Analysis of hospital dental care for patients with special needs in Brazil.

This analytical cross-sectional study aimed to analyze the access of patients with special needs (PSN) in Brazilian municipalities to hospital dental care of the Unified Health System (Sistema Único de Saúde - SUS), based on data from the Hospital Information System of the Unified Health System (Sistema de Informações Hospitalares do SUS- SIH/SUS - SIH), from 2010 to 2018. The Kolmogorov-Smirnov normality test was performed; the Poisson regression was used to verify factors associated with the variable total number of hospitalization authorizations with the main procedure of dental treatment for PSN ("Total de Autorizações de Internação Hospitalar" - AIH), the Spearman correlation test with a significance level of 5% was used to characterize the relationships between the Municipal Human Development Index per municipality - (Índice de Desenvolvimento Humano Municipal - HDI) and the Oral Health Coverage in the Family Health Strategy by municipality (Cobertura de saúde bucal na estratégia saúde da família por município - SBSF Coverage), and the relationship of the AIH with SBSF Coverage. A total of 127,691 procedures were performed, of which 71,517 (56%) were clinical procedures, such as restorations, endodontic treatments, supra and subgingival scaling, among others. Municipalities in the Midwest (PR=5.117) and Southeast (RP = 4.443) regions had more precedures than the others. A weak correlation was found between AIH and SBSF Coverage (r = -0.2, p < 0.001) and HDI and SBSF Coverage (r = -0.074, p < 0.001). Population size, region, health coverage, oral hygiene, and number of dentists in hospitals affected the availability of dental procedures in PSN.

Resumption of brazilian oral medicine health care during the second period of the COVID-19 pandemic

Aim: This present study aims to compare the data from the Brazilian Unified Health System on the number of clinical consultations of Oral Medicine from the first 6 months (March-August 2020) of the COVID-19 pandemic in Brazil with the last 6 months (September-February 2020/2021) to update the data, verify the measures' effectiveness to return clinical activities in the following months. Methods: perform a literature review of recent articles that report the impact of the COVID-19 pandemic on Oral Medicine. Results: There was an increase in the number of Oral Medicine clinical consultations in the second half of the pandemic throughout Brazil (+64.2%), representing over 9,235 appointments in this period. Conclusion: measures for the return of health assistance and the practice of Telemedicine proved to be effective after the second period of the pandemic. Even so, strengthening security measures against the coronavirus is essential to ward off a new wave since the Omicron variant emerged in the country and, consequently, possible new lockdowns that might affect healthcare in Brazil

Photobiomodulation for Oral Mucositis - A Microcosting and Budget Impact Analysis from a Brazilian Perspective

ABSTRACT Objective: To measure the costs of preventive and therapeutic protocols of Photobiomodulation (PBM) for oral mucositis (OM) and their budgetary impact on Brazil's Ministry of Health (BMH). Material and Methods: A partial economic analysis was performed to estimate the costs using a bottom-up approach from a social perspective. Monetary values were assigned in Brazilian reais (BRL). The costs of the preventive protocol were calculated for five, 30, and 33 consecutive PBM sessions, depending on the antineoplastic treatment instituted. The costs of the therapeutic protocol were calculated for 5 or 10 sessions. The annual financial and budgetary impact was calculated considering the groups of oncologic patients with a higher risk of development of OM, such as those with head and neck and hematological cancer and pediatric patients. Results: The cost of a PBM session was estimated at BRL 23.75. The financial impact of providing one preventive protocol per year for all oncologic patients would be BRL 14,282,680.00, 0.030% of the estimated budget for hospital and outpatient care of the BMH in 2022. The financial and budgetary impacts of providing one treatment for OM for all patients in one year would be BRL 2,225,630.31 (0.005%, most optimistic scenario) and BRL 4,451,355.63 (0.009%, most pessimistic scenario). Conclusion: The budgetary impact of implementing PBM protocols in the Brazilian Healthcare System is small, even in a pessimistic scenario.

Oral health surveys of Traditional Peoples and Communities in Brazil: a scoping review protocol.

