45 research outputs found
Embarazo exitoso en paciente con hemodiafiltración on-line de alto volumen predilucional: ¿la mejor opción dialítica en mujeres con enfermedad renal crónica y embarazo?
Contextual and individual factors associated with dental services utilisation by Brazilian adults: A multilevel analysis
BACKGROUND: Inequalities in the utilisation of dental services in Brazil are remarkable. The aim of this study was to evaluate the association of contextual and individual factors with the utilisation of dental services by Brazilian adults using the Andersen's behavioural model. METHODS: Individual-level data from 27,017 adults residents in the State capitals who were interviewed in the 2013 Brazilian National Health Survey were pooled with contextual city-level data. The outcomes were non-utilisation of dental services and last dental visit over 12 months ago. Individual predisposing variables were age, sex, race/skin colour, schooling and social network. Individual enabling variables included income, health insurance and registration in primary health care. Individual need variables were self-perceived dental health and self-reported missing teeth. Multilevel logistic regression models were performed to estimate odds ratio (OR) and 95% confidence intervals (95% CIs) of the association of contextual and individual predisposing, enabling and need-related variables with dental services outcomes. RESULTS: Predisposing (OR = 0.89; 95% CI 0.81-0.97) and enabling (OR = 0.90; 95% CI 0.85-0.96) contextual factors were associated with non-utilisation of dental services. Individual predisposing (sex, race/skin colour, schooling), enabling (income, health insurance) and need (self-perceived oral health, missing teeth) were associated with non-utilisation of dental services and last dental visit over 12 months ago. The latter was also associated with other individual predisposing (age, social network) and need (eating difficulties due to oral problems) characteristics. CONCLUSIONS: Individual and contextual determinants influenced dental services utilisation in Brazilian adults. These factors should be on the policy agenda and considered in the organisation of health services aiming to reduce oral health inequalities related to access and utilisation of dental services
From theoretical concepts to policies and applied programmes: the landscape of integration of oral health in primary care
Background: Despite its importance, the integration of oral health into primary care is still an emerging practice in
the field of health care services. This scoping review aims to map the literature and provide a summary on the
conceptual frameworks, policies and programs related to this concept.
Methods: Using the Levac et al. six-stage framework, we performed a systematic search of electronic databases,
organizational websites and grey literature from 1978 to April 2016. All relevant original publications with a focus
on the integration of oral health into primary care were retrieved. Content analyses were performed to synthesize
the results.
Results: From a total of 1619 citations, 67 publications were included in the review. Two conceptual
frameworks were identified. Policies regarding oral heath integration into primary care were mostly oriented
toward common risk factors approach and care coordination processes. In general, oral health integrated care
programs were designed in the public health sector and based on partnerships with various private and
public health organizations, governmental bodies and academic institutions. These programmes used various
strategies to empower oral health integrated care, including building interdisciplinary networks, training nondental
care providers, oral health champion modelling, enabling care linkages and care coordinated process,
as well as the use of e-health technologies. The majority of studies on the programs outcomes were
descriptive in nature without reporting long-term outcomes.
Conclusions: This scoping review provided a comprehensive overview on the concept of integration of oral
health in primary care. The findings identified major gaps in reported programs outcomes mainly because of
the lack of related research. However, the results could be considered as a first step in the development of
health care policies that support collaborative practices and patient-centred care in the field of primary care
sector