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The objective was to perform a spatial analysis of the hospital mortality rate (HMR) due to severe acute respiratory syndrome (SARS) attributed to COVID-19 among children and adolescents in Brazil from 2020 to 2021. A cluster method was used to group federal units (FUs) based on HMR. In 2020, clusters with high HMRs were formed by north/northeast FUs. In 2021, there was a reduction in HMR. Clusters with higher rates remained in the N/NE region. Regional differences were observed in the HMR. The findings may reflect social inequalities and access to hospital care, especially in the under 1-year-old age group due to the severity of the disease in this group.

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Abstract The objective was to perform a spatial analysis of the hospital mortality rate (HMR) due to severe acute respiratory syndrome (SARS) attributed to COVID-19 among children and adolescents in Brazil from 2020 to 2021. A cluster method was used to group federal units (FUs) based on HMR. In 2020, clusters with high HMRs were formed by north/northeast FUs. In 2021, there was a reduction in HMR. Clusters with higher rates remained in the N/NE region. Regional differences were observed in the HMR. The findings may reflect social inequalities and access to hospital care, especially in the under 1-year-old age group due to the severity of the disease in this group.

Resumo Objetivou-se realizar uma análise espacial da taxa de mortalidade hospitalar (TMH) por síndrome respiratória aguda grave (SRAG) atribuída à COVID-19 em crianças e adolescentes no Brasil no período de 2020 a 2021. Utilizou-se o método de cluster para agrupar as unidades federativas (UFs) com base na TMH. Em 2020, clusters com altas TMHs foram formados por UFs Norte/Nordeste. Em 2021, houve redução na TMH. Os clusters com maiores taxas permaneceram na região N/NE. Diferenças regionais foram observadas nas TMHs. Os achados podem refletir as desigualdades sociais e o acesso à atenção hospitalar, principalmente na faixa etária de menores de 1 ano pela gravidade da doença neste grupo.

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OBJECTIVE: This study analyzes the effect of the Brazilian National Oral Health Policy (NOHP) on oral cancer mortality rates (OCMR). METHOD: This is an ecological study with secondary oral cancer death data, using interrupted time series analysis (ARIMA, Autoregressive Integrated Moving Average). Annual death data were collected from the Mortality Information System (1996-2019). The outcome was the OCMR, standardized by gender and age We considered the NOHP, categorized as "0" (before its implementation), from 1996 to 2004, and "1 to 15", from 2005 to 2019. ARIMA modeling was carried out for temporal analysis, and regression coefficient estimation (RC). RESULTS: The Brazilian NOHP implementation was associated with an increase in OCMR in the North region (CR = 0.16; p = 0.022) and with a decrease in the Southeast region (CR = -0.04; p<0.001), but did not affect the other macro-regions nor Brazil. The forecast models estimated an increase in OCMR for the North, and Northeast, a decrease for the Southeast, and stability for the South and Brazil. CONCLUSION: The Brazilian NOHP is not being effective in reducing the OCMR. The trends behaved differently in the Brazilian territory, highlighting health inequities. We recommend that the NOHP strengthen the oral health care network, incorporating oral cancer as a notifiable disease, adopting strategies for prevention, screening, and providing opportunities for early treatment of the disease.

