{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T04:47:36Z","timestamp":1792039656920,"version":"4.4.0"},"reference-count":41,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T00:00:00Z","timestamp":1791936000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T00:00:00Z","timestamp":1791936000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Comm Dent Oral Epid"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>This study analysed the integration levels and co\u2010assistance patterns of the dentistry service within a high\u2010complexity hospital in Paraguay, under the framework of Integrated Health Service Delivery Networks (IHSDN).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using a retrospective observational design, Big Data from the Hospital Information System (HIS) were processed between March and August 2025. Care trajectories and functional interdependence with 19 clinical services were evaluated using network analysis techniques in RStudio, with associations determined through Relative Risk (RR).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The results demonstrate an operational integration network in which dental functions complement one another, yet with a predominant linkage to Internal Medicine Emergency services (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009397). A low density of interdependence was detected with strategic specialties for chronic disease management, such as Cardiology (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200997) and Diabetology (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200979). A critical finding was that patients accessing services through scheduled care were 4.16 times more likely to receive proactive and continuous care than those entering through emergency departments (RR\u2009=\u20094.16; 95% CI;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Furthermore, a capacity gap was observed: while global hospital demand grew by 10.2%, the dental supply only increased by 0.5%. In light of these arguments, although the IHSDN structure is solid, its operability remains reactive and fragmented.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The study demonstrates that scheduled management is the key to quadrupling care integration. The HIS is positioned as an essential governance tool to identify bottlenecks, eliminate access barriers, and strengthen proactive referrals, ensuring that oral health is effectively integrated into the comprehensive care of patients with chronic conditions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/cdoe.70119","type":"journal-article","created":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T04:21:57Z","timestamp":1792038117000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Oral Health and High\u2010Complexity Networks: A Functional Interdependence Analysis via Health Information Systems"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6264-7526","authenticated-orcid":false,"given":"Eva Ruzena","family":"Montiel Fern\u00e1ndez","sequence":"first","affiliation":[{"name":"Universidad Cat\u00f3lica, Facultad de Ciencias de la Salud  Alto Paran\u00e1 Paraguay"},{"name":"Hospital General de Coronel Oviedo Ministerio de Salud P\u00fablica y Bienestar Social  Coronel Oviedo Paraguay"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,14]]},"reference":[{"key":"e_1_2_11_2_1","volume-title":"Redes Integradas de Servicios de Salud: Conceptos, Opciones de Pol\u00edtica y Hoja de Ruta Para su Implementaci\u00f3n en las Am\u00e9ricas","author":"Organizaci\u00f3n Panamericana de la Salud","year":"2010"},{"key":"e_1_2_11_3_1","unstructured":"Salud Universal https:\/\/www.paho.org\/es\/temas\/salud\u2010universal."},{"key":"e_1_2_11_4_1","unstructured":"Cobertura Universal de Salud https:\/\/www.who.int\/es\/news\u2010room\/fact\u2010sheets\/detail\/universal\u2010health\u2010coverage\u2010(uhc)."