Análise da oferta de hospitais e leitos hospitalares no estado do Amazonas ante a pandemia da Covid-19 / Analysis of the offer of hospitals and hospital beds in the state of Amazonas in the face of the COVID-19 pandemic

RESUMO Na dinâmica da gestão pública da saúde do estado do Amazonas durante a pandemia da Covid-19, o cenário que se descortina é a concentração de renda focada em Manaus imposta pela busca de melhor qualidade de vida na capital, exibindo um panorama de prestação precária de saúde pública por falta e sucateamento de equipamentos, insuficiência de leitos, ausência de hospitais e Unidades de Terapia Intensiva no interior do estado. Desta feita, o objetivo da pesquisa teve como proposta a análise da oferta de hospitais e leitos hospitalares diante do momento pandêmico que se abateu na região, utilizando abordagem descritiva a partir de levantamento bibliográfico e de dados secundários, cujo recorte temporal obedeceu a três momentos: antes da pandemia no Brasil (janeiro de 2020); segunda onda (janeiro de 2021) e terceira onda da Covid-19 no Amazonas (janeiro de 2022), visando possibilitar uma observação da situação pandêmica. Desse modo, o estado do Amazonas apresentou dados acima da média nacional referentes à pandemia da Covid-19. No tocante à oferta de hospitais e leitos hospitalares, conclui-se que não houve mudanças expressivas no quantitativo, além da ausência de assistência hospitalar especializada no interior do estado, cuja atenção terciária do Amazonas encontra-se concentrada em Manaus.

ABSTRACT In the dynamics of public health management of the state of Amazonas during the COVID-19 pandemic, the scenario that unfolds is the concentration of income focused on Manaus imposed by the search for a better quality of life in the capital, showing a scenery of precarious provision of health public due to the lack and scrapping of equipment, insufficient beds, absence of hospitals and Intensive Care Units in the interior of the state. The research aimed to analyze the supply of hospitals and hospital beds in the face of the pandemic moment that hit the region, using a descriptive approach based on a bibliographic survey and secondary data, whose temporal cut followed three moments: before the pandemic in Brazil (January 2020); second wave (January 2021); and third wave of COVID-19 in Amazonas (January 2022), to better observe the pandemic situation. Thus, the state of Amazonas presented data above the national average, regarding the COVID-19 pandemic. Regarding the supply of hospitals and hospital beds, it was concluded that there were no significant changes in the quantity, in addition to the absence of specialized hospital care in the interior of the state, whose tertiary care in the Amazon is concentrated in Manaus.

Multiple oral sinus tract and trismus leading to a surprising diagnosis of osteopetrosis: Case report.

AIMS: We report a rare case of late diagnosis of malignant osteopetrosis in a 36-year-old male patient due to multiple intraoral sinus tracts and trismus. CASE REPORT: The patient reported a history of facial scars that could not be attributed to the older external fistulas that were present and various complicated dental extractions since infancy. In addition, the patient had not been previously diagnosed with any other significant diseases other than blindness since infancy. Computed tomography revealed a marble-like sclerotic pattern of all cranial bones, a thickened parietal bone, and a narrowing of the encephalic space and the optic canal. Further laboratory and imaging studies revealed complete sclerosed bone of the chest and pelvis, anemia, reticulocitosis, extramedular hematopoiesis, altered dehydrogenasis lactate, and acid phosphatasis. An interdisciplinary treatment was initiated with medical and dental care monitoring. The patient is still receiving attention after 4 years of follow-up. CONCLUSIONS: The outcome of this case represents the daily challenges faced by interdisciplinary care providers and reveals pearls and pitfalls that can serve as a reference for professional practice in such cases.

