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1.
BMC Oral Health ; 22(1): 344, 2022 08 11.
Artigo em Inglês | MEDLINE | ID: mdl-35953805

RESUMO

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.


Assuntos
Preparo de Canal Radicular , Raiz Dentária , Criança , Análise Custo-Benefício , Humanos
2.
Rev. bras. med. fam. comunidade ; 17(44): 2510, 20220304. graf, tab
Artigo em Português | LILACS, Coleciona SUS | ID: biblio-1379863

RESUMO

Introdução: Do ponto de vista da saúde pública, a população masculina adulta mostra-se vulnerável ao uso de álcool e as suas consequências. A detecção precoce, assim como a busca por fatores associados são necessárias e as unidades de Saúde da Família são importantes locais para esta abordagem. Objetivo: Este estudo teve como objetivo identificar o uso de álcool em homens adultos e verificar sua associação com fatores socioeconômicos, demográficos e transtornos mentais (episódio depressivo maior e transtorno de ansiedade generalizada). Métodos: Foi realizado um estudo transversal em adultos de 20 a 59 anos do município de Piracicaba, cadastrados nas Unidades de Saúde da Família (USF) no ano 2018. Após análises descritivas, as variáveis com p<0,20 nas análises simples foram estudas em modelos de regressão binomial negativa múltipla. Pelo modelo final, estimaram-se as razões de médias ajustadas com os intervalos de 95% de confiança. Resultados: Observou-se prevalência de 26,9% de consumo de álcool na população estudada. O escore do The Alcohol Use Disorders Identification Test (AUDIT) apresentou relação direta com a idade (razões de médias ­ RM=1,02; intervalo de confiança ­ IC95% 0,99­1,03). Quanto à religião, protestantes e evangélicos apresentaram escore médio de AUDIT menor que os demais (RM=1,78; IC95% 1,14­2,79). Pessoas com transtorno mental apresentam escore médio de AUDIT maior que os sem transtorno (RM=2,30; IC95% 1,28­4,11). Conclusões: Concluímos que o consumo de álcool na população adulta masculina é bastante prevalente, que seu consumo aumenta com a idade, que a religião tem efeito protetor e que pessoas com depressão e ansiedade apresentam maior propensão ao uso. Com base nesses dados, destacamos a importância da USF no desenvolvimento de estratégias que rastreiem as condições de risco de sua população, bem como discutam abordagens e possíveis intervenções.


Introduction: From the point of view of public health, the adult male population is vulnerable to alcohol use and its consequences. Early detection and the search for associated factors are necessary, and the Family Health Units are important places for this approach. Objective: This study aimed to identify the use of alcohol in adult men and to verify its association with socioeconomic and demographic factors and mental disorders (major depressive episode and generalized anxiety disorder). Methods: A cross-sectional analytical study was carried out on adults aged 20 to 59 years in the city of Piracicaba, Brazil, registered in Family Health Units in the year 2018. After descriptive analyses, variables with p<0.20 in simple analyses were studied in multiple negative binomial regression models. According to the final model, the adjusted ratios of means were estimated with 95% confidence intervals. Results: There was a high prevalence of alcohol consumption (26.9%) in the study population. Alcohol Use Disorders Identification Test (AUDIT) score increased with age (ratios of means ­ RoM=1.02; confidence interval ­ 95%CI 0.99­1.03). Concerning religion, Protestants and Evangelicals had an average AUDIT score lower than other religions (RoM=1.78; 95%CI 1.14­2.79). People with mental disorders have an average AUDIT score higher than those without disorders (RoM=2.30; 95%CI 1.28­4.11). Conclusions: The authors conclude that alcohol in the adult male population is prevalent, with consumption increasing with age; religion has a protective effect, and people with depression and anxiety are more likely to use it. Taking this into consideration, it is worth highlighting the importance of Family Health Units in the development of strategies to monitor the risk conditions of its population as well as the discussion and approach of interventions.


