Cost-effectiveness analysis of COVID-19 tests in the unified health system.

BACKGROUND: To evaluate the cost-effectiveness ratio and economic impact of the Rapid Antigen Test (TR-Ag) to replace RT-PCR for the detection of the new Coronavirus in the Unified Health System (SUS). METHODS: This is a cost-effectiveness analysis. Clinical protocols were used for the diagnosis of COVID-19 at the São José Municipal Hospital, located in the city of Itaberá-SP. The Incremental Cost-Effectiveness Ratio (ICER) was divided into two scenarios. In the first, the accuracy reported by the test manufacturers was included, and in the second, the cost resulting from a systematic review. Both were compared with the performance of the RT-PCR test. The increase in diagnoses was chosen as a health outcome and absenteeism was used as a criterion for assessing the economic impact. RESULTS: The analysis resulted in incremental cost-effectiveness ratios of R$ 42,136.67 and R$ 68,329.73 for every thousand tests, according to the accuracy of the manufacturers' TR-Ag tests and what is reported in the literature in relation to RT-PCR, respectively. The average value found for the RT-PCR test (R$ 202.87) represents an increase of 165.32% in cost in relation to the value found for the TR-Ag. 4,305 tests were performed between April 2020 and December 2021 at the referral hospital. Also, maintaining the use of RT-PCR as the first choice for diagnosing COVID-19 and regulating absenteeism in the economically active population could have an impact of up to R$ 1,022,779.68 on municipal management. CONCLUSION: It is concluded that the TR-Ag are configured as a cost-effective alternative for the SUS in the detection of the new Coronavirus. The strategy becomes economically favorable for the expansion of testing, combating the COVID-19 pandemic and reducing the impact on the local economy. However, studies are needed to validate the accuracy of the tests so that economic evaluations on the subject are more assertive.

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.

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.

Factors associated with utilisation of dental services by the elders from São Paulo, Brazil.

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.

Influence of socioeconomic status on oral disease burden: a population-based study.

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.

Dental vulnerability scale in primary health care: evidence of content and structure internal validity.

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.

Physical and psychological states interfere with health-related quality of life of institutionalized elderly: a cross-sectional study.

BACKGROUND: Nursing home elders experience many problems that may influence their quality of life, in example of cognitive, mental, nutritional and physical disabilities. Concerning about elders' wellbeing may help them living with dignity. This study aimed to investigate factors associated with Health-Related Quality of Life (HRQoL) of institutionalized elders in a capital city of Brazilian Northeast. METHODS: A cross-sectional study was conducted with 125 institutionalized elders living in the metropolitan region of João Pessoa (Brazil). The following variables were tested regarding their association with the elders' HRQoL: Socio-demographic characteristics; Performance of daily-living activities, Frailty status, Cognitive status, Nutritional status, Self-perception of oral health and Depression status. Hierarchical multiple Poisson loglinear and binary logistic regressions analyses were performed in order to assess the impact of each independent variable on HRQoL, considering a significance level of 5%. RESULTS: The median of HRQoL of institutionalized elders was 64. Multivariate regression models showed that retirement, frailty and depression were statistically associated with poor HRQoL (p < 0.05). Not-frail elderly and less depressed were more likely to present higher HRQoL scores. CONCLUSIONS: Lower HRQoL of institutionalized elderly is associated with decline of physical and psychological states. Institutions should be advised to plan and implement actions that would improve the HRQoL of institutionalized elderly.

Factors that influence the oral impact on daily performance of older people in Brazil: A cross-sectional population-based study.

