Factors associated with the absence of Brazilians in specialized dental centers.

AIM: To identify the individual and contextual factors associated with the absence of Brazilians at a scheduled appointment in Dental Specialties Centers (DSC). METHODS: This cross-sectional design uses the National Program for Improving Access and Quality of Dental Specialties Centers database, 2018. The outcome was the users' lack of at least one of the scheduled appointments. Contextual and individual independent variables were used, considering Andersen's behavioural model. The analyses were performed with the R Core Team and SAS (Studio 3.8, Institute Inc, North Carolina, U.S, 2019) programs. RESULTS: Of the 10,391 patients interviewed, 27.7% missed at least one of the consultations. In the adjusted multivariate model, the interpretation based on the effect size and 95% CI showed that the behaviour individual predisposing factors such as age ≤ 42 years (OR = 1.10; 95%CI:1.01-1.21), individual need factors such as participation in the "Bolsa Família" program (OR = 1,14; 95%CI:1.02-1.27), not being covered by the Family Health Strategy (OR = 1.15; 95% CI:1.02-1.30), and users of periodontics services (OR = 1.22;95%CI:1.05-1.40) were associated with absences. The behavioural factor associated with the outcome was that the DSC facilities were not in good condition (OR = 1.18; 95%CI:1.03-1.34). DSC located in the capital (OR = 1.12; 95% CI: 0.92-1.48) were 12% more likely to have dental absences than those in the interior region. CONCLUSION: There are individual and contextual barriers associated with patients not attending specialised public dental consultations. DSC should offer adequate hours to patients, especially young adults and vulnerable people.

Sociodemographic, Behavioral and Oral Health Factors in Maternal and Child Health: An Interventional and Associative Study from the Network Perspective.

Oral healthcare during pregnancy needs to be part of the assistance routine given to pregnant women by health professionals as a way to encourage self-care and strengthen the general health of the mother and the baby. The aim of this study was to evaluate the effectiveness of an integrated oral healthcare intervention for pregnant women and to analyze the association of sociodemographic, behavioral, oral health and general maternal and child health factors in prenatal care at usual risk in primary care in a city in the northeast of Brazil, in 2018-2019. A controlled, randomized, single-blinded community trial was conducted. The intervention group (IG) received dental assistance and collective health education actions in conversation circles, while the control group (CG) received the usual assistance. All pregnant women (146 in total, 58 from IG and 88 from CG) that took part in the trial answered a questionnaire and underwent a dental examination at the beginning of prenatal care and at the puerperal visit. To assess the effect of the intervention, a network analysis was used. The results have shown that being in the control group was associated with neonatal complications (0.89) and prematurity (0.54); the use of tobacco and alcohol are associated with high risk in initial and final oral health; lower educational level of the pregnant women implicates high risk for initial oral health (-0.19), final oral health (-0.26), pregnancy complications (-0.13), low birth weight (-0.23), prematurity (-0.19) and complications in the newborn (-0.14). Having a low family income (≤261.36 USD) has shown a high risk for initial oral health (-0.14), final oral health (-0.20) and prematurity (-0.15). The intervention based on integrated oral healthcare for pregnant women indicated that socioeconomic and behavioral factors must be considered as determinants for the quality of women and children's health and that multi-professional performance during prenatal care contributes to the positive outcomes of pregnancy.

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

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

Increase in dental caries and change in the socioeconomic profile of families in a child cohort of the primary health care in Northeast Brazil.