Introducción: Desde el punto de vista de la salud pública, la población masculina adulta es vulnerable al consumo de alcohol y sus consecuencias. La detección precoz, así como la búsqueda de factores asociados son necesarios y las unidades de Salud de la Familia son lugares importantes para ese abordaje. Objetivo: Este estudio tuvo como objetivo identificar el uso de alcohol en hombres adultos y verificar la asociación con trastornos socioeconómicos, demográficos y mentales (episodio depresivo mayor y trastorno de ansiedad generalizada). Métodos: Se realizó un estudio analítico transversal en adultos de 20 a 59 años de edad en la ciudad de Piracicaba registrados en las Unidades de Salud Familiar en el año 2018. Después de los análisis descriptivos, se estudiaron las variables con valor p<0,20 en análisis simples en modelos de regresión, binomio negativo múltiple. El modelo final estimó las razones medias ajustadas con los intervalos de confianza del 95%. Resultados: Hubo una alta prevalencia de consumo de alcohol, 26,9%. El puntaje AUDIT aumentó con la edad (RM=1,02; IC95% 0,99­1,03). Los protestantes y los evangélicos tuvieron un puntaje promedio de AUDIT más bajo que otras religiones (RM=1,78; IC95% 1,14­2,79). Las personas con trastornos mentales tienen un puntaje AUDIT promedio más alto que aquellos sin trastornos (RM=2,30; IC95% 1,28­4,11). Conclusiones: Concluimos que el alcohol en la población masculina adulta es prevalente, con la edad hay un aumento en el consumo, la religión tiene un efecto protector y que las personas con depresión y ansiedad tienen más probabilidades de usarlo, destacando la importancia de la USF en el desarrollo de estrategias que rastrean las condiciones población, así como la discusión y el enfoque de las intervenciones.


Assuntos
Humanos , Masculino , Adolescente , Adulto , Pessoa de Meia-Idade , Ansiedade , Atenção Primária à Saúde , Depressão , Consumo Excessivo de Bebidas Alcoólicas
3.
BMC Public Health ; 21(1): 2234, 2021 12 08.
Artigo em Inglês | MEDLINE | ID: mdl-34879828

RESUMO

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.


Assuntos
Agendamento de Consultas , Atenção Primária à Saúde , Idoso , Brasil , Estudos Transversais , Assistência Odontológica , Humanos , Saúde Bucal
4.
BMC Oral Health ; 21(1): 608, 2021 11 30.
Artigo em Inglês | MEDLINE | ID: mdl-34847895

RESUMO

BACKGROUND: Dental caries is associated with Biological, behavioral, socioeconomic, and environmental factors; however, socioeconomic status is a distal determinant of dental caries development that modulates exposure to risk and protective factors. This study aimed to analyze the socioeconomic factors associated with the concentration of oral diseases in a population-based study in Brazil. METHODS: This is a quantitative, analytical, cross-sectional study based on secondary data from the SB São Paulo 2015 epidemiological survey. A total of 17,560 subjects were included. The concentration of oral disease in the population was estimated by the oral disease burden (ODB) variable. The ODB consists of four components: dental caries; tooth loss; need for dental prosthesis and periodontal condition. Thus, the total score on the ODB could vary between 0 and 4, with the highest score indicating the worst possible situation. ODB was analyzed in multivariate negative binomial regression, and multivariate binary logistic regression analysis. The following factors were included as independent variables: age group, skin color, socioeconomic factors, family income and Oral Impact on Daily Performance (OIDP). RESULTS: In the sample, 86.9% had no minimum ODP component. Negative multivariate binomial regression showed a statistically significant relationship (p < 0.005) between ODB and all variables analyzed (skin color, family income, education, OIDP results and age range). The adjusted multivariate binary logistic regression showed that the individuals most likely to have at least one component of ODB were nonwhite (25.5%), had a family income of up to R$ 1500.00/month (19.6%), had only completed primary education (19.1%), and reported that their oral health had an impact on their daily activities (57.6%). Older adults individuals were two times more likely than adolescents to have an ODB component. CONCLUSIONS: ODB is associated with factors related to social inequality. Adults and older adults individuals had the highest cumulative number of ODB components.


