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

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Revisão de Anyphaeninae Bertkau a nível de gêneros na Região Neotropical (Araneae, Anyphaenidae) Revision of Anyphaeninae Bertkau at genera level in the Neotropical Region (Araneae, Anyphaenidae)

<abstract language="eng">The subfamily Anyphaeninae is revised at genera level in the Neotropical region. Anyphaeninae is diagnosed by the tracheal spiracle approximately in the midway of venter or between the midway of venter and the epigastric groove; retromargin of chelicerae with more than four denticles; and male palp with tegulum basket-like or cup-like, without the basal lightly sclerotized area. The subfamily contais 32 genera, 14 of which are new: Aljassa (type species Teudis annulipes Caporiacco), Buckupiella (type species B. imperatriz sp.n., from Brazil and Argentina), Hatitia (type species H.yhuaia sp.n., from Peru) Iguarima (type species Anyphaena censoria Keyserling), Ilocomba (type species I. marta sp.n., from Colombia), Italaman (type species I. santamarina sp.n., from Brazil, Colombia and Argentine), Jessica (type species Osoriella osoriana Mello-Leitão), Katissa (type from Jamaica), Otoniela (type species O. adisi sp.n., from Brazil), Pippuhana (type species P. gandu sp.n., from Brazil), Timbuka (type species T. boquete sp.n., from Costa Rica, Panamá and Colômbia), Umuara (type species Clubiona fasciata Blackwall), Xiruana (type species Aysha gracilipes Keyserling). Other new species and the male of Bromelina zuniala are described: Iguarima pichinha and Lepajan edwardsi from Ecuador; Temnida rosário, Umuara pydanieli and U. juquia from Brazil; Umuara junin, Hatitia conchaque from Peru; Ilcomba perija from Colombia. Twelve new synonyms are presenteei: Wuljilopsis keyserlingi soares & Camargo witn W. tenuips (Keyserling); Teudis foliatus Schmidt with Patrera ruber (F.O.P. - Cambridge); Teudis moreirae Mello-Leitão with Teudis angusticeps (Keyserling); Anyphaena rufibarbis Mello-Leitão with Jessica osoriana (Mello-Leitão); Aysha cinereoviítata Mello-Leitão with Iguarima censoria (Keyserling); Teudis bucolicus Chickering with Katissa simplicipalpis (Simon); Gayenna minutissima Petrunkevitch with Lupetíiana mordax (O.P.-Cambridge); Teudis adfabilis (Keyserling) and Teudis leucochlorus Mello-Leitão with Umuara fasciata (Blackwall); Aysha fulviceps Keyserling with Xiruana gracilipes (Keyserling); Aysha mandibularis (Keyserling) with Aljassa subpallida (L. Koch). Seventy new combinations are presented: Wulfilopsis frenata (Keyserling); W. pygmaea (Keyserling); W. tenuipes (Keyserling); W. tripunctata (Mello-Leitão); Patrera apora (Chamberlin); P.armata (Chickering); P.auricoma (L. Koch); P. cita (Keyserling); P. lauta (Chickering); P. longipes (Keyserling); P. procera (Keyserling); P. puta (O.P.-Cambridge); P. ruber (F.O.P.-Cambridge); P. stylifer (F.O.P.-Cambridge); P. virgata (Keyserling); Teudis bicornutus (Tullgren); T. buelowae (Mello-Leitão); T. comstocki (Soares & Camargo); T. morenus (Mello-Leitão); Jessica campesina (Bauab-Vianna); J. glabra (Keyserling); J. goodnight (Soares & Camargo); J. osoriana (Mello-Leitão); J. erythrostoma (Mello- Leitão); J. rubricephala (Mello-Leitão); Iguarima censoria (Keyserling); Katissa delicatula (Banks); K. elegans (Banks); K. lycosoides (Chickering); K. simplicipalpis (Simon); K. zimarae (Reimoser); Otoniella quadrivittata (Simon); Lupettiana mordax (O.P.-Cambridge); L. parvula (Banks); L. perpusilla (Banks); L. spinosa (Bryant); Timbuka bogotensis (L. Koch); T. granadensis (Keyserling); T. larvata (O.P.-Cambridge), T. masseneti (Berland); T.meridiana (L. Koch); Tafana quelchii (pocock); T. silhavyi (Caporiacco); T. straminea (L. Koch); Umuara fascia J(Blackwall); Aysha basilisca (Mello-Leitâo); A. diversicolor (Keyserling); A. heraldica (Mello-Leitão); A. gentilis (Keyserling); A. helvola (Keyserling); A. robusta (Keyserling); A. rubro- maculata (Keyserling); A. striolata (Keyserling); A. subruba (Keyserling); Xiruana affinis (Mello-Leitão); X. gracilipes (Keyserling); X. hirsuta (Mello-Leitão); X. tetraseta (Mello-Leitão); Aljassa annulipes (Caporiacco); A. notata (Keyserling); A. poicila (Chamberlin); A. subpallida(L. Koch); A. venezuelica (Caporiacco); Pippuhana calcar (Bryant); H. donaldi (Chickering); P. unicolor (Keyserling); Hatitia defolonguei (Berland); H. riveti (Berland); H. sericea (L. Koch). Two spedes are revalidated: Sillus dubius (Chickering) and Hatitia defolongli (Berland). Lectotypes and paralectotypes are here designated for eigth species: Anyphaena censoria Keyserling, 1891; A. adfabilis Keyserling, 1891. A simplicipalpis Simon, 1897; Aysha septena Franganillo, 1935; A. cinereovittata Mello-Leitão, 1945; Osoriella osoriana Mello-Leitão, 1922; Teudis sordidus Mello-Leitão, 1941 e Temnida simplex Simon, 1896. A key to 32 genera of Anyphaeninae are provided. Diagnoses, descriptions and illustrations are provided for the genera and species included in this work