BACKGROUND: Factors associated with increases in dental caries and changes in the family socioeconomic profile were investigated in a paediatric primary health care (PHC) cohort in Northeast Brazil during the implementation of social and income transfer programmes. METHOD: A prospective analytical study compared data from two surveys on caries in primary dentition conducted in 2006 (age: 18-36 months, n = 1045) and 2010 (age: 5-7 years). Data from the sample recruited and re-examined in 2010 (n = 469) were analysed. Prevalences (P) and the mean primary decayed, missing and filled teeth (dmft) index, cumulative incidence and mean increase were calculated. Differences (p ≤ 0.05 and 95% CI) in dmft ≥1 were identified via McNemar's test. Differences in the mean dmft were evaluated according to socioeconomic variables (Kruskal-Wallis test and p ≤ 0.05). Multivariate analysis with a negative binomial model was used for the risk factors associated with increasing dmft. In the univariate analyses, nonparametric methods (Kruskal-Wallis test) were used to compare subsamples. Variables with p ≤ 0.20 were included in the multivariate model and retained when p ≤ 0.05. RESULTS: The prevalence and mean dmft (18-36 months and 5-7 years: p = 28.6 and 68.9%, mean = 1.01 and 3.46, respectively) and variation in mean dmft changed significantly (p < 0.005) with the education level and occupation of the mother; the prevalence and mean dmft were lower for higher maternal education level and maternal participation in the labour market. The cumulative incidence and mean increase in dmft were 8.71% and 2.45, respectively. Common risk predictors for increases in caries were consumption of sweets (RR = 1.53, 95% CI 1.09-2.14) and attendance at public schools (RR = 1.49, 95% CI: 1.81-1.89). Use of private clinical services was a protective factor (RR = 0.68, 95% CI 0.54-0.87). CONCLUSION: Increases in caries were observed despite positive changes in the distribution of socioeconomic indicators for the analysed children's families. The risk factors identified for the increase in caries suggest ongoing problems regarding the effectiveness of intersectoral and health measures for controlling caries in populations exposed to PHC programmes.

Clustering of oral and general health risk behaviors among adolescents.

Since the co-occurrence of several health-risk behaviors is associated with an increase in chronic diseases, the study of clustering is relevant. The aim of this study was to evaluate how seven types of general and oral health-risk behaviors, cluster among adolescents. A cross-sectional analysis was performed with a sample of high school students from state public schools in São Lourenco da Mata, State of Pernambuco, Brazil (n = 1154). Data were obtained using a self-reported questionnaire. To identify cluster solutions of seven general and oral health-risk behaviors, Hierarchical Agglomerative Cluster Analysis (HACA) was performed. Most of the adolescents participating in the study was female (54.3%) and aged <16 years old (77.1%). HACA indicated two broad stable clusters for the seven health-risk types of behaviors. The first cluster included following behaviors: smoking, drinking and less frequent tooth brushing. The second cluster reveals the combination of high bread, pasta and snack intake; high intake of sweets; high intake of soft drinks; low intake of fruits and vegetables. Results provided by HACA identified two groups of health-risk behaviors. The first cluster mainly shows risk (problematic) behaviors, whereas the second cluster denotes the non-adhesion of preventive behavior (non-healthy diet). Health-compromising behaviors are common among teens and occur in distinct clusters. These findings could be used by schools, health promotion authorities and other stakeholders to design and implement tailored preventive interventions in Pernambuco, Brazil. Therefore, clustering of several types of behavior has important implications for a comprehensive strategy in health promotion policies and practices.

Evaluation of Specialized Oral Health Procedures Performed in Brazil in the Period from 2008 to 2012

Objective: To analyze the correlations between the production of specialized dental procedures from 2008 to 2012 and factors related to the services and context of the Brazilian states. Material and Methods: A quantitative ecological-type study was developed, in which secondary data from Brazilian national databases were used. Procedures for outpatient production of specialized procedures throughout Brazil, from 2008 to 2012, were consolidated from the offering state, the state of the federation being the analysis unit. In order to collect data on coverage by oral health family teams in the Family Health Strategy, as well as the number of CEOs per state, the Strategic Support Management Room (SAGE) was accessed. The corresponding indicator mean proportion of specialized procedures in Brazil (Pmb) was used as dependent variable. Correlations were tested using Spearman's test. The software was Statistical Package for Social Sciences, v. 17.0, with a level of significance of 5%. Results: Pmb was 4.9% for the evaluated period. There was a negative correlation between indicator and the coverage of oral health teams in the family health strategy. Conclusion: The correlations analyzed were influenced by the organization and distribution of the professionals' workforce; revealing that the non-organization of the health care network may increase the performance of specialized procedures resulting from spontaneous demand due to the poor basic care coverage.

