Effectiveness and safety of biological and target synthetic drugs treatment for psoriatic arthritis: a systematic review with network meta-analysis.

BACKGROUND: Psoriatic arthritis (PA) is a chronic inflammatory systemic arthritis that can result in loss of functional capacity and joint deformation. This systematic review assessed the effectiveness and safety of biological and target synthetic drugs for treating PA. METHODS: We searched for randomized clinical trials (RCTs) that evaluated the use of Adalimumab, Etanercept, Infliximab, Golimumab, Secukinumab, Certolizumab Pegol and Tofacitinib in the main general databases and clinical trial registers databases. The primary outcomes were ACR 50, PsARC, and serious adverse events. Two independent reviewers performed study selection and data extraction. Network meta-analyses were conducted using a random effects model and frequentist approach. The CINeMA software was used to assess the certainty of evidence. RESULTS: We included 33 RCTs (n = 11,034). The results from the network meta-analysis for the ACR 50 at 6-months follow-up showed that all drugs were superior to placebo, with Secukinumab (high certainty of evidence), Infliximab (very low certainty of evidence) and Adalimumab (high certainty of evidence) ranking the highest. Regarding the PsARC (at 6-months follow-up), all drugs, except for Golimumab (very low certainty of evidence), were superior to placebo, with Etanercept (low certainty of evidence), Infliximab (low certainty of evidence) and Certolizumab Pegol (low certainty of evidence) being the most effective drugs. There were no significant differences in the risk of serious adverse events between the drugs and placebo. Golimumab (very low certainty of evidence), Secukinumab (low certainty of evidence), and Adalimumab (very low certainty of evidence) ranked the highest for safety. CONCLUSIONS: In conclusion, based on the balance between efficacy and safety, Secukinumab and Adalimumab may be the preferred options among the evaluated drugs for treating patients with PsA. However, caution is necessary when interpreting the safety findings, as they are supported by evidence of low to very low certainty. Consequently, the balance between benefits and potential risks may change as new safety evaluation studies become available. PROTOCOL REGISTRATION: PROSPERO: CRD42022315577.

Factors associated with interprofessional collaboration in Primary Health Care: a multilevel analysis.

Working with an interprofessional focus is increasingly necessary, in view of the growing complexity of the population's health needs. This study aims to assess interprofessional collaboration and the teamwork climate in primary health care (PHC) and determine whether there is a relationship between these two variables. The AITCS-II instrument was used to measure interprofessional collaboration, while to diagnose teamwork climate, the ECTE instrument was used, a version adapted to the SUS context of the Teamwork Climate Inventory instrument. These two instruments were applied online together with a questionnaire for the sociodemographic characterization of the 544 participants, who belonged to 97 Family Health Strategy (FHS) teams in a Brazilian municipality. The obtained data were submitted to a multilevel analysis. A positive correlation was observed between interprofessional collaboration and three of the four teamwork climate factors. The better the work climate, the better the interprofessional collaboration in the corresponding team, and this characteristic stands out in relation to other individual analyzed characteristics.

Cost-Effectiveness of Onasemnogene Abeparvovec Compared With Nusinersen and Risdiplam in Patients With Spinal Muscular Atrophy Type 1 in Brazil: Custo-Efetividade do Onasemnogeno Abeparvoveque (AVXS-101) em Comparação ao Nusinersena e Risdiplam em Pacientes com Atrofia Muscular Espinhal Tipo 1 no Brasil.

OBJECTIVES: This study aimed to evaluate the cost-effectiveness of the onasemnogene abeparvovec in relation to nusinersen and risdiplam in the treatment of spinal muscular atrophy type 1 from the perspective of the Brazilian Unified Health System. METHODS: A Markov model was built on a lifetime horizon. Short-term data were obtained from clinical trials of the technologies and from published cohort survival curves (long term). Costs were measured in current 2022 local currency (R$) values and benefits in quality-adjusted life-years (QALYs). Utility values were derived from type 1 spinal muscular atrophy literature, whereas costs related to technologies and maintenance care in each health state were obtained from official sources of reimbursement in Brazil. Deterministic and probabilistic, as well as scenario, sensitivity analyses were performed. RESULTS: Compared with the less costly strategy (nusinersen), the use of onasemnogene abeparvovec resulted in an incremental cost of R$2.468.448,06 ($975 671.169 - purchasing power parity [PPP]) and a 3-QALY increment and incremental cost-effectiveness ratio of R$742.890,92 ($293 632.774 - PPP)/QALY. Risdiplam had an extended dominance from other strategies, resulting in an incremental cost-effectiveness ratio of R$926.586,22 ($366 239.612 - PPP)/QALY compared with nusinersen. Sensitivity analysis showed a significant impact of the follow-up time of the cohort and the cost of acquiring onasemnogene abeparvovec. CONCLUSIONS: Over a lifetime horizon, onasemnogene abeparvovec seems to be a potentially more effective option than nusinersen and risdiplam, albeit with an incremental cost. Such a trade-off should be weighed in efficiency criteria during decision making and outcome monitoring from the perspective of the Brazilian Unified Health System.

