de profesionales y carga horaria semanal de cirujanos-dentistas, ejerciendo en las especialidades mínimas por 10.000 habitantes. Se realizó un análisis factorial exploratorio para la creación de una puntuación que midiera el desempeño de los municipios, respecto a la disponibilidad de servicios odontológicos especializados. Con el fin de evaluar los factores asociados con el desempeño de los municipios, se utilizó el test de chi-quadrado de Pearson, teniendo como variables independientes los siguientes indicadores municipales categorizados en terciles: renta per cápita, Índice de Desarrollo Humano Municipal (IDH-M), población residente, gasto total por habitante en salud y equipos de salud bucal por 10.000 habitantes. El mayor desempeño respecto a la disponibilidad de servicios especializados en salud bucal estuvo asociado a municipios con menor tamaño poblacional (67,3%; IC: 61,6-73,0; p < 0,001), con menor IDH-M (41,9%; IC: 35,8-48,0; p < 0,001) y con menor renta per cápita (41,2%; IC: 35,2-47,3; p < 0,001) y mayor media de equipos de salud bucal por 10.000 habitantes (50,6%; IC: 46,0-58,4; p < 0,001). Los resultados demuestran impactos positivos de la implantación de la Política Nacional de Salud Bucal en el país, como el cumplimiento del objetivo de ampliación de la oferta de los servicios de atención secundaria, basados en el principio de la equidad en la asistencia.
Assuntos
Serviços de Saúde , Saúde Bucal , Brasil , Cidades , Acessibilidade aos Serviços de Saúde , Humanos , Fatores SocioeconômicosRESUMO
BACKGROUND: This study verified the association between contextual and individual factors and public dental services utilisation in Brazil. METHODS: The study was conducted based on a cross-sectional population-based household survey performed in Brazil (National Health Survey- 2019)). Data was collected between August 2019 and March 2020. Total sample included 43,167 individuals aged ≥15 years who had at least one dental appointment in the last 12 months before interview. Study outcome was 'public dental service utilisation', and Andersen's behavioral model was adopted for selecting independent variables. A multilevel analysis was performed using individual factors as first level and federation units as second level. RESULTS: The highest prevalence of public dental service utilisation on an individual level was observed among unable to read or write people (PR: 3.31; p<0.001), indigenous (PR: 1.40; p<0.001), black or brown (PR: 1.16; p<0.001), with per capita household income of up to U$124 (PR: 2.40; p<0.001), living in the rural area (PR: 1.28; p<0.001), and who self-rated oral health as regular (PR: 1.15; p<0.001) or very bad/bad (PR: 1.26; p<0.001). On the contextual level, highest PR of public dental service utilisation was observed among those living in federal units with increased oral health coverage in primary health care. CONCLUSIONS: Public dental service utilisation is associated with individual and contextual factors. These results can guide decision-making based on evidence from policymakers, demonstrating the potential for mitigating oral health inequalities and increasing service coverage in a public and universal health system.
Assuntos
Análise Multinível , Adulto , Brasil , Estudos Transversais , Utilização de Instalações e Serviços , Humanos , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
The study aimed to analyze strategies for the implementation of the Brazilian National Oral Health Policy (PNSB) and its influence on oral health conditions in state capitals in the first decade of the 21st century. This is a policy assessment study. Data on oral health conditions were obtained from the databases of the Brazilian National Oral Health Surveys in 2003 and 2010 (SBBrasil 2003 and SBBrasil 2010), calculating the annual percent change in variables pertaining to oral health conditions as dependent variables for Brazilian state capitals. The PNSB was analyzed according to its conceptual foundations: oral healthcare model, organization of the supply of oral health services, implementation of oral health promotion strategies, and existence of fluoridation of the public water supply. Data were obtained from the national health databases and face-to-face interviews with oral health coordinators in 13 state capitals. The analyses were controlled and adjusted by the target population's socioeconomic conditions. An association was observed between the characteristics of oral health promotion, services supply, and model of care, indicating that the public services' dynamic is dependent on the management priorities and the policy's conduction. In conclusion, the PNSB is implemented differently in Brazil's state capitals according to the ways its guidelines are conducted in each capital and whether it favors best practices and strategies in oral healthcare. However, the influence of the PNSB is still not clear on the modification of oral health indicators from 2003 to 2010.
Objetivou-se analisar estratégias de implantação da Política Nacional de Saúde Bucal (PNSB) e sua possível influência sobre a morbidade bucal em capitais do Brasil na primeira década do século XXI. Trata-se de um estudo de avaliação de políticas. Os dados de morbidade bucal foram obtidos nos bancos das Pesquisas Nacionais de Saúde Bucal em 2003 e 2010 (SBBrasil 2003 e SBBrasil 2010), sendo calculada a modificação percentual anual de variáveis relativas às condições de saúde bucal como variáveis dependentes para as capitais brasileiras. A PNSB foi investigada relativamente às suas bases conceituais: modelo de atenção em saúde bucal, organização da oferta de serviços de saúde bucal, implementação de estratégias de promoção da saúde bucal e existência de fluoretação nas águas de abastecimento público. Para isso, foram utilizados dados dos sistemas de informação em saúde nacionais e aplicação de questionário face a face com coordenadores de saúde bucal de 13 capitais selecionadas. As análises foram controladas e ajustadas pelas condições socioeconômicas da população investigada. Observou-se uma associação entre as características de promoção de saúde bucal, da oferta de serviços e do modelo de atenção, o que representa que a dinâmica dos serviços públicos é dependente das prioridades de gestão e da condução da política. Conclui-se que a PNSB é implementada de forma diferente nas capitais brasileiras e o modo de condução de suas diretrizes, em cada capital, favorece ou não o desenvolvimento de melhores práticas e estratégias na atenção à saúde bucal. Contudo, a influência da PNSB sobre a modificação nos indicadores de saúde bucal entre 2003 e 2010 ainda é pouco clara.
