Oral Medicine and Pharmacology Teleconsulting Sessions of the Telehealth Program in one Southeastern State of Brazil

ABSTRACT Objective: To evaluate questions concerning oral medicineand pharmacology-related specialties of asynchronous dental teleconsulting sessions of the Telehealth Brazil Networks Program. Material and Methods: Data were collected from secondary databases of asynchronous dental teleconsulting sessions of the telehealth centers of Minas Gerais from July 2015 to July 2017. The variables for dental underlying fields and the types of questions were evaluated. Descriptive analysis was performed with the SPSS v.22.0 program. Results: 3,920 teleconsulting sessions were referred to the telehealth centers of Minas Gerais during the study period. Regarding oral medicine-related questions (n=745), most (n=469; 62.95%) addressed diagnosis, whereas the underlying field questions mostly regarded fungal, viral, and bacterial infections (17.3%), biopsies (16.4%), developmental defects and dental abnormalities (9.9%), and soft tissue tumors (9.4%). Pharmacology-related questions (n=738) mostly addressed general approaches (n=672; 91.06%), and the most common questions were about underlying fields' prescriptions (44.7%), anesthetics (17.6%), adverse effects of medications and anesthetics (10.2%), and selection of anesthetics for patients with systemic conditions (9.8%). Conclusion: Most teleconsulting sessions regarded conditions or procedures common in primary health care and essential for diagnosis and treatment planning at all care levels, which suggests a need for more academic learning processes for healthcare professionals, especially in dentistry primary fields.

Psychometric properties of an oral health literacy scale for people living with diabetes

Abstract This study evaluated the construct validity of the instrument Oral Health Literacy among diabetics. A probabilistic random sample of 239 diabetics from an infinite population answered the 10 items of the questionnaire. The structural validity was assessed by confirmatory factor analysis and goodness of fit, chi-square per degrees of freedom ratio (X2/df), comparative fit index (CFI), goodness-of-fit index (GFI), and root-mean-square error of approximation (RMSEA). Internal consistency was estimated by the average variance extracted (AVE) and composite reliability (CR). The scores were dichotomized with the upper limit of the 95% confidence interval as the cutoff point. The three-dimensional model presented good quality parameters (X2 /df = 2.459; CFI = 0.988; TLI = 0.981) and poor RMSEA (0.078). Internal consistency was adequate; AVE for the Access, Understand/appraise, and Apply subscales were 0.831, 0.981, and 0.954 and the CR for these subscales were 0.893, 0.962, and 0.822, respectively. Inadequate literacy ranged from 41.8 to 48.1%. The three-dimensional model identified (access, understand/appraise, and apply) showed structural validity, good internal consistency, and understandability.

Fatores de risco e proteção para doenças crônicas não transmissíveis entre professores da educação básica / Risk and protective factors for noncommunicable chronic diseases among primary education teachers

Resumo Objetivo: descrever as prevalências de fatores de risco e de proteção para doenças crônicas não transmissíveis (DCNT) e testar associações desses fatores com sexo, idade e satisfação com o trabalho entre professores da educação básica. Métodos: estudo transversal analítico realizado em Montes Claros, MG, Brasil, em 2016. Amostra probabilística por conglomerados. Utilizou-se questionário autoaplicável e avaliações físicas. Estimaram-se razões de prevalências (RP) e intervalos de confiança de 95% (IC95%) pela Regressão de Poisson. Resultados: dos 745 participantes, 83% eram mulheres, 81% tinham até 49 anos e 60% estavam insatisfeitos com o trabalho. Houve maior prevalência de fumantes entre homens (RP: 2,33; IC95%: 1,13;4,81), bem como consumo abusivo de álcool (RP: 7,24; IC95%: 2,19;23,91), excesso de peso (RP:1,48; IC95%: 1,04;2,13), menor prevalência de sintomas depressivos (RP:0,93; IC95%: 0,88;0,98) e de estresse (RP:0,88; IC95%: 0,82;0,95). Professores mais velhos apresentaram menor prevalência de Burnout (RP:0,87; IC95%: 0,81;0,94) e maior prevalência de comportamentos de proteção, apesar de terem maior comprometimento da saúde física. Professores insatisfeitos apresentaram maior prevalência de sintomas depressivos (RP:2,52; IC95%: 1,61;3,93), estresse (RP:1,76; IC95%: 1,33;2,32) e Burnout (RP:9,20; IC95%: 4,46;18,99). Conclusões: tabagismo, etilismo, excesso de peso e comprometimento da saúde mental foram fatores de risco frequentes para DCNT entre professores. Observaram-se diferenças nas prevalências de fatores de risco e de proteção para DCNT segundo sexo, idade e satisfação com o trabalho.

Abstract Objective: to describe the prevalence of risk and protective factors for noncomunicable chronic diseases (NCD) and test the association of these factors with sex, age, and job satisfaction among public primary and secondary schools teachers. Methods: analytical cross-sectional study in Montes Claros, MG, Brazil, carried out in 2016. We applied the probability cluster sampling technique. We used a self-applicable questionnaire and physical evaluations. We estimated Prevalence ratios (PR) and 95% Confidence Intervals (95%CI) using Poisson's regression. Results: of the 745 participants, 83% were women, 81% were 49 years old or younger, and 60% were unsatisfied with work. Smoking was more prevalent among men (PR: 2.33; 95%CI: 1.13;4.81), as well as alcohol abuse (PR: 7.24; 95%CI: 2.19;23.91), overweight (PR:1.48; 95%CI: 1.04;2.13), lower prevalence of depressive symptoms (PR: 0.93; 95%CI: 0.88;0.98) and stress (PR: 0.88; 95%CI: 0.82;0.95). Older teachers had a lower prevalence of burnout (PR: 0.87; 95%CI: 0.81;0.94) and a higher prevalence of protective behaviors, despite having a greater impairment of physical health. Unsatisfied teachers showed higher prevalence of depressive symptoms (PR: 2.52; 95%CI: 1.61;3.93), stress (PR: 1.76; 95%CI: 1.33;2.32), and burnout (PR: 9.20; 95%CI: 4.46;18.99). Conclusions: smoking, alcoholism, overweight, and mental health impairment were frequent risk factors for NCD among teachers. Differences were observed in the prevalence of risk and protection factors for NCD according to sex, age, and job satisfaction.