Legislation in Hospital Dentistry: Gaps, Perspectives and Desires

Abstract Objective: To analyze the existing state legislation, including not only the ordinary laws, but also their infralegal regulation and the state legislation on Hospital Dentistry. Material and Methods: A survey was carried out in the databases of the Legislative Assemblies of the Brazilian States and the Federal District, as well as the Regional and Federal Councils of Dentistry in Brazil. Subsequently, a survey was carried out in the databases of the Ministry of Health, State Dental Councils and Federal Dental Council in Brazil. Results: Only 8 Brazilian states have legislation in force regarding hospital dentistry, which represents 29.63% of the federative units. Among the Brazilian regions, the Midwest presented the highest prevalence of the laws found (37.50%), followed by the North (25%) and the other regions with the same coverage (12.50%). Also, an orientation and an ordinance from the Ministry of Health, six resolutions from the Federal Council of Dentistry, and a technical note from the National Health Surveillance Agency were found. Conclusion: Several States do not have rules on the subject, making it imperative to create a federal rule that not only imposes the presence of the dentist, but also regulates the proportion of the team, workload, and availability.

Factors associated with interprofessional collaboration in Primary Health Care: a multilevel analysis / Fatores associados à colaboração interprofissional na Atenção Primária à Saúde: uma análise multinível

Abstract Working with an interprofessional focus is increasingly necessary, in view of the growing complexity of the population's health needs. This study aims to assess interprofessional collaboration and the teamwork climate in primary health care (PHC) and determine whether there is a relationship between these two variables. The AITCS-II instrument was used to measure interprofessional collaboration, while to diagnose teamwork climate, the ECTE instrument was used, a version adapted to the SUS context of the Teamwork Climate Inventory instrument. These two instruments were applied online together with a questionnaire for the sociodemographic characterization of the 544 participants, who belonged to 97 Family Health Strategy (FHS) teams in a Brazilian municipality. The obtained data were submitted to a multilevel analysis. A positive correlation was observed between interprofessional collaboration and three of the four teamwork climate factors. The better the work climate, the better the interprofessional collaboration in the corresponding team, and this characteristic stands out in relation to other individual analyzed characteristics.

Resumo Trabalhar com foco interprofissional é cada vez mais necessário, tendo em vista a crescente complexidade das necessidades de saúde da população. Este estudo tem como objetivo avaliar a colaboração interprofissional e o clima de trabalho em equipe na atenção primária à saúde (APS) e verificar possível relação entre estas duas variáveis. Para mensurar a colaboração interprofissional foi utilizado o instrumento AITCS-II, enquanto para o diagnóstico do clima de trabalho em equipe foi utilizado o instrumento ECTE, versão adaptada para o contexto SUS do instrumento Teamwork Climate Inventory. Esses dois instrumentos foram aplicados on-line juntamente com um questionário para caracterização sociodemográfica dos 544 participantes, pertencentes a 97 equipes da Estratégia Saúde da Família (ESF) de um município brasileiro. Os dados obtidos foram submetidos a uma análise multinível. Foi observada uma correlação positiva entre a colaboração interprofissional e três dos quatro fatores do clima de trabalho em equipe. Quanto melhor o clima de trabalho, melhor a colaboração interprofissional na equipe correspondente, e essa característica se destaca em relação às demais características individuais analisadas.

Factors affecting the performance of periodontal specialty in secondary oral health care in Brazil.

OBJECTIVE: The aim of this study was to investigate, at a national level, which individual factors of the work process/infrastructure are associated with the achievement of goals in the periodontics specialty in Brazilian Dental Specialty Centers (BDSC). METHODS: This was a quantitative, analytical, cross-sectional study. Secondary data from DATASUS and the external evaluation of the second cycle of the BDSC Access and Quality Improvement Program were used. Variable description was carried out in the first stage, and then the bivariate Poisson regression was performed to verify possible associations between the variables and the outcome (achievement of goals in Periodontics in the BDSC). In this analysis, the covariates that were associated with the outcome at the p <0.20 significance level were included in the next step of the analysis. Multivariate Poisson regression with a robust estimator was then performed with those that met the above criterion. The variables that showed a p value < 0.05 were considered in the final model. RESULTS: The outcome was achieved in more than seven months of the year (mean 7.03 months, SD 4.20). Most BDSC monitored the established goals (93.2%), had referral as the only way of access (61.7%), had only municipal coverage (68.4%), carried out planning and periodic evaluation of actions (89.2%). A minority has quotas of procedures by Oral Health teams (OHTs) in Primary Health Care (PHC) (18.8%). The presence of a specialist in periodontics was (on average) 1.16 per BDSC and the sum of the workload of dentists working in this specialty was 31.1 hours (SD = 23.9). CONCLUSION: It was concluded that the individual factors of the work process/infrastructure associated with the achievement of goals in periodontics in Brazilian BDSC are: monitoring of established goals, BDSC scope and number of professionals working in the specialty.

