João Henrique Lara do Amaral

Relationship between Primary and Secondary Dental Care in Public Health Services in Brazil

This cross-sectional study evaluated the relationship between primary and secondary oral health care in Brazil. For this purpose, data from the National Program for Improving Access and Quality of Primary Care were used. Dentists from 12,403 oral health teams (OHTs) answered a structured questionnaire in 2012. The data were analyzed descriptively and by cluster analysis. Of the 12,387 (99.9%) OHTs that answered all the questions, 62.2% reported the existence of Dental Specialties Centers (DSCs) to which they could refer patients. The specialties with the highest frequencies were endodontics (68.4%), minor oral surgery (65.8%), periodontics (63.0%), radiology (46.8%), oral medicine (40.2%), orthodontics (20.5%) and implantology (6.2%). In all percentiles, the shortest wait time for secondary care was for radiology, followed by oral medicine and the other specialties. In the 50th percentile, the wait for endodontics, periodontics, minor oral surgery and orthodontics was 30 days, while for implantology, the wait was 60 days. Finally, in the 75th percentile, the wait for endodontics, orthodontics and implantology was 90 days or more. Two clusters, with different frequencies of OHT access to specialties, were identified. Cluster 1 (n = 7,913) included the OHTs with lower frequencies in all specialties except orthodontics and implantology compared with Cluster 2 (n = 4,474). Of the Brazilian regions, the South and Southeast regions had the highest frequencies for Cluster 2, with better rates for the relationship between primary and secondary care. This study suggests certain difficulties in the relationship between primary and secondary care in specific specialties in oral health, with a great number of OHTs with limited access to DSCs, in addition to different performance in terms of OHT access to DSCs across Brazilian regions.

Describing the primary care actions of oral health teams in Brazil.

Objective: To describe the primary care actions performed by oral health teams (OHTs) that participated in a large national survey led by the Ministry of Health in 2012. Methods: A total of 12,403 dentists from OHTs completed a set of survey questions (response rate = 85.01%) on the organization of care, basic dental procedures and oral health surveillance actions of OHTs. Descriptive and hierarchical cluster analyses were developed. Results: The majority of OHTs (85.2%) reported that they performed “patient welcoming”. The delivery of services was based on a patient’s identified disease risk (83.1%), and continuity of care was ensured by 85.9% of OHTs. Individual preventive, restorative and surgical procedures were performed by the majority of the teams; however, screening for oral cancer and construction of dental prostheses/dentures occurred less frequently. Cluster 1 was composed of OHTs with the lowest proportion of oral healthcare actions related to oral cancer and dental prostheses/dentures, and the Southeastern and Southern regions had higher proportions of OHTs from cluster 2. Conclusions: OHTs adhere to some of the principles of primary care organizations; however, the teams perform fewer actions related to oral cancer treatment and rehabilitation with complete dentures. The geographical distribution of the clusters was unequal in Brazil.

Desafios para a oferta de prótese dentária na rede de saúde pública

Objetivo Conhecer os desafios enfrentados pelos municipios na implantacao e manutencao dos Laboratorios Regionais de Proteses Dentarias (LRPD), alem de identificar o perfil dos municipios com LRPD implantados. Metodo Estudo exploratorio, transversal, baseado em um questionario aplicado a 317 gestores municipais de saude, no ano de 2014-2015, e em informacoes extraidas dos bancos oficiais. Para analise dos dados secundarios, foi realizado o teste do Qui-quadrado, tendo como variavel dependente a presenca do LRPD credenciado e, como covariaveis, a Cobertura de Equipe de Saude Bucal (ESB), o Contingente populacional, o Indice de Desenvolvimento Humano (IDH), o Fator de Alocacao (FA) e os dados relativos aos Gestores Municipais de Saude. Resultado A baixa oferta do Tecnico de Protese Dentaria (TPD) foi o maior desafio para a implantacao dos LRPD e, para a manutencao dos LRPD, o baixo financiamento foi o fator limitante. Os municipios com populacao maior que dez mil habitantes tiveram mais chance de possuir um LRPD credenciado (RP = 2,42). Conclusao Os desafios enfrentados pelos municipios para a oferta de protese dentaria na rede de saude publica demandam acoes que extrapolam a esfera municipal, sendo necessario o envolvimento das instituicoes de ensino, a fim de garantir a capacitacao dos recursos humanos e dos demais entes da federacao na criacao de estrategias de regionalizacao que minimizem os custos e ampliem o acesso dos municipios de menor porte populacional aos LRPD.