Integração das ações do Programa Saúde na Escola entre profissionais da saúde e da educação: um estudo de caso em Belo Horizonte, Minas Gerais / Integration of School Health Program actions among health and education professionals: a case study in Belo Horizonte, Minas Gerais

RESUMO O Programa Saúde na Escola tem como meta a construção de escolas saudáveis. Estudo de caso, de abordagem qualitativa com intenção de identificar e compreender como se comportam, no esforço de integração, profissionais envolvidos no Programa Saúde na Escola, a partir de sua inserção nas atividades preconizadas. Após construção do modelo lógico do programa, foi realizado consenso com experts para elaboração de matriz de indicadores, originando roteiro semiestruturado. Foram realizadas 25 entrevistas, nas Unidades Básicas de Saúde e Escolas de Ensino Fundamental, além das Gerências Regionais da Saúde e da Educação. As práticas foram consideradas multissetoriais, sem soma de esforços e coparticipação efetiva, sendo planejadas por um único setor ou profissional; os gaps existentes são reconhecidos tanto quanto a importância do programa; as práticas acontecem com baixo vínculo entre equipes. A forma fragmentada de perceber os problemas dos escolares dificulta essa integração.

ABSTRACT The School Health Program aims to build healthy schools. This qualitative case study aimed to identify and understand how professionals involved in the School Health Program behave in the integration based on their inclusion in the recommended activities. The consensus was reached with experts to develop a matrix of indicators after building the Program's logical model, resulting in a semi-structured roadmap. Twenty-five interviews were held in the Basic Health Units, Elementary Schools, and the Regional Health and Education Administrations. The practices were multisectoral, with no combined efforts and effective co-participation, planned by a single sector or professional, the existing gaps are recognized as much as the importance of the program, and the practices are implemented with a low bond between teams. The fragmented perception of students' problems hinders this integration.

Percepção e atitude do cirurgião-dentista diante do atendimento emergencial a mulheres em situação de violência: uma revisão de escopo / Dentists' perceptions and attitudes towards emergency care for women in situations of violence: a scope review

Resumo Avaliar por meio de uma revisão de escopo estudos que abordam a percepção e atitude do cirurgião-dentista diante do atendimento a mulheres em situação de violência. Utilizando os descritores women violence, dentist attendence ou dentist care, foram identificados 473 artigos, sendo incluídos 13, ao final da seleção. Embora a necessidade de capacitação tenha sido predominante, ela não é suficiente. Existe uma fragilidade em se compreender a violência como problema de saúde, de entender o papel do profissional na solução desse problema, os fatores que podem contribuir com seu crescimento ou seu controle. Os resultados revelaram que o cirurgião-dentista apresentou maior dificuldade do que os outros profissionais no enfrentamento e exigem um amplo aprendizado. O reconhecimento dos referidos casos pelo cirurgião-dentista exige a incorporação de medidas educativas que provoquem mudanças culturais, desconstrução de normas de gênero e a desnaturalização desse fenômeno social.

Abstract The purpose of this study was to evaluate, through a scope review, studies that address the perceptions and attitudes of dentists regarding the care of women in situations of violence. Using the descriptors women violence, dentist attendance or dentist care, 473 articles were identified, of which 13 were included at the end of the selection process. Although the need for training was predominant, it was not sufficient. There is a weakness in understanding violence as a health problem, in understanding the role of the professional in solving this problem, and the factors that can contribute to its growth or its control. The results revealed that the dentist had greater difficulty than other professionals in coping with the issue and required extensive training. The recognition of these cases of abuse by the dentist requires the incorporation of educational measures that cause cultural changes, deconstruction of gender norms and the denaturalization of this social phenomenon.

Pain Perception Before Endodontic Treatment: from Primary Care to Specialized Care

Abstract Objective: To analyze patients' pain perception requiring endodontic treatment referred to a Dental Specialties Center. Material and Methods: Data was collected through a self-administered questionnaire for patients about their experience of pain and another for endodontists about the treatment performed. The results were analyzed descriptively using Pearson's Chi-square test and Fisher's Exact test, with Bonferroni correction (p≤0.05). Results: The median age of the patients was 39 years, and 71.1% were female. The median waiting time for treatment was five months. Pain was reported by 75.2% of patients, occurred more than one month earlier (63.6%), with moderate/severe intensity (66.9%), and most patients sought emergency treatment more than once (79.1%). In addition, pain was associated with sex (female; p=0.008); moderate/severe intensity (p<0.001); the number of times that patient had to go to the dentist because of the tooth treatment (twice or more; p=0.002); and type of tooth treated (posterior tooth; p=0.002). Conclusion: Severe pain episodes resulted in a repeated search for emergency services, which may overload the primary care service, especially if the waiting time for endodontic treatment is long.