},{"key":"e_1_2_11_5_1","volume-title":"Gu\u00eda Para la implementaci\u00f3n de las Redes Integradas e Integrales de Servicios de Salud (RIISS) en el Paraguay","author":"Ministerio de Salud P\u00fablica y Bienestar Social","year":"2015"},{"key":"e_1_2_11_6_1","volume-title":"Resoluci\u00f3n S.G.N\u00b0749: Pol\u00edtica Nacional de recursos humanos en salud del Paraguay 2020\u20132030","author":"Poder ejecutivo","year":"2020"},{"key":"e_1_2_11_7_1","unstructured":"ASSA2030\u2013Objetivo 9 https:\/\/www.paho.org\/es\/assa2030\u2010objetivo\u20109."},{"key":"e_1_2_11_8_1","unstructured":"Mejor Atenci\u00f3n Para Las Enfermedades No Transmisibles (ENT) https:\/\/www.paho.org\/es\/mejor\u2010atencion\u2010para\u2010enfermedades\u2010no\u2010transmisibles\u2010ent."},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1590\/1807\u20103107bor\u20102020.vol34.0026"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00125\u2010011\u20102342\u2010y"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcpe.12803"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2023.1270557"},{"key":"e_1_2_11_13_1","unstructured":"\u201cCaries Cero: Una Sonrisa Saludable \u201d(2015) https:\/\/www.mspbs.gov.py\/portal\/32681\/caries\u2010cero\u2010una\u2010sonrisa\u2010saludable.html."},{"key":"e_1_2_11_14_1","unstructured":"\u201cD\u00eda del Odont\u00f3logo: Compromiso Con Una Salud Bucodental Inclusiva y Preventiva \u201d(2015) https:\/\/www.mspbs.gov.py\/portal\/33971\/dia\u2010del\u2010odontologo\u2010compromiso\u2010con\u2010una\u2010salud\u2010bucodental\u2010inclusiva\u2010y\u2010preventiva.html."},{"key":"e_1_2_11_15_1","unstructured":"Poder ejecutivo del Paraguay \u201cSegundo Informe Presidencial: Paraguay Sano \u201d(2025) https:\/\/drive.google.com\/file\/d\/1QAUQwsTki8beRELx9oN0O\u2010VAlBx4ndA4\/view."},{"key":"e_1_2_11_16_1","unstructured":"World Health Organization Extracts From Document EB148\/2021\/REC\/1 for Consideration by the Seventy\u2010fourth World Health Assembly https:\/\/apps.who.int\/gb\/ebwha\/pdf_files\/WHA74\/B148_REC1_EXT\u2010en.pdf."},{"issue":"7","key":"e_1_2_11_17_1","article-title":"Perspectives for Primary Health Care Public Policy in South America","volume":"29","author":"Fidelis P.","year":"2024","journal-title":"PubMed"},{"key":"e_1_2_11_18_1","volume-title":"Pautas \u00c9ticas Internacionales Para la Investigaci\u00f3n Biom\u00e9dica en Seres Humanos","author":"Consejo de Organizaciones Internacionales de las Ciencias M\u00e9dicas (CIOMS)","year":"2002"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0140\u20106736(19)31146\u20108"},{"key":"e_1_2_11_20_1","unstructured":"Oral Health \u201cPAHO\/WHO | Pan American Health Organization \u201d(2025) https:\/\/www.paho.org\/en\/topics\/oral\u2010health."},{"key":"e_1_2_11_21_1","doi-asserted-by":"crossref","DOI":"10.69849\/revistaft\/th102411131558","article-title":"A Sa\u00fade Bucal No Envelhecimento: Impacto Das Altera\u00e7\u00f5es Bucais Prevalentes Na Qualidade De Vida Dos Idosos","volume":"28","author":"Ghazzaoui I.","year":"2024","journal-title":"Revista Ft"},{"key":"e_1_2_11_22_1","volume-title":"A sa\u00fade bucal no Sistema \u00danico de Sa\u00fade","author":"Minist\u00e9rio da Sa\u00fade, Secretaria de Aten\u00e7\u00e3o \u00e0 Sa\u00fade, Departamento de Aten\u00e7\u00e3o B\u00e1sica","year":"2026"},{"key":"e_1_2_11_23_1","volume-title":"Aten\u00e7\u00e3o B\u00e1sica No Sistema \u00danico de Sa\u00dade: Abordagem Interdisciplinar Para os Servi\u00e7os de sa\u00dade Bucal","author":"Botazzo C.","year":"2008"},{"key":"e_1_2_11_24_1","unstructured":"\u201cAtenci\u00f3n Odontol\u00f3gica de Calidad en el Hospital General de Itap\u00faa \u201d(2015) https:\/\/www.mspbs.gov.py\/portal\/34553\/atencion\u2010odontologica\u2010de\u2010calidad\u2010en\u2010el\u2010hospital\u2010general\u2010de\u2010itapua.html."},{"key":"e_1_2_11_25_1","unstructured":"Mejorar el Acceso a la Atenci\u00f3n Bucodental https:\/\/www.fdiworlddental.org\/es\/mejorar\u2010el\u2010acceso\u2010la\u2010atencion\u2010bucodental."