RESUMEN
This cross-sectional analytical study assessed the frequency of avoided referrals of primary care to other care levels by dental teleconsulting and its association with individual and contextual variables using a multilevel approach. It appraised asynchronous dental teleconsulting sessions from the secondary database of the Monitoring and Evaluation System of the Telehealth Results during 2020, during the COVID-19 pandemic. The outcome was "whether referral to secondary care was avoided". Individual variables were related to teleconsulting and professionals that requested it: sex, dental specialty, and dentistry field. Contextual variables were related to each municipality that requested responses: Municipal Human Development Index, oral health teams (OHTs) in primary health care coverage, dental specialty centers coverage, illiteracy rate, Gini index, longevity, and per capita income. A descriptive analysis was made using the Statistical Package for the Social Sciences. Hierarchical Linear and Nonlinear Modeling software was used to perform multilevel analyses to assess the association of individual and contextual variables with avoiding patient referral to other care levels. Most teleconsulting sessions avoided patient referral to other care levels (65.1%). Contextual variables explained 44.23% of the variance in the outcome. Female dentists were more likely to avoid patient referrals than male dentists (OR = 1.74; CI = 0.99-3.44; p = 0.055). In addition, an increase of one percentage point in OHT/PHC coverage of municipalities increased the likelihood of avoiding patient referral by 1% (OR = 1.01; CI = 1.00-1.02; p = 0.02). Teleconsulting sessions efficiently avoided patient referral to other care levels. Both contextual and individual factors were associated with avoided referrals by teleconsulting sessions.
Asunto(s)
COVID-19 , Pandemias , Humanos , Masculino , Femenino , Brasil , Estudios Transversales , COVID-19/epidemiología , Derivación y Consulta , Salud BucalRESUMEN
OBJECTIVES: First, to assess the psychometric properties of key questions included in a public sector evaluation of primary dental care in Brazil; and second, to evaluate the performance of dental teams in relation to these items. METHODS: Secondary analysis of a national primary care dataset monitoring quality and access to dental care. Data were collected through face-to-face interviews with representatives of dental teams participating in the 'National Programme for Improving Access and Quality of Primary Care'. Twenty-three mandatory questions about the dentists' reported delivery of dental procedures were included in the analysis. Item Response Theory (IRT) modelling was applied to measure the psychometric properties of the instrument-level of difficulty and discrimination parameter of each item-and then to estimate dental team performance scores based on these parameters. Based on IRT, possible scores ranged from -4 to +4. RESULTS: Three of the 23 mandatory items were removed due to poor internal consistency, resulting in a scale of 20 items for assessing dental team performance. The results showed variation in procedures delivered by the dental teams; whilst more than a half of the procedures were executed by at least 80% of the dental teams, those relating to dentures (partial/total) and frenectomy (lingual/labial) were performed by less than 30%. Amongst the 20 items included in the model, those related to partial/total dentures and oral cancer follow-up presented higher levels of difficulty and were less frequently provided. The items relating to the treatment of deciduous teeth and access to the dental pulp of permanent teeth had the highest discrimination parameters and, consequently, greater weight in the performance's score estimation; therefore, dental teams that did not perform these items had the lowest performance scores. In the present study, dental team performance scores ranged from -3.66 to +1.87 with a mean/median of -0.06/+0.01. CONCLUSION: The findings suggest that whilst the items within the instrument demonstrated some potential to discriminate between poor and very poor teams, they were ineffective in discriminating between poor and good teams. Whilst Brazilian dental teams perform many mandatory procedures, variation in the nature of their delivery of care requires further investigation to enhance service provision to the population.
Asunto(s)
Atención Odontológica/psicología , Atención Odontológica/estadística & datos numéricos , Odontólogos/psicología , Odontólogos/estadística & datos numéricos , Atención Primaria de Salud/estadística & datos numéricos , Psicometría/estadística & datos numéricos , Brasil , Dentaduras/psicología , Dentaduras/estadística & datos numéricos , Humanos , Salud Bucal/estadística & datos numéricos , Encuestas y CuestionariosRESUMEN
The aim of this study was to examine the procedures of primary dental health care performed by oral health teams (OHTs) adhering to the second cycle of the 'National Programme for Improving Access and Quality of Primary Care' (PMAQ-AB) in Brazil. A cross-sectional descriptive analysis was performed, across 23 dental procedures comprising preventive, restorative/prosthetic, surgical, endodontic and oral cancer monitoring. Descriptive analysis shows that most of the oral health teams carry out basic dental procedures. However, most of the time, they do not keep adequate records of suspected cases of oral cancer, diagnosis tests or follow-ups, and do not perform dental prosthetic procedures. Data also showed disparities in the average number of procedures performed in each Brazilian geographical region in 2013-2014, ranging from 13.9 in the northern to 16.5 in the southern and south-eastern regions, reinforcing the great social disparities between them. Brazilian regions with the highest volume of dental needs deliver the lowest number of dental procedures. The need to expand the supply of prostheses and the early diagnosis of oral cancer in primary health care (PHC) is evident.
