Economic Impact of the COVID-19 Pandemic among Dentists in One of the Poorest Brazilian States: A Cross-Sectional Study

ABSTRACT Objective: To analyze the impact of the COVID-19 pandemic on dentists' income and to identify associated factors in one of the poorest Brazilian states. Material and Methods: A cross-sectional study including dentists who volunteered to answer an electronic questionnaire in Maranhão. Hierarchical multinomial logistic regression analyses were performed, estimating crude and adjusted odds ratios (OR) and respective 95% confidence intervals (95%CI) (alpha=5%). Results: The COVID-19 pandemic impacted the professionals´ income negatively [55.44% (50.26-60.52%)] and also positively [6.9% (4.55-9.94%)]. The negative impact on income was greater among male dentists (OR=2.54; 95%CI: 1.16-5.53), over 30 years of age (OR=3.03; 95%CI: 1.34-6.87), with family income below two minimum wages (OR=4.63; 95%CI: 1.50-14.30), who worked in the continent instead of in the capital island (OR=2.21; 95%CI: 1.14-4.29) and in the private sector (OR=31.43; 95%CI: 11.59-85.22). Moreover, those who had been tested for COVID-19, with a negative result, had a 21.3-fold greater chance of having an increased household income when compared to those who had not been tested. Conclusion: The COVID-19 pandemic negatively impacted the dentists' income in Maranhão, especially the older, males, with lower incomes, and who worked in the private sector, living far from the capital. The SUS played an important role in the social protection of dentists during the COVID-19 pandemic, mitigating the economic impacts on the public sector working class.

Avaliação da satisfação do usuário no serviço de saúde bucal: revisão integrativa da literatura / Evaluation of patient satisfaction in the oral health service: integrative literature review

Resumo Introdução A avaliação da satisfação de usuários no serviço de saúde bucal tem sua relevância enquanto medida de efeito da atenção à saúde, sobre os aspectos biopsicossociais dos usuários, contudo são escassos os estudos de revisão de literatura sobre o tema. Objetivo Esta revisão integrativa buscou analisar os estudos de avaliação da satisfação de usuários em serviços de saúde bucal, segundo as características metodológicas dos artigos, atributos utilizados, perfil dos usuários e fatores relacionados à satisfação, bem como potencialidades e limitações dos estudos. Método Foi executada uma busca nas bases de dados BBO, Pubmed e Lilacs, para leitura de títulos e resumos e inclusão dos estudos sobre avaliação da satisfação de usuários em serviços de saúde bucal, utilizando os descritores "saúde bucal" e "satisfação do paciente". Resultados A satisfação esteve associada à autopercepção quanto à saúde bucal, às relações humanas entre usuários e profissionais, à forma de agendamento de consultas. A principal limitação encontrada foi a predominância de respostas positivas dos usuários, devido ao "viés de gratidão" e ao grau de subjetividade na determinação da satisfação. Conclusão As pesquisas apresentam potencialidades quanto ao controle social, empoderamento do usuário e qualificação da gestão e planejamento da atenção odontológica.

Abstract Background The assessment of the satisfaction of patient in the oral health service has its relevance as a measure of effect of health care, on the biopsychosocial aspects of patients, however the literature review studies on the subject are scarce. Objective This integrative review aimed to analyze the studies evaluating the satisfaction of patient in oral health services, according to the methodological characteristics of the research articles, attributes used, patients' profile and factors related to satisfaction, and the potential and limitations of the studies. Method A search was performed on the databases BBO, Pubmed e Lilacs, for inclusion of studies about satisfaction of patient in the oral health service, 02 descriptors were used: "oral health" and "patient satisfaction". Results Satisfaction was associated with self-perception about oral health, human relations between patients and professionals, and the way to scheduling consultations. The main limitation found was the predominance of positive responses from patients, due to the "gratitude bias" and the subjectivity in determining satisfaction. Conclusion This research has potential in terms of social control, user empowerment and qualification of management and planning of dental care.

Oral health care for people with disabilities in Brazil: Transition from the specialized dental services between 2014 and 2018.