OBJECTIVE: The objective of this review protocol is to map the available evidence regarding all the oral health surveys of Traditional Peoples and Communities (TPCs) in Brazil. METHODS AND ANALYSIS: The review question of the protocol is: 'What evidence is available on the oral health surveys of Traditional Peoples and Communities in Brazil?'. Observational studies that report oral health surveys of TPC in Brazil will be included. The protocol considered the Problem, Concept and Context strategy to guide data collection, as established by the Joanna Briggs Institute. The search strategy will consider Medical Subject Headings terms, synonyms and relevant free terms about epidemiological surveys in oral health and TPC in Brazil, with no limits to data, language, subject or search type, in the databases Medical Literature Analysis and Retrieval System Online (MEDLINE/PubMed), Literatura Latino-americana e do Caribe em Ciências da Saúde (LILACS), Scopus, Web of Science and Embase. Bibliographic searches will be updated until June 2023. The selection will be carried out by two independent, blinded reviewers, following the eligibility criteria, based on the title and abstract identified in the initial search. Potentially eligible studies will be fully read to confirm eligibility and collect relevant information. The categorisation of the studies will consider the author and year of publication, the traditional group studied, the study design, geographic location, age group, sample size, data collection method and the main oral health problem evaluated and its outcome. The data obtained and extracted will be presented in table format and text and presented using the visualisation of similarities method. ETHICS AND DISSEMINATION: The present study does not need ethical approval. The protocol title was registered in the Open Science Framework (DOI 10.17605/OSF.IO/BQ5J3). A final article will be prepared presenting the results of the scoping review, and will be submitted for publication in a peer-reviewed journal. The findings of this review will be presented at national conferences and scientific meetings.

The continuous increase in the number of systemic lupus erythematosus cases in Brazil in the COVID-19 era.

This study aims to reevaluate and compare the data from the Brazilian Unified Health System (SUS) on the number of diagnoses of systemic lupus erythematosus (SLE) in the pre-pandemic period with those in the pandemic period, as well as to compare the first year (2020) of the COVID-19 pandemic in Brazil with the last year (2021), to update the data, and to verify whether SLE disease control measures were effective in 2021. There was a consistent and significant increase in the incidence of SLE cases all over Brazil between the first and second pandemic years and between the pre-pandemic triennium and the second pandemic year. Therefore, it is inescapable to have larger clinical studies with different populations to better understand the relationship between these two conditions and find measures to improve the control of this disease.

Economic Impact of the COVID-19 Pandemic among Dentists in One of the Poorest Brazilian States: A Cross-Sectional Study

ABSTRACT Objective: To analyze the impact of the COVID-19 pandemic on dentists' income and to identify associated factors in one of the poorest Brazilian states. Material and Methods: A cross-sectional study including dentists who volunteered to answer an electronic questionnaire in Maranhão. Hierarchical multinomial logistic regression analyses were performed, estimating crude and adjusted odds ratios (OR) and respective 95% confidence intervals (95%CI) (alpha=5%). Results: The COVID-19 pandemic impacted the professionals´ income negatively [55.44% (50.26-60.52%)] and also positively [6.9% (4.55-9.94%)]. The negative impact on income was greater among male dentists (OR=2.54; 95%CI: 1.16-5.53), over 30 years of age (OR=3.03; 95%CI: 1.34-6.87), with family income below two minimum wages (OR=4.63; 95%CI: 1.50-14.30), who worked in the continent instead of in the capital island (OR=2.21; 95%CI: 1.14-4.29) and in the private sector (OR=31.43; 95%CI: 11.59-85.22). Moreover, those who had been tested for COVID-19, with a negative result, had a 21.3-fold greater chance of having an increased household income when compared to those who had not been tested. Conclusion: The COVID-19 pandemic negatively impacted the dentists' income in Maranhão, especially the older, males, with lower incomes, and who worked in the private sector, living far from the capital. The SUS played an important role in the social protection of dentists during the COVID-19 pandemic, mitigating the economic impacts on the public sector working class.

The continuous increase in the number of systemic lupus erythematosus cases in Brazil in the COVID-19 era

Abstract This study aims to reevaluate and compare the data from the Brazilian Unified Health System (SUS) on the number of diagnoses of systemic lupus erythematosus (SLE) in the pre-pandemic period with those in the pandemic period, as well as to compare the first year (2020) of the COVID-19 pandemic in Brazil with the last year (2021), to update the data, and to verify whether SLE disease control measures were effective in 2021. There was a consistent and significant increase in the incidence of SLE cases all over Brazil between the first and second pandemic years and between the pre-pandemic triennium and the second pandemic year. Therefore, it is inescapable to have larger clinical studies with different populations to better understand the relationship between these two conditions and find measures to improve the control of this disease.

PNAB 2017 and the number of community health agents in primary care in Brazil.

OBJECTIVE: To analyze the effect of the 2017 Basic Primary Care Policy (PNAB) on the number of community health agents per primary health care team. METHODS: This is a cross-sectional, descriptive and analytical study using data available on the Ministry of Health platform called e-Gestor da Atenção Básica, about Brazil's 5,570 towns between October 2017 and December 2019. The survival of the number of towns that did not reduce the number of community health agents was analyzed according to region of the country, the Human Development Index (HDI), the Gini Inequality Index and population size. Cox regression was used to analyze the factors associated with a reduction in the number of CHAs after one month and, from then on, every three months until two years had passed since the publication of the 2017 PNAB Ordinance, considering p < 0.05. CONCLUSIONS: After two years, the greatest reduction was observed in towns in the Midwest and South regions, which presented a high HDI, lower inequality and larger populations. Towns in the Midwest (HR = 1.256) had a higher chance of reducing the number of CHAs compared to the North region. Towns with a higher HDI (HR = 1.053) and larger population size (HR = 1.186) were also more likely to reduc the number of community health agents. Therefore, after the 2017 PNA, the number of towns reducing the amount of community health workers in primary health care increased over the months.

