Abstract The present study aimed to investigate the prevalence of dissatisfaction with dental appearance among 24-year-old Brazilian adults and the associated factors in life course. A subsample (n = 720) of the 1982 Pelotas Birth Cohort in southern Brazil was investigated at the ages of 15 and 24 years using clinical (caries and periodontal) examinations and interviews. The outcome was dissatisfaction with dental appearance at the age of 24 years. Covariate variables included socioeconomic factors, oral health, and dissatisfaction with general appearance collected during different periods of life. Poisson regression models with robust variance were applied. The prevalence of dissatisfaction with dental appearance was 43.5% (95%CI: 39.8–47.1). Individuals with downward income mobility (PR = 1.22, 95%CI: 1.07–1.79) and those always poor (PR = 1.21, 95%CI: 1.00–1.57) presented a higher prevalence of dissatisfaction with their dental appearance even after oral health variables and dissatisfaction with general appearance were controlled for. Moderate/severe malocclusion at 15 years (PR = 1.34, 95%CI: 1.13–1.59), highest experience of untreated dental caries at 24 years (PR = 1.82, 95%CI: 1.46–2.27), and dental pain experience at 24 years (PR = 1.29, 95%CI: 1.22–1.75) were associated with the outcome. Also, the prevalence of dissatisfaction with dental appearance was 20% higher (PR = 1.20, 95%CI: 1.01–1.43) among those dissatisfied with their general appearance. Our findings demonstrated a high prevalence of dissatisfaction with dental appearance among young adults. Lifetime economic disadvantage and dental problems (malocclusion at 15 years, untreated dental caries at 24 years, and dental pain at 24 years) were associated with dissatisfaction with dental appearance among young adults. 24yearold yearold year old course n 720 198 1 2 periodontal interviews applied 435 43 5 43.5 95%CI 95CI CI 95 (95%CI 39.8–47.1. 398471 39.8–47.1 . 39 8 47 39.8–47.1) PR 122 22 1.22 1.07–1.79 107179 07 79 121 21 1.21 1.00–1.57 100157 00 57 for Moderatesevere Moderate severe 134 34 1.34 1.13–1.59, 113159 1.13–1.59 , 13 59 1.13–1.59) 182 82 1.82 1.46–2.27, 146227 1.46–2.27 46 27 1.46–2.27) 129 29 1.29 1.22–1.75 122175 75 Also 20 120 1.20 1.01–1.43 101143 01 72 19 4 43. 9 39847 39.8–47. 3 12 1.2 1.07–1.7 10717 0 7 1.00–1.5 10015 1.3 11315 1.13–1.5 18 1.8 14622 1.46–2.2 1.22–1.7 12217 1.01–1.4 10114 3984 39.8–47 1. 1.07–1. 1071 1.00–1. 1001 1131 1.13–1. 1462 1.46–2. 1.22–1. 1221 1.01–1. 1011 398 39.8–4 1.07–1 107 1.00–1 100 113 1.13–1 146 1.46–2 1.22–1 1.01–1 101 39.8– 1.07– 10 1.00– 11 1.13– 14 1.46– 1.22– 1.01– 39.8 1.07 1.00 1.13 1.46 1.01 39. 1.0 1.1 1.4

Abstract The present study aimed to investigate the contextual inequalities of specialized public dental care (SPDC) in Brazil. The outcome was the trajectory of dental specialized production in municipalities with SPDC (from 2015 to 2017) obtained by group-based trajectory modeling. A Poisson regression model was used to analyze the factors associated with the high trajectory of SPDC production. The inequality indicators for SPDC production were the slope index and the concentration index according to contextual factors. The study included 954 SPDC units distributed across 893 municipalities. Among the municipalities evaluated, 62.9% had a low trajectory of SPDC. Large-sized municipalities had the highest production (IRR = 2.84, 95%CI: 1.94–4.14) and the southern region had the lowest production (IRR = 0.73, 95%CI: 0.58–0.92). Municipalities presenting a very high human development index (HDI) showed the greatest SPDC production (IRR = 3.34, 95%CI: 1.09–10.24), as well as municipalities with the highest tertile of schooling rate (IRR = 1.23, 95%CI: 1.00–1.50). The absolute inequality was 52.1 percentage points for the average monthly wage (p < 0.001), 61.0 percentage points for the HDI (p < 0.001), -22.1 for infant mortality rate (p <0.001), and 14.8 for the schooling rate (p = 0.012). Thus, there are contextual inequalities in the Brazilian SPDC. Higher scores for social indicators were associated with better SPDC performance. (SPDC Brazil from 201 2017 groupbased group based modeling 95 89 evaluated 629 62 9 62.9 Largesized Large sized IRR 284 2 84 2.84 95%CI 95CI CI 1.94–4.14 194414 1 94 4 14 073 0 73 0.73 0.58–0.92. 058092 0.58–0.92 . 58 92 0.58–0.92) (HDI 334 3 34 3.34 1.09–10.24, 1091024 1.09–10.24 , 09 10 24 1.09–10.24) 123 23 1.23 1.00–1.50. 100150 1.00–1.50 00 50 1.00–1.50) 521 52 52. p 0.001, 0001 0.001 001 0.001) 610 61 61. 22.1 221 22 -22. <0.001, <0.001 <0.001) 148 8 14. 0.012. 0012 0.012 012 0.012) Thus performance 20 6 62. 28 2.8 1.94–4.1 19441 07 7 0.7 05809 0.58–0.9 5 33 3.3 109102 1.09–10.2 12 1.2 10015 1.00–1.5 000 0.00 22. -22 <0.00 0.01 01 2. 1.94–4. 1944 0. 0580 0.58–0. 3. 10910 1.09–10. 1. 1001 1.00–1. 0.0 -2 <0.0 1.94–4 194 058 0.58–0 1091 1.09–10 100 1.00–1 - <0. 1.94– 19 05 0.58– 109 1.09–1 1.00– <0 1.94 0.58 1.09– 1.00 1.9 0.5 1.09 1.0

