Hospitalizations for oral and oropharyngeal cancer in Brazil by the SUS: impacts of the covid-19 pandemic / Hospitalizações por câncer bucal e orofaríngeo no Brasil pelo SUS: impactos da pandemia de covid-19

ABSTRACT OBJECTIVE To analyze the impact of the different phases of the covid-19 pandemic on hospitalizations for oral (CaB) and oropharyngeal (CaOR) cancer in Brazil, carried out within the scope of the Brazilian Unified Health System (SUS). METHODS We obtained data regarding hospital admissions due to CaB and CaOR between January 2018 and August 2021 from the SUS Hospital Information System, analyzing hospital admissions as rates per 100,000 inhabitants. We divided the pandemic (January 2020 to August 2021) and pre-pandemic (January 2018 to December 2019) periods into four-month periods, comparing the pandemic period rates with analogous rates for the pre-pandemic period - for Brazil, by macro-region and by a group of procedures performed during hospitalization. We also analyzed the impact of the pandemic on the average cost of hospitalizations, expressing the results in percentage change. RESULTS Rates of hospitalization in the SUS due to CaB and CaOR decreased during the pandemic in Brazil. The most significant reduction occurred in the second four-month period of 2020 (18.42%), followed by decreases in the third four-month period of 2020 (17.76%) and the first and second four-month periods of 2021 (respectively, 14.64% and 17.07%), compared with 2019. The South and Southeast showed the most expressive and constant reductions between the different phases of the pandemic. Hospitalizations for clinical procedures suffered a more significant decrease than for surgical procedures. In Brazil, the average expenditure per hospitalization in the four-month pandemic periods was higher than in the reference periods. CONCLUSION After more than a year of the pandemic's beginning in Brazil, the SUS hospital care network for CaB and CaOR had yet to be re-established. The repressed demand for hospitalizations for these diseases, which have fast evolution, will possibly result in delays in treatment, negatively impacting the survival of these patients. Future studies are needed to monitor this situation.

RESUMO OBJETIVO Analisar o impacto das diferentes fases da pandemia de covid-19 sobre as hospitalizações por câncer bucal (CaB) e de orofaringe (CaOR) no Brasil, realizadas no âmbito do Sistema Único de Saúde (SUS). MÉTODOS Os dados quanto às internações hospitalares por CaB e CaOR, entre janeiro de 2018 e agosto de 2021, foram obtidos no Sistema de Informações Hospitalares do SUS. As internações foram analisadas sob a forma de taxas por 100 mil habitantes. Os períodos de pandemia (janeiro de 2020 a agosto de 2021) e pré-pandemia (janeiro de 2018 a dezembro de 2019) foram divididos em quadrimestres; as taxas quadrimestrais do período pandêmico foram comparadas às taxas análogas do período pré-pandemia - para o Brasil, por macrorregião e por grupo de procedimentos realizados na internação. O impacto da pandemia sobre o valor médio das internações também foi analisado. Os resultados foram expressos em variação percentual. RESULTADOS As taxas de internação hospitalar no SUS por CaB e CaOR reduziram durante a pandemia no Brasil. Em comparação com os quadrimestres de 2019, a maior redução foi identificada no segundo quadrimestre de 2020 (18,42%), seguida das reduções do terceiro quadrimestre de 2020 (17,76%) e do primeiro e segundo quadrimestres de 2021 (respectivamente, 14,64% e 17,07%). Sul e Sudeste apresentaram as reduções mais expressivas e constantes entre as diferentes fases da pandemia. As internações para procedimentos clínicos sofreram maior redução do que para procedimentos cirúrgicos. No Brasil, o gasto médio por internação nos quadrimestres da pandemia foi maior do que nos quadrimestres de referência. CONCLUSÃO Após mais de um ano do início da pandemia no Brasil, a rede hospitalar de cuidado ao CaB e CaOR do SUS ainda não tinha se restabelecido. A demanda reprimida de hospitalizações por essas doenças, que são de rápida evolução, possivelmente resultará em atrasos para tratamento, com impacto negativo para a sobrevida desses pacientes; futuros estudos são necessários para monitorar essa situação.

