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Fagundes MLB, Junior OLDA, Hugo FN, Kassebaum NJ, Giordani JMDA. Distribution of edentulism by the Macro determinants of Health in 204 countries and territories: An Analysis of the Global Burden of Disease Study. J Dent 2024:105008. [PMID: 38685342 DOI: 10.1016/j.jdent.2024.105008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 03/27/2024] [Accepted: 04/18/2024] [Indexed: 05/02/2024] Open
Abstract
OBJECTIVE To carry out a comprehensive description of edentulism estimates by the macro determinants of health in 2000, 2010, and 2019 worldwide. METHODS This ecological study analyzed data from the Global Burden of Disease Study (GBD) to describe the incidence rate, prevalence rate and years lived with disability (YLDs) rate due to edentulism by macro determinants of health (governance, macroeconomic policy, social policy, public policies, societal values), for 204 countries and territories. The estimates were reported as rates (cases/100,000 people), for people of both sexes aged 55 years or older. RESULTS Countries belonging to the least privileged categories of the macro determinants showed the lowest prevalence rate, incidence rate, and YLD rate due to edentulism for all exposures. Countries with low government expenditure on health showed the lowest prevalence rate of edentulism in 2000 (18972.1; 95%CI 15960.0 - 21984.3) and 2010 (16646.8; 95%CI: 14218.3-19075.4) than those with high government expenditure on health in 2000 (25196.6; 95%CI: 23226.9 - 27166.2) and 2010 (21014.7; 95%CI: 19317.9 - 22711.5). Countries with low SDI showed the lowest YLDs in 2000 (321.0, 95%CI: 260.1- 381.9), 2010 (332.0; 95%CI: 267.7-396.3), and 2019 (331.6; 95%CI: 266.6-396.5). CONCLUSION The findings point to persistent inequalities in the distribution of edentulism between countries worldwide. The most privileged countries, with higher economic development, better governance, and better social and public policies, have shown higher rates of edentulism. CLINICAL SIGNIFICANCE This model must be reconsidered by advancing toward upstream and midstream strategies, beyond its conventional downstream clinical interventions.
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Affiliation(s)
| | | | - Fernando Neves Hugo
- Department of Preventive and Social Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Nicholas J Kassebaum
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
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Dietrich TR, Debona G, de Spessato Schwerz P, Fagundes MLB, Hugo FN, Hilgert JB, do Amaral Giordani JM, do Amaral Júnior OL. Preventive dental service use and oral health-related quality of life in Brazilian older adults. Gerodontology 2024; 41:40-45. [PMID: 37386716 DOI: 10.1111/ger.12700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND Information on the use of preventive dental services and associated variables is needed to guide policy for the old adult population and consequently promote better oral health-related quality of life (OHRQoL). OBJECTIVE To investigate the association between preventive dental service use and OHRQoL by older Brazilians. MATERIALS AND METHODS This cross-sectional study was carried out using the baseline data of participants of the Brazilian Longitudinal Stud of Aging (ELSEI-Brazil) who were aged 60 years or more. Associations with the use of preventive dental services were carried out using Poisson regression models with robust variance, adjusting for confounders. RESULTS The final sample consisted of 5432 older adults. Almost all (90.7%) participants reported not having sought preventive dental services in the last year. Individuals who used dental services for prevention had fewer impacts on their OHRQoL (RR: 0.74; [95% CI: 0.57-0.97]). CONCLUSION Preventive dental service use is associated with a better OHRQoL in older Brazilians. Policies to improve access to preventive dental services may result in improved OHRQoL in this age group.
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Affiliation(s)
- Tauana Rabuske Dietrich
- Department of Oral Health, School of Dentistry, Unidade Central de Educação FAI Faculdades - UCEFF, Itapiranga, Brazil
| | - Gabriela Debona
- Department of Oral Health, School of Dentistry, Unidade Central de Educação FAI Faculdades - UCEFF, Itapiranga, Brazil
| | - Paola de Spessato Schwerz
- Department of Oral Health, School of Dentistry, Unidade Central de Educação FAI Faculdades - UCEFF, Itapiranga, Brazil
| | | | - Fernando Neves Hugo
- Department of Preventive and Social Dentistry Porto Alegre (RS), Universidade Federal do Rio Grande do Sul - UFRGS, Porto Alegre, Brazil
| | - Juliana Balbinot Hilgert
- Department of Preventive and Social Dentistry Porto Alegre (RS), Universidade Federal do Rio Grande do Sul - UFRGS, Porto Alegre, Brazil
| | | | - Orlando Luiz do Amaral Júnior
- Department of Oral Health, School of Dentistry, Unidade Central de Educação FAI Faculdades - UCEFF, Itapiranga, Brazil
- Department of Dental Sciences, School of Dentistry, Universidade Federal de Santa Maria - UFSM, Santa Maria, Brazil
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de Vasconcellos NBT, Fagundes MLB, Menegazzo GR, do Amaral Júnior OL, Hilgert JB, do Amaral Giordani JM. Association between frailty and oral health services use in Brazilian older adults. Gerodontology 2024; 41:46-53. [PMID: 37750043 DOI: 10.1111/ger.12716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2023] [Indexed: 09/27/2023]
Abstract
OBJECTIVES To assess the association between frailty and oral health services use in Brazilian older adults. METHODS This cross-sectional study analysed the baseline data from the Longitudinal Study on Brazilian Ageing (ELSI-Brazil) representative of Brazilians aged 50 or over. The outcome was oral health services used in the year prior to the interview. The main exposure variable was Frailty defined by the frailty phenotype. Age, skin colour, wealth, sex, education, type of service, health insurance, number of teeth and self-perceived oral health were included as covariates. Prevalence ratios (PR) with their respective 95% confidence intervals (CI) were estimated using Poisson regression with robust variance. RESULTS 8405 individuals were included in this study. The prevalence of frailty was 7.5%. Regarding frailty status, the prevalence of dental service use was 47.0%, 48.5% and 4.5% for robust, pre-frail and frail individuals, respectively. Frail individuals had a 7% higher prevalence of not using dental (PR: 1.07; 95% CI: 1.01-1.13) than robust individuals. Frailty was independently associated with not using oral health services. CONCLUSION Given the complexity of the determinants of dental service use, frailty adds another dimension to be examined in older adults. Public health strategies considering a common risk factor approach should be endorsed.
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Affiliation(s)
| | | | | | | | - Juliana Balbinot Hilgert
- Departament of Preventive and Social Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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Manica LR, do Amaral Júnior OL, Fagundes MLB, Menegazzo GR, do Amaral Giordani JM. Psychosocial aspects associated with self-reported oral health in Brazilians older adults. Int J Dent Hyg 2024; 22:268-273. [PMID: 37602553 DOI: 10.1111/idh.12718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 04/13/2023] [Accepted: 08/06/2023] [Indexed: 08/22/2023]
Abstract
OBJECTIVES Oral health conditions can be determined by a series of factors that include psychosocial aspects. Therefore, this study aimed to investigate the association between psychosocial aspects and self-reported oral health in Brazilian older adults. METHODS The Brazilian Longitudinal Study of Ageing (ELSI-Brazil) baseline data was analysed to develop this cross-sectional study. The outcome was self-reported oral health, and the psychosocial aspects included neighbourhood trust, life satisfaction and depressive symptoms. The associations were determined through Poisson regression models, controlling for socioeconomic, demographic and behavioural characteristics. RESULTS A total of 9365 individuals with aged 50 years or over were included in this study. Individuals with good life satisfaction had 16% (PR: 0.84; 95% CI: 0.78-0.90) lower prevalence of having poor self-reported oral health. Individuals who have depressive symptoms and do not trust in the neighbourhood presented 17% (PR: 1.17; 95% CI: 1.09-1.25) and 12% (PR: 1.12; 95% CI: 1.04-1.21) higher prevalence of poor self-report oral health compared to those who did not show depressive symptoms and trust the neighbourhood. CONCLUSION Our findings suggest that positive psychosocial aspects are moderately associated with better self-reported oral health. Therefore, we suggest that psychological health and social interaction should be present in public health policy actions.
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Affiliation(s)
- Laura Ramos Manica
- Dentistry Course, Federal University of Santa Maria, Santa Maria, Brazil
| | | | | | | | - Jessye Melgarejo do Amaral Giordani
- Dentistry Course, Federal University of Santa Maria, Santa Maria, Brazil
- Program in Dental Sciences, Federal University of Santa Maria, Santa Maria, Brazil
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do Amaral Júnior OL, Fagundes MLB, Menegazzo GR, do Amaral Giordani JM. The mediating role of social capital in socioeconomic inequalities of oral health behaviours among Brazilian older adults. Community Dent Oral Epidemiol 2023; 51:879-886. [PMID: 35964240 DOI: 10.1111/cdoe.12780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 07/20/2022] [Accepted: 07/27/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Knowledge of the possible pathways linking socioeconomic status (SES) to oral health-related behaviours can improve the understanding of inequalities in oral health. Therefore, in this study, it was investigated whether social capital mediates the relationship between SES and oral health behaviours. METHODS Through a cross-sectional study, data were analysed from participants aged ≥60 years from the Brazilian National Health Survey 2019 (n = 21 575). Structural equation modelling was used to test the direct and indirect pathways from a latent variable for SES to a latent variable for oral health behaviours: daily flossing, toothbrushing frequency and the use of dental care services. RESULTS The maximum likelihood estimator was used for complex samples with robust standard errors, and the final model demonstrated an adequate fit. The findings demonstrated that a higher SES was directly associated with better oral health-related behaviours (standardized coefficient [SC]: 0.82; [90% CI: 0.78-0.85]) and indirectly via structural social capital (SC: 0.05; [90% CI: 0.02-0.07]). The total effect of SES on oral health-related behaviours was (SC: 0.87, [90% CI: 0.85-0.89]). CONCLUSION The findings demonstrate that structural social capital in older Brazilian adults might partly mediate the pathways to socioeconomic inequalities in oral health behaviours. However, there is a direct effect on oral health behaviours, reinforcing the hypothesis that SES is associated with oral health, based on paths that link income inequality to oral health.
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Affiliation(s)
- Orlando Luiz do Amaral Júnior
- Department of Stomatology, School of Dentistry, Universidade Federal de Santa Maria - UFSM, Santa Maria, Brazil
- Department of Oral Health, School of Dentistry, Centro Universitário FAI - UCEFF, Itapiranga, Brazil
| | | | - Gabriele Rissotto Menegazzo
- Department of Stomatology, School of Dentistry, Universidade Federal de Santa Maria - UFSM, Santa Maria, Brazil
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Campagnol PB, do Amaral Júnior OL, Fagundes MLB, Menegazzo GR, Neves M, Maroneze MC, do Amaral Giordani JM. Social capital and dental service use in older Brazilians. Gerodontology 2023; 40:334-339. [PMID: 36151702 DOI: 10.1111/ger.12658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To estimate the prevalence of dental services use and its association with social capital among Brazilian older adults. BACKGROUND Health inequities can be explained by the social determinants of health, which are the social, environmental, cultural and behavioural factors that directly or indirectly affect people's health. Among these determinants is social capital, that seem to affect health behaviours, such as use of dental services among older adults. MATERIALS AND METHODS This was a cross-sectional study using baseline data from the Longitudinal Study of the Health of the Brazilian Elderly, nationally representative of people aged 50 years or older. The baseline survey was carried out between 2015 and 2016, using structured questionnaires. The dependent variable was use of dental services in the last year. The main exposure variable was social capital, assessed through two dimensions: structural and cognitive. The covariates used were sex, skin colour, age, education, wealth, need for dental treatment, self-perception of oral health, tooth loss, type of dental services used, reason for dental care, smoking and alcohol consumption. Descriptive analyses and Poisson regression modelling were used. RESULTS The sample consisted of 9323 individuals. The prevalence of dental services use was 32.6% (95% CI: 30.7-34.5). No associations were found between social capital and the use of dental services. CONCLUSION This study did not find an association between structural and cognitive social capital and dental services use in Brazilian older adults. Further researches using instruments with different assessments of social capital are needed.
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Affiliation(s)
| | | | | | | | - Matheus Neves
- Postgraduate Program in Public Health, Federal University of Rio Grande do Sul - UFRGS, Porto Alegre, Brazil
| | - Marília Cunha Maroneze
- Postgraduate Program in Dental Sciences, Federal University of Santa Maria - UFSM, Santa Maria, Brazil
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do Amaral Júnior OL, Fagundes MLB, Menegazzo GR, Giordani JMDA. Wealth index association with self-reported oral health between white and non-white older Brazilians. CAD SAUDE PUBLICA 2023; 39:e00188122. [PMID: 37377295 PMCID: PMC10494672 DOI: 10.1590/0102-311xen188122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 03/02/2023] [Accepted: 03/30/2023] [Indexed: 06/29/2023] Open
Abstract
This cross-sectional study aimed to identify the association between self-reported oral health status and a wealth index among white and non-white older adults in Brazil. Data from individual assessments of 9,365 Brazilians aged 50 years or older were analyzed. Poisson regression models were performed to estimate the prevalence ratio between wealth index and self-reported oral health among whites and non-whites adjusted for intermediate and proximal determinants. The total prevalence of poor self-reported oral health on white and non-white individuals was 41.6% (95%CI: 40.0-43.4) and 48% (95%CI: 47.1-49.8) respectively. The adjusted analysis showed that, for whites, the wealth index is associated with self-reported oral health since individuals in the 3rd, 4th, and 5th quintiles have 25% (PR = 0.75; 95%CI: 0.65-0.88), 20% (PR = 0.80; 95%CI: 0.67-0.95), and 39% (PR = 0.61; 95%CI: 0.50-0.75) lower prevalence of poor self-reported oral health than those in the poorest quintile. For non-white individuals, the wealth index is associated with self-reported oral health only for those in the 5th quintile, with 25% (PR = 0.85; 95%CI: 0.72-0.99) lower prevalence of poor self-reported oral health than those in the poorest quintile. The wealth index showed different effects on self-reported oral health among whites and non-whites. Socioeconomic status indicators may reflect racial inequalities due to the historical legacy of institutional discrimination. This study highlights the importance of developing policies to combat racial inequities and how these can contribute to better oral health conditions for the older Brazilian population.
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Affiliation(s)
| | | | - Gabriele Rissotto Menegazzo
- Programa de Pós-graduação em Ciências Odontológicas, Universidade Federal de Santa Maria, Santa Maria, Brasil
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Amaral Júnior OLD, Fagundes MLB, Bastos LF, Menegazzo GR, Hugo FN, Abreu LG, Iser BPM, Hilgert JB, Giordani JMDA. Dental visits and depression mediating the association of socioeconomic status with oral health behaviors. Braz Oral Res 2023; 36:e094. [PMID: 36651385 DOI: 10.1590/1807-3107bor-2022.vol36.0094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 03/07/2022] [Indexed: 01/18/2023] Open
Abstract
Determinants of oral diseases include behaviors, which in turn are influenced by a series of social determinants such as psychosocial aspects and dental care services. Therefore, the aim of this study was to investigate whether depressive symptoms and use of dental care services mediate the relationship between socioeconomic status (SES) and oral health behaviors. This was a cross-sectional study that analyzed data from participants in the 2019 National Health Survey (PNS) (n = 88,531). The eligibility criteria were individuals who were 18 years and older and exclusion criterion was living in households located in special or sparsely populated census tracts. Structural equation modeling (SEM) was used to test direct and indirect pathways from a latent variable for SES to oral health through depressive symptoms (assessed through the "Patient Health Questionnaire-9") and use of dental care services. The maximum likelihood estimator for complex samples with the robust standard error was used. The final model presented an adequate fit: RMESA of 0.008, CFI of 0.998, and SMRM of 0.005. The results showed that higher SES was directly associated with better oral health-related behaviors [standardized coefficient (SC): 0.428; p < 0.01] and indirectly through depressive symptoms [(SC): 0.002; p < 0.01] and dental care services [(SC): 0.089; p < 0.01]. The total effect of SES on oral health-related behaviors was equal to [(SC: 0.519 (p < 0.01)]. In conclusion, the findings suggest that high socioeconomic status, mediated by depressive symptoms and dental care services, has a positive effect on oral health.