Aim The study aimed to evaluate the association between oral health and academic performance and/or school absenteeism. Methods Electronic searches were performed of the PubMed, Web of Science, SCOPUS and LILACS/BVS databases. We included observational studies that evaluated the association between dental caries, tooth loss, dental pain or oral health status with school absenteeism or academic performance. The studies had to contain a representative sample of the population: schoolchildren, children or adolescents. After the removal of duplicates, the electronic searches produced 3,789 articles. Of these, 25 studies were included in the systematic review and 13 in the meta-analysis. Results Considering all the studies evaluated in the meta-analysis, seven articles satisfied 100% of the Joanna Briggs Institute Critical Appraisal checklist, and six contained between 90% and 75% positive answers. The pooled effects showed that the chances of school absenteeism were 31% higher in subjects with dental caries (OR 1.31; 95%CI 1.12-1.54). Students with fair/poor dental health had a 50% higher chance of suffering poor academic performance (OR 1.50; 95%CI 1.22-1.84) and 34% higher chance of having problems at school (OR 1.34; 95%CI 1.06-1.70). Students with a history of toothache had a 3.7 higher chance of being absent from school (OR 6.65; 95%CI 1.60-8.32) and 71% higher chance of missing class due to toothache (OR 1.71; 95%CI 1.15-2.56). Subjects with a history of toothache had a 2.5 times higher chance of suffering poor academic performance (OR 2.58; 95% CI 2.04-3.27). Conclusion Therefore, students with oral problems were more likely to take time off school and present inferior academic performance. andor PubMed Science LILACSBVS LILACS BVS databases loss population schoolchildren adolescents duplicates 3789 3 789 3,78 these 2 1 metaanalysis. metaanalysis meta analysis. analysis meta-analysis metaanalysis, analysis, 100 checklist 90 75 answers 31 OR 1.31 131 95CI 95 1.121.54. 112154 1.12 1.54 . 12 54 1.12-1.54) fairpoor fair 50 1.50 150 1.221.84 122184 1.22 1.84 22 84 1.22-1.84 34 1.34 134 1.061.70. 106170 1.06 1.70 06 70 1.06-1.70) 37 7 3. 6.65 665 6 65 1.608.32 160832 1.60 8.32 60 8 32 1.60-8.32 71 1.71 171 1.152.56. 115256 1.15 2.56 15 56 1.15-2.56) 5 2. 2.58 258 58 2.043.27. 204327 2.04 3.27 04 27 2.04-3.27) Therefore 378 78 3,7 10 9 1.3 121 1.121.54 11215 112 1.1 154 1.5 1.12-1.54 221 1.221.8 12218 122 1.2 184 1.8 1.22-1.8 061 1.061.70 10617 106 1.0 170 1.7 0 1.06-1.70 6.6 66 608 1.608.3 16083 160 1.6 832 8.3 1.60-8.3 17 152 1.152.56 11525 115 256 1.15-2.56 043 2.043.27 20432 204 2.0 327 3.2 2.04-3.27 3, 1. 1.121.5 1121 11 1.12-1.5 1.221. 1221 18 1.22-1. 1.061.7 1061 1.06-1.7 6. 1.608. 1608 16 83 8. 1.60-8. 1.152.5 1152 1.15-2.5 2.043.2 2043 20 2.04-3.2 1.121. 1.12-1. 1.221 1.22-1 1.061. 1.06-1. 1.608 1.60-8 1.152. 1.15-2. 2.043. 2.04-3. 1.121 1.12-1 1.22- 1.061 1.06-1 1.60- 1.152 1.15-2 2.043 2.04-3 1.12- 1.06- 1.15- 2.04-

