How different attributes are weighted in professionals' decision-making in Pediatric Dentistry-a protocol for guiding discrete choice experiment focused on shortening the evidence-based practice implementation for dental care.

BACKGROUND: Important evidence has been constantly produced and needs to be converted into practice. Professional consumption of such evidence may be a barrier to its implementation. Then, effective implementation of evidence-based interventions in clinical practice leans on the understanding of how professionals value attributes when choosing between options for dental care, permitting to guide this implementation process by maximizing strengthens and minimizing barriers related to that. METHODS: This is part of a broader project investigating the potential of incorporating scientific evidence into clinical practice and public policy recommendations and guidelines, identifying strengths and barriers in such an implementation process. The present research protocol comprises a Discrete Choice Experiment (DCE) from the Brazilian oral health professionals' perspective, aiming to assess how different factors are associated with professional decision-making in dental care, including the role of scientific evidence. Different choice sets will be developed, either focusing on understanding the role of scientific evidence in the professional decision-making process or on understanding specific attributes associated with different interventions recently tested in randomized clinical trials and available as newly produced scientific evidence to be used in clinical practice. DISCUSSION: Translating research into practice usually requires time and effort. Shortening this process may be useful for faster incorporation into clinical practice and beneficial to the population. Understanding the context and professionals' decision-making preferences is crucial to designing more effective implementation and/or educational initiatives. Ultimately, we expect to design an efficient implementation strategy that overcomes threats and potential opportunities identified during the DCEs, creating a customized structure for dental professionals. TRIAL REGISTRATION: https://osf.io/bhncv .

The association of the Bolsa Familia Program with children's oral health in Brazil.

BACKGROUND: Several studies have demonstrated that Conditional Cash Transfer (CCT) programs reduce poverty/inequity and childhood mortality. However, none of these studies investigated the link between CCT programs and children's oral health. This study examines the association between receiving the Brazilian conditional cash transfer, Bolsa Familia Program (BFP), and the oral health of five-year-old children in the Northeast of Brazil. METHODS: We conducted a cross-sectional study with 230 caregivers/children randomly selected in primary health care clinics in the city of Fortaleza in 2016. Interviews and oral health examinations were performed. Descriptive statistics and multiple logistic regression analyses were conducted to identify factors associated with dental caries among five-year-old children enrolled in the BFP. RESULTS: Around 40% of children enrolled in the BFP had dental caries. However, those who received Bolsa Familia (BF) for a period up to two years (OR = 0.13, 95% CI 0.05-0.35) had substantially lower adjusted odds of having dental caries than those who had never received BF. In addition, the association of BF and dental caries was more prominent among extremely poor families (OR = 0.05, 95% CI 0.01-0.28). CONCLUSIONS: Although initial enrolment in the BFP predicted low dental caries among five-year-old children, the prevalence of dental caries in this population is still high, thus, public health programs should target BF children's oral health. An ongoing effort should be made to reduce oral health inequalities among children in Brazil.

Brazilian immigrants' oral health literacy and participation in oral health care in Canada.

BACKGROUND: Inadequate functional health literacy is a common problem in immigrant populations. The aim of this study was to investigate the association between oral (dental) health literacy (OHL) and participation in oral health care among Brazilian immigrants in Toronto, Ontario, Canada. METHODS: The study used a cross-sectional design and a convenience sample of 101 Brazilian immigrants selected through the snowball sampling technique. Data were analyzed using descriptive statistics and logistic regression modeling. RESULTS: Most of the sample had adequate OHL (83.1 %). Inadequate/marginal OHL was associated with not visiting a dentist in the preceding year (OR = 3.61; p = 0.04), not having a dentist as the primary source of dental information (OR = 5.55; p < 0.01), and not participating in shared dental treatment decision making (OR = 1.06; p = 0.05; OHL as a continuous variable) in multivariate logistic regressions controlling for covariates. A low average annual family income was associated with two indicators of poor participation in oral health care (i.e., not having visited a dentist in the previous year, and not having a dentist as regular source of dental information). CONCLUSION: Limited OHL was linked to lower participation in the oral health care system and with barriers to using dental services among a sample of Brazilian immigrants. More effective knowledge transfer will be required to help specific groups of immigrants to better navigate the Canadian dental care system.

