Efeitos da pandemia da COVID-19 em indicadores de saúde bucal da Atenção Primária à Saúde no Maranhão

Detalhes bibliográficos
Autor(a) principal: SOUSA, Francenilde Silva de
Data de Publicação: 2022
Tipo de documento: Dissertação
Idioma: por
Título da fonte: Biblioteca Digital de Teses e Dissertações da UFMA
Texto Completo: https://tedebc.ufma.br/jspui/handle/tede/tede/3548
Resumo: Objective: To analyze indicators of use of oral health services (USSB) of Primary Health Care (PHC) in Maranhão, before and during the COVID-19 pandemic. Methods: An interrupted time series ecological study was carried out whose unit of analysis was Maranhão. The exposure variable was the COVID-19 pandemic, dichotomized into pre pandemic (Jan/2015 to Mar/2020) and pandemic (Apr/2020 to Jun/2021), considering the first case of the disease in the state. Data were taken from epidemiological bulletins available on portals of the State Health Department of Maranhão. The outcome variables were calculated by the ratio between the number of procedures related to disease prevention and health promotion (RPP-APS), urgency (RPU-APS) and Curative procedures (RPC-APS), and the census projection of the population of the state, multiplied by one thousand, monthly. The numerator data came from the Health Information System for Primary Care, and the denominator data from the Brazilian Institute of Geography and Statistics. Different autoregressive, integrated and seasonally moving average (SARIMA) models were tested (α=5%), the ones with the best fit were selected based on the criterion of parsimony of AIC (Akaike Information Criterion), BIC (Bayesian Information Criterion), MAPE (Mean Absolute Percentage Error), RMSE (Root Mean Squared Error) and the Ljung-Box and Box-Pierce tests. Results: The autoregressive, integrated and seasonally moving average (SARIMA) models with the best adjustments were: (0.1.0) (1.0.0) in the RPP-APS; (2.1.0) (1.0.0) in RPU-APS; and (0.1.0) (1.0.0) in RPC-APS. The pandemic caused a significant reduction in preventive procedures (Xreg=-6.52; p-value=0.0004) and in dressings (Xreg=-5.18; p value=0.0004). Although there was also a reduction in emergency procedures, there was no statistical difference in this indicator Xreg=-0,03; p-valor=0,1507). Conclusion: The COVID-19 pandemic had an impact on the reduction in the use of preventive and curative oral health services in PHC in Maranhão; and the actions taken in the state were not able to mitigate such effects until the first half of 2021. Constant discussion is recommended about the strategies that must be maintained and the necessary adjustments so that health units are adapted during the pandemic, in case of new waves, and, in the future, in the post-pandemic period.
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spelling THOMAZ, Erika Barbara Abreu Fonsecahttp://lattes.cnpq.br/3644251156905353THOMAZ, Erika Barbara Abreu Fonsecahttp://lattes.cnpq.br/3644251156905353HILGERT, Juliana Balbinothttp://lattes.cnpq.br/5502111775606712SILVA, Antônio Augusto Moura dahttp://lattes.cnpq.br/8652081312944025http://lattes.cnpq.br/8905685535626110SOUSA, Francenilde Silva de2022-05-02T15:36:30Z2022-01-21SOUSA, Francenilde Silva de. Efeitos da pandemia da COVID-19 em indicadores de saúde bucal da Atenção Primária à Saúde no Maranhão. 2022. 81 f. Dissertação (Programa de Pós-Graduação em Saúde Coletiva/CCBS) - Universidade Federal do Maranhão, São Luís, 2022.https://tedebc.ufma.br/jspui/handle/tede/tede/3548Objective: To analyze indicators of use of oral health services (USSB) of Primary Health Care (PHC) in Maranhão, before and during the COVID-19 pandemic. Methods: An interrupted time series ecological study was carried out whose unit of analysis was Maranhão. The exposure variable was the COVID-19 pandemic, dichotomized into pre pandemic (Jan/2015 to Mar/2020) and pandemic (Apr/2020 to Jun/2021), considering the first case of the disease in the state. Data were taken from epidemiological bulletins available on portals of the State Health Department of Maranhão. The outcome variables were calculated by the ratio between the number of procedures related to disease prevention and health promotion (RPP-APS), urgency (RPU-APS) and Curative procedures (RPC-APS), and the census projection of the population