Asunto(s)
Atención Odontológica/estadística & datos numéricos , Atención Primaria de Salud/estadística & datos numéricos , Brasil , Estudios Transversales , Programas de Gobierno , Humanos , Programas Nacionales de Salud , Salud BucalRESUMEN
O teste de estimulação com ACTH é o teste de escolha para realizar o controle dos valores de cortisol endógeno em pacientes sob tratamento para o hiperadrenocorticismo canino, podendo ser utilizado também para diagnosticar a doença. Os protocolos atuais utilizam doses que variam entre 5ug/kg a 250ug/animal por administração intravenosa ou intramuscular. Não se constatam estudos com doses menores que as de 5ug/kg em pacientes portadores de hiperadrenocorticismo. No presente estudo, foi testada a dose de 1ug/kg/IV; comparada à dose consagrada de 5ug/kg/IV, em grupos de animais suspeitos de HAC (HAC Diag), animais portadores de HAC e em tratamento (HAC Control) e animais sadios (Sadios). Na dose de 1ug/kg/IV, os valores basais de cortisol dos Sadios foram iguais à média 2,40ug/dL(+/-1,57ug/dL), dos HAC control foi de média 1,53ug/dL(+/-0,93,ug/dL) e dos HAC diag foi média 3,37ug/dL(+/-1,57ug/dL). Os valores pós-ACTH na dose de 1ug/kg foram de média 11,43ug/dL(+/-2,46ug/dL) para animais sadios, 2,67ug/dL(+/-1,39ug/dL) para o grupo HAC Control e média 16,56ug/dL(+/-7,62ug/dL) para o grupo HAC Diag. Os valores basais de cortisol na dose de 5ug/kg foram 0,89ug/dL(+/-0,23ug/dL) para o grupo HAC Control; média 3,08ug/dL(+/-1,99 ug/dL) para o grupo HAC Diag. Os valores pós-ACTH na dose de 5ug/kg foram de média 3,71ug/dL(+/-1,57ug/dL), para o grupo HAC control e média 22,52ug/dL (+/-8,75ug/dL) para o grupo HAC diag. Analisando-se os resultados obtidos, constatou-se que as doses 1 e 5ug/kg de ACTH sintético não diferem entre si, promovendo o mesmo tipo de variação nos valores de cortisol (ANOVA; p=0,225). Também, que a dose de 1ug/kg de ACTH foi igualmente eficaz na elevação dos níveis de cortisol nos três grupo testados (Sadios, HAC Control e HAC Diag; ANOVA, p<0,05). E, pelo teste de Dunn observamos que o grupo HAC control apresenta Δ-cortisol (delta =diferença entre cortisol após estimulo e o cortisol basal) significativamente menor que o dos grupos diagnóstico (p<0,05) e animais sadios (p<0,05). Concluiu-se que a dose de 1ug/kg de ACTH sintético pode ser utilizada com eficácia para a realização do teste de estimulação com ACTH.(AU)
ACTH stimulation is the gold standard test to monitor levels of endogen control of patients under treatment for canine hyperadrenocorticism and it may also be used to diagnose the disease. Current protocols use doses ranging from 5ug/kg to 250ug per animal by intravenous or intramuscular administration. There are no studies with doses inferior to 5ug/kg in adrenopatic patients. In the present investigation, the dose of 1ug/kg/IV was tested; compared with the recommended dose of d 5ug/kg/IV in groups of dogs under clinical suspicion of HAC (HAC Diag), animals under treatment for HAC (HAC Control) and healthy animals (Healthy). Under the dose of 1ug/kg/IV, average results for baseline cortisol values were equal to 2.40ug/dL(+/- 1.57ug/dL) for healthy, 1.53g/dL(+/-0.93ug/dL) for HAC Control and 3.37ug/dL(+/-1.57ug/dL) for HAC Diag. Post-ACTH values in the dose of 1ug/kg were average 11.43ug/dL(+/-2.46ug/dL) for healthy animals, 2.67ug/dL (+/-1.39ug/dL) for HAC Control and 16.56ug/dL(+/-7.62ug/dL) for HAC Diag group. Basal cortisol values at a dose of 5ug/kg were 