Factors associated with unmet dental care needs in Canadian immigrants: an analysis of the longitudinal survey of immigrants to Canada.

BACKGROUND: Immigrants are often considered to have poorer oral health than native born-populations. One possible explanation for immigrants' poor oral health is lack of access to dental care. There is very little information on Canadian immigrants' access to dental care, and unmet dental care needs. This study examines predictors of unmet dental care needs among a sample of adult immigrants to Canada over a three-point-five-year post-migration period. METHODS: A secondary data analysis was conducted on the Longitudinal Survey of Immigrants to Canada (LSIC). Sampling and bootstrap weights were applied to make the data nationally representative. Simple descriptive analyses were conducted to describe the demographic characteristics of the sample. Bivariate and multiple logistic regression analyses were applied to identify factors associated with immigrants' unmet dental care needs over a three-point-five-year period. RESULTS: Approximately 32% of immigrants reported unmet dental care needs. Immigrants lacking dental insurance (OR = 2.63; 95% CI: 2.05-3.37), and those with an average household income of $20,000 to $40,000 per year (OR = 1.62; 95% CI: 1.01-2.61), and lower than $20,000 (OR = 2.25; 95% CI: 1.31-3.86), were more likely to report unmet dental care needs than those earning more than $60,000 per year. In addition, South Asian (OR = 1.85; CI: 1.25-2.73) and Chinese (OR = 2.17; CI: 1.47-3.21) immigrants had significantly higher odds of reporting unmet dental care needs than Europeans. CONCLUSIONS: Lack of dental insurance, low income and ethnicity predicted unmet dental care needs over a three-point-five-year period in a sample of immigrants to Canada.

Oral healthcare networks: the invisible transversality. / Redes de atenção à saúde bucal: a transversalidade invisível.

This article discusses the structuring of health care networks in the Unified Health Care System, detailing the main priority thematic networks. It is argued that the transversal insertion of oral health in priority networks makes the specific demands of the area invisible. It is argued that the oral health care network has all the elements to constitute a priority network, with points of care, logistical and diagnostic support. It is concluded that it is necessary to place dental management beyond the primary health care division in order to develop a specific network, and strengthen the municipal and state dental management instances.

Este artigo discute a estruturação das redes de atenção à saúde no Sistema Único de Saúde, detalhando as principais redes temáticas prioritárias. Argumenta-se que a inserção transversal da saúde bucal nas redes prioritárias torna invisível as demandas específicas da área. Defende-se que a rede de atenção de saúde bucal possui todos os elementos para constituir-se em uma rede prioritária, com pontos de atenção e apoios logístico e diagnóstico. Conclui-se que é preciso situar o espaço de gestão da saúde bucal para além da atenção primária, de forma a fortalecer a rede e as instâncias municipais e estaduais de gestão.

Fatores associados à insegurança laboral em profissionais de saúde bucal do Sistema Único de Saúde durante a pandemia de COVID-19 / Factors associated with workplace insecurity in brazilian Unified Health System's oral health professionals during the COVID-19 pandemic

Resumo Objetivos: analisar os fatores associados à insegurança na realização das atividades laborais durante a pandemia de COVID-19 entre profissionais de saúde bucal do Sistema Único de Saúde do Ceará. Métodos: estudo transversal com dados secundários disponibilizados pela Coordenadoria de Atenção à Saúde do Ceará, coletados em maio de 2020. Foram construídos modelos de regressão logística. Resultados: participaram 801 profissionais, dos quais 72,8% eram cirurgiões-dentistas, 73,9% relataram não ter recebido todos os equipamentos de proteção individual (EPI) recomendados e 58,2% relataram não se sentirem seguros para realizar atividades laborais. Na análise ajustada, foram associados à insegurança laboral: maior tempo de formação (RC=1,90; IC95%: 1,12; 3,20), vínculo empregatício efetivo (RC=1,85; IC95%: 1,15; 2,99) e não recebimento de todos os EPI recomendados (RC=1,84; IC95%: 1,16; 2,91); enquanto a chance de insegurança foi menor entre os profissionais que atuavam no nível secundário de atenção à saúde (RC=0,52; IC95%: 0,28; 0,96). Conclusão: os profissionais relataram situação de insegurança laboral durante a primeira onda da pandemia. O estudo revelou a necessidade de melhorias nas condições de trabalho com distribuição de EPI de forma equitativa em todo o estado, garantindo um exercício laboral mais seguro.

