Objective: To investigate factors associated with non-access to oral health in Brazil. Methods: Cross-sectional study that analyzed data from the external evaluation of the National Program to Improve Access and Quality (2014 and 2018), using hierarchical multivariate logistic regression. Non-access category was defined as the situation in which user was unable to make an appointment with a dentist. Results: We analyzed data from 37.262 individuals (2014 sample) and 117.570 people (2018 sample). A greater chance of non-access was found for those who: live in more unequal municipalities and with less oral health coverage, whose travel time to the unit is more than 11 minutes; female, aged between 25 and 39 years and whose income was up to 1 minimum wage. Conclusion: Non-access was associated with municipal factors such as grater inequality; organizational factors such as less coverage and travel time to the unit; and individual factors such as sex, age and income.

Objetivo: Investigar os fatores associados ao não acesso em saúde bucal no Brasil. Métodos: Estudo transversal, sobre dados da avaliação externa do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica, em 2014 e 2018, mediante regressão logística multivariada hierarquizada. Definiu-se como ‘não acesso’ quando o usuário não consegue marcar consulta com cirurgião-dentista. Resultados: Analisou-se dados de 37.262 indivíduos do segundo ciclo (2014) e 117.570 do terceiro ciclo (2018). Maior chance de não acesso ocorreu para residentes em municípios mais desiguais e com menor cobertura de saúde bucal, deslocamento para a unidade de saúde superior a 11 minutos, sexo feminino, idade entre 25 e 39 anos e renda de até 1 salário mínimo. Conclusão: O não acesso associou-se a fatores municipais, como maior desigualdade; fatores organizacionais, como menor cobertura e tempo de deslocamento até a unidade; e fatores individuais, como sexo, idade e renda

ABSTRACT Objective: To evaluate the antibacterial effect and the solubility of experimental root canal filling pastes containing the phytoconstituents terpineol and cinnamaldehyde. Material and Methods: Minimum Inhibitory Concentration (MIC) of each phytoconstituent was determined against Enterococcus faecalis. Five groups of antibiotic pastes based on zinc oxide were obtained by mixing: only terpineol, only cinnamaldehyde, terpineol and cinnamaldehyde combined, chlorhexidine (antibiotic control), and CTZ paste (control paste). Antibacterial activity was analyzed through direct contact test within 24 and 72 hours. Solubility was evaluated by spectrophotometry within 48 and 144 hours. Antibacterial activity data were analyzed descriptively, and solubility data was analyzed using ANOVA and Tukey tests (p<0.05). Results: The MIC obtained for terpineol and cinnamaldehyde were, respectively, 2000 µg/mL and 500 µg/mL. After 24h, only the terpineol paste did not inhibit E. faecalis growth. After 72h, all groups inhibited E. faecalis growth. After 48h, the highest solubility was verified in the terpineol paste (p<0.05), and no differences were detected among other groups (p>0.05). After and 144h, highest solubility was observed in the terpineol paste (p<0.05), followed by the CTZ paste (p<0.05). No differences were detected for cinnamaldehyde, terpineol+cinnamaldehyde and chlorhexidine pastes (p>0.05). Conclusion: Pastes containing cinnamaldehyde or terpineol+cinnamaldehyde showed antibacterial activity against E. faecalis similar to CTZ paste, with lower solubility.

Abstract This study aimed to analyze the influence of socioeconomic factors on the frequency of diagnoses of oral mucosal changes and the number of hospitalized patients with oral and oropharyngeal cancer in Brazil. This cross-sectional study analyzed data from all Brazilian cities in the period 2011–2017. The frequency of diagnoses of oral mucosal changes and the number of hospitalized patients of oral and oropharyngeal cancer in Brazil were extracted from the Primary Care Information System (SIAB) and Brazilian National Cancer Institute (INCA) databases. The socioeconomic factors evaluated were the Gini coefficient of inequality, municipal Human Development Index (MHDI), inadequate basic sanitation rate, employment rate, illiteracy rate and expected years of schooling. Associated factors were examined using bivariate Spearman’s correlations and multivariate Poisson regressions, and statistically significant (p < 0.05) correlations between study variables and regression coefficients were obtained. A higher frequency of diagnoses of mucosal changes was observed in cities with a higher Gini coefficient (B = 11.614; p < 0.001), higher MHDI (B = 11.298; p < 0.001), and higher number of hospitalized patients with oral and oropharyngeal cancer (B = 0.001, p < 0.002). Cities with higher Gini coefficients (B = 8.159, p < 0.001), higher inadequate basic sanitation rates (B = 0.09, p = 0.001), lower expected years of schooling (B = -0.718, p < 0.001), and higher illiteracy rates (B = 0.191, p < 0.001) had a higher frequency of hospitalized patients with oral and oropharyngeal cancer. In conclusion, more developed cities showed a higher frequency of diagnoses of mucosal changes. Greater inequality and worse socioeconomic conditions are associated with a higher frequency of hospitalized patients with oral and oropharyngeal cancer in Brazil.