Assuntos
Cárie Dentária , Adolescente , Idoso , Brasil/epidemiologia , Efeitos Psicossociais da Doença , Estudos Transversais , Cárie Dentária/epidemiologia , Humanos , Saúde Bucal , Qualidade de Vida , Classe Social , Fatores Socioeconômicos
5.
Braz. j. oral sci ; 20: e211606, jan.-dez. 2021. tab
Artigo em Inglês | LILACS, BBO - Odontologia | ID: biblio-1253158

RESUMO

Aim: The present study sought to investigate dental caries experience and its association with sociodemographic, postnatal and breastfeeding variables in children in the agerange from 6 to 71 months of age, in the Xingu Indigenous Park, Mato Grosso, Brazil. Methods: This was an analytical cross-sectional study that used secondary data pertaining to 402 indigenous children of the Low, Middle and Eastern Xingu regions, who participated in the Oral Health Epidemiological Survey in 2013. The dependent variable was dental caries, dichotomized by the median (dmf-t≤1 and dmf-t>1). The data of independent variables were obtained by means of instruments of the Local Health Information System of the Xingu Indigenous Special Sanitary District (DSEI). Raw analyses were performed to test the association of the independent variables with the dependent variable. The variables were tested in the multiple logistic regression model. Results: The mean value of the dmf-t index was 2.60 and the prevalence of affected children was 51%. In the multiple analysis, only children older than 36 months (OR: 6.64; CI95%: 4.11 to 10.73) and those that were breastfed for a longer period of time (OR: 1.88; CI95%: 1.16 to 3.02) showed significant association with the dmf-t>1 index. Conclusion: Childhood dental caries among indigenous children was associated with age and breastfeeding prolonged for over 26 months, therefore, pointing out the need to offer dental follow-up care at earlier ages


Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Aleitamento Materno , Índios Sul-Americanos , Saúde Bucal , Cárie Dentária
6.
Cien Saude Colet ; 26(suppl 2): 3589-3597, 2021.
Artigo em Português | MEDLINE | ID: mdl-34468654

RESUMO

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.


Assuntos
Saúde Bucal , Atenção Primária à Saúde , Brasil , Estudos Transversais , Humanos , Fatores Socioeconômicos
7.
Einstein (Sao Paulo) ; 19: eAO5554, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34495084

RESUMO

OBJECTIVE: To evaluate the consumption of ultra-processed foods among children, and to investigate associations with socioeconomic and demographic factors. METHODS: An analytical cross-sectional study with 599 children aged 6 months to 2 years, and listed as users of Family Health Units, in a medium-size city. Mothers were approached at home by researchers and community health workers from the Family Health Units, for data collection. Two questionnaires were used: the socioeconomic and demographic questionnaire, and the form Sistema de Vigilância Alimentar e Nutricional of Ministério da Saúde do Brasil , for children aged 6 months to 2 years. Ultra-processed food consumption and socioeconomic and demographic factors were defined as dependent and independent variables, respectively. Multiple regression analysis with a significance level of 5% was used to test associations between ultra-processed food consumption and socioeconomic and demographic variables. RESULTS: Ultra-processed food consumption was associated with child age between 1 and 2 years (OR=3.89; 95%CI: 2.32-6.50 and OR=3.33; 95%CI: 2.00-5.56, respectively), number of people living in the same household (OR=1.94; 95%CI: 1.23-3.05), and recipients of government benefits (OR=1.88; 95%CI: 1.15-3.04). CONCLUSION: Ultra-processed food consumption among children undergoing complementary feeding may be influenced by socioeconomic and demographic factors.


Assuntos
Comportamento Alimentar , Mães , Brasil , Criança , Pré-Escolar , Estudos Transversais , Demografia , Dieta , Feminino , Humanos , Lactente , Fatores Socioeconômicos
9.
Einstein (Sao Paulo) ; 19: eGS5817, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34346989

