The Role of Socioeconomic and Health Services Organizational Factors on Infection Control Structure Score, Brazil.

This study aimed to analyze possible associations between the Infection Control Structure Score (ICSS), health services, and social characteristics of the municipalities in Brazil. Secondary data from the third cycle 2017-2018 of the Brazilian National Program for Improving Primary Care Access and Quality (PMAQ) was analyzed. Six independent variables - FIRJAN Index of Municipal Development, number of inhabitants, number of family health teams receiving a financial incentive from the federal government, healthcare expenditure per capita, and number of Oral Health Teams modalities 1 and 2 - were included to assess their influence on ICSS, measured for each Brazilian town. Data analysis used the Classification and Regression Tree model performed with IBM SPSS 25. A total of 4,900 municipalities were included, and the mean ICSS was 0.905 (±0.092). A positive relationship was observed between healthcare expenditure per capita, municipal development, and the outcome. Conversely, towns with a higher number of family health teams receiving a financial incentive from the federal government showed lower mean ICSS. The findings suggest that inequalities in the infection control structures exist within the country, and they were related to the health services and social characteristics of the municipalities.

The Role of Socioeconomic and Health Services Organizational Factors on Infection Control Structure Score, Brazil / O Papel dos Fatores Socioeconômicos e de Organização dos Serviços de Saúde sobre o Escore da Estrutura de Controle de Infecção, Brasil

Abstract This study aimed to analyze possible associations between the Infection Control Structure Score (ICSS), health services, and social characteristics of the municipalities in Brazil. Secondary data from the third cycle 2017-2018 of the Brazilian National Program for Improving Primary Care Access and Quality (PMAQ) was analyzed. Six independent variables - FIRJAN Index of Municipal Development, number of inhabitants, number of family health teams receiving a financial incentive from the federal government, healthcare expenditure per capita, and number of Oral Health Teams modalities 1 and 2 - were included to assess their influence on ICSS, measured for each Brazilian town. Data analysis used the Classification and Regression Tree model performed with IBM SPSS 25. A total of 4,900 municipalities were included, and the mean ICSS was 0.905 (±0.092). A positive relationship was observed between healthcare expenditure per capita, municipal development, and the outcome. Conversely, towns with a higher number of family health teams receiving a financial incentive from the federal government showed lower mean ICSS. The findings suggest that inequalities in the infection control structures exist within the country, and they were related to the health services and social characteristics of the municipalities.

Resumo Este estudo objetivou analisar as possíveis associações entre o Escore da Estrutura de Controle de Infecção (EECI), os serviços de saúde e características sociais dos municípios brasileiros. Foram analisados dados secundários do terceiro ciclo 2017-2018 do Programa Nacional de Melhoria do Acesso e Qualidade da Atenção Básica (PMAQ). Seis variáveis independentes - Índice FIRJAN de Desenvolvimento Municipal, número de habitantes, número de Equipes de Saúde da Família que recebiam incentivo financeiro do governo federal, gasto com saúde per capita e número de Equipes de Saúde Bucal modalidades 1 e 2 - foram incluídas para avaliar a influência sobre o EECI, medido para cada município brasileiro. Para a análise dos dados, foi utilizado o modelo de Árvore de Classificação e Regressão no IBM SPSS 25. Foram incluídos 4.900 municípios, e o EECI médio foi de 0,905 (±0,092). Observou-se uma associação positiva entre o gasto com saúde per capita, o desenvolvimento municipal e o desfecho. Por outro lado, municípios com maior número de Equipes de Saúde da Família com incentivo financeiro do governo federal apresentaram menor média do EECI. Os achados sugerem que existem desigualdades nas estruturas de controle de infecções no país, relacionadas aos serviços de saúde e às características sociais dos municípios.

NON ADHERENCE TO TUBERCULOSIS TREATMENT IN SÃO PAULO STATE: REFLECTIONS ON HEALTH MANAGEMENT AND NURSING

Objective: To associate abandonment of tuberculosis treatment with the variables of access to health services in the state of São Paulo was estimated. Methods: was an epidemiological observational study with data to individuals diagnosed with tuberculosis, residing in the state of São Paulo in the period 2012 to 2017. Generalized Estimating Equations models were used to analyze the relationships between independent variables and noncompliance with tuberculosis treatment over time. Results: A prevalence of over 12% of noncompliance with tuberculosis treatment was identified. Individuals residing in medium and large-sized municipalities had, 2.64 (95% CI: 2.15-3;24) and 4.48 (CI 95%: 4.62-5.55) times more risk, respectively, of abandoning TB treatment when compared with those living in small cities (p<0.05). Moreover, presence of Psychosocial Care Centers did not contribute to the reduction of treatment abandonment [1.20 (1.03-1.40) p<0.05]. Conclusions: Was an association between municipal size and abandonment of tuberculosis treatment.