RESUMO OBJETIVO: Analisar o efeito da Política Nacional de Atenção Básica (PNAB) de 2017 no quantitativo de agentes comunitários de saúde, por equipe de atenção primária em saúde. MÉTODOS: Trata-se de um estudo transversal, descritivo e analítico, utilizando dados disponibilizados na plataforma e-Gestor da Atenção Básica, do Ministério da Saúde, sobre os 5.570 municípios brasileiros, entre outubro de 2017 e dezembro de 2019. A sobrevida do número de municípios que não reduziram o quantitativo de agentes comunitários de saúde foi analisada segundo a região do país, índice de desenvolvimento humano (IDH), índice de desigualdade de Gini e porte populacional. A Regressão de Cox foi utilizada para analisar os fatores associados à redução do número de ACS após um mês e, a partir de então, a cada três meses, até completarem os dois anos da publicação da portaria da PNAB 2017, considerando-se p < 0,05. CONCLUSÕES: Após dois anos, a maior redução foi observada em municípios das regiões Centro-Oeste e Sul, que apresentaram IDH alto, menos desiguais e com maior porte populacional. Municípios do Centro-Oeste (HR = 1,256) apresentaram maior chance de redução do número de ACS comparado à região Norte. Municípios com maior IDH (HR = 1,053) e maior porte populacional (HR = 1,186) também apresentaram maior chance de reduzir o número de agentes comunitários de saúde. Portanto, após a PNAB 2017, houve um aumento ao longo dos meses no número de municípios que reduziram a quantidade de agentes comunitários em saúde na atenção primária de saúde.

ABSTRACT OBJECTIVE: To analyze the effect of the 2017 Basic Primary Care Policy (PNAB) on the number of community health agents per primary health care team. METHODS: This is a cross-sectional, descriptive and analytical study using data available on the Ministry of Health platform called e-Gestor da Atenção Básica, about Brazil's 5,570 towns between October 2017 and December 2019. The survival of the number of towns that did not reduce the number of community health agents was analyzed according to region of the country, the Human Development Index (HDI), the Gini Inequality Index and population size. Cox regression was used to analyze the factors associated with a reduction in the number of CHAs after one month and, from then on, every three months until two years had passed since the publication of the 2017 PNAB Ordinance, considering p < 0.05. CONCLUSIONS: After two years, the greatest reduction was observed in towns in the Midwest and South regions, which presented a high HDI, lower inequality and larger populations. Towns in the Midwest (HR = 1.256) had a higher chance of reducing the number of CHAs compared to the North region. Towns with a higher HDI (HR = 1.053) and larger population size (HR = 1.186) were also more likely to reduc the number of community health agents. Therefore, after the 2017 PNA, the number of towns reducing the amount of community health workers in primary health care increased over the months