OBJECTIVE: To identify changes in the dental service provision to people with disabilities (PD) in the Dental Specialties Centers (acronym CEO in Portuguese-Centro de Especialidades Odontológicas) between the first and second cycles of the Program for the Improvement of Access and Quality of CEO and analyse factors associated with any changes. METHODS: This nationwide ecological time series study adopted the CEO as the analysis unit. The 827 CEO who participated in the two program's cycles (2014 and 2018) were included. Data on the structure and the work process were considered to identify features of providing services to PD in both cycles. Latent transition analysis (LTA) was performed to identify latent status (LS) with similar features and model the transition between LS over time. Models with five variables and with two to five LS were tested, considered best conceptual interpretability and best model fit parameters: human resources structure (dentist working exclusively with PD) and work process that identified guarantee of PD treatment at the CEO, the CEO's interface with primary care, and the interface with tertiary care. Spatial analysis was performed to identify spatial patterns of LS in the Brazilian territory with choropleth maps. A multinomial logistic regression model was performed to identify factors associated with changes in the provision of CEO (improved, remained or worsened). FINDINGS: The best-fit model identified four LS: 'Better', 'Medium better', 'Medium worse' and 'Worse'. CEO remained in the LS 'Better' (94%), LS 'Medium' (5.3%) and LS 'Worse' (78.4%). It is noteworthy that the highest proportion of CEO, in both cycles, was in the LS 'Better', featured by the CEO, characterized by all the CEO guaranteeing treatment to users with PD, high proportions of professionals working exclusively with PD, and most CEO articulated with primary care and with tertiary care. However, there is a decrease in the number of postgraduate professionals specializing in this service profile (1.3%). The higher the population growth, the greater the likelihood of the CEO achieving 'improved' in the LS. Moreover, the higher the number of goals, the lower the likelihood of the CEO getting 'worse' in the LS. CONCLUSION: Advances in dental service provision were observed, with more significant transitions to the 'Better' class, with improvements mainly in the interface with primary and tertiary care. Disability will be an even more significant concern as the population ages. Initiatives that can remove barriers and empower PD are potent in the provision of oral health services.

User satisfaction with Dental Specialty Centers in Brazil: Proposal of satisfaction index and associated factors.

OBJECTIVES: To investigate the satisfaction of users of Dental Specialty Centers (CEO) in Brazil employing the Service Satisfaction Index (SSI) and identify associated factors. METHODS: This quantitative, evaluative, and cross-sectional study used secondary data extracted from the Second External Evaluation of the Program for the Improvement of Access and Quality of Brazilian Dental Specialty Centers (PMAQ-CEO) held in 2018 in 901 municipalities, accounting for 1097 CEO, of which 1042 were investigated. A total of 10391 users participated in the study. Considering user satisfaction as an aggregate variable, SSI was classified into two categories: Lower Satisfaction (SSI < 20) and Maximum Satisfaction (SSI = 20). Data were analyzed by descriptive and inferential statistics using the SPSS® software. The exploratory factor analysis verified the statistical correlations between attributes and SSI. RESULTS: The maximum satisfaction with the service was 21.1%; factors that expressed the most significant influence on SSI were waiting time (OR = 1.17; CI 95%: 1.05-1.31), feeling that CEO has good conditions of use (OR = 7.05; CI 95%: 5.15-9.65), not wishing to be assisted at another CEO (OR = 4.17; CI 95%: 3.12-5.57), not having treatment interrupted due to lack of material (OR = 2.05; CI 95%: 1.70-2.47), age up to 40 years of users (OR = 1.31; CI 95%: 1.18-1.46) and higher education (OR = 1.30; CI 95%: 1.14-1.49). CONCLUSIONS: SSI appropriately described the user's satisfaction with the service. The maximum satisfaction with the service was influenced by age, education, waiting time, not having treatment interrupted, and considering CEO clean and hygienic environment.

Advances and weaknesses of the work process of the oral cancer care network in Brazil: A latent class transition analysis.

OBJECTIVE: To analyse the provision of oral cancer (OC) care services in the Dental Specialties Centers (Centros de Especialidades Odontológicas-CEO) in Brazil and identify changes over two cycles of external evaluation of the Program for the Improvement of Access and Quality-PMAQ, in 2014 and 2018. METHOD: This is a nationwide panel ecological study, including 916 CEO. Data from interviews with managers and dentists of the CEO were used, including variables related to training on OC, clinical protocols, biopsies, referral for diagnosis and treatment, and registration of users with OC. We carried out Latent Transition Analysis (LTA) to identify patterns (latent status LS) of service adequacy and work processes' changes between the two assessment cycles. We tested models with three, four, and five LS, selecting the one with the best conceptual interpretability and good model fit parameters. Data from the LS were plotted on choropleth and hotspots maps in Brazil allowing us to identify areas with the better or worse provision of specialized OC services. RESULTS: The model with four LS was chosen. The four LS were named: 1.'Most indicators inadequate for OC care' (the worst); 2. 'Most indicators suitable for OC care' (the best); 3. 'CEO with a poor relation with Primary Health Care (PHC) services'; and 4. 'CEO with a poor relation with tertiary hospital services'. The comparison of the LS transition between the two cycles revealed that 419 (45.7%) CEO remained in the same LS (1→1, 3→4, 2→2); 228 (24.9%) switched to a worse status (2→1, 2→4, 3→1) and 269 (29.4%) switched to a better LS (1→2, 1→4, 3→2). While the majority of the CEO improved, we identified a decline of 17.8% in those who reported performing biopsies and 18.3% in the number of CEO that had hospitals for referring confirmed OC cases. Almost all Brazilian states had CEO that improved the work process. The Southeast and South regions had the highest percentage of CEO with the better work process in both cycles. Hotspots showed areas concentrating improvements in the work process in the Northeast region. However, some hotspots in the North revealed some CEO where the work process deteriorated or remained unsatisfactory. CONCLUSIONS: There are regional inequities in the provision of OC care in CEO. Most services improved their work process or remained stable. However, the biopsies and the referral to hospital care for confirmed cases declined, indicating that CEO need to improve planning and care provision to reduce OC morbimortality.