Introdução: Estimou-se a associação entre o abandono do tratamento da tuberculose com variáveis de acesso ao serviço de saúde no estado de São Paulo. Métodos: Trata-se de um estudo epidemiológico ecológico com fonte de dados secundários de indivíduos diagnosticados com tuberculose, no período de janeiro/2012 a dezembro/2017 residentes no estado de São Paulo. A variável desfecho é o abandono do tratamento da tuberculose. Foram efetuadas análises e considerada a distribuição de Poisson, estimados os riscos relativos brutos e ajustados, dispostas em dois blocos de variáveis considerando nível de significância de 5%. Resultados: Identificou-se uma prevalência superior a 12% no abandono do tratamento da TB no estado de São Paulo no período estudado. Indivíduos residentes em municípios de médio e grande porte têm, respectivamente, 2,64 (IC95%: 2,15-3,24) e 4,48 (IC95%: 4,62-5,55) vezes mais risco de abandonar o tratamento da TB quando comparados ao que vivem em municípios pequeno porte (p<0,05), bem como, municípios com a presença do CAPS não contribuíram para a diminuição do abandono [1,20 (1,03-1,40) p<0,05]. Conclusão: houve associação entre o porte municipal e o abandono do tratamento de Tuberculose.

[Malocclusion in adolescents in the State of São Paulo: spatial and hierarchical analysis]. / Má oclusão em adolescentes do estado de São Paulo: análise espacial e hierárquica.

The scope of this study was to analyze the spatial distribution of malocclusion (MO), estimate the prevalence and evaluate the associated factors in adolescents. It was a study with results of 5,558 adolescents aged 15 to 19 from the São Paulo Oral Health (SB) 2015 survey. The outcome was MO. Sociodemographic aspects, access to dental services, dental caries and tooth loss were the independent variables. A total of 162 municipalities in the state of São Paulo were included and spatial statistics techniques were applied. Hierarchical logistic regression models were performed. The prevalence of MO was 29.3%. There was a spread pattern between the types of MO and positive detachment (p<0,05). Non-white adolescents (OR=1.32, 95%CI: 1.24-1.42), with less years of schooling (OR=1.30, 95%CI: 1.22-1.42), with teeth extracted due to caries (OR=1.40, 95%CI: 1.03-1.88) were more likely to have MO. Adolescent access to dental consultation did not contribute to reducing the chance of developing MO, regardless of whether the dental consultation occurred less (OR=2.02, 95%CI: 1.65-2.47) or more than one year before (OR=1.63, 95%CI: 1.31-2.03). Thus, the occurrence of MO is unequally distributed in the state of São Paulo and associated with sociodemographic conditions, access to consultations and tooth loss due to caries.

O objetivo foi analisar a distribuição espacial da má oclusão (MO) em adolescentes, estimar a prevalência e avaliar os fatores associados. Estudo com dados de 5.558 adolescentes entre 15 e 19 anos de idade do inquérito - SB São Paulo 2015. O desfecho foi a MO. As variáveis independentes foram os aspectos sociodemográficos, acesso aos serviços odontológicos, cárie e perdas dentárias. Foram incluídos 162 municípios do estado de São Paulo e aplicadas técnicas de estatística espacial. Foram realizados modelos de regressão logística hierarquizada. A prevalência de MO foi de 29,3%. Houve um padrão de espalhamento entre os tipos de MO e correlação espacial positiva (p<0,05). Adolescentes não brancos (OR=1,32, IC95%: 1,24-1,42), com menor tempo de estudo (OR=1,30, IC95%: 1,22-1,42) e com dentes extraídos por cárie (OR=1,40, IC95%: 1,03-1,88) tiveram mais chances de apresentarem MO. O acesso dos adolescentes à consulta odontológica não contribuiu para reduzir a chance de apresentar a MO, independentemente de a consulta ao dentista ter ocorrido há menos (OR=2,02, IC95%: 1,65-2,47) ou há mais de um ano (OR=1,63, IC95%: 1,31-2,03). Assim, a ocorrência de MO é desigualmente distribuída no estado de São Paulo, e associada a condições sociodemográficas de acesso à consulta e perda dentária por cárie.

Má oclusão em adolescentes do estado de São Paulo: análise espacial e hierárquica / Malocclusion in adolescents in the State of São Paulo: spatial and hierarchical analysis

Resumo O objetivo foi analisar a distribuição espacial da má oclusão (MO) em adolescentes, estimar a prevalência e avaliar os fatores associados. Estudo com dados de 5.558 adolescentes entre 15 e 19 anos de idade do inquérito - SB São Paulo 2015. O desfecho foi a MO. As variáveis independentes foram os aspectos sociodemográficos, acesso aos serviços odontológicos, cárie e perdas dentárias. Foram incluídos 162 municípios do estado de São Paulo e aplicadas técnicas de estatística espacial. Foram realizados modelos de regressão logística hierarquizada. A prevalência de MO foi de 29,3%. Houve um padrão de espalhamento entre os tipos de MO e correlação espacial positiva (p<0,05). Adolescentes não brancos (OR=1,32, IC95%: 1,24-1,42), com menor tempo de estudo (OR=1,30, IC95%: 1,22-1,42) e com dentes extraídos por cárie (OR=1,40, IC95%: 1,03-1,88) tiveram mais chances de apresentarem MO. O acesso dos adolescentes à consulta odontológica não contribuiu para reduzir a chance de apresentar a MO, independentemente de a consulta ao dentista ter ocorrido há menos (OR=2,02, IC95%: 1,65-2,47) ou há mais de um ano (OR=1,63, IC95%: 1,31-2,03). Assim, a ocorrência de MO é desigualmente distribuída no estado de São Paulo, e associada a condições sociodemográficas de acesso à consulta e perda dentária por cárie.

