Area-level inequalities in Covid-19 outcomes in Brazil in 2020 and 2021: An analysis of 1,894,165 severe Covid-19 cases.

The study aims to analyze inequalities in Covid-19 outcomes in Brazil in 2020/2021 according to the per capita Gross Domestic Product (pcGDP) of municipalities. All cases of Severe Acute Respiratory Syndrome (SARS) who were hospitalized or died, regardless of hospitalization, registered in Brazil in 2020 and 2021 were analyzed (n = 2,902,742), including those with a confirmed diagnosis of Covid-19 (n = 1,894,165). We calculated lethality due to Covid-19, the performance of diagnostic tests among patients with SARS, and the hospital care received by those with Covid-19 according to the pcGDP of the patients' municipalities of residence. Data were analyzed for each epidemiological week and the risk of each outcome was estimated using Poisson regression. Municipalities in the lowest pcGDP decile had (i) 30% (95%CI 28%-32%) higher lethality from Covid-19, (ii) three times higher proportion of patients with SARS without the collection of biological material for the diagnosis of Covid-19, (iii) 16% (95%CI 15%-16%) higher proportion of SARS patients testing in a period longer than two days from the onset of symptoms, (iv) 140% (95%CI 134%-145%) higher absence of CT scan use. There is deep socioeconomic inequality among Brazilian municipalities regarding the occurrence of Covid-19 negative outcomes.

Telehealth Centers: A Proposal of a Theoretical Model for Evaluation.

BACKGROUND: Telehealth is a form of assistance support and continuing education for professionals who work in Primary Healthcare. INTRODUCTION: The implementation of the Brazilian Telehealth Program has extended the need for evaluation of its results to improve its use and benefits. Thus, it is necessary to systematize the theory, principals, and guidelines that guide the program organization, its activities, and resources. The objective of this study is to propose a theoretical model of functioning and organization for telehealth centers of the Brazilian Telehealth Program. MATERIALS AND METHODS: A study that combined bibliographic, documental research and empiric data to systematize information, which are the basis functioning of the program, and verify the availability of telehealth centers in Brazil. RESULTS: The results were the construction of a theoretical model that demonstrated the evaluability of the object and the definition of methodological paths to continue the evaluation research that respond with fragilities and potentialities. DISCUSSION: In Brazil, there is public funding for telehealth activities offered by telehealth centers linked to the Ministry of Health. Its operation is guided by support for training and assistance activities, enabling qualification and strengthening of professionals to improve patient care and increase access. The transformation of reality is possible and favored by the articulation of teaching and service. More research is needed to evaluate these services offered. Theoretical guidance through modeling is fundamental to qualify the evaluation. CONCLUSION: The theoretical model is an important tool to qualify and optimize the evaluative research process.

Association between maternal schooling and caries prevalence: a cross-sectional study in southern Brazil.

PURPOSE: To assess the prevalence and severity of dental caries among 12-year-old schoolchildren and to examine its possible association with maternal schooling. MATERIALS AND METHODS: A cross-sectional study involving a representative sample (n = 253) of the 12-year-old schoolchildren enrolled in 14 schools of the municipality of Curitibanos, Brazil was carried out in 2006. Clinical information was obtained through the World Health Organization criteria. Non-clinical data were obtained through interviews with schoolchildren. Associations were analysed using chi-square test or Fisher exact test followed by non-conditional multiple logistic regression analysis to test the independence of associations between outcome and explanatory variables. P-values were set at < 0.05. RESULTS: The prevalence of caries was 81.7% and the mean decayed, missing or filled teeth score was 4.08. Prevalence was significantly higher among girls, with a prevalence ratio of 2.58 (95% CI 1.25, 5.32) (P = 0.010); among schoolchildren from mothers with lower education level, with a prevalence ratio of 3.26 (95% CI 1.32, 8.06) (P = 0.010); and among schoolchildren who had ever visited a dentist, with a prevalence ratio of 2.91 (95% CI 1.14, 7.62) (P = 0.030). CONCLUSIONS: The prevalence and severity of caries were higher than the Brazilian national average. The prevalence was statistically associated with maternal schooling, had visited a dentist, and gender.