RESUMO OBJETIVO: Analisar o efeito da Política Nacional de Atenção Básica (PNAB) de 2017 no quantitativo de agentes comunitários de saúde, por equipe de atenção primária em saúde. MÉTODOS: Trata-se de um estudo transversal, descritivo e analítico, utilizando dados disponibilizados na plataforma e-Gestor da Atenção Básica, do Ministério da Saúde, sobre os 5.570 municípios brasileiros, entre outubro de 2017 e dezembro de 2019. A sobrevida do número de municípios que não reduziram o quantitativo de agentes comunitários de saúde foi analisada segundo a região do país, índice de desenvolvimento humano (IDH), índice de desigualdade de Gini e porte populacional. A Regressão de Cox foi utilizada para analisar os fatores associados à redução do número de ACS após um mês e, a partir de então, a cada três meses, até completarem os dois anos da publicação da portaria da PNAB 2017, considerando-se p < 0,05. CONCLUSÕES: Após dois anos, a maior redução foi observada em municípios das regiões Centro-Oeste e Sul, que apresentaram IDH alto, menos desiguais e com maior porte populacional. Municípios do Centro-Oeste (HR = 1,256) apresentaram maior chance de redução do número de ACS comparado à região Norte. Municípios com maior IDH (HR = 1,053) e maior porte populacional (HR = 1,186) também apresentaram maior chance de reduzir o número de agentes comunitários de saúde. Portanto, após a PNAB 2017, houve um aumento ao longo dos meses no número de municípios que reduziram a quantidade de agentes comunitários em saúde na atenção primária de saúde.

ABSTRACT OBJECTIVE: To analyze the effect of the 2017 Basic Primary Care Policy (PNAB) on the number of community health agents per primary health care team. METHODS: This is a cross-sectional, descriptive and analytical study using data available on the Ministry of Health platform called e-Gestor da Atenção Básica, about Brazil's 5,570 towns between October 2017 and December 2019. The survival of the number of towns that did not reduce the number of community health agents was analyzed according to region of the country, the Human Development Index (HDI), the Gini Inequality Index and population size. Cox regression was used to analyze the factors associated with a reduction in the number of CHAs after one month and, from then on, every three months until two years had passed since the publication of the 2017 PNAB Ordinance, considering p < 0.05. CONCLUSIONS: After two years, the greatest reduction was observed in towns in the Midwest and South regions, which presented a high HDI, lower inequality and larger populations. Towns in the Midwest (HR = 1.256) had a higher chance of reducing the number of CHAs compared to the North region. Towns with a higher HDI (HR = 1.053) and larger population size (HR = 1.186) were also more likely to reduc the number of community health agents. Therefore, after the 2017 PNA, the number of towns reducing the amount of community health workers in primary health care increased over the months

Resumo Objetivo: Investigar os fatores associados ao não acesso em saúde bucal no Brasil. Métodos: Estudo transversal, sobre dados da avaliação externa do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica, em 2014 e 2018, mediante regressão logística multivariada hierarquizada. Definiu-se como ‘não acesso’ quando o usuário não consegue marcar consulta com cirurgião-dentista. Resultados: Foram analisados dados de 37.262 indivíduos do segundo ciclo (2014) e 117.570 do terceiro ciclo (2018). Maior chance de não acesso ocorreu para residentes em municípios mais desiguais e com menor cobertura de saúde bucal, deslocamento para a unidade de saúde superior a 11 minutos, sexo feminino, idade entre 25 e 39 anos e renda de até 1 salário mínimo. Conclusão: O não acesso associou-se a fatores municipais, como maior desigualdade; fatores organizacionais, como menor cobertura e tempo de deslocamento até a unidade; e fatores individuais, como sexo, idade e renda.

Abstract Objective: To investigate factors associated with non-access to oral health in Brazil. Methods: This was a cross-sectional study of data from external evaluations of the National Primary Care Access and Quality Improvement Program (2014 and 2018), using hierarchical multivariate logistic regression. ‘Non-access’ was defined as the service user not being able to make an appointment with a dentist. Results: We analyzed data on 37.262 individuals (2014 sample) and on a further 117.570 individuals (2018 sample). Greater likelihood of non-access was found for those who live in municipalities with greater inequalities and with less oral health coverage, those whose travel time to the health center is more than 11 minutes, being female, being aged between 25 and 39 years and those whose income was up to 1 minimum wage. Conclusion: Non-access was associated with municipal factors such as greater inequality; organizational factors such as less oral health coverage and travel time to the health center; and individual factors such as sex, age and income.