Oral health access in Brazil: analysis of inequities and non-access from the service user's perspective, according to the National Primary Care Access and Quality Improvement Program, 2014 and 2018. / Acesso em saúde bucal no Brasil: análise das iniquidades e não acesso na perspectiva do usuário, segundo o Programa de Melhoria do Acesso e da Qualidade da Atenção Básica, 2014 e 2018.

OBJECTIVE: To investigate factors associated with non-access to oral health in Brazil. METHODS: This was a cross-sectional study of data from external evaluations of the National Primary Care Access and Quality Improvement Program (2014 and 2018), using hierarchical multivariate logistic regression. 'Non-access' was defined as the service user not being able to make an appointment with a dentist. RESULTS: We analyzed data on 37.262 individuals (2014 sample) and on a further 117.570 individuals (2018 sample). Greater likelihood of non-access was found for those who live in municipalities with greater inequalities and with less oral health coverage, those whose travel time to the health center is more than 11 minutes, being female, being aged between 25 and 39 years and those whose income was up to 1 minimum wage. CONCLUSION: Non-access was associated with municipal factors such as greater inequality; organizational factors such as less oral health coverage and travel time to the health center; and individual factors such as sex, age and income.

[Resolvability of primary care in oral health in the State of Paraíba, Brazil]. / Resolutividade da atenção básica em saúde bucal em municípios do estado da Paraíba, Brasil.

Oral health resolvability in primary care of municipalities in the State of Paraíba, Brazil, was analyzed, and a cross-sectional study was conducted, using an inductive approach, comparative procedure and indirect documentation. The Resolvability Indicator (RI) consisted of the ratio between the number of Completed Treatments and First Programmatic Dental Consultations in municipalities in Paraíba (n = 223), between 2011 and 2014, by using data collected from the DATASUS/TABNET platform. The following explanatory variables were considered: Coverage of First Programmatic Dental Consultation (CFPDC), Coverage of Primary Care Teams (CPCT), Coverage of Oral Health Teams (COHT), Coverage of Family Health Teams (CFHT), Percentage of Tooth Extraction (PTE), Gross Domestic Product (GDP), Municipal Human Development Index (MHDI) and Gini Coefficient (GC). Descriptive statistics and negative binomial multiple regression were performed (α = 0.05). The median RI in 2011, 2012, 2013 and 2014 was, respectively, 20.4, 17.5, 15.2 and 15.7. There was a positive association between RI and CFPDC (PR = 1.14, CI = 1.02-1.28), CPCT (PR = 1.02, CI = 1.01-1.03), in addition to a negative association. between RI and year (PR = 0.83; IC = 0.74-0.94). The resolvability of oral health in primary care is influenced by coverage-related factors.

Analisou-se a resolutividade da atenção básica em saúde bucal nos municípios do estado da Paraíba, Brasil. Trata-se de um estudo transversal de abordagem indutiva, com procedimento comparativo e técnica de documentação indireta. O indicador de resolutividade (IR) constituiu da razão entre o número de tratamentos concluídos e primeiras consultas odontológicas programáticas dos municípios paraibanos (n = 223) entre 2011 e 2014, utilizando dados coletados da plataforma Datasus/TABNET. Foram consideradas variáveis explicativas: cobertura de primeira consulta odontoló gica programática (CPCOP), cobertura de equipes de atenção básica (CEAB), cobertura de equi pes de saúde bucal (CESB), cobertura de equipes de saúde da família (CESF), percentual de exodontia (PE), Produto Interno Bruto (PIB), Índice de Desenvolvimento Humano Municipal (IDHM) e coeficiente de Gini (CG). Os dados foram analisados por estatística descritiva e regressão múltipla binomial negativa (α = 0,05). As medianas do IR em 2011, 2012, 2013 e 2014 foram, respectivamente, 20,4, 17,5, 15,2 e 15,7. Houve associação positiva do IR com CPCOP (RP = 1,14; IC = 1,02-1,28), CEAB (RP = 1,02; IC = 1,01-1,03), e negativa com ano (RP = 0,83; IC = 0,74-0,94). A resolutividade em saúde bucal na atenção básica é influenciada por fatores relacionados à cobertura.

