The impact of bolsonarismo on COVID-19 vaccination coverage in Brazilian municipalities / O impacto do bolsonarismo na cobertura vacinal de Covid-19 em municípios brasileiros

ABSTRACT The immunization campaign against COVID-19 started in Brazil in January 2021 after strong pressure from society on the federal government, which had created a series of ideological obstacles against vaccines, especially those produced with Chinese inputs. This article analyzes the impact of far-right ideology on the spatial distribution of vaccine coverage against COVID-19 in Brazilian municipalities. By means of hierarchical models, it was identified that, maintaining constant socio-demographic characteristics and the structures of the Unified Health System, the degree of bolsonarismo in the municipalities had a negative impact on the coverage rates of the first, second and, especially, of the third dose.

RESUMO A campanha de imunização contra a Covid-19 foi iniciada no Brasil em janeiro de 2021 após forte pressão da sociedade sobre o governo federal, que havia criado uma série de empecilhos ideológicos às vacinas, sobretudo as produzidas com insumos chineses. Este artigo analisa o impacto da ideologia de extrema direita na distribuição espacial da cobertura vacinal contra Covid-19 nos municípios brasileiros. Por meio de modelos hierárquicos multiníveis de dois estágios identificou-se que, mantidas constantes as características sociodemográficas e as estruturas do Sistema Único de Saúde, o grau de bolsonarismo nos municípios impactou negativamente as taxas de cobertura da primeira, da segunda e, especialmente, da terceira dose da vacina.

Factors affecting the community's attitude toward COVID-19 vaccination: cross-sectional study / Fatores que afetam a atitude da comunidade em relação à vacinação contra a COVID-19: estudo transversal / Factores que afectan la actitud de la comunidad hacia la vacunación contra el COVID-19: estudio transversal

ABSTRACT Objective: The study aimed to analyze the factors that affect the community's attitude towards COVID-19 vaccination in Tangerang District. Methods: A cross-sectional study was used. Convenience sampling was used to select 400 respondents. Inclusion criteria are living in Tangerang District, aged between 18 and 55, and earning a living. An online questionnaire was used and passed validity and reliability tests. This study received ethical approval. Results: Most respondents had a high level of education (48.50%), low income (72.50%), high knowledge (78%), and a positive attitude (76.50%) regarding vaccination against COVID-19. The Chi-square test revealed a correlation between knowledge and attitudes towards COVID-19 vaccination (p=0.001), as well as education levels (p=0.001), but there was no correlation between income and attitudes (p=0.094). Conclusions: Health professionals should engage in extensive socialization and face-to-face visits with people with limited access to information to promote a positive attitude and expand the scope of COVID-19 vaccination.

RESUMO Objetivo: o objetivo deste estudo foi analisar os fatores que afetam a atitude da comunidade em relação à vacinação contra COVID-19 no distrito de Tangerang. Métodos: Estudo transversal com uso da amostragem por conveniência para selecionar 400 respondentes. Os critérios de inclusão foram residir no distrito de Tangerang, idade entre 18 e 55 anos e trabalhar. O questionário online utilizado foi aprovado nos testes de validade e confiabilidade. O estudo recebeu aprovação ética. Resultados: A maioria dos entrevistados possuía alta escolaridade (48,50%), baixa renda (72,50%), alto conhecimento (78%) e atitude positiva (76,50%) em relação à vacinação contra a COVID-19. O teste do qui-quadrado revelou correlação entre conhecimento e atitudes em relação à vacinação contra COVID-19 (p=0,001) e níveis de escolaridade (p=0,001). Não houve correlação entre renda e atitudes (p=0,094). Conclusões: Os profissionais de saúde devem realizar ampla socialização e visitas presenciais com indivíduos que possuem acesso limitado a informações para promover uma atitude positiva e expandir o escopo da vacinação contra a COVID-19.

RESUMEN Objetivo: El objetivo de este estudio fue analizar los factores que afectan la actitud de la comunidad hacia la vacunación contra el COVID-19 en el distrito de Tangerang. Métodos: Estudio transversal en el que se utilizó un muestreo por conveniencia para seleccionar a 400 encuestados. Los criterios de inclusión fueron vivir en el distrito de Tangerang, edad 18-55 años y trabajar. Se utilizó un cuestionario en línea, el cual pasó pruebas de validez y confiabilidad. Este estudio recibió aprobación ética. Resultados: La mayoría de los encuestados tenía un alto nivel de educación (48,50%), bajos ingresos (72,50%), alto conocimiento (78%) y una actitud positiva (76,50%) respecto a la vacunación contra el COVID-19. La prueba chi-cuadrado reveló una correlación entre el conocimiento y las actitudes hacia la vacunación contra el COVID-19 (p=0,001) y los niveles educativos (p=0,001). No hubo correlación entre los ingresos y las actitudes (p=0,094). Conclusiones: Los profesionales de la salud deben realizar una amplia socialización y visitas cara a cara con personas con acceso limitado a la información para promover una actitud positiva y ampliar el alcance de la vacunación contra el COVID-19.

Particularidades de la esfera afectivo motivacional en pacientes diabéticos crónicos

Introducción : La diabetes mellitus, debe abordarse desde un enfoque holístico, donde se considere el funcionamiento afectivo motivacional de los pacientes que la padecen. Objetivo: Determinar las particularidades afectivo motivacionales en pacientes diabéticos crónicos. Métodos: Se realizó un estudio exploratorio descriptivo con un paradigma de investigación mixto, donde se integraron los análisis cuantitativo y cualitativo. La muestra quedó conformada por 10 sujetos diabéticos crónicos, no se pretendió que los hallazgos derivados de su estudio fuesen generalizados a la población, pero sí, por su carácter inductivo, reflejaran la perspectiva de aquel que vivencia el fenómeno objeto de estudio. Para la pesquisa se aplicó el análisis psicológico de la historia clínica, el RAMDI (S), la Escala Dembo -Rubinstein, el test de completamiento de frases, la técnica de la composición, así como la entrevista semiestructurada. Resultados: Se constató conciencia de la enfermedad, se manifestó una adecuada valoración de la misma, acompañado de un compromiso afectivo y una elaboración personal en sus reflexiones, donde se conjugan sus vivencias y experiencias de vida, que da una orientación afectivo-motivacional a su comportamiento. Conclusiones: La categoría salud aparece como un motivo central y jerárquico en estos sujetos, pero a pesar de esto no todos logran regular su comportamiento de una manera efectiva y saludable.

Introduction: Diabetes mellitus should be approached from a holistic approach, where the motivational affective functioning of patients suffering from it is considered. Objective: To determine the motivational affective characteristics in chronic diabetic patients. Methods: A descriptive exploratory study was carried out with a mixed research paradigm, where quantitative and qualitative analyzes were integrated. Responding to this approach, the sample was made up of 10 chronic diabetic subjects, not intending that the findings derived from their study were generalized to the population, but yes, due to their inductive nature, they reflected the perspective of the person experiencing the phenomenon under study. For the research, the psychological analysis of the clinical history, the RAMDI (S), the Dembo-Rubinstein Scale, the Phrase Completion Test, the Composition Technique, as well as the semi-structured interview were applied. Results: Awareness of the disease was found, showing an adequate assessment of it, accompanied by an emotional commitment and personal elaboration in their reflections, where their experiences and life experiences are combined, and giving an emotional-motivational orientation to their behavior. Conclusions: The health category appears as a central and hierarchical motive in these subjects, but despite this, not everyone manages to regulate their behavior in an effective and healthy way.

O itinerário terapêutico dos sobreviventes da Covid-19 / The therapeutic itinerary of Covid-19 survivors

Resumo: Anunciado pela Organização Mundial da Saúde no início de janeiro de 2020, o novo coronavírus, com altos níveis de transmissibilidade e letalidade, tornou-se uma pandemia, desafiando a ciência e os governos mundiais. Trata-se de um estudo de natureza qualitativa, de abordagem descritiva e exploratória, com a questão norteadora: como ocorreu o itinerário terapêutico dos sobreviventes das formas graves da COVID-19, no município de Itapiranga/SC? Pesquisa aprovada pelo Comitê de Ética em Pesquisa em Seres Humanos, com parecer nº 5.163.229. O referencial teórico adotado foram os Sistemas de Cuidado em Saúde de Arthur Kleinman, composto por três esferas; popular, profissional e folk. Com os objetivos de conhecer o itinerário terapêutico de pessoas sobreviventes que desenvolveram a forma grave da COVID-19, no município de Itapiranga, no estado de Santa Catarina; caracterizar os sobreviventes que desenvolveram a forma grave da COVID-19; identificar os sistemas de cuidado à saúde utilizados pelos sobreviventes da COVID-19; identificar os cuidados à saúde realizados pelos sobreviventes da COVID-19. Participaram 10 sobreviventes da COVID-19 grave. A coleta de dados foi realizada entre abril e maio de 2022, através de entrevista semiestruturada gravada em áudio. Para análise de dados utilizou-se o método de análise de conteúdo com codificação de forma manual. Os resultados evidenciaram que oito eram de sexo masculino; sete foram intubados, porém todos estiveram hospitalizados na UTI por COVID- 19. A faixa etária variou de 26 e 65 anos. As comorbidades encontradas foram hipertensão arterial sistêmica, diabetes mellitus e sobrepeso. Os sintomas iniciais apresentados: febre, tosse, mal-estar, cefaleia e alterações gastrointestinais e no agravamento com tosse, dispneia, febre, cansaço e hemoptise. O início dos sintomas até a hospitalização variou entre 4 e 14 dias. Após a internação, a evolução para intubação ou internação em UTI ocorreu na média de 6 dias. O tempo de hospitalização foi de 13 a 34 dias. As esferas de cuidado acessadas foram; popular, folk e profissional. Da análise das narrativas surgiram as seguintes categorias: Percepções do adoecimento repentino; esfera popular e a práxis do autocuidado; esfera profissional e a busca pela resolutividade; esfera profissional e a vivência da COVID-19 grave; transcendência como fonte de melhora e restauração; da fase aguda para as sequelas imprevisíveis. O início da doença foi marcado pela rotulagem e cuidados populares. A esfera profissional foi responsável pelo diagnóstico e vivências mais impactantes relacionadas à hospitalização na UTI. A prática de busca por auxílio espiritual por meio de orações marcou a esfera folk. Considera-se que no itinerário terapêutico o uso concomitante das três esferas foi representado pela influência que a cultura exerce no processo saúde-doença e sua interligação com o sistema de cuidado à saúde.

Abstract: The World Health Organization announced the new coronavirus in early January 2020, with high levels of transmissibility and lethality, which has become a pandemic, challenging science and world governments. It is a qualitative study, with a descriptive and exploratory approach, with the guiding question: how did the therapeutic itinerary of survivors of the severe forms of COVID-19 occur, in the municipality of Itapiranga/SC? The research was approved by the Ethics Committee for Research in Human Beings with opinion number 5.163.229. The theoretical reference adopted was Arthur Kleinman's Health Care Systems, composed of three spheres: popular, professional and folk. The objectives were: to know the therapeutic itinerary of survivors who developed the severe form of COVID-19, in the municipality of Itapiranga, in the state of Santa Catarina; to characterize the survivors who developed the severe form of COVID-19; to identify the health care systems used by survivors of COVID-19; to identify the health care carried out by survivors of COVID-19. Ten survivors of severe COVID-19 participated. Data collection was conducted between April and May 2022, through audio-recorded semistructured interview. For data analysis, the content analysis method was used with manual coding. The results showed that eight were male; seven were intubated, but all were hospitalized in the ICU for COVID-19. The age ranged from 26 to 65 years. The comorbidities found were systemic arterial hypertension, diabetes mellitus and overweight. The initial symptoms presented: fever, cough, malaise, headache, and gastrointestinal changes, and in aggravation with cough, dyspnea, fever, fatigue, and hemoptysis. The onset of symptoms until hospitalization ranged from 4 to 14 days. After hospitalization, the evolution to intubation or ICU admission occurred in an average of 6 days. The length of hospital stay ranged from 13 to 34 days. The spheres of care accessed were; popular, folk and professional. From the analysis of the narratives the following categories emerged: Perceptions of the sudden illness; folk sphere and the practice of self-care; professional sphere and the search for resoluteness; professional sphere and the experience of severe COVID-19; transcendence as a source of improvement and restoration; from the acute phase to the unpredictable sequelae. The onset of the disease was marked by popular labeling and care. The professional sphere was responsible for the most impactful diagnosis and experiences related to ICU hospitalization. The practice of seeking spiritual help through prayers marked the folk sphere. It is considered that in the therapeutic itinerary the concomitant use of the three spheres was represented by the influence that culture exerts on the health-disease process and its interconnection with the health care system.

Association between the level of indifference to dental treatment and habits of oral hygiene in adults / Asociación entre el nivel de indiferencia al tratamiento dental y los hábitos de higiene bucal

Introduction: Inadequate oral hygiene habits such as lack of tooth brushing, use of irrigators, fluoridated toothpastes, and dental floss, as well as the importance of worrying about going to the dentist in the event of any problem in the oral cavity and the continuity of treatment are factors that could increase the risk in patients. Objetive: To determine the association between the level of indifference to dental treatment and the oral hygiene habits of those surveyed adults. Material and Methods: An observational, analytical and cross-sectional study. The level of indifference to dental treatment was evaluated using a translated virtual questionnaire and subsequently internally validated (Cronbach's alpha: 0.91). There were a total of 249 participants, 150 males and 99 females, with a mean age of 30.69 years. For the association of the qualitative variables and the report of the crude and adjusted odds' ratio (OR), a logistic regression was used. We worked with a level of statistical significance of p<0.05 and a confidence interval of 95%. Results: A high level of indifference to dental treatment was obtained in 57.83% of the respondents. Likewise, a statistically significant association was found between indifference to dental treatment and education (p = 0.012). Regarding oral hygiene habits, a statistically significant association was found with flossing (OR = 2.22; 95% CI: 1.10-4.46) (p = 0.025) and brushing before sleeping (OR = 5.26; 95%: 2.26-12-22) (p<0.001). Conclusion: There is a statistically significant association between the level of indifference to dental treatment with oral hygiene habits, flossing and brushing before sleeping. It is advisable to carry out activities in the communities to promote oral health care to reduce levels of indifference to dental treatment.

Introducción: Los inadecuados hábitos de higiene bucal como la falta de cepillado dental, uso de irrigadores, pastas dentales fluoradas e hilo dental, así como la importancia de preocuparse por acudir al odontólogo ante cualquier problema en la cavidad oral y la continuidad del tratamiento son factores que podrían agravar el riesgo en los pacientes. Objetivo: Determinar la asociación entre el nivel de indiferencia al tratamiento dental y los hábitos de higiene bucal de los encuestados en adultos en edades comprendidas entre los 18 a 45 años de la urbanización Buenos Aires de Villa en Chorrillos, Perú. Material y Métodos: Se realizó un estudio observacional, analítico y transversal. El nivel de indiferencia al tratamiento dental fue evaluado mediante un cuestionario virtual traducido y posteriormente validado internamente (alpha de Cronbach: 0.91). Se tuvo un total de 249 participantes, entre ellos 150 hombres y 99 mujeres con una media edad de 30,69 años. Para la asociación de las variables cualitativas y el reporte de las Odds Ratio (OR) crudas y ajustadas, se empleó una regresión logística. Se trabajó con un nivel de significancia estadística de p<0.05 y un intervalo de confianza del 95%. Resultados: Se obtuvo un alto nivel de indiferencia al tratamiento dental en el 57.83% de los encuestados. Asimismo, se encontró una asociación estadísticamente significativa de la indiferencia al tratamiento dental con la educación (p= 0.012). Respecto a los hábitos de higiene bucal, se encontró asociación estadísticamente significativa con uso de hilo dental (OR=2.22; IC del 95%: 1.10-4.46) (p=0.025) y el cepillado antes de dormir (OR=5.26; IC del 95%: 2.26-12-22) (p<0.001). Conclusión: Se concluyó que existe una asociación estadísticamente significativa entre el nivel de indiferencia al tratamiento dental con los hábitos de higiene bucal uso de hilo dental y cepillado antes de dormir. Se aconseja realizar actividades en las comunidades para promover el cuidado de la salud bucal con la finalidad de reducir los niveles de indiferencia al tratamiento dental.

Factores asociados a las actitudes de odontólogos peruanos hacia el aislamiento absoluto en tiempos de la COVID-19

RESUMEN Introducción: El aislamiento absoluto es una técnica odontológica que aumenta la probabilidad de éxito del tratamiento, más en esta pandemia. Objetivo: Caracterizar las actitudes de odontólogos peruanos hacia el aislamiento absoluto en tiempo de pandemia por la COVID-19 e identificar factores asociados. Métodos: Estudio observacional y transversal con empleo de técnicas analíticas, realizado a través de una encuesta virtual a odontólogos del Perú. Se usó la escala Act-AA-Cov19, al puntaje se le dividió en tercil superior (los de acuerdo) versus los otros puntajes (categoría de comparación); se obtuvieron estadísticos de asociación. Resultados: En los 279 odontólogos, la importancia del aislamiento absoluto y el uso de equipos de protección personal fue lo más aceptado (96 % de acuerdo siempre y 4 % casi siempre). La necesidad de actualizar los conocimientos sobre aislamiento absoluto se asoció con una mejor actitud hacia el proceder (RPc: 1,52; IC 95 %: 1,18-1,95; valor p= 0,001); mientras que el resultado fue opuesto en los graduados en universidades privadas (RPc: 0,79; IC 95 %: 0,66-0,95; valor p= 0,011). Conclusión: La premisa más aceptada es sobre la importancia del aislamiento absoluto y uso de equipos de protección personal, seguido por el hecho de que un campo de trabajo libre de saliva/ sangre facilita el procedimiento.