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OBJECTIVE: Little is known about the effect of maternal immunological factors on the etiology of developmental defects of enamel (DDE). RANTES (Regulated on Activation Normal T Cell Expressed and Secreted) is a chemokine produced by fibroblasts, lymphoid and epithelial mucosa cells in response to various external stimuli. Despite its importance for embryogenesis, RANTES expression has been demonstrated in multiple diseases characterized by inflammation, tumor and immune response, and wound healing. We hypothesized that altered levels of RANTES during pregnancy are associated with the immune and inflammatory response in women, which could lead to the occurrence of DDE in utero (DDE-iu), directly or mediated by preterm birth. Therefore, this study aimed to evaluate the direct and indirect effects of serum levels of RANTES in pregnant women in the occurrence of DDE-iu in children. METHODS: This is a longitudinal case-control study. The mothers and their children (327) were evaluated in three moments: prenatal care, post childbirth, and when the child was between 12.3 and 36 months of age. The analysis was performed with structural equation modeling, estimating the standardized coefficient (SC), adopting α = 5%. RESULTS: There was a direct and negative effect of RANTES on the outcome (SC = -0.137; p = 0.022). This association was not mediated by preterm birth (SC = 0.007; P = 0.551). When considering the specific types of DDE-iu, RANTES had a direct effect on hypoplasia (SC = -0.190; p = 0.007), but not on opacity (SC = 0.343; p = 0.074). CONCLUSION: Lower serum levels of RANTES may contribute to a higher number of teeth with DDE-iu, specifically hypoplasia. However, more evidence supported by clinical, laboratory and epidemiological studies is still needed.

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Resumo O objetivo deste artigo é analisar indicadores de uso de serviços de saúde bucal da atenção primária à saúde no Maranhão antes e durante a pandemia de COVID-19. Estudo ecológico de série temporal interrompida cuja unidade de análise foi o Maranhão. A exposição foi a pandemia de COVID-19, dicotomizada em pré e pandemia. Os desfechos foram calculados pela razão da quantidade de procedimentos preventivos (RPP), de urgência (RPU) e procedimentos curativos (RPC), e a projeção censitária da população do estado, multiplicada por mil, mensalmente. Os dados foram coletados do Sistema de Informação em Saúde para a Atenção Básica e do Instituto Brasileiro de Geografia e Estatística, no período de 2015.1 a 2022.2. As análises foram realizadas por meio do modelo autorregressivo, integrado e de médias móveis com sazonalidade. Houve tendência crescente dos três indicadores até jan./2019. A pandemia causou redução significativa na RPP (Xreg = -6,55; p-valor = 0,0008) e na RPC (Xreg = -4,74; p-valor = 0,0005), mas não influenciou a RPU (Xreg = -0,03; p-valor = 0,12) desde o primeiro semestre de 2020, persistindo até o segundo semestre de 2022. A pandemia de COVID-19 provocou redução nos serviços preventivos e curativos de saúde bucal no Maranhão.

Abstract This article aims to analyze indicators of the utilization of oral health services (UOHS) in primary health care in the state of Maranhão, Brazil, before and during the COVID-19 pandemic. We conducted an ecological time series study. The unit of analysis was the state of Maranhão, and the exposure variable was the COVID-19 pandemic, dichotomized into pre-pandemic and pandemic. The outcome variables were the monthly rates per 1,000 population of three UOHS indicators: rate of preventive procedures (RPP-PHC); rate of urgent procedures (RUP-PHC), and rate of curative procedures (RCP-PHC). The data were collected from the Primary Health Care Information System (SISAB) and the Brazilian Institute of Geography and Statistics (IBGE) for the period from 2015-2022. The analyses were performed using the Seasonal Autoregressive Integrated Moving Average (SARIMA) model. The three indicators showed an upward trend up to January 2019. The pandemic caused a significant reduction in the RPP (Xreg = -6.55; p-value = 0.0008) and RCP (Xreg = -4.74; p-value = 0.0005), starting in the first semester of 2020 and continuing into the second semester of 2022, but did not influence the RUP (Xreg = -0.03; p-value = 0.12). The COVID-19 pandemic caused a reduction in preventive and curative oral health services in Maranhão.