Aim Venous blood derivatives (VBDs) have been suggested as substitutes for Fetal Bovine Serum (FBS) to improve the clinical transition of cell-based therapies. The literature is not clear about which is the best VBDs substitute. The present study aimed to evaluate the influence of VBDs on cell viability and describe a new method to seed these cells in a 3D Platelet-Rich Fibrin (PRF). Methods Blood was processed to obtain Platelet-Poor Plasma from PRF (P-PRF), Human Serum (HS), Platelet-Poor Plasma from PRP (P-PRP), activated-PRP (a-PRP), and Platelet lysate (PL). Cells were supplemented with each VBD at 10% and FBS at 10% was the control. Cell viability (fibroblast 3T3/NIH) test was evaluated with MTT assay in two ways: i) cell-seeded and expanded with VBD; ii) cell-seed with FBS and expanded with VBD. To seed the Fibrin construct, cells were suspended in PBS and dropped into the blood sample before performing Choukroun’s protocol for PRF. Constructs were cultured for 7 days in VBD supplements and FBS. Histological and Immunohistochemical analysis with vimentin was performed. Cell viability was analyzed by one-way ANOVA. Results VBD’s production time was very heterogeneous. Cells expanded in HS and a-PRP has grown faster. VBD-supplemented culture media provided cell culture highly sensible to trypsin/EDTA 0.25%. Cells seeded and expanded with VBD presented viability comparable to FBS in HS, a-PRP, and P-PRP (p>0.05) and lower in P-PRF and PL groups (p<0.05). The viability of cell seed with FBS and expanded with VBD was similar between P-PRF, a-PRP, PL, and FBS (p>0.05) and lower in HS and P-PRP (p<0.005). PRF-seeded cells showed a positive expression of vimentin and were able to maintain all cells supplemented with VBD. Conclusion VBD supplements were able to maintain fibroblast cells in 2D and 3D cultures. The new method of the fibrin-cell construct was efficient to insert the cells into the fibrin network. (VBDs (FBS cellbased based therapies substitute D PlateletRich Rich . (PRF) PlateletPoor Poor PPRF, PPRF P , (P-PRF) (HS) PPRP, PPRP (P-PRP) activatedPRP activated aPRP, aPRP (a-PRP) PL. (PL) 10 control 3T3/NIH 3T3NIH TNIH 3T3 NIH T ways i cellseeded ii cellseed Choukrouns Choukroun s performed oneway one way ANOVA heterogeneous faster VBDsupplemented trypsinEDTA trypsin EDTA 025 0 25 0.25% PRP, p>0.05 p005 p 05 (p>0.05 p<0.05. p<0.05 (p<0.05) PRF, p<0.005. p0005 p<0.005 005 (p<0.005) PRFseeded cultures fibrincell network (PRF (P-PRF (HS (P-PRP (a-PRP (PL 1 3T 02 2 0.25 p>0.0 p00 (p>0.0 p<0.0 (p<0.05 p000 p<0.00 00 (p<0.005 0.2 p>0. p0 (p>0. p<0. (p<0.0 (p<0.00 0. p>0 (p>0 p<0 (p<0. p> (p> p< (p<0 (p (p<

Aim The present study aimed to investigate if cannabis use can be associated with gingival bleeding and caries experience among Brazilian students. Methods A cross-sectional study was performed in 2016 with first-semester university students in Pelotas. Data was collected via a self-administered questionnaire. Self-reported gingival bleeding and caries experienced were collected. Cannabis use was assessed using a modified version of the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST). We define cannabis users as individuals who report using cannabis at least once a month. A Poisson regression model with robust variance was used to analyze the data. Results A total of 2,058 (64.5% of eligible students) students were assessed. The prevalence of caries experience was 68.2% and gingival bleeding was 50.8%. The prevalence of cannabis use was 11.7%. After controlling (sex, skin color, age, family income, depressive symptoms, oral health self-perception tobacco use), individuals who use cannabis present a prevalence of gingival bleeding 2.51 (CI95%[1.42–4;53]) higher than individuals who did not use cannabis. The association was maintained even when the individuals who used tobacco were excluded from the sample (PR=2.24, CI95%[1.16 – 4.31]). Cannabis use did not show an association with the experience of dental caries in both crude (PR 0.91 CI95%[0.82 – 1.01]) and adjusted models (PR 0.93 CI 95%[0.83 – 1.05]). Conclusion Cannabis use was associated with the presence of gingival bleeding among the students of a public university in the south of Brazil. However, the experience of dental caries did not present an association with cannabis use. crosssectional cross sectional 201 firstsemester first semester Pelotas selfadministered self administered questionnaire Selfreported Self reported Alcohol Smoking ASSIST. ASSIST . (ASSIST) month data 2058 2 058 2,05 64.5% 645 64 5 (64.5 682 68 68.2 508 50 8 50.8% 117 11 7 11.7% sex, sex (sex color age income symptoms selfperception perception use, , use) 251 51 2.5 CI95%1.42–453 CI95142453 CI95% 1.42–4 53 CI95 1 42 4 (CI95%[1.42–4;53] PR=2.24, PR224 PR 24 (PR=2.24 CI95%1.16 CI95116 1.16 16 CI95%[1.1 4.31. 431 4.31 31 4.31]) 091 0 91 0.9 CI95%0.82 CI95082 0.82 82 CI95%[0.8 1.01 101 01 1.01] 093 93 95%0.83 95083 95% 0.83 95 83 95%[0.8 1.05. 105 1.05 05 1.05]) Brazil However 20 (ASSIST 205 2,0 64.5 6 (64. 68. 50.8 11.7 25 2. 453 CI95%1.42–45 CI9514245 1424 1.42– CI9 (CI95%[1.42–4;53 PR=2.24 PR22 (PR=2.2 CI95%1.1 CI9511 116 1.1 CI95%[1. 43 4.3 3 4.31] 09 9 0. CI95%0.8 CI9508 082 0.8 CI95%[0. 1.0 10 95%0.8 9508 083 95%[0. 1.05] 2, 64. (64 50. 11. 45 CI95%1.42–4 CI951424 142 1.42 (CI95%[1.42–4;5 PR=2.2 PR2 (PR=2. CI95%1. CI951 1. CI95%[1 4. CI95%0. CI950 08 CI95%[0 95%0. 950 95%[0 (6 CI95%1.42– CI95142 14 1.4 (CI95%[1.42–4; PR=2. (PR=2 CI95%1 CI95%[ CI95%0 95%0 95%[ ( CI95%1.42 CI9514 (CI95%[1.42–4 PR=2 (PR= CI95%1.4 (CI95%[1.42– PR= (CI95%[1.42 (CI95%[1.4 (CI95%[1. (CI95%[1 (CI95%[ (CI95% (CI95 (CI9 (CI