Immunogenicity and safety of inactivated quadrivalent influenza vaccine compared with the trivalent vaccine for influenza infection: an overview of systematic reviews.

BACKGROUND: Influenza infection is a highly preventable transmissible viral disease associated with mild upper respiratory symptoms and more severe conditions such as lethal pneumonia. Studies have shown that a broader spectrum influenza vaccine could reduce influenza's burden of disease in low- and middle-income countries. A considerable number of systematic reviews reported that quadrivalent influenza vaccines are considered more effective compared to trivalent vaccines, hence, there is a need for an overview in order to synthesize the current evidence pertaining to the comparison between quadrivalent and trivalent inactivated influenza vaccines. OBJECTIVE: The aim was to summarize the evidence from systematic reviews that investigated the immunogenicity and safety of the Influenza's inactivated quadrivalent vaccine (QIV) compared to the trivalent vaccine (TIV), in the general population. METHODS: We searched articles up to December 2022 at: Web of Science, EMBASE, MEDLINE, Cochrane Library, and SCOPUS. The search strategy was conducted following the PICO model. We included systematic reviews comparing the primary outcomes of immunogenicity (seroprotection rate and seroconversion rate) and adverse events using risk ratios. The AMSTAR 2 and ROBIS were used for quality assessments, and GRADE was used for evidence certainty assessments. FINDINGS: We included five systematic reviews, totalling 47,740 participants. The Quadrivalent Inactivated Influenza Vaccine (QIV) exhibited enhanced immunogenicity in the context of B-lineage mismatch when compared to the Trivalent Inactivated Influenza Vaccine (TIV). While the safety profile of QIV was found to be comparable to that of TIV, the QIV showed a higher incidence of solicited local pain among children and adolescents, as well as an increased frequency of local adverse events within the adult population. CONCLUSION: Our findings suggest that the QIV provides a superior immunogenicity response compared to the TIV in all age groups evaluated, especially when a lineage mismatch occurred. The safety of QIV was considered similar to the TIV, with no serious or systemic solicited or unsolicited adverse events; tough pain at the injection site was greater for QIV. We recommend caution owing to the high risk of bias in the selection process and no protocol registration.

Clinical efficacy of bioactive restorative materials in controlling secondary caries: a systematic review and network meta-analysis.

BACKGROUND: This systematic review and network meta-analysis aimed to compare the clinical efficacy of bioactive and conventional restorative materials in controlling secondary caries (SC) and to provide a classification of these materials according to their effectiveness. METHODS: A search was performed in Pubmed, Web of Science, Embase, BBO, Lilacs, Cochrane Library, Scopus, IBECS and gray literature. Clinical trials were included, with no language or publication date limitations. Paired and network meta-analyses were performed with random-effects models, comparing treatments of interest and classifying them according to effectiveness in the permanent and deciduous dentition and at 1-year or 2/more years of follow-up. The risk of bias and certainty of evidence were evaluated. RESULTS: Sixty-two studies were included in the qualitative syntheses and 39 in the quantitative ones. In permanent teeth, resin composite (RC) (RR = 2.00; 95%CI = 1.10, 3.64) and amalgam (AAG) (RR = 1.79; 95%CI = 1.04, 3.09) showed a higher risk of SC than Glass Ionomer Cement (GIC). In the deciduous teeth, however, a higher risk of SC was observed with RC than with AAG (RR = 2.46; 95%CI = 1.42, 4.27) and in GIC when compared to Resin-Modified Glass Ionomer Cement (RMGIC = 1.79; 95%CI = 1.04, 3.09). Most randomized clinical trials studies showed low or moderate risk of bias. CONCLUSION: There is a difference between bioactive restorative materials for SC control, with GIC being more effective in the permanent teeth and the RMGIC in the deciduous teeth. Bioactive restorative materials can be adjuvants in the control of SC in patients at high risk for caries.

INEQUITIES IN SECONDARY CARE IN ORAL HEALTH FOR SPECIAL NEEDS PATIENTS IN BRAZIL / INIQUIDADES NA ATENÇÃO SECUNDÁRIA EM SAÚDE BUCAL PARA PACIENTES COM NECESSIDADES ESPECIAIS NO BRASIL

This study examined individual and contextual factors that impact the attainment of objectives set by the Ministry of Health for Special Needs Patients Dentistry (OPNE) in Brazilian Centers for Dental Specialties (CEO). Secondary data from DATASUS and the CEO Access and Quality Improvement Program (PMAQ-CEO) were utilized, encompassing 1013 facilities. Statistical analysis employed Poisson regression and multilevel analysis, with a 95% confidence interval (CI). The findings revealed that CEOs, on average, achieved goals for basic OPNE procedures for six months each year. The Municipal Human Development Index (IDHM) and CEO type exerted an influence on goal attainment, with CEO types II and III displaying a greater likelihood of achieving the goals. The Southeast and South regions exhibited lower chances of achieving the objectives. The scarcity of specialized professionals remains a challenge in the treatment of patients with special needs. In conclusion, in Brazil, CEO type and IDHM are associated with improved CEO performance in attaining goals for the OPNE specialty.