AIM: To investigate factors that influence the oral health-related quality of life of older people (65 years and over) in Brazil. BACKGROUND: Population-based studies should be conducted to support health-planning interventions. MATERIALS AND METHODS: Data from the São Paulo State Survey on Oral Health (SBSP-2015), which consisted of 5951 individuals, were used. A theoretical-conceptual model was built based on the impact of family socio-economic characteristics, individual social-demographic features and self-perceived and clinical oral health status on the oral impact on daily performance (OIDP). Multivariate binary logistic regression analysis was conducted at 5% significance level. Statistically significant variables included within the adjusted logistic regression model entered the multiple correspondence analysis (MCA). RESULTS: Oral health impact on daily activities was observed in 34.6% of older people. Characteristics significantly related to impact on OIDP score were as follows: family income up to R$ 500 (OR = 2.73), self-perceived treatment need (OR = 1.33), self-perceived toothache (OR = 1.52), self-perception of denture replacement need (OR = 1.27), dissatisfaction (OR = 1.50) or very dissatisfied (OR = 2.57) with own oral health, partial lower denture use (OR = 1.34) and needing partial lower dentures (OR = 1.28). Increased number of people living in the same house (B = 0.05, OR = 1.06), number of bedrooms in the house (B = -0.10, OR = 0.90), age (B = -0.03, OR = 0.97) and number of teeth needing treatment (B = 0.08, OR = 1.08) contributed significantly to OIDP. CONCLUSION: Prevalence of OIDP of older people in the state of São Paulo was related to factors other than their clinical and self-perceived oral health status.

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

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

Functional dentition and associated factors in Brazilian elderly people: A multilevel generalised structural equation modelling approach.

INTRODUCTION: The objective of the present study was to evaluate the association of socioeconomic status (SES) as a latent variable on oral health-related quality of life (OHRQoL) using four definitions of functional dentition (FD) for elderly people. METHODS: Four sets of multilevel generalised structural equation models (GSEM) were used: (i) WHO Functional Dentition (FDWHO); (ii) Well-distributed teeth (WDT); (iii) FDclass5 ; and (iv) FDclass6 . The indirect effects of SES on OHRQoL were measured in 5951 elderly participants in the São Paulo Oral Health 2015 (SBSP-15) survey. The latent variable (OHRQoL) was extracted from the Oral Impacts on Daily Performances questionnaire, and GSEM was used to estimate the direction of association among the variables. RESULTS: SES was directly and strongly associated with FDWHO (Total effects [SC] = 0.56, P < .001); WDT (Total Effects [SC] = 0.55, P < .001); FDclass5 (Total effects [SC] = 0.07, P < .001); and FDclass6 (Total effects [SC] = 0.05, P = .001). All FD outcomes mediate effects of SES on OHRQoL (P < .05). SES had a direct effect on happiness which, in turn, had a direct effect on OHRQoL ([SC] = 0.05, P < .001). CONCLUSIONS: All definitions of FD were good at mediating the effects of SES on OHRQoL, showing the importance of occlusal and periodontal statuses of elderly individuals.

Relations of drug use and socioeconomic factors with adherence to dental treatment among adolescents.

BACKGROUND: Adolescents are vulnerable to behaviors that weaken health, by adopting habits that interfere with adherence to treatment. The aims of the present study were to investigate adolescents' adherence to dental treatment and the relations between this behavior and socioeconomic factors and consumption of licit and illicit chemical substances. METHODS: A longitudinal study was conducted with 474 adolescents from Piracicaba/SP/Brazil, who initially underwent a dental examination to verify the adherence for dental treatment. After 18 months, 325 adolescents were reassessed. Valid questions about socioeconomic conditions and use of alcohol and drugs were applied to participants. The chi-square test and Fisher's exact test were used. The prevalence ratios were estimated with the respective 95% confidence intervals, using generalized linear models with Poisson distribution. RESULTS: Eighteen (18) months after the first consultation, 325 adolescents were reassessed: 161 (49%) did not adhere to the treatment, and 164 (51%) adhered to it and answered the socioeconomic and alcohol and illicit drug questionnaires. Their mean age was 15 ± 1 years; of them, 189 (58%) were female. The prevalence of adherence to treatment decreased in patients without their own home (p = 0.034). In the individual analysis of the variables, drinking alcohol alone, experimenting with drugs, and proximity of friends who consumed illicit substances were associated with the outcome (p < 0.05). However, in the joint analysis, only proximity of friends who consumed drugs was the factor related to low adherence to dental treatment among the adolescents (p = 0.035). CONCLUSION: Adolescents who consumed alcohol and socialized with friends who used illicit drugs had greater difficulty in adhering to dental treatment.

Spatial analysis of the death associated factors due oral cancer in Brazil: an ecological study.