Observatório de Saúde Bucal/UFPE: ações estratégicas de gestão da informação e de saúde digital em saúde bucal para melhoria da governança no SUS / Oral Health Observatory/UFPE: strategic information management and digital health actions in oral health to improve governance in SUS

O programa de extensão Observatório de Saúde Bucal (OSB/UFPE) objetiva a gestão da informação e desenvolvimento de ferramentas digitais para amelhoria da governança na saúde bucal no Sistema Único de Saúde (SUS), por meiodo desenvolvimento de pesquisa-ensino-extensão. Atualmente, abriga dois projetos: (1) Saúde Digital­desenvolvimento de ferramentas eletrônicas para avaliação de serviços e programas de saúde­e (2) Gestão da Informação em Saúde Bucal. A execução das ações tem caráter remoto, nas plataformas digitais e presenciais no Laboratório de Gestão da Informação em Saúde Bucal. Para cada projeto,visandomelhorar a qualificação dos atores envolvidos, tem havidoseminários, cursos e eventos, bem como a disponibilização de produtos técnicos e científicos: pesquisas com estudantes de graduação e pós-graduação; elaboração e divulgaçãodeboletins analíticos de serviços de saúde; desenvolvimento e uso de ferramentas de saúde digital.O OSB constituiu-secomo umarede colaborativa de trabalho com agentes múltiplosda academia(docentes, graduandos, residentes, mestrandos e mestres da área de Saúde Coletiva e Informática) e do serviço (gestores municipais e estadual, gerentes, profissionais e usuários dos serviços odontológicos do SUS),os quais se articulam sistematicamente para implementação das ações desenvolvidas conjuntamente. A operacionalização deste programa tem promovido a integraçãocom oserviço, visando à melhoria das práticas da gestãoe da atuação de profissionais nessa áreae tem contribuídoparaa tomada de decisão ágil e oportuna, pautada na evidência científica, possibilitando melhoria de qualidade e promoção de saúde (AU).

The Oral Health Observatory extension program (OSB/UFPE) aims to manage information and develop digital tools that improve the governance in oral health in the Unified Health System (SUS), through the development of research-teaching-extension. It currently shelters two projects: (1) Digital Health ­development of electronic tools for the evaluation of services and health programs ­and (2) Oral Health Information Management. The execution of these actions has a remote nature, in digital platforms and on-site at the Oral Health Information Management Laboratory. Aiming to improve the qualification of the actors involved, there has been seminars, courses, and events for each project, as well as the provision of technical and scientific products: research with undergraduate and post-graduate students; elaboration and dissemination of analytical newsletters for health services; development and use of digital health tools. The OSB is a collaborative support work network with multiple academic representatives (professors, undergraduates, residents, masters, and masters in the field of Public Health and Informatics) and services (city and state administrators, managers, professionals, and users of the dental services of the SUS), in which systematically coordinate to implement actions developed collectively. The operationalization of this program has promoted the integration with the service, aiming the improvement of management practices and the practice of professional in this field and has contributed to rapid and timely decision-making, guided on scientific evidence, enabling the improvement of the quality and promotion of health (AU).

[Fluoride levels in springs and water sources and in the public supply networks of municipalities in the State of Pernambuco, Brazil]. / Teores de flúor em mananciais e na rede de abastecimento público de municípios de Pernambuco, Brasil.

Fluoridation is considered an effective and wide-ranging measure in combatting dental caries. Despite being mandatory in Brazil since 1974, the implementation continues to be unequal throughout the country. The objective was to describe and analyze fluorine levels in the waters of the public supply grid of the 2nd macro region of the state of Pernambuco in municipalities with 50,000 inhabitants or more. This is a descriptive study based on a comparison of data from Pernambuco Sanitation Company (Compesa), the Vigifluor Project, the Water Quality Surveillance Information System for Human Consumption (Sisagua) the Brazilian Institute of Geography and Statistics (IBGE) and the National Sanitation Information System (SNIS), on the fluoridation of water in municipalities of the 2nd health macro region of Pernambuco. Although the municipalities studied do not have artificial fluoridation, significant levels of natural fluorine were found in the sources that supply the regions. However, these levels of fluorine do not remain constant in the waters of the supply network of the municipalities studied, therefore there is no effective prevention against caries. Artificial fluoridation is an effective measure in preventing caries and should therefore be expanded in regions that are not yet fluoridated.