National analysis of dental teleconsulting of the Brazilian Telehealth Program

Abstract This cross-sectional study nationally evaluated asynchronous dental teleconsulting services offered by the Telehealth Brazil Networks Program, using the 2019 Telehealth Results Monitoring and Evaluation System database and considering Brazilian regional differences. The following teleconsulting variables were collected: dentist's sex and specialty, date/time of question and answer, response time; dental specialty, professional satisfaction, and patient referral. Five Brazilian regions were socioeconomically characterized according to the Human Development Index, estimated population, Gini coefficient, coverage of dental specialty centers, oral health teams in Family Health Strategy, and oral health teams in primary health care (PHC). In total, 2,703 teleconsulting sessions occurred in Brazil in the analyzed period. The Southeast exhibited the highest demand (49.1%). Most dentists were female (60.6%) and were dental surgeons from the Family Health Strategy (61.3%). Most teleconsulting sessions occurred during working hours (85.5%) and questions were answered within 72 hours (66.7%). Level of satisfaction and avoidance of referral yielded rates of 90.9% and 66.8%, respectively, among dentists who answered about these topics. Semiology was the most frequently demanded area in teleconsulting (33.9%). The different demands from the regions reflected regional differences. The most frequently demanded specialties represent the Brazilian PHC scenario. Professionals incorporated teleconsulting into their work routine and most teleconsultants responded within the stipulated timeframe. Professional feedback should be encouraged.

Prevalence of recognition and reporting of child physical abuse by dental surgeons and associated factors / Prevalência de identificação e notificação de abuso físico infantil por dentistas e fatores associados

Abstract Studies evaluating the factors associated with under reporting and with the recognition and reporting of child physical abuse are scarce and highly necessary. This study aimed to assess the prevalence of recognition and reporting of child physical abuse (CPA) by Brazilian dentistsin primary care and associated factors. A cross-sectional study was carried out with a representative sample of dentistsfrom the Family Health Strategy in Belo Horizonte. A self-administered questionnaire validated to Brazilian Portuguesewas used for data collection. Statistical analysis included univariate and multiple analyses through Poisson regression. A total of 181dentists participated in the study. Among them, 73 (40.3%) had already recognized some cases of CPA, but only 11 (6.1%) ended up reporting. Dentists with six to 19 years of experience as a municipal worker presented 2.38 times [PR = 2.38 (95%CI: 1.29-4.41)] more probability to recognize cases of CPA than the ones with less than six years. Having a graduate degree with a major in childcare [PR = 4.50 (95%CI: 1.08-18.68)] was associated with a larger number of reports. The employment duration as municipal worker was positively associated with the recognition of CPA cases and the prevalence of reporting was low.

Resumo Estudos que avaliem os fatores associados à subnotificação e às dificuldades dos dentistas para identificar e notificar abuso físico infantil são escassos e necessários. Este estudo teve como objetivo investigar a prevalência de identificação e de notificação de abuso físico infantil (AFI) e fatores associados por dentistas da atenção primária. Trata-se de um estudo transversal com amostra representativa dos dentistas da Estratégia Saúde da Família de Belo Horizonte. Para a coleta de dados foi utilizado um questionário autoaplicável, validado para uso no Brasil. A análise estatística incluiu análise univariada e múltipla pela regressão de Poisson. Um total de 181 profissionais participaram do estudo. Destes, 73 (40,3%) já identificaram algum caso de AFI, mas apenas 11 (6,1%) realizaram a notificação. Dentistas com seis a 19 anos de trabalho no município apresentaram probabilidade 2,38 vezes [RP = 2,38 (CI 95%: 1,29-4,41)] maior de identificar casos de AFI do que aqueles com menos de seis anos de atuação. Possuir pós-graduação com foco em crianças [PR = 4,50(CI 95%: 1,08-18,68)] esteve positivamente associado a um maior número de notificações. O tempo de trabalho no município esteve associado à identificação de casos de AFI. A prevalência de notificação encontrada foi baixa.

Análise de detecção automática de interação qui-quadrado (chaid) das diferenças de gênero determinantes de sintomas depressivos em idosos / Chi-square automatic interaction detection (chaid) analysis of sex differences determining of depressive symptoms in the elderly

O objetivo deste estudo foi determinar a prevalência de sintomas depressivos em idosos residentes em comunidade e analisar a associação entre depressão, condições socioeconômicas e de saúde estratificadas por sexo. A presente investigação deriva de análise da linha de base do estudo Aging, Gender and Quality of Life (AGEQOL), é uma coorte envolvendo 2.052 indivíduos com 60 anos de idade ou mais, residentes na comunidade em um município brasileiro. Os sintomas de depressão foram avaliados pela escala de 15 itens de Depressão Geriátrica. A Regressão de Poisson foi utilizada para avaliar associações com covariáveis. Análise de Árvore de Decisão foi utilizada para investigar fatores preditores de sintomas depressivos separadamente entre homens e mulheres. A prevalência de sintomas depressivos na população estudada foi de 30,2% (34,4% entre as mulheres e 23,8% entre os homens). Para o sexo masculino, os sintomas depressivos foram explicados por faixa etária (p=0,025), doenças crônicas (p=<0,001), capacidade funcional para AIVD (p=0,005) e arranjos domiciliares (p=0,002). Para o sexo feminino, o padrão de preditores de sintomas depressivos foi significativamente diferente entre os grupos etários (p=0,005). Conclui-se que existem diferenças relevantes entre os sexos na prevalência de sintomas depressivos observados em idosos, que podem ser explicadas por idade, capacidade funcional, doenças crônicas e arranjos domiciliares.(AU)