Abstract Objectives: to analyze the factors associated with workplace insecurity during the COVID-19 pandemic among oral healthcare providers of the Unified Health System of the state of Ceará. Methods: cross-sectional study with secondary data made available by the Health Care Coordination, which were collected in May 2020. Logistic regression models were constructed. Results: in total, 801 professionals participated in this research, of whom 72.8% were dentists, 73.9% reported receiving only some of the recommended Personal Protective Equipment (PPE), and 58.2% reported feeling unsafe to carry out work activities. In the adjusted analysis, the following factors were associated with workplace insecurity: permanent employment (OR=1.85; 95%CI: 1.15; 2.99) and not receiving all the recommended PPE (OR=1.84; 95%CI: 1.16; 2.91); whereas the chance of feeling insecure was higher among dental assistants and technicians (OR=2.13; 95%CI 1.34; 3.40) than among dental surgeons. Conclusion: professionals reported workplace insecurity during the first wave of the pandemic. This study shows the need for improving working conditions with equal distribution of PPE throughout the state, ensuring safer working conditions.

Cultural significance of primary teeth for caregivers in Northeast Brazil.

This anthropological study critically evaluates Brazilian caregivers' symbolic production and significance of their malnourished offspring's primary teeth, as well as their own, and describes popular dental practices. From January to June 2004, ethnographic interviews of 27 poor, low-literacy mothers were conducted at a public Malnutrition Treatment Center in Fortaleza, Ceará State. Participant observation of clinical pathways and home environments supplemented the data. Content analysis was performed. Results confirm that primary teeth are imbued with cultural significance in Northeast Brazil. Mothers examine mouths, perceive signs of decay, associate primary with permanent tooth healthiness, identify ethnodental illnesses, seek assistance, and perform rituals with exfoliated teeth. The mother's motivation to care for primary teeth is sparked by her memories of past toothache and attempts to avoid stigma and discrimination. Social determinants, not mothers' beliefs or behaviors, are the most critical obstacles to effective dental care. Legitimizing lay knowledge and empowering caregivers and children can improve oral health in Northeast Brazil.

Redes de atenção à saúde bucal: a transversalidade invisível / Oral healthcare networks: the invisible transversality

Resumo Este artigo discute a estruturação das redes de atenção à saúde no Sistema Único de Saúde, detalhando as principais redes temáticas prioritárias. Argumenta-se que a inserção transversal da saúde bucal nas redes prioritárias torna invisível as demandas específicas da área. Defende-se que a rede de atenção de saúde bucal possui todos os elementos para constituir-se em uma rede prioritária, com pontos de atenção e apoios logístico e diagnóstico. Conclui-se que é preciso situar o espaço de gestão da saúde bucal para além da atenção primária, de forma a fortalecer a rede e as instâncias municipais e estaduais de gestão.

Abstract This article discusses the structuring of health care networks in the Unified Health Care System, detailing the main priority thematic networks. It is argued that the transversal insertion of oral health in priority networks makes the specific demands of the area invisible. It is argued that the oral health care network has all the elements to constitute a priority network, with points of care, logistical and diagnostic support. It is concluded that it is necessary to place dental management beyond the primary health care division in order to develop a specific network, and strengthen the municipal and state dental management instances.

Developing a Research Agenda on the Political Economy of Immigrants' Oral Health.

Acculturation has been widely used in health research to explain oral health disparities between immigrants and their native born counterparts. However, immigrants' oral health studies have not clearly defined the acculturation construct. Also, a narrow focus on cultural oral health behaviours is likely to be inadequate for explaining immigrants' oral health inequities, which are also rooted in societal, political and economic factors produced across the globe. In this brief report, we discuss the use of the acculturation framework in the dental public health literature, note gaps in this approach, and argue for the need to incorporate the political economy lens to help better understand the complexities of immigrants' oral health.

["Birth weakness": cultural meanings of maternal impressions for infant health in Northeast Brazil]. / "Fraqueza de nascença": sentidos e significados culturais de impressões maternas na saúde infantil no Nordeste brasileiro.