A fluoretação é considerada uma medida eficaz e de grande abrangência no combate à cárie dentária. Apesar de ser obrigatória no Brasil desde 1974, sua implantação permanece de forma desigual no país. Teve-se como objetivo descrever e analisar os teores de flúor nas águas da rede pública de abastecimento da 2ª macrorregião do estado de Pernambuco em municípios com 50.000 habitantes ou mais. Trata-se de um estudo descritivo a partir da comparação de dados da Companhia Pernambucana de Saneamento (Compesa), do projeto Vigiflúor, do Sistema de Informação de Vigilância da Qualidade da Água para Consumo Humano (Sisagua), do Instituto Brasileiro de Geografia e Estatística (IBGE) e do Sistema Nacional de Informação sobre Saneamento (SNIS) acerca da fluoretação de águas em municípios da 2ª macrorregião de saúde de Pernambuco. Apesar dos municípios estudados não possuírem fluoretação artificial, teores significativos de flúor natural foram encontrados nos mananciais que abastecem a região. No entanto, esses valores de flúor não permanecem constantes nas águas da rede de abastecimento dos municípios estudados, não havendo, portanto, efeito preventivo contra a cárie. A fluoretação artificial é uma medida eficaz na prevenção da cárie, portanto deve ser expandida nas regiões ainda não fluoretadas.

Estudo comparativo entre indicadores assistenciais de saúde bucal na Atenção Básica em Recife, Pernambuco / Oral healthcare comparative study among indicators in Primary Care, in Recife, Pernambuco

RESUMO A rede de atenção à Saúde Bucal (SB) se ampliou com a Política Nacional de Saúde Bucal, sendo os indicadores ferramentas para avaliar conquistas ou necessidade de mudanças. Este trabalho objetivou analisar indicadores de SB da Atenção Básica por tipo de organização das unidades de saúde em Recife, 2018. Trata-se de um estudo transversal, de natureza descritiva e analítica com base em dados secundários. Analisou-se a associação entre tipos de organização da Atenção Básica (Unidade de Saúde da Família - USF; Upinha e Unidade Básica Tradicional - UBT) e indicadores assistenciais de SB, através dos testes qui-quadrado e Kruskal-Wallis (p<0,05). A cobertura de primeira consulta odontológica e os procedimentos odontológicos per capita apresentaram mediana maior nas UBT, 31,8% (p=0,00) e 0,6 (p=0,127), respectivamente. A proporção de exodontia e procedimentos clínicos foi maior nas USF com mediana 8,2% (p=0,703). As USF foram as que realizaram o maior número de atividades coletivas de escovação dental supervisionada (45,3%, p=0,082) e aplicação de flúor (44,6%, p=0,174). Conclui-se que as UBT apresentaram melhores resultados nos indicadores relacionados ao acesso ao tratamento clínico e as USF realizaram mais ações coletivas de prevenção.

ABSTRACT The Oral Health care network (OH) has expanded with the National Oral Health Policy, and the indicators are tools to assess achievements or the need for changes. This study aimed to analyze the OH indicators of Primary Care Basic by health units organization type in Recife, 2018. This is a cross-sectional, quantitative, descriptive and analytical study, based on secondary data. The association between organization type of Primary Care (Family Health Unity/USF; Upinha and Traditional Basic Health Unit/UBT) and OH assistance indicators was analyzed using the chi-square and Kruskal-Wallis tests (p<0,05). The first dental appointment coverage and the average number of procedures per capita showed a higher median in the UBT, 31,8% (p=0,00) and 0,6 (p=0,127), respectively. The tooth extraction proportion was higher in the USF, with a median of 8,2% (p=0,703). The USF were the ones that performed the largest number of collective activities of supervised tooth brushing (45.3%, p=0.082) and fluoride application (44.6%, p=0.174). It is concluded that the UBT showed better results in the indicators related to access to clinical treatment and the USF performed more collective activities.

Specialized dental care for people with disabilities in Brazil: profile of the Dental Specialty Centers, 2014. / Atenção odontológica especializada para pessoas com deficiência no Brasil: perfil dos centros de especialidades odontológicas, 2014.

OBJECTIVE: To describe the oral health care services for people with disabilities treated within the Dentistry for Patients with Special Needs (PSN) specialty. METHODS: This was a cross-sectional study with data from the Program for Improving Access and Quality of Dental Specialty Centers (PMAQ-CEO) in 2014. RESULTS: Of the total of 932 services evaluated, 89.8% did provide care for PSNs, 30.4% had physical accessibility, 59.7% provided referral to hospital care and most guaranteed complete treatment. Only a third of the Dental Specialty Centers planned 40 or more hours a week for providing clinical care to PSNs. CONCLUSION: The care network for people with disabilities is being formed but, even with specific financial incentives, it has limitations. Services need to eliminate physical and attitudinal barriers to ensure universal accessibility. Protocols based on risk classification are necessary, prioritizing care at DSCs for complex cases not attended to in Primary Care and organizing the dental health care network for people with disabilities.