Need of Dental Prosthesis in Older People and the Offer of Specialized Care in the Unified Health System, Brazil

Objective: To analyze the offer of dental prosthesis by Centers of Dental Specialties (CEO) considering the need by individuals aged 65-74 years in state capitals and other regions of the country. Material and Methods: The study was conducted with data from the external evaluation of the Improving Access and Quality Program (AVE/PMAQ CEO) and with data from the SBBRASIL 2010 project. AVE / PMAQ CEO is an evaluative investigation using a cross-sectional research design, performed in all CEOs of Brazil, totaling 932 services evaluated. The analysis of data and distribution of CEOs that offered dental prosthesis was described by maps, using TabWin (DATASUS) and quantitative description of the following variables: need for total and partial dentures, CEO, Regional Prosthodontic Laboratories (RLDP), average monthly number of delivered prostheses and the proportion of capitals with RLDP, number of CEOs, RLDP and prostheses delivered per 100,000 inhabitants in state capitals and other regions. Results: Of the 5,570 municipalities in the country, 780 have CEO, mainly located on municipalities with larger populations. Most CEOs were located in the northeastern (38.3%) and southeastern regions of Brazil (36.2%) with the northern and mid-western regions presenting the lowest absolute number of units. Low offer of prostheses was observed, considering the high need of dentures, as well as an unequal distribution among Brazilian regions. A high percentage of older adults aged 65-74 years require total (74.6%) or partial (99.8%) prosthetic rehabilitation, more critical situation is observed in the northern and northeastern regions. Conclusion: The provision of dental services in CEOs is still limited and unevenly distributed, especially for PPR, compromising the universality and integrality of oral health care.

Clinical Analysis of Management Aspects of Centers for Dental Specialties

Objective: To evaluate the different management aspects of Centers for Dental Specialties (CEO) in Brazil. Material and Methods: Quantitative study with analysis of secondary data. The results of external evaluation of the first PMAQ-CEO cycle were considered, especially those related to planning and self-assessment, demand organization, work process, human resources as well as the availability of supplies/materials/dental equipment. The selected data were analyzed based on the calculation of proportions using the Microsoft Office Excel and Statistical Package for the Social Sciences (SPSS) programs. Results: The planning of actions in CEOs is conducted in nearly 80% of units, with the participation of dental surgeons, receiving support, mainly, from the local dental health or state public manager. The access to CEO is given, mostly, in a referenced or mixed (referenced and spontaneous) form. Only 49% of CEOs offer permanent education actions for workers. The work management process has been guided by quality standards of PMAQ-CEO for 77% of managers. Conclusion: The study allowed perceiving the presence of an often shared management, on the CEO organization, on self-evaluation process, planning, demand organization and work process, as well as human resources and infrastructure, showing conformity with the Oral Health National Policy guidelines. However, the results show that some problems with regard to the evaluation as work routine and management of access to CEOs still persist, pointing to the need for further studies and effort of managers to overcome them.