El objetivo fue analizar estrategias de implantación de la Política Nacional de Salud Bucal (PNSB) y su posible influencia sobre la morbilidad bucal en capitales de Brasil, durante la primera década del siglo XXI. Se trata de un estudio de evaluación de políticas. Los datos de morbilidad bucal se obtuvieron en los bancos de datos de las Encuestas Nacionales de Salud Bucal en 2003 y 2010 (SBBrasil 2003 y SBBrasil 2010), calculándose la modificación del porcentaje anual de variables relacionadas con las condiciones de salud bucal, como variables dependientes para las capitales brasileñas. Se investigó la PNSB respecto a sus bases conceptuales: modelo de atención en salud bucal, organización de la oferta de servicios de salud bucal, implementación de estrategias de promoción de la salud bucal y existencia de fluoración en las aguas de abastecimiento público. Para eso, se utilizaron datos de los sistemas de información en salud nacionales y la aplicación de un cuestionario cara a cara con coordinadores de salud bucal de 13 capitales seleccionadas. Se controlaron los análisis y se ajustaron por las condiciones socioeconómicas de la población investigada. Se observó una asociación entre las características de promoción de salud bucal, oferta de servicios y modelo de atención, lo que indica que la dinámica de los servicios públicos es dependiente de las prioridades de gestión, así como de su dirección de la política. Se concluye que la PNSB se implementa de forma diferente en las capitales brasileñas, y la forma en la que se implementan sus directrices, en cada capital, favorece o no el desarrollo de mejores prácticas y estrategias de atención en salud bucal. No obstante, la influencia de la PNSB sobre la modificación de los indicadores en salud bucal entre 2003 y 2010 todavía es poco clara.
Assuntos
Política de Saúde , Saúde Bucal , Brasil , Fluoretação , Promoção da Saúde , HumanosRESUMO
BACKGROUND: Scoliosis is considered one of the main musculoskeletal changes in childhood, and is characterized by three-dimensional changes in the spine. Schoolchildren is a group who are directly exposed to this condition because they go through a rapid growth phase in adolescence, added to other external factors such as school environment and daily living habits such as little physical activity. This study aimed to identify the risk factors associated with scoliosis in schoolchildren. METHODS: An observational, retrospective case control study with a quantitative approach was carried out in the city of Santa Cruz/RN. The presence of scoliosis was assessed using the Adams test and physical activity by the Daily Physical Activity Index (IPAQ) and by a questionnaire on competitive sports practice, in addition to a questionnaire on postural habits in childhood and adolescence. Conditional multiple logistic regression was performed for statistical analysis, and the adjusted Odds Ratios (OR) and the respective confidence intervals (95%) of the outcome variable were estimated. RESULTS: A total of 156 schoolchildren participated in the study, with an average age of 13.9 years, with 55.1% being female and 44.9% male, attending between the 6th grade of elementary school and the 3rd year of high school. Furthermore, 42.9% of these participants were considered irregularly active and only 33.3% practiced physical activity on a regular basis. After bivariate analysis and conditional logistic regression, little physical activity was shown to be a risk factor for scoliosis (p = 0.041; OR: 2.81; 95% CI: 1.04-7.57), while the postural habits evaluated in this study did not show a statistical association with scoliosis. CONCLUSION: Low practice of physical activity and schoolchildren being classified as irregularly active were considered as risk factors for scoliosis, however postural habits do not seem to be associated with this condition.
RESUMO
Identifying the risk factors for dental caries is vital in epidemiology and clinical practices for developing effective preventive strategies, both, at the individual and collective levels. Different causality/determination models have been proposed to understand the development process of dental caries. In the present review, we designed a model inspired by the world-known social determinants models proposed in the 90s and more recently in the 10s, wherein the contextual factors are placed more externally and encompass the individual factors. The contextual factors included those related to the cultural and societal values, as well as the social and health government policies. The individual factors were classified into the following categories: socioeconomic (social class, occupation, income, and education level), demographic characteristics (age, sex, and ethnicity), behavioral factors (non-use of fluoride dentifrice, sugar consumption, poor oral hygiene, and lack of preventive dental care), and biological factors (recent caries experience/active caries lesions, biofilm retentive factors, developmental defects of the enamel, disabilities, saliva amount and quality, cariogenic biofilm). Each of these variables was addressed, while focusing on the current evidence from studies conducted in Latin American and Caribbean countries (LACC). Based on the proposed model, educational aspects were addressed, and individual caries risk assessment and management decisions were proposed; further, implications for public health policies and clinical practice were described. The identification of modifiable risk factors for dental caries should be the basis for multi-strategy actions that consider the diversity of Latin American communities.