How oral health literacy and parental behavior during the meals relate to dental caries in children

Abstract This cross-sectional study aimed to verify the influence of parental behavior on the development of dental caries in children by assessing parents' behavior during their children's meals and their parental level of oral health literacy. This study was conducted with children aged 2 to 4 in Diadema, São Paulo, Brazil. Six hundred and thirty children were examined to assess the prevalence of dental caries (dmft index). Parents answered a questionnaire related to socio-demographic conditions, oral health literacy (OHL), and the parents' behavior during the meal - Parent Mealtime Action Scale - (PMAS). The analysis fitted zero-inflated negative binomial regression (ZINB) models to assess unadjusted and adjusted associations between the study outcome and covariates. In the unadjusted analysis, the child's age, the number of siblings, household crowding, family income, socioeconomic status and OHL were associated with the outcome (p <0.05). In the adjusted model, dental caries was more prevalent among 3- (PR: 1.85, 95%CI: 1.19-2.87) and 4-year-old children (PR: 2.43, 95%CI: 1.60-3.71), those with at least one sibling (PR: 1.66, 95%CI:1.18-2.33). Poor children were more likely to have dental caries (PR: 0.66, 95%CI: 0.48-0.91); the Use of Rewards dimension of the PMAS was associated positively with dental caries severity (RR: 0.90, 95%CI: 0.84-0.97). Although OHL was not associated with caries, parents' mealtime behaviors were related to dental caries. This suggested that communication between parents and children related to good eating practices could play a protective role against dental caries in children.

The impacts of oral health-related quality of life of elderly people living at home: a cross-sectional study / Impactos da qualidade de vida relacionada à saúde bucal de idosos em domicílio: estudo transversal

Abstract The scope was to verify the impact of oral and sociodemographic conditions, the dental treatment needs and dental pain, on the quality of life of the elderly. This cross-sectional study was conducted in 15 primary health care areas. A backward multivariate linear regression model was used (p<0.05) with oral health related-quality of life as dependent variable. There were 335 elderly people with predominance of women (56.72%) and aged up to 74 years (59.40%). Those who had up to 8 years of education predominated (87.46%), and those who were still working were the minority (13.43%). Multivariate linear regression (p<0.05) showed association with missing teeth (β=0,12; IC 0,00:0,04; p<0,04) and dental prosthesis needs (β=0,14; IC 0,13:0,81; p<0,01), women (β=0,18; IC 0,23:0,85; p<0,01), less aged (β=-0,12; IC -0,05:0,00; p<0,02), not working (β=-0,15; IC -1,09:-0,20; p<0,01), with dental care need (β=0,24; IC 0,25:0,63; p<0,01) and dental pain (β=0,14; IC 0,10:0,64; p<0,01). Missing teeth, sociodemographic conditions, dental treatment needs and dental pain might impact oral health-related quality of life of elders.

Resumo O objetivo foi verificar o impacto da condição bucal e sociodemográfica, necessidade de tratamento odontológico e dor dentária na qualidade de vida de idosos. Este estudo transversal realizou-se em 15 áreas de cuidados primários de saúde. O modelo de regressão linear multivariado foi utilizado (p <0,05) considerando qualidade de vida como variável dependente. Participaram 335 idosos, predomínio de mulheres (56,72%) com idade até 74 anos (59,40%). Ter até 8 anos de estudo predominou (87,46%) e os que trabalhavam eram minoria (13,43%). A regressão linear multivariada (p <0,05) apresentou associação da qualidade de vida com dentes perdidos (β=0,12; IC 0,00:0,04; p<0,04) e necessidade de próteses (β =0,14; IC 0,13:0,81; p<0,01), com mulheres (β=0,18; IC 0,23:0,85; p<0,01), idosos mais jovens (β=-0,12; IC -0,05:0,00; p<0,02), que não trabalham (β=-0,15; IC -1,09:-0,20; p<0,01), com necessidades de tratamento odontológico (β=0,24; IC 0,25:0,63; p<0,01) e dor dentária (β=0,14; IC 0,10:0,64; p<0,01). Dentes perdidos, aspectos sociodemográficos, necessidade de tratamento odontológico e dor dentária podem impactar a qualidade de vida relacionada à saúde bucal de idosos.