Resumen Objetivo: Investigar los factores asociados a la falta de acceso a la salud bucal en Brasil. Métodos: Estudio transversal, con datos de la evaluación externa del Programa de Mejoramiento del Acceso y la Calidad de la Atención Primaria (2014 y 2018), mediante regresión logística multivariable jerárquica. La categoría ‘sin acceso’ se definió cuando el usuario no consiguió concertar una consulta con un cirujano dentista. Resultados: Analizamos datos de 37.262 (2014) y 117.570 (2018) individuos. Se encontró una mayor probabilidad de no acceso para quienes: vivían en municipios con más desigualdad y con menor cobertura de salud bucal, cuyo tiempo de viaje a la unidad era superior a 11 minutos; mujeres, entre 25 y 39 años e ingresos de hasta 1 sueldo mínimo. Conclusión: La falta de acceso se asoció con factores municipales como mayor desigualdad; factores organizacionales como menor cobertura y tiempo de viaje a la unidad; y factores individuales como sexo, edad e ingresos.

Resumo Objetivo: Investigar os fatores associados ao não acesso em saúde bucal no Brasil. Métodos: Estudo transversal, sobre dados da avaliação externa do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica, em 2014 e 2018, mediante regressão logística multivariada hierarquizada. Definiu-se como ‘não acesso’ quando o usuário não consegue marcar consulta com cirurgião-dentista. Resultados: Foram analisados dados de 37.262 indivíduos do segundo ciclo (2014) e 117.570 do terceiro ciclo (2018). Maior chance de não acesso ocorreu para residentes em municípios mais desiguais e com menor cobertura de saúde bucal, deslocamento para a unidade de saúde superior a 11 minutos, sexo feminino, idade entre 25 e 39 anos e renda de até 1 salário mínimo. Conclusão: O não acesso associou-se a fatores municipais, como maior desigualdade; fatores organizacionais, como menor cobertura e tempo de deslocamento até a unidade; e fatores individuais, como sexo, idade e renda.

Abstract Objective: To investigate factors associated with non-access to oral health in Brazil. Methods: This was a cross-sectional study of data from external evaluations of the National Primary Care Access and Quality Improvement Program (2014 and 2018), using hierarchical multivariate logistic regression. ‘Non-access’ was defined as the service user not being able to make an appointment with a dentist. Results: We analyzed data on 37.262 individuals (2014 sample) and on a further 117.570 individuals (2018 sample). Greater likelihood of non-access was found for those who live in municipalities with greater inequalities and with less oral health coverage, those whose travel time to the health center is more than 11 minutes, being female, being aged between 25 and 39 years and those whose income was up to 1 minimum wage. Conclusion: Non-access was associated with municipal factors such as greater inequality; organizational factors such as less oral health coverage and travel time to the health center; and individual factors such as sex, age and income.

Resumen Objetivo: Investigar los factores asociados a la falta de acceso a la salud bucal en Brasil. Métodos: Estudio transversal, con datos de la evaluación externa del Programa de Mejoramiento del Acceso y la Calidad de la Atención Primaria (2014 y 2018), mediante regresión logística multivariable jerárquica. La categoría ‘sin acceso’ se definió cuando el usuario no consiguió concertar una consulta con un cirujano dentista. Resultados: Analizamos datos de 37.262 (2014) y 117.570 (2018) individuos. Se encontró una mayor probabilidad de no acceso para quienes: vivían en municipios con más desigualdad y con menor cobertura de salud bucal, cuyo tiempo de viaje a la unidad era superior a 11 minutos; mujeres, entre 25 y 39 años e ingresos de hasta 1 sueldo mínimo. Conclusión: La falta de acceso se asoció con factores municipales como mayor desigualdad; factores organizacionales como menor cobertura y tiempo de viaje a la unidad; y factores individuales como sexo, edad e ingresos.

