Caracterização do processo de trabalho das equipes de saúde bucal em municípios de Pernambuco, Brasil, segundo porte populacional: da articulação comunitária à organização do atendimento clínico Characterization of the work process by oral health teams in municipalities in Pernambuco State, Brazil, according to population size: from community links to organization of clinical care

O estudo teve como objetivo analisar o processo de trabalho das equipes de saúde bucal no Estado de Pernambuco, Brasil, segundo porte populacional, enfocando a articulação junto à comunidade e a organização do atendimento clínico. Foram aplicados questionários estruturados a 121 equipes de saúde bucal de 29 municípios. Para verificar a associação entre as ações realizadas e o porte populacional dos municípios, utilizou-se o teste qui-quadrado. Na integração das equipes com a comunidade, observou-se o maior foco nas escolas (81,2%), entretanto a integração com igrejas (p = 0,000) e creches (p = 0,000) demonstrou associação com os municípios de grande porte. A forma de organização do atendimento clínico evidenciou a atenção aos grupos prioritários (82,3%), sendo ainda bastante presente a marcação por demanda espontânea, principalmente nos municípios de pequeno porte. Assim, é necessário investir em educação permanente para a adequação dos processos de trabalho realizados pelas equipes e a redução das diferenças entre as práticas realizadas nos diversos municípios de Pernambuco.<br>This study aimed to analyze the work process in oral health teams in Pernambuco State, Brazil, according to population size in the various municipalities (counties), focusing on the relationship with the community and organization of clinical care. Structured questionnaires were applied to 121 oral health teams in 29 cities. The chi-square test was used to verify the association between the actions and the municipalities' population size. In the integration of the oral health teams with the community, there was a greater focus on schools (81.2%), while integration with churches (p = 0.000) and daycare centers (p = 0.000) was associated with larger municipalities. Organization of clinical care showed attention to priority groups (82.3%), while dental visits were still largely scheduled by spontaneous demand, especially in the smaller municipalities. It is thus necessary to invest in continuing education to adjust the work processes by the team and reduce the differences between practices in the various municipalities in Pernambuco State

ABC₂-SPH risk score for in-hospital mortality in COVID-19 patients

Objectives: The majority of available scores to assess mortality risk of coronavirus disease 2019 (COVID-19) patients in the emergency department have high risk of bias. Therefore, this cohort aimed to develop and validate a score at hospital admission for predicting in-hospital mortality in COVID-19 patients and to compare this score with other existing ones. Methods: Consecutive patients (≥ 18 years) with confirmed COVID-19 admitted to the participating hospitals were included. Logistic regression analysis was performed to develop a prediction model for in-hospital mortality, based on the 3978 patients admitted between March–July, 2020. The model was validated in the 1054 patients admitted during August–September, as well as in an external cohort of 474 Spanish patients. Results: Median (25–75th percentile) age of the model-derivation cohort was 60 (48–72) years, and in-hospital mortality was 20.3%. The validation cohorts had similar age distribution and in-hospital mortality. Seven significant variables were included in the risk score: age, blood urea nitrogen, number of comorbidities, C-reactive protein, SpO2/FiO2 ratio, platelet count, and heart rate. The model had high discriminatory value (AUROC 0.844, 95% CI 0.829–0.859), which was confirmed in the Brazilian (0.859 [95% CI 0.833–0.885]) and Spanish (0.894 [95% CI 0.870–0.919]) validation cohorts, and displayed better discrimination ability than other existing scores. It is implemented in a freely available online risk calculator (https://abc2sph.com/). Conclusions: An easy-to-use rapid scoring system based on characteristics of COVID-19 patients commonly available at hospital presentation was designed and validated for early stratification of in-hospital mortality risk of patients with COVID-19.</p