Dental care for persons with disabilities: discretion on the frontline.

OBJECTIVE: To depict the influence of discretionary actions exercised by frontline professionals and organizations on the implementation of diverse modalities of access to specialized dental care within the Care Network for Persons with Disabilities. METHODS: A case study conducted in two Brazilian health regions characterized by distinct means of access to specialized dental care employing documentary analysis and interviews with key stakeholders across the period spanning from July to December 2019. RESULTS: In the referenced access region, there was a notable centrality of Primary Health Care (PHC) in caregiving, wherein planning and assessment were integral components of institutional routines. Where spontaneous demand scheduling was accepted, sporadic exchanges of information were evident between PHC units and specialized facilities. The coordination role in caregiving was not vested in PHC teams, and activities such as planning and assessment were not assimilated into organizational routines. CONCLUSIONS: The implementation of policies for specialized dental care for persons with disabilities relied on the coordination furnished by PHC and the orchestration of planning and assessment endeavors aimed at establishing an integrated care network. This implementation proved subject to the discretionary authority of frontline professionals and organizations, highlighting the significant role of relational and institutional environments in the context of public policy implementation within a decentralized and regionalized healthcare system.

Rede de cuidados à pessoa com deficiência: o direito à saúde bucal e a implementação da assistência odontológica especializada / Care network for persons with disabilities: the right to oral health and the implementation of specialized dental care

A implementação de políticas públicas depende das interrelações entre Estado, sociedade, política e economia, as quais produzem efeitos que irão repercutir na vida das pessoas. Na literatura, diferentes modelos teóricos estão disponíveis para estudo da implementação de políticas públicas. A relevância das necessidades de saúde da pessoa com deficiência cresceu, após a aprovação da Declaração dos Direitos das Pessoas com Deficiência (PcD), elevando a consciência sobre a necessidade da implementação de políticas públicas efetivas e duradouras de inclusão das PcD. Esta tese objetivou estudar o processo de implementação da Rede de Cuidados à Pessoa com Deficiência (RCPD) a partir do Modelo de Coalização de Defesa e da teoria da Burocracia do Nível de Rua; e descrever a extensão da integração sistêmica que orienta a conformação do cuidado da RCPD, no âmbito da saúde bucal, em seis regiões de saúde brasileiras, bem como produzir uma síntese de recomendações/expectativas sobre a assistência odontológica às PcD, adicionalmente. Para a viabilização dos resultados, foram utilizados dois métodos de pesquisa: o estudo de caso (único e múltiplo) e a revisão integrativa. Os resultados foram a elaboração de quatro artigos que tratam sobre: a descrição, sob o Modelo de Coalizão de Defesa, das condições que favoreceram a conformação do subsistema da política pública e o processo de implementação da RCPD em duas regiões de saúde brasileiras semelhantes (Artigo 1); a descrição da influência da discricionariedade dos profissionais e organizações da linha de frente na implementação de diferentes formas de acesso à assistência odontológica especializada na RCPD (Artigo 2); a produção de uma síntese da literatura científica sobre as expectativas/recomendações a respeito da assistência odontológica como direito à saúde bucal para pessoas com deficiência no âmbito internacional (Artigo 3); e a descrição da extensão da integração sistêmica da assistência odontológica na RCPD, em seis regiões de saúde brasileiras (Artigo 4). No contexto internacional, o direito à saúde bucal para PcD atravessa um cenário complexo e por vezes contraditório, afetado pelo modelo de proteção social dos países abordados pelos pesquisadores. No Brasil, os estudos de caso mostraram que a implementação da RCPD sofreu influência das crenças/convicções dos seus implementadores, bem como do poder discricionário deles. Além disso; a extensão da integração sistêmica foi influenciada pela indução federal, e pelas características do contexto loco-regional no processo de implementação da RCPD no âmbito da saúde bucal.