This study compared the access to oral health in primary care, before and after the beginning of the COVID-19 pandemic in Brazil. An observational study with a cross-sectional ecological design was carried out, using data from the Health Information System for Primary Care (SISAB). Data regarding the number of Oral Health Teams (OHT), Oral Health Coverage in Primary Care (OHC), number of First Programmatic Dental Consultations (FPDC), and number of visits due to dental abscess and toothache were collected. Data were collected by state as consolidated of the first quarter (January to April) of 2019 and of 2020. The median of the difference (MD) and the percentage of variation (%V) were obtained for each variable. Data were compared by Wilcoxon test (α&lt;0,05). An increase in the number of OHT was observed in 25 states (MD=45, %V=6.13%, p&lt;0.001), whilst the OHC increased in 17 states (MD=1.01, %V=1.62%, p=0.035) between the 2019 and 2020. We also verified a significant reduction in the number of FPDC (MD=- 42,806, %V=-38.70%, p&lt;0.001), as well as in the number of visits due to dental abscess (MD=-1,032, % V=-29.04%, p=0.002) and due to toothache (MD=-14,445, %V=-32.68%, p&lt;0.001). Although an expansion of OHT and OHC between 2019 and 2020 was verified, access to oral health in primary care has decreased due to the COVID-19 pandemic.

Este estudo analisou acesso em saúde bucal na atenção básica, antes e após o início da pandemia do COVID-19 no Brasil. Realizou-se um estudo observacional, com delineamento ecológico transversal, que utilizou dados do Sistema de Informação em Saúde para a Atenção Básica (SISAB). Foram coletados dados referentes ao número de Equipes de Saúde Bucal (ESB), Cobertura de Saúde Bucal na Atenção Básica (CobSB), número de Primeiras Consultas Odontológicas Programadas (PCOP), e número de atendimentos devido abscesso dento-alveolar e dor de dente. Os dados foram coletados por estado como um consolidado do primeiro quadrimestre (Janeiro a Abril) de 2019 e 2020. A mediana da diferença (MD) e o percentual de variação (%V) dos valores foram obtidos para cada variável em estudo. Os dados foram comparados por meio do teste Wilcoxon (α&lt;0,05). Um aumento do número de ESB foi observado em 25 estados (MD=45, %V=6,13%, p&lt;0,001), enquanto a CobSB aumentou em 17 estados (MD=1,01, %V=1,62%, p=0,035), entre 2019 e 2020. Observou-se ainda redução significativa no número de PCOP (MD=-42.806, %V=-38,70%, p&lt;0,001), bem como no número de atendimentos devido abscesso dento-alveolar (MD=-1.032, %V=-29,04%, p=0,002) e a dor de dente (MD=-14.445, %V=-32,68%, p&lt;0,001). Embora tenha sido verificada ampliação de ESB e CobSB entre 2019 e 2020, o acesso à saúde bucal na atenção básica foi reduzido devido a pandemia do COVID-19.

Resumo Este estudo investigou a utilização dos serviços de saúde segundo determinantes sociais, comportamentos em saúde e qualidade de vida entre diabéticos. A amostra foi composta por 416 diabéticos cadastrados na Estratégia Saúde da Família de um município do Nordeste do Brasil. A análise dos dados incluiu estatísticas descritivas, bivariadas e multivariada por meio da modelagem de Árvore de Decisão usando o algoritmo Chi-squared Automatic Interaction Detector (CHAID). Evidenciou-se expressiva utilização dos serviços públicos de saúde (80,7%). A utilização do serviço público de saúde com regularidade envolveu indivíduos com escolaridade baixa ou média (p < 0,001), empregados ou aposentados e/ou pensionistas (p = 0,019), com alto impacto do diabetes na qualidade de vida (p = 0,032), e que realizavam a quantidade recomendada de exames de glicemia em jejum ao ano (p < 0,001). A utilização dos serviços de saúde pôde ser explicada por diferenças relacionadas aos determinantes sociais, aos comportamentos em saúde e ao impacto do diabetes na qualidade de vida dos usuários.

Abstract The aim of this study was to investigate the use of health services according to social determinants, health behaviors and quality of life among diabetics (n = 416) attended by the Family Health Strategy in a northeastern city in Brazil. Data analysis included descriptive, bivariate and multivariate statistics. Decision Tree modeling was applied using the Chi-squared Automatic Interaction Detector (CHAID) algorithm. Results showed that public health services were used by 80.7% of the sample. The regular use of public health services involved individuals with low or medium schooling (p < 0.001), employed or retired and/or pensioners (p = 0.019), with a high impact of diabetes on quality of life (p = 0.032), and who performed the number of fasting blood glucose tests per year recommended by the Ministry of Health (p < 0.001). The use of health services could be explained by differences related to social determinants, health behaviors and the impact of diabetes on quality of life.