Este estudo analisou variáveis individuais e contextuais que influenciam o cumprimento de metas estabelecidas pelo Ministério da Saúde para a Odontologia para Pacientes com Necessidades Especiais (OPNE) em Centros de Especialidades Odontológicas (CEO) brasileiros. Foram utilizados dados secundários do DATASUS e do Programa de Melhoria do Acesso e da Qualidade dos CEO (PMAQ-CEO), referentes a 1013 estabelecimentos. Realizou-se regressão de Poisson e análise multinível, com intervalo de confiança (IC) de 95%. Os resultados indicaram que os CEO alcançaram as metas para procedimentos básicos em OPNE em média seis meses por ano. O Índice de Desenvolvimento Humano Municipal (IDHM) e o tipo de CEO influenciaram o cumprimento das metas, com os CEO tipo II e III tendo mais chances de atingi-las. A escassez de profissionais especialistas ainda é um desafio para o atendimento aos pacientes com necessidades especiais. Conclui-se que, no Brasil, o tipo de CEO e o IDHM estão relacionados ao melhor desempenho dos CEO no cumprimento das metas para a especialidade de OPNE.

Factors related to the waiting time for scheduling an oral biopsy in Brazil: a multilevel analysis.

BACKGROUND: Timely diagnosis of oral cancers is critical, and performing biopsies of oral lesions with suspected malignancy is a crucial step in achieving this goal. The waiting time for the diagnosis may be related to the progression and prognosis of malignant neoplasms. OBJECTIVE: The aim of this observational, cross-sectional, national-level study was to identify the factors associated with the waiting time for scheduling an oral biopsy, based on the identification of its need. METHODS: We used secondary data from the Brazilian public health system, obtained from the 2nd cycle of the National Program to Improve Access and Quality of Dental Specialty Centers (PMAQ-CEO). The study outcome was the waiting time for scheduling an oral biopsy, starting from the identification of the need for the exam. We analyzed individual and contextual variables using multilevel statistical analysis. RESULTS: In 51.8% of DSC the waiting time for scheduling a biopsy was non-immediate; in 58.1% of CEOs, the sum of the weekly workload of dentists working in the Stomatology specialty is up to 20 h per week; in terms of coverage, 67.1% of the CEOs have only municipal coverage and 34.0% are references for up to 12 oral health teams in primary health care; only the coverage variable remained significant in the multivariate model (p < 0.05). Of the contextual variables, none of the variables remained significant (p > 0.05). When these were analyzed together, only the coverage remained significant (p < 0.05); CONCLUSION: Our analysis indicates that the waiting time for scheduling an oral biopsy is longer in CEOs that cover only one municipality and is not related to contextual factors.

Clima de equipe na atenção primária à saúde: uma revisão sistemática da literatura / Team climate in primary health care: a systematic review of the literature / Clima del equipo en la atención primaria de salud: una revisión sistemática de la literatura

Introdução: Avaliar o clima da equipe é fundamental para identificar os desafios que as equipes de saúde enfrentam na implementação dos processos de trabalho interprofissional. Objetivo: O objetivo deste estudo foi determinar qual é o clima da equipe na APS e se há associação entre clima da equipe e a qualidade da assistência oferecida ao usuário. Métodos: Este estudo teve como objetivo realizar uma revisão sistemática da literatura para definir o clima da equipe de atenção primária à saúde e determinar se existe uma associação entre o clima da equipe e a qualidade do cuidado. O protocolo foi registrado sob o número de protocolo CRD 42019133389 no International Prospective Register of Systematic Reviews (PROSPERO). Uma busca de artigos sobre clima de equipe na atenção primária à saúde foi realizada usando qualquer versão do instrumento de inventário de clima de equipe em seis bases de dados. Não houve restrições quanto à data de publicação ou idioma (espanhol, inglês e português). Resultados: Dos 1.106 estudos obtidos após a remoção de duplicatas, 23 foram selecionados para uma leitura completa com base nas avaliações dos resumos. Observou-se que equipes com melhores climas de trabalho alcançaram melhores resultados de saúde. No entanto, por causa da heterogeneidade metodológica entre os estudos, não foi possível determinar um valor médio para o clima da equipe de atenção primária à saúde como proposto inicialmente. Conclusões: O estudo concluiu que, embora existam indícios de uma possível associação positiva entre o clima da equipe e a qualidade da atenção à saúde em ambientes de atenção primária à saúde, ainda não existem estudos suficientes que nos permitam afirmar categoricamente que essa associação existe

Introduction: Evaluating team climate is crucial in identifying challenges that health teams face when implementing interprofessional work processes. Objective: The aim of this study was to determine what the team climate in PHC is and whether there is an association between the team climate factor and the quality of care offered to the user. Methods: This study aimed to conduct a systematic literature review to define primary health care team climate and determine whether an association exists between team climate and healthcare quality. The protocol was registered under protocol number CRD 42019133389 with the International Prospective Register of Systematic Reviews (PROSPERO). A search for articles on team climate in primary health care was conducted using any version of the team climate inventory instrument in six databases. There were no restrictions on the publication date or language (Spanish, English, and Portuguese). Results: Of the 1,106 studies obtained after removing duplicates, 23 were selected for a full reading based on abstract evaluations. It was observed that teams with better work climates achieved better health care outcomes. However, due to methodological heterogeneity between studies, it was not possible to determine an average value for primary health care team climate as initially proposed. Conclusions: The study concluded that, although there are indications of a possible positive association between the team climate and the quality of health care in primary health care settings, there are still not enough studies to allow us to categorically state that this association exists.