The implementation of public policies depends on the interrelationships between the State, society, policy and economy, which produce effects that will have repercussions on people's lives. In the literature, different theoretical models are available to study the implementation of public policies. The relevance of the health needs of people with disabilities grew after the approval of the Declaration of the Rights of People with Disabilities (PwD), raising awareness of the need to implement effective and lasting public policies for the inclusion of PwD. This thesis aimed to study the implementation process o f the Care Network for People with Disabilities (CNPD) based on the Defense Coalition Model and the Street Levei Bureaucracy theory; and describe the extent of systemic integration that guides the shaping of CNPD care, within the scope of oral health, in six brazilian health regions, as well as producing a synthesis of recommendations/expectations regarding dental care for PwD, in addition. To make the results viable, two research methods were used: the case study (single and multiple) and the integrative review. The results were the elaboration o f four articles that deal with: the description, under the Advocay Coalition Framework, o f the conditions that favored the conforrnation ofthe public policy subsystem and the process of implementing the CNPD in two similar Brazilian health regions (Article 1); the description ofthe influence ofthe discretion offrontline professionals and organizations in the implementation of different forms of access to specialized dental care in the CNPD (Article 2); the production of a synthesis of the scientific literature of expectations/recommendations regarding dental care as a right to oral health for people with disabilities at the international levei (Article 3); and the description of the extent of the systemic integration of dental care in the CNPD, in six Brazilian health regions (Article 4). At international context, the right to oral health for PwD has been crossed by a complex and sometimes contradictory scenario, affected by the social protection model o f the countries addressed by the researchers. In Brazil, the case studies showed that the implementation o f the CNPD was influenced by the beliefs/convictions of its implementers, as well as their discretion. Moreover, the extent of systemic integration was influenced by federal induction, in addition to characteristics o f the loco-regional context in the process of implementing the CNPD in the field of oral health.

Dental care for persons with disabilities: discretion on the frontline / Assistência odontológica à pessoa com deficiência: discricionariedade na linha de frente

ABSTRACT OBJECTIVE To depict the influence of discretionary actions exercised by frontline professionals and organizations on the implementation of diverse modalities of access to specialized dental care within the Care Network for Persons with Disabilities. METHODS A case study conducted in two Brazilian health regions characterized by distinct means of access to specialized dental care employing documentary analysis and interviews with key stakeholders across the period spanning from July to December 2019. RESULTS In the referenced access region, there was a notable centrality of Primary Health Care (PHC) in caregiving, wherein planning and assessment were integral components of institutional routines. Where spontaneous demand scheduling was accepted, sporadic exchanges of information were evident between PHC units and specialized facilities. The coordination role in caregiving was not vested in PHC teams, and activities such as planning and assessment were not assimilated into organizational routines. CONCLUSIONS The implementation of policies for specialized dental care for persons with disabilities relied on the coordination furnished by PHC and the orchestration of planning and assessment endeavors aimed at establishing an integrated care network. This implementation proved subject to the discretionary authority of frontline professionals and organizations, highlighting the significant role of relational and institutional environments in the context of public policy implementation within a decentralized and regionalized healthcare system.

RESUMO OBJETIVO Descrever a influência da discricionariedade dos profissionais e organizações da linha de frente na implementação de diferentes formas de acesso à assistência odontológica especializada na Rede de Cuidados à Pessoa com Deficiência. MÉTODOS Estudo de caso em duas regiões de saúde brasileiras cujo acesso à assistência odontológica especializada era distinto, com análise documental e entrevista com atores-chave, entre julho e dezembro de 2019. RESULTADOS Na região com acesso referenciado, observou-se que a atenção primária à saúde (APS) tinha centralidade no cuidado e o planejamento/avaliação faziam parte da rotina institucional dos serviços. Na região onde o agendamento era possível por demanda espontânea, notou-se trocas episódicas de informação entre as unidades de APS e as especializadas; o papel de coordenação do cuidado não era um atributo das equipes de APS e as atividades de planejamento/avaliação não estavam incorporadas à rotina das organizações. CONCLUSÕES A implementação da política de assistência odontológica especializada à pessoa com deficiência se mostrou dependente da coordenação da APS e da condução de atividades de planejamento/avaliação voltadas à construção de uma rede de cuidados integrada e sujeita ao poder discricionário dos profissionais e das organizações da linha de frente, sugerindo que o ambiente relacional e institucional possui um papel importante no processo de implementação de políticas públicas em um sistema descentralizado e regionalizado de saúde.

Structural shifts in sea ice prokaryotic communities across a salinity gradient in the subarctic.

Current knowledge of the processes that shape prokaryotic community assembly in sea ice across polar ecosystems is scarce. Here, we coupled culture-dependent (bacterial isolation on R2A medium) and culture-independent (high-throughput 16S rRNA gene sequencing) approaches to provide the first comprehensive assessment of prokaryotic communities in the late winter ice and its underlying water along a natural salinity gradient in coastal Hudson Bay, an iconic cryo-environment that marks the ecological transition between Canadian Subarctic and Arctic biomes. We found that prokaryotic community assembly processes in the ice were less selective at low salinity since typical freshwater taxa such as Frankiales, Burkholderiales, and Chitinophagales dominated both the ice and its underlying water. In contrast, there were sharp shifts in community structure between the ice and underlying water samples at sites with higher salinity, with the orders Alteromonadales and Flavobacteriales dominating the ice, while the abovementioned freshwater taxa dominated the underlying water communities. Moreover, primary producers including Cyanobium (Cyanobacteria, Synechococcales) may play a role in shaping the ice communities and were accompanied by known Planctomycetes and Verrucomicrobiae taxa. Culture-dependent analyses showed that the ice contained pigment-producing psychrotolerant or psychrophilic bacteria from the phyla Proteobacteria, Actinobacteriota, and Bacteroidota, likely favored by the combination of low temperatures and the seasonal increase in sunlight. Our findings suggest that salinity, photosynthesis and dissolved organic matter are the main drivers of prokaryotic community structure in the late winter ice of coastal Hudson Bay, the ecosystem with the fastest sea ice loss rate in the Canadian North.

Coalizão partidária, aporte financeiro e desempenho da assistência médica e odontológica em duas regiões de saúde brasileiras / Party coalitions, budget outlay, and performance of medical and dental care in two health regions of Brazil / Coalición partidaria, aporte financiero y desempeño de la asistencia médica y odontológica en dos regiones de salud brasileñas

Coalizações de governo distintas encontram limites para produzir mudanças na orientação de políticas. O objetivo foi descrever a orientação política dos partidos de coalização, o aporte financeiro, a estrutura e o desempenho da assistência médica e odontológica em duas regiões de saúde brasileiras distintas socioeconomicamente e na oferta de serviços. Utilizaram-se indicadores a partir de dados oficiais relativos ao período de 2007 a 2014 e caraterísticas da coalização partidária definidas pelas preferências eleitorais municipais e de intensidade da competição eleitoral em cada estado da respectiva região. Maior aporte financeiro per capita e maior porcentagem de população potencialmente coberta pela atenção básica e pelas equipes de saúde bucal da Estratégia Saúde da Família estavam relacionados com o município-polo da região de coalização partidária mais à esquerda, ao passo que o município-polo da região de coalização partidária mais à direita mostrou aumento expressivo na porcentagem de população potencialmente coberta por médicos. Em ambos os municípios-polo, a efetividade melhorou. Os achados confirmaram a noção de que as coalizações mais à esquerda aportam mais recursos em políticas sociais, mas encontram limites para superar desigualdades estruturais e converter suas preferências programáticas em políticas efetivas.

Various government coalitions encounter limits when attempting to implement policy changes. The study aimed to describe the policy orientation of party coalitions, budget outlay, and the structure and performance of medical and dental care in two health regions of Brazil with different socioeconomic conditions and supplies of services. The indicators used were based on official data from 2007 and 2014 and characteristics of the party coalition defined by municipal electoral preferences and the intensity of electoral competition in each state of the respective major geographic region. Higher per capita budget outlay and higher percentage of the population potentially covered by primary care and by the oral health teams under the Family Health Strategy were related to the regional hub municipality with a more left-leaning party coalition, while the regional hub municipality with the more right-leaning party coalition showed an important increase in the percentage of the population potentially covered by physicians. The effectiveness improved in both hub municipalities. The findings confirmed the notion that more left-leaning coalitions tend to earmark more budget resources for social policies but encounter limits for overcoming structural inequalities and for converting their platform preferences into actual policies.