Our objective was to determine the prevalence of depressive symptoms in community-dwelling elderly and to analyze the association between depression, socioeconomic and health conditions stratified by sex. This research comes from the baseline analysis of the AGEQOL study (Aging, Gender, and Quality of Life) is a cohort study involving 2052 individuals aged 60 years or older, living in the community in a Brazilian town. Depression symptoms were assessed using was assessed using the scale of 15 items Geriatric Depression. We used Poisson regression to assess associations with covariates, and analysis of the decision to investigate predictors of depressive symptoms among men and women separately. The prevalence of depressive symptoms in this population was 30.2% (34.4% among women and 23.8% among men). For males, depressive symptoms were explained by age (p=0.025), chronic diseases (p<0.001), functional capacity for IADL (p=0.005) and living arrangements (p=0.002). For females, the pattern of predictors of depressive symptoms was significantly different between the groups (p=0.005). We conclude that there are significant differences between genders in the prevalence of depressive symptoms in the elderly, which could be explained by age, functional ability, chronic illness, and living arrangements.(AU)

Analysis of Dental Teleconsulting in the Pediatric Dentistry Field of Telehealth Minas Gerais: A Cross-Sectional Study

ABSTRACT Objective: To analyze the profile of the dental teleconsulting in the Pediatric Dentistry field of Telehealth Brazil Networks Program, in Minas Gerais centers, Brazil. Material and Methods: Asynchronous dental teleconsulting was evaluated in the Pediatric Dentistry specialty, extracted from secondary databases of the telehealth centers: the Clinical Hospital of the Universidade Federal de Minas Gerais and UFMG Medical School, from July 2015 to July 2017. The variables collected were: type of issues and area and sub-area of Pediatric Dentistry. The results were descriptively analyzed using the SPSS v.22,0 program by frequencies. Results: Most of the issues in the Pediatric Dentistry specialty were about clinical conduct (81.4%). There was a predominance of issues regarding prevention (16.6%), surgery (15.3%), tooth eruption (15.1%), endodontics (12.1%), harmful oral habits (9.7%), patient cooperation (8.7%), primary teeth trauma (7.2%) and dentistry (6.7%). Regarding sub-areas, most issues were related to child oral hygiene (68.5%), tooth extraction (92%), tooth eruption chronology (65.6%), pulp diagnosis (49.0%), bruxism (64%), patient management (74.3%), post-trauma treatment (79.3%), and restoration (88.9%). Conclusion: Pediatric Dentistry teleconsulting suggested a difficulty of the professionals in the pediatric patient approach. Continuing education programs and training courses for professionals working in primary health care are crucial for the comprehensive care of pediatric patients.

A ciência da saúde coletiva por escrito: contribuição para estudos em saúde bucal coletiva / The science of collective health in writing: contribution to studies in collective oral health

Resumo Comemorando os 25 anos da Revista Ciência & Saúde Coletiva (C&SC), o presente artigo analisou 375 documentos publicados entre 2000-2019 neste periódico, como parte integrante da editoria de saúde bucal coletiva. A análise da produção visou compreender como o núcleo de saúde bucal aparece nas publicações e como poderia ter contribuído com o conhecimento sobre a saúde-doença da população, as políticas públicas específicas, o ensino e a gestão dos serviços de saúde bucal no SUS. O processo privilegiou a análise bibliométrica e a de documentos. Foi possível explicitar a distribuição institucional dos autores, sua expressiva rede de colaboradores e a dimensão das citações das publicações inclusive no plano internacional. Os estados brasileiros mais presentes nas publicações foram São Paulo e Minas Gerais, seguidos por autores de Pernambuco, Rio Grande do Sul e Santa Catarina. As citações foram mais frequentemente do Brasil (85,14%), seguido por Estados Unidos (2,31%), Portugal (1,34%) e Austrália (1,34%). Conclui-se que, mesmo com limitações, C&SC se mostrou, inequivocamente, um potente instrumento de divulgação da produção científica na perspectiva da saúde bucal coletiva, possibilitando a divulgação e o intercâmbio de informações, facilitando a integração entre os pesquisadores e possibilitando um caminho da sua consolidação.

Abstract Celebrating the 25 years of existence of the Journal Ciência & Saúde Coletiva (C&SC), this paper analyzed 375 documents published between 2000-2019 as an integral part of the editorial of collective oral health. The production analysis aimed to understand how oral health core appears in publications and how it could have contributed to knowledge on the population's health-disease, specific public policies, education, and management of oral health services in the SUS. The process employed bibliometric and documental analysis. We could show the authors' territorial distribution, their extensive collaboration network, and the dimension of citations in publications, including the international plan. The Brazilian states most present in the publications were São Paulo and Minas Gerais, followed by authors from Pernambuco, Rio Grande do Sul, and Santa Catarina. Citations were more frequent in Brazil (85.14%), followed by the United States (2.31%), Portugal (1.34%), and Australia (1.34%). We concluded that, despite the limitations, the C&SC showed unequivocally a powerful instrument for the dissemination of scientific production from the perspective of collective oral health, enabling the exchange of information and facilitating the integration between researchers and enabling a path to its consolidation.