Introducción: Evaluar el clima de equipo es fundamental para identificar los desafíos que enfrentan los equipos de salud en la implementación de procesos de trabajo interprofesional. Objetivo: El objetivo de este estudio fue determinar cuál es el clima de equipo en la APS y si existe asociación entre el clima de equipo y la calidad de la atención ofrecida al usuario. Métodos: Este estudio tuvo como objetivo realizar una revisión sistemática de la literatura para definir el clima del equipo de atención primaria de salud y determinar si existe una asociación entre el clima del equipo y la calidad de la atención. El protocolo fue registrado con el número de protocolo CRD 42019133389 en el Registro Prospectivo Internacional de Revisiones Sistemáticas (PROSPERO). Se realizó una búsqueda de artículos sobre clima de equipo en atención primaria de salud utilizando cualquier versión del instrumento de inventario de clima de equipo en seis bases de datos. No hubo restricciones de fecha de publicación ni de idioma (español, inglés y portugués). Resultados: De 1106 estudios recuperados después de eliminar los duplicados, 23 fueron seleccionados para una lectura completa basada en calificaciones de resúmenes. Se observó que los equipos con mejores climas de trabajo lograron mejores resultados de salud. Sin embargo, debido a la heterogeneidad metodológica entre los estudios, no fue posible determinar un valor promedio para el clima del equipo de atención primaria de salud como se planteó inicialmente. Conclusiones: El estudio concluyó que, aunque hay indicios de una posible asociación positiva entre el clima de equipo y la calidad de la atención en salud en los entornos de atención primaria de salud, aún no hay suficientes estudios que permitan afirmar categóricamente que esta asociación existe.

Immunogenicity and safety of inactivated quadrivalent influenza vaccine compared with the trivalent vaccine for influenza infection: an overview of systematic reviews

Influenza infection is a highly preventable transmissible viral disease associated with mild upper respiratory symptoms and more severe conditions such as lethal pneumonia. Studies have shown that a broader spectrum influenza vaccine could reduce influenza’s burden of disease in low- and middle-income countries. A considerable number of systematic reviews reported that quadrivalent influenza vaccines are considered more effective compared to trivalent vaccines, hence, there is a need for an overview in order to synthesize the current evidence pertaining to the comparison between quadrivalent and trivalent inactivated influenza vaccines. Objective: The aim was to summarize the evidence from systematic reviews that investigated the immunogenicity and safety of the Influenza’s inactivated quadrivalent vaccine (QIV) compared to the trivalent vaccine (TIV), in the general population. Methods We searched articles up to December 2022 at: Web of Science, EMBASE, MEDLINE, Cochrane Library, and SCOPUS. The search strategy was conducted following the PICO model. We included systematic reviews comparing the primary outcomes of immunogenicity (seroprotection rate and seroconversion rate) and adverse events using risk ratios. The AMSTAR 2 and ROBIS were used for quality assessments, and GRADE was used for evidence certainty assessments. Findings We included five systematic reviews, totalling 47,740 participants. The Quadrivalent Inactivated Influenza Vaccine (QIV) exhibited enhanced immunogenicity in the context of B-lineage mismatch when compared to the Trivalent Inactivated Influenza Vaccine (TIV). While the safety profile of QIV was found to be comparable to that of TIV, the QIV showed a higher incidence of solicited local pain among children and adolescents, as well as an increased frequency of local adverse events within the adult population. Conclusion Our findings suggest that the QIV provides a superior immunogenicity response compared to the TIV in all age groups evaluated, especially when a lineage mismatch occurred. The safety of QIV was considered similar to the TIV, with no serious or systemic solicited or unsolicited adverse events; tough pain at the injection site was greater for QIV. We recommend caution owing to the high risk of bias in the selection process and no protocol registration.

Economic analysis of the different endodontic instrumentation techniques used in the Unified Health System.