The impact of the COVID-19 pandemic on the provision of dental procedures performed by the Brazilian Unified Health System: a syndemic perspective / O impacto da pandemia de Covid-19 na oferta de procedimentos odontológicos realizados pelo Sistema Único de Saúde: uma perspectiva sindêmica

ABSTRACT: Objectives: This study investigated the impact of the COVID-19 pandemic on the provision of dental care procedures performed by the Brazilian Unified Health System (SUS) nationally and by regions. Considering that the most underprivileged population disproportionately suffers with the reduction in dental care provision, the study hypothesis suggests the presence of a syndemic nature. Methodology: The SUS Outpatient Information System (SIA-SUS) was assessed to gather data on dental care activities and procedures performed between April and July 2018, 2019, and 2020 by dentists registered in the SUS. The 30 most frequent activities and procedures performed by dentists were selected and classified into three categories (urgent dental care, nonemergency dental care, and case-dependent urgency procedures), based on the guidance for dental care during the pandemic published by the American Dental Association. Results: Results demonstrated a reduction in the provision of dental care of all categories during the pandemic. Urgency dental consultations and procedures in primary and specialized dental care services decreased by 42.5 and 44.1%, respectively, between 2020 and 2019. Non-urgent procedures decreased by 92.3%. Although decreases in dental care activities and procedures were reported in all Brazilian regions, the largest relative decreases in urgent procedures - that should have been maintained during the pandemic - occurred in the North and Northeast regions, which are the poorest regions of the country. Conclusions: These results suggest that the COVID-19 pandemic has a syndemic behavior. Further investigation into the pandemic-syndemic impacts on oral disease burden is necessary.

RESUMO: Objetivo: O presente estudo investigou o impacto da pandemia de Covid-19 na oferta de atendimento odontológico pelo Sistema Único de Saúde (SUS) no Brasil. Considerando que a população de menor nível socioeconômico sofre desproporcionalmente com a redução da oferta de atendimento odontológico, a hipótese do artigo sugere a presença de caráter sindêmico nessa situação. Métodos: O Sistema de Informação Ambulatorial do SUS (SIA-SUS) foi utilizado para coletar os dados das atividades e procedimentos odontológicos realizados entre abril e julho de 2018, 2019 e 2020 por dentistas cadastrados no SUS. Os 30 procedimentos mais frequentes realizados por dentistas foram selecionados e classificados em três categorias (atendimento odontológico de urgência, atendimento odontológico não emergencial e atendimento de urgência dependente de casos), com base nas orientações para atendimento odontológico durante a pandemia em curso, publicadas pela Associação Odontológica Americana. Resultados: Houve uma redução na oferta de atendimento odontológico em todas as categorias durante a pandemia. As consultas e procedimentos odontológicos de urgência em serviços de atenção básica e especializada diminuíram 42,5 e 44,1%, respectivamente, entre 2020 e 2019. Os procedimentos não urgentes diminuíram 92,3%. Embora as reduções nas atividades e procedimentos odontológicos tenham ocorrido em todas as regiões brasileiras, as maiores quedas relativas aos procedimentos de urgência — que deveriam ter sido mantidas durante a pandemia de covid-19 — ocorreram nas regiões Norte e Nordeste, que são as mais pobres do país. Conclusões: Os resultados sugerem que a pandemia covid-19 possui um comportamento sindêmico. Uma investigação mais aprofundada sobre os impactos da pandemia-sindemia na carga de doenças bucais é necessária.