Coaliciones de gobierno distintas encuentran límites para producir cambios en la orientación de políticas. El objetivo fue describir la orientación política de los partidos de coalición, el aporte financiero, la estructura y desempeño de la asistencia médica y odontológica en dos regiones de salud brasileñas, distintas socioeconómicamente y en la oferta de servicios. Se utilizaron indicadores a partir de datos oficiales relacionados con el período de 2007 a 2014 y características de la coalición partidaria, definidas por las preferencias electorales municipales y de intensidad en la competición electoral en cada estado de la respectiva región. Mayor aporte financiero per cápita y mayor porcentaje de población potencialmente cubierta por la atención básica y por los equipos de salud bucal de la Estrategia Salud de la Familia estaban relacionados con el municipio polo de la región de la coalición partidaria más a la izquierda, mientras que el municipio polo de la región de coalición partidaria más a la derecha mostró un aumento expresivo en el porcentaje de población potencialmente cubierta por médicos. En ambos municipios polo, la efectividad mejoró. Los resultados confirmaron la noción de que las coaliciones más a la izquierda aportan más recursos en políticas sociales, pero encuentran límites para superar desigualdades estructurales y convertir sus preferencias programáticas en políticas efectivas.

Structure and performance of medical and dental care in two Brazilian health regions between 2007 and 2014. / Estrutura e desempenho da assistência médica e odontológica em duas regiões de saúde brasileiras entre 2007 e 2014.

The structure and performance of medical and dental care were analyzed in two health regions that differed socioeconomically and in the provision of services, through case study in the Norte-Barretos (São Paulo) and Juazeiro (Bahia) regions from 2007 and 2014, taking into account political, organizational and structural dimensions and structure and performance indicators. The results showed that the regionalization was positively recognized, the distribution of services did not meet the population demand, and the installed capacity of the health care network was not adequate for the health needs of the population. Norte-Barretos stood out regarding structure (except for potential coverage of oral health teams in the Family Health Strategy) and effectiveness, while Juazeiro stood out concerning efficiency; e.g. although with fewer resources, the use of services was relatively higher. The observed pattern seems to reflect aspects related to the regionalization and the political path of each care provided, the so-called "silos effect". The results may support the design of health policies aimed at overcoming the undersized structure of public health services in regions of lower socioeconomic development and search for parameters and coordination mechanisms to balance performance indicators better.

O artigo analisa a estrutura e o desempenho das assistências médica e odontológica de duas regiões, distintas socioeconomicamente e na oferta de serviços, por meio de estudo de caso nas regiões Norte-Barretos (São Paulo) e Juazeiro (Bahia) entre 2007-2014, a partir das dimensões política, organizacional e estrutural e de indicadores de estrutura e desempenho. Observou-se que a regionalização foi reconhecida de forma positiva, a distribuição dos serviços não atendia à demanda populacional e a capacidade instalada da rede de atenção à saúde não estava adequada às necessidades da população. Norte-Barretos se sobressaiu em relação à estrutura (exceto para cobertura potencial da ESB na ESF) e efetividade; enquanto Juazeiro se destacou em relação à eficiência; embora com menos recursos, a utilização dos serviços foi relativamente mais elevada. O padrão observado parece refletir aspectos relacionados à re gionalização e à trajetória política de cada assistência, o efeito silos. Os resultados podem subsidiar o desenho de políticas de saúde voltadas a superar o subdimensionamento da estrutura de serviços públicos assistenciais nas regiões de menor desenvolvimento socioeconômico e a busca de parâmetros e mecanismos de coordenação a fim de equilibrar indicadores de desempenho.

Chemical, physical, and biological attributes in soils affected by deposition of iron ore tailings from the Fundão Dam failure.