Abstract The scope of this study was to analyze the spatial distribution of malocclusion (MO), estimate the prevalence and evaluate the associated factors in adolescents. It was a study with results of 5,558 adolescents aged 15 to 19 from the São Paulo Oral Health (SB) 2015 survey. The outcome was MO. Sociodemographic aspects, access to dental services, dental caries and tooth loss were the independent variables. A total of 162 municipalities in the state of São Paulo were included and spatial statistics techniques were applied. Hierarchical logistic regression models were performed. The prevalence of MO was 29.3%. There was a spread pattern between the types of MO and positive detachment (p<0,05). Non-white adolescents (OR=1.32, 95%CI: 1.24-1.42), with less years of schooling (OR=1.30, 95%CI: 1.22-1.42), with teeth extracted due to caries (OR=1.40, 95%CI: 1.03-1.88) were more likely to have MO. Adolescent access to dental consultation did not contribute to reducing the chance of developing MO, regardless of whether the dental consultation occurred less (OR=2.02, 95%CI: 1.65-2.47) or more than one year before (OR=1.63, 95%CI: 1.31-2.03). Thus, the occurrence of MO is unequally distributed in the state of São Paulo and associated with sociodemographic conditions, access to consultations and tooth loss due to caries.

Age and Type of Delivery as Risk Indicators for Maternal Mortality.

OBJECTIVE: This study assessed maternal mortality (MM) and related factors in a large-sized municipality in the Southeastern region of Brazil (Campinas, São Paulo) during the period 2000-2015. METHODS: This study consisted of two phases: 1. An analytical nested case-control phase that assessed the impact of individual and contextual variables on MM; and 2. an ecological phase designed to contextualize maternal deaths by means of spatial analysis. The case group consisted of all maternal deaths (n = 87) and the control group consisted of 348 women who gave birth during the same period. Data analysis included descriptive statistics, association, and multiple logistic regression (MLR) tests at p < 0.05 as well as spatial analysis. RESULTS: Maternal Mortality Ratio was 37 deaths per 100.000 live births. Deaths were dispersed throughout the urban territory and no formation of cluster was observed. MLR showed that pregnant women aged ≥ 35 years old (OR = 2.63) or those with cesarean delivery (OR = 2.51) were more prone to maternal death. CONCLUSION: Maternal deaths were distributed dispersedly among the different socioeconomic levels and more prone to occur among older women or those undergoing cesarean deliveries.

OBJETIVO: Esse estudo avaliou a mortalidade materna (MM) e fatores relacionados em um município de grande porte da região sudeste do Brasil (Campinas, São Paulo) no período de 2000-2015. MéTODOS:: Esse estudo consistiu de duas fases: 1. Uma fase analítica de caso-controle que avaliou o impacto de variáveis individuais e contextuais na MM; 2. Uma fase ecológica delineada para contextualizar as mortes maternas por meio de análise espacial. O grupo caso consistiu de 87 mortes maternas e o grupo controle de 348 mulheres que tiveram bebês durante o mesmo período. Os dados foram analisados por estatística descritiva, testes de associação e regressão logística múltipla (RLM) (p < 0,05) assim como análise espacial. RESULTADOS: A taxa de mortalidade materna foi de 37 mortes para cada 100.000 nascidos vivos. As mortes foram dispersas por todo o território urbano e não se observou formação de clusters. Na RLM observou-se que mulheres grávidas com idade ≥ 35 anos (OR = 2,63) ou aquelas que passaram por cesárea (OR = 2,51) foram mais propensas à morte materna. CONCLUSãO:: As mortes maternas foram distribuídas dispersamente entre os diferentes níveis socioeconômicos e mais propensas a ocorrer entre mulheres ≥ 35 anos de idade ou que passaram por cesárea.

Age and Type of Delivery as Risk Indicators for Maternal Mortality / Idade e tipo de parto como indicadores de risco para mortalidade materna

Abstract Objective: This study assessed maternal mortality (MM) and related factors in a large-sized municipality in the Southeastern region of Brazil (Campinas, São Paulo) during the period 2000-2015. Methods: This study consisted of two phases: 1. An analytical nested case-control phase that assessed the impact of individual and contextual variables on MM; and 2. an ecological phase designed to contextualize maternal deaths by means of spatial analysis. The case group consisted of all maternal deaths (n = 87) and the control group consisted of 348 women who gave birth during the same period. Data analysis included descriptive statistics, association, and multiple logistic regression (MLR) tests at p < 0.05 as well as spatial analysis. Results: Maternal Mortality Ratio was 37 deaths per 100.000 live births. Deaths were dispersed throughout the urban territory and no formation of cluster was observed. MLR showed that pregnant women aged > 35 years old (OR = 2.63) or those with cesarean delivery (OR = 2.51) were more prone to maternal death. Conclusion: Maternal deaths were distributed dispersedly among the different socioeconomic levels and more prone to occur among older women or those undergoing cesarean deliveries.