A Web-Based Tool for Monitoring and Evaluating Health Care Services: An Analysis of Centers for Dental Specialties Webpage

Objective: To evaluate the quality of Centers for Dental Specialties (CEO) using an electronic tool - the CEO webpage. Material and Methods: Evaluative research was carried out through the use of a web-based tool, which has two modules with forms for the evaluation of quality of CEO components to Managers and Professionals. The tool generates classification scores and recommendation letters according to the score obtained. Satisfactory classification was used for scores equal to or above 7.0 and unsatisfactory for scores lower than 7.0. Representatives of manager and professionals of CEOs who attended the invitation of the research were qualified to use the CEO webpage. Portal data were analyzed in a descriptive way and the average scores were tested according to service and context variables. Results: Thirty-eight health facilities were evaluated. The average score for CEOs was rated as satisfactory for both the Manager and Professional modules. However, when quality components were evaluated, there was higher concentration of unsatisfactory scores to those related to the work process, particularly to the quality components of Personnel Management; Social control and Financing; and, Organizational Criteria. Conclusion: The CEO webpage, for instantly generating evaluation and recommendations for change, is easy to handle and lacks minimal technological resources (computer with access to the internet network), has become a tool for information management that allows immediate decision making. In addition, they can make a major contribution to planning / management support in identifying critical aspects of the service that impair quality, with strong potential to serve as supplementary institutional support to PMAQ / CEO. Initiatives such as the CEO webpage should be encouraged and disseminated for use within Unified Health System.

Theoretical and Methodological Aspects of the External Evaluation of the Improvement, Access and Quality of Centers for Dental Specialties Program

Objective: To introduce the main theoretical and methodological aspects of the external evaluation of the 1st cycle National Program for Quality Evaluation (AEPMAQ/ CEO). Material and Methods: This is an evaluative and quantitative research carried out in all Centers for Dental Specialties - CEO of Brazil, and macro-geographical regions were taken into account for analysis. The general AE-PMAQ/CEO coordination was from the Collaborative Centre for Oral Health Surveillance of the Ministry of Health - Federal University of Pernambuco and Department for Primary Health Care of the Ministry of Health. A collaborative network was established to offer a scientific and technical support for the Project among different higher education institutions around the country, state oral health coordination and quality researchers of AE-PMAQ/CEO. Data collection was carried out through interviews with managers, dentists and users. In addition, researchers used an observation template to check for infrastructure and a questionnaire to register previously discussed quality standards. Conclusion: The external evaluation of the 1st cycle National Program for Quality Evaluation offered data to demonstrate and give recognition to CEO services and municipalities' managers to assure quality for specialized dental care.

The Regulation of Services in Secondary Oral Health Care in Brazil

Objective: To analyze the regulation of access to Centers for Dental Specialties (CEO) in the 1st cycle of Program for Improving Access and Quality of Centers for Dental Specialties (PMAQ-CEO), specifically the waiting time for the first consultation in association with socioeconomic and demographic factors of users and the characteristics of services. Material and Methods: The quantitative database of the 1st cycle PMAQCEO external evaluation was used, with question directed to the CEO user (Module III - 3.1 and 3.2), which sought to identify user characteristics and access to CEO. To obtain data, a field phase was carried out between months of February to June 2014 in 930 CEOs in all Brazilian states. Results: Users who obtained the first appointment within thirty days of waiting were those who had family incomes above 10 minimum wages; which showed higher schooling; appointment scheduling by telephone made directly to the CEO; and that the consultation was accomplished by "squeeze in" option. Conclusion: It was observed that aspects related to schooling, family income and primary health care coverage influence the waiting time to obtain the first consultation in CEO. There were several ways of referencing of users, and those who performed better were those who shared accountability for the appointments between service and user.

The Interface between Primary Care and Emergency Dental Services (SOU) in the SUS: the interface between levels of care in oral health.

Considering that emergency dental services include the referral network and the counter-referral network, interacting at the intersection between primary, secondary and tertiary healthcare, this study aims to describe the interface between primary healthcare (APS - Atenção Primária a Saúde), particularly of the Family Health Strategy, and secondary care in oral health, using the Emergency Dental Services (SOU), in the municipality of Recife. It is a qualitative, exploratory and descriptive case study. The data was collected through semi-structured interviews. Classical ALCESTE analysis was used based on the Descending Hierarchical Classification Dendrogram, making it possible to understand the expressions and each one of the words spoken by the dental health professionals, analyzing them using their social places and contexts as a starting point. What we found was only a fragile degree of integration, and little capacity for solution, between the levels of care - a partially disconnected network. Undoubtedly the problems with the interface between primary care and the emergency services in oral health are multiple and complex. The individual solutions have low efficacy, and are complex in their operation.