Monitoring degraded areas is essential for evaluation of the quality of the rehabilitation process. In this study, we evaluate how the physical and chemical characteristics of the mixture of iron ore tailings with the soil have affected the soil microbial biomass and activity in areas along the Gualaxo do Norte River after the Fundão Dam disaster. Composite soil samples were collected from areas that were impacted (I) and not impacted (NI) by the tailings. The following attributes were evaluated: chemical element content; soil density, porosity, and texture; microbial biomass carbon; basal respiration; and enzyme activity and density of microbial groups (bacteria, actinobacteria, fungi, arbuscular mycorrhizae, phosphate solubilizers, cellulolytic microorganisms, nitrifiers, ammonifiers, and diazotrophs). According to result, the deposition of tailings increased the pH and the soil available P, Cr, Fe, and Mn content and reduced organic matter. The physical and biological attributes were negatively affected, with increases in the silt content and density of the soil, and reduction in macroporosity and in the microbial biomass and activity of the soil (respiration and enzymes) in the impacted area. However, the impacted areas exhibited greater densities of some microbial groups (cellulolytic microorganisms, nitrifiers, and diazotrophic bacteria). Modifications in the organic matter and silt content are the main attributes associated with deposition of the tailings that affected soil microbial biomass and microbial activity. This may affect erosive conditions and the functionality of the ecosystem, indicating an imbalance in this environment. In contrast, the higher density of some microbial groups in the impacted areas show the high rehabilitation potential of these areas.

Environmental drivers of shifts on microbial traits in sites disturbed by a large-scale tailing dam collapse.

This study aimed to assess the most affected traits related to microbial ecophysiology and activity and investigate its relationships with environmental drivers in mine tailings spilled from the Fundão dam at disturbed sites across Gualaxo do Norte river, Minas Gerais, Brazil. The mine tailings are characterized by increased pH value, silt percentage, and bulk density, while clay percentage, organic carbon (Corg), total nitrogen (Nt), and moisture contents are reduced. Microbial biomass, enzymatic activities (arylsulfatase, ß-1,4-glucosidase, acid and alkaline phosphatases), and the total microbial activity potential (FDA hydrolysis) were generally lower in tailings compared to undisturbed reference soil (Und). Enzyme-based indexes (GMea, WMean, and IBRv2) showed microbial communities with significantly lower degradative efficacy in the tailings than Und in all sites (R2 ≥ 0.94, p < 0.001). Non-metric multidimensional scaling and distance-based redundancy analysis revealed that microbial communities exhibited significant differentiation (R2 adjusted = 0.73, p = 0.0001) between mine tailings and Und over the different studied sites, which was strongly influenced by changes on physicochemical properties (pH, Corg and Nt contents, the predominance of small-sized particles of silt, and bulk density) and the presence of Se, Cr, Fe, and Ni, even at low concentrations. Our study suggests that the physicochemical properties and the presence of low bioavailable concentrations of heavy metals in dam tailings promote shifts on microbial communities through reductions in the C storage and biogeochemical cycling of nutrients by these communities compared to those in undisturbed reference soils surrounding and, therefore, has negative implications for the ecosystem functioning.

Self-Perception on the Institutionalized Elderly Need of Dental Prosthesis

Abstract Objective: To make an association between self-perception and the implementation of sociodemographic variables for the autonomous and / or partially dependent individuals in nursing homes. Material and Methods: Epidemiological, observational and cross-sectional study. The sample consisted of 208 institutionalized elderly, both sexes, 60 years old or older, independent or partially dependent, randomly selected from two long-term residential institutions. Subjective evaluation: self-perception questionnaire, Geriatric Oral Health Assessment Index, quality of life assessment, Oral Impacts on Daily Performance (OIDP), oral health self-assessment (OH) and the need for dental prostheses. Bivariate analysis, chi-square test and multiple logistic regression were used, with the variables with p<0.05 remaining in the model. Results: Men were edentulous (53.43%), 68.75% used some type of denture, and 64.91% required dental prostheses, 60.58% self-assessed (OH) as good / excellent; who reported a need for dental prostheses presented 6.7 times (95% CI: 3.2-14.3) and more likely to have an impact on OIDP, those who needed prosthetics had a 2.8 times chance (95% CI: 1.3-6.1) (p<0.0001). The self-reported need for prostheses was associated with prevalence severity of impacts on QoL, eating, pronounce words correctly, Smile without feeling embarrassed; and the main reasons for not having badly adjusted teeth / dentures. Conclusion: The institutionalized elderly self-perceive the need for dental prostheses, but it does not have a negative impact on quality of life.

