Effectiveness and Legitimacy of the Motivational Interviewing With Caregivers on the Oral Health of Special Patients

ABSTRACT: Difficulty of caregivers in performing oral hygiene for Patients with Special Needs, usually leads to demotivation and negligence. In order to adhere to healthy habits, an intervention model was created: Motivational Interview (MI). It consists of a collaborative conversation to strengthen motivation and commitment to change. Objective: To evaluate the effectiveness and legitimacy of MI in a single session on the oral health of children with special needs, unable to perform the ir hygiene. Methods: Exploratory study with paired randomization, double-blind, including caregivers of patients aged 2 to 19 years treated at the Physical and Motor Rehabilitation Center of IMIP/Recife-Brazil. Caregivers were allocated to a test (Motiv ational Interview) or control (Traditional Counseling) group. In t0, they answered questionnaires, and the child's dental chart and Vis ible Plaque Index (VPI) were filled. MI group participated in a 10 min Motivational Interview involving guidance on brushing techniq ues and making mouth openers. TC group attended a lecture addressing the same theme. In t1, questionnaires were reapplied, followed by a new VPI and dental chart, in addition to a satisfaction survey regarding the methodology used. Results: After 30 days, the MI group showed a decrease in VPI when comparing the medians (14.70 vs. 10.71) and an increase in the frequency of daily brushing to 03 x or more (44.4 % vs. 77.8 %), while the TC group remained practically stable (8.75 vs. 10.71 and 28.6), but with no statistically significant difference between groups (p = 5 %). Both legitimized the workshop as a pleasurable activity (100 %) and felt motivated after completion (TC = 85.7 %, MI = 100 %). Conclusion: A single session of MI reduced VPI from disabled children, however, without proving to be more effective than Traditional Counseling.

RESUMEN: La dificultad de los cuidadores para realizar la higiene oral en pacientes con necesidades especiales, generalmente conduce a la desmotivación y negligencia. Con el objetivo de adherirse a los hábitos saludables, se creó un modelo de intervención a partir de una conversación colaborativa: Entrevista Motivacional (EM). El objetivo de este trabajo fue evaluar la eficacia y la legitimidad de la EM en la salud oral para los PNE infantiles. Estudio exploratorio con aleatorización pareada, doble ciego, que incluye cuidadores de pacientes de 2 a 19 años tratados en el Centro de Rehabilitación Física y Motora del IMIP/Recife- Brasil. Los cuidadores fueron asignados en dos grupos: prueba (Entrevista Motivacional - EM) y control (Consejería Tradicional - CT). En t0, se respondieron los cuestionarios y se realizó el Odontograma y el Índice de Placa Visible (IPV) del niño. Grupo EM participó en una entrevista motivacional de 10 minutos que incluyó orientación sobre las técnicas de cepillado y la apertura de la cavidad oral. Grupo CT asistió a una conferencia sobre el mismo tema. En t1, se volvieron a aplicar los cuestionarios, seguidos de una nueva IPV y un odontograma, además de una encuesta de satisfacción sobre la metodología utilizada. Después de 30 días, el grupo EM mostró una disminución en IPV al comparar las media- nas (14,70 vs. 10,71) y un aumento en la frecuencia diaria de cepillado a 03x o más (44,4 % vs. 77,8 %), mientras que el grupo CT permaneció prácticamente estable (8,75 vs. 8,92 y 28,6), pero sin diferencias estadísticamente significativas entre los grupos (p = 5 %). Ambos legitimaron el taller como una actividad placentera (100 %) y se sintieron motivados después de la finalización (AT = 85,7 %, EM = 100 %). Una sola sesión de EM redujo la IPV de las PNE, sin demostrar que es más efectiva que la asesoría tradicional.

Parents' knowledge about the oral health care of oncological children / Conhecimento dos pais de crianças oncológicas em saúde bucal

ABSTRACT Objective: identifying the parents/guardians' knowledge about the oral health condition of oncological children assisted at the Pediatric Oncology Department of the Institute of Integral Medicine Professor Fernando Figueira. Methods: A cross-sectional study comprising a sample of 163 parents/guardians of children assisted at the Pediatric Oncology Department of the IIMP in the city of Recife, Pernambuco, applying a semi-structured form, tested with 10% of the sample in a pilot study. Results: Most of the parents/guardians were female subjects (87%) and patients' mothers (81%), between 25 and 34 years of age (44.8%), with a family income of a minimum wage (47%), educational level until elementary school (51.6%) and from the countryside of the state of Pernambuco (56%). Most of the children were male subjects (58.9%) with average age of 7.57 years, who had attended or stopped primary school (54.6%) and had been diagnosed with Acute Lymphoblastic Leukemia (57.7%) and treated with chemotherapy (92.6%). All parents considered important to have dental surgeons in the oncology department assisting the children in their oral hygiene. More than half of these parents reported knowing about how to avoid caries (63%) and, almost half of the children had never had a consultation with a dentist before (41.1%). Conclusion: Parents/guardians have information about oral health care, but they do not put it into practice.

RESUMO Objetivo: Identificar o conhecimento dos pais/responsáveis de crianças oncológicas sobre os cuidados de saúde bucal dedicados aos seus filhos acompanhados na oncologia pediátrica do Instituto de Medicina Integral Prof. Fernando Figueira. Métodos: Estudo transversal, com amostra de 163 Pais/responsáveis de crianças acompanhadas pelo Setor de Oncologia Pediátrica do IMIP na cidade do Recife/PE através da aplicação de formulário semiestruturado, testado com 10% da amostra em um estudo-piloto. Resultados: Os pais/responsáveis em sua maioria pertenciam ao sexo feminino (87%), eram mães dos pacientes (81%), com idade entre 25 a 34 anos (44,8%), com renda familiar de um salário mínimo (47%), com escolaridade até o ensino fundamental (51,6%) e do interior do Estado de Pernambuco (56%). As crianças na maior parte eram do sexo masculino (58,9%) e tinha idade média de 7, 57 anos, cursavam ou haviam parado de estudar no ensino fundamental (54,6%), foram diagnosticados com Leucemia Linfóide Aguda (57,7%) e tratados através de quimioterapia (92,6%). Todos os pais consideravam importante a presença do cirurgião dentista no Setor de Oncologia e realizavam a higiene bucal da criança, mais da metade afirmaram ter conhecimento sobre como evitar a cárie (63%) e quase metade das crianças nunca foram ao dentista (41,1%). Conclusão: Os pais/responsáveis possuem conhecimento sobre saúde bucal, mas não colocam em prática.

Access to Dental Care among Adolescents with Heart Disease

Objective: To evaluate the access of adolescents aged 15 to 19 years with heart disease to oral health services at a reference hospital in the city of Recife, Brazil. Material and Methods: A cross-sectional study was conducted at the Cardiology Clinic of Instituto de Medicina Integral Prof. Fernando Figueira (IMIP) from April to September 2015 using a convenience sample of 83 adolescents with heart disease. A questionnaire was administered in interview form to adolescents and/or parents/guardians to collect information on socio-demographic characteristics, the use of dental services and oral health habits. Data analysis was performed using descriptive statistics and association tests (chi-square test and Fisher's exact test), with the significance level set to 5% to identify possible associated factors. Results: Fifty-two adolescents (62.7%) had never been denied dental care due to their condition. Public services accounted for 66.3% of the care offered. Checkup/prevention was the main reason for seeking care (39.8%). Many of the adolescents exhibited inadequate oral hygiene habits. Forty-four (53%) did not brush their teeth regularly at night and 66 (79.5%) did not floss. No statistically significant association was found between access to dental care and social class (p=0.148), with whom the adolescent resided (p=0.607), birth order (p=0.598), race (p=0.068), education level of the head of the household (p=0.828) or scholastic failure on the part of the adolescent (p=0.196). Conclusion: Most adolescents with heart disease obtained dental care, although most did not have adequate hygiene habits. Moreover, socio-demographic, psychosocial and behavioral factors exerted no influence on access to oral health services. Further studies on this issue are needed.