Hipertensão Arterial e trabalho entre docentes da educação básica da rede pública de ensino / Arterial Hypertension and work among teachers of basic education in the public-school system

Resumo Objetivou-se investigar a relação entre Hipertensão Arterial (HA) e perfil ocupacional de docentes da educação básica pública e apresentar modelo teórico. Adotou-se amostra probabilística por conglomerados. A HA foi a variável dependente. As variáveis independentes foram agrupadas em blocos temáticos (Características Sociodemográficas, Perfil Ocupacional, Comportamentos e Desfechos em Saúde), que compuseram o modelo teórico. As análises foram corrigidas pelo desenho amostral. Foi conduzida regressão logística hierarquizada. A prevalência de HA foi de 25%, enquanto que 58% apresentaram insatisfação com o trabalho. Houve maior chance de HA entre os docentes mais velhos (OR = 3,7), sem pós-graduação (OR = 1,4), que atuavam também na rede privada (OR = 2,6), que apresentavam maior consumo de sal (OR = 1,7), com sobrepeso (OR = 2,1) / obesidade (OR = 7,2), com relação cintura-quadril elevada (OR = 1,9) e com hipercolesterolemia/hipertrigliceridemia (OR = 1,5) e menor chance entre os do sexo feminino (OR = 0,5), que exerciam outra atividade de trabalho (OR = 0,6) e insatisfeitos com o trabalho (OR = 0,6). Assim, o perfil ocupacional docente apresentou influência sobre a HA. A relação trabalho e saúde docente carece de atenção e cuidado, com adoção de medidas que preservem e promovam sua saúde e seu bem-estar.

Abstract The scope of this paper was to investigate the relationship between Arterial Hypertension (AH) and the occupational profile of teachers of basic public education and present a theoretical model. A probabilistic sample was adopted by clusters, with AH as the dependent variable. The independent variables were grouped in thematic blocks (Sociodemographic Characteristics, Occupational Profile, Behaviors and Health Outcomes) that composed the theoretical model. The analyses were corrected by the sample design. Hierarchical logistic regression was conducted. The prevalence of AH was 25%, and 58% reported dissatisfaction with the work. There was a higher probability of AH among older teachers (OR = 3.7), without postgraduate qualification (OR = 1.4), who also worked in the private network (OR = 2.6), who had a higher salt intake (OR = 1.7), with a high waist-hip ratio (OR = 1.9) and hypercholesterolemia / hypertriglyceridemia (OR = 1, 5) and a lower chance among females (OR = 0.5), who had other work activity (OR = 0.6) and were dissatisfied with the work (OR = 0.6). Thus, the occupational profile of teachers had an influence on AH. The relationship between work and teacher health demands attention and care, with measures that preserve and promote the health and well-being of teachers.

Uso de serviços odontológicos públicos entre idosos brasileiros: uma análise multinível / Use of public dental services by elderly Brazilians: a multilevel analysis

Resumo Avaliou-se, entre idosos brasileiros, se o uso dos serviços odontológicos provenientes do Sistema Único de Saúde (SUS) é equânime. Utilizaram-se dados individuais de exames conduzidos por profissionais calibrados do levantamento nacional de saúde bucal (2010) e dados contextuais originários do DATASUS e do IBGE. A variável dependente foi o tipo de serviço utilizado: SUS e Outros. Foram conduzidas análises multiníveis através de regressão logística (α = 5%) (OR/IC 95%), através do SPSS 24.0. Participaram 6.303 idosos, a prevalência do uso no SUS foi de 30%, os fatores contextuais associados foram o acesso a banheiro e a água encanada (1,54/1,19-2,00) e o índice de cuidados odontológicos (1,41/1,10-1,81); já os individuais: idade (0,77/0,66-0,90), anos de estudo (1,83/1,53-2,20), renda familiar (2,57/2,20-3,01), motivo da última consulta (0,75/0,60-0,93), no de dentes cariados (1,26/1,08-1,48), no de dentes obturados (0,63/0,54-0,74), uso de próteses (2,23/1,91-2,59), dor de dente (1,36/1.11-1,67), autopercepção da necessidade de tratamento odontológico (1,20/1,12-1,51) e da necessidade de próteses (1,38/1,20-159). O uso no SUS tem sido equânime, porém é preciso organizar o processo de trabalho, viabilizando tal uso de forma regular e preventiva buscando a universalidade e a integralidade.

Abstract This study evaluated whether the use of dental services of the Unified Health System (SUS) by elderly Brazilians is equitable. Individual data collected by qualified professionals during the national oral health survey (2010) and contextual data from DATASUS and IBGE were used. The dependent variable was the type of service used: SUS and others. Multilevel analyses were conducted using logistic regression (α=5%) (OR/CI 95%) using SPSS 24.0. A total of 6,303 elderly people were included and the prevalence of dental service use in SUS was 30%. Associated contextual factors were: access to bathroom and running water (1.54/1.19-2.00) and the dental care index (1.41/1.10-1.81); the individual factors were: age (0.77/0.66-0.90), years of schooling (1.83/1.53-2.20), family income (2.57/2.20-3.01), reason for last dental visit (0.75/0.60-0.93), decayed teeth total (1.26/1.08-1.48), plugged teeth total (0.63/0.54-0.74), dental prosthesis use (2.23/1.91-2.59), dental pain (1.36/1.11-1.67), self-perception of the need for dental treatment (1.20/1.12-1.51) and need for dental prosthesis (1.38/1.20-1.59). Dental service from SUS has been equitable, however it is necessary to organize the working process, enabling its use in a regular and preventive manner, thereby seeking universality and comprehensiveness.