The study investigated the factors associated with the self-perception safety of dental students in clinical activities during the COVID-19 pandemic. This cross-sectional study was based on a semi-structured online (google forms) self-applied questionnaire, sent by e-mail to three private Dental Schools in Brazil. The variables were: 1) sociodemographic information; 2) questions about the measures adopted by dental schools before returning to clinical activities; 3) dental students’ self-perception of security; 4) the General Health Questionnaire. Data were submitted to Fisher’s exact test (p<0.05). Of the 294 eligible students, 97% were evaluated and 100% received previous specific biosafety training predominantly theoretical (72.16%) longer than one hour (51.55%). Most students (81.44%) felt secure performing clinical care during the COVID-19 pandemic. Students undergoing specific biosafety training for longer than one hour felt safer than those perfoming training for up to 1 hour (p=0.004). Students from schools where the aerosol-producing restriction was applied felt safer than those without restrictions (p=0.016). Women reported feeling less secure than men (p=0.046), and students who submitted to COVID-19 Specific Biosafety Training felt safer in clinical activities than those submitted to theoretical training only (p=0.011). Students from private universities presenting psychosomatic changes felt less secure in practicing clinical dental care activities (p=0.006). In conclusion, time-spent training in biosafety, restriction of the use of aerosol-producing procedures, and the gender of students were associated with the self-perception safety of students. Students with practical training felt safer in clinical activities for patients with COVID-19 than those who had only theoretical training. selfperception self perception COVID19 COVID 19 COVID-1 pandemic crosssectional cross sectional semistructured semi structured google forms selfapplied questionnaire email e mail Brazil information 2 3 security 4 Questionnaire Fishers Fisher s p<0.05. p005 p p<0.05 . 0 05 (p<0.05) 29 97 100 72.16% 7216 72 16 (72.16% 51.55%. 5155 51.55% 51 55 (51.55%) 81.44% 8144 81 44 (81.44% p=0.004. p0004 p=0.004 004 (p=0.004) aerosolproducing aerosol producing p=0.016. p0016 p=0.016 016 (p=0.016) p=0.046, p0046 p=0.046 , 046 (p=0.046) p=0.011. p0011 p=0.011 011 (p=0.011) p=0.006. p0006 p=0.006 006 (p=0.006) conclusion timespent time spent procedures COVID1 COVID- p00 p<0.0 (p<0.05 9 10 72.16 721 7 (72.16 515 51.55 5 (51.55% 81.44 814 8 (81.44 p000 p=0.00 00 (p=0.004 p001 p=0.01 01 (p=0.016 p004 p=0.04 04 (p=0.046 (p=0.011 (p=0.006 p0 p<0. (p<0.0 72.1 (72.1 51.5 (51.55 81.4 (81.4 p=0.0 (p=0.00 (p=0.01 (p=0.04 p<0 (p<0. 72. (72. 51. (51.5 81. (81. p=0. (p=0.0 p< (p<0 (72 (51. (81 p=0 (p=0. (p< (7 (51 (8 p= (p=0 (p ( (5 (p=

ABSTRACT Aim The aim of our study was to analyze the content related to dentistry published on Instagram ® and to investigate the students’ profiles related to the use of social networks in a sample from a Dentistry School. Methods This study was carried out in two stages. First, research was conducted to analyze content published on Instagram® related to dentistry. The second part investigated the profiles of students’ from a dental school in relation to the use of social networks through a questionnaire. A descriptive analysis was performed and associations between the variables were tested using Fisher’s exact test. Results We found a diversified and large amount of content related to dentistry published on Instagram ® , and publications that involved advertising were more prevalent in our study. There are also many publications that are violating the Code of Dental Ethics. In addition, in the second part of our study, we observed an enormous use of social networks by dental students (98.4%). Conclusions As a result, we believe that it is important to update professionals about the ethical infractions related to social networks which could be approached during graduate courses in universities. Finally, the analyzed social network seems to be an interesting alternative for disseminating health information in order to dialogue with greater proximity to the large number of users who participate in it.

Aim In Brazil, COVID-19 remains one of the epicenters of the pandemic, thus, presential educational activities are suspended. The study aimed to describe the approach of flipped classroom performed to provide social distancing and to maintain teaching activities during COVID-19-pandemic. Methods Flipped Classroom was chosen to be associated with the role-play technique as a central methodology. To bring students closer to activities performed in the non-pandemic period, some actions and assessments were also role-played by Professor simulating patients in virtual meetings. Results Although the changes in the format of the lessons, our approaches stimulated the students maintained the high frequency of students in the activities (almost 100%) providing continuity activities. Conclusions This report can reinforce that meaningful learning can be taught by using a virtual/remote approach. However, the potential positive results observed cannot be used as an excuse to maintain remote teaching activities with the objective of cost-cutting by the institutions.