ABSTRACT Introduction: Rubber dam isolation is a dental technique that increases the probability of successful treatment, especially in this pandemic. Aim: To characterize the attitudes of Peruvian dentists towards rubber dam insolation in times of COVID-19 pandemic and to identify factors associated with them. Methods: Observational and cross-sectional study using analytical techniques, carried out through a virtual survey of dentists in Peru. The Act-AA-Cov19 scale was used, the score was divided into the upper tertile (those in agreement) versus the other scores (comparison category); association statistics were obtained. Results: Of the 279 dentists, the importance of rubber dam isolation and use of personal protective equipment was the most accepted (96 % always agreed and 4 % almost always). The need to update knowledge about rubber dam isolation was associated with a better attitude towards the procedure (PRc: 1,52; 95 % CI: 1,18-1.95; p value = 0,001); while the result was the opposite in graduates from private universities (PRc: 0,79; 95 % CI: 0,66-0,95; p value = 0,011). Conclusion: The most widely accepted premise is about the importance of rubber dam isolation and use of personal protective equipment, followed by the fact that a saliva / blood-free work area facilitates the procedure.

Application of Remote Follow-Up Via the WeChat Platform for Patients who Underwent Congenital Cardiac Surgery During the COVID-19 Epidemic

Abstract Objective: To investigate the effect of WeChat-based telehealth services on the postoperative follow-up of children who underwent congenital heart surgery during the COVID-19 epidemic. Methods: This study retrospectively analyzed the clinical and family data of 108 children who underwent congenital heart surgery and underwent remote follow-up via the WeChat platform from December 2019 to March 2020 in our hospital. Results: During the follow-up period, the WeChat platform was used to refer 8 children with respiratory infection symptoms to local hospitals for treatment. Two children with poor incision healing were healed after we used the WeChat platform to guide the parents in dressing the wounds on a regular basis at home. Nutritional guidance was given via the WeChat platform to 13 patients with poor growth and development. The psychological evaluation results of the parents showed that the median (range) SDS score was 43 (34-59), and 7 parents (6.5%) were classified as depressed; the median (range) SAS score was 41 (32-58), and 12 parents (11.1%) were classified as having mild anxiety. Conclusion: The use of WeChat-based telehealth services was effective for the remote postoperative follow-up of children who underwent congenital cardiac surgery during the COVID-19 epidemic. Providing WeChat-based telehealth services can reduce the amount of travel required for these children and their families, which is helpful for controlling and preventing the spread of COVID-19.

Perceptions about the Therapeutic Itinerary after stroke: a qualitative research / Percepciones sobre el Itinerario Terapéutico después del ictus: investigación cualitativa / Percepções sobre o Itinerário Terapêutico após acidente vascular cerebral: pesquisa qualitativa

ABSTRACT Objectives: to analyze the understanding of the Therapeutic Itinerary of people affected by stroke in the Unified Health System context of a medium-sized city in the state of São Paulo. Methods: this is a clinical-qualitative, using in-depth semi-structured interviews, conducted in 2019 with 6 patients, a number determined by theoretical saturation. Results: qualitative content analysis allowed the construction of four categories that emerged from the data: a) You are having a stroke! - Identifying the problem; b) Anguish and expectations in waiting for assistance; c) Helplessness and guidance for rehabilitation after hospital discharge; d) Spirituality in rehabilitation after stroke. Final Considerations: the affected people expressed feelings and meanings, such as fear, anguish, sadness, beliefs and uncertainties, in order to shed light on the complexity inherent to the experiences of Therapeutic Itinerary of stroke.

RESUMEN Objetivos: analizar la comprensión del Itinerario Terapéutico de personas afectadas por ictus en el contexto del Sistema Único de Salud de una ciudad mediana del estado de São Paulo. Métodos: clínico-cualitativo, mediante entrevistas semiestructuradas en profundidad, realizadas en 2019, con 6 pacientes, número determinado por saturación teórica. Resultados: el análisis de contenido cualitativo permitió la construcción de cuatro categorías que surgieron de los datos: a) ¡Estás sufriendo un derrame cerebral! - La identificación del problema; b) Angustia y expectativa en espera de asistencia; c) Desamparo y orientación para la rehabilitación después del alta hospitalaria; d) Espiritualidad en la rehabilitación después de un ictus. Consideraciones Finales: las personas afectadas expresaron sentimientos y significados, como miedo, angustia, tristeza, creencias e incertidumbres, con el fin de arrojar luz sobre la complejidad inherente al Itinerario Terapéutico de las experiencias del ictus.

RESUMO Objetivos: analisar a compreensão sobre o Itinerário Terapêutico de pessoas acometidas por acidente vascular cerebral no contexto do Sistema Único de Saúde de município de médio porte do estado de São Paulo. Métodos: clínico-qualitativo, com uso de entrevistas semiestruturadas em profundidade, realizadas em 2019, com 6 pacientes, número determinado pela saturação teórica. Resultados: a análise qualitativa de conteúdo permitiu a construção de quatro categorias que emergiram dos dados: a) Você está tendo um derrame! - A identificação do problema; b) Angústias e expectativas na espera por atendimento; c) O desamparo e a orientação para reabilitação após a alta hospitalar; d) A espiritualidade na reabilitação após Acidente Vascular Cerebral. Considerações Finais: as pessoas acometidas expressaram sentimentos e significados, como medo, angústias, tristezas, crenças e incertezas, de forma a jogar luz sobre a complexidade inerente às experiências de Itinerário Terapêutico do acidente vascular cerebral.

Patient Satisfaction Towards Dentist-Patient Interaction Among Patients Attending Outpatient Dental Clinic Hospital Universiti Sains Malaysia

ABSTRACT Objective: To determine the satisfaction with the dentist-patient interaction and factors associated with patient satisfaction among patients attending the outpatient dental clinic Hospital Universiti Sains Malaysia (HUSM). Material and Methods: This cross-sectional study involved 229 patients who attended outpatient dental clinic Hospital USM that located in the East Coast region of Malaysia. A self-administered Skala Kepuasan Interaksi Perubatan - 11 (SKIP-11) questionnaire was used to assess the satisfaction towards dentist-patient interaction. Systematic random sampling was applied in this study. The data were analyzed using simple logistic regression analysis to determine the factors associated with patient satisfaction with dentist-patient interaction. Results: The mean age of patients was 32.6 ± 13.9 years, 71.6% of them study up to tertiary level, 31.5% came to for dental check up and 23.6% of them had tooth decay. More than half (64.6%) of the patients were satisfactory with dentist-patient interaction. The satisfaction percentage in the distress relief domain was 60.7%, 56.8% in the rapport domain, and 53.7% in the interaction outcome domain. Satisfaction with dentist-patient interaction was significantly associated with the dentists' characteristics such as age (OR = 0.583, 95%CI 0.44-0.76, p=0.001), gender (OR = 0.386, 95% CI 0.22-0.69, p=0.001) and years of service (OR = 0.294, 95% CI 0.15-0.57, p=0.001). Conclusion: The result showed that slightly more than half of the patients who attended the outpatient dental clinic HUSM were satisfied with the dentist-patient interaction, which was found to be influenced by the characteristics of the dentists. Efforts to improve patient-dentist interaction are recommended to ensure delivery of good quality oral health care.

Effect of work environment and specialty degree of dentists on cross-infection control in COVID-19 pandemic

ABSTRACT Objectives: The aim of this study was to evaluate the effect of the work environment and expertise/specialty degree of dentists on their behavior, awareness, and attitudes regarding cross-infection control during the COVID-19 pandemic. Design: The study population consisted of Turkish dentists who work in private clinics, public clinics and university hospitals. The demographic information of the participants, their awareness of the COVID-19 acute respiratory disease, and clinical measures taken against cross-infection were evaluated with an online survey. Between the 10th and 20th of November 2020, 2,400 surveys were e-mailed to dentists. Results: A total 454 professionals answered the survey. According to the results, 29.3% of the participants performed only urgent care during the pandemic period, whereas 59.9% of them performed both urgent and routine treatments. Among the responding dentists, 90.6% stated that they were worried about aerosol-generating dental procedures, but there was no differences between genders (p = 0.119). Most participants, especially specialists (p = 0.160), applied strict cross-infection control methods during the COVID-19 pandemic (77.2%). These dentists used personal protective equipment (PPE) at rates that varied between 75.5% and 98.4%. Nonetheless, the rate of PPE use was different between genders and degrees of expertise: women used PPE more frequently than men (p = 0.025), and specialists used PPE more often than the other dentists (p = 0.04). Finally, there was a weak positive correlation between the level of PPE use and expertise (r = 0.121; p = 0.010). Conclusions: Despite the overall knowledge of the participants regarding COVID-19 symptoms, transmission routes, and the guidelines needed to prevent the virus from spreading, the dental specialists followed infection control methods more strictly. Even though the participants were concerned about dental practices that create microbial aerosols during the pandemic period, they continued their clinical routines using high PPE levels and taking extra clinical precautions to avoid cross-infection.

Cross-cultural adaptation and content validity of leisure attitude measurement for older adults

ABSTRACT OBJECTIVE: To adapt the Leisure Attitude Measurement to the Brazilian culture and to evaluate the face and content validity of the Brazilian version for older population. METHODS: Methodological study of cross-cultural adaptation in five stages: initial translation; synthesis of translations; back translation; evaluation by a committee of experts using a face and content validity assessment instrument; pre-test with 36 elderly, selected by convenience, with the application of a pre-test evaluation instrument. Data were analyzed descriptively and internal consistency measured by Cronbach's alpha coefficient. RESULTS: Evidenced face and content validity of the adapted version, as well as its equivalence with the original version. In the pretest, the elderly were 71.5 years old on average, 66.7% were women, 47.2% had a stable union, 66.7% lived with family members, 47.2% had 12 or more years of education and 58.3% received two minimum wages or more. The instrument revealed good internal consistency with a coefficient of 0.95 for the total global instrument and 0.88, 0.92 and 0.88 for the cognitive, affective and behavioral domains, respectively. CONCLUSIONS: The instrument's adaptation to the Brazilian culture was successful and allows to assess the attitude of the elderly in relation to leisure in a reliable manner, even though the results are a preliminary version, to be concluded after the psychometric analysis. The instrument could be incorporated in various health fields in Brazil and will allow the production of standardized data, comparison between cultures and strategies to promote positive attitudes towards leisure.

Patients Attitudes Toward Chairside Medical Screening in a Dental Setting

Abstract Objective: To assess patient's attitudes toward chairside medical screening in a dental setting. Material and Methods: In this descriptive-analytic study, subjects referring to the dental school, dental offices, and clinics of Kerman were evaluated. Each subject filled a questionnaire containing demographic data, patient's attitude towards the performance of examination and the medical status of the subjects. The questionnaire consisted of seven main questions and the subjects were asked to rate them from very important (score 5) to not important at all (score 1). Wilcoxon and Mann-Whitney tests and t-test were used. Friedman's nonparametric analysis of variance was used to compare response items within each question. Results: Screening for medical conditions by dentists was important for most of the participants, and it was important for them to be monitored for their medical condition by the dentists. The majority of patients had the will to be screened for each medical condition by the dentists. Male subjects stated skillfulness and professionality (88.4%) as the most important characteristics of the dentist and compassion as the least important one (56.2%). Female subjects stated knowledge of the dentists (96.3%) as the most essential characteristic and compassion as the least important one (85.8%). The will to undertake screening tests was higher in elder subjects. Conclusion: Dental patients have a positive attitude for medical conditions screening. Screening for medical conditions in a dental setting is a new approach, which might be an important contributor to disease control in the general population.

Mothers Knowledge and Behaviour Towards Oral Health During Pregnancy

Abstract Objective: To evaluate the knowledge and behaviour of mothers in maintaining their oral health during pregnancy. Material and Methods: This study included 167 women in five community primary health centres in Central Jakarta whose last child ranged between 0-59 months. The participants were asked to fill the questionnaire "Knowledge and Behaviour Towards Oral Health during Pregnancy" (KBOHP). This questionnaire assessed the knowledge and behaviour in maintaining oral health during pregnancy. Results: Almost 80% of participants reported that they had government dental health coverage. Only about 16% of participants reported that they visit dentist before pregnancy and only about 32% of the participants reported to have oral health problems during pregnancy. Although they have oral health problems, only 18% of them visited the dentists during pregnancy. Only 33% of the participants knew that the periodontal problems can affect pregnancy outcome, and 54.5% of participants had never heard of a possible connection between oral health and pregnancy. About 74% of participants reported that they never had specific oral health care instruction during pregnancy. Participants who received oral health instruction from their health providers also tend to have dental visit during pregnancy. Conclusion: Knowledge and behaviour towards oral health during pregnancy in this population was still low. A program that is developed to improve knowledge and behaviour in maintaining oral health during pregnancy is needed.

O Itinerário Terapêutico no Brasil: revisão sistemática e metassíntese a partir das concepções negativa e positiva de saúde / The Therapeutic Itinerary in Brazil: systematic review and meta-synthesis from the health negative and positive conceptions of health

RESUMO A compreensão de como as pessoas procuram ajuda para resolver suas demandas ou problemas de saúde tem sido cada vez mais o foco de pesquisas. Objetiva-se analisar a produção científica nacional que aborda os Itinerários Terapêuticos (IT) a partir das concepções negativa e positiva de saúde. Foram pesquisados estudos na Biblioteca Virtual em Saúde, no período de 2008 a 2019. O metaestudo teve como objetivo interpretar e resumir os resultados. Foram identificados 224 estudos, e 50 foram selecionados. O principal núcleo de interesse na abordagem teórica considerou a doença/problema como disparador para a busca de terapêutica. Observa-se o predomínio de estudos com alto rigor metodológico e que usaram entrevistas e análise de conteúdo para produção de dados. Os resultados dos estudos revelam os sentidos que os sujeitos atribuem ao processo saúde-doença-cuidado. Entre as redes de apoio aos IT, destacam-se a família e os serviços de saúde. A resolutividade do sistema formal e a integralidade do cuidado também foram analisadas. Conclui-se que a ampliação de referenciais de análise e as perspectivas teóricas nos estudos sobre IT, a exemplo da concepção positiva de saúde, podem contribuir para a efetividade da integralidade e a eficácia simbólica no cuidado em saúde.

ABSTRACT The understanding of how people look for help to solve their demands or health problems has increasingly been the focus of researches. The objective is to analyze national scientific production that addresses the Therapeutic Itineraries (TI) in Brazil from the negative and positive conceptions of health. Studies from the period between 2008 and 2019 were investigated on the Virtual Library in Health. The meta-study had the objective of interpreting and summarizing the results. 224 studies were identified, and 50 were selected. The main core of interest in the theoretical approach deemed the disease/problem as the trigger to the quest for treatment. It was noticed the dominance of studies with high methodological accuracy that used interviews and content analysis for data production. The results of the studies indicate the meaning that the subjects attach to the health-disease-care process. Among the IT support networks, the family and the healthcare services are emphasized. The formal system resolvability and care comprehensiveness were also analyzed. It is concluded that the expansion of analytical frameworks and theoretical perspectives on IT studies, such as the positive conception of health, can contribute to the effectiveness of comprehensiveness and symbolic effectiveness in health care.

Creencias y actitudes de trabajadores sanitarios y estudiantes de enfermería de una región de España ante una pandemia de gripe / Beliefs and attitudes of health workers and nursing students toward an influenza pandemic in a region of Spain

RESUMEN Con el objetivo de analizar las creencias y actitudes de trabajadores sanitarios y estudiantes de enfermería de Las Palmas de Gran Canaria en España ante una pandemia por gripe, se aplicó una encuesta durante marzo-mayo del 2017. Un alto porcentaje duda que exista una vacuna que les proteja ante una pandemia por gripe aunque los trabajadores muestran mayor seguridad con respecto al acceso a una vacuna que los estudiantes, los trabajadores sanitarios manifestaron una mayor responsabilidad ante su trabajo que los estudiantes, así un 46,7% estaría de acuerdo en sancionar al que se negase a ir a trabajar, debido a que existe un alto porcentaje lo anteponen a su responsabilidad para sí y su familia. En conclusión, se sugiere la promoción de iniciativas encaminadas a reducir el absentismo, identificando aquellos factores que lo facilitarían y tener preparado un plan de contingencia ante una pandemia por gripe.

ABSTRACT A survey was carried out during March-May 2017 to analyze the beliefs and attitudes of health workers and nursing students in the face of an influenza pandemic in Las Palmas de Gran Canaria, Spain. A high percentage doubted that there is a vaccine to protect them against an influenza pandemic, although workers showed greater certainty than students concerning access to a vaccine. Health workers showed themselves as more responsible for their work than students; i.e., 46.7% would be in favor of penalizing anyone who refused to go to work because there is a high percentage that put work before their responsibility toward themselves and their families. In conclusion, this study suggests promoting initiatives for reducing absenteeism, identifying those factors that would facilitate it, and having a contingency plan prepared in the event of an influenza pandemic.

Conductas de riesgo relacionadas con el cáncer en un grupo de jóvenes universitarios / Cancer risk behavior in a group of university students

RESUMEN Introducción: ciertas conductas y la falta de percepción del riesgo, principalmente en los jóvenes, pueden conducirlos a ser víctimas de enfermedades crónicas no transmisibles como el cáncer. Objetivo: caracterizar los hábitos y conductas de los estudiantes de la Universidad de Ciencias Médicas en Cienfuegos que pueden incidir como factores de riesgo en la aparición de afecciones cancerígenas. Materiales y métodos: estudio transversal y retrospectivo realizado a 98 estudiantes entre 18 y 22 años de edad. Resultados: los principales eventos de salud detectados en la conducta de los estudiantes fueron el consumo regular de bebidas alcohólicas y la poca práctica de ejercicios físicos. Conclusiones: los comportamientos de salud establecidos por los estudiantes universitarios pueden tener un impacto significativo en la adultez tardía.

ABSTRACT Introduction: certain behaviors and lack of perception of risk, especially among young people, can lead them to be victims of chronic noncommunicable diseases such as cancer. Objective: to characterize the habits and behaviors of the students of the University of Medical Sciences in Cienfuegos that can influence as risk factors in the appearance of cancerous affections. Materials and methods: cross-sectional and retrospective study of 98 students between 18 and 22 years of age. Results: the main health events detected in the behavior of the students were the regular consumption of alcoholic beverages and the little practice of physical exercises. Conclusions: health behaviors established by university students can have a significant impact on late adulthood.

Conhecimento da população sobre pneumologia, doenças respiratórias e tabagismo / Population knowledge about pneumology, respiratory diseases, and smoking

Objetivo: Avaliar o conhecimento da população sobre pneumologia, doença pulmonar obstrutiva crônica , asma e tabagismo. Métodos: Estudo transversal conduzido entre julho e outubro de 2017, avaliando o conhecimento da população de Curitiba, a partir de 18 anos, a respeito de pneumologia, asma, doença pulmonar obstrutiva crônica e tabagismo, por meio de questionários aplicados em espaços públicos. Médicos foram excluídos. Resultados: Foram entrevistadas 384 pessoas, com idade média de 35±14 anos, sendo 52% mulheres. Tinham Ensino Superior (completo ou incompleto) 55%, 44% não ultrapassaram o Ensino Médio e 5%, o Fundamental. Fumantes atuais ou pregressos representaram 32% da amostra. Sabiam o significado da palavra pneumologista 77%, já o termo "doença pulmonar obstrutiva crônica" foi reconhecido por apenas 7%. A maioria procuraria um clínico geral se apresentasse tosse persistente (69%) ou dispneia (63%). As doenças associadas ao tabagismo mais lembradas foram neoplasia de pulmão (86%) e doenças pulmonares (37%). O tabagismo foi reconhecido como causador de dependência por 98% e como doença por 64%. Em relação aos sintomas da asma, foram citados dispneia (90%), tosse (18%), aperto no peito (16%) e chiado (10%). Da amostra, 53% acreditavam que os dispositivos inalatórios engordavam e 59% que geravam dependência. Maior escolaridade associou-se com menor frequência de tabagismo, maior conhecimento sobre o pneumologista e sobre a associação do tabagismo com doença pulmonar obstrutiva crônica. Conclusão: Os curitibanos têm conhecimento limitado a respeito da doença pulmonar obstrutiva crônica, asma e tabagismo, além de acreditarem em mitos relacionados aos dispositivos inalatórios. A procura pelo médico pneumologista é baixa. (AU)

Objective: To evaluate the population knowledge about pneumology, chronic obstructive pulmonary disease, asthma and smoking. Methods: This is a cross-sectional study conducted from July to October 2017 to evaluate the knowledge of the population of the city of Curitiba, above 18 years old, about pneumology, chronic obstructive pulmonary disease, asthma and smoking, using questionnaires applied in public places. Physicians were excluded. Results: A total of 384 people was interviewed, with an average age of 35±14 years, 52% of them being women. Fifty-five percent reported (complete or incomplete) higher education, 44% did not go further than high school, and 5%, intermediate school. Current or past smokers accounted for 32% of the sample. The meaning of the word pulmonologist was known by 77% of people, while the term "chronic obstructive pulmonary disease" was recognized by only 7%. Most would go to a general practitioner if they had persistent cough (69%) or dyspnea (63%). The most remembered smoking-related diseases were: lung cancer (86%) and lung diseases (37%). Smoking was recognized to cause dependence by 98%, and as a disease by 64%. Dyspnea (90%), cough (18%), chest tightness and wheezing (10%) were mentioned as symptoms of asthma. Fifty-three percent of the sample believed that inhaling devices led to weight gain, and 59% believed they generated dependence. Higher level of education was associated with a lower smoking frequency, greater knowledge about the pulmonologist and about the association of smoking with respiratory diseases. Conclusions: The population of Curitiba has a limited knowledge about chronic obstructive pulmonary disease, asthma and smoking, and frequently believes in myths related to inhaling devices. The search for a pulmonologist is low. (AU)

Religiosity and self-rated health among older adults in Colombia / Religiosidad y el auto-reporte de salud entre adultos mayores en Colombia

Abstract Objective: To identify the relationship between religiosity and self-rated health among older adults in Colombia. Methods: Data are drawn from the SABE (Salud, Bienestar y Envejecimiento) Colombia Study, a cross-sectional survey conducted in 2015 involving 18,871 community-dwelling adults aged 60 years and older living in urban and rural areas of Colombia. Religiosity was assessed by self-rated religiosity (how religious are you: not at all, somewhat or very). Self-rated health during previous 30 days was assessed as very good, good, fair, poor or very poor, analyzed as an ordinal variable (1-5) using weighted logistic regression, adjusting for confounders. Results: Those who were more religious were older, female, had lower socioeconomic status, and were more likely to be married. Multivariate analyses demonstrated that older adults who were more religious had better self-rated health (OR: 0.92, 95% CI: 0.86-0.99, p= 0.038); however, there was a significant interaction effect between gender and religiosity on self-rated health (p= 0.002), such that the relationship between religiosity and health was stronger in men (OR: 0.86, 95% CI: 0.79-0.94, p= 0.001) but not significant in women. Conclusion: Older adults in Colombia who consider themselves more religious, especially men, are less likely to perceive their physical health as poor compared to those who are less religious.