Avaliação da atenção secundária em endodontia em um Centro de Especialidades Odontológicas (CEO) / Evaluation of secondary care in endodontics at a Dental Specialties Center (DSC)

Resumo Objetivou-se avaliar a atenção secundária em endodontia em um Centro de Especialidades Odontológicas (CEO) de Belo Horizonte (MG). A coleta de dados utilizou dois formulários: (1) sobre o tratamento endodôntico, preenchido pelos endodontistas; (2) sobre o tratamento restaurador, com dados dos prontuários. O programa SPSS 19.0 foi utilizado para analisar os resultados por meio de frequência e percentis. Foram finalizados 452 tratamentos endodônticos em pacientes adultos. Os pacientes apresentaram mediana de 39 anos de idade, a maioria era do sexo feminino (69,7%) e apresentou guia de referência da atenção básica (96,2%). A maior parte dos tratamentos endodônticos foi realizada em pré-molares superiores (23,7%), seguida de molares inferiores (22,3%), utilizando técnica mista (74,1%) e em única sessão (64,2%). O encaminhamento para o tratamento restaurador foi para o CEO em 81,2% dos casos e finalizado em 24,1% casos (n = 109). A contrarreferência após o tratamento restaurador ocorreu em 58,7% dos casos finalizados. É necessário um planejamento conjunto do tratamento odontológico entre a atenção básica e secundária e, dentro desta última, entre as especialidades, além de um adequado processo de referência e contrarreferência, visando garantir a integralidade do cuidado e a eficiência e eficácia do serviço.

Abstract This study aimed to evaluate secondary endodontic care at a Dental Specialties Center (DSC) in Belo Horizonte, MG. Data collection used two forms: (1) on endodontic treatment, completed by the endodontists (2) on the restorative treatment, with data from the medical records. The SPSS 22.0 program was used to analyze the results using frequency and percentiles. In total, 452 endodontic procedures were completed in adult patients. The patients had a median of 39 years of age, most were female (69.7%) and had a primary care referral order (96.2%). Most endodontic treatments were performed in upper premolars (23.7%) followed by lower molars (22.3%), using a mixed technique (74.1%) and in a single session (64.2%). The referral for restorative treatment was for the DSC in 81.2% of cases and finished in 24.1% (n = 109). The counter-referral following restorative treatment occurred in 58.7% of the completed cases. It is necessary to jointly plan the dental treatment between primary and secondary care and, within the latter, among the specialties, in addition to an adequate referral and counter-referral process aimed at ensuring comprehensive care and efficient and effective service.

O capital social entre adolescentes escolares de um município brasileiro / The social capital among adolescent students of a brazilian municipality

Resumo O objetivo do artigo foi verificar associação do capital social de adolescentes com os fatores condições de vida e participação em atividades coletivas. No estudo transversal, aplicou-se questionário validado (SCQ-AS) para medir o capital social de escolares do sétimo ano de escolas públicas e privadas de um município brasileiro. Os pais responderam a um questionário sobre condições de vida e participação dos filhos em atividades coletivas. Após teste qui-quadrado, fez-se regressão logística múltipla com os domínios do capital social, variáveis dependentes e variáveis independentes (p≤0.20). Observou-se maior frequência de coesão social na escola, em adolescentes de escolas privadas (OR= 4.08; IC 95% 1.39 - 11.96) e com renda familiar de 1 a 3 salários mínimos, maior rede de amigos entre os que tinham pais vivendo juntos (OR= 2.21; IC 95% 1.28 - 3.78) e maior frequência de confiança na escola/bairro em escolares de escolas privadas (OR=2.71; IC 95% 1.16 - 6.32). Não houve associação com coesão social no bairro. Estudar em escola privada e ter renda familiar de 1 a 3 salários mínimos podem impulsionar a coesão social na escola, bem como a pratica de atividade esportiva. Os pais viverem juntos pode favorecer maior rede de amigos.

Abstract The article aimed to verify the association of adolescent social capital with living conditions factors and participation in collective activities. In the cross-sectional study, a validated questionnaire (SCQ-AS) was used to measure the social capital of seventh grade students from public and private schools in a Brazilian city. The parents answered a questionnaire on living conditions and children's participation in collective activities. After chi-square test, multiple logistic regression was performed with social capital' domains, dependent variables and independent variables (p≤0.20). There was higher frequency of social cohesion at school in adolescents from private schools (OR=4.08, 95% CI 1.39-11.96) and who have a family income of 1 to 3 minimum wages, a larger network of friends among those with parents living together OR = 2.21, 95% CI 1.28 - 3.78) and higher school/neighborhood confidence in private school students (OR=2.71, 95% CI 1.16 - 6.32). There was no association with neighborhood social cohesion. Studying in private school and having a family income of 1 to 3 minimum wages can boost social cohesion in school, as well as practice sports. Parents living together can favor larger network of friends.

Associação entre o uso de prótese dentária total e o tipo de serviço odontológico utilizado entre idosos edêntulos totais / Association between the use of total dental prosthesis (denture) and the type of oral health care service used by toothless elderly individuals

Resumo A reabilitação protética foi prevista pela política nacional de saúde bucal em função da alta prevalência de perda de todos os dentes e do baixo uso de prótese dentária entre idosos. Há necessidade de se avaliar o impacto dessa política de reabilitação. Portanto, objetivou-se investigar se o tipo de serviço odontológico utilizado foi um dos fatores associados ao uso de prótese dentária total entre idosos. Trata-se de um estudo transversal conduzido em uma amostra probabilística de idosos (60 anos ou mais) residentes na zona urbana de um município brasileiro de pequeno porte populacional por examinadores calibrados. Realizaram-se análises descritiva, bivariada e múltipla (Regressão logística - odds ratio - OR). Participaram 287 idosos, destes, 186 (64,8%) faziam uso de prótese dentária total. O uso de prótese dentária total foi associado a maiores chances de uso de serviços odontológicos supletivos ou particulares (OR = 4,19; p < 0,001) e a presença de lesão no palato (OR = 7,52; p = 0,002) e, também, a menores chances em idades maiores ou iguais a 73 anos (OR = 0,52; p = 0,023) e entre os com comprometimento na dimensão incapacidade física do OHIP-14 (OR = 0,20; p = 0,002). O uso de prótese dentária total foi associado ao tipo de serviço odontológico entre idosos, sendo maior o uso entre usuários dos serviços supletivos ou particulares.