Resumo O objetivo deste estudo é descrever o perfil de utilização dos serviços de atenção primária à saúde, estimado pela Pesquisa Nacional de Saúde (PNS), da população residente em domicílios cadastrados e não cadastrados na Estratégia de Saúde da Família (ESF), nos anos de 2013 e 2019. Estudo transversal realizado com microdados dos inquéritos nacionais de saúde entre 2013 e 2019. A amostra originou-se de uma amostra mestra, composta por um conjunto de unidades de áreas selecionadas em um cadastro. Variáveis sexo, idade, cor da pele, renda, escolaridade, autopercepção de saúde, domicílio cadastrado na ESF, atendimento médico no último ano, tipo de serviço que você procura quando está doente foram selecionados. As variáveis dependentes foram uso de serviços de saúde e uso de serviços públicos de saúde. As variáveis dependentes e independentes foram descritas com os respectivos intervalos de confiança e foi realizada regressão logística ajustada para cada desfecho analisado. Nos serviços públicos de saúde, menor renda, ter doenças crônicas (hipertensão arterial ou colesterol alto), estar grávida e ter uma autopercepção de saúde ruim estiveram associados à maior utilização de serviços de saúde nos dois períodos. Morar em domicílios cadastrados na ESF foi associado aos serviços de saúde mais utilizados (públicos ou privados). A estratégia de saúde da família é uma estratégia importante para expandir o acesso de forma igualitária.

Abstract The objective of this study is to describe the profile of use of primary health care services, estimated by the PNS, of the population living in households registered and not registered with the Famly Health Strategy - FHS, in the years 2013 and 2019. Cross-sectional study carried out using microdata from national health surveys 2013 and 2019. The sample originated from a master sample, consisting of a set of units from selected areas in a register..The variables sex, age, skin color, income, education, self-perceived health, home registered with the FHS, medical care in the last year, type of service you seek when you are ill were selected. The dependent variables were use of health services and use of public health services. The dependent and independent variables were described with the respective confidence interval and adjusted logistic regression was performed for each outcome analyzed. In public health services, lower income, have chronic diseases (arterial hypertension or high cholesterol), be pregnant, and having a bad self-perception of health were associated with used more health services in both periods. Living in registered households was associated with more used health services (public or private). The family health strategy is an important strategy for expanding access equally.

Resumo O objetivo deste estudo é descrever o perfil de utilização dos serviços de atenção primária à saúde, estimado pela Pesquisa Nacional de Saúde (PNS), da população residente em domicílios cadastrados e não cadastrados na Estratégia de Saúde da Família (ESF), nos anos de 2013 e 2019. Estudo transversal realizado com microdados dos inquéritos nacionais de saúde entre 2013 e 2019. A amostra originou-se de uma amostra mestra, composta por um conjunto de unidades de áreas selecionadas em um cadastro. Variáveis sexo, idade, cor da pele, renda, escolaridade, autopercepção de saúde, domicílio cadastrado na ESF, atendimento médico no último ano, tipo de serviço que você procura quando está doente foram selecionados. As variáveis dependentes foram uso de serviços de saúde e uso de serviços públicos de saúde. As variáveis dependentes e independentes foram descritas com os respectivos intervalos de confiança e foi realizada regressão logística ajustada para cada desfecho analisado. Nos serviços públicos de saúde, menor renda, ter doenças crônicas (hipertensão arterial ou colesterol alto), estar grávida e ter uma autopercepção de saúde ruim estiveram associados à maior utilização de serviços de saúde nos dois períodos. Morar em domicílios cadastrados na ESF foi associado aos serviços de saúde mais utilizados (públicos ou privados). A estratégia de saúde da família é uma estratégia importante para expandir o acesso de forma igualitária.

Abstract The objective of this study is to describe the profile of use of primary health care services, estimated by the PNS, of the population living in households registered and not registered with the Famly Health Strategy - FHS, in the years 2013 and 2019. Cross-sectional study carried out using microdata from national health surveys 2013 and 2019. The sample originated from a master sample, consisting of a set of units from selected areas in a register..The variables sex, age, skin color, income, education, self-perceived health, home registered with the FHS, medical care in the last year, type of service you seek when you are ill were selected. The dependent variables were use of health services and use of public health services. The dependent and independent variables were described with the respective confidence interval and adjusted logistic regression was performed for each outcome analyzed. In public health services, lower income, have chronic diseases (arterial hypertension or high cholesterol), be pregnant, and having a bad self-perception of health were associated with used more health services in both periods. Living in registered households was associated with more used health services (public or private). The family health strategy is an important strategy for expanding access equally.

Objectives: the purpose of this study was to describe the impact of the COVID-19 pandemic on Primary Health Care in Brazil. Methods: This retrospective ecological study was carried out using Brazilian municipality data obtained from the information systems of the National Public Health System. The outcomes were medical appointments, prenatal procedures and diabetes care. The exposure variable was the occurrence of the COVID-19 pandemic, based on the first case notified in Brazil. Multilevel mixed-effects negative binomial regression was used to analyze the association between the number of procedures per 10,000 inhabitants and COVID-19. Results: Data from 5,564 Brazilian municipalities were included in the present study. Regarding medical appointments, the largest reduction occasioned by the pandemic occurred in May (IRR = 0.27, CI 95% [0.24 – 0.30]). As far as prenatal procedures are concerned, the reduction was 65% (IRR= 0.35, CI 95% [0.32 – 0.38], also in May. In addition, diabetes care saw the biggest reductions in April 2020 (IRR = 0.24, CI 95% [0.11 – 0.53]) and May 2020 (IRR = 0.19, CI 95% [0.09 – 0.43]). From February to December 2020, the pandemic had a significant effect on the total number of procedures evaluated. Conclusion: The findings showed a reduction in prenatal procedures, diabetes and medical consultations performed in Brazil’s Primary Health Care, subsequent to the onset of the COVID-19 pandemic.