0.89ug/dL (+/-0.23ug/dL) Control group for HAC; average 3.08ug/dL (+/-1.99ug/dL) for HAC Diag group. Baseline cortisol under the dose of 5ug/kg were average 3.71ug/dL(+/-1.57ug/dL) for HAC Control and 22.52g/dL(+/-8.75ug/dL) for HAC diag. Based on the present results, it was found that both doses of 1 and 5ug/kg of synthetic ACTH do not differ, providing the same kind of change in cortisol values (ANOVA, p=0.225). Also, the dose of 1ug/kg of ACTH was equally effective in raising levels of cortisol in the three groups tested (Healthy, HAC and HAC Control Diag; ANOVA, p<0.05). Through the Dunn test it was observed that HAC Control presented HAC-Δ cortisol (delta = difference between cortisol after stimulation and basal cortisol) significantly lower than HAC Diag (p<0.05) and healthy animals (p<0.05). Therefore the dose of 1ug/kg of synthetic ACTH can be effectively used to perform the ACTH stimulation test effectively.(AU)
Asunto(s)
Animales , Perros , Hiperfunción de las Glándulas Suprarrenales/prevención & control , Hormona Adrenocorticotrópica/administración & dosificación , Cosintropina , Diagnóstico , Enfermedades del Sistema Endocrino/veterinaria , Hidrocortisona/análisisRESUMEN
O teste de estimulação com ACTH é o teste de escolha para realizar o controle dos valores de cortisol endógeno em pacientes sob tratamento para o hiperadrenocorticismo canino, podendo ser utilizado também para diagnosticar a doença. Os protocolos atuais utilizam doses que variam entre 5ug/kg a 250ug/animal por administração intravenosa ou intramuscular. Não se constatam estudos com doses menores que as de 5ug/kg em pacientes portadores de hiperadrenocorticismo. No presente estudo, foi testada a dose de 1ug/kg/IV; comparada à dose consagrada de 5ug/kg/IV, em grupos de animais suspeitos de HAC (HAC Diag), animais portadores de HAC e em tratamento (HAC Control) e animais sadios (Sadios). Na dose de 1ug/kg/IV, os valores basais de cortisol dos Sadios foram iguais à média 2,40ug/dL(+/-1,57ug/dL), dos HAC control foi de média 1,53ug/dL(+/-0,93,ug/dL) e dos HAC diag foi média 3,37ug/dL(+/-1,57ug/dL). Os valores pós-ACTH na dose de 1ug/kg foram de média 11,43ug/dL(+/-2,46ug/dL) para animais sadios, 2,67ug/dL(+/-1,39ug/dL) para o grupo HAC Control e média 16,56ug/dL(+/-7,62ug/dL) para o grupo HAC Diag. Os valores basais de cortisol na dose de 5ug/kg foram 0,89ug/dL(+/-0,23ug/dL) para o grupo HAC Control; média 3,08ug/dL(+/-1,99 ug/dL) para o grupo HAC Diag. Os valores pós-ACTH na dose de 5ug/kg foram de média 3,71ug/dL(+/-1,57ug/dL), para o grupo HAC control e média 22,52ug/dL (+/-8,75ug/dL) para o grupo HAC diag. Analisando-se os resultados obtidos, constatou-se que as doses 1 e 5ug/kg de ACTH sintético não diferem entre si, promovendo o mesmo tipo de variação nos valores de cortisol (ANOVA; p=0,225). Também, que a dose de 1ug/kg de ACTH foi igualmente eficaz na elevação dos níveis de cortisol nos três grupo testados (Sadios, HAC Control e HAC Diag; ANOVA, p<0,05). E, pelo teste de Dunn observamos que o grupo HAC control apresenta Δ-cortisol (delta =diferença entre cortisol após estimulo e o cortisol basal) significativamente [...](AU)