Knowledge of lay people and dentists in emergency management of dental trauma.

The multidisciplinary nature of the follow-up evaluations of traumatic dental injuries (TDI) requires that both the lay public and practitioners possess knowledge of the treatment strategies involved. The aim of this paper was to assess the level of knowledge of elementary public schoolteachers, parents and dentists of the city of Joaçaba, Southern Brazil, about the emergency management of TDI. Three independent cross sectional studies were carried out involving samples of elementary public schoolteachers (n = 245), parents (n = 107) and dentists (n = 85) in the city in 2001. Data were collected through structured interviews for schoolteachers and dentists, and questionnaires for parents, containing questions about socio-demographic characteristics and about incidents resulting in TDI. The responses in the three studies showed a wide variability of indicated procedures for the situations of TDI proposed. The results of association studies showed that older schoolteachers (P = 0.003), older dentists (P = 0.013) and dentists who had graduated more recently (P = 0.032) chose significantly more correct answers in some TDI incidents. The answers of schoolteachers, parents and dentists showed a wide variability of indicated procedures for the situations proposed. The great majority of them would not follow the approaches most recommended in the literature. A greater importance should be placed on TDI through educational campaigns aiming schoolteachers and parents and also through undergraduation and postgraduation dental curricula in order of improving its management.

The oral impact on daily performances and self-reported quality of life in elderly people in Florianópolis, Brazil.

PURPOSE: The aim of this study was to estimate the oral impact on daily performances (OIDPs) and its association with self-reported quality of life, sociodemographic and oral health conditions, self-reported oral symptoms and access to a clinician in elderly people. MATERIALS AND METHODS: A cross-sectional study was performed involving individuals over the age of 59 years, resident in the city of Florianópolis, Brazil. A sample of 180 individuals selected in a two-stage approach was examined and interviewed. The World Health Organization Quality of Life-BREF (WHOQOL-BREF) was used to collect data on self-reported quality of life. The OIDP questionnaire was used to collect data on oral impact on daily performances. The criteria for the clinical data were those proposed by the World Health Organization. The dependent variable was the oral impact on daily performances. The chi-square test was used to examine the association between the dependent and the exploratory variables. Variables were inserted in a model of multiple logistic regression. The level of significance was set at P < 0.05. RESULTS: The proportion of individuals who reported oral impact on daily performances was 45.6%. The results of the multiple logistic regression analysis showed that only the altered condition of the oral mucosa and the social domain of the WHOQOL-BREF maintained an independent association with oral impact on daily performance. CONCLUSION: Of the investigated elderly individuals 45.6% reported oral impact on daily performances. Those who presented altered oral mucosa and had a lower performance in the WHOQOL-BREF social domain were more likely to report such an impact.

Thresholds of restorative decision in dental caries treatment among dentists from small Brazilian cities.

PURPOSE: To investigate the thresholds of restorative intervention in dental caries treatment, based upon the lesion depth seen in radiographs, among Brazilian dentists working in small cities. In addition, the threshold of restorative intervention was compared with demographic and work-related characteristics. MATERIAL AND METHODS: The studied population comprised dentists (n = 89) who were working in 2000 in 20 small cities of the Midwest region of the Southern Brazilian State of Santa Catarina. Four different radiographs were shown of extracted premolars fixed upon a plaster base. The criteria for the radiograph analyses were proposed by Nuttall et al (1993). RESULTS: Of investigated dentists, 16.7% would restore a carious lesion confined to the outer half of the enamel and 33.3% would restore a carious lesion in the outer and inner half of the enamel, but without involving the enamel-dentine junction. The percentage that would restore lesions in the outer half of dentine was 91.7%. Dentists who had attended postgraduate courses in areas of interest of this study tended to adopt a more conservative treatment when compared with dentists who had not attended (p < 0.01). CONCLUSIONS: There was a great variation in the thresholds of intervention based upon lesion depth seen in radiographic images amongthe investigated Brazilian dentists. An interventionist attitude was observed, which could result in over-treatment. It is highly recommended to educate general practitioners from the studied region in performing early diagnosis of lesions and non-invasive care in order to treat initial carious lesions with only remineralisation and monitoring.

