Mortalidade por câncer bucal e de orofaringe no Brasil : impacto do Programa Brasil Sorridente

Introdução: O câncer bucal e de orofaringe é considerado um problema de saúde pública em todo o mundo. O padrão de incidência e mortalidade por essa patologia no Brasil vem apresentando mudanças nas últimas décadas; entre as causas sugeridas para explicar esse fenômeno, podem estar as significativas mudanças no sistema de saúde do Brasil a partir dos anos 1980 e a consequente restruturação da atenção à saúde bucal no país. Objetivos: Analisar a distribuição e a tendência das taxas de mortalidade por câncer bucal e de orofaringe no Brasil e avaliar a relação entre essas taxas e a implantação e expansão do Programa Brasil Sorridente, no período de 2000 a 2013. Métodos: Os dados sobre a mortalidade por câncer bucal e de orofaringe foram obtidos através do Sistema de Informações de Mortalidade (SIM), geridos pelo Ministério da Saúde; os dados “Cobertura de Equipes de Saúde Bucal (ESB) da Estratégia de Saúde da Família” e “Número de Centros de Especialidades Odontológicas (CEO)” foram obtidos através do Portal “Sala de Apoio à Gestão Estratégica” do SUS e através de Portal do Departamento de Atenção Básica (DAB) da Secretaria de Atenção à Saúde do Ministério da Saúde. As taxas de mortalidade foram padronizadas por sexo e por faixa etária, pelo método direto. Para estimação de tendência de mortalidade da série histórica, utilizou-se a regressão linear generalizada pelo método de Prais-Winsten. Para a análise estatística da relação das taxas de mortalidade por câncer bucal e de orofaringe com a cobertura populacional por ESB da Estratégia de Saúde da Família, com o número de CEO e com as demais covariáveis, foi utilizado um modelo misto, também conhecido como modelo de coeficiente aleatório. Resultados: No período estudado, a taxa de mortalidade por câncer bucal e de orofaringe foi 3,94 vezes mais elevada para homens do que para mulheres, a faixa etária que concentrou o maior número de óbitos foi “50 a 59 anos” e o sítio anatômico responsável pelo maior número de óbitos foi “orofaringe”. Em relação à tendência das taxas de mortalidade, foi identificado padrão crescente para a população feminina, estacionário para a população masculina e estacionário para ambos os sexos; “base da língua” e “assoalho da boca” foram os sítios anatômicos que apresentaram tendência crescente, “amígdala” apresentou tendência decrescente e os demais sítios anatômicos apresentaram tendência estacionária. Na análise de associação, identificou-se que a taxa de mortalidade por câncer bucal e de orofaringe no Brasil, na população masculina, diminui com aumento da cobertura por ESB e com o aumento do número de CEO. Conclusões: Os resultados do presente trabalho sugerem que a implantação da Política Nacional de Saúde Bucal, também reconhecida como “Programa Brasil Sorridente”, que objetivou a reorganização da atenção à saúde bucal em todos os níveis de atenção, pode ter apresentado impacto positivo nas taxas de mortalidade por câncer bucal e de orofaringe no Brasil, especialmente em homens, parcela da população mais acometida por essa patologia.Introduction: The oral and oropharyngeal cancer are considered a public health problem worldwide. The pattern of incidence and mortality from this disease in Brazil has shown significant changes in the recent decades. Among the causes suggested to explain this phenomenon, may be the significant changes in the health system in Brazil from the 1980s and the consequent restructuring of oral health care in the country. Objectives: Analyze the distribution and mortality trend from oral and oropharyngeal cancer in Brazil and evaluate the relation between these rates and the implementation and expansion of the National Oral Health Policy (“Brasil Sorridente” program), between 2000 and 2013. Methods: The mortality data were obtained from the Mortality Information System (SIM) of the Ministry of Health of Brazil. The data "Coverage of Oral Health Teams (ESB) of the Family Health Strategy" and "Number of Specialized Dental Clinics (CEO)" were obtained through the portal "Room Support Strategic Management" and through the portal of Department of Primary Care (DAB), both from Brazil’s Ministry of Health. Mortality coefficients were adjusted by sex and age using the direct method. The general linear regressions by Prais-Winsten method was used to estimate the trend of mortality rate at the historical series. For the statistical analysis of the relation between the mortality rates for oral and oropharyngeal cancer, the population with coverage by ESB of the Family Health Strategy, the number of CEO and other covariates, it was used a Mixed Model, also known as Random Coefficient Model. Results: During the study period, the mortality rate for oral and oropharyngeal cancer was 3.94 times higher for men than for women, the age group that had the highest number of deaths was "50 to 59 years" and the anatomical site responsible for the largest number of deaths was "oropharynx". Regarding the trend in mortality rates, was identified increasing pattern for the female population, stationary for male population and stationary for both sexes. "Base of the tongue" and "floor of the mouth" were the anatomical sites that showed growing trend, "tonsils" showed a declining trend and the other anatomical sites showed stationary trend. Regarding association analysis, it was found that the death rate for oral and oropharyngeal cancer in Brazil, in the male population, reduces with increasing coverage by ESB and with increase in the number of CEOs. Conclusions: The results of this study suggest that the implementation of the National Oral Health Policy, also known as "Brasil Sorridente" program, which aimed the reorganization of oral health care at all levels of care, may have had a positive impact on mortality rates from oral and oropharyngeal cancer in Brazil, especially in men, the portion of population most affected by this disease