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Affiliation(s)
- Orlando Luiz do Amaral Júnior
- Universidade Federal de Santa Maria - UFSM, School of Dentistry, Department of Stoatology, Santa Maria, RS, Brazil.,Centro Universitário FAI - UCEF, School of Dentistry, Department of Oral Health, Itapiranga, SC, Brazil
| | | | - Lucelen Fontoura Bastos
- Universidade Federal do Rio Grande do Sul - UFRS, School of Dentistry, Department of Preventive and Social Dentistry, Porto Alegre, RS, Brazil
| | - Gabriele Rissotto Menegazzo
- Universidade Federal de Santa Maria - UFSM, School of Dentistry, Department of Stoatology, Santa Maria, RS, Brazil
| | - Fernando Neves Hugo
- Universidade Federal do Rio Grande do Sul - UFRS, School of Dentistry, Department of Preventive and Social Dentistry, Porto Alegre, RS, Brazil
| | - Lucas Guimarães Abreu
- Universidade Federal de Minas Gerais - UFMG, School of Dentistry, Department of Child and Adolescent Oral Health, Belo Horizonte. MG, Brazil
| | - Betine Pinto Moehlecke Iser
- Universidade do Sul de Santa Catarina - Unisul, Post-Graduate Program in Health Sciences, Tubarão, SC, Brazil
| | - Juliana Balbinot Hilgert
- Universidade Federal do Rio Grande do Sul - UFRS, School of Dentistry, Department of Preventive and Social Dentistry, Porto Alegre, RS, Brazil
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Menegazzo GR, Cunha ARD, Fagundes MLB, Amaral Júnior OLD, Giordani JMDA, Hilgert JB, Abreu LG, Hugo FN. Pathways that explain racial differences on edentulism among older adults: 2019 Brazil National Health Survey. Braz Oral Res 2023; 37:e40. [PMID: 37132727 DOI: 10.1590/1807-3107bor-2023.vol37.0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 04/04/2022] [Indexed: 05/04/2023] Open
Abstract
This study aimed to evaluate the pathways that explain the association between race/skin color and edentulism in elderly Brazilians. This was a cross-sectional study using data from participants aged 60 years or older from the 2019 Brazilian National Health Survey, a nationally representative population-based sample. Data were obtained by a structured interview and participants were classified as edentulous if they reported having lost all natural teeth. Information on race, socioeconomic level, behavioral aspects, psychosocial aspects, and access to dental care was collected by interviewers using a questionnaire. The pathways between race/skin color and edentulism were analyzed using structural equation modeling. The final sample of the study included 22,357 participants. Most participants were white (51.5%; 95% confidence interval [CI]: 50.3-52.6), and 36.8% (95%CI: 35.7-37.9) were edentulous. Race/skin color was indirectly associated with edentulism via enabling factors. These findings suggest that socioeconomic inequalities are key in explaining racial inequalities in edentulism among Brazilian older adults.
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Affiliation(s)
| | - Amanda Ramos da Cunha
- Universidade Federal do Rio Grande do Sul - UFRGS, School of Dentistry , Department of Preventive and Social Dentistry , Porto Alegre , RS , Brazil
| | | | | | | | - Juliana Balbinot Hilgert
- Universidade Federal do Rio Grande do Sul - UFRGS, School of Dentistry , Department of Preventive and Social Dentistry , Porto Alegre , RS , Brazil
| | - Lucas Guimarães Abreu
- Universidade Federal de Minas Gerais - UFMG - School of Dentistry , Department of Child's and Adolescent's Oral Health , Belo Horizonte , MG , Brazil
| | - Fernando Neves Hugo
- Universidade Federal do Rio Grande do Sul - UFRGS, School of Dentistry , Department of Preventive and Social Dentistry , Porto Alegre , RS , Brazil
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Lucas AS, Fagundes MLB, do Amaral OL, Menegazzo GR, Giordani JMDA. Association between integrative and complementary health practices and use of dental services among older adults in Brazil: a cross-sectional study, 2019. Epidemiol Serv Saude 2022; 31:e2022314. [PMID: 36259891 PMCID: PMC9887975 DOI: 10.1590/s2237-96222022000300007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 08/01/2022] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE To analyze association between participation in integrative practices and regular use of dental services in Brazilian older adults. METHODS This was a cross-sectional study based on secondary data from the 2019 National Health Survey. All older adults aged 60 years and over were included. The study outcome was regular dental service use. Poisson regression models were used to estimate crude and adjusted prevalence ratios (PRs) and their respective at confidence intervals 95% (95%CI). RESULTS A total of 22,728 older adults were analyzed. Most were female (55.5%), reported that they were White (51.3%), had incomplete primary education (47.0%); 7.0% (95%CI 6.8;7.5) had used some form of integrative practice and 34.3% (95%CI 33.2;35.4) had used their dental service regularly. Individuals who used integrative practices had higher prevalence of dental service use even after adjusting the model (PR = 1.15; 95%CI 1.07;1.23). CONCLUSION Among Brazilian older adults use of integrative practices was associated with regular use of dental services.
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Affiliation(s)
- Aneiza Simoní Lucas
- Universidade Federal de Santa Maria, Departamento de
Estomatologia, Santa Maria, RS, Brazil
| | | | - Orlando Luiz do Amaral
- Universidade Federal de Santa Maria, Departamento de
Estomatologia, Santa Maria, RS, Brazil
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Fagundes MLB, Amaral Júnior OLD, Menegazzo GR, Bastos LF, Hugo FN, Abreu LG, Iser BPM, Giordani JMDA, Hilgert JB. Pathways of socioeconomic inequalities in self-perceived oral health. Braz Oral Res 2022; 36:e088. [PMID: 35703713 DOI: 10.1590/1807-3107bor-2022.vol36.0088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 02/02/2022] [Indexed: 11/22/2022] Open
Abstract
Although there is a large body of evidence of the influence of social determinants on oral health, information on the mechanisms by which these determinants operate is poorly documented. Therefore, we aimed to investigate the pathways through which socioeconomic inequalities may influence self-perceived oral health (SPOH) in Brazilian adults. This cross-sectional study used data from the National Health Survey (NHS) of 2019, with a representative sample of adults aged 18 to 59 years (n = 65,803). The outcome was SPOH, assessed by a global self-item. Structural equation modeling was used to test direct and indirect pathways connecting a latent variable for socioeconomic position (SEP) to SPOH via psychosocial, behavioral, and biological factors. Higher SEP was directly associated with better SPOH [standardized coefficient (SC) = 0.069; p < 0.01)] fewer depressive symptoms (SC = -0.059; p < 0.01), fewer missing teeth (SC = 0.131; p < 0.01), and more healthy behaviors (SC = 0.643; p < 0.01). Fewer depressive symptoms (SC = -0.141; p < 0.01), more healthy behaviors (SC = 0.242; p < 0.01), and fewer missing teeth (SC = 0.058; p < 0.01) were directly associated with good SPOH. Among specific indirect effects of SEP on SPOH, the behavioral pathway was the one that best explained this association (SC = 0.155). Socioeconomic inequities in SPOH are mediate by psychosocial, behavioral, and biological factors. This has implications for positioning health strategies in the social context in which people live, to facilitate healthy choices and promote good oral health.