Objetivos: o objetivo do estudo foi descrever o impacto da pandemia COVID-19 na Atenção Primária à Saúde Brasileira. Métodos: Estudo ecológico retrospectivo realizado com dados de municípios Brasileiros dos sistemas de informação do Sistema Único de Saúde. Os desfechos do estudo foram as consultas médicas, procedimentos de pré-natal e tratamento de diabetes. A exposição foi a ocorrência da pandemia de COVID-19, a partir do primeiro caso notificado no Brasil. Regressões binomiais negativas de efeitos mistos multinível foram utilizadas para analisar a associação entre o número de procedimentos por 10.000 habitantes e a pandemia de COVID-19. Resultados: Dados de 5.564 municípios brasileiros foram incluídos no presente estudo. Em relação à consulta médica, a maior redução devido à pandemia ocorreu em maio (IRR = 0,27, IC 95% [0,24 - 0,30]). Para os procedimentos de pré-natal, a redução foi de 65% (IRR= 0.35, IC 95% [0.32 – 0.38]) em maio. Ainda assim, os procedimentos de tratamento do diabetes tiveram maiores reduções em abril (IRR = 0,24, IC 95% [0,11 - 0,53]) e maio (IRR = 0,19, IC 95% [0,09 - 0,43]) de 2020. De fevereiro a dezembro de 2020 a pandemia impactou significantemente no total de procedimentos avaliados. Conclusão: Os achados mostraram uma redução de procedimentos de pré-natal, diabetes e consultas médicas realizadas na Atenção Primária à Saúde do Brasil, após o início da pandemia de COVID-19.

RESUMO: Objetivos: O objetivo do presente estudo foi descrever o impacto da pandemia de covid-19 na Atenção Primária à Saúde (APS) Brasileira. Métodos: Estudo ecológico retrospectivo realizado com dados de municípios brasileiros, obtidos nos sistemas de informação do Sistema Único de Saúde (SUS). Os desfechos do estudo foram as consultas médicas, procedimentos de pré-natal e tratamento de diabetes. A exposição foi a ocorrência da pandemia de covid-19, a partir do primeiro caso notificado no Brasil. Regressões binomiais negativas de efeitos mistos multinível foram utilizadas para analisar a associação entre o número de procedimentos por 10.000 habitantes e a pandemia de covid-19. Resultados: Dados de 5.564 municípios brasileiros foram incluídos no presente estudo. Em relação à consulta médica, a maior redução devido à pandemia em curso ocorreu em maio (IRR = 0,27, IC95% 0,24 - 0,30). Para os procedimentos de pré-natal, a redução foi de 65% (IRR = 0,35, IC95% 0.32 - 0.38), também em maio. Ainda assim, os procedimentos de tratamento do diabetes tiveram maiores reduções em abril (IRR = 0,24, IC95% 0,11 - 0,53) e maio (IRR = 0,19, IC95% 0,09 - 0,43) de 2020. De fevereiro a dezembro de 2020, a pandemia de covid-19 impactou significantemente o total de procedimentos avaliados. Conclusão: Os achados mostraram uma redução de procedimentos de pré-natal, diabetes e consultas médicas realizadas na Atenção Primária à Saúde (APS) do Brasil, após o início da pandemia de covid-19.

ABSTRACT: Objectives: The purpose of this study was to describe the impact of the COVID-19 pandemic on Primary Health Care in Brazil. Methodology: This retrospective ecological study was carried out using Brazilian municipality data obtained from the information systems of the National Public Health System. The outcomes were medical appointments, prenatal procedures and diabetes care. The exposure variable was the occurrence of the COVID-19 pandemic, based on the first case reported in Brazil. Multilevel mixed-effects negative binomial regression was used to analyze the association between the number of procedures per 10,000 inhabitants and COVID-19. Results: Data from 5,564 Brazilian municipalities were included in the present study. Regarding medical appointments, the largest reduction occasioned by the pandemic occurred in May (IRR = 0.27, 95%CI 0.24 – 0.30). Prenatal procedures were reduced by 65% (IRR = 0.35, 95%CI 0.32 – 0.38), also in May. In addition, diabetes care saw the biggest reductions in April 2020 (IRR = 0.24, 95%CI 0.11 – 0.53) and May 2020 (IRR = 0.19, 95%CI 0.09 – 0.43). From February to December 2020, the pandemic had a significant effect on the total number of procedures evaluated. Conclusion: The findings showed a reduction in prenatal procedures, diabetes and medical consultations performed in Brazil's Primary Health Care, following the onset of the COVID-19 pandemic.

RESUMO: Objetivos: O objetivo do presente estudo foi descrever o impacto da pandemia de covid-19 na Atenção Primária à Saúde (APS) Brasileira. Métodos: Estudo ecológico retrospectivo realizado com dados de municípios brasileiros, obtidos nos sistemas de informação do Sistema Único de Saúde (SUS). Os desfechos do estudo foram as consultas médicas, procedimentos de pré-natal e tratamento de diabetes. A exposição foi a ocorrência da pandemia de covid-19, a partir do primeiro caso notificado no Brasil. Regressões binomiais negativas de efeitos mistos multinível foram utilizadas para analisar a associação entre o número de procedimentos por 10.000 habitantes e a pandemia de covid-19. Resultados: Dados de 5.564 municípios brasileiros foram incluídos no presente estudo. Em relação à consulta médica, a maior redução devido à pandemia em curso ocorreu em maio (IRR = 0,27, IC95% 0,24 - 0,30). Para os procedimentos de pré-natal, a redução foi de 65% (IRR = 0,35, IC95% 0.32 - 0.38), também em maio. Ainda assim, os procedimentos de tratamento do diabetes tiveram maiores reduções em abril (IRR = 0,24, IC95% 0,11 - 0,53) e maio (IRR = 0,19, IC95% 0,09 - 0,43) de 2020. De fevereiro a dezembro de 2020, a pandemia de covid-19 impactou significantemente o total de procedimentos avaliados. Conclusão: Os achados mostraram uma redução de procedimentos de pré-natal, diabetes e consultas médicas realizadas na Atenção Primária à Saúde (APS) do Brasil, após o início da pandemia de covid-19.

