RESUMO
CONTEXT: Home visit is a modality of health care that is expanding in Brazil and in the world. Public and private services have invested in the implementation of this type of assistance. It happens due to its potential to transform the model of care, highlighting the work quality of the primary health care teams. AIMS: To analyze house call rates in primary care in the Brazilian public healthcare system according to professional categories and health macro-regions in the state of Minas Gerais, southeast region of Brazil. SETTINGS AND DESIGN: An ecological study that used as the information source the production data from the Primary Care Information System (2010 to 2015). METHODS AND MATERIALS: House call rates (per 3000 inhabitants) by primary care professionals constituted the response variable. The independent variables were professional categories and the 13 health macro-regions of the state. STATISTICAL ANALYSIS USED: The data were analyzed using the Mann-Whitney test. RESULTS: A total of 26,932,463 house calls were performed in the period, but the number of visits in 2015 was significantly lower compared to 2010. Significantly higher house call rates were found for some professional categories (mid-level professionals and nurses) and significant differences were found among the macro-regions (P < 0.05). CONCLUSIONS: The profile of house calls by primary care professionals revealed the constant presence of this care modality, but the distribution of these visits is uneven among the different professional categories and macro-regions of the state.
Assuntos
Visita Domiciliar , Atenção Primária à Saúde , Brasil , HumanosRESUMO
OBJECTIVES: Estimate the prevalence of functional dentition among Brazilian adults using four different definitions and identify associated factors. METHODS: A cross-sectional study was conducted involving 9564 Brazilian adults aged 35-44 years who participated in the 2010 National Oral Health Survey. Data collection involved oral examinations and the administration of questionnaires. The following definitions were used: 1-WHO Functional Dentition (FDWHO: ≥ 20 teeth present); 2-well-distributed teeth (WDT: ≥ 10 teeth in each arch); 3 -Functional dentition classified by esthetics and occlusion (FDClass5: dentitions that sequentially exhibit at least one tooth in each arch, at least 10 teeth in each arch, all maxillary and mandibular anterior teeth, three or four premolar posterior occluding pairs [POPs], and at least one molar POP bilaterally); 4-Functional dentition classified by esthetics, occlusion and periodontal status (FDClass6: corresponds to FDClass5 with the addition of periodontal status of all sextants in the oral cavity with, at most, shallow pockets and/or clinical attachment level of 5 mm (CPI ≤ 3 and/or CAL ≤ 1). The independent variables were individual factors (gender, self-declared skin color, schooling, monthly household income, age group, self-rated treatment need, dental pain, dental appointment in the previous 12 months and dental services) and contextual factors (Municipal Human Development Index [MHDI]), Gini coefficient, fluoridated water supply and oral health coverage). Multilevel mixed-effect Poisson regression analyses were performed. RESULTS: The prevalence of functional dentition based on the FDWHO, WDT, FDClass5 and FDClass6 definitions was 77.9%, 72.9%, 42.6% and 40.3%, respectively. Adults with ≥12 years of schooling and monthly household income from US$ 853 to 2557 had higher prevalence rates of FDWHO (PR: 1.41 and 1.10, respectively), WDT (PR: 1.58 and 1.14, respectively), FDClass5 (PR: 2.03 and 1.27, respectively) and FDClass6 (PR: 2.15 and 1.35, respectively). These values in the final models were adjusted for gender, self-declared skin color (FDClass5), age group, self-rated treatment need (FDWHO, FDClass5 and FDClass6), dental appointment in the previous 12 months (FDWHO and WDT), dental services (FDWHO and WDT) and contextual factors. A very high MHDI and presence of fluoridated water supply were associated with higher prevalence rates of the four outcomes. CONCLUSIONS: The incorporation of the criteria of new definitions of functional dentition led to a lower prevalence rate among Brazilian adults. Striking individual and contextual inequalities were identified with regard to the four definitions analyzed, which need to be addressed through inter-sector efforts.
Assuntos
Dentição Permanente , Determinantes Sociais da Saúde , Adulto , Brasil/epidemiologia , Estudos Transversais , Índice CPO , Serviços de Saúde Bucal/estatística & dados numéricos , Inquéritos de Saúde Bucal , Escolaridade , Feminino , Fluoretação , Disparidades em Assistência à Saúde , Humanos , Renda , Arcada Edêntula/epidemiologia , Masculino , Grupos Raciais , Fatores Socioeconômicos , Perda de Dente/epidemiologiaRESUMO
AIMS: The aims of the present study were to evaluate oral health status among Brazilian adults aged 35 to 44 years with regard to functional dentition based on four different definitions and classify dentition configurations using a dental functional status classification system. METHODS: The sample was composed of 9564 individuals who participated in the 2010 National Oral Health Survey. The definitions were "well-distributed teeth" concept (WDT), the World Health Organization functional dentition concept (FDWHO), functional dentition classified by esthetics and occlusion (FDClass5), and functional dentition classified by esthetics, occlusion, and periodontal status (FDClass6). Dentitions were classified on six sequential, accumulative levels (anyone reaching level VI necessarily met the criteria on all previous levels): I-≥one tooth in each arch; II-≥10 teeth in each arch (WDT) or ≥20 teeth present (FDWHO); III-all 12 anterior teeth present; IV-≥3 premolar posterior occluding pairs (POPs) present; V-≥one molar POP bilaterally (FDClass5); VI-all sextants with Community Periodontal Index <3 and/or loss of attachment ≤1 (FDClass6). RESULTS: The prevalence rates of the different definitions of functional dentition ranged from 42.6 % (FDClass5) and 40.3 % (FDClass6) to 72.9 % (WDT) and 77.9 % (FDWHO). CONCLUSIONS: The oral health status of Brazilian adults exhibited considerable variation due to the different definitions of functional dentition, and less than half of Brazilian adults met all the criteria of function. CLINICAL RELEVANCE: The indication and planning of prosthetic rehabilitation should not only be based on the absence of teeth but also the distribution and periodontal status of the teeth present.