Does the presence of oral health teams influence the incidence of ventilator-associated pneumonia and mortality of patients in intensive care units? Systematic review.

AIMS: To verify whether oral health teams influence the oral health status, ventilator-associated pneumonia incidence and mortality rate of patients in Intensive Care Units (ICU). MATERIALS AND METHODS: Bibliographic searches were performed in PubMed, Scopus, Web of Science, Lilacs, Embase, Livivo, Open Grey, Academic Google, and Cochrane databases. The assessment of the methodological quality and risk of bias of the included studies and a random-effects meta-analysis to summarize relative risk data for ventilator-associated pneumonia (VAP) and mortality were performed. An analysis of the certainty of the evidence was performed for the main outcomes analyzed. RESULTS: Records of 518 studies were analyzed by reading titles and abstracts. Five studies were included according to eligibility criteria. The meta-analysis showed that ICU patients undergoing dental care by an oral health team had a lower incidence of VAP (OR = 0.33; 95% CI: 014-0.76) but did not lower mortality rates (OR = 0.46 95% CI: 0.16-1.32). The certainty of the evidence was considered very low. CONCLUSION: Dental care provided by oral health teams in a hospital environment did not influence oral health status or mortality, although it contributed to a reduction in VAP of patients admitted to the ICU.

Factors associated with the waiting time for access to specialized oral healthcare services in Brazil.

OBJECTIVES: To explore the factors associated with the waiting time for access to specialized care at Dental Specialties Centers (CEO, in Portuguese), by specialty (Stomatology, Surgery, Endodontics, Patients with Special Needs and Periodontology). METHODS: The study was a descriptive and analytic exploratory secondary analysis of data from the 2nd phase of the National Program for Improving the Access to and Quality of CEO (PMAQ-CEO, in Portuguese). All 1097 CEO in Brazil were evaluated in loco in 2018. Binary logistic regression was used to analyse the likelihood of users having a shorter time for assistance at CEO, by specialty. RESULTS: The highest and lowest median waiting times were found for endodontics (30 days) and stomatology (5 days), respectively. Smaller centres (type I CEO) had a shorter waiting list for patients with special needs (95%CI: 1.20-3.37), Endodontics (95%CI: 1.03-3.02) and Surgery (95%CI: 1.04-3.05). As for the specialties with the longest waiting list (Endodontics and Surgery), the direct route of user access to CEO was more effective than that regulated by the Healthcare System. CONCLUSIONS: Factors related to the service, management, and to the form of relationship with primary health care influenced the waiting time for specialized care in CEO. The contact between professionals in the oral health network (primary care and secondary) was associated with a shorter waiting time, regardless of the specialty.

Influence of socioeconomic status on oral disease burden: a population-based study.

BACKGROUND: Dental caries is associated with Biological, behavioral, socioeconomic, and environmental factors; however, socioeconomic status is a distal determinant of dental caries development that modulates exposure to risk and protective factors. This study aimed to analyze the socioeconomic factors associated with the concentration of oral diseases in a population-based study in Brazil. METHODS: This is a quantitative, analytical, cross-sectional study based on secondary data from the SB São Paulo 2015 epidemiological survey. A total of 17,560 subjects were included. The concentration of oral disease in the population was estimated by the oral disease burden (ODB) variable. The ODB consists of four components: dental caries; tooth loss; need for dental prosthesis and periodontal condition. Thus, the total score on the ODB could vary between 0 and 4, with the highest score indicating the worst possible situation. ODB was analyzed in multivariate negative binomial regression, and multivariate binary logistic regression analysis. The following factors were included as independent variables: age group, skin color, socioeconomic factors, family income and Oral Impact on Daily Performance (OIDP). RESULTS: In the sample, 86.9% had no minimum ODP component. Negative multivariate binomial regression showed a statistically significant relationship (p < 0.005) between ODB and all variables analyzed (skin color, family income, education, OIDP results and age range). The adjusted multivariate binary logistic regression showed that the individuals most likely to have at least one component of ODB were nonwhite (25.5%), had a family income of up to R$ 1500.00/month (19.6%), had only completed primary education (19.1%), and reported that their oral health had an impact on their daily activities (57.6%). Older adults individuals were two times more likely than adolescents to have an ODB component. CONCLUSIONS: ODB is associated with factors related to social inequality. Adults and older adults individuals had the highest cumulative number of ODB components.

Análise dos custos da adoção das novas medidas de biossegurança nos institutos oficiais de perícias médico e odontolegais brasileiros durante a pandemia do COVID-19 / Analysis of the costs of implementing the new biosafety measures in the Brazilian official Institutes of Medical and Dental Expertise during the COVID-19 pandemic

Introdução: A COVID-19 é uma doença de etiologia viral associada à infecção causada pelo novo coronavírus. Devido ao seu padrão de transmissão, foram estabelecidas novas medidas de biossegurança. O uso dos equipamentos de proteção individual (EPI) é fundamental para controle da disseminação da doença, inclusive durante a realização de exames periciais nos Institutos Oficiais de Perícias (IOP). Objetivo: Analisar os custos das medidas de biossegurança adotadas a partir da pandemia do COVID-19 nos IOP do Brasil. Material e Método: O estudo consiste em uma avaliação econômica parcial do tipo microcusteio. A coleta foi realizada para estimar os custos diretos incorridos da adoção de novas normas de biossegurança, considerando uma equipe de necropsia de um IOP. Adotou-se a perspectiva do gestor do IOP e seguiram-se as práticas recomendadas pela REBRATS. A estimativa dos custos foi calculada por turno. Foi considerado um cenário mais otimista (-20% dos custos) e mais pessimista (+20% dos custos). Resultados: O valor total por turno variou de R$106,93 a R$160,39 segundo análise de sensibilidade. Será necessário investir, em média, R$100.000,00 anuais para cada IOP. Considerando a despesa do funcionário, na ausência de fornecimento de EPI pela gestão, o valor médio por turno foi de R$57,62. Conclusão: Os custos para adoção das novas medidas de biossegurança nos IOP durante a pandemia do COVID-19 são onerosos. Anualmente, o investimento representa um montante significativo, porém indispensável para garantir a segurança da equipe e o adequado fornecimento do serviço.

Factors associated with conducting planning for secondary oral health care services in Brazil.

BACKGROUND: Planning in health services specifically aims to improve the health status of a given population, guaranteeing access with equity and justice, as well as streamlining the response of the health system to the needs perceived by the community. This research aims to identify the factors associated with planning Specialized Dental Clinics (SDCs). METHODS: Secondary data were used from the external evaluation of the database of the first National Program for Access and Quality Improvement of SDCs (NPAQI-SDCs) and the informed Outpatient Information System of the Unified Health System (OIS/UHS), which contains data on the specialized dental procedures performed at SDCs. It consisted of a quantitative study in which Pearson chi-square statistical tests (p < 0.05) and a multivariate logistic regression were applied with odds ratio (OR) estimate. RESULTS: The results indicated that the realization of planning in SDCs was associated with lower coverage of the Oral Health Team of the Familiy Health Strategy in a municipality (OR = 1.4; 95% CI: 1.0-1.9, p = 0.049), additional training for managers (p = 0.038), the practice of self-assessment (OR = 8.2; 95% CI: 5.8-11.6; p = 0.000) and meeting service production targets (OR = 1.9; 95% CI: 1.2-3.2; p = 0.011). CONCLUSION: The results indicate that the work processes of the SDCs, especially with regard to service management, are essential to the proper functioning of the service and the practice of planning is linked to the technical capacity and commitment of service managers.