BACKGROUND: Oral cancer (OC) is among the ten most common cancers and the seventh most frequent cause of death worldwide. It has been reported that these incidence rates are higher in developed country and these mortality rates are higher in less developed areas. So, the objective of the present study was to analyze the spatial joint distribution and to explore possible associations of the epidemiological aspects with mortality rates due to OC in the Brazil. METHODS: An exploratory ecological study investigated the global spatial autocorrelation of epidemiological aspects with mortality rates due to OC from the Brazilian Federative Units (FUs) (n = 27) in the period 2005-2014, using the "global" and "local" Moran statistic method and a multiple spatial regression, having as variables of exposure the habits and lifestyle, sociodemographic indicators, the consumption of pesticides, the presence of comorbidities, the use of health services and food consumption; and, as a variable response, mortality rates due to OC. The software used was Stata 11.0, SPSS 18.0 and GeoDa 0.95-i. RESULTS: The spatial distribution of OC mortality rates to age-standard was not random and showed high spatial autocorrelation and predominance of significant spatial groupings in the Central-South region of Brazil. In the multiple regression, statistically negative associations were observed between the Human Development Index (HDI) and OC age-standardized in the studied period (p < 0.05) and positive associations among the proportion of the population with dental appointment within last year, percentage of consumption of oils and fats, percentage of consumption of ready-to-eat foods and industrial mixtures and percentage of overweight adults with this type of cancer (p < 0.05). CONCLUSION: This is the first study that analyzed the factors associated to the spatial clusters of mortality due to oral cancer in the Brazilian FUs. A fairly unequal distribution of OC mortality rates was found, being that these rates presented inverse association with HDI and direct association with dental appointment, consumption of oils and fats, ready-to-eat foods and industrial mixtures consumption and overweight these rates. It suggests the need to redirect Brazilian public policies aimed at combating them so that they cease to be temporary and become permanent.

Social vulnerability and factors associated with oral impact on daily performance among adolescents.

BACKGROUND: Oral disorders may negatively affect the quality of life (QoL) of adolescents. To investigate how social vulnerability and oral-health status factors affect QoL in 15-19 years olds who participated in the "SB São Paulo 2015" state survey. METHODS: The relationship of several independent variables, namely Paulista Social Vulnerability Index (PSVI) score, gender, skin color, family income, age, untreated caries, tooth loss [determined by the Decayed, Missing, Filled-Teeth (DMF-T) index], toothache, periodontal condition [determined by the Community Periodontal Index (CPI)], and malocclusion (maxillary overjet, cross bite, or open bite) affect daily life, measured by the Oral Impacts on Daily Performance (OIDP) instrument. Logistic regression analyses were carried out based on a hierarchical model. RESULTS: The final sample consisted of 5402 adolescents. The prevalence of at least one negative impact of oral health on QoL was 37.3%. After adjustment, demographic factors that were found to influence this impact significantly (p < 0.01) were female gender [odds ratio (OR) 1.78, 95% confidence interval (CI) = 1.59-2.0], non-white skin color (OR 1.66, 95% CI = 1.47-1.88), and a low family income (OR 1.28, 95% CI = 1.28-1.29). Additionally, oral conditions associated with oral health impact on QoL included the presence of at least one untreated tooth decay lesion (OR 1.42, 95% CI = 1.25-1.61), loss of at least one tooth (OR 1.49; 95% CI = 1.25-1.78), toothache (OR 4.87, 95% CI = 4.25-5.59), bleeding on probing (OR 1.45, 95% CI = 1.25-1.68), and severe maxillary overjet (OR 1.68, 95% CI = 1.15-2.45). CONCLUSION: Social vulnerability (PSVI score) was not associated with the OIDP score, but oral health conditions and socio-demographic variables, including gender, skin color, and income, were found to affect adolescents' daily activities. Strategies that consider the perceptions of this segment of the population should be implemented to strengthen their autonomy and totality of care.

School performance and oral health conditions: analysis of the impact mediated by socio-economic factors.