Abstract Oral rehabilitation with dental prosthesis was mandated by national oral health policy in Brazil, due to the high prevalence of total teeth loss and low use of dental prosthesis among the elderly. There is a pressing need to assess the impact of this rehabilitation policy. An attempt was therefore made to investigate if the dental service used was one of the factors associated with the use of total dental prosthesis among the elderly. To achieve this, a cross-sectional study using a probabilistic sample of elderly (60 years and above) urban-area residents of a small city was conducted by qualified examiners. Descriptive, bivariate and multiple (logistic regression/odds ratio - OR) analyses were conducted on 287 elderly people, of which 186 (64.8%) used dental prosthesis. The use of total dental prosthesis was associated with a higher probability of being attended by private dental services (OR = 4.19; p < 0.001) and the presence of lesions on the palate (OR = 7.52; p = 0.002). Conversely, it was associated with lower probability in ages greater than or equal to 73 years (OR = 0.52; p = 0.023) and among those with impairment of OHIP-14 (OR = 0.20; p = 0.002) in the physical disability dimension. The use of total dental prosthesis was associated with the type of dental service used by the elderly, it being greater among private service users.

"Tihik quando bebe Kaxmuk não tem pai, nem mãe, nem irmão": Percepções sociais das consequências do uso da cachaça no povo indígena Maxakali/MG/Brasil / "When a Tihik drinks kaxmuk he neither has a father, nor a mother, or a brother": perceptions of Maxakali on the effects of sugarcane liquor consumption

Resumo Este artigo explora um dos aspectos mais interessantes e menos estudados no Brasil: as consequências das experiências complexas e contraditórias da substituição total de bebidas tradicionais indígenas pela cachaça, introduzida pelo contato interétnico. Contribui com a carência de ampliação de estudos na temática, analisando as consequências negativas do uso de álcool Maxakali. Enquanto estudos antropológicos enfatizam funções do beber tradicional e contemporâneo como "lubrificantes" sociais, as percepções sociais Maxakali ressaltam consequências negativas do uso da cachaça vendida ou trocada no contato interétnico. Interpretou-se no cotidiano, símbolos e significados dessas consequências, narradas por 21 lideranças em grupos focais. Com a substituição da Kaxmuk pelos Maxakali, ocorreram adaptações surgidas pelo contato interétnico, com relações negativas para quem bebe, suas família, aldeia e comunidade. No mundo-da-vida, as consequências negativas apresentaram-se em forma de acidentes, desarmonias conjugais, negligências, além de comportamentos violentos, doenças e mortes. Este estudo reforça a importância de produção de conhecimentos aprofundados e abrangentes visando a identificação de grupos vulneráveis em busca de soluções participantes.

Abstract This study explores one of the most interesting and least studied issues in Brazil: the consequences of complex and contradictory experiences by replacing the traditional drinks by cachaça, introduced through interethnic contact. Given the rarity of the study of Maxakali alcohol consumption in research, this study aims to understand, from the native's point of view, the negative aftereffect of alcohol consumption. Although anthropological studies emphasize functions of traditional and contemporary drinking as social "lubricants", social perceptions of the Maxakali highlight the problems of cachaça bought through interethnic contact. Symbols and meanings of these consequences were interpreted through their daily life histories, recorded by 21 leaders in focus group. Through the interethnic contact, some adaptations have occurred in the Maxakali alcohol use, with negative consequences for those who drink, their families, their villages and their community. In the world-of-life, these changes these changes can be seen through accidents, insults, marital disharmony, neglects, violent behavior, illness and death. This study's findings highlight the importance of producing comprehensive and in-depth knowledge in search of to identify vulnerable groups and to develop participatory solutions.

Cárie dentária na América do Sul: realidade entre escolares do Brasil e Argentina / Dental caries in South America: reality among schoolchildren from Brazil and Argentina

Objetivo: este estudo transversal multicêntrico objetivou determinar a proporção de cárie dentária, sua gravidade e atividade em escolares brasileiros e argentinos. Métodos: a amostra foi composta por escolares selecionados por conveniência, 406 do Brasil (Belo Horizonte - MG) e 241 da Argentina (Córdoba-Cba). Os dados foram coletados por seis dentistas previamente treinados e calibrados (kappaintra≥0,63; kappainter≥0,67). A proporção e gravidade da cárie foram medidas pelos índices ceod e CPOD. A alta experiência de cárie foi identificada pelo Significant Caries Index (SiC). A atividade de cárie foi avaliada segundo a reflexão e a textura da superfície (Nyvad et al., 1999) e o Índice de Cuidados (O/CPO*100) foi mensurado. Resultados: a proporção de livres de cárie (ceod e CPOD = 0) no Brasil foi de 45,7% e 19,9% na Argentina. O ceod foi de 1,48 (IC95%: 1,26-1,71) e 2,38 (IC95%: 2,0-2,72) entre escolares do Brasil e da Argentina, respectivamente. Nos dois países, o componente cariado foi o mais frequente. Entre os indivíduos com experiência de cárie (ceod > 1 e/ou CPOD > 1), a atividade de cárie esteve presente em 77,5% das crianças examinadas no Brasil e em 26,4% na Argentina. No grupo SiC, o CPOD foi de 2,20 (IC95%: 1,95-2,20) no Brasil e 2,17 (IC95%: 1,91-2,43) na Argentina, e o ceod no Brasil foi de 3,37 (3,01-3,72) e na Argentina 5,56 (5,04-6,07). O Índice de Cuidados foi baixo. Conclusão: em ambos os países, a proporção de crianças com experiência de cárie foi alta. Concentração de carga e atividade de cárie foi encontrada em grupos de polarização. Cabe ressaltar que a cárie dentária na dentição decídua é um problema relevante que necessita de esforços direcionados em ambos os países.