Oral health access in Brazil: analysis of inequities and non-access from the user's perspective, according to National Primary Care Access and Quality Improvement Program, 2014 and 2018 / Acceso a la salud oral en Brasil: análisis de desigualdades y falta de acceso desde la perspectiva del usuario, según Programa para Mejorar el Acceso y la Calidad de la Atención Primaria, 2014 y 2018 / Acesso em saúde bucal no Brasil: análise das iniquidades e não acesso na perspectiva do usuário, segundo o Programa de Melhoria do Acesso e da Qualidade da Atenção Básica, 2014 e 2018

Objective: To investigate factors associated with non-access to oral health in Brazil. Methods: Cross-sectional study that analyzed data from the external evaluation of the National Program to Improve Access and Quality (2014 and 2018), using hierarchical multivariate logistic regression. Non-access category was defined as the situation in which user was unable to make an appointment with a dentist. Results: We analyzed data from 37.262 individuals (2014 sample) and 117.570 people (2018 sample). A greater chance of non-access was found for those who: live in more unequal municipalities and with less oral health coverage, whose travel time to the unit is more than 11 minutes; female, aged between 25 and 39 years and whose income was up to 1 minimum wage. Conclusion: Non-access was associated with municipal factors such as grater inequality; organizational factors such as less coverage and travel time to the unit; and individual factors such as sex, age and income.

Objetivo: Investigar os fatores associados ao não acesso em saúde bucal no Brasil. Métodos: Estudo transversal, sobre dados da avaliação externa do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica, em 2014 e 2018, mediante regressão logística multivariada hierarquizada. Definiu-se como 'não acesso' quando o usuário não consegue marcar consulta com cirurgião-dentista. Resultados: Analisou-se dados de 37.262 indivíduos do segundo ciclo (2014) e 117.570 do terceiro ciclo (2018). Maior chance de não acesso ocorreu para residentes em municípios mais desiguais e com menor cobertura de saúde bucal, deslocamento para a unidade de saúde superior a 11 minutos, sexo feminino, idade entre 25 e 39 anos e renda de até 1 salário mínimo. Conclusão: O não acesso associou-se a fatores municipais, como maior desigualdade; fatores organizacionais, como menor cobertura e tempo de deslocamento até a unidade; e fatores individuais, como sexo, idade e renda

Diagnosis of mucosal changes and hospitalized oral cancer patients in Brazil: influence of socioeconomic factors.

This study aimed to analyze the influence of socioeconomic factors on the frequency of diagnoses of oral mucosal changes and the number of hospitalized patients with oral and oropharyngeal cancer in Brazil. This cross-sectional study analyzed data from all Brazilian cities in the period 2011-2017. The frequency of diagnoses of oral mucosal changes and the number of hospitalized patients of oral and oropharyngeal cancer in Brazil were extracted from the Primary Care Information System (SIAB) and Brazilian National Cancer Institute (INCA) databases. The socioeconomic factors evaluated were the Gini coefficient of inequality, municipal Human Development Index (MHDI), inadequate basic sanitation rate, employment rate, illiteracy rate and expected years of schooling. Associated factors were examined using bivariate Spearman's correlations and multivariate Poisson regressions, and statistically significant (p < 0.05) correlations between study variables and regression coefficients were obtained. A higher frequency of diagnoses of mucosal changes was observed in cities with a higher Gini coefficient (B = 11.614; p < 0.001), higher MHDI (B = 11.298; p < 0.001), and higher number of hospitalized patients with oral and oropharyngeal cancer (B = 0.001, p < 0.002). Cities with higher Gini coefficients (B = 8.159, p < 0.001), higher inadequate basic sanitation rates (B = 0.09, p = 0.001), lower expected years of schooling (B = -0.718, p < 0.001), and higher illiteracy rates (B = 0.191, p < 0.001) had a higher frequency of hospitalized patients with oral and oropharyngeal cancer. In conclusion, more developed cities showed a higher frequency of diagnoses of mucosal changes. Greater inequality and worse socioeconomic conditions are associated with a higher frequency of hospitalized patients with oral and oropharyngeal cancer in Brazil.