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Affiliation(s)
- Maria Laura Braccini Fagundes
- Universidade Federal de Santa Maria - UFSM, School of Dentistry , Department of Dental Sciences , Santa Maria , RS , Brazil
| | - Orlando Luiz do Amaral Júnior
- Universidade Federal de Santa Maria - UFSM, School of Dentistry , Department of Dental Sciences , Santa Maria , RS , Brazil .,Unidade Central de Educação FAI Faculdades - UCEFF , School of Dentistry , Department of Oral Health , Itapiranga , SC , Brazil
| | - Gabriele Rissotto Menegazzo
- Universidade Federal de Santa Maria - UFSM, School of Dentistry , Department of Dental Sciences , Santa Maria , RS , Brazil
| | - Lucelen Fontoura Bastos
- Universidade Federal do Rio Grande do Sul - UFRS, School of Dentistry , Department of Preventive and Social Dentistry , Porto Alegre , RS , Brazil
| | - Fernando Neves Hugo
- Universidade Federal do Rio Grande do Sul - UFRS, School of Dentistry , Department of Preventive and Social Dentistry , Porto Alegre , RS , Brazil
| | - Lucas Guimarães Abreu
- Universidade Federal de Minas Gerais - UFMG, School of Dentistry , Department of Child and Adolescent Oral Health , Belo Horizonte . MG , Brazil
| | - Betine Pinto Moehlecke Iser
- Universidade do Sul de Santa Catarina - Unisul, Post-Graduate Program in Health Sciences , Tubarão , SC , Brazil
| | | | - Juliana Balbinot Hilgert
- Universidade Federal do Rio Grande do Sul - UFRS, School of Dentistry , Department of Preventive and Social Dentistry , Porto Alegre , RS , Brazil
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Fagundes MLB, Amaral Júnior OLD, Menegazzo GR, Hugo FN, Giordani JMDA. Measuring health inequalities: implications of choosing different socioeconomic indicators. CAD SAUDE PUBLICA 2022; 38:e00035521. [PMID: 35107506 DOI: 10.1590/0102-311x00035521] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 07/02/2021] [Indexed: 11/22/2022] Open
Abstract
We aimed to verify the association between different socioeconomic indicators and self-rated health in a nationally representative sample of older adults. This cross-sectional study analyzed the baseline data from the Brazilian Longitudinal Study of Aging (ELSI-Brazil), a population-based cohort study of persons aged 50 years or older. Data was collected using a household and an individual questionnaire at participants' households. Self-rated health was assessed by a global self-rating item. Three socioeconomic indicators were assessed: individual income, per capita household income, and wealth index. Poisson regression models were performed to estimate the prevalence ratio (PR) and 95% confidence intervals (95%CI) of self-rated health and each socioeconomic indicator, adjusting for covariates. In total, 9,390 older adults answered the outcome question. Whilst for the individual income indicator only the richest quintile showed a statistically significant association with the outcome (PR: 0.90; 95%CI: 0.87; 0.93), for the per capita household income, the fourth (PR: 0.95; 95%CI: 0.91; 0.98) and the fifth quintiles (PR: 0.90; 95%CI: 0.86; 0.94) remained associated with the outcome. Regarding the wealth index, only the second quintile was not associated with the outcome, with lower prevalence of poor self-rated health as richer was the quintile, showing a social gradient. The wealth index seems to be a more adequate indicator, as it reflects resources accumulated over the life course.
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Affiliation(s)
| | | | - Gabriele Rissotto Menegazzo
- Programa de Pós-graduação em Ciências Odontológicas, Universidade Federal de Santa Maria, Santa Maria, Brasil
| | - Fernando Neves Hugo
- Departamento de Odontologia Preventiva e Social, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil
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Menegazzo GR, Fagundes MLB, do Amaral Junior OL, de Vasconcellos NBT, Felin CM, de Camargo FD, do Amaral Giordani JM. Pathways Between Religiosity and Tooth Loss in Older Adults in Brazil. J Relig Health 2022; 61:552-563. [PMID: 34037909 DOI: 10.1007/s10943-021-01291-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/17/2021] [Indexed: 06/12/2023]
Abstract
The aim of this cross-sectional study was to evaluate the direct and indirect pathways between religiosity and tooth loss in older adults from Brazil. We analyzed the data of the Brazilian Longitudinal Study of Aging, a nationally representative study of individuals aged 50 years or older. The pathways were analyzed through structural equation modeling. A total of 9073 individuals were evaluated. It was observed that oral hygiene and smoking were mediators of the relationship between religiosity and tooth loss, through spirituality and social support, respectively. Spirituality also directly influenced the tooth loss.
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Affiliation(s)
- Gabriele Rissotto Menegazzo
- Department of Stomatology, Postgraduate Program in Dental Sciences, Federal University of Santa Maria, Av. Roraima, 1000, UFSM, University City Building 26F, Dentistry. Camobi, Santa Maria, RS, 97105-900, Brazil.
| | - Maria Laura Braccini Fagundes
- Department of Stomatology, Postgraduate Program in Dental Sciences, Federal University of Santa Maria, Av. Roraima, 1000, UFSM, University City Building 26F, Dentistry. Camobi, Santa Maria, RS, 97105-900, Brazil
| | - Orlando Luiz do Amaral Junior
- Department of Stomatology, Postgraduate Program in Dental Sciences, Federal University of Santa Maria, Av. Roraima, 1000, UFSM, University City Building 26F, Dentistry. Camobi, Santa Maria, RS, 97105-900, Brazil
| | - Natália Boessio Tex de Vasconcellos
- Department of Stomatology, Postgraduate Program in Dental Sciences, Federal University of Santa Maria, Av. Roraima, 1000, UFSM, University City Building 26F, Dentistry. Camobi, Santa Maria, RS, 97105-900, Brazil
| | - Carolina Marchesan Felin
- Department of Stomatology, Postgraduate Program in Dental Sciences, Federal University of Santa Maria, Av. Roraima, 1000, UFSM, University City Building 26F, Dentistry. Camobi, Santa Maria, RS, 97105-900, Brazil
| | - Fernanda Dalmolin de Camargo
- Department of Stomatology, Postgraduate Program in Dental Sciences, Federal University of Santa Maria, Av. Roraima, 1000, UFSM, University City Building 26F, Dentistry. Camobi, Santa Maria, RS, 97105-900, Brazil
| | - Jessye Melgarejo do Amaral Giordani
- Department of Stomatology, Postgraduate Program in Dental Sciences, Federal University of Santa Maria, Av. Roraima, 1000, UFSM, University City Building 26F, Dentistry. Camobi, Santa Maria, RS, 97105-900, Brazil
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Hugo FN, Bailey JA, Stein C, da Cunha AR, Iser BPM, Malta DC, Giordani JMDA, Hilgert JB, Abreu LG, Kassebaum NJ. Prevalence, incidence, and years-lived with disability due to oral disorders in Brazil: an analysis of the Global Burden of Disease Study 2019. Rev Soc Bras Med Trop 2022; 55:e0284. [PMID: 35107534 PMCID: PMC9009423 DOI: 10.1590/0037-8682-0284-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 08/16/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Epidemiological surveys revealed that Brazil has a high burden of oral diseases. However, no prior study has reported estimates of untreated dental caries, periodontitis, and edentulism over a three-decade period. The objective of this study is to report the trends of prevalence, incidence, and years-lived with disability (YLDs) due to untreated dental caries in primary and permanent teeth, periodontitis, and edentulism in Brazil between 1990 and 2019. METHODS Estimates of prevalence, incidence, and YLDs due to dental caries in primary and permanent teeth, periodontitis, and edentulism were produced for Brazil, by sex and age, between 1990 and 2019, using Dismod-MR 2.1, as part of the Global Burden of Disease Study 2019 (GBD 2019). Trends of oral disorders were analyzed using generalized linear regression models applying the Prais-Winsten method. RESULTS Almost 100 million Brazilians presented at least one oral disorder in 2019, which was equivalent to a prevalence of 45.3%. All oral diseases combined ranked eighth among all causes of disability, causing more than 970,000 YLDs. Untreated dental caries in primary teeth were estimated to affect 13.5 million children, and untreated dental caries in permanent teeth affected more than 52 million people. Periodontitis affected 29.5 million people, and edentulism affected almost 22 million. The generalized linear regression models revealed a trend of stability of oral disorders between 1990 and 2019. CONCLUSIONS The burden of oral diseases in Brazil is extremely high. Oral disorders, edentulism in particular, caused disability at levels that are comparable to other important chronic diseases.