RESUMO

OBJECTIVE: To analyze the expenses of hospitalizations for ambulatory care sensitive conditions in the Health Regional Offices of the State of São Paulo. METHODS: An ecological, retrospective cohort, with analysis of hospital admissions for ambulatory care sensitive conditions in the state of São Paulo, from 2014 to 2018, compiled by the Hospital Information System. Data were extracted using the Tabwin application and analyzed using descriptive statistics. RESULTS: There was a 14.49% reduction in the amount spent on hospitalizations for ambulatory care sensitive conditions. There were reductions in the frequency of hospitalizations (-1.26) and hospital stay (-0.54), and an increase in the occurrence of deaths (8.02). The Regional Offices of Barretos, Taubaté and Araraquara showed an increase in expenses in the period, by 37.86%, 15.38% and 3.78%, respectively, while all other Regional Offices showed a reduction; in that, the most significant were in Bauru (-31.90%), São João da Boa Vista (-26.18%), Presidente Prudente (-21.00%) and São Paulo (-19.17%). The value of hospitalizations for ambulatory care sensitive conditions showed a strong and positive correlation with the variables frequency and hospital stay. CONCLUSION: The results pointed to a difference in the amounts spent on hospitalizations for ambulatory care sensitive conditions in the Regional Offices, although there was no difference in the frequency and duration of these hospitalizations. The expansion of Primary Health Care resources is a possible element for reducing the frequency and spending on hospitalizations for ambulatory care sensitive conditions; nonetheless, it is necessary to consider other factors, such as social determinants and the organization of health services.


Assuntos
Assistência Ambulatorial , Hospitalização , Brasil , Humanos , Tempo de Internação , Estudos Retrospectivos
10.
Cien Saude Colet ; 26(8): 3335-3344, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34378720

RESUMO

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.


Assuntos
Revestimento de Dentadura , Arcada Edêntula , Brasil , Prótese Total Inferior , Serviços de Saúde , Humanos , Mandíbula , Satisfação do Paciente
11.
BMC Oral Health ; 21(1): 421, 2021 08 28.
Artigo em Inglês | MEDLINE | ID: mdl-34454449

RESUMO

BACKGROUND: Access to oral health services remains a challenge in the Brazilian healthcare system, especially in the primary health care setting, where the use of a risk stratification tool that could identify individuals with higher dental vulnerability would be extremely valuable. However, there literature on this theme is scarce, and there is no validated instrument in Brazil that is capable of measuring dental vulnerability. Hence, this psychometric study aimed at the development and evaluation of content and internal structure validity of the Dental Vulnerability Scale for Primary Health Care (PHC). METHODS: The items were developed based on a qualitative exploratory analysis. A total of 172 items were prepared and submitted to a panel of specialists, with content validity analyzed with the Content Validity Ratio (CVR), resulting in an the initial version of the instrument composed by 41 items. Internal structure validity was analyzed by Exploratory Factor Analysis (EFA), Confirmatory Factor Analysis (CFA), and by applying 3 reliability indicators (Cronbach's Alpha, McDonald's Omega and Greatest Lower Bound - GBL), with a sample of 1227 individuals. RESULTS: The final configuration indicated a scale of 15 items divided into 4 dimensions (overall health, oral health, infrastructure, and healthcare services) with explained variance of 72.11%. The factor loads varied from 0.37 to 0.96. The model adjustment indices were set at × 2/df(51) = 3.23, NNFI = 0.95, CFI = 0.98, GFI = 0.96, AGFI = 0.97, RMSEA = 0.04 and RMSR = 0.03. CONCLUSION: DVS presented satisfactory evidence of validity, indicating its suitability to be used by healthcare professionals, students and managers to plan oral health actions and services at PHC.


Assuntos
Atenção Primária à Saúde , Análise Fatorial , Humanos , Psicometria , Reprodutibilidade dos Testes , Inquéritos e Questionários
12.
Ciênc. Saúde Colet ; 26(8): 3335-3344, ago. 2021. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1285978

RESUMO

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.


Assuntos
Humanos , Arcada Edêntula , Revestimento de Dentadura , Brasil , Satisfação do Paciente , Prótese Total Inferior , Serviços de Saúde , Mandíbula
13.
BMC Res Notes ; 14(1): 116, 2021 Mar 25.
Artigo em Inglês | MEDLINE | ID: mdl-33766088

RESUMO

OBJECTIVE: Different studies with adolescents address the difficulty they have to adhere to oral dental treatments. Therefore, better understanding the processes involved in adherence to treatment in this population is necessary. The aim of this study was to investigate the factors that influence adherence to dental treatment in socially underprivileged adolescents in primary care. RESULTS: Non-adherence to treatment showed high rate in the studied sample (49.5%). Family income (p = 0.039) and number of individuals in the family (p = 0.003) were associated with non-adherence to dental treatment. It is concluded that the adolescents' social vulnerability condition resulted in situations that are incompatible with adherence, which hinders dental treatment and health service planning.