of the state, multiplied by one thousand, monthly. The numerator data came from the Health Information System for Primary Care, and the denominator data from the Brazilian Institute of Geography and Statistics. Different autoregressive, integrated and seasonally moving average (SARIMA) models were tested (α=5%), the ones with the best fit were selected based on the criterion of parsimony of AIC (Akaike Information Criterion), BIC (Bayesian Information Criterion), MAPE (Mean Absolute Percentage Error), RMSE (Root Mean Squared Error) and the Ljung-Box and Box-Pierce tests. Results: The autoregressive, integrated and seasonally moving average (SARIMA) models with the best adjustments were: (0.1.0) (1.0.0) in the RPP-APS; (2.1.0) (1.0.0) in RPU-APS; and (0.1.0) (1.0.0) in RPC-APS. The pandemic caused a significant reduction in preventive procedures (Xreg=-6.52; p-value=0.0004) and in dressings (Xreg=-5.18; p value=0.0004). Although there was also a reduction in emergency procedures, there was no statistical difference in this indicator Xreg=-0,03; p-valor=0,1507). Conclusion: The COVID-19 pandemic had an impact on the reduction in the use of preventive and curative oral health services in PHC in Maranhão; and the actions taken in the state were not able to mitigate such effects until the first half of 2021. Constant discussion is recommended about the strategies that must be maintained and the necessary adjustments so that health units are adapted during the pandemic, in case of new waves, and, in the future, in the post-pandemic period.Objetivo: Analisar indicadores de uso de serviços de saúde bucal (USSB) da Atenção Primária à Saúde (APS) no Maranhão, antes e durante a pandemia de COVID-19. Métodos: Foi realizado um estudo ecológico de série temporal interrompida cuja unidade de análise foi o Maranhão. A variável exposição foi a pandemia de COVID-19, dicotomizada em pré-pandemia (jan/2015 a mar/2020) e pandemia (abr/2020 a jun/2021), considerando o primeiro caso da doença no estado. Os dados foram retirados dos boletins epidemiológicos disponibilizados em portais da Secretaria Estadual de Saúde do Maranhão. As variáveis de desfecho foram calculadas pela razão entre a quantidade de procedimentos relacionados à prevenção de doença e promoção da saúde (RPP-APS), de urgência (RPU-APS) e Procedimentos curativos (RPC-APS), e a projeção censitária da população do estado, multiplicado por mil, mensalmente. Os dados do numerador foram provenientes do Sistema de Informação em Saúde para a Atenção Básica, e do denominador, do Instituto Brasileiro de Geografia e Estatística. Diferentes modelos autorregressivos, integrados e de médias móveis com sazonalidade (SARIMA) foram testados (α=5%), os com melhores ajustes foram selecionados a partir do critério de parcimônia dos valores de AIC (Akaike Information Criterion), BIC (Bayesian Information Criterion), MAPE (Mean Absolute Percentual Error), RMSE (Root Mean Squared Error) e dos testes de Ljung-Box e Box-Pierce. Resultados: Os modelos autorregressivos, integrados e de médias móveis com sazonalidade (SARIMA) com melhores ajustes foram: (0,1,0) (1,0,0) na RPP-APS; (2,1,0) (1,0,0) na RPU-APS; e (0,1,0) (1,0,0) na RPC-APS. A pandemia causou redução significante nos procedimentos preventivos (Xreg=-6,52; p-valor=0,0004) e nos curativos (Xreg=-5,18; p-valor=0,0004). Embora também tenha ocorrido redução nos procedimentos de urgência, não houve diferença estatística neste indicador (Xreg=-0,03; p-valor=0,1507). Conclusão: A pandemia de COVID-19 impactou na redução do uso dos serviços preventivos e curativos de saúde bucal na APS do Maranhão; e as ações empreendidas no estado não foram capazes de mitigar tais efeitos até o primeiro semestre de 2021. Recomenda-se constante discussão acerca das estratégias que devem ser mantidas e de ajustes necessários para que as unidades de saúde sejam adaptadas durante a pandemia, em caso de novas ondas, e, futuramente, no pós-pandemia.Submitted by Jonathan Sousa de Almeida (jonathan.sousa@ufma.br) on 2022-05-02T15:36:30Z No. of bitstreams: 1 FrancenildeSilvadeSousa.pdf: 277424 bytes, checksum: d7ff291ed9e6528c58e9476b984c37ba (MD5)Made available in DSpace on 2022-05-02T15:36:30Z (GMT). No. of bitstreams: 1 FrancenildeSilvadeSousa.pdf: 277424 bytes, checksum: d7ff291ed9e6528c58e9476b984c37ba (MD5) Previous issue date: 2022-01-21application/pdfporUniversidade Federal do MaranhãoPROGRAMA DE PÓS-GRADUAÇÃO EM SAÚDE COLETIVA/CCBSUFMABrasilDEPARTAMENTO DE SAÚDE PÚBLICA/CCBSCOVID-19;indicadores Básicos de Saúde;saúde bucal;Atenção Primária à Saúde;análise de Séries Temporais Interrompida.COVID-19;Health Status indicators;oral health;Primary Health Care;Interrupted Time Series analysis.Odontologia Social e PreventivaCiências da SaúdeEfeitos da pandemia da COVID-19 em indicadores de saúde bucal da Atenção Primária à Saúde no MaranhãoEffects of pandemic COVID-19 on oral health indicators in Primary Health Care in MaranhãoDocumento sob sigilo. Prazo provável para disponibilização total: 21/01/2023. Motivo do sigilo: publicação em periódico.info:eu-repo/semantics/masterThesisinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/openAccessreponame:Biblioteca Digital de Teses e Dissertações da UFMAinstname:Universidade Federal do Maranhão (UFMA)instacron:UFMAORIGINALFrancenildeSilvadeSousa.pdfFrancenildeSilvadeSousa.pdfapplication/pdf277424http://tedebc.ufma.br:8080/bitstream/tede/3548/2/FrancenildeSilvadeSousa.pdfd7ff291ed9e6528c58e9476b984c37baMD52LICENSElicense.txtlicense.txttext/plain; charset=utf-82255http://tedebc.ufma.br:8080/bitstream/tede/3548/1/license.txt97eeade1fce43278e63fe063657f8083MD51tede/35482023-05-15 15:53:25.46oai:tede2: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Biblioteca Digital de Teses e Dissertaçõeshttps://tedebc.ufma.br/jspui/PUBhttp://tedebc.ufma.br:8080/oai/requestrepositorio@ufma.br||repositorio@ufma.bropendoar:21312023-05-15T18:53:25Biblioteca Digital de Teses e Dissertações da UFMA - Universidade Federal do Maranhão (UFMA)false
dc.title.por.fl_str_mv Efeitos da pandemia da COVID-19 em indicadores de saúde bucal da Atenção Primária à Saúde no Maranhão
dc.title.alternative.eng.fl_str_mv Effects of pandemic COVID-19 on oral health indicators in Primary Health Care in Maranhão
title Efeitos da pandemia da COVID-19 em indicadores de saúde bucal da Atenção Primária à Saúde no Maranhão
spellingShingle Efeitos da pandemia da COVID-19 em indicadores de saúde bucal da Atenção Primária à Saúde no Maranhão
SOUSA, Francenilde Silva de
COVID-19;
indicadores Básicos de Saúde;
saúde bucal;
Atenção Primária à Saúde;
análise de Séries Temporais Interrompida.
COVID-19;
Health Status indicators;
oral health;
Primary Health Care;
Interrupted Time Series analysis.
Odontologia Social e Preventiva
Ciências da Saúde
title_short Efeitos da pandemia da COVID-19 em indicadores de saúde bucal da Atenção Primária à Saúde no Maranhão
title_full Efeitos da pandemia da COVID-19 em indicadores de saúde bucal da Atenção Primária à Saúde no Maranhão
title_fullStr Efeitos da pandemia da COVID-19 em indicadores de saúde bucal da Atenção Primária à Saúde no Maranhão
title_full_unstemmed Efeitos da pandemia da COVID-19 em indicadores de saúde bucal da Atenção Primária à Saúde no Maranhão
title_sort Efeitos da pandemia da COVID-19 em indicadores de saúde bucal da Atenção Primária à Saúde no Maranhão
author SOUSA, Francenilde Silva de
author_facet SOUSA, Francenilde Silva de
author_role author
dc.contributor.advisor1.fl_str_mv THOMAZ, Erika Barbara Abreu Fonseca
dc.contributor.advisor1Lattes.fl_str_mv http://lattes.cnpq.br/3644251156905353
dc.contributor.referee1.fl_str_mv THOMAZ, Erika Barbara Abreu Fonseca
dc.contributor.referee1Lattes.fl_str_mv http://lattes.cnpq.br/3644251156905353
dc.contributor.referee2.fl_str_mv HILGERT, Juliana Balbinot
dc.contributor.referee2Lattes.fl_str_mv http://lattes.cnpq.br/5502111775606712
dc.contributor.referee3.fl_str_mv SILVA, Antônio Augusto Moura da
dc.contributor.referee3Lattes.fl_str_mv http://lattes.cnpq.br/8652081312944025
dc.contributor.authorLattes.fl_str_mv http://lattes.cnpq.br/8905685535626110
dc.contributor.author.fl_str_mv SOUSA, Francenilde Silva de
contributor_str_mv THOMAZ, Erika Barbara Abreu Fonseca
THOMAZ, Erika Barbara Abreu Fonseca
HILGERT, Juliana Balbinot
SILVA, Antônio Augusto Moura da
dc.subject.por.fl_str_mv COVID-19;
indicadores Básicos de Saúde;
saúde bucal;
Atenção Primária à Saúde;
análise de Séries Temporais Interrompida.
topic COVID-19;
indicadores Básicos de Saúde;
saúde bucal;
Atenção Primária à Saúde;
análise de Séries Temporais Interrompida.