Resumo Objetivo: Esse estudo avaliou a mortalidade materna (MM) e fatores relacionados em um município de grande porte da região sudeste do Brasil (Campinas, São Paulo) no período de 2000-2015. Métodos: Esse estudo consistiu de duas fases: 1. Uma fase analítica de caso-controle que avaliou o impacto de variáveis individuais e contextuais na MM; 2. Uma fase ecológica delineada para contextualizar as mortes maternas por meio de análise espacial. O grupo caso consistiu de 87 mortes maternas e o grupo controle de 348 mulheres que tiveram bebês durante o mesmo período. Os dados foram analisados por estatística descritiva, testes de associação e regressão logística múltipla (RLM) (p < 0,05) assim como análise espacial. Resultados: A taxa de mortalidade materna foi de 37 mortes para cada 100.000 nascidos vivos. As mortes foram dispersas por todo o território urbano e não se observou formação de clusters. Na RLM observou-se que mulheres grávidas com idade > 35 anos (OR = 2,63) ou aquelas que passaram por cesárea (OR = 2,51) foram mais propensas à morte materna. Conclusão: As mortes maternas foram distribuídas dispersamente entre os diferentes níveis socioeconômicos e mais propensas a ocorrer entre mulheres > 35 anos de idade ou que passaram por cesárea.

Level of Satisfaction and Quality of Life of Caregivers of People with Disabilities in Secondary Dental Care

Abstract Objective: To assess the level of satisfaction and quality of life (QOL) of caregivers of Patients with Special Needs seen at the Dental Specialties Center in Aracaju, Brazil. Material and Methods: The Program for Primary Care Access and Quality Improvement (PMAQ - DSC) and the World Health Organization's Quality of Life - Brief (WHOQOL-BREF) questionnaires were applied to PSN and caregivers. Results: The PMAQ questionnaire was applied to 31 patients or caregivers; 97% had no paid work and 61% used public transportation to reach the Dental Specialties Center. The WHOQOL-BREF questionnaire was applied to 20 caregivers; 60% considered their life to be good; however, 60% had practically no leisure time. Correlation tests (Pearson's coefficient) showed a statistically significant correlation between the physical and psychological domain (p=0.02; r=0.64), the psychological and social domain (p=0.033; r=0.48), and the psychological and environment domain (p<0.001; r=0.80). Conclusion: The caregivers and patients with special needs felt satisfied with the specialized oral health service offered by the municipality. Concerning the quality of life of caregivers, the majority stated they had a good quality of life, despite not having the opportunity to participate in leisure-oriented activities and often having negative feelings.

Fatores clínicos e socioeconômicos relacionados à má oclusão em adolescentes brasileiros: estudo transversal / Clinical and socioeconomic factors related to malocclusion in brazilian adolescents: a cross-sectional study

Objetivo: Testar as associações da má oclusão (MO) com as variáveis clínicas odontológicas e socioeconômicas em adolescentes brasileiros de 15 a 19 anos. Métodos: Trata-se de um estudo observacional transversal analítico que utilizou os dados do relatório final da Pesquisa Estadual de Saúde Bucal do ano de 2015. Resultados:Adolescentes não brancos, com baixa escolaridade, com menor frequência de consultas ao dentista e com dentes extraídos por cárie tiveram, respectivamente, 1,32, 1,32, 2,02 e 1,63, e 1,40 vezes mais chance de apresentar MO. Conclusão: A MO é um problema de saúde pública e sofre influência dos determinantes socioeconômicos, deste modo, deve-se garantir o acesso ao tratamento ortodôntico para aqueles que apresentem maior vulnerabilidade social e, consequentemente, maior susceptibilidade aos agravos em saúde bucal.

Aim: To test the associations of malocclusion with clinical and socioeconomic variables in Brazilian adolescents aged 15 to 19 years. Methods: This is an analytical cross-sectional observational study, which used data from the final report of the 2015 State Oral Health Survey. Results: Non-white adolescents, low educational level, with fewer visits to the dentist, and teeth extracted due to caries, had, respectively, 1.32, 1.32, 2.02 and 1.63, and 1.40-fold greater chances of presenting malocclusion. Conclusion:Malocclusion is a public health problem and is influenced by socioeconomic determinants. Therefore, conditions for orthodontic treatment must be guaranteed for those who are more socially vulnerable and, consequently are more likely to suffer from oral health problems.

Autoimmune Responses in Oncology: Causes and Significance.

Specific anti-tumor immune responses have proven to be pivotal in shaping tumorigenesis and tumor progression in solid cancers. These responses can also be of an autoimmune nature, and autoantibodies can sometimes be present even before the onset of clinically overt disease. Autoantibodies can be generated due to mutated gene products, aberrant expression and post-transcriptional modification of proteins, a pro-immunogenic milieu, anti-cancer treatments, cross-reactivity of tumor-specific lymphocytes, epitope spreading, and microbiota-related and genetic factors. Understanding these responses has implications for both basic and clinical immunology. Autoantibodies in solid cancers can be used for early detection of cancer as well as for biomarkers of prognosis and treatment response. High-throughput techniques such as protein microarrays make parallel detection of multiple autoantibodies for increased specificity and sensitivity feasible, affordable, and quick. Cancer immunotherapy has revolutionized cancer treatments and has made a considerable impact on reducing cancer-associated morbidity and mortality. However, immunotherapeutic interventions such as immune checkpoint inhibition can induce immune-related toxicities, which can even be life-threatening. Uncovering the reasons for treatment-induced autoimmunity can lead to fine-tuning of cancer immunotherapy approaches to evade toxic events while inducing an effective anti-tumor immune response.