Olmesartan: A Little-Known Cause of Diarrhoea.

Olmesartan's sprue-like enteropathy was first described in 2012 and typically presents with diarrhoea, weight loss, nausea, vomiting, low albumin and histological evidence of intestinal villous atrophy. Coeliac disease is one of the main differential diagnoses and should be excluded. We present the clinical case of a 63-year-old man treated with olmesartan for 10 years who presented with a 2-month history of diarrhoea and was diagnosed with olmesartan's enteropathy. This case highlights the need for clinical suspicion of this new entity in order to reduce the associated morbidity and unnecessary costly investigations. LEARNING POINTS: Sprue-like enteropathy associated with olmesartan is a recently described and recognized disease.This condition should be suspected in patients taking olmesartan who have chronic diarrhoea, intestinal villous atrophy and negative serology for coeliac disease, or an absent response to a gluten-free diet.Early suspicion of olmesartan's enteropathy can reduce the associated morbidity and avoid costly investigation.

Estrutura e desempenho da assistência médica e odontológica: o efeito silos e os impasses da regionalização da saúde / Structure and performance of medical and dental care the silos effect and the impasses of health regionalization

A estratégia da regionalização da atenção à saúde aconteceu em consonância com as reformas promovidas pelos estados nacionais ocidentais, de cunho neoliberalista, a partir do final da década de 70, pautada tanto pela lógica do esgotamento do estado de bem-estar social quanto pela racionalização de recursos, na área social, incluindo a saúde. No Brasil, ambas iniciativas fazem parte da agenda política do setor saúde de modo concomitante a partir da primeira década do século XXI, propiciando um espaço promissor para explorar as relações entre as características regionais, a oferta de serviços de saúde e o componente relativo à atenção à saúde bucal. Objetivou-se caracterizar, a partir de um estudo de caso, a estrutura e o desempenho de efetividade e eficiência das assistências médica e odontológica em duas regiões de saúde distintas socioeconomicamente e na oferta de serviços, Norte-Barretos e Juazeiro, a fim de elaborar proposições que possam orientam futuros estudos. Os resultados apontaram que os aspectos estruturais e de desempenho da assistência médica e odontológica não assumiram um padrão diretamente favorável à região com melhores indicadores socioeconômicos e de oferta de serviços de saúde. Enquanto a região Norte-Barretos se sobressaiu em relação aos indicadores de estrutura (exceto para cobertura potencial da ESB na ESF) e efetividade, a região Juazeiro se destacou em relação à eficiência, ou seja, embora com menos recursos, a utilização dos serviços foi relativamente mais expressiva. Os aspectos qualitativos apontaram que a regionalização aconteceu em ambos os locais, e foi reconhecida de forma positiva (dimensão política); a distribuição dos serviços não atende à demanda populacional (dimensão organizacional); a capacidade instalada das RAS não estava adequada às necessidades de saúde da população (dimensão estrutural). Os achados permitiram um diálogo entre a realidade atual da regionalização, bem como os seus impasses, e entre o desempenho da assistência odontológica e as forças específicas que buscam romper com o isolamento entre as práticas de saúde (efeito silos)

The strategy of the regionalization of health care happened along with the changes promoted by neo-liberalist west national states, since the end of the 70s, thought by the logic of the well fare exhaustion as much as the rationalization of the resources on the social field, including health. In Brazil, both actions are part of the political agenda on health section since the first decade of the 21th century, providing a promissing space to explore the relations between regional characters, the health service offers and the element of the oral health care. This research aims to organize the structure and performance of efficacy and efficiency, the medical and dental care in two socioeconomic different health regions and the provision of services, Norte-Barretos and Juazeiro, for the clarification and explanatory hypotheses that may guide future studies. The case study was a methodology adopted. The results pointed out that the structural and performance aspects of medical and dental care were not considered compatible with both socioeconomic aand health indicators. While the North-Barretos region excelled in relation to the structure indicators (except for potential ESB coverage in the ESF) and effectiveness, the Juazeiro region stood out in relation to efficiency, that is, although with less resources, the use of the services was relatively more expressive. The qualitative aspects pointed out that regionalization occurred in both places and was positively recognized (political dimension); the distribution of services doesn\'t meet the population demand (organizational dimension); the installed capacity of RAS was not appropriate to the health needs of the population (structural dimension). The objectives allow a dialogue between the current performance of regionalization, as well as its impasses, and between the performance of dental care and the specific forces they seek, to break with the separation of health practices (silos effect)