BACKGROUND: To assess the financial impact of incorporating a new (reciprocal) technology into endodontic treatments in the public health system (SUS). METHODS: This was a economic evaluation study (comparing the 3 different endodontic instrumentation techniques-manual, rotary and reciprocating), allocative efficiency analysis to optimize existing resources in the SUS, and financial contribution impact analysis of incorporation of a new technology. Thirty-one (31) 12 years-old volunteers were evaluated. RESULTS: The incremental cost-effectiveness ratio (ICER) was calculated at R$1.34/min, - R$0.60/min and BRL 0.10/min for the single-rooted, bi-rooted and tri-rooted teeth, respectively, when the rotary technique was compared with the manual type. In turn, the ICER was R$ 21.04/min, - R$ 0.73/min and - R$ 2.81/min for the 3 types of teeth, respectively, when the reciprocating technique was compared with the manual type. The incremental financial impact of replacing manual endodontic with rotary endodontic treatments would be - R$ 2060963.66 in the case of single-rooted teeth, but the number of treatments would also be reduced (- 19,379). In the case of two-rooted teeth, the incremental financial impact would be BRL 34921540.62 with the possibility of performing an additional 204,110 treatments. In turn, BRL 11523561.50 represented the incremental financial impact for teeth with 3 or more roots and with an increase of 72,545 procedures. When we analyzed the incremental financial impact of replacing manual endodontic with reciprocating endodontic treatments, it would be - R$ 730227.80 in the case of single-rooted teeth, allowing for an additional 2538 treatments. In turn, R$ 21674853.00 represented the incremental financial impact for bi-radicular teeth, with an increase of 121,700 procedures. In the case of two-rooted teeth, the incremental financial impact would be BRL 13591742.90 with the possibility of performing an additional 40,670 treatments. CONCLUSIONS: The reciprocating technique could improve access to endodontic treatment in the SUS as it allowed a simultaneous reduction in clinical time and associated costs. However, the higher number of endodontic treatments performed would have a financial impact.

Characteristics and in-hospital morbidity trends associated with oral and oropharyngeal cancers in Brazil.

BACKGROUND: Brazil experienced an expansion of the population's access to oral health policies after the creation of the Unified Health System (SUS, Sistema Único de Saúde). Through public policies, the consolidation of Primary Health Care (PHC) and the incorporation of dental care into primary and hospital care took place. The objective of this study was to identify epidemiological aspects, including the temporal trend, of hospital morbidity from oral and oropharyngeal cancer in Brazil, considering hospitalizations for this neoplasm in a hospital network linked to the public care system. METHODS: Observational study based on information on hospital admissions for oral cancer throughout Brazil. The research used data from the Brazilian Cancer Registry Information System. For the temporal series analysis, generalized linear regression model was used with the Prais-Winsten method. RESULTS: Of the 121,971 patients hospitalized with oral and oropharyngeal cancers, 76.40% were male and 23.60% were female, resulting in a M:F ratio of 3.24:1. Regarding the anatomical region of involvement among hospitalized patients with oral cavity neoplastic lesions, there was a predominance in non-specific places in the mouth, such as the floor of the mouth, soft and hard palate, among others (32.68%), followed by lesions in the region of tongue (28.89%). In this population, the predominant age group was between the fifth decade (31.09%) and sixth decade of life (24.99%); men presented neoplastic lesions of oral and oropharyngeal cancers at an earlier age than women. In all regions of the country, the staging of cases diagnosed in the tertiary health network accredited to the José Alencar Gomes da Silva National Cancer Institute (INCA) was late, with higher tendency for metastasis. The temporal trend of the adjusted in-hospital morbidity rates showed to be increasing in the Northeast, South and Midwest regions for the male gender. For females, they were increasing in the Northeast and South regions. CONCLUSIONS: It is concluded that the distribution of in-hospital morbidity rates of oral and oropharyngeal cancers in the country is irregular. There is a greater number of cases identified by the study in male patients and in the Southeast and South regions; with an increasing tendency of this coefficient in both genders.

Space-time risk cluster and time trends of congenital syphilis in Brazil: an ecological study.

BACKGROUND: Congenital syphilis (CS) is a problem of great concern for public health, especially in Brazil. The aim of this study was to analyse the time trends and the space-time dynamics of morbidity and mortality from CS in Brazil. METHODS: An ecological and time series study, which included all cases and deaths from CS recorded in a national Brazilian database from 2013 to 2019 was performed. Time trends in CS incidence and mortality were assessed using segmented linear regression. Univariate global and local Moran indices and space-time scan statistics were used in the space and space-time analyses. RESULTS: A total of 183 171 cases and 2401 deaths from CS were recorded in Brazil, with the highest number of cases being observed in the Southeast Region (n=82 612 [45.1%]). Only 21.1% of pregnant mothers with syphilis received adequate treatment. There was an upward trend in CS rates among mothers ages 20-29 y (average annual percent change [AAPC] 1.4 [95% confidence interval {CI} 1.0 to 1.7]) and with <8 y of schooling (AAPC 6.6 [95% CI 5.3 to 7.9]). The primary space-time cluster involved 338 municipalities in the Southeast Region (relative risk 3.06, p<0.001) and occurred between 2017 and 2019. CONCLUSIONS: To reduce the trends in CS rates, it is necessary to develop actions to improve the quality of prenatal care and expand early diagnosis and adequate treatment of syphilis in pregnant women and their sexual partners, especially in groups with upward trends (mothers ages 20-29 y and <8 y of schooling) and living in higher-risk regions (Southeast, North and Northeast).