A Description of Infection Control Structure in Primary Dental Health Care, Brazil.

OBJECTIVE: This study is aimed at describing a score to assess infection control structures in Oral Health Teams (OHT) in Primary Health Care (PHC) in Brazil. METHODS: Secondary data from a national external evaluation of PHC conducted in 2017 and 2018 were analyzed. The construction of the score used 14 variables, divided into the following: structural characteristics of the PHC, infection control equipment under conditions of use, and biosafety supplies in sufficient quantity. The questions were mostly dichotomous (yes/no). Descriptive analyses were carried out to characterize the OHT and factor analyses to reduce the number of observed variables to a specific number of factors. RESULTS: Among 20,301 health units with OHT, 4,510 (22.2%) units did not have washable floors, ceilings, and walls; 8,406 (41.4%) did not have a sealer; 16,780 (82.7%) did not have taps with noncontact activation, and 4,663 (23.0%) units did not have rubber gloves. Regarding personal protective equipment (PPE), 1,618 (8.0%) units did not have a sufficient quantity of basic PPE. Three factors were defined to explain the 14 evaluated variables. The South region had the best score of infection control, while the North had the worst. CONCLUSIONS: Regional inequalities in the failures in infection control structures identified in PHC with OHT were related to the physical structure, equipment, and supplies used for infection control and the absence of PPE for OHT.

Tracking the Antibody Immunome in Sporadic Colorectal Cancer by Using Antigen Self-Assembled Protein Arrays.

Sporadic Colorectal Cancer (sCRC) is the third leading cause of cancer death in the Western world, and the sCRC patients presenting with synchronic metastasis have the poorest prognosis. Genetic alterations accumulated in sCRC tumor cells translate into mutated proteins and/or abnormal protein expression levels, which contribute to the development of sCRC. Then, the tumor-associated proteins (TAAs) might induce the production of auto-antibodies (aAb) via humoral immune response. Here, Nucleic Acid Programmable Protein Arrays (NAPPArray) are employed to identify aAb in plasma samples from a set of 50 sCRC patients compared to seven healthy donors. Our goal was to establish a systematic workflow based on NAPPArray to define differential aAb profiles between healthy individuals and sCRC patients as well as between non-metastatic (n = 38) and metastatic (n = 12) sCRC, in order to gain insight into the role of the humoral immune system in controlling the development and progression of sCRC. Our results showed aAb profile based on 141 TAA including TAAs associated with biological cellular processes altered in genesis and progress of sCRC (e.g., FSCN1, VTI2 and RPS28) that discriminated healthy donors vs. sCRC patients. In addition, the potential capacity of discrimination (between non-metastatic vs. metastatic sCRC) of 7 TAAs (USP5, ML4, MARCKSL1, CKMT1B, HMOX2, VTI2, TP53) have been analyzed individually in an independent cohort of sCRC patients, where two of them (VTI2 and TP53) were validated (AUC ~75%). In turn, these findings provided novel insights into the immunome of sCRC, in combination with transcriptomics profiles and protein antigenicity characterizations, wich might lead to the identification of novel sCRC biomarkers that might be of clinical utility for early diagnosis of the tumor. These results explore the immunomic analysis as potent source for biomarkers with diagnostic and prognostic value in CRC. Additional prospective studies in larger series of patients are required to confirm the clinical utility of these novel sCRC immunomic biomarkers.

Effects of 12-week inspiratory muscle training with low resistance in patients with multiple sclerosis: A non-randomised, double-blind, controlled trial.

BACKGROUND: Patients with multiple sclerosis (MS) have respiratory limitations like fatigue or muscle weakness. The aim of the study was to evaluate the effectiveness of a low-intensity protocol with inspiratory muscle training (IMT) to improve respiratory strength, spirometric parameters and dyspnea in patients with MS. METHODS: This study was a controlled, non-randomised, double-blind trial on 67 patients with MS distributed in 2 groups, intervention group (IG) (n = 36) and respiratory exercise group (REG) (n = 31). Over 12 weeks, 5 days/week, 15 min/day all subjects followed a respiratory training program. IG trained with IMT with low resistance (20% maximum inspiratory pressure (MIP) during the first two weeks, 30% MIP after the second week). REG followed a program involving nasal breathing and maximum exhalation. Main outcome measured was inspiratory strength (MIP); secondary outcomes were maximum expiratory pressure (MEP), spirometry, dyspnea and health-related quality of life. RESULTS: After respiratory training, the intervention group improved MIP, MEP, MVV, peak expiratory flow (PEF), tidal volume (TV) and dyspnea, 51%, 36%, 21%,11%, 51% and 19% respectively (p < .001, p < .001, p < .001, p < .05, p < .05, p < .05). The control group improved MIP, MEP, MVV and PEF, 24%, 27%, 28% and 12% respectively (p < .001, p < .001, p < .001, p < .05). Improvements achieved on MIP and dyspnea were significantly higher in IG patients (p=.002, p=.046, respectively). CONCLUSION: 12-week inspiratory muscle training with low resistance was more effective than conventional respiratory exercises to improve respiratory strength, spirometric parameters and dyspnea in patients with multiple sclerosis.