Política Nacional de Saúde Bucal e a Rede de Cuidados à Pessoa com Deficiência: uma análise da experiência no estado do Amazonas / National Oral Health Policy and Care Network for People with Disability: an analysis of the experience in the estate of Amazonas

Esta tese tem como objeto analisar a Política Nacional de Saúde Bucal (PNSB) e a sua conexão com a Rede de Cuidados à Pessoa com Deficiência (RCPD) no estado do Amazonas. Para compreender a configuração da Política e a transversalidade com a Rede nessa localidade, os processos de pesquisa foram delineados para o cerne dessa questão e o enfoque dos referenciais teóricos e levantamento de dados obtidos a partir desse direcionamento. Os encaminhamentos metodológicos partiram de duas frentes de busca - configuração da Política e atenção à saúde bucal às pessoas com deficiência (PcD) no Amazonas, nos três níveis de atenção. Desta forma os dados foram coletados através dos bancos de dados oficias do governo federal - Sistemas de Informações Ambulatoriais (SIA/SUS), Sistema de Informações Hospitalares (SIH/SUS) e Cadastro Nacional de Estabelecimentos de Saúde (CNES), todos do Departamento de Informática do Sistema Único de Saúde (DATASUS), através das ferramentas TABNET e TABWIN. Os resultados das pesquisas verificaram que este estado possui os mesmos problemas de ordem nacional que os demais estados brasileiros, somados ao desfavorecimento regional e aos problemas locais, a falta de infraestrutura associada ao isolamento geográfico e político, a grande dispersão populacional e a dificuldade de locomoção são características peculiares desse estado. Além de existirem grandes desigualdades socioeconômicas entre os municípios amazonenses, expressas pela desigualdade de renda no Amazonas (maior que no Brasil) e pelos indicadores sociais insatisfatórios (40,3% dos municípios têm Índice de Desenvolvimento Humano (IDH) baixo e o estado possui o progresso social baixo ­ Índice de Progresso Social IPS/54,92). Essas adversidades não podem ser tratadas de maneira singular e, por consequência, esse estado demanda atenção diferenciada com necessidade de investimentos em diversos setores, incluindo a saúde. A configuração da PNSB está fortemente concentrada na cidade de Manaus, principalmente no que diz respeito a atenção terciária, pois os dois hospitais aderidos à RCPD estão localizados nessa cidade. A atenção à saúde bucal, na atenção básica (AB), no Amazonas, apresenta baixa cobertura populacional tanto no estado (36,1%) quanto na capital (14,0%), refletindo em baixo acesso à saúde bucal individualizada. E a lógica do SIA/SUS não permite separar a população individualmente, o que prejudica o planejamento, programação, regulação, avaliação, controle e auditoria dos serviços ambulatoriais de saúde bucal para as PcD na AB. Na média complexidade, constatamos que dos 62 municípios amazonenses apenas nove (14,5%) possuem oferta da atenção à saúde bucal especializada, sendo 13 Centros de Especialidades Odontológicas (CEO) no estado, o que significa que 35% da população do Amazonas (1.427.527 habitantes), encontra-se desassistida da atenção à saúde bucal nesse nível de atenção. Sendo assim apresentamos algumas sugestões com o intuito de aprimorar a PNSB e a atenção à saúde bucal das PcD