Assuntos
Renda , Populações Vulneráveis , Adolescente , Estudos de Coortes , Assistência Odontológica , Humanos
14.
Gerodontology ; 38(2): 216-227, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33354806

RESUMO

BACKGROUND: Population ageing in Brazil is rapid and is likely to place additional pressure over the Brazilian public health system. OBJECTIVE: This study aims to examine the factors associated with utilisation of dental services in the previous year among a representative sample of older adults from São Paulo, Brazil. METHODS: The sample included 5951 older adults who participated in the SBSP-15 study, an epidemiological survey conducted in 2015 in the State of São Paulo, Brazil. The outcome "utilisation of dental services" was defined as having visited a dentist in the previous year. Chi-square tests were employed in the bivariate analyses and Poisson regressions with robust variance in the multilevel analysis. RESULTS: Only 30.5% of the participants had their last dental appointment within the previous year. Number of teeth and dental pain presented the strongest effects on the investigated outcome. Education, income, age, ethnicity, living alone, higher Family Health Strategy coverage and the Metropolitan area were associated with having visited a dentist in the previous year. Older adults who rated their oral health as positive did not report treatment need nor prosthodontic need, presented negative oral health-related quality of life, had their last dental appointment in the public health system and sought treatment due to pain or extraction also were more likely to report the utilisation of dental services in the previous year. CONCLUSION: Regional, sociodemographic and subjective factors are associated with utilisation of dental services in the previous year among the elders from the State of São Paulo, Brazil.


Assuntos
Saúde Bucal , Qualidade de Vida , Idoso , Brasil/epidemiologia , Estudos Transversais , Assistência Odontológica , Humanos , Fatores Socioeconômicos , Inquéritos e Questionários
15.
Einstein (Säo Paulo) ; 19: eAO5554, 2021. tab
Artigo em Inglês | LILACS | ID: biblio-1339828

RESUMO

ABSTRACT Objective To evaluate the consumption of ultra-processed foods among children, and to investigate associations with socioeconomic and demographic factors. Methods An analytical cross-sectional study with 599 children aged 6 months to 2 years, and listed as users of Family Health Units, in a medium-size city. Mothers were approached at home by researchers and community health workers from the Family Health Units, for data collection. Two questionnaires were used: the socioeconomic and demographic questionnaire, and the form Sistema de Vigilância Alimentar e Nutricional of Ministério da Saúde do Brasil , for children aged 6 months to 2 years. Ultra-processed food consumption and socioeconomic and demographic factors were defined as dependent and independent variables, respectively. Multiple regression analysis with a significance level of 5% was used to test associations between ultra-processed food consumption and socioeconomic and demographic variables. Results Ultra-processed food consumption was associated with child age between 1 and 2 years (OR=3.89; 95%CI: 2.32-6.50 and OR=3.33; 95%CI: 2.00-5.56, respectively), number of people living in the same household (OR=1.94; 95%CI: 1.23-3.05), and recipients of government benefits (OR=1.88; 95%CI: 1.15-3.04). Conclusion Ultra-processed food consumption among children undergoing complementary feeding may be influenced by socioeconomic and demographic factors.


RESUMO Objetivo Avaliar a ingestão de alimentos ultraprocessados em crianças, e verificar se há associação com o contexto socioeconômico e demográfico. Métodos Trata-se de estudo analítico, do tipo transversal, com 599 crianças entre 6 meses e 2 anos de idade, cadastradas em Unidades de Saúde da Família, de um município de médio porte. Para a realização da coleta, as mães das crianças foram abordadas em seus domicílios pelas pesquisadoras e por um Agente Comunitário de Saúde da Unidade Saúde da Família e responderam dois questionários, o socioeconômico e demográfico e o marcador do Sistema de Vigilância Alimentar e Nutricional do Ministério da Saúde do Brasil para crianças entre 6 meses e 2 anos. A variável dependente do estudo foi a ingestão de alimentos ultraprocessados pela criança e as independentes foram as socioeconômicas e demográficas. Foi realizada análise de regressão múltipla, no nível de significância de 5%, para testar a associação entre a ingestão de alimentos ultraprocessados com as variáveis socioeconômicas e demográficas. Resultados A ingestão de ultraprocessados esteve associada com a idade da criança entre 1 e 2 anos (RC=3,89; IC95%: 2,32-6,50 e RC=3,33; IC95%: 2,00-5,56, respectivamente), com o número de pessoas que residiam na mesma casa (RC=1,94; IC95%: 1,23-3,05) e com as famílias que recebiam auxílio do governo (RC=1,88; IC95%: 1,15-3,04). Conclusão A ingestão de alimentos ultraprocessados por crianças no período da alimentação complementar pode ser influenciada por fatores socioeconômicos e demográficos.


