Indicators for dental appointment scheduling in primary health care: a national cross-sectional study.

BACKGROUND: Integrated dental services within the Health System, particularly at primary health care, are crucial to reverse the current impact of oral diseases, which are among the most prevalent diseases worldwide. However, the use of dental services is determined by complex phenomena related to the individual, the environment and practices in which care is offered. Therefore, factors associated with dental appointments scheduling can affect positively or negatively the use of dental services. The aim of the present study was to evaluate the indicators for dental appointment scheduling in Primary Health Care (PHC). METHODS: The present is a cross-sectional analytical study that used data from the external assessment of the third cycle of the National Program for Improving Access and Quality in Primary Care (PMAQ-AB), carried out between 2017 and 2018, in Brazil. The final sample consisted of 85,231 patients and 22,475 Oral Health teams (OHTs). The outcome variable was the fact that the user sought for a dental appointment at the Primary Health Care Unit. A multilevel analysis was carried out to verify the association between individual variables (related to users) and contextual variables (related to the OHTs) in relation to the outcome. RESULTS: Only 58.1% of the users interviewed at these Primary Health Care Units seek the available dental care. The variables with the greatest effect on the outcome were the patient's age up to 42 years old (OR = 2.03, 95% CI: 1.96-2.10), at individual level, and 'oral health teams that assisted no more than a single family health team (FHT)' (OR = 1.29, 95% CI: 1.23-1.36) at contextual level. Other variables were also associated with the outcome, but with a smaller effect size. CONCLUSION: In conclusion, users' age and work process of OHT were indicators for dental appointment scheduling. Our results suggest that when OHT put the National Oral Health Policy guidelines into practice, by assisting only one FHT, the chance for PHC users seeking dental appointments is higher than OHTs that assist more than one FHT. Regarding age, patients aged up to 42 years are more likely to seek an appointment with a dentist.

Can the primary health care model affect the determinants of neonatal, post-neonatal and maternal mortality? A study from Brazil.

BACKGROUND: The state of São Paulo recorded a significant reduction in infant mortality from 1990 to 2013, but the desired reduction in maternal mortality was not achieved. Knowledge of the factors with impact on these indicators would be of help in formulating public policies. The aims of this study were to evaluate the relations between socioeconomic and demographic factors, health care model and both infant mortality (considering the neonatal and post-neonatal dimensions) and maternal mortality in the state of São Paulo, Brazil. METHODS: In this ecological study, data from national official open sources were used to conduct a population-based study. The units analyzed were 645 municipalities in the state of São Paulo, Brazil. For each municipality, the infant mortality (in both neonatal and post-neonatal dimensions) and maternal mortality rates were calculated for every 1000 live births, referring to 2013. Subsequently, the association between these rates, socioeconomic variables, demographic models and the primary care organization model in the municipality were verified. For statistical analysis, we used the zero-inflated negative binomial model. Gross analysis was performed and then multiple regression models were estimated. For associations, we adopted "p" at 5%. RESULTS: The increase in the HDI of the city and proportion of Family Health Care Strategy implemented were significantly associated with the reduction in both infant mortality (neonatal + post-neonatal) and maternal mortality rates. In turn, the increase in birth and caesarean delivery rates were associated with the increase in infant and maternal mortality rates. CONCLUSIONS: It was concluded that the Family Health Care Strategy was a Primary Care organization model that contributed to the reduction in infant (neonatal + post-neonatal) and maternal mortality rates, and so did actors such as HDI and cesarean section. Thus, public health managers should prefer this model when planning the organization of Primary Care services for the population.

Influence of the quality of life and locus of control of mothers of disabled children on the oral health of their children.

AIM: To investigate whether quality of life of mothers is related to oral health of disabled children. METHOD: This is an analytical cross-sectional study, based on interviews with 49 mothers and oral clinical examination (DMFT and OHI-S) in children with disabilities from 2 to 6 years old, assisted by the Rehabilitation Center of Piracicaba, SP. Mothers answered WHOQOL BREF quality of life instrument and Multidimensional Health Locus of Control Scale. Data analysis was performed with descriptive statistics, Chi-square test, Fisher's exact test, and multiple logistic regression. RESULT: Most children of the sample were aged from 37 to 48 months (40.81%) and presented neuropsychomotor development delay. Mothers reported (55.1%) that their interference in the health/illness of their children was a fortuitous process. The social relationships domain of WHOQOL BREF presented significant association (p = 0.0404) with DMFT index. CONCLUSION: We observed that quality of life of mothers can interfere in oral health of children, regarding social relationships.