Objective: This multicentric cross-sectional study aimed to determine the proportion of dental caries, its' severity and activity among Brazilian and Argentines schoolchildren. Methods: The sample was selected by convenience and comprised of 406 schoolchildren from Brazil (Belo Horizonte-MG) and 241 in Argentina (Córdoba-Cba). Data were collected by six previously trained and calibrated dentists (kappaintra≥0.63; kappainter≥0.67). The proportion and severity of dental caries were measured by dmft and DMFT index. The high caries experiences was identified using Significant Caries Index (SiC). The caries activity was evaluated according to the reflection and texture of the surface (Nyvad et al., 1999) and the Care Index (O/CPO * 100) was measured. Results: The caries free (dmft and DMFT = 0) in Brazil was 45.7% and 19.9% in Argentina. The dmft was 1.48 (95% CI: 1.26-1.71) and 2.38 (95% CI: 2.0-2.72) among schoolchildren in Brazil and Argentina, respectively. In both countries, decayed component was the most frequent observed. Among subjects with caries experience (dmft > 1 and / or DMFT > 1) the caries activity was present in 77.5% of the children examined in Brazil and 26.4% in Argentina. In SiC group, DMFT was 2.20 (95% CI: 1.95-2.20) in Brazil and 2.17 (95% CI: 1.91-2.43) in Argentina and dmft in Brazil was 3.37 (3.01-3.72) and in Argentina was 5.56 (5.04-6.07). The Care Index was low. Conclusions: In both countries, the proportion of children with caries experience was high. Concentration of burden and caries activity was found in polarization' groups. It is noteworthy that caries in the primary dentition is a relevant problem that needs targeted efforts in both countries.

Exploring the effect of time and sex in family and community violence from 2008 to 2014

ABSTRACT OBJECTIVE To evaluate the effect of the time and the sex of victims and perpetrators on the rates of family and community physical violence in a Brazilian municipality over seven years (2008-2014). METHODS We made a census analysis from non-fatal victims attended in the Forensic Institute of the Scientific Civil Police. The monthly and annual violence rates were calculated based on the population size of the municipality. Time series was evaluated by negative binomial regression models, based on the number of cases with population offset and considering the effect of the sex of victims and perpetrators. RESULTS A total of 3,324 cases of family and 4,634 cases of community violence were analyzed. There was a significant increase in family violence rates for female victims and male perpetrators. Family violence rates were always higher for female victims than for male and it was always lower for female perpetrators than for male (p < 0.001). There was a lower risk of community violence for male victims after 2013 and a decrease of aggression perpetrated by men over time. Men and women were similarly affected by community violence; however, the perpetrators were more frequently men. CONCLUSIONS The results indicate a trend of increasing female victims in the family violence, mainly perpetrated by men. The reduction in community violence rates could be the result of policies to reduce crime.

Insatisfação com os serviços odontológicos entre idosos brasileiros dentados e edentados: análise multinível / Dissatisfaction with dental services among dentate and edentulous elderly Brazilians: a multilevel analysis

Resumo Avaliou-se a insatisfação com os serviços odontológicos entre idosos brasileiros dentados e edentados e sua associação com variáveis contextuais e individuais. Foram utilizados os dados do Levantamento Nacional de Saúde bucal realizado em 2010 e dados contextuais referentes aos municípios. Análises descritivas, bivariadas e multinível foram realizadas. Incluiu-se 1.989 idosos. Destes, 11,2% dos idosos dentados e 22,1% dos edentados estavam insatisfeitos. Entre os dentados, a insatisfação foi associada com variáveis contextuais (localização do município, índice de desenvolvimento humano, Índice de GINI, presença de Centro de Especialidades Odontológicas e cobertura das equipes de saúde bucal) e individuais pertencentes à atenção à saúde e condições de saúde bucal. Para os idosos edentados, não foi identificado associação com variáveis contextuais. Apenas o motivo do uso do serviço e a satisfação com dentes e boca foram associados. Identificou-se uma prevalência considerável de insatisfação com os serviços, sendo maior entre os idosos edentados. Entre os idosos dentados, foi observado associação com variáveis contextuais.

Abstract The scope of this study was to evaluate dissatisfaction with dental services among dentate and edentulous elderly Brazilians and its association with contextual and individual variables. The data from the National Oral Health Survey conducted in 2010 and contextual variables related to cities were used. Descriptive, bivariate and multilevel analysis was conducted among 1,989 elderly individuals. Of these, 11.2% of dentate and 22.1% of edentulous elderly people were dissatisfied. Among the dentate individuals, dissatisfaction was associated with contextual variables (location of municipality, human development index, GINI Index, the presence of Dental Specialty Centers and the coverage of oral health in public service) and persons related to health care and oral health conditions. For the edentulous individuals, no associated contextual variables were identified. Only the motive for the use of the service and satisfaction with teeth and mouth were associated with dissatisfaction with dental services. A considerable prevalence of dissatisfaction with the services was identified, being higher among edentulous elderly Brazilians. Among dentate elderly Brazilians, an association with contextual variables was detected.