Resumen Objetivo: Identificar la relación entre religiosidad y el auto reporte de salud entre adultos mayores en Colombia. Métodos: Los datos provienen del estudio SABE (Salud, Bienestar y Envejecimiento) Colombia, una encuesta transversal realizada en 2015 en la que participaron 18,871 adultos de 60 años o más que viven en la comunidad y provienen de zonas urbanas y rurales en Colombia. La religiosidad fue autoevaluada (qué tan religiosa eres: nada, algo o muy). La autoevaluación de la salud durante los 30 días previos se evaluó como muy buena, buena, regular, mala o muy mala, analizada como variable ordinal (1-5) usando la regresión logística ponderada, ajustando por factores de confusión. Resultados: La edad avanzada, el sexo femenino, estar casado, y tener bajo nivel socioeconómico se asociaron con ser más religiosos. Los análisis multivariados demostraron que ser más religioso se asociaba con mejor salud autoevaluada (OR= 0.92; IC 95%= 0.86-0.99; p= 0.038). Sin embargo hubo una interacción significativa entre género y religiosidad sobre la salud autoevaluada (p= 0.002), tal que la relación entre religiosidad y salud fue mas fuerte en los hombres (OR= 0.86; IC 95%= 0.79-0.94; p= 0.001), pero no fue significativa en mujeres. Conclusión: Los adultos mayores en Colombia que se consideran a sí mismos más religiosos, especialmente los hombres, tienen menos probabilidades de percibir su salud como pobre en comparación con aquellos que son menos religiosos.

Atitudes psicológicas em pessoas com diabetes mellitus tipo 2: associação com características sociodemográficas e controle glicêmico / Psychological attitudes in people with type 2 diabetes mellitus; Association with sociodemographic chacteristics and glycemic control

Introdução: As atitudes psicológicas das pessoas acometidas por diabetes tipo 2, como tristeza e raiva ou confiança e satisfação em conviver com a condição crônica podem estar relacionadas às características sociodemográficas e ao controle glicêmico. Objetivo: Associar as atitudes psicológicas de pessoas com diabetes tipo 2 com as características sociodemográficas e o controle glicêmico. Método: O estudo utilizou o banco de dados da pesquisa intitulada: "Avaliação da efetividade de um programa educativo em diabetes mellitus tipo 2 na Atenção Primária à Saúde", que avaliou as atitudes psicológicas das pessoas com diabetes tipo 2. Trata-se de ensaio randomizado com cluster, realizado com 278 pessoas com diabetes tipo 2, em 10 Unidades Básicas de Saúde, do município de Divinópolis, Minas Gerais, entre os anos de 2013 e 2016. Cada unidade constituiu um cluster, sendo 5 delas aleatorizadas no grupo intervenção (GI=160) e as restantes, no grupo controle (GC=118). Todos os participantes continuaram recebendo o atendimento convencional oferecido nas unidades e apenas o GI participou do programa educativo, durante 12 meses. Os dados foram coletados por meio de questionário sociodemográfico no tempo inicial e do instrumento de atitudes psicológicas (ATT-19) e exame de hemoglobina glicada (Hb1Ac), nos tempos inicial e final do programa educativo. O programa Statistical Package for the Social Sciences® (SPSS), versão 20.0 foi utilizado para a realização dos testes estatísticos. As médias do escore de atitudes psicológicas e HbA1c entre GC e GI foram comparadas após término do programa educativo, utilizando o Generalized Estimating Equations Model (GEE). Os coeficientes não padronizados (ß) e seus respectivos intervalos de confiança (IC = 95%) foram calculados e apresentados. Para verificar as associações, foi calculado o valor p dos efeitos intragrupos, da interação entre tempo e grupo e da interação entre tempo, grupo e características sociodemográficas/tempo de diabetes. Foi realizada estatística descritiva com tabelas de distribuição de frequência, cálculos de medidas de tendência central e de dispersão. Considerou-se o nível de significância de 5% (p<0,05) para as análises. Resultados: Os participantes do GI terminaram a intervenção com valores maiores de atitudes psicológicas (ß=11,21; IC=95%: 7,4-15,0), quando comparados ao GC. Observou-se valor de p significativo para a interação entre tempo, grupo e escolaridade (p=0,025), o que indica que ter maior escolaridade potencializou o efeito da intervenção, uma vez que a diferença das médias de GC e GI no tempo final foram maiores entre aqueles de maior escolaridade, comparado àqueles de menor escolaridade. Considerando somente os participantes que tiveram evolução positiva dos escores de atitudes psicológicas, verifica-se que houve redução da HbA1c no GI (7,9±0,2 vs. 7,4±0,2, p<0,001) e aumento da HbA1c no GC (7,5±0,2 vs, 7,8±0,2, p=0,044) e participantes do GI apresentaram menores valores de HbA1c no tempo final em relação ao GC (ß=-0,9; IC 85%: -1,4; -0,5). Conclusão: Observou-se que a evolução positiva das atitudes psicológicas entre os participantes do programa educativo esteve associada aos maiores níveis de escolaridade e ao melhor controle glicêmico.(AU)

Sociodemography, Oral Health Status and Behaviours Related to Oral Health Literacy

Abstract Objective: To assess the relationships of socio-demography, self-reported oral health status, and behaviour with oral health literacy (OHL) among adults. Material and Methods: A cross-sectional study was conducted during a mega carnival in Kuala Lumpur. Socio-demographic, oral health status, and oral health behaviour data were obtained using a questionnaire, and OHL was determined by a validated Malay version of the 14 items Health Literacy in Dentistry Scale (HeLD-14). A total of 165 data of participating adults were tested using Pearson's correlation, Independent t-test and One-way ANOVA with a significance level set at p<0.05 Results: The mean age of participants was 30.4 years (S.D. 9.7 years). Malay HeLD-14 scores were higher among those who were from better socio-economic class (household income within the top 20% of the population) (p<0.005) those with good self-reported oral health status (good oral health status, no active caries) (p<0.005) and those with good oral health behaviours (brushed daily, flossed daily, does not vape) (p<0.05) Conclusion: Household income, self-reported oral health status, and behaviours were significantly associated with oral health literacy. Therefore, oral health literacy assessment is vital to help tailor appropriate oral health education and care.