Atenção odontológica especializada para pessoas com deficiência no Brasil: perfil dos centros de especialidades odontológicas, 2014 / Atención odontológica especializada para personas con discapacidad en Brasil: perfil de los centros de especialidades odontológicas, 2014 / Specialized dental care for people with disabilities in Brazil: profile of the Dental Specialty Centers, 2014

Objetivo: Descrever os serviços de atenção à saúde bucal para pessoas com deficiência, atendidas pela especialidade Odontologia para Pacientes com Necessidades Especiais (PNE). Métodos: Estudo transversal, com dados do Programa de Melhoria do Acesso e Qualidade dos Centros de Especialidades Odontológicas (PMAQ-CEO), 2014. Resultados: Dos 932 serviços avaliados, 89,8% contavam com atendimento a PNEs, 30,4% apresentavam acessibilidade física e 59,7% contavam com referência para atendimento hospitalar. A maioria garantia tratamento completo. São disponibilizadas 40h semanais de atendimento clínico a PNEs em 1/3 dos CEOs. Conclusão: A rede de cuidado para pessoas com deficiência encontra-se em formação e, apesar dos incentivos financeiros específicos, apresenta limitações. Os serviços precisam eliminar barreiras físicas e atitudinais para garantir acessibilidade universal. Protocolos baseados em classificação de risco são necessários, priorizando atendimento no CEO dos casos complexos, não atendidos na Atenção Básica e organizando a rede de cuidados em saúde bucal da pessoa com deficiência.

Objetivo: Describir los servicios de atención a la salud bucal para personas con discapacidad, atendidos por la especialidad Odontología para Pacientes con Necesidades Especiales (PNE). Métodos: Estudio transversal, con datos del Programa de Mejora del Acceso y Calidad de los Centros de Especialidades Odontológicas (PMAC-CEO), 2014. Resultados: Se evaluaron 932 servicios: 89,8% contaba con atención a los PNEs, 30,4% tenía accesibilidad física y 59,7% tenía referencia para atención hospitalaria. La mayoría garantía tratamiento completo. Sólo 1/3 ofrecían 40hs semanales de atención PNE. Conclusión: La red de atención para personas con discapacidades se está formando, y a pesar de los incentivos financieros específicos, tiene limitaciones. Los servicios necesitan eliminar las barreras físicas y de actitud para garantizar la accesibilidad universal. Protocolos basados en clasificación de riesgo son necesarios, priorizando la atención en el CEO de los casos complejos, no atendidos en la atención básica y organizando la red de atención en salud bucal de la persona con discapacidad.

Objective: To describe the oral health care services for people with disabilities treated within the Dentistry for Patients with Special Needs (PSN) specialty. Methods: This was a cross-sectional study with data from the Program for Improving Access and Quality of Dental Specialty Centers (PMAQ-CEO) in 2014. Results: Of the total of 932 services evaluated, 89.8% did provide care for PSNs, 30.4% had physical accessibility, 59.7% provided referral to hospital care and most guaranteed complete treatment. Only a third of the Dental Specialty Centers planned 40 or more hours a week for providing clinical care to PSNs. Conclusion: The care network for people with disabilities is being formed but, even with specific financial incentives, it has limitations. Services need to eliminate physical and attitudinal barriers to ensure universal accessibility. Protocols based on risk classification are necessary, prioritizing care at DSCs for complex cases not attended to in Primary Care and organizing the dental health care network for people with disabilities.

Characterization of Dental Surgeons of Pernambuco State in the COVID-19 Pandemic Context: Preliminary Data

Abstract Objective: To present the results of preliminary research on the characterization of dental surgeons in the state of Pernambuco, during a pandemic of COVID-19. Material and Methods: This is a cross-sectional, descriptive, and exploratory study, whose population was composed of dental surgeons with active enrollment in the Regional Dentistry Council of Pernambuco. Data collection was performed using an electronic form and included characterization of professionals (gender, age, time since graduation, marital status, family income and field of work) and health status (vaccination schedule, presence of comorbidities, biosafety knowledge and testing for COVID-19). Preliminary data correspond to the first week of collection, which were analyzed from the frequency, proportions, and measures of central tendency distributions. Results: Of the 363 dental surgeons, for the field of work, 38.6% work in both the public and private sectors. Comorbidities related to the worsening of COVID-19 were identified in 35.0% of participants, 24.5% are not up to date with influenza and hepatitis vaccines, and 79.3% have not been tested for COVID-19. Regarding the biosafety instructions for COVID-19, 30.7% received no training. Conclusion: It is necessary to immunize dental surgeons to prevent immunological diseases and expansion of the testing capacity for COVID-19, especially for professionals belonging to the risk group. In addition to guaranteeing the offer of qualification courses on biosafety, which is essential for the safe resumption of activities.

Development and validation of the Logical Model of the Neonatal Hearing Screening Program / Construção e validação do Modelo Lógico do Programa de Triagem Auditiva Neonatal

ABSTRACT Purpose: to develop and validate the logical model of the Neonatal Hearing Screening Program in the hearing health network. Methods: a methodological developmental research aimed to build the logical model of the Neonatal Hearing Screening Program and validate its content through a "consensus conference". The research was carried out in three stages: 1) Literature review, analysis of the normative documents, and official recommendations regarding the Neonatal Hearing Screening; 2) Development of the logical model; 3) Validation of the logical model through rounds of consultation with specialists. Results: based on the documentary analysis, the logical model was designed in three dimensions: (1) Education in Hearing Health, (2) Neonatal Hearing Screening, and (3) Administration. It was validated based on the judgment of specialists in the field. After the validation process, three variables in the "process" and one in the "structure" aspects, were adjusted, whereas another two aspects in "process" were excluded. Conclusion: the logical model presented the dimensions, activities, and results of the Neonatal Hearing Screening Program in practical and clear terms. Hence, it is useful not only to communicate and announce its results, but also to offer support to future evaluative research in the field of neonatal hearing health.