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.

Mask decontamination methods (model N95) for respiratory protection: a rapid review.

BACKGROUND: N95 respiratory protection masks are used by healthcare professionals to prevent contamination from infectious microorganisms transmitted by droplets or aerosols. METHODS: We conducted a rapid review of the literature analyzing the effectiveness of decontamination methods for mask reuse. The database searches were carried out up to September 2020. The systematic review was conducted in a way which simplified the stages of a complete systematic review, due to the worldwide necessity for reliable fast evidences on this matter. RESULTS: A total of 563 articles were retrieved of which 48 laboratory-based studies were selected. Fifteen decontamination methods were included in the studies. A total of 19 laboratory studies used hydrogen peroxide, 21 studies used ultraviolet germicidal irradiation, 4 studies used ethylene oxide, 11 studies used dry heat, 9 studies used moist heat, 5 studies used ethanol, two studies used isopropanol solution, 11 studies used microwave oven, 10 studies used sodium hypochlorite, 7 studies used autoclave, 3 studies used an electric rice cooker, 1 study used cleaning wipes, 1 study used bar soap, 1 study used water, 1 study used multi-purpose high-level disinfection cabinet, and another 1 study used chlorine dioxide. Five methods that are promising are as follows: hydrogen peroxide vapor, ultraviolet irradiation, dry heat, wet heat/pasteurization, and microwave ovens. CONCLUSIONS: We have presented the best available evidence on mask decontamination; nevertheless, its applicability is limited due to few studies on the topic and the lack of studies on real environments.

Overdentures as an alternative to conventional dentures: a micro-costing analysis for Public Health Service in Brazil.

This study aimed to estimate cost and compatibility with public financial incentives of two technologies for treating the edentulous mandible: lower complete dentures (CD) and overdentures retained by two dental implants (OD). This study consisted of a partial economic evaluation, with a micro-costing bottom-up approach for the calculation of direct costs. The estimates involved the number of consultations, proportion of materials, equipment, instruments' lifetime, and human resources, described in the price panel website of the Ministry of Economy in Brazil. Complementary information was obtained from a panel of experts. A sensitivity analysis was based on 20% variation. The estimated cost of a CD was R$ 189.89 (base scenario), and this varied between R$ 151.91 and R$ 227.89 according to sensibility analysis. The cost of an OD was R$ 663.05 (ranging from R$ 795.66 to R$ 530.44 - 1US=R$ 3.80/July 2019). The Ministry of Health covers appropriately the costs of the CD and OD. Both technologies showed costs that are within the limits of financial public incentives obtained by municipalities. The technologies are economically viable and should be induced through public policies due to their positive impacts on several functional domains of health.

Overdentures as an alternative to conventional dentures: a micro-costing analysis for Public Health Service in Brazil / Overdentures como alternativa às próteses convencionais: uma análise de micro-custeio para o Sistema Único de Saúde

Abstract This study aimed to estimate cost and compatibility with public financial incentives of two technologies for treating the edentulous mandible: lower complete dentures (CD) and overdentures retained by two dental implants (OD). This study consisted of a partial economic evaluation, with a micro-costing bottom-up approach for the calculation of direct costs. The estimates involved the number of consultations, proportion of materials, equipment, instruments' lifetime, and human resources, described in the price panel website of the Ministry of Economy in Brazil. Complementary information was obtained from a panel of experts. A sensitivity analysis was based on 20% variation. The estimated cost of a CD was R$ 189.89 (base scenario), and this varied between R$ 151.91 and R$ 227.89 according to sensibility analysis. The cost of an OD was R$ 663.05 (ranging from R$ 795.66 to R$ 530.44 - 1US=R$ 3.80/July 2019). The Ministry of Health covers appropriately the costs of the CD and OD. Both technologies showed costs that are within the limits of financial public incentives obtained by municipalities. The technologies are economically viable and should be induced through public policies due to their positive impacts on several functional domains of health.

Resumo Estimar os custos e a compatibilidade dos incentivos públicos de duas tecnologias para o tratamento da mandíbula edêntula: prótese total convencional (PTC) e overdenture retida por dois implantes (OD). Este estudo consistiu em uma avaliação econômica parcial, com abordagem "bottom-up" para o cálculo dos custos diretos. As estimativas levaram em consideração o número de consultas, proporção de materiais, equipamentos, vida útil dos instrumentais e recursos humanos. Os custos foram baseados no painel de preços do Ministério da Economia do Brasil e informações complementares foram obtidas de um painel de especialistas. Uma análise de sensibilidade foi baseada na variação de 20% dos custos. Os custos da PTC foram estimados em R$ 189,89 (cenário base) com variação entre R$ 151,91 e R$ 227,89 na análise de sensibilidade. Os custos da OD foram R$ 663,05 (variando de R$ 795,66 a R$ 530,44). O Ministério da Saúde cobre apropriadamente os custos de ambas as tecnologias nos cenários base e mais otimista. Ambas as tecnologias apresentaram custos dentro dos limites dos incentivos públicos recebidos. As tecnologias são economicamente viáveis e devem ser induzidas por políticas públicas diante do impacto positivo em vários domínios funcionais da saúde.