Dental caries spectrum profile in Brazilian public school children and adolescents

Abstract Dental caries remains a major public health problem, with a higher prevalence among in adolescence. The present study aimed to assess the dental caries spectrum profile in children and adolescents in Brazilian public schools. A cross-sectional study was performed in two public schools in Brazil to examine the permanent teeth of children and adolescents. The dental caries were assessed by applying the Caries Assessment Spectrum and Treatment (CAST) instrument, and the results were distributed as per disease status (healthy/codes 0-2; pre-morbidity/code 3; morbidity/code 4-5; severe morbidity/codes 6-7; mortality/code 8) and by severity as per the CAST-F1 formula (no severity, mild, moderate, and severe). The CAST data were described by age groups (8-9 y, 10-11 y, 12-13 y, 14-15 y, 16-17 y, and 18-19 y). The Kruskal-Wallis test was used to investigate differences in CAST prevalence and severity among the groups (p < 0.05). Total 598 students were enrolled. Most of the subjects were male (53.34%) and belonged to the age group of 12-13 y (34.95%). The variables CAST 0/1 (p = 0.024), CAST (p = 0.024), and CAST-F1 (p = 0.029) showed significant differences among age groups, and the post hoc test showed the differences in these variables as per the age groups of 14-15 y and 16-17 y (CAST 0/1, p = 0.047; CAST, p = 0.047; CAST-F1, p = 0.033). The dental caries spectrum increased from 8 to 19 y with a peak in the prevalence and severity in the middle of adolescence.

Alfabetismo em saúde bucal e comportamento de pais/cuidadores durante as refeições dos seus filhos: impactos na prevalência de cárie e qualidade de vida de pré-escolares em Diadema, São Paulo / Oral health literacy and behavior of parents / caregivers during their children's meals: impacts on the prevalence of caries and quality of life in preschoolers in Diadema, São Paulo

Introdução: O alfabetismo em saúde bucal é o grau em que os indivíduos têm a capacidade de obter, processar e compreender informações de saúde e utilizar os serviços básicos de saúde, para tomar decisões de saúde bucal apropriadas. Objetivos: 1) Avaliar a associação da cárie dentária em pré-escolares com o alfabetismo em saúde bucal (ASB) e o comportamento dos pais/cuidadores durante a refeição dos seus filhos 2) Avaliar a associação da Qualidade de Vida Relacionada à Saúde Bucal (QVRSB) e cárie dentária das crianças e alfabetismo em saúde bucal dos pais. Métodos: Foi realizado um estudo transversal com crianças de 2 a 4 anos durante a Campanha Nacional de vacinação (setembro, 2017) em todas as 18 Unidades Básicas de Saúde (UBS) em Diadema, São Paulo, Brasil. O exame de 630 crianças teve como objetivo avaliar a prevalência de cárie dentária (índice ceo-d). Os pais foram entrevistados para obter informações sobre as condições sociodemográficas (idade parental, número de irmãos, renda familiar, nível de escolaridade dos pais e aglomeração domiciliar), comportamentos de saúde bucal (consumo de açúcar e frequência da escovação dentaria), comportamento dos pais durante a refeição (Parent Mealtime Action Scale PMAS) bem como o nível de alfabetismo em saúde bucal (ASB - Rapid Estimate of Adult Literacy in Dentistry - BREALD-30). A avaliação da qualidade de vida relacionada à saúde bucal (QVRSB) das crianças utilizou a Early Childhood Oral Health Impact Scale (ECOHIS). A análise utilizou modelos de regressão binomial negativa inflada de zeros (ZINB) para avaliar associações não ajustadas e ajustadas entre os desfechos do estudo e variáveis independentes. Resultados: No modelo ajustado, a cárie dentária foi mais prevalente entre crianças de 3 (RP = 1,85, IC 95% = 1,19-2,87) e 4 anos (RP = 2,43, IC 95% = 1,60-3,71), aquelas com um ou mais irmãos (RP = 1,66, IC 95% = 1,18-2,33). No entanto, crianças cujos pais / cuidadores recebiam 2 salários mínimos ou mais tiveram menos probabilidade de ter cárie dentária (RP = 0,66, IC 95% = 0,48-0,91). A dimensão Uso de Recompensas do PMAS associou-se diretamente à severidade da cárie dentária (RT = 0,90, IC 95% = 0,84-0,97). A qualidade de vida relacionada à saúde bucal das crianças não foi associada ao ASB. A cárie dentária teve impacto negativo na qualidade de vida das crianças (p <0,05). Um impacto positivo na qualidade de vida foi associado ao número de irmãos (RP = 0,70, IC 95% = 0,52-0,95) e a maior idade da mãe reduziu o impacto na QVRSB (RP = 0,72, IC 95% = 0,52-0,98). Conclusão: A idade dos filhos, número de irmãos, renda familiar e dimensão Uso de Recompensa estiveram associados à cárie dentária. O número de irmãos, a idade das mães e a cárie dentária foram associados à QVRSB das crianças. Este estudo não observou associação entre o alfabetismo dos pais, QVRSB das crianças e a cárie dentária.