Sociodemographic Factors and Oral Health Conditions Related to the Impact on the Quality of Life of Adolescents

Objective: To identify the sociodemographic factors and the oral health conditions related to the impact on the quality of life of adolescents. Material and Methods: Cross-sectional study with 1,417 students of both sex aged 15-19 years in São Lourenço da Mata - PE, Brazil. The collected information comprised sociodemographic data (gender, age, race / color), oral health status (dental caries, periodontal disease and pain) and impact on oral health-related quality of life of adolescents through the OIDP test. Statistical analysis used the Pearson's chi-square test and multiple logistic regression, with 5% significance level. Results: High impact on oral health-related quality of life was evidenced in 66.1% of adolescents. The prevalence of dental caries, gingival bleeding and pain was respectively 51.29%, 49.60% and 73.6%. The multiple regression analysis found that the high impact on the quality of life was related to the oral health condition and sex of teenagers, showing that girls, who had higher prevalence of dental caries and pain, had greater impact related to oral health. Conclusion: Dental caries and pain of dental origin cause a high impact on the quality of life of adolescents, being higher among girls.

Acolhimento e satisfação do usuário na estratégia de saúde da família: uma experiência de êxito / Embracement and satisfaction of the user in the family health strategy: a successful experience

Objetivo: analisar a satisfação dos usuários de uma Unidadede Saúde da Família (USF) após a implantação doacolhimento. Métodos: estudo descritivo com abordagemqualitativa, realizado em uma Unidade de Saúde daFamília, Recife - PE, Brasil. Participaram 9 usuários doserviço, estabelecendo-se como critérios de inclusão: idadeigual ou superior a 18 anos, ter sido atendido na referidaUSF antes e após a implantação do acolhimento, alémda participação voluntária. A coleta de dados ocorreu, emmarço de 2013, por meio da técnica do grupo focal. Osdados coletados foram analisados conforme a técnica deAnálise de Conteúdo de Bardin. Resultados: os usuários,de um modo geral, demonstraram estar satisfeitos como acolhimento realizado pela equipe de saúde da referidaUSF, e com as mudanças decorrentes da implantação destadiretriz da Política de Humanização da Saúde no servi-ço utilizado por eles, principalmente no que diz respeitoà resolutividade, acesso e reorganização do processo detrabalho. Conclusão: os usuários apresentaram uma visãolimitada do que vem a ser o acolhimento e de sua amplacapacidade de prover o cuidar. Porém, a avaliação de satisfaçãodestes com o acolhimento e o serviço de saúde é defundamental importância para a melhoria da assistência àsaúde prestada.

Objective: to analyze the satisfaction of users of aFamily Health Unit (FHU) after implementation ofuser embracement. Methods: a descriptive qualitativeapproach, performed in a Family Health Unit, inRecife, PE, Brazil. Nine service users participated, theinclusion criteria being: age 18 years or over, having beenattended in that FHU before and after implementationof user embracement, and voluntary participation. Datacollection occurred in March 2013, using the focus grouptechnique. The collected data were analyzed accordingto Bardin's content analysis technique. Results: users, ingeneral, proved to be pleased with the user embracementby the health team of the USF, and with the changesresulting from the implementation of this guideline ofthe Health Humanization Policy in the service they used,especially regarding resolution, access, and reorganizationof the work process. Conclusion: users had a limitedview of what embracement will be and of its ability toprovide comprehensive care. However, evaluating theirsatisfaction with embracement and with the health serviceis crucial for improving the health care provided.