Estudo comparativo entre indicadores assistenciais de saúde bucal na Atenção Básica em Recife, Pernambuco / Oral healthcare comparative study among indicators in Primary Care, in Recife, Pernambuco

RESUMO A rede de atenção à Saúde Bucal (SB) se ampliou com a Política Nacional de Saúde Bucal, sendo os indicadores ferramentas para avaliar conquistas ou necessidade de mudanças. Este trabalho objetivou analisar indicadores de SB da Atenção Básica por tipo de organização das unidades de saúde em Recife, 2018. Trata-se de um estudo transversal, de natureza descritiva e analítica com base em dados secundários. Analisou-se a associação entre tipos de organização da Atenção Básica (Unidade de Saúde da Família - USF; Upinha e Unidade Básica Tradicional - UBT) e indicadores assistenciais de SB, através dos testes qui-quadrado e Kruskal-Wallis (p<0,05). A cobertura de primeira consulta odontológica e os procedimentos odontológicos per capita apresentaram mediana maior nas UBT, 31,8% (p=0,00) e 0,6 (p=0,127), respectivamente. A proporção de exodontia e procedimentos clínicos foi maior nas USF com mediana 8,2% (p=0,703). As USF foram as que realizaram o maior número de atividades coletivas de escovação dental supervisionada (45,3%, p=0,082) e aplicação de flúor (44,6%, p=0,174). Conclui-se que as UBT apresentaram melhores resultados nos indicadores relacionados ao acesso ao tratamento clínico e as USF realizaram mais ações coletivas de prevenção.

ABSTRACT The Oral Health care network (OH) has expanded with the National Oral Health Policy, and the indicators are tools to assess achievements or the need for changes. This study aimed to analyze the OH indicators of Primary Care Basic by health units organization type in Recife, 2018. This is a cross-sectional, quantitative, descriptive and analytical study, based on secondary data. The association between organization type of Primary Care (Family Health Unity/USF; Upinha and Traditional Basic Health Unit/UBT) and OH assistance indicators was analyzed using the chi-square and Kruskal-Wallis tests (p<0,05). The first dental appointment coverage and the average number of procedures per capita showed a higher median in the UBT, 31,8% (p=0,00) and 0,6 (p=0,127), respectively. The tooth extraction proportion was higher in the USF, with a median of 8,2% (p=0,703). The USF were the ones that performed the largest number of collective activities of supervised tooth brushing (45.3%, p=0.082) and fluoride application (44.6%, p=0.174). It is concluded that the UBT showed better results in the indicators related to access to clinical treatment and the USF performed more collective activities.

PNAB 2017 and the number of community health agents in primary care in Brazil / A PNAB 2017 e o número de agentes comunitários de saúde na atenção primária do Brasil

ABSTRACT OBJECTIVE: To analyze the effect of the 2017 Basic Primary Care Policy (PNAB) on the number of community health agents per primary health care team. METHODS: This is a cross-sectional, descriptive and analytical study using data available on the Ministry of Health platform called e-Gestor da Atenção Básica, about Brazil's 5,570 towns between October 2017 and December 2019. The survival of the number of towns that did not reduce the number of community health agents was analyzed according to region of the country, the Human Development Index (HDI), the Gini Inequality Index and population size. Cox regression was used to analyze the factors associated with a reduction in the number of CHAs after one month and, from then on, every three months until two years had passed since the publication of the 2017 PNAB Ordinance, considering p < 0.05. CONCLUSIONS: After two years, the greatest reduction was observed in towns in the Midwest and South regions, which presented a high HDI, lower inequality and larger populations. Towns in the Midwest (HR = 1.256) had a higher chance of reducing the number of CHAs compared to the North region. Towns with a higher HDI (HR = 1.053) and larger population size (HR = 1.186) were also more likely to reduc the number of community health agents. Therefore, after the 2017 PNA, the number of towns reducing the amount of community health workers in primary health care increased over the months

RESUMO OBJETIVO: Analisar o efeito da Política Nacional de Atenção Básica (PNAB) de 2017 no quantitativo de agentes comunitários de saúde, por equipe de atenção primária em saúde. MÉTODOS: Trata-se de um estudo transversal, descritivo e analítico, utilizando dados disponibilizados na plataforma e-Gestor da Atenção Básica, do Ministério da Saúde, sobre os 5.570 municípios brasileiros, entre outubro de 2017 e dezembro de 2019. A sobrevida do número de municípios que não reduziram o quantitativo de agentes comunitários de saúde foi analisada segundo a região do país, índice de desenvolvimento humano (IDH), índice de desigualdade de Gini e porte populacional. A Regressão de Cox foi utilizada para analisar os fatores associados à redução do número de ACS após um mês e, a partir de então, a cada três meses, até completarem os dois anos da publicação da portaria da PNAB 2017, considerando-se p < 0,05. CONCLUSÕES: Após dois anos, a maior redução foi observada em municípios das regiões Centro-Oeste e Sul, que apresentaram IDH alto, menos desiguais e com maior porte populacional. Municípios do Centro-Oeste (HR = 1,256) apresentaram maior chance de redução do número de ACS comparado à região Norte. Municípios com maior IDH (HR = 1,053) e maior porte populacional (HR = 1,186) também apresentaram maior chance de reduzir o número de agentes comunitários de saúde. Portanto, após a PNAB 2017, houve um aumento ao longo dos meses no número de municípios que reduziram a quantidade de agentes comunitários em saúde na atenção primária de saúde.