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Affiliation(s)
- Fernando Neves Hugo
- Universidade Federal do Rio Grande do Sul, Departamento de Odontologia Preventiva e Social, Porto Alegre, RS, Brasil
| | - Jordan A Bailey
- University of Washington, Institute of Health Metrics and Evaluation, Seattle, WA, USA
| | - Caroline Stein
- Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação em Epidemiologia, Porto Alegre, RS, Brasil
| | - Amanda Ramos da Cunha
- Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação em Odontologia, Porto Alegre, RS, Brasil
| | | | - Deborah Carvalho Malta
- Universidade Federal de Minas Gerais, Departamento de Saúde Materno-Infantil e Saúde Pública, Belo Horizonte, MG, Brasil
| | | | - Juliana Balbinot Hilgert
- Universidade Federal do Rio Grande do Sul, Departamento de Odontologia Preventiva e Social, Porto Alegre, RS, Brasil
| | - Lucas Guimarães Abreu
- Universidade Federal de Minas Gerais, Departamento de Saúde Bucal da Criança e do Adolescente, Belo Horizonte, MG, Brasil
| | - Nicholas J Kassebaum
- University of Washington, Institute of Health Metrics and Evaluation, Seattle, WA, USA
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Fagundes MLB, Bastos LF, Amaral Júnior OLD, Menegazzo GR, Cunha ARD, Stein C, Abreu LG, Hugo FN, Giordani JMDA, Malta DC, Iser BPM. Socioeconomic inequalities in the use of dental services in Brazil: an analysis of the 2019 National Health Survey. Rev Bras Epidemiol 2021; 24:e210004. [PMID: 34910058 DOI: 10.1590/1980-549720210004.supl.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 06/25/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To describe the prevalence of use of dental services in Brazil according to states and the Federal District and its relationship with socioeconomic variables and types of services, based on the 2019 National Health Survey. METHODS This is a cross-sectional population-based study using data from the 2019 National Health Survey, which included 88,531 participants aged 18 or older. We assessed variables related to the use of dental health services according to sociodemographic and behavioral characteristics through multivariate analysis, using a Poisson regression model with robust variance. RESULTS The use of dental services in the year prior to the interview was higher among adults (53.2%, confidence interval - 95%CI 52.5-53.9) than older adults (34.3%, 95%CI 33.2-34.4). The multivariate analysis revealed that the use of dental services was greater in people with better schooling (prevalence ratio - PR=2.02, 95%CI 1.87-2.18) and higher income (PR=1.54, 95%CI 1.45-1.64). States from the Southeast, Midwest, and South regions presented the highest percentages of individuals who visited a dentist in the previous year - between 49.0 and 57.6% of the population. CONCLUSION Inequalities were found in the use of dental health services among the adult and older adult population, with regional differences; the use was higher among women, younger individuals, those with better schooling, higher income, healthier behaviors, better self-perceived oral health status, and who paid for their last dental treatment.
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Affiliation(s)
| | - Lucelen Fontoura Bastos
- Post-Graduate Program in Dentistry, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brazil
| | | | | | - Amanda Ramos da Cunha
- Post-Graduate Program in Dentistry, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brazil
| | - Caroline Stein
- Post-Graduate Program in Epidemiology, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brazil
| | - Lucas Guimarães Abreu
- School of Dentistry, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brazil
| | - Fernando Neves Hugo
- Department of Preventive and Social Dentistry, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brazil
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do Amaral Júnior OL, Braccini Fagundes ML, Menegazzo GR, Melgarejo do Amaral Giordani J. Individual social capital and dental pain in older adults. Gerodontology 2021; 39:320-326. [PMID: 34545594 DOI: 10.1111/ger.12589] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/24/2021] [Accepted: 09/05/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To investigate the association between the structural and cognitive dimensions of social capital and dental pain in Brazilian adults aged 50 years and over. METHODS This cross-sectional study conducted individual assessments of 6154 Brazilians aged 50 years or older. Four individual variables based on structural and cognitive dimensions of social capital were assessed. We used hierarchical logistic regression models to estimate the odds ratio for dental pain with individual structural and cognitive social capital variables adjusted for associated factors. The model followed hypothetical pathways linking social capital to oral health. RESULTS Cognitive social capital was associated with dental pain. Participants who did not trust their neighbourhood had a 28% greater chance (OR, 1.28; 95% CI, 1.02-1.60) of dental pain than those who did. CONCLUSION Elements of cognitive dimension of social capital, particularly trust, reciprocity and support, as part of a common risk factor approach, should be considered when planning oral health promotion and preventive activities for older people.
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Gonçalves KF, Menegazzo GR, Hilgert JB, Hugo FN, Giordani JMDA. [Contextual and individual factors associated with dissatisfaction with dental care in Brazil]. Cien Saude Colet 2021; 26:3715-3724. [PMID: 34468665 DOI: 10.1590/1413-81232021269.2.04162020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 04/05/2020] [Indexed: 11/21/2022] Open
Abstract
The scope of this study was to evaluate the influence of contextual and individual factors associated with dissatisfaction of users of the Unified Health System (SUS) with the care provided by dentists in Primary Health Care. It is a cross-sectional and multilevel study, based on secondary data derived from a national basic research project to assess user satisfaction with the SUS. Data were collected by the Ombudsman's Department of the SUS by telephone contact with a sample of 35,393 individuals from around the country. Contextual and individual variables were associated with dissatisfaction with the dental service provided by the SUS. For the analysis, Stata version 11.0 software was used together with multilevel random effects logistic regression. A total of 2,331 individuals from 61 municipalities were included in the final sample of satisfaction with the dental service. Only 43% of the participants reported that their claims had been resolved, and a seven times greater chance of dissatisfaction was perceived for those individuals who had unresolved demand in relation to those who resolved it. This research provides input that can subsidize the government in actions aimed at improving access and quality of care provided in dental care.
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Affiliation(s)
- Katiéli Fagundes Gonçalves
- Programa de Pós-Graduação em Odontologia, Universidade Federal do Rio Grande do Sul. R. Ramiro Barcelos 2492, Santa Cecília. 90035-003 Porto Alegre RS Brasil.
| | - Gabriele Rissotto Menegazzo
- Programa de Pós-Graduação em Ciências Odontológicas, Universidade Federal de Santa Maria. Santa Maria RS Brasil
| | - Juliana Balbinot Hilgert
- Programa de Pós-Graduação em Odontologia, Universidade Federal do Rio Grande do Sul. R. Ramiro Barcelos 2492, Santa Cecília. 90035-003 Porto Alegre RS Brasil.
| | - Fernando Neves Hugo
- Programa de Pós-Graduação em Odontologia, Universidade Federal do Rio Grande do Sul. R. Ramiro Barcelos 2492, Santa Cecília. 90035-003 Porto Alegre RS Brasil.
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Amaral Júnior OLD, Menegazzo GR, Fagundes MLB, Tomazoni F, Giordani JMDA. Impact of adopting different socioeconomic indicators in older adults' oral health research. Braz Oral Res 2021; 35:e040. [PMID: 33909862 DOI: 10.1590/1807-3107bor-2021.vol35.0040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 12/08/2020] [Indexed: 12/23/2022] Open
Abstract
This study aimed to evaluate the influence of choosing different socioeconomic status indicators in research regarding older adults' oral health. This is a cross-sectional study that analyzed baseline data from the Brazilian Longitudinal Study on Aging (ELSI-Brazil). The outcomes were edentulism (n = 9,073) and self-reported oral health (n = 9,365). The following socioeconomic indicators were assessed: individual income, per capita household income, and wealth index. Poisson regression analysis with robust variance was performed to estimate prevalence ratios (PR), with their respective 95% confidence intervals (CI), after adjusting for socioeconomic and oral health behavior variables. Absolute inequality measures were also estimated. The individual income indicator was not statistically associated with the results after adjustments. When using per capita household income indicator, individuals in the richest quintile showed a 12% lower prevalence of poor self-reported oral health [PR: 0.88 (CI: 0.78-0.98)], relative to the poorest, and there was no association with edentulism. When the wealth index was chosen, there was a 22% lower prevalence of edentulism [PR: 0.78 (CI: 0.64-0.94)] and 15% lower prevalence of self-reported poor oral health [PR: 0.85 (CI: 0.78-0.93)] in individuals of the richest quintile, both relative to the poorest quintile. Regarding absolute inequality measures, for edentulism, the wealth index showed the highest absolute inequality. When considering self-reported oral health, per capita household income showed the greatest absolute inequality. Despite scientific challenges and the difficulty of socioeconomic indicator metrics, further investments in its development are critical to measure, promote, and improve population oral health.