Abstract Objective: To compare the offer and use of oral health services in primary care, before and after the beginning of the COVID-19 pandemic in Brazil. Material and Methods: An observational study with a cross-sectional ecological design, using data from the Health Information System for Primary Care. Data regarding the number of Oral Health Teams (OHT), Oral Health Coverage in Primary Care (OHC), number of First Programmatic Dental Consultations (FPDC), and number of visits due to dental abscess and toothache were collected. Data regarding the 26 Brazilian states and Federal District were collected, as consolidated of the first quarter (January to April) of 2019 and of 2020. The median of the difference (MD) and the percentage of variation (%V) were obtained for each variable and were compared by Wilcoxon test (α<0.05). Results: An increase in the number of OHT was observed in 25 states (MD=45; %V=6.13; p<0.001), whilst the OHC increased in 17 states (MD=1.01; %V=1.62; p=0.035) between the 2019 and 2020. We also verified a significant reduction in the number of FPDC (MD=- 42.806; %V=-38.70; p<0.001), as well as in the number of visits due to dental abscess (MD=-1.032; %V=-29.04; p=0.002) and due to toothache (MD=-14.445; %V=-32.68; p<0.001). Conclusion: Although an expansion of OHT and OHC between 2019 and 2020 was verified, the offer and use of oral health services in primary care has decreased due to the COVID-19 pandemic.

Resumo Este estudo investigou a utilização dos serviços de saúde segundo determinantes sociais, comportamentos em saúde e qualidade de vida entre diabéticos. A amostra foi composta por 416 diabéticos cadastrados na Estratégia Saúde da Família de um município do Nordeste do Brasil. A análise dos dados incluiu estatísticas descritivas, bivariadas e multivariada por meio da modelagem de Árvore de Decisão usando o algoritmo Chi-squared Automatic Interaction Detector (CHAID). Evidenciou-se expressiva utilização dos serviços públicos de saúde (80,7%). A utilização do serviço público de saúde com regularidade envolveu indivíduos com escolaridade baixa ou média (p < 0,001), empregados ou aposentados e/ou pensionistas (p = 0,019), com alto impacto do diabetes na qualidade de vida (p = 0,032), e que realizavam a quantidade recomendada de exames de glicemia em jejum ao ano (p < 0,001). A utilização dos serviços de saúde pôde ser explicada por diferenças relacionadas aos determinantes sociais, aos comportamentos em saúde e ao impacto do diabetes na qualidade de vida dos usuários.

Abstract The aim of this study was to investigate the use of health services according to social determinants, health behaviors and quality of life among diabetics (n = 416) attended by the Family Health Strategy in a northeastern city in Brazil. Data analysis included descriptive, bivariate and multivariate statistics. Decision Tree modeling was applied using the Chi-squared Automatic Interaction Detector (CHAID) algorithm. Results showed that public health services were used by 80.7% of the sample. The regular use of public health services involved individuals with low or medium schooling (p < 0.001), employed or retired and/or pensioners (p = 0.019), with a high impact of diabetes on quality of life (p = 0.032), and who performed the number of fasting blood glucose tests per year recommended by the Ministry of Health (p < 0.001). The use of health services could be explained by differences related to social determinants, health behaviors and the impact of diabetes on quality of life.

Abstract Objective: To investigate the socioeconomic, demographic and health needs that influence the access to oral health actions. Material and Methods: The sample consisted of 609 individuals who lived in areas covered by the Family Health Strategy in a city of the Northeast of Brazil. All individuals living in areas covered by the FHS with age equal to or higher than six years were included. Data analysis included descriptive, bivariate and multivariate statistics using decision-tree based Chi-squared automatic interaction detection (CHAID). Results: Most participants were female, aged 25-34 years, ranging in age from 6 to 87 years. It was evidenced that, among the studied variables, the most relevant for understanding the access to oral health actions were: age (p<0.001), educational level (p-value in Node 1 = 0.009; p-value in Node 7 = 0.005) and self-perception of oral health (p=0.001). Conclusion: The results suggest that access to oral health actions is influenced by several social and individual factors, and it is marked by inequalities that favor individuals with higher educational level, better self-perception of oral health and lower age groups.