Effect of oral exercises and photobiomodulation therapy in the rehabilitation of patients with mandible fractures: randomized double-blind clinical trial.

Mandible fractures compromise stomatognathic functions, requiring rehabilitation. Evaluate the effectiveness of photobiomodulation (PBM) associated with oral exercises for rehabilitation of patients with mandible fractures. In this randomized clinical trial, we compared PBM with PBM sham in 14 adults with mandibular fractures who underwent surgical intervention. The sessions were performed 24 h and 48 h after surgical procedure, and weekly for 4 weeks after hospital discharge. Both groups performed oral exercises after each PBM session. Restriction of food consistencies, mandibular mobility, pain, and facial sensitivity measured before and after the surgical procedure were the outcomes evaluated, one and 3 months after surgery. Maximum interincisal distances (MID), exercise pain, and restriction of food consistencies were also evaluated during each week of intervention. Both groups showed normal MID (> 35 mm) and food consistencies consumed 1 month after the surgical procedure, with no significant differences between them. Individuals in the PBM group had less pain response to exercise during all the weeks of intervention than the sham group (p < 0.05). The patients presented a reduction in the painful response in MID and mandibular laterality movements 1 month after surgery compared to the preoperative period. In contrast, there was an improvement in laterality in the sham group only 3 months postoperatively and persistent pain in MID. There was no significant difference in facial sensitivity within and between groups during follow-up. The performance of oral exercises associated with PBM effectively facilitated the early rehabilitation of oral functions, with significant gains in pain management.

Brazilian Oral Health Policy: metasynthesis of studies on the Oral Health Network.

OBJECTIVE: Analyze the performance of the oriented oral health care network from its implementation, in 2004 to 2020, according to publications on the subject. METHODS: This is a research with a methodological description of metasynthesis. RESULTS: The searches resulted in 600 complete publications (586 in the first search and another 14 in the second search), according to the established criteria. 539 articles were excluded: 151 after duplication analysis, 236 after reading the title, 45 by type of publication and 107 after reading the abstract, as they did not fit the research theme. Thus, 61 original publications and another 29 publications in snowball sampling were selected and analyzed, totaling 90 publications. From this selection, we chose to use the model proposed by the Projeto de Avaliações de Desempenho de Sistemas de Saúde (PROADESS - Health Systems Performance Assessment Project). The study will use its guiding principles on the dimension "Health Services Performance". CONCLUSION: The analyzed set allowed us to identify that the way the Brazilian State organizes and finances oral health care made it possible to expand access and the number of procedures performed, but not the creation of an effective comprehensive care network, after more than a decade of implementation of Brasil Sorridente (Smiling Brazil).

Brazilian Oral Health Policy: metasynthesis of studies on the Oral Health Network / Política Nacional de Saúde Bucal: metassíntese dos estudos sobre a Rede de Saúde Bucal

ABSTRACT OBJECTIVE Analyze the performance of the oriented oral health care network from its implementation, in 2004 to 2020, according to publications on the subject. METHODS This is a research with a methodological description of metasynthesis. RESULTS The searches resulted in 600 complete publications (586 in the first search and another 14 in the second search), according to the established criteria. 539 articles were excluded: 151 after duplication analysis, 236 after reading the title, 45 by type of publication and 107 after reading the abstract, as they did not fit the research theme. Thus, 61 original publications and another 29 publications in snowball sampling were selected and analyzed, totaling 90 publications. From this selection, we chose to use the model proposed by the Projeto de Avaliações de Desempenho de Sistemas de Saúde (PROADESS — Health Systems Performance Assessment Project). The study will use its guiding principles on the dimension "Health Services Performance". CONCLUSION The analyzed set allowed us to identify that the way the Brazilian State organizes and finances oral health care made it possible to expand access and the number of procedures performed, but not the creation of an effective comprehensive care network, after more than a decade of implementation of Brasil Sorridente (Smiling Brazil).