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Affiliation(s)
| | - Gabriele Rissotto Menegazzo
- Universidade Federal de Santa Maria - UFSM, Postgraduate Program in Dental Sciences, Santa Maria, RS, Brazil
| | | | - Fernanda Tomazoni
- Universidade Federal de Santa Maria - UFSM, Postgraduate Program in Dental Sciences, Santa Maria, RS, Brazil
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do Amaral Júnior OL, Menegazzo GR, Fagundes MLB, Campagnol PB, Giordani JMDA. Social capital and self-reported oral health at baseline of the brazilian longitudinal study of aging. Community Dent Oral Epidemiol 2020; 49:249-255. [PMID: 33191497 DOI: 10.1111/cdoe.12596] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 10/23/2020] [Accepted: 10/28/2020] [Indexed: 02/01/2023]
Abstract
OBJECTIVES This cross-sectional study aimed to estimate the association between the structural and cognitive dimensions of social capital and self-reported oral health. METHODS This study conducted individual assessments of 9,365 individuals aged 50 years or older from Brazil. Four individual variables based on structural and cognitive dimensions of social capital were assessed. We used hierarchical Poisson regression models to estimate the prevalence ratio of self-reported oral health with individual structural and cognitive social capital variables adjusted for associated factors. RESULTS Cognitive social capital was associated with self-reported oral health. Individuals who reported lack of neighbourhood trust and not having friends presented 14% (RP: 1.14; 95% CI: 1.07-1.21) and 9% (RP: 1.09; 95% CI: 1.01-1.19), respectively, higher prevalence of poor self-reported oral health, relative to those who trust in their neighbourhood and reported having friends. CONCLUSION The cognitive dimension of social capital may be linked with self-reported oral health. Therefore, social capital can be stimulated in the context of social policies as its encouragement can be an efficient tool for improving individuals' health and, consequently, the oral health of the older people.
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Giordani JMDA, Amaral Júnior OLD, Hugo FN, Hilgert JB. Factors associated with service user embracement by Primary Health Care teams in Brazil, 2012: a cross-sectional study. ACTA ACUST UNITED AC 2020; 29:e2019468. [PMID: 33146321 DOI: 10.1590/s1679-49742020000500017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 06/26/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To evaluate prevalence and factors associated with service user embracement by Primary Health Care teams in Brazil. METHODS This is a cross-sectional study that included teams that took part in the 2012 National Program for Primary Health Care Access and Quality Improvement (PMAQ-AB) (Cycle I). The outcome used was 'user embracement by the health team'. The independent variables were macro-region, municipal profile, Gini index and Family Health Strategy population coverage, team meetings, study of spontaneous demand, consideration of user opinions and existence of continuing education. Multilevel Poisson regression analysis was performed. RESULTS The sample consisted of 13,751 teams. User embracement prevalence was 78.3% (95%CI 77.6;79.1). In the hierarchical analysis, the highest prevalence of user embracement was found among Southern region teams (PR=1.37 - 95%CI 1.27;1.48) taking the Northeast region as a reference. CONCLUSION There is an uneven distribution of Primary Care teams practicing user embracement in Brazil, possibly associated with regional inequalities.
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Affiliation(s)
| | | | - Fernando Neves Hugo
- Universidade Federal do Rio Grande do Sul, Faculdade de Odontologia, Porto Alegre, RS, Brasil
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Junior OLDA, Menegazzo GR, Fagundes MLB, de Sousa JL, Tôrres LHDN, Giordani JMDA. Perceived discrimination in health services and preventive dental attendance in Brazilian adults. Community Dent Oral Epidemiol 2020; 48:533-539. [DOI: 10.1111/cdoe.12565] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 06/24/2020] [Accepted: 07/06/2020] [Indexed: 11/27/2022]
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Condessa AM, Giordani JMDA, Neves M, Hugo FN, Hilgert JB. Barriers to and facilitators of communication to care for people with sensory disabilities in primary health care: a multilevel study. Rev Bras Epidemiol 2020; 23:e200074. [PMID: 32638857 DOI: 10.1590/1980-549720200074] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 01/07/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE Communication barriers are the main obstacle for people with sensory disabilities (visual and hearing) to access health services. This study aims to describe the presence of facilitators of communication of basic health units in Brazil and to verify its associated factors. METHODS Cross-sectional multilevel study, of 38,811 health units in 5,543 municipalities between 2012 and 2013, collected in the National Program for Improving Access and Quality in Primary Care (Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica - PMAQ-AB). The outcome was defined by grouping facilitators of communication (braille material; hearing resources; visual communication; accessible list of service; professionals to welcome users with sensory disabilities). The two levels were structured, using the variables: level I (contextual): macro region, population size, and GDP per capita; and level II (service): extended professional team (psychologist/social worker); service shifts; welcoming room; publishing of service hours; presence of physical access facilitators. Multilevel Poisson regression with hierarchical modeling was used in both stages. RESULTS The presence of facilitators of communication is small in Brazilian health units (32.1%). It is more frequent in the municipalities with a higher GDP (RP = 1.02, 95%CI 0.92 - 1.12) and population size (RP = 1.25, 95%CI 1.02 - 1.52). CONCLUSION Welcoming users is the main access facilitator and should be the focus of initiatives to improve health care for disabled persons. Universal access with adequate services, removal of communication barriers and encouragement to properly welcome users must be promoted.
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Affiliation(s)
| | | | - Matheus Neves
- Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
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Do Amaral Júnior OL, Fagundes MLB, Menegazzo GR, Tôrres LHDN, Giordani JMDA. AVALIAÇÃO DOS SERVIÇOS DE SAÚDE BUCAL NA ATENÇÃO PRIMÁRIA À SAÚDE: PERSPECTIVAS REGIONAIS COM BASE NO PMAQ. TEMPUS 2020. [DOI: 10.18569/tempus.v14i1.2618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objetivo: O objetivo do estudo foi analisar o perfil epidemiológico da assistência odontológica dos municípios da 4ª Coordenadoria Regional de Saúde do Rio Grande do Sul (4ª CRS/RS) a partir dos dados gerados no 2ª ciclo do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB). Metodologia: Trata-se de um estudo observacional transversal utilizando como instrumento os microdados da avaliação externa do PMAQ-AB divididos nas dimensões de estrutura das unidades básicas, processo de trabalho das equipes de atenção à saúde bucal e usuários do serviço. Dos 32 municípios pertencentes à 4ª CRS/RS, 21 aderiram ao programa e fazem parte deste estudo, sendo que estes são divididos em duas regiões de saúde. Esse estudo foi aprovado pelo Comitê de Ética em Pesquisa da Universidade Federal de Santa Maria e a análise estatística dos dados foi realizada através do programa Stata 14.0, onde foram realizadas análises de frequência para variáveis selecionadas. Resultados: Participaram da avaliação 56 Unidades de Atenção Básica, 44 equipes de saúde bucal e 261 usuários do serviço de atenção básica e com isso observamos que, apesar da maioria das unidades possuírem atendimento odontológico com agendamento e capacidade de resolução dos casos, a maioria dos usuários não o utilizam. Conclusão: Com estes resultados almejamos desencadear processos que tragam melhorias para as unidades, equipes e usuários da atenção básica no que tange o planejamento, organização e cuidado em saúde e concluímos que este tipo de avaliação se mostra importante para o desenvolvimento de ações de saúde pública.