BACKGROUND: Oral problems can cause strong impact on functional, emotional, and social aspects of children and adolescents, as well as changes in school performance. AIM: To evaluate the associations of subjective perceptions of parents, socio-economic factors, and oral clinical conditions of children with their school performance. DESIGN: A case-control design was used with a sample of 1411 schoolchildren aged 8-10 years from city of Piracicaba, São Paulo, Brazil. Clinical conditions were evaluated using the DMFT and dmft indexes. Socio-economic data were obtained using a questionnaire sent to schoolchildren's parents. School performance was evaluated by the final scores of each schoolchild at the end of the 2011 school year. RESULTS: According to the final logistic regression model, the schoolchildren who had carious lesions and underwent curative dental treatment at the beginning of the academic year presented 1.51 more chance of having low performance compared with schoolchildren who had no caries lesions. In addition, socio-economic and demographic variables were associated with a greater chance of poor school performance. CONCLUSION: Socio-economic factors and presence of caries lesions, even if treated, were risk indicators for poor school performance.

Relationship between quality of root canal obturation and periapical lesion in elderly patients: a systematic review.

OBJECTIVE: The aim of this study was to investigate the relationship between quality of root canal obturations and the presence/absence of periapical lesion in elderly patients. METHODOLOGY: This was a systematic conducted by means analysing studies on the quality of root canal obturations and their relationship with periapical health in elderly patients. The methodological procedures were based on Cochrane. The inclusion criteria for selection of the titles were the following: (i) studies in humans; (ii) sample consisting of individuals aged 60 years or older; (iii) intending criteria defined for the evaluation of quality of root canal obturations; (iv) intending criteria defined for the evaluation of periapical health; (v) determination of the relationship between quality of endodontic treatment and presence of periapical lesions; and (vi) articles published between 1st March 2003 and 1st March 2013. RESULTS: A total of 3161 potentially relevant studies were found in three databases chosen for the literature review, with 1669 being repeated and 395 duplicated. Therefore, the abstracts of 1097 studies were read. A total of 1022 studies were excluded, resulting in 75 articles for full analysis. However, no study could be included in the present literature review. CONCLUSION: There is no consensus on the relationship between the quality of root canal obturations and periapical health in older patients.

Quality of life and socio-dental impact among underprivileged Brazilian adolescents.

PURPOSE: To evaluate the influence of clinical variables, individual and contextual characteristics on the quality of life (QL) of underprivileged adolescents in a municipality in the interior of the State of São Paulo, Brazil. METHODS: An analytical cross-sectional study was conducted in Piracicaba, in 2012, with 1,172 adolescents aged 15-19 years, from 21 state schools and 34 Family Health Units. The dependent variables included the socio-dental impact (OIDP) and quality of life (WHOQOL-bref) indices. The dependent variables were classified as individual (DMFT index, CPI Index, age, sex, income, parents' educational level) and contextual (Social Exclusion Index) variable. The multilevel regression model was estimated by the PROC GLIMMIX ("Generalized Linear Models-Mixed") procedure, considering the individuals' variables as being Level 1 and the contextual variables as being Level 2, and the statistical significance was evaluated at level of significance of 5 %. RESULTS: Girls were found to have the worst QL (p < 0.000) and greatest OIDP (p = 0.000). There was an increase in OIDP (p < 0.001) and diminished QL (p < 0.052) with an increase in the periodontal index. This result is marginally significant since the significance probability is marginally greater than 0.05. In turn, there was an increase in QL (p = 0.000) and reduction in OIDP (p < 0.000) with an increase in the family income. Adolescents who resided in areas of greatest social exclusion (p = 0.031) and with greater OIDP (p < 0.000) presented the worst QL. CONCLUSION: Individual and contextual variables were related to the OIDP and QL in underprivileged Brazilian adolescents.

The impact of oral health conditions, socioeconomic status and use of specific substances on quality of life of addicted persons.