ABSTRACT: Objectives: The purpose of this study was to describe the impact of the COVID-19 pandemic on Primary Health Care in Brazil. Methodology: This retrospective ecological study was carried out using Brazilian municipality data obtained from the information systems of the National Public Health System. The outcomes were medical appointments, prenatal procedures and diabetes care. The exposure variable was the occurrence of the COVID-19 pandemic, based on the first case reported in Brazil. Multilevel mixed-effects negative binomial regression was used to analyze the association between the number of procedures per 10,000 inhabitants and COVID-19. Results: Data from 5,564 Brazilian municipalities were included in the present study. Regarding medical appointments, the largest reduction occasioned by the pandemic occurred in May (IRR = 0.27, 95%CI 0.24 – 0.30). Prenatal procedures were reduced by 65% (IRR = 0.35, 95%CI 0.32 – 0.38), also in May. In addition, diabetes care saw the biggest reductions in April 2020 (IRR = 0.24, 95%CI 0.11 – 0.53) and May 2020 (IRR = 0.19, 95%CI 0.09 – 0.43). From February to December 2020, the pandemic had a significant effect on the total number of procedures evaluated. Conclusion: The findings showed a reduction in prenatal procedures, diabetes and medical consultations performed in Brazil's Primary Health Care, following the onset of the COVID-19 pandemic.

Resumo: O estudo teve dois objetivos: (a) investigar as desigualdades raciais enquanto uma dimensão específica que afeta a prevalência de dor de dente em adolescentes brasileiros, e (b) analisar as variações regionais na prevalência de dor de dente. O estudo transversal usou dados da Pesquisa Nacional de Saúde do Escolar (PeNSE), realizada com adolescentes em 2009, 2012 e 2015. Dor de dente foi avaliada com a pergunta: “Nos últimos seis meses, você teve dor de dente?”. As principais exposições foram raça/cor e macrorregiões brasileiras, usadas para avaliar as desigualdades relacionadas ao desfecho. Sexo, idade, tipo de escola e escolaridade materna foram as covariáveis utilizadas. A significância estatística das tendências na prevalência de dor de dente foi testada com regressão linear. As análises foram realizadas com o programa estatístico Stata 13.0, usando o comando svy. A prevalência padrão de dor de dente foi 18,8%, 21,1% e 23,7%, com uma tendência crescente ao longo do tempo (p < 0,001). Foram observadas desigualdades absolutas na prevalência de dor de dente de acordo com raça e macrorregião. A prevalência mais alta esteve associada ao sexo feminino, raça não-branca, escola pública e Região Norte do país. Os índices de desigualdade aumentaram no grupo de meninas negras, refletidos em um aumento na prevalência de dor de dente em meninas cujas mães tinham menos escolaridade. A prevalência de dor de dente em adolescentes brasileiros aumentou ao longo do tempo, e as desigualdades em relação à dor de dente persistiram nas populações marginalizadas e de acordo com a região do país.

Abstract: The aim of the study is: (a) investigate the racial inequalities as one specific dimension that affects dental pain in Brazilian adolescents; and (b) investigate the regional variations of dental pain. This cross-sectional study used data from Brazilian National Survey of School Health (PeNSE), carried out with adolescents in 2009, 2012 and 2015. Dental pain was evaluated through the question: “Did you have dental pain in the last six months?”. The main exposures were race and Brazilian regions, used to evaluate inequalities related to the outcome. Sex, age, school type and maternal education were used as covariables. The statistical significance of the trends in dental pain was tested using linear regression. The analysis was conducted in Stata 13.0 statistical package using the svy command. The standard prevalence of dental pain was 18.8%, 21.1% and 23.7%, showing an increasing trend over time (p < 0.001). We observed absolute inequalities in dental pain related to race and regions. A higher prevalence was found in non-white girls of public schools and in the Northern Region. The indexes of inequalities increased in the group of black girls, related to an increase of dental pain predominantly in girls whose mothers had lower educational level. It was observed that the prevalence of dental pain in Brazilian adolescents increased over time as well as its inequalities, which remained in marginalized populations and linked to Brazilian regions.