},{"key":"e_1_2_11_26_1","volume-title":"Determinaci\u00f3n de Costos de Los Servicios Prestados Por Niveles de Establecimientos del MSPyBS","author":"Ministerio de Salud P\u00fablica y Bienestar Social","year":"2014"},{"key":"e_1_2_11_27_1","unstructured":"SPOyP Aranceles https:\/\/www.spoyp.com.py\/aranceles\/."},{"key":"e_1_2_11_28_1","unstructured":"Poder Ejecutivo Del Paraguay \u201cDecreto N\u00b04122\/2025: Reajuste de Los Sueldos y Jornales M\u00ednimos de Trabajadores Del Sector Privado \u201d(2025) https:\/\/impuestospy.com\/impuestos\/decreto\u2010n\u20104122\u20102025\/."},{"key":"e_1_2_11_29_1","volume-title":"Pobreza Total se Situ\u00f3 en 24,7% en el A\u00f1o 2022","author":"Instituto Nacional de Estad\u00edstica","year":"2023"},{"key":"e_1_2_11_30_1","volume-title":"La pol\u00edtica Nacional de Salud Bucal de Brasil: Registro de Uma Conquista Hist\u00f3rica","author":"Riani Costa J. F.","year":"2006"},{"key":"e_1_2_11_31_1","volume-title":"Pol\u00edtica Nacional de Salud 2015\u20132030","author":"Ministerio de Salud P\u00fablica y Bienestar Social","year":"2015"},{"key":"e_1_2_11_32_1","unstructured":"Organizaci\u00f3n Panamericana de la Salud \u201cOPS Presenta Informe Regional de la OMS\/OPS Sobre el Estado de la Salud Oral \u201d(2023) https:\/\/www.paho.org\/es\/noticias\/27\u201010\u20102023\u2010ops\u2010presenta\u2010informe\u2010regional\u2010omsops\u2010sobre\u2010estado\u2010salud\u2010oral."},{"key":"e_1_2_11_33_1","volume-title":"74.a Asamblea Mundial de la Salud","author":"Organizaci\u00f3n Mundial de la Salud","year":"2021"},{"key":"e_1_2_11_34_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcpe.13189"},{"key":"e_1_2_11_35_1","doi-asserted-by":"publisher","DOI":"10.1080\/13814788.2024.2320120"},{"key":"e_1_2_11_36_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcpe.12808"},{"key":"e_1_2_11_37_1","unstructured":"D.Edwards \u201cTransforming Oral Health Care Through Interprofessional Education \u2013 CareQuest Institute \u201d(2025) https:\/\/carequest.org\/resource\/transforming\u2010oral\u2010health\u2010care\u2010through\u2010interprofessional\u2010education\/."},{"key":"e_1_2_11_38_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12909\u2010025\u201006969\u20103"},{"key":"e_1_2_11_39_1","doi-asserted-by":"publisher","DOI":"10.3390\/healthcare13212780"},{"key":"e_1_2_11_40_1","unstructured":"Integration of Oral Health and Primary Care: Communication Coordination and Referral \u2013 NAM https:\/\/nam.edu\/perspectives\/integration\u2010of\u2010oral\u2010health\u2010and\u2010primary\u2010care\u2010communication\u2010coordination\u2010and\u2010referral\/."},{"key":"e_1_2_11_41_1","volume-title":"Manual de Organizaci\u00f3n de los Servicios de Salud en el marco de las RIISS Paraguay","author":"Ministerio de Salud P\u00fablica y Bienestar Social","year":"2019"},{"key":"e_1_2_11_42_1","volume-title":"Manual de Categorizaci\u00f3n y Acreditaci\u00f3n de la Superintendencia de Salud","author":"Superintendencia de Salud","year":"2009"}],"container-title":["Community Dentistry and Oral Epidemiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/cdoe.70119","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/cdoe.70119","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/cdoe.70119","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T04:22:01Z","timestamp":1792038121000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/cdoe.70119"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,14]]},"references-count":41,"alternative-id":["10.1111\/cdoe.70119"],"URL":"https:\/\/doi.org\/10.1111\/cdoe.70119","archive":["Portico"],"relation":{},"ISSN":["0301-5661","1600-0528"],"issn-type":[{"value":"0301-5661","type":"print"},{"value":"1600-0528","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,14]]},"assertion":[{"value":"2026-02-19","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-04","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-14","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"cdoe.70119"}}