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Braccini Fagundes ML, Do Amaral Júnior OL, Soares Krassmann A, Bastianello Campagnol P, Rissotto Menegazzo G, Do Nascimento Tôrres LH, Melgarejo do Amaral Giordani J. BAIXA COBERTURA DE SAÚDE BUCAL: COMO POTENCIALIZAR O CUIDADO? TEMPUS 2020. [DOI: 10.18569/tempus.v14i1.2624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objetivo: Este estudo trata-se de um relato de experiência acerca de um programa da prefeitura da cidade de Santa Maria, sul do Brasil, vinculado à um projeto de extensão denominado Sorria Santa Maria que teve seu início em 2017 e permanece em andamento. Nosso objetivo com isso foi, além de contribui com os usuários que têm dificuldade em acessar os atendimentos odontológicos na atenção básica, promover e demonstrar as práticas em saúde coletiva, construídas em diferentes processos de trabalho e estreitamente ligadas a estruturas da sociedade. Relato de experiência: O programa destina-se aos usuários do Sistema Único de Saúde do município que não conseguem acessar as Unidades Básicas de Saúde, devido à baixa cobertura de saúde bucal municipal e às funções profissionais exercidas durante horário comercial pelos usuários. Os agendamentos são realizados segundo uma lista de espera com o contato de pacientes que manifestaram desejo de uma avaliação odontológica. Nas consultas, realiza-se então acolhimento, avaliação e atendimento destes pacientes até a conclusão do plano de tratamento. Conclusão: Importantes impactos foram alcançados até o presente momento, tanto em relação ao expressivo número de atendimentos odontológicos realizados quanto à redução das listas de espera para atendimento odontológico. Além disto, ressaltam-se que as ações de promoção de saúde ligadas ao projeto resultam em uma maior integração entre ensino-serviço-comunidade no município.
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Neves M, Giordani JMDA, Hugo FN. [Primary dental healthcare in Brazil: the work process of oral health teams]. Cien Saude Colet 2019; 24:1809-1820. [PMID: 31166514 DOI: 10.1590/1413-81232018245.08892017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 07/28/2017] [Indexed: 11/22/2022] Open
Abstract
Ensuring access to dental care services requires the development of healthsurveillance practices to ensure comprehensive health care. The objective of this study was toinvestigate the association between social and economic indicators of Brazilian municipalities, work process characteristics, and performance of a list of curative dental procedures by oral health teams. It involved an exploratory, cross-sectional study withmulticenter data collection from 11,374 oral health teams assessed by the National Program for Improvement of Access to and Quality of Primary Healthcare. Multilevel Poisson regression was used to obtain the prevalence of curative dental procedures, which was 69.51%. The social/economic and work variables that remained associated with the outcome included municipalities in which the proportion of primary care-sensitive admissions was below 28% and that of tooth extractions below 8%; and oral health teams classified as type II (including oral health assistant and technician) that had different materials available and better work processes. This multilevel analysis, which took into consideration the performance of curative dental care in Brazil, reveals a worrying oral healthcare scenario.
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Affiliation(s)
- Matheus Neves
- Departamento de Odontologia Preventiva e Social, Faculdade de Odontologia, Universidade Federal do Rio Grande do Sul. R. Ramiro Barcelos 2492, Santa Cecília. 90035-004 Porto Alegre RS
| | | | - Fernando Neves Hugo
- Departamento de Odontologia Preventiva e Social, Faculdade de Odontologia, Universidade Federal do Rio Grande do Sul. R. Ramiro Barcelos 2492, Santa Cecília. 90035-004 Porto Alegre RS
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Gonçalves KF, Giordani JMDA, Bidinotto AB, Ferla AA, Martins AB, Hilgert JB. [Oral healthcare utilization during prenatal care in primary healthcare: data from PMAQ-AB]. Cien Saude Colet 2018; 25:519-532. [PMID: 32022192 DOI: 10.1590/1413-81232020252.05342018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 06/22/2018] [Indexed: 11/22/2022] Open
Abstract
The aim was to evaluate the prevalence of utilization of prenatal oral health services and its associated factors, through data from Cycle I (2011-12) and II (2013-14) of PMAQ-AB. This was cross-sectional study with 4,340 women (Cycle I) and 6,209 women (Cycle II), with outcome of utilization oral health service in prenatal care. Multilevel Poisson regression was used for obtain prevalence ratios (PR). In Cycle I, the prevalence of prenatal oral health service utilization was 45.9% and 51.9% in cycle II. In cycle I, large municipalities (PR = 1.35; 95%CI 1.05-1.81), income ranging from 1 to 2 minimum wages (PR = 1.13; 95%CI 1.03-1.25), age ranging from 31 to 40 years old (PR = 1.33, 95%CI 1.15-1.54) and registry of dental appointments (PR = 1.17; 95%CI 1.06-1.29) they were associated with the outcome. In cycle II, southeast region (PR = 1.18; 95%CI 1.03-1.36), high oral healthcare coverage (PR = 1.11; 95%CI 1.01-1.22), age ranging from 31 to 40 years old (PR = 1.22; 95%CI 1.09-1.36), the health workers enrollment in permanent education actions (PR = 1.14; 95%CI 1.01-1.30) and opening times that match the user's needs (PR = 1.40; 95%CI 1.25-1.57) they were associated with the outcome. The individual factors and factors related to the organization of the healthcare service are associated with oral healthcare utilization during prenatal care.
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Affiliation(s)
- Katiéli Fagundes Gonçalves
- Programa de Pós-Graduação em Odontologia, Universidade Federal do Rio Grande do Sul. R. Ramiro Barcelos 2492, Rio Branco. 90035-003, Porto Alegre, RS, Brasil.
| | | | - Augusto Bacelo Bidinotto
- Programa de Pós-Graduação em Odontologia, Universidade Federal do Rio Grande do Sul. R. Ramiro Barcelos 2492, Rio Branco. 90035-003, Porto Alegre, RS, Brasil.
| | - Alcindo Antônio Ferla
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal do Rio Grande do Sul. Porto Alegre, RS, Brasil
| | - Aline Blaya Martins
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal do Rio Grande do Sul. Porto Alegre, RS, Brasil
| | - Juliana Balbinot Hilgert
- Programa de Pós-Graduação em Odontologia, Universidade Federal do Rio Grande do Sul. R. Ramiro Barcelos 2492, Rio Branco. 90035-003, Porto Alegre, RS, Brasil.
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Braga A, Biscaro A, do Amaral Giordani JM, Viggiano M, Elias KM, Berkowitz RS, Seckl MJ. Does a human chorionic gonadotropin level of over 20,000 IU/L four weeks after uterine evacuation for complete hydatidiform mole constitute an indication for chemotherapy for gestational trophoblastic neoplasia? Eur J Obstet Gynecol Reprod Biol 2018; 223:50-55. [PMID: 29477553 DOI: 10.1016/j.ejogrb.2018.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 01/22/2018] [Accepted: 02/01/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To evaluate whether a human chorionic gonadotropin (hCG) level ≥20,000 IU/L four weeks after uterine evacuation for complete hydatidiform mole (CHM) is an appropriate indicator for initiating chemotherapy for the treatment of gestational trophoblastic neoplasia (GTN). STUDY DESIGN Historical database review of 1228 women with CHM who received treatment and follow-up between January 2000 and June 2013 at four Brazilian trophoblastic disease centers. The primary outcome measure was the progression from CHM to GTN. The secondary outcomes were the occurrence of uterine perforation, staging of GTN, WHO/FIGO risk score, and treatment (use of single- or multiagent chemotherapy). RESULTS An hCG level ≥20,000 IU/L four weeks after uterine evacuation for CHM, while occurring in only 6.1% of women, was the most important risk factor for the development of postmolar GTN (adjusted RR = 5.83; p < 0.01; CI: 3.47-9.79), with a sensitivity of 36.8%, a specificity of 98.6%, a positive predictive value of 80%, and a negative predictive value of 91.1%. On the other hand, there were no differences in postmolar GTN stage, prognostic score, or need for multiagent chemotherapy relative to hCG level ≥20,000 IU/L versus <20,000 IU/L. CONCLUSIONS Although hCG level ≥20,000 IU/L four weeks after uterine evacuation for CHM was very predictive of development of post-molar GTN, delay in treatment until hCG plateau or increase did not affect outcomes, with no uterine perforations or treatment failures.