Validation of the multimedia version of the RDC/TMD axis II questionnaire in Portuguese.

OBJECTIVE: The aim of the study was to validate the multimedia version of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis II Questionnaire in Portuguese language. MATERIAL AND METHODS: The sample comprised 30 patients with signs and symptoms of temporomandibular disorders (TMD), evaluated at the Orofacial Pain Control Center of the Dental School of the University of Pernambuco, Brazil, between April and June 2006. Data collection was performed using the following instruments: Simplified Anamnestic Index (SAI) and RDC/TMD Axis II written version and multimedia version. The validation process consisted of analyzing the internal consistency of the scales. Concurrent and convergent validity were evaluated by the Spearman's rank correlation. In addition, test and analysis of reproducibility by the Kappa weighted statistical test and Spearman's rank correlation test were performed. RESULTS: The multimedia version of the RDC/TMD Axis II questionnaire in Portuguese was considered consistent (Crombrach alpha = 0.94), reproducible (Spearman 0.670 to 0.913, p<0.01) and valid (p<0.01). CONCLUSION: The questionnaire showed valid and reproducible results, and represents an instrument of practical application in epidemiological studies of TMD in the Brazilian population.

[Factors associated with self-medication for toothache: analysis using pharmacy personnel in the city of Recife, PE]. / Fatores associados à automedicação em dor de dente: análise a partir dos profissionais dos estabelecimentos farmacêuticos da cidade do Recife, PE.

This paper aims to describe the factors associated with self-medication related to toothache in the city of Recife, Pernambuco, Brazil. The investigation was designed as a cross-sectional study. The sample was random selected among the pharmacies registered in the Regional Pharmacy Council of Pernambuco and distributed over the Health Districts. The level of knowledge of the pharmacy personnel about self-medication related to toothache was analyzed. One hundred and seventy nine professionals from 120 establishments were interviewed. The data were collected by means of a questionnaire. According to the results, 67.0% of the interviewees had attended individuals relating orofacial pain in the last six months, among them 91.6% relating toothache; 83.7% male and 73.3% female personnel had indicated medications for toothache without prescription; personnel with high-school level indicated more medications without prescription (48.6%) The study concludes that to buy pain relievers without prescription including for toothache is common and reinforces the need of informing the population about the correct use of these medicaments.

Validation of the Portuguese version of the RDC/TMD Axis II questionnaire.

The present paper aimed at evaluating the validity of the Portuguese version of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis II Questionnaire. The sample was comprised of 155 patients with signs and symptoms of Temporomandibular Disorders (TMD), evaluated at the Orofacial Pain Control Center, School of Dentistry, University of Pernambuco, Brazil, between July 2003 and February 2004. Data collection was performed with the following tools: the RDC/TMD Axis I (clinical evaluation and TMD classification), and Axis II (psychosocial evaluation), as well as specific questionnaires for evaluation of Oral Health Related Quality of Life, namely, Oral Impacts on Daily Performances and the Oral Health Impact Profile-14, considered to be gold standard criteria. Validity evaluation consisted of internal consistency evaluation by the Cronbach alfa reliability test, reliability and reproducibility estimated by the Kappa test and the Spearman's correlation, and concurring validation through Spearman's correlation. The Portuguese version of the RDC/TMD Axis II questionnaire was considered consistent (Cronbach alfa = 0.72), reproducible (Kappa values from 0.73 to 0.91, p < 0.01), and valid (p < 0.01). It was concluded that this version showed valid and reproducible results for the Brazilian population, thus paving the way for including Brazil in transcultural epidemiological studies on TMD.