Pregnancy encompasses socio-cultural, historical, and affective dimensions that process various meanings in women's bodies. Each society constructs popular concepts, practices, and explanatory models that differ from the biomedical model and aim to protect the mother and fetus and foster a healthy pregnancy. This qualitative study, based on interpretative anthropology, unveils the experiences of 27 poor women and their repercussions on the malnutrition of their infants, treated at a Childhood Malnutrition Treatment Center in Fortaleza, Northeast Brazil. From January to June 2004, ethnographic and narrative interviews were conducted on so-called "birth weakness", in addition to participant observation of outpatient, nursing, and home childcare. The mothers believed that their own physical and emotional suffering and precarious nutritional status were "imprinted" on the fetus, resulting in the child's malnutrition. While the ethno-etiology of "weakness" points to factors outside the body that involuntarily affect the pregnant mother, the medical view tended to incriminate the mother herself. It is necessary to understand the mothers' narratives, sympathize with their suffering, and spawn a closer approach between the popular and biomedical concepts.

Provision of Oral Health Care to Children under Seven Covered by Bolsa Família Program. Is This a Reality?

UNLABELLED: Over the last decade, there has been a great improvement in the oral health of Brazilians. However, such a trend was not observed among five-year-old children. Dental caries are determined by the interplay between biological and behavioral factors that are shaped by broader socioeconomic determinants. It is well established that dental disease is concentrated in socially disadvantaged populations. To reduce social and health inequalities, the Brazilian government created Family Health Program (ESF), and the Bolsa Família Program, the Brazilian conditional cash transfer program (Bolsa Família Program). The aim of this study was to examine the oral health care and promotion provided by the Family Health Teams to children and caregivers covered by the Bolsa Família Program. Data was collected through interviews with three groups of participants: 1) dentists working for the Family Health Program; 2) Family Health Program professionals supervising the Bolsa Família Program health conditionalities (Bolsa Família Program supervisors); and 3) parents/caregivers of children covered by the Bolsa Família Program. A pretested questionnaire included sociodemographic, Bolsa Família Program, oral health promotion, dental prevention and dental treatment questions. The results showed that most dentists performed no systematic efforts to promote oral health care to children covered by the Bolsa Família Program (93.3%; n = 69) or to their parents/caregivers (74.3%; n = 55). Many dentists (33.8%) did not provide oral health care to children covered by the Bolsa Família Program because they felt it was beyond their responsibilities. Nearly all Bolsa Família Program supervisors (97.3%; n = 72) supported the inclusion of oral health care in the health conditionality of the Bolsa Família Program, but 82.4% (n = 61) stated they did not promote oral health activities to children covered by the Bolsa Família Program. Children in the routine care setting were more often referred to dentists than children covered by the Bolsa Familia Program (p≤0.001). Parents/caregivers (99.2%; n = 381) agreed that oral health care is important and 99.5% (n = 382) would like their children to be seen regularly. CONCLUSIONS: No collaboration was observed between the Bolsa Família Program and the Family Health Program with regard to the provision of oral health care. Making oral health care a Bolsa Família Program conditionality may reduce oral health care inequalities for extreme poor children under seven in Brazil.

Oral health in the analysis of patients with hearing disabilities / Saúde bucal na análise de pacientes com deficiência auditiva

Objective: To assess the degree of knowledge of deaf and hard of hearing patients about oral health and relate it to clinical and demographic variables. Methods: The target population was schoolchildren from the 6th to the 9th grade of Elementary School and the 1st year of High School. Data collection took place through a structured questionnaire previously validated. The expressed as absolute and percentage frequencies it was analyzed using Fisher's exact test or Pearson's chi-square test (p <0.05). Results: Assessing the relationship between oral health and quality of life, to 53 students, 32.1% of students never reported pain in their teeth, mouth, or jaws, 55.8% never missed school due to problems with their teeth or dental treatments, 71, 2% never avoided smiling or laughing due to problems with teeth or dental treatments, 53.8% never avoided opening their mouths or talking due to problems with teeth or dental treatments. Conclusion: Professional and patient communication should be emphasized with the deaf and hard of hearing to intensify the importance of monitoring with the dental surgeon, carrying out activities to promote, prevent, cure, and rehabilitate oral health.

Objetivo: Avaliar o grau de conhecimento de pacientes portadores de deficiência auditiva sobre a saúde bucal, e relacionar com as variáveis clínicas e demográficas. Métodos: A população alvo foram escolares do 6º ao 9º ano do Ensino Fundamental e do 1º ano do Ensino Médio. A coleta de dados ocorreu de agosto a novembro de 2018, por meio de um questionário estruturado previamente validado. A análise dos dados foi realizada por meio do programa SPSS (Statistical Package of the Social Sciences) e expressos em forma de frequência absoluta e percentual e analisados pelo teste exato de Fisher ou qui-quadrado de Pearson (p<0,05). Resultados: Avaliando a relação da saúde bucal com a qualidade de vida de 53 alunos; 32,1% dos alunos nunca relataram dores nos dentes, na boca, ou nos maxilares, 55,8% nunca faltaram à escola devido problemas com os dentes ou tratamentos dentários, 71,2% nunca evitaram sorrir ou rir devido a problemas com os dentes ou tratamentos dentários, 53,8% nunca evitaram abrir a boca ou falar devido a problemas com os dentes ou tratamentos dentários. Conclusão: A comunicação profissional e paciente deve ser enfatizada com os portadores de deficientes auditivos, com o intuito de intensificar a importância do acompanhamento com o cirurgião dentista, realizando atividades de promoção, prevenção, cura e reabilitação à saúde bucal

Transnational dental care among Canadian immigrants.

OBJECTIVE: This study examines predictors of transnational dental care utilization, or the use of dental care across national borders, over a 4-year period among immigrants to Canada. METHODS: Data from the Longitudinal Survey of Immigrants to Canada (LSIC, 2001-2005) were used. Sampling and bootstrap weights were applied to make the data nationally representative. Bivariate and multiple logistic regression analyses were applied to identify factors associated with immigrants' transnational dental care utilization. RESULTS: Approximately 13% of immigrants received dental care outside Canada over a period of 4 years. Immigrants lacking dental insurance (OR = 2.05; 95% CI: 1.55-2.70), those reporting dental problems (OR = 1.45; 95% CI: 1.12-1.88), who were female (OR = 1.59; 95% CI: 1.22-2.08), aged ≥ 50 years (OR = 2.30; 95% CI: 1.45-3.64), and who were always unemployed (OR = 1.70; 95% CI: 1.20-2.39) were more likely to report transnational dental care utilization. History of social assistance was inversely correlated with the use of dental services outside Canada (OR = 0.48; 95% CI: 0.30-0.83). CONCLUSIONS: It is estimated that roughly 11 500 immigrants have used dental care outside Canada over a 4-year period. Although transnational dental care utilization may serve as an individual solution for immigrants' initial barriers to accessing dental care, it demonstrates weaknesses to in-country efforts at providing publicly funded dental care to socially marginalized groups. Policy reforms should be enacted to expand dental care coverage among adult immigrants.

The deterioration of Canadian immigrants' oral health: analysis of the Longitudinal Survey of Immigrants to Canada.

OBJECTIVE: To examine the effect of immigration on the self-reported oral health of immigrants to Canada over a 4-year period. METHODS: The study used Statistics Canada's Longitudinal Survey of Immigrants to Canada (LSIC 2001-2005). The target population comprised 3976 non-refugee immigrants to Canada. The dependent variable was self-reported dental problems. The independent variables were as follows: age, sex, ethnicity, income, education, perceived discrimination, history of social assistance, social support, and official language proficiency. A generalized estimation equation approach was used to assess the association between dependent and independent variables. RESULTS: After 2 years, the proportion of immigrants reporting dental problems more than tripled (32.6%) and remained approximately the same at 4 years after immigrating (33.3%). Over time, immigrants were more likely to report dental problems (OR = 2.77; 95% CI 2.55-3.02). An increase in self-reported dental problems over time was associated with sex, history of social assistance, total household income, and self-perceived discrimination. CONCLUSION: An increased likelihood of reporting dental problems occurred over time. Immigrants should arguably constitute an important focus of public policy and programmes aimed at improving their oral health and access to dental care in Canada.

Irregular water supply, household usage and dengue: a bio-social study in the Brazilian Northeast.