Assuntos
Comportamento Alimentar , Mães , Fatores Socioeconômicos , Brasil , Demografia , Estudos Transversais , Dieta
16.
Einstein (Säo Paulo) ; 19: eGS5817, 2021. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1286293

RESUMO

ABSTRACT Objective: To analyze the expenses of hospitalizations for ambulatory care sensitive conditions in the Health Regional Offices of the State of São Paulo. Methods: An ecological, retrospective cohort, with analysis of hospital admissions for ambulatory care sensitive conditions in the state of São Paulo, from 2014 to 2018, compiled by the Hospital Information System. Data were extracted using the Tabwin application and analyzed using descriptive statistics. Results: There was a 14.49% reduction in the amount spent on hospitalizations for ambulatory care sensitive conditions. There were reductions in the frequency of hospitalizations (−1.26) and hospital stay (−0.54), and an increase in the occurrence of deaths (8.02). The Regional Offices of Barretos, Taubaté and Araraquara showed an increase in expenses in the period, by 37.86%, 15.38% and 3.78%, respectively, while all other Regional Offices showed a reduction; in that, the most significant were in Bauru (−31.90%), São João da Boa Vista (−26.18%), Presidente Prudente (−21.00%) and São Paulo (−19.17%). The value of hospitalizations for ambulatory care sensitive conditions showed a strong and positive correlation with the variables frequency and hospital stay. Conclusion: The results pointed to a difference in the amounts spent on hospitalizations for ambulatory care sensitive conditions in the Regional Offices, although there was no difference in the frequency and duration of these hospitalizations. The expansion of Primary Health Care resources is a possible element for reducing the frequency and spending on hospitalizations for ambulatory care sensitive conditions; nonetheless, it is necessary to consider other factors, such as social determinants and the organization of health services.


RESUMO Objetivo: Analisar os gastos com internações por condições sensíveis à Atenção Primária nas Regionais de Saúde do estado de São Paulo. Métodos: Estudo ecológico, de coorte retrospectiva, com análise de internações hospitalares por condições sensíveis à Atenção Primária ocorridas no estado de São Paulo, no período de 2014 a 2018, computadas pelo Sistema de Informação Hospitalar. Os dados foram extraídos por meio do aplicativo Tabwin e analisados por estatística descritiva. Resultados: Houve redução de 14,49% do valor gasto com internações por condições sensíveis à Atenção Primária. Foram observadas reduções na frequência das internações (−1,26) e na permanência hospitalar (−0,54) e aumento da ocorrência de óbitos (8,02). As Regionais de Barretos, Taubaté e Araraquara apresentaram elevação de gastos no período, em 37,86%, 15,38% e 3,78%, respectivamente, enquanto todas as demais Regionais apresentaram redução; e as mais expressivas foram em Bauru (−31,90%), São João da Boa Vista (−26,18%), Presidente Prudente (−21,00%) e São Paulo (−19,17%). O valor das internações por condições sensíveis à Atenção Primária apresentou correlação forte e positiva com as variáveis frequência e permanência hospitalar. Conclusão: Houve diferença de valores gastos com internações por condições sensíveis à Atenção Primária nas regionais, mas não houve diferença na frequência e na duração dessas internações. A expansão de recursos da Atenção Primária à Saúde é um possível elemento para a redução de frequência e dos gastos com internações por condições sensíveis à Atenção Primária; porém é necessário considerar outros fatores, como os determinantes sociais e a organização dos serviços de saúde.