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Objective: To assess the effect of coverage of the Bolsa Família Program (BFP) on oral cancer mortality rates in Brazil between 2005 and 2017, adjusting for health care coverage and socioeconomic characteristics of the Brazilian federative units. Methods: This is an ecological study using annual data (2005-2017) from all the Brazilian federative units. The dependent variable for this study was the oral cancer mortality rate, standardized by gender and age using the direct standardization technique. BFP coverage was the main independent variable, calculated as the ratio of the number of BFP beneficiaries to those families that should potentially be entitled to this conditional cash transfer. Socioeconomic background and health care coverage were covariables. Choropleth maps were drawn, and space-time cube analysis was used to assess changes in the spatiotemporal distribution of BFP and oral cancer mortality rates. Mixed-effects linear regression analysis estimated the coefficients (ß) and 95% confidence intervals (CI) for the association between BFP coverage and oral cancer mortality rates. Results: BFP coverage trends increased and oral cancer mortality rate trends stabilized in Brazilian federative units, except for Maranhão, Goiás, and Minas Gerais, where the oral cancer mortality rates have increased. In the adjusted model, greater BFP coverage was associated with lower oral cancer mortality rates (ß -2.10; 95% CI [-3.291, -0.919]). Conclusions: Egalitarian strategies such as BFP can reduce the oral cancer mortality rate. We recommend the follow-up of families benefiting from conditional cash transfer program by oral health teams to reduce the oral cancer mortality rate.

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[ABSTRACT]. Objective. To assess the effect of coverage of the Bolsa Família Program (BFP) on oral cancer mortality rates in Brazil between 2005 and 2017, adjusting for health care coverage and socioeconomic characteristics of the Brazilian federative units. Methods. This is an ecological study using annual data (2005–2017) from all the Brazilian federative units. The dependent variable for this study was the oral cancer mortality rate, standardized by gender and age using the direct standardization technique. BFP coverage was the main independent variable, calculated as the ratio of the number of BFP beneficiaries to those families that should potentially be entitled to this conditional cash transfer. Socioeconomic background and health care coverage were covariables. Choropleth maps were drawn, and space-time cube analysis was used to assess changes in the spatiotemporal distribution of BFP and oral cancer mortality rates. Mixed-effects linear regression analysis estimated the coefficients (β) and 95% confidence intervals (CI) for the association between BFP coverage and oral cancer mortality rates. Results. BFP coverage trends increased and oral cancer mortality rate trends stabilized in Brazilian federative units, except for Maranhão, Goiás, and Minas Gerais, where the oral cancer mortality rates have increased. In the adjusted model, greater BFP coverage was associated with lower oral cancer mortality rates (β –2.10; 95% CI [–3.291, –0.919]). Conclusions. Egalitarian strategies such as BFP can reduce the oral cancer mortality rate. We recommend the follow-up of families benefiting from conditional cash transfer program by oral health teams to reduce the oral cancer mortality rate.

[RESUMEN]. Objetivo. Evaluar el efecto de la cobertura del Programa Bolsa Família (BFP) en las tasas de mortalidad por cáncer de la cavidad bucal en Brasil entre el 2005 y el 2017, ajustadas por cobertura de atención de salud y características socioeconómicas de las unidades federativas brasileñas. Métodos. Este es un estudio ecológico con datos anuales (2005-2017) de todas las unidades federativas brasileñas. La variable dependiente de este estudio fue la tasa de mortalidad por cáncer de la cavidad bucal, estandarizada por sexo y edad mediante la técnica de estandarización directa. La cobertura del BFP fue la principal variable independiente, calculada como la relación entre el número de beneficiarios del BFP y las familias que podrían tener el derecho a recibir esta transferencia monetaria condicionada. Los antecedentes socioeconómicos y la cobertura de atención de salud fueron covariables. Se trazaron mapas coropléticos y se realizó un análisis con cubos espaciotemporales para evaluar los cambios en la distribución espaciotemporal del BFP y las tasas de mortalidad por cáncer de la cavidad bucal. El análisis de regresión lineal de efectos mixtos calculó los coeficientes (β) y los intervalos de confianza (IC) del 95% para la relación entre la cobertura del BFP y las tasas de mortalidad por cáncer de la cavidad bucal. Resultados. Las tendencias de cobertura del BFP aumentaron y las tendencias de la tasa de mortalidad por cáncer de la cavidad bucal se estabilizaron en las unidades federativas brasileñas, excepto en Maranhão, Goiás y Minas Gerais, donde estas tasas aumentaron. En el modelo ajustado, una mayor cobertura del BFP se asoció con tasas más bajas de mortalidad por cáncer de la cavidad bucal (β –2,10; IC del 95% [–3,291, –0,919]). Conclusiones. Las estrategias igualitarias como el BFP pueden reducir la tasa de mortalidad por cáncer de la cavidad bucal. Recomendamos el seguimiento por parte de los equipos de salud bucodental de las familias que se benefician del programa de transferencias monetarias condicionadas para reducir la tasa de mortali- dad por cáncer de la cavidad bucal.