Resumen: El objetivo del estudio fue doble: (a) investigar las desigualdades raciales, como una dimensión específica que afecta al dolor dental, en adolescentes brasileños; e (b) investigar las variaciones regionales del dolor dental. Este estudio transversal usó datos de la Encuesta Nacional de Salud del Escolar (PeNSE), llevada a cabo con adolescentes en 2009, 2012 y 2015. El dolor dental fue evaluado por la pregunta: “En los últimos seis meses, ¿sufriste dolor dental?”. Los principales factores de exposición fueron raza y regiones brasileñas, y se usaron para evaluar las desigualdades relacionadas con los resultados. Sexo, edad, tipo de escuela y educación maternal fueron las covariables usadas. La significación estadística de las tendencias en el dolor dental fue probada usando regresión lineal. El análisis se realizó con el paquete estadístico Stata 13.0, usando el comando svy. El estándar de prevalencia de dolor dental fue 18,8%, 21,1% y 23,7%, con tendencia a aumentar a lo largo del tiempo (p < 0.001). Se observaron desigualdades absolutas en el dolor dental, relacionadas con raza y regiones. Se encontró una prevalencia más alta en chicas, de raza no blanca, escuelas públicas y Región del Norte. Los índices de desigualdades se incrementaron en el grupo de chicas negras, en detrimento de un incremento en la prevalencia del dolor dental en chicas cuyas madres contaban con menos educación formal. Se observó que la prevalencia de dolor dental en adolescentes brasileñas se incrementó a lo largo del tiempo y las desigualdades, respecto al dolor dental, continuaron manteniéndose en el tiempo en poblaciones marginalizadas y acordes con determinadas regiones brasileñas.

Resumo: O estudo teve dois objetivos: (a) investigar as desigualdades raciais enquanto uma dimensão específica que afeta a prevalência de dor de dente em adolescentes brasileiros, e (b) analisar as variações regionais na prevalência de dor de dente. O estudo transversal usou dados da Pesquisa Nacional de Saúde do Escolar (PeNSE), realizada com adolescentes em 2009, 2012 e 2015. Dor de dente foi avaliada com a pergunta: “Nos últimos seis meses, você teve dor de dente?”. As principais exposições foram raça/cor e macrorregiões brasileiras, usadas para avaliar as desigualdades relacionadas ao desfecho. Sexo, idade, tipo de escola e escolaridade materna foram as covariáveis utilizadas. A significância estatística das tendências na prevalência de dor de dente foi testada com regressão linear. As análises foram realizadas com o programa estatístico Stata 13.0, usando o comando svy. A prevalência padrão de dor de dente foi 18,8%, 21,1% e 23,7%, com uma tendência crescente ao longo do tempo (p < 0,001). Foram observadas desigualdades absolutas na prevalência de dor de dente de acordo com raça e macrorregião. A prevalência mais alta esteve associada ao sexo feminino, raça não-branca, escola pública e Região Norte do país. Os índices de desigualdade aumentaram no grupo de meninas negras, refletidos em um aumento na prevalência de dor de dente em meninas cujas mães tinham menos escolaridade. A prevalência de dor de dente em adolescentes brasileiros aumentou ao longo do tempo, e as desigualdades em relação à dor de dente persistiram nas populações marginalizadas e de acordo com a região do país.

Abstract: The aim of the study is: (a) investigate the racial inequalities as one specific dimension that affects dental pain in Brazilian adolescents; and (b) investigate the regional variations of dental pain. This cross-sectional study used data from Brazilian National Survey of School Health (PeNSE), carried out with adolescents in 2009, 2012 and 2015. Dental pain was evaluated through the question: “Did you have dental pain in the last six months?”. The main exposures were race and Brazilian regions, used to evaluate inequalities related to the outcome. Sex, age, school type and maternal education were used as covariables. The statistical significance of the trends in dental pain was tested using linear regression. The analysis was conducted in Stata 13.0 statistical package using the svy command. The standard prevalence of dental pain was 18.8%, 21.1% and 23.7%, showing an increasing trend over time (p < 0.001). We observed absolute inequalities in dental pain related to race and regions. A higher prevalence was found in non-white girls of public schools and in the Northern Region. The indexes of inequalities increased in the group of black girls, related to an increase of dental pain predominantly in girls whose mothers had lower educational level. It was observed that the prevalence of dental pain in Brazilian adolescents increased over time as well as its inequalities, which remained in marginalized populations and linked to Brazilian regions.

Resumen: El objetivo del estudio fue doble: (a) investigar las desigualdades raciales, como una dimensión específica que afecta al dolor dental, en adolescentes brasileños; e (b) investigar las variaciones regionales del dolor dental. Este estudio transversal usó datos de la Encuesta Nacional de Salud del Escolar (PeNSE), llevada a cabo con adolescentes en 2009, 2012 y 2015. El dolor dental fue evaluado por la pregunta: “En los últimos seis meses, ¿sufriste dolor dental?”. Los principales factores de exposición fueron raza y regiones brasileñas, y se usaron para evaluar las desigualdades relacionadas con los resultados. Sexo, edad, tipo de escuela y educación maternal fueron las covariables usadas. La significación estadística de las tendencias en el dolor dental fue probada usando regresión lineal. El análisis se realizó con el paquete estadístico Stata 13.0, usando el comando svy. El estándar de prevalencia de dolor dental fue 18,8%, 21,1% y 23,7%, con tendencia a aumentar a lo largo del tiempo (p < 0.001). Se observaron desigualdades absolutas en el dolor dental, relacionadas con raza y regiones. Se encontró una prevalencia más alta en chicas, de raza no blanca, escuelas públicas y Región del Norte. Los índices de desigualdades se incrementaron en el grupo de chicas negras, en detrimento de un incremento en la prevalencia del dolor dental en chicas cuyas madres contaban con menos educación formal. Se observó que la prevalencia de dolor dental en adolescentes brasileñas se incrementó a lo largo del tiempo y las desigualdades, respecto al dolor dental, continuaron manteniéndose en el tiempo en poblaciones marginalizadas y acordes con determinadas regiones brasileñas.