Redistributing deaths by ill-defined and unspecified causes on cancer mortality in Brazil

OBJECTIVE to discuss the impact four different redistribution strategies have on the quantitative and temporal trends of cancer mortality assessment in Brazil. METHODOLOGY This study used anonymized and georeferenced data provided by the Brazilian Ministry of Health (BMoH). Four different approaches were used to conduct the redistribution of ill-defined deaths and garbage codes. Age-standardized mortality rates used the world population as reference. Prais-Winsten autoregression allowed the calculation of region, sex, and cancer type trends. RESULTS Death rates increased considerably in all regions after redistribution. Overall, Elisabeth B. França’s and the World Health Organization methods had a milder impact on trends and rate magnitudes when compared to the Global Burden of Disease (GBD) 2010 method. This study also observed that, when the BMoH dealt with the problem of redistributing ill-defined deaths, results were similar to those obtained by the GBD method. The redistribution methods also influenced the assessment of trends; however, differences were less pronounced. CONCLUSIONS Since developing a comparative gold standard is impossible, matching global techniques to local realities may be an alternative for methodological selection. In our study, the compatibility of the findings suggests how valid the GBD method is to the Brazilian context. However, caution is needed. Future studies should assess the impact of these methods as applied to the redistribution of deaths to type-specific neoplasms

O impacto da pandemia de Covid-19 na oferta de procedimentos odontológicos realizados pelo Sistema Único de Saúde : uma perspectiva sindêmica

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.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

Hospitalizações por câncer bucal e orofaríngeo no Brasil pelo SUS: impactos da pandemia de covid-19

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 de 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 quadrimestre 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.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 period 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

Sexual behavior and its association with persistent oral lesions : analysis of the POP-Brazil study

Objectives To investigate whether the presence of persistent self-reported oral lesions (PSOLs) is associated with sexual behaviors and with the presence of sexually transmitted infections (STIs) in individuals aged 16–25 years in the state capitals of Brazil. Materials and Methods Data from the POP-Brazil study were analyzed. An association analysis was performed by Poisson regression with the presence of PSOLs as the outcome. The exposure variables were the age at first sexual intercourse, the number of partners, oral sex practice, and aspects of condom use for model 1, and the presence of a self-reported STI or a positive rapid test for HIV/syphilis and the presence of genital human papillomavirus (HPV) for model 2. The results were adjusted for socioeconomic variables. Results The prevalence of PSOLs was 76% higher among individuals who had two or more sexual partners in the past year (p = 0.046) and 68% higher in those who reported not using condoms for contraception (p = 0.032). The group with HIV/syphilis or self-reported STI had a 140% higher PSOL prevalence (p = 0.003). Conclusions The self-report of oral lesions in adolescents and young adults may suggest risky sexual behavior and the presence of STI. Clinical relevance It is necessary to contextualize the reality of the young person to optimize oral health care

Mortality due to oral and oropharyngeal cancer in Uruguay from 1997 to 2014

Oral and oropharyngeal cancer is considered a public health problem in several countries due to its high incidence and mortality rate. Objective: This study aimed to analyze oral and oropharyngeal cancer mortality in Uruguay from 1997 to 2014 by age, sex and country region. Methodology: A time series ecological study using secondary data was performed. Data on mortality due to oral and oropharyngeal cancers were obtained from the Vital Statistics Department of Uruguay's Ministry of Public Health. Results: The cumulative mortality rate due to oral and oropharyngeal cancer over the study period was of 19.26/100,000 persons in women and 83.61/100.000 in men, with a mean annual rate of 1.75/100,000 in women and 7.60/100,000 in men. Mortality rate from both sites during the study period was 4.34 times higher in men than in women. Malignant neoplasms of other parts of the tongue and base of tongue showed the highest mortality rate. The means of the annual coefficients of deaths were higher for the age groups between 50 and 69 years. Higher mortality rates of oral and oropharyngeal cancer were observed in Artigas (4.63) and Cerro Largo (3.75). Conclusions: Our study described a high mortality rate for oral and oropharyngeal cancer in Uruguay from 1997 to 2014. According to the country's health department, men, tongue cancer, and oral cavity had higher mortality rates, with some variation. Prevention strategies with control of risk factors and early diagnosis are necessary to improve survival in the Uruguayan population