[Proposal of a model for the evaluation of public oral health care for children]. / Proposta de um modelo de avaliação da atenção pública à saúde bucal da criança.

This article proposes a model for quality evaluation of oral health care in children. The conceptual framework for the evaluation matrix consisted of evaluation studies on oral health care services in Brazil and other countries and a survey and review of prevailing public policies for children's health in Brazil. Two dimensions, Management and Provision, were evaluated in the quality of municipal management of pediatric oral health care. Management included two component dimensions, articulation and resources, while Provision included two more, "promotion and prevention" and "diagnosis and treatment". The evaluation matrix consisted of nine indicators in the Management dimension and nine in the Provision dimension. The indicators were elaborated in workshops with specialists. The model proved appropriate for application in municipalities with different population sizes and allows identifying the areas where managers should improve their actions.

Dental caries and orofacial pain trends in 12-year-old school children between 1997 and 2003.

PURPOSE: To estimate the prevalence of dental caries and orofacial pain in 12-year-old schoolchildren in the Southern Brazilian town of Palhoça in 2003 and to compare it with results from 1997. MATERIALS AND METHODS: A cross-sectional study was carried out involving 444 randomly selected 12-year-old schoolchildren in 2003. WHO (1997) criteria for dental caries and Locker and Grushka (1987) criteria for orofacial pain were used. Chi-square and Fisher exact tests were used to examine association between variables. To test the independence of variables, logistic regression analysis was performed. RESULTS: The prevalence of caries was 55.8%. The mean DMF-T was 1.65. Component D was the one that most contributed to the indicator. In 1997, caries prevalence was 73.5% and the mean DMF-T was 2.84. Similarly, the component that most contributed to the indicator was D with 74.0%. In the trend analysis a reduction of 24.1% in the caries prevalence and 41.9% in the severity measured by the DMF-T was observed. The prevalence of orofacial pain was 66.6%. In 1997, the prevalence was 79.5%. In both years the most common type of pain was stimulated toothache. A reduction of 12.9% in the prevalence of orofacial pain and 28.3% in stimulated toothache was observed. Results of the logistic regression analysis showed that orofacial pain was associated with dental caries independently of other studied variables. CONCLUSION: A reduction in both caries and orofacial pain in the studied period was observed. Orofacial pain was independently associated with the presence of caries.

Burden of disease due to cancer in a Southern Brazilian state.

BACKGROUND: Despite the considerable epidemiological relevance of cancer in developing countries, there are very few studies of the burden related to cancer. The aim of this study was to present and discuss data from a burden-of-cancer study performed in a Southern Brazilian state. METHODS: An epidemiological study of ecological design was performed to calculate the disability-adjusted life year (DALY) index. The study was based on records of individuals admitted and treated for cancer in the Brazilian National Health System Hospitals, or individuals who had died of cancer while residing in the state of Santa Catarina in 2008. RESULTS: A total of 73,872.9 DALYs were estimated, which generated a rate of 1220.5 DALYs/100,000 inhabitants. The highest DALYs were those for cancer of the trachea, bronchus and lung with 179.0/100,000 inhabitants, gastric cancer with 101.7/100,000 inhabitants, and breast cancer with 99.7/100,000 inhabitants. The percentage contribution of the DALY component varied according to cancer type; however, mortality was the major component in all types. The highest rates were observed in 60-69-year-olds with 6071.3/100,000 inhabitants, in 70-79-year-olds with 5095.4/100,000 inhabitants, and in 45-59-year-olds with 3189.0 DALY/100,000 inhabitants; 53.7% of DALYs occurred in males. CONCLUSIONS: The greatest burden of disease due to cancer in Santa Catarina was attributed to cancer of the trachea, bronchus and lung, followed by gastric and breast cancers. The mortality component was responsible for the greatest burden.

Differential item functioning in a Brazilian-Portuguese version of the Child Perceptions Questionnaire (CPQ).

OBJECTIVE: To determine whether a Portuguese language version of the Child Perceptions Questionnaire for 11-14-year-olds (CPQ(11-14)) showed differential item functioning (DIF) when compared with the original English language version. METHODS: CPQ(11-14) data from a school-based Brazilian study (n = 138) was compared with CPQ(11-14) data collected as part of a school-based study conducted in New Zealand (n = 322). In order to detect DIF, ordinal logistic regression analysis was performed with each CPQ(11-14) item as the dependent variable. The independent variables were language group (English versus Portuguese), the CPQ(11-14) sub-scale score of which the item was a part, and an interaction term for language*sub-scale score. Nonuniform DIF was deemed to be present if the interaction term was significant. Moderate to large uniform DIF was deemed to be present if after removing the interaction term the beta coefficient (log odds ratio) for language group was significant and numerically greater than 0.64. Analyses were also undertaken to detect pseudo-DIF. RESULTS: Nonuniform DIF was found in five items and moderate to large uniform DIF in an additional four items. Analyses using 'purified' sub-scale scores indicated that little of the DIF detected was pseudo-DIF. A comparison of the language groups using DIF affected and DIF-free overall and subscale CPQ(11-14) scores revealed that the DIF detected had only a marginal effect on the differences between language groups in scores. CONCLUSION: Oral health-related quality of life questionnaires, particularly those that have been translated, need to be assessed for DIF and its likely impact on group comparisons.

Brazilian dentists' knowledge regarding immediate treatment of traumatic dental injuries.

The objective of this study was to assess the knowledge of dentists working in the city of Tubarão, southern Brazil, about the immediate treatment of traumatic dental injuries. A cross-sectional study was carried out involving all dentists who were working in the city in 2004 (n = 108). Data were collected through self-applied questionnaires with questions about sex, time elapsed since graduation, whether the dentists had attended postgraduate courses and also four questions about traumatic dental injuries in which the dentists selected the best answer. The response rate was 86.1%. For the two questions related to dental avulsion, 36.6% and 16.1% of professionals respectively, chose the correct answer according to the literature. For the question related to coronal fracture, 75.3% chose the correct answer. For the questions related to an incident without dental avulsion or fracture, 73.1% chose the correct answer. Time elapsed since graduation was the only variable statistically associated with the correct answer for the question related to coronal fracture. A significantly greater number of professionals with < or = 10 years of experience chose the correct answer when compared with professionals with >10 years experience (P < 0.001). It can be concluded that the great majority of professionals would not intervene according to the literature in the cases of avulsion. Less time elapsed since graduation was statistically associated with the correct answer in the coronal fracture case.

Aetiology and rates of treatment of traumatic dental injuries among 12-year-old school children in a town in southern Brazil.

The objective of this study was to assess the prevalence, aetiology, place of occurrence and rates of treatment of traumatic dental injuries (TDI) among 12-year-old schoolchildren in Herval D'Oeste, Brazil. A cross-sectional survey was carried out through clinical examination of upper and lower permanent incisors and interviews with 297, 12-year-old schoolchildren enrolled in public and private schools. Intra-examiner diagnosis variability, measured by kappa values on tooth-by-tooth basis was above 0.7. The prevalence of TDI was 17.3% (95% CI 12.7-21.9). Children who had an incisal overjet size >5 mm were 3.5 (95% CI 1.5-8.1) times more likely to have TDI than children who had an incisal overjet of <5 mm (P = 0.005). The most common type of injury found was enamel fracture alone. Of the total of 87 traumatized teeth, only 27.6% were treated. Acid etch restorations were the most common treatment provided. Acid etch restorations were the most common type of treatment needed. The majority of the cases of TDI occurred at home (17.8%) and at school (17.8%). Collisions (24.5%), mainly with doors, and physical leisure activities (20.0%) such as cycling and playing soccer were the main activities related to TDI aetiology. It can be concluded that there is a great treatment need reflecting neglect of TDI treatment. The main causes of TDI were collisions and physical leisure activities.