Acesso em saúde bucal no Brasil: análise das iniquidades e não acesso na perspectiva do usuário, segundo o Programa de Melhoria do Acesso e da Qualidade da Atenção Básica, 2014 e 2018 / Acceso a la salud oral en Brasil: análisis de desigualdades y falta de acceso desde la perspectiva del usuario, según Programa para Mejorar el Acceso y la Calidad de la Atención Primaria, 2014 y 2018 / Oral health access in Brazil: analysis of inequities and non-access from the service user's perspective, according to the National Primary Care Access and Quality Improvement Program, 2014 and 2018

Objetivo: Investigar os fatores associados ao não acesso em saúde bucal no Brasil. Métodos: Estudo transversal, sobre dados da avaliação externa do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica, em 2014 e 2018, mediante regressão logística multivariada hierarquizada. Definiu-se como 'não acesso' quando o usuário não consegue marcar consulta com cirurgião-dentista. Resultados: Foram analisados dados de 37.262 indivíduos do segundo ciclo (2014) e 117.570 do terceiro ciclo (2018). Maior chance de não acesso ocorreu para residentes em municípios mais desiguais e com menor cobertura de saúde bucal, deslocamento para a unidade de saúde superior a 11 minutos, sexo feminino, idade entre 25 e 39 anos e renda de até 1 salário mínimo. Conclusão: O não acesso associou-se a fatores municipais, como maior desigualdade; fatores organizacionais, como menor cobertura e tempo de deslocamento até a unidade; e fatores individuais, como sexo, idade e renda.

Objetivo: Investigar los factores asociados a la falta de acceso a la salud bucal en Brasil. Métodos: Estudio transversal, con datos de la evaluación externa del Programa de Mejoramiento del Acceso y la Calidad de la Atención Primaria (2014 y 2018), mediante regresión logística multivariable jerárquica. La categoría 'sin acceso' se definió cuando el usuario no consiguió concertar una consulta con un cirujano dentista. Resultados: Analizamos datos de 37.262 (2014) y 117.570 (2018) individuos. Se encontró una mayor probabilidad de no acceso para quienes: vivían en municipios con más desigualdad y con menor cobertura de salud bucal, cuyo tiempo de viaje a la unidad era superior a 11 minutos; mujeres, entre 25 y 39 años e ingresos de hasta 1 sueldo mínimo. Conclusión: La falta de acceso se asoció con factores municipales como mayor desigualdad; factores organizacionales como menor cobertura y tiempo de viaje a la unidad; y factores individuales como sexo, edad e ingresos.

Objective: To investigate factors associated with non-access to oral health in Brazil. Methods: This was a cross-sectional study of data from external evaluations of the National Primary Care Access and Quality Improvement Program (2014 and 2018), using hierarchical multivariate logistic regression. 'Non-access' was defined as the service user not being able to make an appointment with a dentist. Results: We analyzed data on 37.262 individuals (2014 sample) and on a further 117.570 individuals (2018 sample). Greater likelihood of non-access was found for those who live in municipalities with greater inequalities and with less oral health coverage, those whose travel time to the health center is more than 11 minutes, being female, being aged between 25 and 39 years and those whose income was up to 1 minimum wage. Conclusion: Non-access was associated with municipal factors such as greater inequality; organizational factors such as less oral health coverage and travel time to the health center; and individual factors such as sex, age and income.

Diagnosis of mucosal changes and hospitalized oral cancer patients in Brazil: influence of socioeconomic factors

Abstract This study aimed to analyze the influence of socioeconomic factors on the frequency of diagnoses of oral mucosal changes and the number of hospitalized patients with oral and oropharyngeal cancer in Brazil. This cross-sectional study analyzed data from all Brazilian cities in the period 2011-2017. The frequency of diagnoses of oral mucosal changes and the number of hospitalized patients of oral and oropharyngeal cancer in Brazil were extracted from the Primary Care Information System (SIAB) and Brazilian National Cancer Institute (INCA) databases. The socioeconomic factors evaluated were the Gini coefficient of inequality, municipal Human Development Index (MHDI), inadequate basic sanitation rate, employment rate, illiteracy rate and expected years of schooling. Associated factors were examined using bivariate Spearman's correlations and multivariate Poisson regressions, and statistically significant (p < 0.05) correlations between study variables and regression coefficients were obtained. A higher frequency of diagnoses of mucosal changes was observed in cities with a higher Gini coefficient (B = 11.614; p < 0.001), higher MHDI (B = 11.298; p < 0.001), and higher number of hospitalized patients with oral and oropharyngeal cancer (B = 0.001, p < 0.002). Cities with higher Gini coefficients (B = 8.159, p < 0.001), higher inadequate basic sanitation rates (B = 0.09, p = 0.001), lower expected years of schooling (B = -0.718, p < 0.001), and higher illiteracy rates (B = 0.191, p < 0.001) had a higher frequency of hospitalized patients with oral and oropharyngeal cancer. In conclusion, more developed cities showed a higher frequency of diagnoses of mucosal changes. Greater inequality and worse socioeconomic conditions are associated with a higher frequency of hospitalized patients with oral and oropharyngeal cancer in Brazil.