Mortality due to oral and oropharyngeal cancer in Uruguay from 1997 to 2014

Oral and oropharyngeal cancer is considered a public health problem in several countries due to its high incidence and mortality rate. Objective: This study aimed to analyze oral and oropharyngeal cancer mortality in Uruguay from 1997 to 2014 by age, sex and country region. Methodology: A time series ecological study using secondary data was performed. Data on mortality due to oral and oropharyngeal cancers were obtained from the Vital Statistics Department of Uruguay's Ministry of Public Health. Results: The cumulative mortality rate due to oral and oropharyngeal cancer over the study period was of 19.26/100,000 persons in women and 83.61/100.000 in men, with a mean annual rate of 1.75/100,000 in women and 7.60/100,000 in men. Mortality rate from both sites during the study period was 4.34 times higher in men than in women. Malignant neoplasms of other parts of the tongue and base of tongue showed the highest mortality rate. The means of the annual coefficients of deaths were higher for the age groups between 50 and 69 years. Higher mortality rates of oral and oropharyngeal cancer were observed in Artigas (4.63) and Cerro Largo (3.75). Conclusions: Our study described a high mortality rate for oral and oropharyngeal cancer in Uruguay from 1997 to 2014. According to the country’s health department, men, tongue cancer, and oral cavity had higher mortality rates, with some variation. Prevention strategies with control of risk factors and early diagnosis are necessary to improve survival in the Uruguayan population

Pathways that explain racial differences on edentulism among older adults : 2019 Brazil National Health Survey

This study aimed to evaluate the pathways that explain the association between race/skin color and edentulism in elderly Brazilians. This was a cross-sectional study using data from participants aged 60 years or older from the 2019 Brazilian National Health Survey, a nationally representative population-based sample. Data were obtained by a structured interview and participants were classified as edentulous if they reported having lost all natural teeth. Information on race, socioeconomic level, behavioral aspects, psychosocial aspects, and access to dental care was collected by interviewers using a questionnaire. The pathways between race/skin color and edentulism were analyzed using structural equation modeling. The final sample of the study included 22,357 participants. Most participants were white (51.5%; 95% confidence interval [CI]: 50.3–52.6), and 36.8% (95%CI: 35.7–37.9) were edentulous. Race/skin color was indirectly associated with edentulism via enabling factors. These findings suggest that socioeconomic inequalities are key in explaining racial inequalities in edentulism among Brazilian older adults

Desigualdades socioeconômicas no uso de serviços odontológicos no Brasil: uma análise da Pesquisa Nacional de Saúde de 2019

Objective: To describe the prevalence of use of dental services in Brazil according to the states and its association with socioeconomic variables and types of services in the Brazilian Health Survey of 2019. Methods: A population-based, cross-sectional study using data from the Brazilian Health Survey of 2019, including 88,531 individuals with 18 years of age or more. Results: Dental services utilization in the year prior to the study was more frequent among adults (53.2%, 95% CI:52.5-53.9) than in older adults (34.3%, 95% CI: 33.2-34.4). The multivariate analysis revealed that the use of dental services was more in people with more schooling (PR=2.02, 95% CI: 1.87-2.18) and higher income (PR=1.54, 95% CI: 1.45-1.64). The prevalence of dental services utilization in the year prior to the survey was higher among participants of the southeast, south and Midwest regions, ranging between 49.0% and 57.6%. Conclusion: Inequalities in dental services utilization were common in adults and older adults, with important regional differences; women, younger participants, those with more schooling and higher income, people with better oral health-related behaviors, better self-perceived oral health and those who paid for their lasts dental consultation were more likely to have used dental services in the year prior to the study.Objetivo: Descrever a prevalência do uso de serviços odontológicos no Brasil segundo as Unidades Federadas, sua relação com variáveis socioeconômicas e tipos de serviços, com base na Pesquisa Nacional de Saúde (PNS) de 2019. Métodos: Trata-se de um estudo transversal de base populacional com dados da PNS 2019, incluindo 88.531 participantes de 18 anos ou mais. Foram analisadas variáveis referentes ao uso de serviços de saúde bucal, segundo características sociodemográficas e comportamentais, por meio de análise multivariada, utilizando modelo regressão de Poisson com variância robusta. Resultados: A utilização de serviços odontológicos no ano anterior à entrevista foi maior entre os adultos (53,2%, IC95%: 52,5-53,9) do que entre os idosos (34,3%, IC95% 33,2-34,4). Na análise multivariada, o uso de serviços odontológicos foi maior em pessoas com maior nível educacional (RP:2,02, IC95%: 1,87-2,18) e de maior renda (RP:1,54, IC95%: 1,45-1,64). Os estados das regiões Sudeste, Centro-Oeste e Sul apresentaram as maiores porcentagens de indivíduos que consultaram com dentista no último ano, entre 49,0 a 57,6% da população. Conclusão: Desigualdades no uso dos serviços de saúde bucal foram observadas na população adulta e idosa, com diferenças entre as regiões do país; foi identificado maior uso entre as mulheres, indivíduos mais jovens, escolarizados e de maior renda, e entre a população com melhores comportamentos relacionados à sua saúde, melhor percepção do seu estado de saúde, e aqueles que pagaram pelo último atendimento odontológico

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio