Acceso y práctica odontológica en ámbito de atención privada. Representaciones sociales y salud bucal / Dental access and practice in the private ambit of attention. Social and oral health representations

RESUMEN Las representaciones sociales producto de la forma de percibir, interpretar y significar la realidad social a partir del sentido común generan conductas que influyen directamente en la práctica y solicitud de la atención odontológica, bajo la influencia de las condiciones socioeconómicas actuales del país. Los niveles de pobreza se incrementan de manera acelerada, generando mayores desigualdades sociales, con distribución de beneficios económicos polarizados con concentración de los ingresos más altos en unos pocos. Con ello la salud-enfermedad es determinada por los niveles de ingreso, limitando el acceso a los servicios de salud para los grupos sociales más desfavorecidos. El objetivo de este estudio es conocer las representaciones sociales de salud-enfermedad odontológica y su relación con la atención y el acceso a servicios odontológicos y el tipo de atención al que acuden personas con padecimientos estomatológicos y las características de las prácticas odontológicas de quienes les atienden. Se realizó un estudio cualitativo con profesionales y pacientes del ámbito privado en una zona de la Ciudad de México. Los resultados muestran características de concepción y práctica influidas por el modelo médico hegemónico y de descontextualización de los problemas de atención odontológica de los pacientes. Se concluye que las representaciones sociales de profesionales y pacientes se construyen en el contexto de vida donde prevalece la polarización y exclusión social.

ABSTRACT The social representations resulting from the way of perceiving, interpreting and signifying social reality from the common sense, generate behaviors that directly influence the practice and application of dental care, under the influence of the current socioeconomic conditions of the country. Poverty levels increase rapidly, creating greater social inequalities, with a distribution of polarized economic benefi ts with a concentration of higher incomes in a few. With this, health- dental disease is determined by income levels, limiting access to health levels for the most disadvantaged social groups. The objective of this study is to know the social representations of health-dental disease and its relationship with care and access to dental services and the type of care that people with dental conditions access, and the characteristics of the dentistry practice of those who care for them. A qualitative study was carried out with professionals and patients from the private sector in an area of Mexico City. The results show characteristics of conception and practice infl uenced by the hegemonic medical model and decontextualization of the problems of dental care patients. It is concluded that the social representations of professionals and patients are built in the context of life where polarization and social exclusion prevail.

Relationship between gender, income and education and self-perceived oral health among elderly Mexicans. An exploratory study / Relação entre gênero, renda e educação com a autopercepão da saúde bucal em idosos mexicanos. Um estudo exploratório

The aim of this study was to identify the relationship between sociodemographic factors and self-perceived oral health (SPOH) among the elderly. A cross-sectional, exploratory examination of 150 elderly subjects whose ages ranged from 60-86 was conducted. These subjects used the Geriatric Oral Health Assessment Index (GOHAI) to assess their SPOH. In addition, sociodemographic data were collected from study participants. Data were analyzed using Student's t-test, the examination of odds ratio (OR) of logistic regression analysis, the chi-square test, and analysis of variance (ANOVA). The mean decayed, missing, and filled teeth (DMFT) index for the study participants was 20.1 ± 5.8; 21.3% of subjects were edentulous, and 69.3% of subjects wore removable dentures. 62.7% of study participants had poor SPOH (defined as GOHAI score <44). Poor SPOH was significantly more frequent among males (OR = 2.72, 95% CI: 1.03-7.13, p < 0.05), low-income individuals (OR = 2.7, 95% CI: 1.3 -5.8, p < 0.01), and subjects with less education (OR = 2.26, 95% CI: 1.1-4.6, p < 0.05) than among the overall subject population. The findings suggest that gender (male), low income and low educational levels have a significant influence on the self-perceived oral health status of elderly individuals, irrespective of tooth loss.

O objetivo deste estudo foi identificar a relação entre os fatores sociodemográficos com a autopercepção da saúde bucal (SPOH) em idosos. Realizou-se um estudo transversal exploratório de 150 idosos. Para avaliar a sua percepção da saúde bucal utilizou-se o Geriatric Oral Assesment Index (GOHAI) e também foram coletados dados sociodemográficos. Os dados foram analisados utilizando o teste T Student, a razão de chances (OR) de análise de regressão logística, o teste Chi Quadrado (p < 0.05) e análise de variância ANOVA. A média do índice de dentes cariados, perdidos ou obturados (CPO-D) dos participantes no estudo foi de 20.1 ± 5.8; 21.3% foram edêntulos e 69.3% eram portadores de prótese removível. O 62.7% dos participantes no estudo teve pobre autopercepção da saúde bucal (definida com uma suma de GOHAI < 44), a qual foi significativamente mais frequente nos homens (OR = 2.72, 95% Cl: 1.03-7.13, p < 0.05), com baixa renda (OR = 2.7, 95% Cl: 1.3 - 5.8, p < 0.01), e com menor escolaridade (OR = 2.26, 95% Cl: 1.1-4.6, p <0.05) do que entre a população em geral. Os resultados presentes sugerem que nos idosos a baixa renda e a menor escolaridade têm influência significativa na autopercepção da saúde bucal, independentemente da perda dentária.

La confrontación de la sexualidad en la práctica profesional de los futuros médicos: la mirada de los pasantes de medicina / The confrontation of sexuality in the professional practice of future physicians: the viewpoint of medical interns

El tema de la sexualidad en las instituciones académicas y de servicios se enmarca en perspectivas predominantemente biológicas, desdibujando la subjetividad inmersa en procesos sociales y culturales. Los significados construidos por el personal de salud en torno a la sexualidad impactan su formación y desempeño profesional. Se realizó una investigación cualitativa sobre el significado de la sexualidad en jóvenes pasantes de medicina de la Universidad Autónoma Metropolitana-Xochimilco, entrevistándolos porque sin ser titulados ejercen una práctica profesional autónoma e independiente como parte de su servicio social en comunidades rurales. Al analizar la información con base en la teoría fundamentada emergieron tres dicotomías: biológico-construcción-social; individuo-profesional y aprendizaje teórico-vivencias en la comunidad; estas evidencian el antagonismo del conocimiento adquirido durante su formación universitaria con énfasis biológico y los obstáculos para responder a las demandas de salud sexual y reproductiva de la población que atienden. Ellos se reconocen carentes de habilidades para enfrentar estos tópicos en su práctica profesional. Es relevante integrar la perspectiva subjetiva de este tema en los programas de las licenciaturas del área de la salud.

The subject of sexuality in academic and service institutions is perceived through predominantly biological conceptual perspectives, blurring the subjective component that is imbued in social and cultural processes. The meanings that medical staff construct around sexuality have implications in their professional development and practice. This work presents results from a qualitative study into the meaning of sexuality among medical interns from the Universidad Autónoma Metropolitana-Xochimilco. In-depth interviews were conducted with students during their community service. This group was selected because they had finished their studies and were performing an independent and autonomous professional practice. The results, which were analyzed based on Grounded Theory, revealed three dichotomies: biology vs. social construction, individual vs. professional and theoretical learning vs. experiences in the community. The most relevant aspect revealed was the antagonism found between a medical intern's biology-centered academic knowledge and the challenge posed by their patients' reproductive and sexual health needs. The interns recognize that they lack the necessary skills to face issues of sexuality in their professional practice.