Satisfação dos usuários assistidos em quatro centros regionais de especialidades odontológicas do Ceará, Brasil / Satisfaction of users assisted in four regional dental specialties centers of Ceará, Brazil

RESUMO Objetivou-se avaliar a satisfação de usuários assistidos em Centros Regionais de Especialidades Odontológicas (CEO-R) do Ceará, Brasil. Estudo analítico descritivo transversal. Foram entrevistados 518 usuários, baseado no número de atendimento por dia (136), utilizando-se como instrumento de pesquisa o Questionário de Avaliação da Qualidade dos Serviços de Saúde Bucal (QASSaB). Os dados foram analisados pelo teste Qui-quadrado de Pearson, comparando os resultados entre os CEO. Prevaleceram: sexo feminino (67,8%), baixa escolaridade (67,8%) e renda (63,9%). Em relação à acessibilidade, apenas o tempo de espera na recepção (83,5%) foi considerado positivo, com destaque desfavorável à especialidade ortodontia no tempo para obter uma vaga. As demais dimensões analisadas tiveram avaliação positiva pelo estudo. Relacionando-se as unidades de serviço pesquisadas, houve diferenças estatisticamente significantes (p<0,05) na satisfação dos usuários para a maioria das dimensões analisadas, com exceção do 'auxílio de terceiros' e da 'resolutividade/ satisfação com o tratamento odontológico' (p>0,05). Concluiu-se que o nível de satisfação dos usuários participantes foi positivo, sendo a acessibilidade um problema impactante no sistema, devendo ser repensada no intuito de diminuir as eventuais insatisfações dos usuários.

ABSTRACT The objective of this research was to evaluate the satisfaction of users assisted in Regional Dental Specialties Centers (CEO-R) of Ceará, Brazil. It is a descriptive cross-sectional study. In those establishments, 518 users were interviewed, using the Oral Health Services Quality Assessment Questionnaire (QASSaB) as a research tool. The data collected were analyzed by Pearson's Chi-square test. Prevalence: female (67.8%), low schooling (67.8%) and income (63.9%). Regarding accessibility issues, only the waiting time at reception (83.5%) was considered positive, with unfavorable highlight to the specialty orthodontics in the time to obtain a vacancy. The other dimensions analyzed were positively evaluated by the study. Relating the service units surveyed, there were statistically significant differences (p<0.05) in the satisfaction of users for most of the dimensions analyzed, except for the 'third-party aid' questionnaire and the 'resolution / satisfaction' with dental treatment (p>0.05). It was concluded that the level of satisfaction of the users participating in the research was generally positive, with accessibility being an impacting problem in the system, which should be rethought in order to reduce any dissatisfaction among users who require the specialized dental service of the regional network health care.

Residência multiprofissional em saúde da família: percepções e sentidos para residentes graduados em odontologia / Multiprofessional residence in family health: perceptions and meanings for residents graduated in dentistry / Residencia multiprofesional en salud de la familia: percepciones y sentidos para residentes graduados en odontología

Objetivou-se desvelar os sentidos que graduados em odontologia participantes de programas de residência multiprofissional em saúde da família (RMSF) atribuem a esta modalidade de formação. Realizou-se entrevista semiestruturada com residentes de oito programas de diferentes regiões do país e as narrativas sobre o significado da RMSF para sua formação foram examinadas com base na análise de conteúdo do tipo temática. A maio-ria dos entrevistados declarou-se do sexo feminino (29/37) e tinha entre 20 e 30 anos de idade (33/37). A interpretação do material resultou em quatro categorias: formação para o Sistema Único de Saúde (SUS); Estratégia Saúde da Família; colaboração interprofissional; integralidade da atenção, subcategorizada em humanização do cuidado e rede de aten-ção. Indicaram-se evidências empíricas de que esses programas são muito relevantes para complementar a formação dos profissionais de odontologia que pretendem atuar no SUS.