RESUMO Objetivos: elaborar e validar o modelo lógico do Programa de Triagem Auditiva Neonatal na rede de saúde auditiva. Métodos: estudo do tipo pesquisa de desenvolvimento metodológico com vistas a elaboração do Modelo Lógico do Programa de Triagem Auditiva Neonatal e sua respectiva validação de conteúdo por meio da "conferência de consenso". A pesquisa foi realizada em 3 etapas: 1) revisão de literatura, análise de documentos normativos e recomendações oficiais acerca da Triagem Auditiva Neonatal; 2) elaboração do modelo lógico; e 3) validação do mesmo por meio de rodadas de consulta a especialistas. Resultados: a análise documental possibilitou a delineação de um modelo lógico distribuído em três dimensões: (1) Educação em Saúde Auditiva, (2) Triagem Auditiva Neonatal e (3) Gestão, o qual foi validado com base no julgamento de especialistas na área. Após o processo de validação, três variáveis no aspecto "processo" e uma no aspecto "estrutura" receberam ajustes e duas variáveis do aspecto processo foram excluídas. Conclusão: o modelo lógico explicitou as dimensões, atividades e resultados do Programa de Triagem Auditiva Neonatal de forma prática e clara, podendo auxiliar tanto o processo de comunicação e divulgação de seus resultados, como também para oferecer subsídios para futuras pesquisas avaliativas na área da saúde auditiva neonatal.

Validation of an indicator matrix for the assessment of the Neonatal Hearing Screening Program / Validação de uma matriz de indicadores para avaliação do Programa de Triagem Auditiva Neonatal

ABSTRACT Purpose: to validate an indicator matrix to assess the Neonatal Hearing Screening Program (NHSP). Methods: methodology development research. A total of 13 speech-language-hearing therapists with a specialization in audiology and/or at least three-year experience in neonatal hearing screening participated in the validation process. Quantitative and qualitative data were collected to develop the indicator matrix, which was then submitted to the validation process. The results of the specialists' evaluation, in this stage, were quantitatively analyzed with the item content validation index (I-CVI) and scale content validation index (S-CVI). Results: regarding the indicators classified as quite or fully adequate, the mean I-CVI was the same as the mean S-CVI (0.95), evidencing excellence in their content validity. Concerning the scores classified as quite or fully adequate, the I-CVI mean was also identical to that of S-CVI (0.83), thus, reaching a consensus. Conclusion: this matrix with 33 indicators that had their content validated with consensus, will consistently contribute to assessing NHS services in Brazil.

RESUMO Objetivo: validar uma matriz de indicadores para avaliação do Programa de Triagem Auditiva Neonatal (PTAN). Métodos: pesquisa de desenvolvimento metodológico. Participaram do processo de validação 13 fonoaudiólogos com especialização em audiologia e/ou experiência em triagem auditiva neonatal por um período igual ou superior a 3 anos. Foram coletados dados quantitativos e qualitativos para elaboração da matriz de indicadores que, em seguida, foi submetida ao processo de validação. Os resultados da avaliação dos especialistas, nesta etapa, foram analisados quantitativamente por meio do Índice de Validação de Conteúdo por Item (I-IVC) e do Índice de Validação de Conteúdo por Escala (S-IVC). Resultados: quanto aos indicadores classificados como bastante ou totalmente adequados, a média do I-IVC foi igual a do S-IVC (0,95), o que evidenciou a excelência na validade de seu conteúdo. Em relação às Pontuações classificadas como bastante ou totalmente adequadas, a média do I-IVC também foi idêntica a do S-IVC (0,83), tendo sido considerada a obtenção do consenso. Conclusão: um conjunto de 33 indicadores foram validados no aspecto do conteúdo com a obtenção do consenso, cuja utilização poderá contribuir consistentemente para a avaliação dos serviços de TAN existentes no Brasil.

Evaluation of Specialized Oral Health Procedures Performed in Brazil in the Period from 2008 to 2012

Objective: To analyze the correlations between the production of specialized dental procedures from 2008 to 2012 and factors related to the services and context of the Brazilian states. Material and Methods: A quantitative ecological-type study was developed, in which secondary data from Brazilian national databases were used. Procedures for outpatient production of specialized procedures throughout Brazil, from 2008 to 2012, were consolidated from the offering state, the state of the federation being the analysis unit. In order to collect data on coverage by oral health family teams in the Family Health Strategy, as well as the number of CEOs per state, the Strategic Support Management Room (SAGE) was accessed. The corresponding indicator mean proportion of specialized procedures in Brazil (Pmb) was used as dependent variable. Correlations were tested using Spearman's test. The software was Statistical Package for Social Sciences, v. 17.0, with a level of significance of 5%. Results: Pmb was 4.9% for the evaluated period. There was a negative correlation between indicator and the coverage of oral health teams in the family health strategy. Conclusion: The correlations analyzed were influenced by the organization and distribution of the professionals' workforce; revealing that the non-organization of the health care network may increase the performance of specialized procedures resulting from spontaneous demand due to the poor basic care coverage.