This thesis aims to analyze the National Oral Health Policy (PNSB) and its connection to the Care Network for the Disabled Person (RCPD) in the state of Amazonas. In order to understand the configuration of the Policy and the transversality with the Network in that locality, the research processes were delineated to the core of this issue and the focus of the theoretical references and data collection obtained from this targeting. The methodological guidelines started from two fronts of search - configuration of the Policy and Oral Health Care for People with Disabilities (PwD) in Amazonas, in the three levels of attention. In this way the data were collected through the official databases of the federal government - Outpatient Information Systems (SIA/SUS), Hospital Information System (SIH/SUS) and National Registry of Health Establishments (CNES), all from the Department of Informatics of the Unified Health System (DATASUS), through the tools TABNET and TABWIN. The results of the surveys verified that this state has the same problems of national order as other Brazilian states, together with regional disadvantage and local problems: the lack of infrastructure associated with the geographical and political isolation, a large population dispersion and the difficulty of locomotion are peculiar characteristics of this state. In addition to the large socioeconomic inequalities between Amazonas municipalities, expressed by income inequality in Amazonas (higher than in Brazil) and by unsatisfactory social indicators (40.3% of municipalities have a low Human Development Index (HDI), and the state has low social progress - Social Progress Index IPS/54,92). These adversities cannot be treated in a singular way and, as consequence, this state demands differentiated attention with the need of investments in several sectors, including health. The configuration of the PNSB is strongly concentrated in the city of Manaus, especially regarding tertiary care, as the two hospitals adhered to RCPD are located in that city. The oral health care in primary care (AB) in Amazonas has low population coverage in both the state (36.1%) and the capital (14.0%), reflecting low access to individualized oral health. And the SIA/SUS logic doesn't allow the separation of the individual population, which impairs the planning, programming, regulation, evaluation, control and audit of outpatient oral health services for the PwD in AB. In terms of complexity, we found that only nine (14.5%) of the 62 municipalities of Amazonas have specialized oral health care, 13 of which are Dental Specialty Centers (CEO) in the state, which means that 35% of the Amazonas population (1.427.527) is disassociated from oral health care at this level of care. Thus, we present some suggestions with the aim of improving the PNSB and the oral health care of PcD

Psychometric properties of the OHIP-14 and prevalence and severity of oral health impacts in a rural riverine population in Amazonas State, Brazil.

The objectives of this study were: (1) test the psychometric properties of OHIP-14 in a rural population; and (2) compare the oral health impacts in two riverine communities in the Brazilian Amazon that were living at different distances from an urban center. Data were obtained from a cross-sectional study in a consecutive sample (n = 126). The validity was assessed through the association of OHIP with clinical and subjective variables, which showed a more significant association with: pain, caries, need of extraction or endodontic treatment; than with tooth loss, periodontal disease or need of prostheses. The stability and internal consistency were good (ICC = 0.97; Cronbach's alpha = 0.89). The prevalence of oral impacts was greater in the community far from the urban center [70.3 (59.9-80.7)] than in the community closer to it [44.3 (30.7-57.7)], and in women [66.7 (56.0-77.3)] in comparison with men [49.1 (35.3-62.7)]. The OHIP-14 adapted to rural populations in Amazonas State was valid, reproducible, and consistent. There was high prevalence of impacts, especially for riverine communities that lived far from urban centers.

Psychometric properties of the OHIP-14 and prevalence and severity of oral health impacts in a rural riverine population in Amazonas State, Brazil / Avaliação das propriedades psicométricas do OHIP-14 e da prevalência dos impactos da saúde bucal, em população rural ribeirinha no Amazonas, Brasil

The objectives of this study were: (1) test the psychometric properties of OHIP-14 in a rural population; and (2) compare the oral health impacts in two riverine communities in the Brazilian Amazon that were living at different distances from an urban center. Data were obtained from a cross-sectional study in a consecutive sample (n = 126). The validity was assessed through the association of OHIP with clinical and subjective variables, which showed a more significant association with: pain, caries, need of extraction or endodontic treatment; than with tooth loss, periodontal disease or need of prostheses. The stability and internal consistency were good (ICC = 0.97; Cronbach's α = 0.89). The prevalence of oral impacts was greater in the community far from the urban center [70.3 (59.9-80.7)] than in the community closer to it [44.3 (30.7-57.7)], and in women [66.7 (56.0-77.3)] in comparison with men [49.1 (35.3-62.7)]. The OHIP-14 adapted to rural populations in Amazonas State was valid, reproducible, and consistent. There was high prevalence of impacts, especially for riverine communities that lived far from urban centers.