Fatores associados ao uso não urgente de unidades de pronto atendimento: uma abordagem multinível / Factors associated with non-emergency use of Emergency Care Units: a multilevel approach

Resumo Introdução estudos no Brasil e em diversos países indicam que os serviços de urgência são frequentemente utilizados como portas de entrada para os sistemas de saúde, sobrecarregando-os e impactando na qualidade do serviço prestado à população. Entretanto, pouco se conhece sobre esse fenômeno nas unidades de pronto atendimento (UPAs) do nosso país. Objetivo investigar as variáveis associadas ao uso inadequado de duas UPAs em um município de grande porte. Método estudo transversal com uma amostra de 756 indivíduos que analisou as variáveis individuais, contextuais e dos serviços associadas ao uso inapropriado de UPAs por meio de um modelo de regressão logística múltipla e hierarquizada. Resultados o modelo final de regressão demonstrou que os indivíduos que apresentavam autopercepção de que sua condição era um caso de emergência e cuja idade era igual a ou acima de 60 anos apresentaram mais chances de procurarem esses serviços por motivos não urgentes. Conclusão variáveis individuais estiveram associadas ao uso não urgente dos serviços das UPAs. Estudos futuros de cunho qualitativo poderão auxiliar a compreender os motivos do uso inadequado desses serviços por tais indivíduos.

Abstract Background Studies in Brazil and in several countries indicate that emergency services are often used as gateways to health systems, overburdening them and impacting on the quality of service provided to the population. However, little is known about this phenomenon in the Emergency Care Units (EUCs) of our country. Objective To investigate the variables associated with the inadequate use of two EUCs in a large municipality. Method A cross-sectional study was carried out with a sample of 756 individuals that analyzed individual, contextual and service-related variables associated with the inappropriate use of EUCs through a hierarchical multiple logistic regression model. Results The final regression model showed that individuals who had self-perceived their condition as an emergency and whose age was equal to or older than 60 years presented high odds to seek these services for non-urgent reasons. Conclusions Individual variables were associated with non-urgent use of the ECUs. Future studies of a qualitative nature may help to understand the reasons for the inadequate use of these services by these individuals.

Fatores associados ao uso de serviços odontológicos públicos por adultos no estado de São Paulo, Brasil, 2016 / Factors associated with public dental service use by adults in the state of São Paulo, Brazil, 2016

Resumo O objetivo deste artigo é analisar os fatores associados ao uso dos serviços odontológicos públicos por adultos. Estudo transversal com amostra representativa de adultos de 35 a 44 anos, com dados do Levantamento Epidemiológico das Condições de Saúde Bucal da População do Estado de São Paulo (SBSP-2015). Utilizou-se análise de regressão logística multivariada, baseada em modelo proposto por Andersen para predizer o acesso aos serviços odontológicos públicos. Visitaram o serviço privado 3.421 (59,9%) adultos e 2.288 (40,1%), o público. Os serviços odontológicos públicos foram mais acessados por mulheres (41,8%) e menos escolarizados (50,2%). Indivíduos não brancos (OR = 1,32; IC95%:1,16; 1,50), menor renda familiar (OR = 2,37; IC95%:2,11; 2,65), histórico de dor de dente (OR = 1,60; IC95%:1,39; 1,83) e necessidade de tratamento endodôntico (OR = 1,44; IC95%:1,12; 1,85) foram associados ao uso dos serviços odontológicos públicos. Fatores contextuais, individuais e necessidade de tratamento foram associados à utilização dos serviços odontológicos públicos por adultos residentes no estado de São Paulo, em 2015.

Abstract The aim of this study was to investigate the factors associated with public dental care use by adults in the State of São Paulo, Brazil. A cross-sectional study was conducted with a representative sample of adults aged 35 to 44 years using data from the 2015 Epidemiological Survey of the Oral Health Status of the Population of the State of São Paulo (SBSP-2015). Multivariate logistic regression was performed using variables based on a model proposed by Andersen for predicting access to public dental services. Results: 3,421 (59.9%) adults visited private services and 2,288 (40.1%) visited public services. Prevalence of the use of public dental services was greatest among women (41.8%) and adults with a lower education level (50.2%). Being non-white (OR = 1.32, 95% CI: 1.16, 1.50), lower household income (OR = 2.37, 95% CI: 2.11, 2.65), having had toothache (OR = 1.60, 95% CI: 1.39, 1.83), and need for endodontic treatment (OR = 1.44, 95% CI: 1.12, 1.85) were associated with public dental service use. Predisposing, enabling, and need factors were associated with public dental care use.

Factors associated with public dental service use by adults in the state of São Paulo, Brazil, 2016. / Fatores associados ao uso de serviços odontológicos públicos por adultos no estado de São Paulo, Brasil, 2016.