COVID-19;
Health Status indicators;
oral health;
Primary Health Care;
Interrupted Time Series analysis.
Odontologia Social e Preventiva
Ciências da Saúde
dc.subject.eng.fl_str_mv COVID-19;
Health Status indicators;
oral health;
Primary Health Care;
Interrupted Time Series analysis.
dc.subject.cnpq.fl_str_mv Odontologia Social e Preventiva
Ciências da Saúde
description Objective: To analyze indicators of use of oral health services (USSB) of Primary Health Care (PHC) in Maranhão, before and during the COVID-19 pandemic. Methods: An interrupted time series ecological study was carried out whose unit of analysis was Maranhão. The exposure variable was the COVID-19 pandemic, dichotomized into pre pandemic (Jan/2015 to Mar/2020) and pandemic (Apr/2020 to Jun/2021), considering the first case of the disease in the state. Data were taken from epidemiological bulletins available on portals of the State Health Department of Maranhão. The outcome variables were calculated by the ratio between the number of procedures related to disease prevention and health promotion (RPP-APS), urgency (RPU-APS) and Curative procedures (RPC-APS), and the census projection of the population of the state, multiplied by one thousand, monthly. The numerator data came from the Health Information System for Primary Care, and the denominator data from the Brazilian Institute of Geography and Statistics. Different autoregressive, integrated and seasonally moving average (SARIMA) models were tested (α=5%), the ones with the best fit were selected based on the criterion of parsimony of AIC (Akaike Information Criterion), BIC (Bayesian Information Criterion), MAPE (Mean Absolute Percentage Error), RMSE (Root Mean Squared Error) and the Ljung-Box and Box-Pierce tests. Results: The autoregressive, integrated and seasonally moving average (SARIMA) models with the best adjustments were: (0.1.0) (1.0.0) in the RPP-APS; (2.1.0) (1.0.0) in RPU-APS; and (0.1.0) (1.0.0) in RPC-APS. The pandemic caused a significant reduction in preventive procedures (Xreg=-6.52; p-value=0.0004) and in dressings (Xreg=-5.18; p value=0.0004). Although there was also a reduction in emergency procedures, there was no statistical difference in this indicator Xreg=-0,03; p-valor=0,1507). Conclusion: The COVID-19 pandemic had an impact on the reduction in the use of preventive and curative oral health services in PHC in Maranhão; and the actions taken in the state were not able to mitigate such effects until the first half of 2021. Constant discussion is recommended about the strategies that must be maintained and the necessary adjustments so that health units are adapted during the pandemic, in case of new waves, and, in the future, in the post-pandemic period.
publishDate 2022
dc.date.accessioned.fl_str_mv 2022-05-02T15:36:30Z
dc.date.issued.fl_str_mv 2022-01-21
dc.type.driver.fl_str_mv Documento sob sigilo. Prazo provável para disponibilização total: 21/01/2023. Motivo do sigilo: publicação em periódico.
info:eu-repo/semantics/masterThesis
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
format masterThesis
status_str publishedVersion
dc.identifier.citation.fl_str_mv SOUSA, Francenilde Silva de. Efeitos da pandemia da COVID-19 em indicadores de saúde bucal da Atenção Primária à Saúde no Maranhão. 2022. 81 f. Dissertação (Programa de Pós-Graduação em Saúde Coletiva/CCBS) - Universidade Federal do Maranhão, São Luís, 2022.
dc.identifier.uri.fl_str_mv https://tedebc.ufma.br/jspui/handle/tede/tede/3548
identifier_str_mv SOUSA, Francenilde Silva de. Efeitos da pandemia da COVID-19 em indicadores de saúde bucal da Atenção Primária à Saúde no Maranhão. 2022. 81 f. Dissertação (Programa de Pós-Graduação em Saúde Coletiva/CCBS) - Universidade Federal do Maranhão, São Luís, 2022.
url https://tedebc.ufma.br/jspui/handle/tede/tede/3548
dc.language.iso.fl_str_mv por
language por
dc.rights.driver.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv Universidade Federal do Maranhão
dc.publisher.program.fl_str_mv PROGRAMA DE PÓS-GRADUAÇÃO EM SAÚDE COLETIVA/CCBS
dc.publisher.initials.fl_str_mv UFMA
dc.publisher.country.fl_str_mv Brasil
dc.publisher.department.fl_str_mv DEPARTAMENTO DE SAÚDE PÚBLICA/CCBS
publisher.none.fl_str_mv Universidade Federal do Maranhão
dc.source.none.fl_str_mv reponame:Biblioteca Digital de Teses e Dissertações da UFMA
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