Equity in the Accessibility to Specialized Care in Oral Health in Brazil: Analysis of PMAQ-CEO External Evaluation Data According to the User's Perspective

Objective: To analyze the distribution of Centers of Dental Specialties (CEO) implemented in Brazil until 2014 and identify the contextual and individual variables associated with the geographical accessibility, considering the user's perspective. Material and Methods: The study was conducted with data from the Improving Access and Quality of CEOs (AVE/PMAQ CEO) External Evaluation and contextual characteristics of states and municipalities. The AVE/PMAQ CEO was an evaluative research with cross-sectional observational character, performed in all CEOs in Brazil, with 932 services evaluated and 8,897 users interviewed. Data analysis was conducted in two stages, considering the study dimensions. Analyses were conducted on the availability of units by region, state, population size of the municipality and contextual variables. Then, the relationship between explanatory variables and the user's displacement time and with the intention to change the service location was evaluated using generalized linear regression analysis. Results: The 932 CEOs evaluated were located in 780 of the 5,570 municipalities of the country and the majority was located in the northeastern (38.3%) and southeastern regions (36.2%), with the northern and midwestern regions presenting the lowest absolute number of units. The average displacement time to the CEO was 28.4 minutes, while the intention to change CEO location due to the distance from home was reported by 7.8% of users. Lower geographical accessibility was reported in the northern region and for individuals who reported living in the rural area and in cities with larger populations. Conclusion: The availability of CEOs in the country is still low and not equitably distributed among states and regions.

A Web-Based Tool for Monitoring and Evaluating Health Care Services: An Analysis of Centers for Dental Specialties Webpage

Objective: To evaluate the quality of Centers for Dental Specialties (CEO) using an electronic tool - the CEO webpage. Material and Methods: Evaluative research was carried out through the use of a web-based tool, which has two modules with forms for the evaluation of quality of CEO components to Managers and Professionals. The tool generates classification scores and recommendation letters according to the score obtained. Satisfactory classification was used for scores equal to or above 7.0 and unsatisfactory for scores lower than 7.0. Representatives of manager and professionals of CEOs who attended the invitation of the research were qualified to use the CEO webpage. Portal data were analyzed in a descriptive way and the average scores were tested according to service and context variables. Results: Thirty-eight health facilities were evaluated. The average score for CEOs was rated as satisfactory for both the Manager and Professional modules. However, when quality components were evaluated, there was higher concentration of unsatisfactory scores to those related to the work process, particularly to the quality components of Personnel Management; Social control and Financing; and, Organizational Criteria. Conclusion: The CEO webpage, for instantly generating evaluation and recommendations for change, is easy to handle and lacks minimal technological resources (computer with access to the internet network), has become a tool for information management that allows immediate decision making. In addition, they can make a major contribution to planning / management support in identifying critical aspects of the service that impair quality, with strong potential to serve as supplementary institutional support to PMAQ / CEO. Initiatives such as the CEO webpage should be encouraged and disseminated for use within Unified Health System.

Theoretical and Methodological Aspects of the External Evaluation of the Improvement, Access and Quality of Centers for Dental Specialties Program

Objective: To introduce the main theoretical and methodological aspects of the external evaluation of the 1st cycle National Program for Quality Evaluation (AEPMAQ/ CEO). Material and Methods: This is an evaluative and quantitative research carried out in all Centers for Dental Specialties - CEO of Brazil, and macro-geographical regions were taken into account for analysis. The general AE-PMAQ/CEO coordination was from the Collaborative Centre for Oral Health Surveillance of the Ministry of Health - Federal University of Pernambuco and Department for Primary Health Care of the Ministry of Health. A collaborative network was established to offer a scientific and technical support for the Project among different higher education institutions around the country, state oral health coordination and quality researchers of AE-PMAQ/CEO. Data collection was carried out through interviews with managers, dentists and users. In addition, researchers used an observation template to check for infrastructure and a questionnaire to register previously discussed quality standards. Conclusion: The external evaluation of the 1st cycle National Program for Quality Evaluation offered data to demonstrate and give recognition to CEO services and municipalities' managers to assure quality for specialized dental care.