The aim of this study was to investigate the factors associated with public dental care use by adults in the State of São Paulo, Brazil. A cross-sectional study was conducted with a representative sample of adults aged 35 to 44 years using data from the 2015 Epidemiological Survey of the Oral Health Status of the Population of the State of São Paulo (SBSP-2015). Multivariate logistic regression was performed using variables based on a model proposed by Andersen for predicting access to public dental services. Results: 3,421 (59.9%) adults visited private services and 2,288 (40.1%) visited public services. Prevalence of the use of public dental services was greatest among women (41.8%) and adults with a lower education level (50.2%). Being non-white (OR = 1.32, 95% CI: 1.16, 1.50), lower household income (OR = 2.37, 95% CI: 2.11, 2.65), having had toothache (OR = 1.60, 95% CI: 1.39, 1.83), and need for endodontic treatment (OR = 1.44, 95% CI: 1.12, 1.85) were associated with public dental service use. Predisposing, enabling, and need factors were associated with public dental care use.

O objetivo deste artigo é analisar os fatores associados ao uso dos serviços odontológicos públicos por adultos. Estudo transversal com amostra representativa de adultos de 35 a 44 anos, com dados do Levantamento Epidemiológico das Condições de Saúde Bucal da População do Estado de São Paulo (SBSP-2015). Utilizou-se análise de regressão logística multivariada, baseada em modelo proposto por Andersen para predizer o acesso aos serviços odontológicos públicos. Visitaram o serviço privado 3.421 (59,9%) adultos e 2.288 (40,1%), o público. Os serviços odontológicos públicos foram mais acessados por mulheres (41,8%) e menos escolarizados (50,2%). Indivíduos não brancos (OR = 1,32; IC95%:1,16; 1,50), menor renda familiar (OR = 2,37; IC95%:2,11; 2,65), histórico de dor de dente (OR = 1,60; IC95%:1,39; 1,83) e necessidade de tratamento endodôntico (OR = 1,44; IC95%:1,12; 1,85) foram associados ao uso dos serviços odontológicos públicos. Fatores contextuais, individuais e necessidade de tratamento foram associados à utilização dos serviços odontológicos públicos por adultos residentes no estado de São Paulo, em 2015.

A Judicialização da saúde nos sistemas público e privado de saúde: uma revisão sistemática / Judicialization of health in the public and private health systems: a systematic review / Judicialización de la salud en los sistemas público y privado de salud: una revisión sistemática

No Brasil, o direito à saúde tem previsão constitucional e universal. No entanto, a via judicial tem sido muito utilizada para acesso a bens e serviços de saúde. Assim, o objetivo deste artigo foi revisar a literatura sobre a judicialização da saúde entre 2004 e 2017. A partir de pergunta estruturada, foram revisadas as bases de dados PubMed/MEDLINE, Lilacs, SciELO, Scopus e Bireme/BVS. A maioria das ações refere-se a medicamentos. Houve consenso quanto à característica individual das litigações, à preponderância da prescrição médica e à constitucionalidade da saúde integral. Há divergências em relação a possíveis interferências das decisões judiciais na gestão e na efetivação das políticas públicas e do direito à saúde. Estudos apontam falhas na gestão e disfunções nos sistemas de saúde. Os perfis das demandas de saúde levados à justiça podem auxiliar os gestores de saúde na reorientação das práticas assistenciais.(AU)

In Brazil, the right to health has a constitutional and universal provision. However, litigations have been frequently used to guarantee access to health goods and services. The objective of this study is to review the literature about judicialization of health from 2004 to 2017. Based on a structured question, the databases PubMed/MEDLINE, LILACS, SciELO, Scopus and BIREME/BVS were reviewed. The majority of lawsuits refers to medications. There was a consensus concerning the individual characteristic of the litigations, the preponderance of medical prescription, and the constitutionality of integral health. There are divergences regarding possible interferences of legal decisions in management and in the effectuation of public policies and of the right to health. Studies show management failures and dysfunctions in health systems. The profiles of health demands taken to the court can help health managers in the reorientation of care practices.(AU)

En Brasil, el derecho a la salud tiene previsión constitucional y universal. No obstante, la vía judicial se ha utilizado mucho para tener acceso a bienes y servicios de salud. El propósito del estudio fue revisar la literatura sobre la judicialización de la salud entre 2004 a 2017. A partir de una pregunta estructurada, se revisaron las bases de datos PubMed/MEDLINE, LILACS, SciELO, Scopus y BIREME/BVS. La mayoría de las acciones se refiere a medicamentos. Hubo consenso sobre la característica individual de los litigios, la preponderancia de la prescripción médica y la constitucionalidad de la salud integral. Hay divergencias sobre posibles interferencias de las decisiones judiciales en la gestión, en la realización efectiva de las políticas públicas y del derecho a la salud. Estudios señalan fallas en la gestión y disfunciones en los sistemas de salud. Los perfiles de las demandas de salud llevados ante los tribunales pueden auxiliar a los gestores de salud en la reorientación de las prácticas asistenciales.(AU)

Spatial distribution of decayed and restored teeth in an adult population / Distribuição espacial de dentes cariados e restaurados numa população adulta