Introduction: Oral health literacy is the degree to which individuals have the capacity to obtain, process and understand basic health information and using health services to make appropriate oral health decisions. Objectives: 1) Assess the association of dental caries in preschoolers with oral health literacy (OHL) and the behavior of parents / caregivers during their children's meal 2) Assess the association of children's oral health-related quality of life (OHRQoL) with dental caries and parents' oral health literacy. Methods: This cross-sectional population-based study was conducted with preschool children of 2 to 4 years old, during the national vaccination campaign (September 2017) in all the 18 health centers in Diadema, São Paulo, Brazil. The examination of 630 children aimed at assessing the prevalence of dental caries (dmft index). Parents were interviewed to obtain information on socio-demographic conditions (parental age, the number of siblings, family income, parental level of education and household crowding), oral health behavior (sugar daily intake and tooth brushing frequency), parents' behavior during the meal (Parent Mealtime Action Scale PMAS) and oral health literacy (OHL- Rapid Estimate of Adult Literacy in Dentistry - BREALD-30). The evaluation of the children's oral health-related quality of life used the Early Childhood Oral Health Impact Scale (ECOHIS) The analysis used zero-inflated negative binomial regression (ZINB) models to assess unadjusted and adjusted associations between the study outcomes and covariates. Results: In the adjusted model, dental caries was more prevalent among 3 (PR=1.85, 95%CI=1.19-2.87) and 4-year-old children (PR=2.43, 95%CI=1.60-3.71), those with at least one sibling (PR= 1.66, 95%CI=1.18-2.33). However, children whose parents/caregivers gain 2 minimum wage or more were less likely to have dental caries (PR= 0.66, 95%CI=0.48-0.91). The Use of Rewards dimension of the PMAS was directed associated with dental caries severity (RR= 0.90, 95%CI=0.84-0.97). Children's OHRQoL was not associated with OHL. Dental caries had a negative impact on the children's quality of life (p<0.05). A positive impact on the quality of life was associated with the number of siblings (PR= 0.70, 95%CI=0.52-0.95). A higher age of the mother reduced the impact on the OHRQoL (PR= 0.72, 95%CI=0.52-0.98). Conclusion: Age of the children, number of siblings, family income and the Use of Reward dimension were associated with dental caries. Number of siblings, the mothers' age and dental caries were associated with the children's OHRQoL. This study found no association between parents' literacy, children's OHRQoL and dental caries.

Association Between Presence of Enamel Defects, Dental Caries and Socioeconomic Conditions on Brazilian Children

Objective: To verify the relationship between developmental enamel defects (DED) in permanent incisors and socioeconomic conditions and dental caries in children within the life course context. Material and Methods: A total of 350 children aged 9-11 years from 13 public schools in the city of Bauru, Brazil were examined. Clinical exams were performed to observe the presence of caries and developmental enamel defects using the DMFT and DED indexes, respectively. In addition, information about family income and parental schooling was collected. Statistical analysis used the Spearman Correlation Coefficient and the Chi-square test to verify the association between DED, socioeconomic conditions and dental caries. The significance level adopted was 5%. Results: Association between presence of dental caries and DED (p=0.04), delimited opacity (p=0.02) and opacity (p=0.01) was observed. Inverse correlation for the decayed component with maternal schooling and family income was also verified. Regarding the types of development enamel defect (DED), correlation between delimited opacity, opacity and DED with the DMFT index was observed. Conclusion: The results of this study indicated association between enamel defects and caries, as well as correlation between income and parental schooling and dental caries.