RESUMO OBJETIVO Analisar o desempenho da rede de cuidados em saúde bucal orientada a partir sua implantação, em 2004 até 2020, segundo publicações sobre o tema. MÉTODOS Trata-se de uma pesquisa com descrição metodológica de metassíntese. RESULTADOS As buscas resultaram em 600 publicações completas (586 na primeira busca e mais 14 na segunda busca), de acordo com os critérios estabelecidos. Foram excluídos 539 artigos: 151 artigos após análise de duplicidade, 236 artigos após a leitura do título, 45 pelo tipo de publicação e 107 artigos após leitura do resumo, por não se enquadrarem na temática da pesquisa. Dessa forma, foram selecionadas e analisadas 61 publicações originais e mais 29 publicações em snowball sampling, totalizando 90 publicações. A partir dessa seleção,optou-se por usaro modelo proposto pelo Projeto de Avaliações de Desempenho de Sistemas de Saúde - PROADESS. O estudo se utilizará de seus princípios norteadores sobre a dimensão "Desempenho dos Serviços de Saúde". CONCLUSÃO O conjunto analisado permitiu identificar que a forma como o Estado brasileiro organiza e financia o atendimento em saúde bucal possibilitou a ampliação do acesso e do número de procedimentos realizados, mas não da criação de uma efetiva Rede de cuidados integrais, após mais de uma década de implementação do Brasil Sorridente.

[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.

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

Resumo 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.

Abstract 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.

Speech-language therapy offer and primary health care in Brazil: an analysis based on socioeconomic development.

PURPOSE: To describe the presence of speech-language therapists (SLT) in the primary health care (PHC) in Brazil and its association with socioeconomic inequalities. METHODS: Cross-sectional study with 17,157 PHC services in all Brazilian states. Based on the NASF External Assessment Questionnaire sub-item "speech-language therapist", which was used to answer the question "What NASF professionals support your PHC service?", in addition to contextual data (regional population, number of registered SLP, speech therapy college courses, city HDI and Gini Index). RESULTS: From all the PHC services supported by NASF, 50.8% (8713/17,157) has SLPs as part of the team. Brazil's Southeast region has the higher prevalence of SLP at the team (57.4%; 5,575). South Region has the lower prevalence (28.9%; 625). The presence of SLP support is directly proportional to HDI stratum and Gini Index (average and high). CONCLUSION: There is an important limitation of public care to treat communication and swallowing disorders in Brazil.

Speech-language therapy offer and primary health care in Brazil: an analysis based on socioeconomic development / Oferta de fonoaudiologia e atenção primária em saúde no Brasil: uma análise baseada no desenvolvimento socioeconômico

ABSTRACT Purpose To describe the presence of speech-language therapists (SLT) in the primary health care (PHC) in Brazil and its association with socioeconomic inequalities. Methods Cross-sectional study with 17,157 PHC services in all Brazilian states. Based on the NASF External Assessment Questionnaire sub-item "speech-language therapist", which was used to answer the question "What NASF professionals support your PHC service?", in addition to contextual data (regional population, number of registered SLP, speech therapy college courses, city HDI and Gini Index). Results From all the PHC services supported by NASF, 50.8% (8713/17,157) has SLPs as part of the team. Brazil's Southeast region has the higher prevalence of SLP at the team (57.4%; 5,575). South Region has the lower prevalence (28.9%; 625). The presence of SLP support is directly proportional to HDI stratum and Gini Index (average and high). Conclusion There is an important limitation of public care to treat communication and swallowing disorders in Brazil.

RESUMO Objetivo Descrever a presença de fonoaudiólogos na atenção primária à saúde (APS) no Brasil e sua associação com desigualdades socioeconômicas. Método Estudo transversal com 17.157 serviços de APS em todos os estados brasileiros. Com base no Questionário de Avaliação Externa do NASF utilizou-se o subitem "fonoaudiólogo" para a resposta à pergunta "Que profissionais do NASF apóiam seu serviço de APS?", além disso utilizou-se dados contextuais (população regional, número de fonoaudiólogos registrados, número de faculdades de fonoaudiologia, IDH da cidade e Índice Gini). Resultados De todos os serviços de APS apoiados pelo NASF, 50,8% (871.317.157) tem o fonoaudiólogo como parte da equipe. A região Sudeste do Brasil tem a maior prevalência de fonoaudiólogo na equipe (57,4%; 5.575). A região Sul tem a menor prevalência (28,9%; 625). A presença do suporte fonoaudiológico é diretamente proporcional ao estrato IDH e ao índice de Gini (médio e alto). Conclusão Existe uma importante limitação na oferta dos serviços fonoaudiológicos públicos no Brasil.

Contextual and individual factors associated with dissatisfaction with public emergency health services in Brazil, 2011-2012.