[RESUMO]. Objetivo. Avaliar o efeito da cobertura do Programa Bolsa Família (PBF) sobre as taxas de mortalidade por câncer bucal no Brasil entre 2005 e 2017, com ajuste para a cobertura de saúde e as características socio- econômicas das unidades federativas brasileiras. Métodos. Este é um estudo ecológico com base em dados anuais (2005-2017) de todas as unidades feder- ativas brasileiras. A variável dependente foi a taxa de mortalidade por câncer bucal, padronizada por sexo e idade pela técnica de padronização direta. A cobertura do PBF foi a principal variável independente, cal- culada como a razão entre o número de beneficiários do PBF e de famílias que deveriam ter direito a essa transferência condicionada de renda. O contexto socioeconômico e a cobertura de saúde foram covariáveis. Elaboraram-se mapas coropléticos e usou-se a análise de cubo espaço-temporal para avaliar variações da distribuição espaço-temporal do PBF e das taxas de mortalidade por câncer bucal. A análise por regressão linear de efeitos mistos estimou os coeficientes (β) e intervalos de confiança (IC) de 95% da associação entre cobertura do PBF e taxas de mortalidade por câncer bucal. Resultados. Houve aumento da tendência de cobertura do PBF e estabilização da tendência da taxa de mortalidade por câncer bucal nas unidades federativas brasileiras, com exceção dos estados de Maranhão, Goiás e Minas Gerais, onde as taxas de mortalidade por câncer bucal aumentaram. No modelo ajustado, a maior cobertura do PBF foi associada a menores taxas de mortalidade por câncer bucal (β -2,10; IC 95% [-3,291, -0,919]). Conclusões. Estratégias igualitárias como o PBF podem reduzir a taxa de mortalidade por câncer bucal. Recomendamos o acompanhamento das famílias beneficiadas por programas de transferência condicionada de renda por equipes de saúde bucal para reduzir a taxa de mortalidade por esse câncer.

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INTRODUCTION: Poor oral health can negatively affect general health and quality of life of kidney transplant recipients. The study aimed to investigate the association between chronic oral disease burden, serum biomarkers, and comorbidities in kidney transplant recipients. DESIGN: A cross-sectional comparative study was conducted with 44 patients after kidney transplant. The burden of chronic oral disease was composed of the following observable variables: moderate periodontitis and presence of dental caries. Serum biomarkers and comorbidities data were collected. The chi-square or Fisher's exact tests for categorical variables and Student's t-test or Mann-Whitney test for continuous variables were used. Robust Poisson regression was used to model the association. RESULTS: Higher levels of mean uric acid (P = .01) and creatinine (P = .03) were observed in the group of patients with oral disease burden, while the highest level of high-density lipoprotein was observed in the group without oral disease. Higher values of uric acid were associated with the occurrence of chronic oral disease burden (Adjusted PR = 1.24, 95% CI: 1.03-1.48, P = .019). There was no statistical difference between the groups with and without oral disease burden in comorbidities present. CONCLUSION: The findings suggest that chronic oral diseases burden can be associated with uric acid and creatinine levels in kidney transplant recipients.

