Association between socioeconomic contextual factor, dental care service availability, and prevalence of periodontitis in Brazil : a multilevel analysis

This study aimed to examine the effect of dental care services on periodonti tis cases in Brazilian municipalities. The sample comprised 3,426 individuals aged 35-44 years. Moderate to severe periodontitis with clinical attachment loss and probing depth was the dependent variable, both > 3mm. Its explor atory variables were grouped into four categories: (1) individual characteris tics; (2) contextual development indicators; (3) health service and structural factors; and (4) dental care use. Data were collected using the SBBrasil 2010 Project, the Brazilian Institute of Geography and Statistics, the Brazilian In formation System of Primary and Secondary Care, and the Program to Im prove Access and Quality of Dental Specialization Centers (PMAQ-CEO). Multilevel logistic regression was used to assess associations of periodontitis with individual and context variables. Municipalities with > 1 CEO or > 1 of any centers were associated with periodontitis, with OR = 0.97 (95%CI: 0.55- 1.71) and OR = 0.41 (95%CI: 0.17-0.97), respectively. Prevalence of periodon titis was more likely in older people, lower education levels, and individuals that sought dental visits for pain/extraction and periodontal treatment. Other dental care services availability were not associated with the prevalence of periodontitis

Effect of contextual factors in periodontitis

A periodontite é um agravo bucal importante que afeta aproximadamente 20% de indivíduos no mundo. Fatores socioeconômicos individuais e comportamentais podem explicar parte das disparidades observadas nas estimativas da doença . No entanto, fatores contextuais atribuídos ao efeito da área (físicos/ambientais, socioeconômicos-SES e serviços de saúde bucal) podem contribuir para a prevalência da doença. Diante disso, o presente estudo avaliou o efeito do contexto de área na prevalência da periodontite. Foram realizados dois estudos: 1) revisão sistemática: PubMed, Scopus, Web of Science e EMBASE foram as bases de artigos utilizadas. Considerou-se estudos em que periodontite foi avaliada pela perda de inserção e profundidade à sondagem em adultos acima de 18 anos em estudos com dados contextuais atribuídos ao nível de área-SES e de serviço de saúde bucal. Um total de 646 artigos foram identificados (n= 101.362 indivíduos) sendo 13 incluídos ao final. Dois revisores independentes selecionaram, extraíram e avaliaram os dados qualitativamente. Fatores de contexto atribuídos ao nível de área-SES e de serviço de atenção bucal podem influenciar a periodontite, mas as evidências presentes ainda são inconclusivas. 2) estudo seccional multinivel: A amostra compôs 3.426 indivíduos na faixa etária de 34 a 44 anos. A variável resposta foi a periodontite moderada a severa com perda de inserção e profundidade à sondagem > 3 mm. As variáveis exploratórias foram divididas em quatro blocos: I- individuais composicionais (sexo, idade, renda, nível educacional); II- uso de serviços de saúde (última visita ao dentista, motivo da consulta e taxa de procedimentos periodontais); III- estrutura de serviço de saúde (cobertura de atenção bucal primária, presença de Centro de Especialidades Odontológicas - CEO, outro serviço de atenção bucal secundária e presença de periodontistas), IV- indicadores contextuais de desenvolvimento (população urbana, tamanho da população, índice de Gini, componente renda do Índice de Desenvolvimento Humano-IDH e Produto Interno Bruto-PIB). Os dados foram oriundos do SBBrasil (2010), do Instituto Brasileiro de Geografia e Estatística (IBGE), Sistema de Informação da Atenção- SIA, e do Programa de Melhoria ao Acesso e Qualidade da Atenção Secundária (PMAQ-CEO ciclo 1). Realizou-se análise de regressão multinivel utilizando software R versão 3.4.2 e Stata 16.1. Nas análises ajustadas, a presença de um ou mais CEO, não esteve associada a periodontite (p > 0.10). A presença de algum outro serviço de referencia de atenção bucal secundária foram associadas a menor prevalência de periodontite com OR= 0.41 (95% CI 0.17- 0.97). A chance de ter periodontite foi maior em indivíduos mais velhos, com baixo nível educacional, e que visitaram dentista por motivo de dor e/ou extração dentária e tratamento. A presença unicamente dos CEO não mostrou um gradiente de associação com a periodontite, no entanto o efeito contextual de outros serviços de atenção bucal secundária esteve moderadamente associado a menor prevalência de periodontite, concluindo que municípios necessitam de outros modelos de atenção especializada além do CEO bem como investigar outros determinantes da saúde.Periodontitis is an important oral health issue that affects nearly 20% of individuals in the world. Individual socioeconomic and behavioral factors may explain part of the disparities observed in disease estimates. However, contextual factors attributed to the effect of the area (physical/environmental, socioeconomic status-SES, and oral health services) may contribute to the prevalence of the disease. Therefore, the present study evaluated the effect of the area context on the prevalence of periodontitis. Two studies were carried out: 1) systematic review of articles: PubMed, Scopus, Web of Science, and EMBASE were used as bases. Studies were considered in which periodontitis was evaluated by clinical attachment loss and periodontal probing depth in adults over 18 years old in studies with contextual data attributed to the SESarea and oral health service-level. A total of 646 articles were identified, and 13 were included at the end. Two independent reviewers selected, extracted, and qualitatively evaluated the data. Contextual factors attributed to the level of SES- area and oral health service-level may influence periodontitis, but the present evidence is still inconclusive. 2) multilevel crosssectional study: The sample consisted of 3.426 individuals aged between 34 and 44 years old. The response variable was moderate to severe periodontitis with clinical attachment loss and periodontal probing depth > 3 mm. The exploratory variables were divided into four blocks: Iindividual compositional (sex, age, income, educational level); II- use of health service (last dental visit, reason for consultation, and rate of periodontal procedures); III- health service structure (primary oral care coverage, presence of Secondary Dental Centers (aka CEO), another secondary oral care service and presence of periodontists), IV- contextual indicators of development (urban population, population size, Gini index, income component of the Human Development Index-HDI, and Gross Domestic Product-GDP). The data came from the SBBrasil (2010), the Brazilian Institute of Geography and Statistics (IBGE), the Care Information System -SUS, and the Secondary Dental Care Access and Quality Improvement Program (PMAQ-SDC cycle 1). Multilevel regression analysis was performed using R software version 3.4.2 and Stata 16.1. In the adjusted analyses, the presence of 1 or more CEO was not associated with periodontitis (p > 0.10). The presence of 1 or more any other center was associated with a lower prevalence of periodontitis with OR= 0.41 (95% CI 0.17-0.97). The chance of having periodontitis was higher in older individuals, with a low educational level, and who visited a dentist due to pain and/or tooth extraction and treatment. The contextual effect of CEO did not show a gradient of association with periodontitis, however the contextual effect of any secondary oral care services was moderately associated with a lower prevalence of periodontitis, concluding that municipalities need other models of specialized care in addition to CEO and the investigation of other determinants of health

Assessment of the contextual effects on the prevalence of periodontitis: a systematic review

Abstract This study reviews the influence of contextual factors on periodontitis based on a systematic search of studies recorded in the PubMed, Scopus, Web of Science, and EMBASE databases. Periodontitis was assessed by clinical attachment loss and probing depth for studies with data on the socioeconomic status (SES) of a specific area (area-level SES) or dental care service (service-level) in a catchment area among individuals aged 18 and over. Two independent reviewers performed study selection, data extraction, and assessment of methodological quality. Of the 646 articles identified, 13 were included in the systematic review, representing 101,362 individuals from five countries (USA, UK, Brazil, China, and Uruguay). A higher prevalence of periodontitis was described in lower SES neighborhoods, more deprived postcodes, and poorer provinces. Gini Index results were mixed and inconclusive. Three studies showed that higher coverage of primary dental care at the municipal level was associated with a lower prevalence of periodontitis. Contextual factors at the area-level SES and dental care service might influence periodontitis, but the existing evidence is unclear. The contextual effect is important for periodontal health and may contribute to the prevalence of periodontitis, independent of well-known risk factors and individual levels

Validação inicial do índice de necessidade de atenção à saúde bucal para as equipes de saúde bucal na estratégia de saúde da família Initial validation of the index of oral healtcare needs for oral health teams in the family healthcare strategy

Este trabalho objetivou validar o Índice de Necessidade de Atenção à Saúde Bucal (INASB), a partir de um algoritmo pré-definido baseado nas condições sociais das famílias. Utilizaram-se informações obtidas na ficha A do sistema de informação da atenção básica. A validação do índice foi realizada através da validação de face e de construto, e nesta foram coletados dados de experiência de cárie, dor de dente e acesso aos serviços de saúde bucal através de uma amostra aleatória, estratificada e baseada no índice de 412 crianças nas faixas etárias 3-5 e 7-12 anos em Recife-PE. Para análise foi utilizado o nível de significância de 5%. O índice foi considerado adequado na validação de face. Na validação de construto convergente foi associado ao componente cariado do ceo-d (p = 0,03) e CPO-D (p = 0,01); e na divergente foi associado ao acesso ao dentista (p = 0,001) e ao componente obturado do ceo-d (p = 0,05) não sendo associado ao componente obturado do CPO-D. O Índice de Necessidade de Atenção à Saúde Bucal demonstrou possuir uma boa validade inicial podendo ser usado como instrumento de programação para as equipes de saúde bucal da família.<br>This survey set out to validate the Index of Oral Healthcare Needs (IOHN), based on a pre-defined algorithm of the social status of families. The validation process was divided into two phases, namely a face validation and a construct validation. In the latter, data on caries experience, toothache and access to oral health services was collected. To validate the index a random, stratified sample of 412 children aged 3-5 and 7-12 was obtained, based on the IOHCN algorithm, all the children being from the areas of Recife covered by the family healthcare program. The analysis consisted of a descriptive and an analytical phase, adopting a 5% level of significance. The index was considered by an expert committee to have good face validity. The convergent construct validation was associated with a decay component of dmft (p = 0.03) and DMFT (p = 0.01); the divergent construct validation was associated with access to oral care (p = 0.001) and filled component of dmft (p = 0.05), showing no association with the filled component of DMFT. The Index of Oral Healthcare Needs was shown to have good initial validation and canbe used as a useful tool in the planning of dental care at a local level

Growing knowledge: an overview of Seed Plant diversity in Brazil

Abstract An updated inventory of Brazilian seed plants is presented and offers important insights into the country's biodiversity. This work started in 2010, with the publication of the Plants and Fungi Catalogue, and has been updated since by more than 430 specialists working online. Brazil is home to 32,086 native Angiosperms and 23 native Gymnosperms, showing an increase of 3% in its species richness in relation to 2010. The Amazon Rainforest is the richest Brazilian biome for Gymnosperms, while the Atlantic Rainforest is the richest one for Angiosperms. There was a considerable increment in the number of species and endemism rates for biomes, except for the Amazon that showed a decrease of 2.5% of recorded endemics. However, well over half of Brazillian seed plant species (57.4%) is endemic to this territory. The proportion of life-forms varies among different biomes: trees are more expressive in the Amazon and Atlantic Rainforest biomes while herbs predominate in the Pampa, and lianas are more expressive in the Amazon, Atlantic Rainforest, and Pantanal. This compilation serves not only to quantify Brazilian biodiversity, but also to highlight areas where there information is lacking and to provide a framework for the challenge faced in conserving Brazil's unique and diverse flora