ABSTRACT Objective To analyze the spatial distribution of decayed and restored teeth in adults according to the Social Exclusion Index (SEI) and the proximity of public dental service. Methods: This ecological study used secondary data from an epidemiological survey of oral health and from the Piracicaba Research and Planning Institute (IPPLAP). The oral examinations of the DMFT index examined in households by a single examiner calibrated in 2011, by probability sampling, 248 adults (aged 20 to 64 years) representing the residents in Piracicaba-SP, Brazil. Data on social exclusion and health units with dental service were extracted from IPPLAP. We performed georeferencing of the census tracts selected by draw in the epidemiological survey and their respective districts, in addition to the health units with dental service in a radius of 500 m and 1000 m. Spearman's rank correlation coefficient was analyzed (p<0.05). Results: The smallest value of SEI, that is, the highest social exclusion, showed no correlation with decayed teeth (p=0.09), but had strong positive correlation with restored teeth (r=0.79; p<0.0001). Presence of public dental service in the vicinity of 500 m and 1,000 m showed no correlation, respectively, with the average number of decayed (p=0.07 and p=0.58) and restored (p=0.26 and p=0.56) teeth. Conclusion: Although the correlation between social exclusion and caries in adults was not observed, its case management, namely, the restored teeth, showed correlation with social inequalities. Presence of public dental service showed no correlation with components of caries experience evaluated in this study.

RESUMO Objetivo: Analisar a distribuição espacial dos dentes cariados e restaurados em adultos segundo o Índice de Exclusão Social (IEX) e a proximidade de serviço odontológico público. Metodologia: Este estudo ecológico utilizou-se de dados secundários de um levantamento epidemiológico de saúde bucal e do Instituto de Pesquisa e Planejamento de Piracicaba (IPPLAP). Os exames bucais do índice de dentes permanentes cariado perdidos e obturados (CPOD) examinou em domicílios por um único examinador calibrado em 2011, por amostragem probabilística, 248 adultos (20 a 64 anos) representativos dos residentes em Piracicaba-SP, Brasil. Os dados sobre exclusão social e as unidades de saúde com serviço odontológico foram extraídos do IPPLAP. Realizou-se o georreferenciamento dos setores censitários sorteados no levantamento epidemiológico e seus respectivos bairros, além das unidades de saúde com serviço odontológico em um raio de 500m e 1000m. Foi realizada a análise de correlação de Spearman (p<0.05). Resultados: O menor valor do IEX, ou seja, maior exclusão social, não apresentou correlação com dentes cariados (p=0,09), mas teve correlação positiva forte com dentes restaurados (r=0,79; p<0,0001). A presença de serviço odontológico público em proximidade de 500 e 1000m não apresentou correlação, respectivamente, com a média de dentes cariados (p=0,07 e p=0,58) e restaurados (p=0,26 e p=0,56). Conclusão: Apesar de não ser verificada correlação entre cárie e exclusão social em adultos, sua resolutividade, ou seja, os dentes restaurados apresentaram correlação com as desigualdades sociais. A presença de serviço odontológico público não apresentou correlação com os componentes de experiência de cárie avaliados nesse estudo.

Geographical Variation in Oral and Oropharynx Cancer Mortality in Brazil: A Bayesian Approach.

Recent studies have shown a high number of deaths from oral and oropharyngeal cancer worldwide, Brazil included. For this study, the deaths data (ICD-10, chapter II, categories C00 to C14) was obtained from Mortality Information System (SIM) and standardized by gender and population for each of the 554 Microregions of Brazil. The raw mortality rates were adopted as the standard and compared to the application of smoothing by the Bayesian model. In order to describe the geographical pattern of the occurrence of oral cancer, thematic maps were constructed, based on the distributions of mortality rates for Microregions and gender. Results: There were 7882 deaths registered due to oral and oropharyngeal cancer in Brazil, of which 6291 (79.81%) were male and 1591 (20.19%) female. The Empirical Bayesian Model presented greater scattering with mosaic appearance throughout the country, depicting high rates in Southeast and South regions interpolated with geographic voids of low rates in Midwest and North regions. For males, it was possible to identify expressive clusters in the Southeast and South regions. Conclusion: The Empirical Bayesian Model allowed an alternative interpretation of the oral and oropharynx cancer mortality mapping in Brazil.

Multivariate method to identify inequalities in oral healthcare access.

OBJECTIVE: The aim of this study is to apply a multivariate method for municipality's classification according access to oral health in adults. MATERIALS AND METHODS: This is a cross-sectional epidemiological study. Were used multivariate classification called nonhierarchical cluster analysis K-means. The strategy brings together municipalities' similarity as access to oral health, where the most similar are next and the most different from getting further away. In addition, it allows reducing the intragroup variance and maximizing intergroup variance. It was assumed the number of four groups. RESULTS: Among adults, 3,185 (52.63%) visited the dentist less than a year, and 357 (5.90%) have never been to the dentist. Homogeneous groups showed differences in the time since the last visit to the dentist for adults. The analysis of variance by the F statistic rejected the hypothesis that the variances are equal for the variables related to the time since the last visit to the dentist. CONCLUSION: It was possible to identify the inequalities in the access to oral healthcare services for adults and locate spatially municipalities whose subjects take longer to visit the dentist.