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Affiliation(s)
- Antonio Braga
- Postgraduate Program in Perinatal Health, Rio de Janeiro Trophoblastic Disease Center, Maternity School, Federal University of Rio de Janeiro and Antonio Pedro University Hospital at Fluminense Federal University, Rio de Janeiro, Brazil; Postgraduate Program in Maternal and Child Health, Fluminense Federal University, Niterói, Brazil.
| | - Andressa Biscaro
- Postgraduate Program in Maternal and Child Health, Fluminense Federal University, Niterói, Brazil
| | | | - Maurício Viggiano
- Goiás Trophoblastic Disease Center, Goiás Federal University, Goiânia, Brazil
| | - Kevin M Elias
- New England Trophoblastic Disease Center, Donald P. Goldstein, MD. Trophoblastic Tumor Registry, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Brigham and Women's Hospital, Dana Farber Cancer Institute/Harvard Cancer Center, Harvard Medical School, Boston, United States
| | - Ross S Berkowitz
- New England Trophoblastic Disease Center, Donald P. Goldstein, MD. Trophoblastic Tumor Registry, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Brigham and Women's Hospital, Dana Farber Cancer Institute/Harvard Cancer Center, Harvard Medical School, Boston, United States
| | - Michael J Seckl
- Charing Cross Gestational Trophoblastic Disease Centre, Charing Cross Hospital, Imperial College of London, London, UK
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Rech RS, Hugo FN, Giordani JMDA, Passero LG, Hilgert JB. Contextual and individual factors associated with dissatisfaction with public emergency health services in Brazil, 2011-2012. CAD SAUDE PUBLICA 2018; 34:e00175416. [DOI: 10.1590/0102-311x00175416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 04/25/2017] [Indexed: 11/22/2022] Open
Abstract
The Brazilian network of emergency care, in recent years, has shown significant progress. The objective was to evaluate contextual and individual factors associated with the satisfaction with public emergency health services. This was a cross-sectional multilevel study carried out between June 2011 and January 2012. Data were collected via telephone at the ombudsman’s office of the Brazilian Unified National Health System (SUS). Telephone numbers were randomly selected from a telephone company database. Health services, socioeconomic, and individual demographic variables were evaluated, in addition to information about the municipalities. The outcome variable was dissatisfaction with public emergency health services in Brazil. Multilevel logistic regression was performed and 7,027 individuals from 61 municipalities answered the survey. The prevalence of perceived dissatisfaction was 48.1% (95%CI: 46.9-49.3). Variables that remained significantly associated with the outcome are: age up to 20 years, 16 or more years of education, lives in the Central region, non-resolved demands, longer waiting times, and accessing emergency in a primary care service. Prevalence of a perceived dissatisfaction is predominantly associated with care’s waiting time and the length needed to resolve the demand.
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Hilgert JB, Giordani JMDA, de Souza RF, Wendland EMDR, D'Avila OP, Hugo FN. Interventions for the Management of Denture Stomatitis: A Systematic Review and Meta-Analysis. J Am Geriatr Soc 2016; 64:2539-2545. [DOI: 10.1111/jgs.14399] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Juliana Balbinot Hilgert
- Postgraduate Program in Dentistry; Federal University of Rio Grande do Sul; Porto Alegre Brazil
- Postgraduate Program in Epidemiology; Federal University of Rio Grande do Sul; Porto Alegre Brazil
| | | | - Raphael Freitas de Souza
- Department of Dental Materials and Prosthetics; University of São Paulo; Ribeirão Preto Brazil
- Division of Oral Health and Society; McGill University; Montreal Québec Canada
| | | | - Otavio Pereira D'Avila
- Postgraduate Program in Dentistry; Federal University of Rio Grande do Sul; Porto Alegre Brazil
| | - Fernando Neves Hugo
- Postgraduate Program in Dentistry; Federal University of Rio Grande do Sul; Porto Alegre Brazil
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Passero LG, Giordani JMDA, Hugo FN, Torman VBL, Camey SA, Hilgert JB. Contextual and individual factors associated with dissatisfaction with the Brazilian Unified National Health System, 2011-2012. CAD SAUDE PUBLICA 2016; 32:e00065015. [PMID: 27783752 DOI: 10.1590/0102-311x00065015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 10/24/2015] [Indexed: 11/22/2022] Open
Abstract
User satisfaction is known to be related to quality of healthcare. The aim of this study was to evaluate the influence of contextual and individual factors associated with user dissatisfaction with the Brazilian Unified National Health System (SUS). This was a cross-sectional multilevel study. Data were collected via telephone by the ombudsman's office of the SUS. Telephone numbers were randomly selected from a telephone company database. Health services, socioeconomic, and individual demographic variables were evaluated, in addition to information on the municipalities. The outcome variable was dissatisfaction with the SUS. Hierarchical multilevel logistic regression was used, and 18,673 individuals were contacted. Prevalence of dissatisfaction was 63.4% (95%CI: 62.7-64.1). Unmet demand (OR = 3.66), waiting time > 4 hours (OR = 2.82), and number of Primary Healthcare Units (OR = 0.89) were associated statistically with dissatisfaction. Characteristics of the health teams' work process showed a strong association with dissatisfaction.
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Affiliation(s)
- Lúcia Gimenes Passero
- Programa de Pós-graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil
| | | | - Fernando Neves Hugo
- Programa de Pós-graduação em Odontologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil
| | - Vanessa Bielefeldt Leotti Torman
- Programa de Pós-graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil.,Departamento de Estatística, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil
| | - Suzi Alves Camey
- Programa de Pós-graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil.,Departamento de Estatística, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil
| | - Juliana Balbinot Hilgert
- Programa de Pós-graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil
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Koltermann AP, Giordani JMDA, Pattussi MP. The association between individual and contextual factors and functional dentition status among adults in Rio Grande do Sul State, Brazil: a multilevel study. CAD SAUDE PUBLICA 2011; 27:173-82. [PMID: 21340116 DOI: 10.1590/s0102-311x2011000100018] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2009] [Accepted: 06/07/2010] [Indexed: 11/21/2022] Open
Abstract
Functional dentition plays an important role in maintaining masticatory function, which is closely related to the number of teeth present in the mouth. The objective of this study was to investigate the association between individual and contextual factors and functional dentition (defined as the presence of at least 20 teeth) in Brazilian adults. This was a multilevel cross-sectional population-based study with a two-level structure and a total sample of 10,407 adults from 84 municipalities (counties). The exposures at both levels were demographic, socioeconomic, and oral health treatment-related. Multivariate analyses showed that higher prevalence rates of functional dentition were associated (p < 0.01) with municipalities having higher mean income and fluoridated water supply and with individuals living in urban areas, younger adults, males, those with more schooling and higher income, those that reported having visited the dentist in the previous 12 months, and those with access to information on prevention. The findings suggest that research on tooth loss and functional dentition should take different socioeconomic factors into account.
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Affiliation(s)
- Annie Pozeczek Koltermann
- Programa de Pós-graduação em Saúde Coletiva, Universidade do Vale do Rio dos Sinos, São Leopoldo, Brasil
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Giordani JMDA, de Slavutzky SMB, Koltermann AP, Pattussi MP. Inequalities in prosthetic rehabilitation among elderly people: the importance of context. Community Dent Oral Epidemiol 2010; 39:230-8. [PMID: 21070321 DOI: 10.1111/j.1600-0528.2010.00587.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE It has been demonstrated that social, economic, and environmental factors may influence individuals' oral health conditions, particularly among vulnerable groups such as elderly people. The aim of this study was to investigate the association between contextual factors and the need for full dental prosthesis among elderly people. METHODS This was a cross-sectional population-based epidemiological study of multilevel nature, with two levels of analysis: individual and contextual (municipal). Data at the individual level were obtained from oral clinical examinations (WHO criteria) in 5349 individuals aged 65-74. Data at the contextual level were obtained from the United Nations Development Program for the 250 Brazilian municipalities participating in the survey. The outcome was the need for a full dental prosthesis for at least one arch. Exposures at the contextual level included socioeconomic, demographic, and dental service data. Data analysis used multilevel logistic regression. RESULTS After controlling for individual socioeconomic, demographic, and dental service variables, the chance of needing full prosthesis was higher in municipalities with lower educational levels than in better-off ones (OR 1.57; 95% CI: 1.09-2.27) and lower in municipalities with fewer dentists (per capita) (OR 0.71; 95% CI: 0.52-0.97), compared to those with more dentists. CONCLUSION This study can contribute to the identification of priority municipalities, helping healthcare authorities and communities to formulate equitable public oral healthcare policies that improve the quality of life for this population.
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