Assuntos
Humanos , Assistência Ambulatorial , Hospitalização , Brasil , Estudos Retrospectivos , Tempo de Internação
17.
Arq. odontol ; 57: 260-265, jan.-dez. 2021. tab
Artigo em Inglês | LILACS, BBO - Odontologia | ID: biblio-1352621

RESUMO

Aim:To evaluate the impact of the recording of teeth whose clinical conditions rarely vary (anterior teeth and third molars) in inter-examiner agreement measurements. Methods:Clinical data from 56 schoolchildren, 12 years of age, previously collected by two examiners, according to the "Oral Health Surveys: basic methods" codes and criteria, were analyzed in the present study. The effects from including/excluding such teeth upon reproducibility were measured by general percentage agreement (GPA) and Kappa statistics (к) performances. Results: The exclusion of anterior teeth associated with the inclusion of third molars produced a decrease in GPA that was simultaneous to an increase in the weighted Kappa (nominal data) and simple (dichotomous data) values. The incorrect inclusion of third molars (GPA = 100%; к = + 1) in the reproducibility measurement artificially increased the inter-examiner Kappa values. Conclusion: The inclusion/exclusion of anterior teeth and third molars, seeking a more reliable agreement among examiners, can have a positive or negative impact on the measured reproducibility values. A clear warning about the impact of including third molars in the reproducibility measurement, in the 12 years old age group, should be performed in "Oral Health Surveys: basic methods" and similar manuals.


Objetivo: Avaliar o impacto do registro de dentes anteriores e terceiros molares, cujas condições clínicas pouco variam, sobre as mensurações de concordância inter-examinadores. Métodos: Dados clínicos de 56 escolares de 12 anos de idade, previamente coletados por 2 examinadores, segundo os códigos e critérios expressos no "Levantamentos em Saúde Bucal: métodos básicos" foram analisados neste estudo. Os efeitos da inclusão/exclusão destes dentes sobre a concordância inter-examinadores foram mensurados calculando-se a porcentagem geral de concordância (GPA) e estatística Kappa (к). Resultados:A inclusão de terceiros molares aumentou a GPA para dados dicotomizados ou não. A exclusão de dentes anteriores diminuiu a GPA para dados dicotomizados ou não. Quando associada à inclusão de terceiros molares, sob perfeita concordância (к = +1), os valores de Kappa foram artificialmente aumentados tanto para dados dicotomizados quanto não-dicotomizados. Conclusão: A inclusão/exclusão de dentes anteriores e/ou de terceiros molares, no sentido de se evidenciar melhor as discordâncias entre examinadores, podem impactar positiva ou negativamente sobre a fidedignidade da reprodutibilidade mensurada. Uma advertência clara sobre o impacto da inclusão dos dentes terceiros molares no cálculo da reprodutibilidade, para a faixa etária de 12 anos, deveria estar presente no "Levantamentos em Saúde Bucal: métodos básicos" e manuais semelhantes.


Assuntos
Humanos , Criança , Índice CPO , Cárie Dentária , Incisivo , Dente Serotino , Saúde Bucal , Reprodutibilidade dos Testes , Assistência Odontológica para Crianças
18.
RGO (Porto Alegre) ; 69: e2021012, 2021. tab, graf
Artigo em Inglês | LILACS-Express | LILACS, BBO - Odontologia | ID: biblio-1250644

RESUMO

ABSTRACT Objective Understanding the individual and collective behavior of individuals about their oral health conditions is important to prevent and control of dental caries. This study aimed to seek evidence of the relationship between social capital and caries experience. Methods Using a systematic review with meta-analysis, we searched articles in PubMed, ISI Web of Knowledge, LILACS, IBECS, BBO, SCIELO, The Cochrane Library and MEDLINE databases. Studies with humans, of all ages and languages, published until July 2019, which related social capital to the caries experience, were included in this review. Results We identified 1163 articles evaluated considering inclusion and exclusion criteria, leaving 5 articles selected to compose the study sample, and only 3 included in the meta-analysis. In the final analysis p value was significant (p <0.001), showing that both social cohesion and neighborhood empowerment are associated with the caries experience. In the random model, the individual has 2.39 chances of not having the caries disease. The results reinforce the importance of community social capital in the caries experience of individuals. Conclusions The high level of community social capital is directly related to lower caries experience rates.