BACKGROUND: The aim of this cross-sectional study was to evaluate the impact of oral health conditions, socioeconomic status and use of specific substances on quality of life of alcohol and drug addicted persons, receiving care at outpatient treatment facilities in Brazil. METHODS: A random sample of 262 participants, mean age 37 years, from Psychosocial Care Centers for Alcohol and Drugs (CAPS AD) located in three cities in the state of São Paulo, Brazil, were clinically examined for caries experience (DMFT index) by a calibrated examiner. They were asked to complete a series of questionnaires, including the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), socioeconomic characteristics, and the World Health Organization Quality of Life assessment (WHOQOL), which were considered the outcome variables of the study. Associations between oral health status, socioeconomic characteristics, substance involvement with WHOQOL were investigated by means of the chi-square test and multiple logistic regression analysis with a level of significance α < 0.05. RESULTS: The mean DMF index of the group was 13.0. Subjects with DMFT >14 (OR = 2.25; CI 95% = 1.30-3.89); low-income (OR = 2.41; CI 95% = 1.22-4.77) and users of cocaine/crack (OR = 2.02; CI 95% = 1.15-3.59) were more likely to have poor general quality of life. CONCLUSION: This study demonstrated that the general quality of life of addicted persons was associated with caries experience, low income and cocaine/crack use.

Individual and contextual factors related to dental caries in underprivileged Brazilian adolescents.

BACKGROUND: Investigate the individual and contextual variables related to caries in underprivileged adolescents, and the disparity in distribution of the disease. METHODS: Cross-sectional analytical study, conducted in the city of Piracicaba, SP, Brazil, in 2012. The probabilistic sample was composed of 1,179 adolescents from 15-19 years of age, randomly selected from 21 state schools and 34 Primary Health Units--Family Health (PHU-FH). The dependent variables studied were number of decayed teeth and caries experience (DMFT). The independent variables were classified into individual (clinical, sociodemographic, psychosocial, self-perception, impact on oral health, access to services, and quality of life) and contextual (social exclusion index, total number of residents in suburb, literacy rate, and the following variables given in percentages: residences in the home ownership category, provision of domestic sewerage, trash collection, families with income of over 1 minimum wage per month, and families without monthly income) variables. The multilevel regression model was estimated by the PROC GLIMMIX (Generalized Linear Models-Mixed) procedure, considering the individual variables as Level 1 and the contextual variables of the suburbs as Level 2. Adjustment of the model was evaluated by -2 Res Log Likelihood with α = 0.05. RESULTS: As regards the individual variables, adolescents who declared having a prison inmate in the Family and resided in homes with a larger number of persons, showed a higher number of decayed teeth. There were a larger number of decayed teeth, a higher DMFT value, and worse self-perception as regards the health of their teeth and mouth. Other variables, such as being of the female gender, age and time since last visit to the dentist were related to the DMFT index. As regards the contextual variables, the DMFT was lower in suburbs with greater access to domestic sewage, and the number of decayed teeth was higher in suburbs with the worst social exclusion indices. CONCLUSION: Individual and contextual variables were associated with the presence of caries and DMFT index in underprivileged adolescents, indicating that they must be taken into consideration in the formulation of policies directed towards oral health promotion and prevention activities in this group.

Geographic information system and multilevel analysis: gingival status among 12-year-old schoolchildren in São Paulo, Brazil.

OBJECTIVE: To evaluate gingival and calculus status among schoolchildren 12 years of age using a geographic information system and multilevel analysis. METHODS: A total of 1 002 schoolchildren were selected from 18 municipal districts by means of cluster sampling, from among 25 public and private schools in Piracicaba, São Paulo, Brazil, in 2005. Examinations were carried out by a single calibrated examiner utilizing the criteria of the World Health Organization, as well as the Community Periodontal Index. Social, economic, and behavioral variables were recorded with the use of a questionnaire and were used in the individual analysis (first level). The variables "percentage of heads of families without income" and "percentage of illiterate heads of families" were used in the contextual analysis (second level). RESULTS: A geographic information system was constructed for mapping the distribution of gingival bleeding. The variables were visually distinguished in the maps and demonstrated a tendency toward better gingival health in the central areas of the city, which are recognized as more privileged. On the contextual level, only the "percentage of illiterate heads of families" was significantly associated to gingival bleeding. CONCLUSIONS: The study confirms better oral health status among schoolchildren from privileged families, but does not confirm the data regarding "income." The individuals from areas in which the heads of family did not have income were not associated to a higher prevalence of gingival problems. This suggests that these individuals are reasonably protected from the impact of social privation due to the actions of public health care services in the municipality.