ACTH stimulation is the gold standard test to monitor levels of endogen control of patients under treatment for canine hyperadrenocorticism and it may also be used to diagnose the disease. Current protocols use doses ranging from 5ug/kg to 250ug per animal by intravenous or intramuscular administration. There are no studies with doses inferior to 5ug/kg in adrenopatic patients. In the present investigation, the dose of 1ug/kg/IV was tested; compared with the recommended dose of d 5ug/kg/IV in groups of dogs under clinical suspicion of HAC (HAC Diag), animals under treatment for HAC (HAC Control) and healthy animals (Healthy). Under the dose of 1ug/kg/IV, average results for baseline cortisol values were equal to 2.40ug/dL(+/- 1.57ug/dL) for healthy, 1.53g/dL(+/-0.93ug/dL) for HAC Control and 3.37ug/dL(+/-1.57ug/dL) for HAC Diag. Post-ACTH values in the dose of 1ug/kg were average 11.43ug/dL(+/-2.46ug/dL) for healthy animals, 2.67ug/dL (+/-1.39ug/dL) for HAC Control and 16.56ug/dL(+/-7.62ug/dL) for HAC Diag group. Basal cortisol values at a dose of 5ug/kg were 0.89ug/dL (+/-0.23ug/dL) Control group for HAC; average 3.08ug/dL (+/-1.99ug/dL) for HAC Diag group. Baseline cortisol under the dose of 5ug/kg were average 3.71ug/dL(+/-1.57ug/dL) for HAC Control and 22.52g/dL(+/-8.75ug/dL) for HAC diag. Based on the present results, it was found that both doses of 1 and 5ug/kg of synthetic ACTH do not differ, providing the same kind of change in cortisol values (ANOVA, p=0.225). Also, the dose of 1ug/kg of ACTH was equally effective in raising levels of cortisol in the three groups tested (Healthy, HAC and HAC Control Diag; ANOVA, p<0.05). Through the Dunn test it was observed that HAC Control presented HAC-Δ cortisol (delta = difference between cortisol after stimulation and basal cortisol) significantly lower than HAC Diag (p<0.05) and healthy animals (p<0.05). Therefore [...](AU)
Asunto(s)
Animales , Perros , Hormona Adrenocorticotrópica/administración & dosificación , Hiperfunción de las Glándulas Suprarrenales/prevención & control , Diagnóstico , Enfermedades del Sistema Endocrino/veterinaria , Cosintropina , Hidrocortisona/análisisRESUMEN
Including students' perceptions in the educational process is considered a key component in monitoring the quality of academic programs. This study aimed to evaluate the concept of one's learning experience in endodontic teaching from the perspective of a group of Brazilian students. A total of 126 self-administered, structured questionnaires were distributed to undergraduate dental students enrolled in endodontics courses during the second semester of the 2009 academic year. The questionnaires were administered during final examinations and focused on students' opinions concerning learning during endodontic treatments, time spent during endodontic treatments, difficulties found during endodontic treatments, quality of endodontic treatments performed, characteristics of the technique employed, and suggestions to improve endodontic teaching. Ninety-one percent of the questionnaires were returned for evaluation. The obtained answers were discussed and analyzed, thereby generating quantitative and qualitative data showing students' perceptions of their experiences in endodontics courses. The main points that can affect the teaching of endodontics, according to the undergraduate students, included patients' absences and delays, selection of patients, preclinical and clinical training, difficulties found, type of technique employed, and teachers' orientation during endodontic treatment. The students' perceptions provided valuable information about the development of the course and the teacher-student relationship, together with the added intention of enhancing the teaching of endodontics as well as other courses.