Terapia a laser de baixa potência no tratamento de lesões periféricas do nervo trigêmio em odontologia: revisão de literatura / Low level laser therapy in the treatment of peripheral injuries of trigeminal nerve in dentistry: literature review / Terapia por láser de bajo nivel en el tratamiento de las lesiones periféricas del nervio trigémino en odontología: revisión de la literatura

A parestesia é um distúrbio neurossensorial decorrente de lesão nervosa que ocorre após uma intervenção odontológica e leva à perda de sensibilidade prolongada de uma região específica da face, além de outros sintomas, podendo ser resolvida espontaneamente após alguns dias ou meses, mas dependendo da extensão e tipo de lesão nervosa, este dano pode ser permanente. Com o avanço da tecnologia, os lasers vêm se popularizando na Odontologia, juntamente com os avanços em pesquisas. A terapia de fotobiomodulação com laser de baixa potência tem se mostrado como uma opção favorável ao tratamento de distúrbios neurossensoriais e aceleração do processo de reparo tecidual. Foi realizada uma revisão da literatura, a partir de buscas nas bases de dados do PubMed/MEDLINE, Biblioteca Virtual em Saúde (BVS), The Cochrane Librarye Scielo, entre os anos de 2010 a 2020. O presente estudo tem como objetivo analisar a eficácia, a utilização terapêutica, e os mecanismos de ação da terapia a laser de baixa potência (LLLT), como também causas e fatores de risco relacionados aos procedimentos mais comuns de injúria nervosa. As recentes pesquisas envolvendo o uso da terapia de fotobiomodulação evidenciam a capacidade do laser em promover aceleração do processo de reparo tecidual, com fenômenos analgésicos, anti-inflamatórios, cicatrizantes e regenerativos. Embora tenha havido grandes descobertas nos últimos anos, a literatura ainda carece de protocolos e ensaios clínicos sobre o uso do laser, verificando e comprovando seus efeitos sobre lesões nervosas, devendo este ser o foco de pesquisas futuras(AU)

Paresthesiais a neurosensory disorder resulting from nerve damage that occurs after a dental intervention and leads to prolonged loss of sensation in a specific region of the face, in addition to other symptoms, which can be resolved spontaneously after a few days or months, but depending on the extension and type of nerve damage, this damage can be permanent. With the advancement of technology, lasers have become popular in dentistry, along with advances in research. The photobiomodulation therapy with low level laser has been shown to be a favorable option for the treatment of neurosensory disorders and acceleration of the tissue repair process. A literature review was carried out, based on searches in the databases of PubMed / MEDLINE, Virtual Health Library (VHL),The Cochrane Library and Scielo, between 2010 and 2020. The present study aims to analyze the effect, therapeutic use, and the mechanisms of action of low level laser therapy (LLLT), as well ascauses and factors related to the most common nerve injury procedures. Recent research involving the use of photobiomodulation therapy shows the laser's ability to accelerate the tissue repair process, with analgesic, anti-inflammatory, healing and regenerative phenomena. Although there have been major discoveries in the years, the literature still lacks protocols and clinical trials on the use of lasers, verifying and proving their effects on nerve injuries, which should be the focus of future research(AU)

La parestesia es un trastorno neurosensorial resultante del daño de los nervios que se produce tras una intervención dental yconduce a una pérdida prolongada de la sensibilidad en una región específica del rostro, además de otros síntomas, que pueden resolverse espontáneamente a los pocos días o meses, pero que se prolongan en extensión y tipo de daño nervioso, este daño puede ser permanente. Con el avance de la tecnología, los láseres aprenden a hacerse populares en odontología, junto con los avances en la investigación. Una terapia de fotobiomodulación con láser de baja potencia tiene que ser una opción favorable para el tratamiento de los trastornos neurosensoriales y la aceleración del proceso de reparación tisular. Se realizó una revisión bibliográfica, a partir de búsquedas en las bases de datos de PubMed / MEDLINE, Virtual Health Library (BVS), The Cochrane Library y Scielo, entre 2010 y 2020. El presente estudio tiene como objetivo analizar la efecto, uso terapéutico y los mecanismos de acción de la terapia con láser de baja potencia (LLLT), así como las causas y factores relacionados con los procedimientos de lesión nerviosa más comunes. Investigaciones recientes que involucran el uso de terapia de fotobiomodulación muestran la capacidad del láser para acelerar el proceso de reparación de tejidos, con fenómenos analgésicos, antiinflamatorios, cicatrizantes y regenerativos. Aunque ha habido grandes descubrimientos a lo largo de los años, la literatura aún carece de protocolos y ensayos clínicos sobre el uso de láseres, verificando y demostrando sus efectos sobre las lesiones nerviosas, que deberían ser el foco de futuras investigaciones(AU)