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OBJECTIVE: To analyse the provision of oral cancer (OC) care services in the Dental Specialties Centers (Centros de Especialidades Odontológicas-CEO) in Brazil and identify changes over two cycles of external evaluation of the Program for the Improvement of Access and Quality-PMAQ, in 2014 and 2018. METHOD: This is a nationwide panel ecological study, including 916 CEO. Data from interviews with managers and dentists of the CEO were used, including variables related to training on OC, clinical protocols, biopsies, referral for diagnosis and treatment, and registration of users with OC. We carried out Latent Transition Analysis (LTA) to identify patterns (latent status LS) of service adequacy and work processes' changes between the two assessment cycles. We tested models with three, four, and five LS, selecting the one with the best conceptual interpretability and good model fit parameters. Data from the LS were plotted on choropleth and hotspots maps in Brazil allowing us to identify areas with the better or worse provision of specialized OC services. RESULTS: The model with four LS was chosen. The four LS were named: 1.'Most indicators inadequate for OC care' (the worst); 2. 'Most indicators suitable for OC care' (the best); 3. 'CEO with a poor relation with Primary Health Care (PHC) services'; and 4. 'CEO with a poor relation with tertiary hospital services'. The comparison of the LS transition between the two cycles revealed that 419 (45.7%) CEO remained in the same LS (1→1, 3→4, 2→2); 228 (24.9%) switched to a worse status (2→1, 2→4, 3→1) and 269 (29.4%) switched to a better LS (1→2, 1→4, 3→2). While the majority of the CEO improved, we identified a decline of 17.8% in those who reported performing biopsies and 18.3% in the number of CEO that had hospitals for referring confirmed OC cases. Almost all Brazilian states had CEO that improved the work process. The Southeast and South regions had the highest percentage of CEO with the better work process in both cycles. Hotspots showed areas concentrating improvements in the work process in the Northeast region. However, some hotspots in the North revealed some CEO where the work process deteriorated or remained unsatisfactory. CONCLUSIONS: There are regional inequities in the provision of OC care in CEO. Most services improved their work process or remained stable. However, the biopsies and the referral to hospital care for confirmed cases declined, indicating that CEO need to improve planning and care provision to reduce OC morbimortality.

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ABSTRACT Objective. To assess the effect of coverage of the Bolsa Família Program (BFP) on oral cancer mortality rates in Brazil between 2005 and 2017, adjusting for health care coverage and socioeconomic characteristics of the Brazilian federative units. Methods. This is an ecological study using annual data (2005-2017) from all the Brazilian federative units. The dependent variable for this study was the oral cancer mortality rate, standardized by gender and age using the direct standardization technique. BFP coverage was the main independent variable, calculated as the ratio of the number of BFP beneficiaries to those families that should potentially be entitled to this conditional cash transfer. Socioeconomic background and health care coverage were covariables. Choropleth maps were drawn, and space-time cube analysis was used to assess changes in the spatiotemporal distribution of BFP and oral cancer mortality rates. Mixed-effects linear regression analysis estimated the coefficients (β) and 95% confidence intervals (CI) for the association between BFP coverage and oral cancer mortality rates. Results. BFP coverage trends increased and oral cancer mortality rate trends stabilized in Brazilian federative units, except for Maranhão, Goiás, and Minas Gerais, where the oral cancer mortality rates have increased. In the adjusted model, greater BFP coverage was associated with lower oral cancer mortality rates (β -2.10; 95% CI [-3.291, -0.919]). Conclusions. Egalitarian strategies such as BFP can reduce the oral cancer mortality rate. We recommend the follow-up of families benefiting from conditional cash transfer program by oral health teams to reduce the oral cancer mortality rate.