Equidade na estratégia saúde da família (ESF) / Equity in the family health strategy (FHS) / Equidad de la estrategia de salud de la família (ESF)

OBJETIVO: Relacionar a implantação da Estratégia de Saúde da Família (ESF) entre 2001 e 2010 ]com as variáveis do Índice de Desenvolvimento Humano Municipal (IDH-M) e indicadores socioeconômicos. MÉTODOS: Estudo ecológico coletou informações sobre o IDH-M,indicadores socioeconômicos e da ESF referentes ao número de Agentes Comunitários de Saúde (ACS), Equipes de Saúde da Família (ESF), Equipes de Saúde Bucal (ESB), cobertura populacional e relativa (%) em 645 municípios do estado de São Paulo no período de 2001 a 2010. A análise descritiva foi conduzida por meio de frequências absoluta e relativa para avaliação de cada indicador. Utilizaram-se testes não paramétricos: coeficientes de correlação de Spearman para as variáveis da ESF e os indicadores socioeconômicos, e Wilcoxon Test (p<0,05) para a comparação entre as duas datas. RESULTADOS: Houve correlação positiva para o incremento das equipes de ESF e da ESB com o IDH-M (p<0,01). Os dados sociais (acesso à água, percentual de lixo coletado e renda média) apresentaram correlação positiva com ESF e cobertura populacional (p<0,05). Encontrou-se correlação negativa entre todas as variáveis sociais, exceto analfabetismo, com cobertura populacional (%). CONCLUSÃO: A evolução da ESF no estado de São Paulo durante o período estudado foi positiva no combateàs iniquidades em saúde

OBJECTIVE: To associate the implementation of the Family Health Strategy (FHS) between2001 and 2010 with the variables of the Municipal Human Development Index (MHDI) and socioeconomic indicators. METHODS: Ecological study collected information on the MHDI, socioeconomic indicators, and the FHS, regarding the number of Community Health Workers (CHW), Family Health Teams (FHT), Oral Health Teams (OHT), and population and relative(%) coverage in 645 municipalities in the state of São Paulo, Brazil, in the period from 2001 to 2010. Descriptive analysis was conducted by means of absolute and relative frequencies for evaluation of each indicator. Non-parametric tests were used: Spearman's correlation coefficient for the FHS variables and the socioeconomic indicators, and Wilcoxon test (p<0.05) for comparison between the two dates. RESULTS: There was positive correlation between the increase in FHS and OHT teams, and the MHDI (p<0.01). Social data (access to water, waste collection percentage, and average income presented positive correlation with FHS and population coverage. A negative correlation was found between population coverage (%) and all the social variables except illiteracy. CONCLUSION: The evolution of the FHS in the state of São Paulo during the studied period was positive in fighting the health inequalities

OBJETIVO: Relacionar la implantación de la Estrategia de Salud de la Familia (ESF) entre 2001 y 2010 con las variables del Índice de Desarrollo Humano Municipal (IDH-M) y los indicadores socioeconómicos. MÉTODOS: El estudio ecológico recogió informaciones del IDH-M, indicadores socioeconómicos y de la ESF referentes al número de Agentes Comunitarios de Salud (ACS), Equipos de Salud de la Familia (ESF), Equipos de Salud Bucal (ESB), cobertura poblacional y relativa (%) en 645 municipios del estado de São Paulo en el período entre 2001 y 2010. El análisis descriptivo fue realizado a través de las frecuencias absoluta y relativa para la evaluación de cada uno de los indicadores. Se utilizó las pruebas no paramétricas: coeficientes de correlación de Spearman para las variables de la ESF y los indicadores socioeconómicos; y la Prueba de Wilcoxon (p<0,05) para la comparación de las dos fechas. RESULTADOS: Hubo correlación positiva para el aumento de los equipos de la ESF y de la ESB con el IDH-M (p<0,01). Los datos sociales (acceso al agua, el porcentaje de basura recogida y la renta media) presentaron correlación positiva entre el ESF y la cobertura poblacional (p<0,05). Se encontró correlación negativa entre todas las variables sociales, excepto entre el analfabetismo y la cobertura poblacional (%). CONCLUSIÓN: La evolución de la ESF en el estado de São Paulo durante el período del estudio fue positiva para la lucha con las iniquidades en salud