The objective of this research was to unveil the meanings that undergraduates in dentistry participating in multiprofessional residency programs in family health (MRFH) attribute to this training modality. A semi-structured interview was conducted with residents of eight programs from different regions of the country and the narratives about the meaning of the MRFH for their formation were examined based on the thematic content analysis. Most participants were between 20 and 30 years of age (33/37). The interpretation of the material resulted in four categories: formation for Brazilian Health System (SUS); Family Health Strategy; interprofessional collaboration; integrality of care, subcategorized in humanization of care and care network, indicating by empirical evidences that these programs are very relevant to complement the training of dentistry professionals who intend to work in SUS.

Se objetivó desvelar los sentidos que graduados en Odontología, participantes de programas de residencia multiprofesional en salud de la familia (RMSF), atribuyen a esta modalidad de formación. Se realizó una entrevista semiestructurada con residentes de ocho programas de diferentes regiones del país, y las narrativas sobre el significado de la RMSF para su formación se examinaron con base en el análisis de contenido de tipo temático. La mayoría tenía entre 20 y 30 años de edad (33/37) y era del sexo femenino (29/37). La interpretación del material resultó cuatro categorías: formación para el Sistema Único de Salud (SUS); Estrategia Salud de la Familia; colaboración interprofesional; e integralidad de la atención, subcategorizada en humanización del cuidado y red de atención. Las evidencias empíricas indicaron que esos programas son muy relevantes para complementar la formación de los profesionales de Odontología que pretenden actuar en el SUS.

Cyclohexane selective photocatalytic oxidation by anatase TiO2: influence of particle size and crystallinity.

A systematic study is presented on the effect of crystallite size of Anatase (Hombikat, Sachtleben), varied by calcination at different temperatures up to 800 degrees C, on photocatalytic activity in cyclohexane selective oxidation. Two different reactors were used to test the materials: a top illumination reactor and an in situ ATR-FTIR cell. Properties such as crystallinity and associated availability of holes and electrons for surface reactions, as well as the amount of surface OH-groups, are shown to have a significant influence on TiO(2) activity, (surface) selectivity, and stability. Upon increasing the crystallite size, productivity (g(-1)(catalyst)) decreases, while (i) the TOF (moles of cyclohexanone formed per minute per OH-site), (ii) the rate of cyclohexanone desorption, (iii) catalytic site stability, and (iv) the cyclohexanol/cyclohexanone ratio increase. The results are discussed on the basis of a reaction scheme, and a simple reaction rate equation.

Experimental evidence for electron localization on Au upon photo-activation of Au/anatase catalysts.

Time resolved microwave conductivity (TRMC) measurements show that the presence of Au on anatase Hombikat UV100 significantly reduces the lifetime of mobile electrons formed by photo-excitation of this photocatalyst at 300 nm, providing evidence for the widely acclaimed electron localization effect of Au in promoting TiO(2) photocatalysts. Electron localization efficiency of Au was even higher for Au-promoted Hombikat calcined at 400 degrees C, explained by enlargement of the anatase particle size and the associated, relatively larger fraction of anatase particles in direct contact with Au.

An optimized method for determination of benzene in exhaled air by gas chromatography-mass spectrometry using solid phase microextraction as a sampling technique.

The determination of benzene in exhaled air has contributed for the increase in the use of breath analysis in biological monitoring. This paper describes SPME as a sampling technique for determining benzene in exhaled air by GC-MS. A system was developed to generate a gaseous benzene standard by a permeation method to accomplish the breath analyses. The method presented good resolution, repeatability (the mean of %RSD values for intra-day measurements was 6.3), sensitivity (2.4 and 3.1 ppb for LOD and LOQ, respectively), and linearity of response (R(2)=0.994). After optimizing the conditions, analyses of real samples were performed on two groups (exposed and not exposed to benzene). The results presented an average of 8.2 ppb for the control group and 25.3 ppb for the exposed group.