Monitoring of oral health teams after National Primary Care Policy 2017.

OBJECTIVE: To monitor the number of oral health teams implemented in the Family Health Strategy after National Primary Care Policy 2017. METHODS: This is a study of quantitative, descriptive and analytical nature that used the data from the public reports of the history of oral health coverage available in the e-Manager platform of Primary Care of the Ministry of Health of all Brazilian municipalities (5,570). The survival rate of the municipalities that did not reduce the number of oral health teams was analyzed according to the region of the country, human development index, Gini inequality index and population size. Cox regression was used to analyze the factors associated with the decrease in the number of teams implanted after 1, 3, 6, 9, 12, 15, 18 and 21 months of publication of the 2017 national policy ordinance, considering the hazard ratio (HR) and p < 0.05. RESULTS: After 21 months of publication of the policy, 6.7% of Brazilian municipalities reduced the number of oral health teams. This reduction was higher in the South (6.7%) and Northeast (4.8%), in municipalities with the highest human development index, i.e., greater than or equal to 0.7 (5.6%), more unequal in terms of income distribution (Gini index > 0.62) and larger population size (more than 100,000 inhabitants). Municipalities in the Northeast (HR = 1.220) and South (HR = 1.771) regions had a higher chance of reducing the number of teams compared with those in the North region. More unequal municipalities (HR = 6.405) and with larger population size (HR = 4.273) were also more likely to reduce the coverage of oral health teams. CONCLUSION: The municipalities that reduced the number of oral health teams in the Family Health Strategy are from the South and Northeast regions, with greater social inequality and larger population size. This scenario can significantly affect the population's access to dental health services in the Unified Health System, especially among those in need.

Specialized dental care for people with disabilities in Brazil: profile of the Dental Specialty Centers, 2014. / Atenção odontológica especializada para pessoas com deficiência no Brasil: perfil dos centros de especialidades odontológicas, 2014.

OBJECTIVE: To describe the oral health care services for people with disabilities treated within the Dentistry for Patients with Special Needs (PSN) specialty. METHODS: This was a cross-sectional study with data from the Program for Improving Access and Quality of Dental Specialty Centers (PMAQ-CEO) in 2014. RESULTS: Of the total of 932 services evaluated, 89.8% did provide care for PSNs, 30.4% had physical accessibility, 59.7% provided referral to hospital care and most guaranteed complete treatment. Only a third of the Dental Specialty Centers planned 40 or more hours a week for providing clinical care to PSNs. CONCLUSION: The care network for people with disabilities is being formed but, even with specific financial incentives, it has limitations. Services need to eliminate physical and attitudinal barriers to ensure universal accessibility. Protocols based on risk classification are necessary, prioritizing care at DSCs for complex cases not attended to in Primary Care and organizing the dental health care network for people with disabilities.

Acesso e cobertura populacional à saúde bucal após a implementação da Política Nacional de Saúde Bucal "Brasil Sorridente" / Access and oral health population coverage after implementation of the National Oral Health Policy "Smiling Brazil" / Acceso y cobertura de la salud oral después de la implementación de la Política Nacional de Salud Oral "Brasil Sonriente"

O objetivo foi analisar a Política Nacional de Saúde Bucal, na perspectiva do acesso e cobertura das ações desenvolvidas na odontologia do Sistema Único de Saúde, entre 2002 e 2016. A partir do quadro conceitual da Organização Mundial da Saúde, que se divide em blocos para garantir acesso, cobertura e qualidade dos sistemas de saúde, foi realizado um estudo de caso do Brasil Sorridente referentes à implantação e financiamento das equipes. O bloco "força de trabalho" revelou um crescimento superior a 470% no número de equipes de saúde bucal no Brasil; no bloco "financiamento" fica evidente o grande aporte financeiro destinado à política, com ênfase ao papel indutor deste processo nos municípios; o bloco "tecnologia" evidenciou o incremento tecnológico para viabilizar os serviços de saúde bucal em todo o Brasil; já no bloco "disponibilidade dos serviços de saúde" observa-se uma ampliação de 4% na atenção básica e os serviços especializados essas porcentagens ultrapassam os 200% entre 2001 e 2015, finalmente, no bloco "acesso e cobertura" foi possível verificar o aumento de cobertura populacional de 9% para 43% no Brasil. Os dados apontam que a política permitiu um avanço referente aos blocos estruturantes do framework e melhorou o acesso e a cobertura em saúde bucal. (AU)