The Brazilian network of emergency care, in recent years, has shown significant progress. The objective was to evaluate contextual and individual factors associated with the satisfaction with public emergency health services. This was a cross-sectional multilevel study carried out between June 2011 and January 2012. Data were collected via telephone at the ombudsman's office of the Brazilian Unified National Health System (SUS). Telephone numbers were randomly selected from a telephone company database. Health services, socioeconomic, and individual demographic variables were evaluated, in addition to information about the municipalities. The outcome variable was dissatisfaction with public emergency health services in Brazil. Multilevel logistic regression was performed and 7,027 individuals from 61 municipalities answered the survey. The prevalence of perceived dissatisfaction was 48.1% (95%CI: 46.9-49.3). Variables that remained significantly associated with the outcome are: age up to 20 years, 16 or more years of education, lives in the Central region, non-resolved demands, longer waiting times, and accessing emergency in a primary care service. Prevalence of a perceived dissatisfaction is predominantly associated with care's waiting time and the length needed to resolve the demand.

Contextual and individual factors associated with dissatisfaction with public emergency health services in Brazil, 2011-2012 / Fatores contextuais e individuais associados à insatisfação com os serviços de emergência na rede pública brasileira, 2011-2012 / Factores contextuales e individuales asociados a la insatisfacción con los servicios de urgencia en la red pública brasileña, 2011-2012

The Brazilian network of emergency care, in recent years, has shown significant progress. The objective was to evaluate contextual and individual factors associated with the satisfaction with public emergency health services. This was a cross-sectional multilevel study carried out between June 2011 and January 2012. Data were collected via telephone at the ombudsman's office of the Brazilian Unified National Health System (SUS). Telephone numbers were randomly selected from a telephone company database. Health services, socioeconomic, and individual demographic variables were evaluated, in addition to information about the municipalities. The outcome variable was dissatisfaction with public emergency health services in Brazil. Multilevel logistic regression was performed and 7,027 individuals from 61 municipalities answered the survey. The prevalence of perceived dissatisfaction was 48.1% (95%CI: 46.9-49.3). Variables that remained significantly associated with the outcome are: age up to 20 years, 16 or more years of education, lives in the Central region, non-resolved demands, longer waiting times, and accessing emergency in a primary care service. Prevalence of a perceived dissatisfaction is predominantly associated with care's waiting time and the length needed to resolve the demand.

Nos últimos anos houve avanços significativos na rede brasileira de serviços de emergência. O estudo teve como objetivo avaliar os fatores contextuais e individuais associados à satisfação com os serviços públicos de emergência. Através deste estudo transversal multinível realizado entre junho de 2011 e janeiro de 2012, foram coletados dados via telefone na Ouvidoria do Sistema Único de Saúde (SUS). Os números telefônicos foram selecionados aleatoriamente a partir de um banco de dados da empresa de telefonia. Foram avaliadas variáveis socioeconômicas, demográficas e de serviços de saúde, além de dados dos municípios. A variável dependente era a insatisfação com serviços públicos de emergência no Brasil. Foi realizada regressão logística multinível, e 7.027 indivíduos de 61 municípios responderam a pesquisa. A prevalência de insatisfação percebida era 48,1% (IC95%: 46,9-49,3). As variáveis que mantiveram a associação significativa com o desfecho foram: idade > 20 anos, escolaridade ≥ 16 anos, Região Centro-oeste, demandas não atendidas, tempo de espera mais longo e acesso ao atendimento de emergência em serviços de atenção primária. A prevalência da insatisfação percebida está relacionada predominantemente ao tempo de espera e ao tempo necessário para resolver a demanda.

En los últimos años se produjeron avances significativos en la red brasileña de servicios de urgencia. El objetivo del estudio fue evaluar los factores contextuales e individuales asociados a la satisfacción con los servicios públicos de emergencia. A través de este estudio transversal multinivel, realizado entre junio de 2011 y enero de 2012, se recogieron datos vía teléfono en la Defensoría del Sistema Único de Salud (SUS). Los números telefónicos fueron seleccionados aleatoriamente, a partir de un banco de datos de la empresa de telefonía. Se evaluaron variables socioeconómicas, demográficas y de servicios de salud, además de los datos de los municipios. La variable dependiente era la insatisfacción con los servicios públicos de emergencia en Brasil. Se realizó una regresión logística multinivel, y 7.027 individuos de 61 municipios respondieron a la investigación. La prevalencia de insatisfacción percibida era de un 48,1% (IC95%: 46,9-49,3). Las variables que mantuvieron la asociación significativa con el desenlace fueron: edad > 20 años, escolaridad ≥ 16 años, Región Centro-oeste, demandas no atendidas, tiempo de espera más largo y acceso a la atención de emergencia en servicios de atención primaria. La prevalencia de la insatisfacción percibida está relacionada predominantemente al tiempo de espera y al tiempo necesario para resolver la demanda.