Análise da Intersetorialidade no Programa Saúde na Escola / Cross-sectorial Analysis in the Health at Schools Program

RESUMO A pesquisa objetivou conhecer e analisar o processo da intersetorialidade no Programa Saúde na Escola (PSE)em um município da região metropolitana de Pernambuco. Trata-se de uma pesquisa qualitativa que abordou, por meio de entrevista semiestruturada, profissionais da saúde e da educaçãonas 20 primeiras escolas que aderiram ao PSE desde seu lançamento no município. Os dados foram analisados por meio da análise de conteúdo proposta por Bardin, associada ao programa computacional NVivo®, assim como também foi utilizado o diário de campo. A pesquisa revelou que o maior dilema é operar uma política necessariamente intersetorial, explicitada num ambiente com atores que possuem agendas setoriais previamente montadas e sem espaço suficiente para a correta execução da política, o que leva à dificuldade de conciliar os tempos institucionais dos vários setores e o comprometimento e envolvimento setorial, impedindo a sustentabilidade das ações. Mudanças estão sendo implementadas, mas o que se observa é a escassez de capacitação e educação permanente, além da inexistência de protocolos que norteiem o desenvolvimento de ações intersetoriais.

ABSTRACT This research aimed to identify and analyze the process of cross-sectorialcooperation in the Health at Schools Program in a cityin Pernambuco state. Through semi-structured interviews this qualitative research addressed health care and education professionals in the first 20 schools that joined the PSE since its launch in the city. Data were analyzed using content analysis proposed by Bardin, associated with the computer program NVivo ®, as well as field diary also being used. The survey revealed that the biggest dilemma is to operate a necessarily cross-sectorial policy explained in an environment with actors that have previously established sectorial agendas and without sufficient space for the correct implementation of the policy, which leads to difficulty in reconciling institutional times of the various sectors and the sector involvement and commitment, preventing the sustainability of actions. Changes are being implemented, but what can be seen is the lack of training and continuing education, besides the lack of protocols to guide the development of cross-sectorial actions.

The Interface between Primary Care and Emergency Dental Services (SOU) in the SUS: the interface between levels of care in oral health.

Considering that emergency dental services include the referral network and the counter-referral network, interacting at the intersection between primary, secondary and tertiary healthcare, this study aims to describe the interface between primary healthcare (APS - Atenção Primária a Saúde), particularly of the Family Health Strategy, and secondary care in oral health, using the Emergency Dental Services (SOU), in the municipality of Recife. It is a qualitative, exploratory and descriptive case study. The data was collected through semi-structured interviews. Classical ALCESTE analysis was used based on the Descending Hierarchical Classification Dendrogram, making it possible to understand the expressions and each one of the words spoken by the dental health professionals, analyzing them using their social places and contexts as a starting point. What we found was only a fragile degree of integration, and little capacity for solution, between the levels of care - a partially disconnected network. Undoubtedly the problems with the interface between primary care and the emergency services in oral health are multiple and complex. The individual solutions have low efficacy, and are complex in their operation.

A Interface entre a Atenção Primária e os Serviços Odontológicos de Urgência (SOU) no SUS: a interface entre níveis de atenção em saúde bucal / The Interface between Primary Care and Emergency Dental Services (SOU) in the SUS: the interface between levels of care in oral health

ResumoConsiderando que os serviços de urgência odontológica compõem a rede de referência e contrarreferência, interagindo na intersecção do atendimento primário, secundário e terciário, a presente pesquisa visou descrever a interface entre a atenção primária à saúde (APS), particularmente da Estratégia de Saúde da Família, e a atenção secundária em saúde bucal, utilizando-se dos Serviços Odontológicos de Urgência (SOU), no município do Recife. Trata-se de um estudo de caso qualitativo, exploratório e descritivo. A coleta de dados se deu a partir da realização de entrevistas semiestruturadas. Foi utilizada a análise clássica do ALCESTE a partir do Dendograma de Classificação Hierárquica Descendente, permitindo compreender as expressões e cada uma das palavras pronunciadas pelos profissionais de odontologia, analisando-as a partir de seus lugares e inserções sociais. Evidenciamos uma frágil integração e pouca resolutividade entre os níveis de atenção, apresentando uma rede parcialmente desconectada. Indubitavelmente os problemas com a interface entre a atenção primária e os serviços de urgência em saúde bucal são múltiplos e complexos. As soluções individuais possuem baixa efetividade, sendo estas complexas em sua operacionalização.

AbstractConsidering that emergency dental services include the referral network and the counter-referral network, interacting at the intersection between primary, secondary and tertiary healthcare, this study aims to describe the interface between primary healthcare (APS – Atenção Primária a Saúde), particularly of the Family Health Strategy, and secondary care in oral health, using the Emergency Dental Services (SOU), in the municipality of Recife. It is a qualitative, exploratory and descriptive case study. The data was collected through semi-structured interviews. Classical ALCESTE analysis was used based on the Descending Hierarchical Classification Dendrogram, making it possible to understand the expressions and each one of the words spoken by the dental health professionals, analyzing them using their social places and contexts as a starting point. What we found was only a fragile degree of integration, and little capacity for solution, between the levels of care – a partially disconnected network. Undoubtedly the problems with the interface between primary care and the emergency services in oral health are multiple and complex. The individual solutions have low efficacy, and are complex in their operation.