RESUMEN Objetivo. Evaluar el efecto de la cobertura del Programa Bolsa Família (BFP) en las tasas de mortalidad por cáncer de la cavidad bucal en Brasil entre el 2005 y el 2017, ajustadas por cobertura de atención de salud y características socioeconómicas de las unidades federativas brasileñas. Métodos. Este es un estudio ecológico con datos anuales (2005-2017) de todas las unidades federativas brasileñas. La variable dependiente de este estudio fue la tasa de mortalidad por cáncer de la cavidad bucal, estandarizada por sexo y edad mediante la técnica de estandarización directa. La cobertura del BFP fue la principal variable independiente, calculada como la relación entre el número de beneficiarios del BFP y las familias que podrían tener el derecho a recibir esta transferencia monetaria condicionada. Los antecedentes socioeconómicos y la cobertura de atención de salud fueron covariables. Se trazaron mapas coropléticos y se realizó un análisis con cubos espaciotemporales para evaluar los cambios en la distribución espaciotemporal del BFP y las tasas de mortalidad por cáncer de la cavidad bucal. El análisis de regresión lineal de efectos mixtos calculó los coeficientes (β) y los intervalos de confianza (IC) del 95% para la relación entre la cobertura del BFP y las tasas de mortalidad por cáncer de la cavidad bucal. Resultados. Las tendencias de cobertura del BFP aumentaron y las tendencias de la tasa de mortalidad por cáncer de la cavidad bucal se estabilizaron en las unidades federativas brasileñas, excepto en Maranhão, Goiás y Minas Gerais, donde estas tasas aumentaron. En el modelo ajustado, una mayor cobertura del BFP se asoció con tasas más bajas de mortalidad por cáncer de la cavidad bucal (β -2,10; IC del 95% [-3,291, -0,919]). Conclusiones. Las estrategias igualitarias como el BFP pueden reducir la tasa de mortalidad por cáncer de la cavidad bucal. Recomendamos el seguimiento por parte de los equipos de salud bucodental de las familias que se benefician del programa de transferencias monetarias condicionadas para reducir la tasa de mortalidad por cáncer de la cavidad bucal.

RESUMO Objetivo. Avaliar o efeito da cobertura do Programa Bolsa Família (PBF) sobre as taxas de mortalidade por câncer bucal no Brasil entre 2005 e 2017, com ajuste para a cobertura de saúde e as características socioeconômicas das unidades federativas brasileiras. Métodos. Este é um estudo ecológico com base em dados anuais (2005-2017) de todas as unidades federativas brasileiras. A variável dependente foi a taxa de mortalidade por câncer bucal, padronizada por sexo e idade pela técnica de padronização direta. A cobertura do PBF foi a principal variável independente, calculada como a razão entre o número de beneficiários do PBF e de famílias que deveriam ter direito a essa transferência condicionada de renda. O contexto socioeconômico e a cobertura de saúde foram covariáveis. Elaboraram-se mapas coropléticos e usou-se a análise de cubo espaço-temporal para avaliar variações da distribuição espaço-temporal do PBF e das taxas de mortalidade por câncer bucal. A análise por regressão linear de efeitos mistos estimou os coeficientes (β) e intervalos de confiança (IC) de 95% da associação entre cobertura do PBF e taxas de mortalidade por câncer bucal. Resultados. Houve aumento da tendência de cobertura do PBF e estabilização da tendência da taxa de mortalidade por câncer bucal nas unidades federativas brasileiras, com exceção dos estados de Maranhão, Goiás e Minas Gerais, onde as taxas de mortalidade por câncer bucal aumentaram. No modelo ajustado, a maior cobertura do PBF foi associada a menores taxas de mortalidade por câncer bucal (β -2,10; IC 95% [-3,291, -0,919]). Conclusões. Estratégias igualitárias como o PBF podem reduzir a taxa de mortalidade por câncer bucal. Recomendamos o acompanhamento das famílias beneficiadas por programas de transferência condicionada de renda por equipes de saúde bucal para reduzir a taxa de mortalidade por esse câncer.