Os objetivos do trabalho foram: (1) testar as propriedades psicométricas do OHIP-14 em população rural e (2) comparar os impactos da saúde bucal em duas comunidades ribeirinhas amazônicas, com diferentes distâncias do centro urbano. Os dados foram obtidos de uma amostra consecutiva de pacientes (n = 126) em estudo de corte transversal. A validade do instrumento foi testada pela associação do OHIP com variáveis clínicas e subjetivas, sendo mais significativa para as variáveis: dor, cárie, necessidade de extração e de endodontia que para perda dentária, doença periodontal e necessidade de prótese. Estabilidade e consistência interna foram boas (CCI = 0,97; α Cronbach = 0,89). A prevalência de impactos foi maior na comunidade mais distante do centro urbano [70,3 (59,9-80,7)] que na mais próxima [44,3 (30,7-57,7)], e nas mulheres [66,7 (56,0-77,3)] comparadas aos homens [49,1 (35,3-62,7)]. O OHIP-14 adaptado às populações rurais da Amazônia foi válido, reproduzível e consistente. A prevalência dos impactos foi alta, especialmente para ribeirinhos que vivem distante dos centros urbanos.

[Provision and utilization of dental services in Amazonas State, Brazil: a case study in a riverine population in Coari municipality]. / Oferta e utilização de serviços de saúde bucal no Amazonas, Brasil: estudo de caso em população ribeirinha do Município de Coari.

This case study described the conditions in the provision and utilization of dental services in two riverine populations in the municipality (county) of Coari, Amazonas State, Brazil. Structured questionnaires were applied to individuals 18 years and older to measure dental services utilization rates. Semi-structured interviews were also conducted with key informants to characterize the provision of such services. Although the bivariate analysis did not detect any statistically significant differences, residents of the area farthest from the county seat had gone more time since their last dental visit and received less care from public health services and riverboat clinics. The qualitative analysis showed: no permanent dental services in the communities; sporadic services provided by riverboat clinics, with less frequent visits to the remotest community; high transportation cost for river-dwellers to seek treatment in the county seat; and dental treatment focused on pain control, mainly through tooth extraction. Limited access to dental services for riverine populations highlights the need to implement comprehensive health promotion measures and expand the availability of services.

Oferta e utilização de serviços de saúde bucal no Amazonas, Brasil: estudo de caso em população ribeirinha do Município de Coari / Provision and utilization of dental services in Amazonas State, Brazil: a case study in a riverine population in Coari Municipality

O presente estudo de caso teve o objetivo de descrever a oferta e utilização de serviços odontológicos em duas comunidades ribeirinhas do Município de Coari, Amazonas, Brasil. Para tanto, foram colhidos dados sobre freqüência de utilização de serviços de saúde bucal, por entrevistas estruturadas com indivíduos acima de 18 anos, e dados sobre oferta de serviços obtidos por entrevistas semi-estruturadas com informantes-chave. Nas análises bivariadas, embora sem diferença estatística, os indivíduos da comunidade mais distante da sede do município apresentaram maior tempo decorrido da última consulta, e menor proporção de atendimentos pelo serviço público e por barcos de saúde. A análise qualitativa das entrevistas revelou: ausência de serviço odontológico permanente nas comunidades; oferta esporádica através de barcos da saúde, com menor ocorrência dos serviços na comunidade mais distante; alto custo do deslocamento do ribeirinho à sede do município; e tratamento odontológico voltado para o controle da dor, basicamente se resumindo à extração dentária. O acesso precário dos ribeirinhos aos serviços de saúde bucal aponta para a necessidade de implantação de medidas amplas de promoção de saúde, aliada a maior oferta de serviços.

This case study described the conditions in the provision and utilization of dental services in two riverine populations in the municipality (county) of Coari, Amazonas State, Brazil. Structured questionnaires were applied to individuals 18 years and older to measure dental services utilization rates. Semi-structured interviews were also conducted with key informants to characterize the provision of such services. Although the bivariate analysis did not detect any statistically significant differences, residents of the area farthest from the county seat had gone more time since their last dental visit and received less care from public health services and riverboat clinics. The qualitative analysis showed: no permanent dental services in the communities; sporadic services provided by riverboat clinics, with less frequent visits to the remotest community; high transportation cost for river-dwellers to seek treatment in the county seat; and dental treatment focused on pain control, mainly through tooth extraction. Limited access to dental services for riverine populations highlights the need to implement comprehensive health promotion measures and expand the availability of services.