Preenchimento da Caderneta de Saúde da Criança nos serviços de saúde em Belo Horizonte, Minas Gerais, Brasil

OBJECTIVE to describe the filling process of the Child Health Record (CHR) in health care services. METHODS descriptive study held in Belo Horizonte, Minas Gerais, Brazil; an interview was conducted with parents/guardians of children aged 3-5 years old; 21 essential items to child monitoring were observed in the CHR during the 2014 Multi-vaccination Day; fields that should be filled in maternity wards, Primary Health Care (PHC), and other services were assessed separately. RESULTS 367 children (96.1%) were included; 44.5% of CHR presented ≥60% of completeness; among the items that should be recorded in maternity wards, birth weight showed the highest proportion of completeness (64.5%); for those that should be filled in PHC/other services, records of vaccines (94.0%) presented the highest completeness; there was more filling in maternity wards than in PHC and other services (p<0.001). CONCLUSION a low proportion of filling was observed, especially in PHC and other services.

Hospital Dental Treatment for Special Health Care Needs Patients in Minas Gerais state, Brazil: A Cluster Analysis

Objective: To describe and group some demographic and healthcare characteristics of hospital dental care for the special health care needs population. Material and Methods: Cross-sectional census survey with a total of 1,063 visits with special health care need patients under general anesthesia or sedation at the Brazilian Health System Minas Gerais, Brazil, over 12 months. Clinical diagnosis was divided into “mental and behavioral disorders and diseases of the nervous system” and “others”. Age group, gender, clinical diagnosis and care by a general dentist were submitted to descriptive and multivariate cluster analysis. The analysis was performed using the software SPSS version 19.0. Results: Cluster 1 (N=173) had no ICD codes for nervous system (NS) diseases and mental and behavioral disorders. Clusters 2 (N=564) and 3 (N=326) are quite similar except for gender distribution. Cluster 1 was 3.5 times more frequent among non-host cities than HER host cities. Dental treatment was mostly performed on males diagnosed with mental and behavioral disorders and diseases of the NS who were over the age of 25 years and were seen by general dentists. The clusters were distributed unevenly between EHR host and non-host cities. Conclusion: Non-host performed more frequently treatment for patients with no mental and behavioral disorders and diseases of the NS than EHR host cities.

Utilização dos serviços de atendimento odontológico hospitalar sob sedação e/ou anestesia geral por pessoas com necessidades especiais no SUS-MG, Brasil

This study identified the demographic characteristics of individuals and dental treatment care under sedation/general anesthesia in a hospital environment in the Unified Health System in the State of Minas Gerais (SUS-MG). All Hospitalization Authorizations (AIHs) for Dental Treatment for Patients with Special Needs procedures were evaluated between July 2011 and June 2012. Demographic and health care variables for treatment were also assessed. Hospitalization rates per 10,000 inhabitants, and health care coverage provided in the state of Minas Gerais and in each of the Broader Health Regions were calculated. Descriptive analysis of data was carried out by calculating the central trend and variability frequency and measurements. All 1,063 AIHs paid during the study period were evaluated, which is equivalent to a rate of 0.54 hospitalizations per 10,000 individuals. The majority of the patients were adult, male, diagnosed with mental or behavioral disorders and resident in 27.7% of the municipalities in Minas Gerais. The procedures were performed in 39 municipalities and the care coverage was equal to 1.58%. The study reveals a classic demographic and clinical profile of patient attendance. Difficulties in establishing a network of dental care were identified.This study identified the demographic characteristics of individuals and dental treatment care under sedation/general anesthesia in a hospital environment in the Unified Health System in the State of Minas Gerais (SUS-MG). All Hospitalization Authorizations (AIHs) for Dental Treatment for Patients with Special Needs procedures were evaluated between July 2011 and June 2012. Demographic and health care variables for treatment were also assessed. Hospitalization rates per 10,000 inhabitants, and health care coverage provided in the state of Minas Gerais and in each of the Broader Health Regions were calculated. Descriptive analysis of data was carried out by calculating the central trend and variability frequency and measurements. All 1,063 AIHs paid during the study period were evaluated, which is equivalent to a rate of 0.54 hospitalizations per 10,000 individuals. The majority of the patients were adult, male, diagnosed with mental or behavioral disorders and resident in 27.7% of the municipalities in Minas Gerais. The procedures were performed in 39 municipalities and the care coverage was equal to 1.58%. The study reveals a classic demographic and clinical profile of patient attendance. Difficulties in establishing a network of dental care were identified.

A Probabilistic Model Checking Analysis of the Potassium Reactions with the Palytoxin and Na + /K + -ATPase Complex

In this paper, Probabilistic Model Checking (PMC) is used to model and analyze the effects of the palytoxin toxin (PTX) in cell transport systems, structures responsible for exchanging ions through the plasma membrane. The correct behavior of these systems is necessary for all animal cells, otherwise the individual could present pathologies. We have developed a model which focuses on potassium and cell energy related reactions, due to the known inhibitory effect of potassium on PTX action and the ATP role in its transportation. We have used PMC to estimate state probabilities and use the Goldman-Hodgkin-Katz equation to measure the induced current created by ion exchange. Our model suggests that as the concentration of external potassium increases, ion exchange occurs against its electrochemical gradient, despite the PTX effect. This suggests that potassium could be used to inhibit PTX action. PMC allowed us to further characterize the system dynamics.