The objective was to analyze the National Oral Health Policy, from the perspective of access and coverage of dentistry actions in the Unified Health System, between 2002 and 2016. Based on the World Health Organization conceptual framework, which is divided into blocks to guarantee access, coverage and quality of health systems, a case study was carried out in the Smiling Brazil considering the implementation and financing. As a result, the "workforce" block revealed a growth rate superior than 470% in the number of oral health teams in Brazil. In the "financing" block, the great financial support to the policy is evident, with emphasis on the role of this process in the municipalities. The "technology" block evidenced the technological increase to make oral health services viable in Brazil. Furthermore, in the block "availability of health services" was observed an increase of 4% in primary care. On the other hand, between 2001 and 2015, in the specialized services this percentage exceed 200%. Finally, in the block "access and coverage" was possible to verify the increase of population coverage from 9% to 43% in Brazil. The data indicate that the policy allowed an advance regarding the framework structuring blocks, as well as improved the access and coverage in oral health. (AU)

El objetivo fue analizar la Política Nacional de Salud Oral, desde la perspectiva de acceso y cobertura de las acciones desarrolladas en la odontología del Sistema Único de Salud, entre 2002 y 2016. Desde el marco conceptual de la Organización Mundial de la Salud, que se divide en bloques para garantizar el acceso, la cobertura y la calidad de los sistemas de salud, se realizó un estudio de caso de Smiling Brazil sobre la implementación y el financiamiento de los equipos. El bloque de "fuerza laboral" reveló un crecimiento de más del 470% en el número de equipos de salud bucal en Brasil; En el bloque de "financiamiento", la gran contribución financiera a la política es evidente, con énfasis en el papel inductivo de este proceso en los municipios; el bloque "tecnología" evidenció el aumento tecnológico para habilitar los servicios de salud bucal en todo Brasil; En el bloque "disponibilidad de servicios de salud" hay un aumento del 4% en atención primaria y servicios especializados, estos porcentajes superan el 200% entre 2001 y 2015, finalmente, en el bloque "acceso y cobertura" fue posible verificar el aumento Cobertura poblacional del 9% al 43% en Brasil. Los datos indican que la política permitió un avance con respecto a los componentes básicos del marco y un mejor acceso y cobertura en salud bucal. (AU)

Specialized dental care for people with disabilities in Brazil: profile of specialized dental clinics, 2014 / Atención odontológica especializada para personas con discapacidad en Brasil: perfil de los centros de especialidades odontológicas, 2014 / Atenção odontológica especializada para pessoas com deficiência no Brasil: perfil dos centros de especialidades odontológicas, 2014

Objective. To analyze the specialized services of oral health care for people with disabilities, attended by the specialty of Special Care Dentistry (SCD). Methods. A cross-sectional study with data from the Program for Improving Access and Quality of Dental Specialties Centers (PMAQ-CEO), 2014. Results. A total of 932 services were evaluated: 89.8% did have SCD, 30.4% had physical accessibility, 59.7% had reference to hospital care and most guaranteed complete treatment. Only a third of the CEOs offered 40 hours per week of SCD. Conclusion. The network of care for people with disabilities is being formed, and even with specific financial incentives, has limitations. Services need to eliminate physical and attitudinal barriers to ensure universal accessibility. Protocols based on risk classification are necessary, prioritizing the attendance in the CEO of the complex cases, not attended in the primary care and organizing the dental health care network of the people with disabilities.

Objetivo. Descrever os serviços de atenção à saúde bucal para pessoas com deficiência, atendidas pela especialidade Odontologia para Pacientes com Necessidades Especiais (PNE). Métodos. Estudo transversal, com dados do Programa de Melhoria do Acesso e Qualidade dos Centros de Especialidades Odontológicas (PMAQ-CEO), 2014. Resultados. Dos 932 serviços avaliados, 89,8% contavam com atendimento a PNEs, 30,4% apresentavam acessibilidade física e 59,7% contavam com referência para atendimento hospitalar. A maioria garantia tratamento completo. São disponibilizadas 40h semanais de atendimento clínico a PNEs em 1/3 dos CEOs. Conclusão. A rede de cuidado para pessoas com deficiência encontra-se em formação e, apesar dos incentivos financeiros específicos, apresenta limitações. Os serviços precisam eliminar barreiras físicas e atitudinais para garantir acessibilidade universal. Protocolos baseados em classificação de risco são necessários, priorizando atendimento no CEO dos casos complexos, não atendidos na Atenção Básica e organizando a rede de cuidados em saúde bucal da pessoa com deficiência.