RESUMO Objetivo A compreensão do o padrão de comportamento dos indivíduos no nível individual e coletivo frente às suas condições de saúde bucal é de importância inequívoca para prevenção e controle da cárie dentária. Nesta perspectiva o objetivo deste estudo foi buscar evidências da relação entre o capital social e a experiência de cárie. Métodos Utilizando como método revisão sistemática com meta-análise, foram pesquisados artigos nas bases de dados PubMed, ISI Web of Knowledge, LILACS, IBECS, BBO, SciELO, The Cochrane Library e MEDLINE. Estudos com humanos, de todas as idades e línguas, publicados até julho de 2019, que relacionaram o capital social com a experiência de cárie, foram incluídos nesta revisão. Resultados Foram identificados 1163 artigos, que passaram por avaliação sob critérios de inclusão e exclusão, restando 5 artigos selecionados para compor a amostra do estudo, sendo apenas 3 incluídos na meta-análise. Na análise final o p-valor foi significativo (<0,001), mostrando que tanto a coesão social como o empoderamento de vizinhança estão associados com a experiência de cárie. No modelo randômico foi constatado que o indivíduo tem 2,39 chances de não ter a doença cárie. Os resultados do estudo reforçam a importância do capital social comunitário na experiência de cárie dos indivíduos. Conclusão O alto nível de capital social comunitário tem relação direta com menores índices de experiência de cárie nos indivíduos.

19.
Artigo em Inglês | LILACS, BBO - Odontologia | ID: biblio-1287484

RESUMO

Abstract Objective: To compare the estimates obtained, considering or not the weighting data. Material and Methods: Secondary data from the Oral Health Survey of the State of São Paulo (SBSP2015) was used for calculation of mean estimates, standard errors of the mean and confidence intervals (CI) for the DMFT index and components (decayed, lost and filled), in the age group of 35-44 years. Multiple logistic regression models were estimated, considering or not the weighting from the sampling plan (p<0.05). Results: It was observed that the estimates of the DMFT index and the carious component did not vary much when the design was considered or not (1.1% and 2.0%, respectively). However, the data referring to the lost and filled component showed greater differences between the values of the means. The averages fluctuated up and down by up to 6.7% for weighted versus unweighted analyses. The standard error was underestimated in the unweighted analysis and the confidence interval showed variations. Differences between the regression models obtained by the weighted and unweighted analysis of the data were detected. Conclusion: Although weighted and unweighted models presented differences of less than 10% in estimates of the mean, confidence intervals, as well as statistical inferences, were different. Thus, weighting should be applied in the population base data analysis collected by sampling with complex designs.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Índice CPO , Saúde Bucal/estatística & dados numéricos , Interpretação Estatística de Dados , Pesquisa em Sistemas de Saúde Pública , Brasil/epidemiologia , Modelos Logísticos , Inquéritos e Questionários
20.
Rev Saude Publica ; 54: 148, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33331491

RESUMO

OBJECTIVE: To estimate the flow of professionals and the financial impact of the Programa Mais Médicos para o Brasil (PMMB - More Doctors for Brazil Program) within the More Doctors Program (MDP) for the Brazilian Ministry of Health and the participating municipalities of the state of São Paulo, from January 2019 to March 2022. METHODS: A financial impact study was conducted in the state of São Paulo based on public secondary databases. The number of PMMB vacancies per municipality, of physicians and vulnerability profiles were described to measure the loss of replacement of professionals in the period. RESULTS: In the specified period, the number of PMMB physicians in participating cities will decrease from 2,533 to 320, and the number of participating municipalities from 373 to 86. The municipalities that will need to replace the physicians will have a financial impact of R$ 929,487,904.77 (with sensitivity analysis, ranging from R$ 650,641,533.34 to R$ 1,208,334,276.20). CONCLUSION: The change of vulnerability methodology adopted for the PMMB will represent serious consequences, that is, less population assistance and high financial impact for the municipalities of the state of São Paulo in a scenario of budget limitations.


Assuntos
Educação Médica , Médicos , Brasil , Cidades , Educação Médica/economia , Humanos , Médicos/provisão & distribuição , Avaliação de Programas e Projetos de Saúde
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