Primary Care Dentistry in Brazil: From Prevention to Comprehensive Care.

This cross-sectional study aimed to evaluate the association between sociodemographic characteristics, health care indicators, work process characteristics, and the performance of preventive dental procedures by oral health care teams (OHCTs) assessed during the first phase of the PMAQ in Brazil. A census of 10 334 primary OHCTs was conducted. The outcome included topical application of fluoride, application of sealants, detection of oral lesions, and monitoring of suspected or confirmed cases of oral cancer. The multilevel Poisson regression model was used to obtain crude and adjusted prevalence ratios. The performance of preventive dental procedures was 29.46% (3044/10 334; 95% confidence interval, 28.57-30.33), which was considered low.

[Primary healthcare geared to the needs of the elderly: from theory to practice]. / Atenção Primária a Saúde voltada as necessidades dos idosos: da teoria à prática.

This article seeks to establish a confrontation between theory and practice with respect to healthcare for the elderly. The theory was evaluated by a study of documents that comprise the legal and theoretical framework related to the health of the elderly, which generated a matrix to assess universal access, equity, comprehensiveness and quality of care. However, the practice of healthcare was evaluated by a population-based study conducted on 862 elderly individuals and a census that assessed primary healthcare (PHC) units in two districts of Porto Alegre in the state of Rio Grande do Sul, Brazil. The variables chosen to verify the categories were type of care accessed, first contact attribute, wheelchair accessibility and availability of priority access. Other variables include comprehensive care and the presence of dental root remains, basic PHC score, the adequacy of health facilities and ongoing professional training, as well as cross-sectional categories, elderly groups and home care. A mismatch was found between recommendation and practice in some factors and advances were observed in the equity and quality of care regarding the ongoing training of professionals.

Atenção Primária a Saúde voltada as necessidades dos idosos: da teoria à prática / Primary healthcare geared to the needs of the elderly: from theory to practice

O objetivo deste artigo é estabelecer uma confrontação entre teoria e prática no que tange ao cuidado com a saúde de pessoas idosas. A teoria foi avaliada através de um estudo de documentos que compõem o arcabouço teórico-legal relacionado com a saúde do idoso e que gerou a construção de uma matriz com as seguintes categorias: Acesso Universal, Equidade, Integralidade e Qualidade do Cuidado. Já a prática foi avaliada por um estudo de base populacional realizado junto a 862 idosos e por um censo que avaliou unidades de atenção primária (APS), ambos em dois distritos sanitários de Porto Alegre (RS). As variáveis que avaliaram as categorias foram respectivamente: tipo de serviço acessado, atributo de primeiro contato, acessibilidade de cadeirantes; presença de acesso prioritário; atributo integralidade e presença de restos radiculares; escore essencial da APS, adequação das estruturas das unidades de APS e capacitação profissional e variáveis transversais: grupos de idosos e visita domiciliar. Verificou-se um descompasso entre o preconizado e o estabelecido em alguns aspectos e observaram-se avanços em relação à equidade e à qualidade do cuidado em relação à capacitação dos profissionais.

This article seeks to establish a confrontation between theory and practice with respect to healthcare for the elderly. The theory was evaluated by a study of documents that comprise the legal and theoretical framework related to the health of the elderly, which generated a matrix to assess universal access, equity, comprehensiveness and quality of care. However, the practice of healthcare was evaluated by a population-based study conducted on 862 elderly individuals and a census that assessed primary healthcare (PHC) units in two districts of Porto Alegre in the state of Rio Grande do Sul, Brazil. The variables chosen to verify the categories were type of care accessed, first contact attribute, wheelchair accessibility and availability of priority access. Other variables include comprehensive care and the presence of dental root remains, basic PHC score, the adequacy of health facilities and ongoing professional training, as well as cross-sectional categories, elderly groups and home care. A mismatch was found between recommendation and practice in some factors and advances were observed in the equity and quality of care regarding the ongoing training of professionals.