Asunto(s)
Actitud , Educación en Odontología , Endodoncia/educación , Aprendizaje , Estudiantes de Odontología/psicología , Brasil , Estudios Transversales , Aleaciones Dentales/química , Diseño de Equipo , Docentes de Odontología , Humanos , Relaciones Interpersonales , Níquel/química , Selección de Paciente , Evaluación de Programas y Proyectos de Salud , Preparación del Conducto Radicular/instrumentación , Tratamiento del Conducto Radicular/métodos , Tratamiento del Conducto Radicular/normas , Autoinforme , Acero Inoxidable/química , Encuestas y Cuestionarios , Enseñanza/métodos , Factores de Tiempo , Titanio/químicaRESUMEN
As florestas e savanas tropicais possuem uma expressiva diversidade de espécies de palmeiras, recursos genéticos de grande valor econômico e cultural para as várias comunidades tradicionais que habitam estes ecossistemas e utilizam estes recursos. A etnia Krahò é um grupo Timbira do tronco lingüístico Macro-Jê, que ocupam um território de 320000ha situado na região nordeste do Estado do Tocantins, Brasil, e inserido na área core do bioma cerrado. Este estudo objetiva descrever a riqueza de espécies e os aspectos etnobotânicos, com ênfase, no seu potencial de utilização em doze aldeias Krahò. Cadastraram-se também nestas aldeias as palmeiras exóticas cultivadas. Foram percorridas as principais fitofisionomias em torno de cada aldeia: cerrado sensu stricto, campo sujo, florestas de galeria, veredas e florestas estacionais. A comunidade de palmeiras nas aldeias está representada por um total 17 espécies nativas e 3 espécies introduzidas. Os gêneros Attalea (4 espécies), Syagrus (3 espécies) e Astrocaryum (3 espécies) foram os que apresentaram o maior número de espécies dentre os 10 gêneros encontrados. Do total das espécies identificadas Oenocarpus distichus Mart. (bacaba), Mauritia flexuosa L. (buriti) e Attalea maripa (Aubl.) Mart. (Inajá) apresentaram a maior diversificação de usos, sendo principalmente utilizadas para alimentação, construções diversas, artesanato e uso medicinal. O suporte ambiental relacionado a alimentação proporcionado pelas palmeiras destacam-se nas aldeias na época de menor disponibilidade alimentar, no período entre as safras de cultivo agrícolas, devendo ser incorporados em programas de conservação e manejo de recursos naturais no território desta etnia.
Tropical forests and savannas have a large diversity of palm species, genetic resources of great economical and cultural value for the several traditional communities which inhabit these ecosystems and use these resources. The ethnic group Krahò is a Timbira group belonging to the linguistic stem Macro-Jê and occupies a 320000ha territory in the northeast region of Tocantins State, Brazil, in the core area of the Cerrado bioma. This study aims to describe palm species richness and ethnobotanical features, emphasizing their potential use, in twelve Krahò villages. Exotic cultivated palms were also surveyed. The main physiognomies around the indigenous village were examined: cerrado sensu stricto, grasslands, gallery forests, swampy palm formations and dry seasonal forests. Palm communities around the villages are represented by a total of 17 native species and 3 exotic ones introduced. The genera Attalea (4 species), Syagrus (3 species) and Astrocaryum (3 species) presented the greatest number of species among the 10 genera encountered. Among the species, Oenocarpus distichus Mart. (bacaba), Mauritia flexuosa L. (buriti) and Attalea maripa (Aubl.) Mart. (inajá) presented the greatest use diversification, being utilized for food, constructions, handcraft and as medicine. The environmental support provided by the palms in terms of food supply increases in the villages at times of lower food availability, between agricultural crop periods. This support should to be incorporated on conservation and natural resource management programs in the ethnic group territory.
Los Bosques y sabanas tropicales poseen una expresiva diversidad de especies de palmeras, recursos genéticos de gran valor económico y cultural para las varias comunidades tradicionales que habitan estos ecosistemas y utilizan estos recursos. La etnia Krahò es un grupo Timbira de la raiz lingüística Macro-Jê, que ocupa un territorio de 320.000 ha, situado en la región noreste del Estado Tocantins, Brasil, e inserido en el área core del bioma Cerrado. Este estudio objetiva describir la riqueza de especies y los aspectos etnobotánicos, con énfasis, en su potencial de utilización en doce aldeas Krahò. Se registraron também en estas aldeas las palmeras exóticas cultivadas. Se percorrieron las principales fitofisionomías alrededor de cada aldea: Cerrado sensu stricto, Campo Sujo, bosques de galería, veredas y bosques estacionales. La comunidad de palmeras en las aldeas está representada por un total de 17 especies nativas y 3 especies introducidas. Los géneros Attalea (4 especies), Syagrus (3 especies) y Astrocaryum (3 especies) fueron los que presentaron el mayor número de especies entre los 10 géneros encontrados. Del total de las especies identificadas, Oenocarpus distichus Mart. (bacaba), Mauritia flexuosa L. (palma de moriche) y Attalea maripa (Aubl.) Mart. (cucurita), presentaron la mayor diversidad de usos, siendo principalmente utilizadas para alimentación, construcciones diversas, artesanato y uso medicinal. El soporte ambiental relacionado con alimentación proporcionado por las palmeras se destaca en las aldeas en la época de menor disponibilidad alimentar, en el período entre safras de cultivo agrícolas, debiendo ser incorporados en programas de conservación y manejo de recursos naturales en el territorio de esta etnia.