Despite increased vector control efforts, dengue fever remains endemic in Fortaleza, Northeast Brazil, where sporadic epidemic outbreaks have occurred since 1986. Multiple factors affect vector ecology such as social policy, migration, urbanization, city water supply, garbage disposal and housing conditions, as well as community level understanding of the disease and related practices. This descriptive study used a multi-disciplinary approach that bridged anthropology and entomology. A multiple case study design was adopted to include research in six study areas, defined as blocks. The water supply is irregular in households from both under-privileged and privileged areas, however, clear differences exist. In the more privileged blocks, several homes are not connected to the public water system, but have a well and pump system and therefore irregularity of supply does not affect them. In households from under-privileged blocks, where the water supply is irregular, the frequent use of water containers such as water tanks, cisterns, barrels and pots, creates environmental conditions with a greater number of breeding areas. In under-privileged homes, there are more possible breeding areas and environmental conditions that may improve the chances of Aedes aegypti survival.

Irregular water supply, household usage and dengue: a bio-social study in the Brazilian Northeast / Abastecimento irregular de água, seu uso domiciliar e dengue: uma pesquisa biossocial no Nordeste do Brasil

Despite increased vector control efforts, dengue fever remains endemic in Fortaleza, Northeast Brazil, where sporadic epidemic outbreaks have occurred since 1986. Multiple factors affect vector ecology such as social policy, migration, urbanization, city water supply, garbage disposal and housing conditions, as well as community level understanding of the disease and related practices. This descriptive study used a multi-disciplinary approach that bridged anthropology and entomology. A multiple case study design was adopted to include research in six study areas, defined as blocks. The water supply is irregular in households from both under-privileged and privileged areas, however, clear differences exist. In the more privileged blocks, several homes are not connected to the public water system, but have a well and pump system and therefore irregularity of supply does not affect them. In households from under-privileged blocks, where the water supply is irregular, the frequent use of water containers such as water tanks, cisterns, barrels and pots, creates environmental conditions with a greater number of breeding areas. In under-privileged homes, there are more possible breeding areas and environmental conditions that may improve the chances of Aedes aegypti survival.

Apesar do crescimento de esforços no controle, desde 1986, a dengue, em Fortaleza, Nordeste do Brasil, continua endêmica com esporádicos surtos epidêmicos. Diversos fatores influenciam a ecologia do vetor, como as políticas sociais, a migração, a urbanização, o abastecimento urbano de água, a coleta de resíduos sólidos, as condições das casas, assim como as interpretações e práticas da comunidade. Este estudo descritivo utiliza uma abordagem multidisciplinar conjugando a antropologia e a entomologia. Foi adotado um desenho de estudo de caso múltiplo em seis quarteirões da cidade. O abastecimento de água é irregular seja nas casas pobres, seja naquelas privilegiadas. Apesar disso, existem diferenças entre os quarteirões em áreas pobres e aqueles mais privilegiados. Nos quarteirões mais privilegiados, existem casas que não têm ligação com o sistema de abastecimento público mas têm sistemas com poço e bomba, por isso a irregularidade não os afeta. Nos domicílios mais pobres, onde o abastecimento de água é irregular, a utilização de reservatórios como caixas d'água, cisternas, tambores, potes, cria as condições ambientais para um maior número de criadouros potenciais que poderiam incrementar a sobrevivência do Aedes aegypti.

Cultural significance of primary teeth for caregivers in Northeast Brazil

Este estudo antropológico analisa a produção simbólica de cuidadoras brasileiras sobre a sua dentição e a de seus filhos desnutridos, descrevendo práticas populares de cuidados em saúde bucal. De janeiro a junho de 2004, foram conduzidas entrevistas etnográficas com 27 cuidadoras, numa instituição pública, no tratamento de desnutrição em Fortaleza, Ceará. A observação participante da dinâmica de atendimento e do ambiente domiciliar suplementaram os dados. Foi utilizada a análise temática. Os resultados confirmam que os dentes decíduos são imbuídos de significados culturais no nordeste brasileiro. As mães examinam as bocas dos filhos, percebem sinais de cárie, associam dentes decíduos saudáveis com permanentes hígidos, identificam enfermidades etnodentárias, procuram assistência e praticam rituais com dente decíduo esfoliado. A motivação das mães para o cuidado com dente decíduo é envolvida por experiências de dor de dente e tentativas de evitar estigma e discriminação. Dificuldades de acesso, serviços precários, pobreza e desigualdade social colocam em risco a saúde bucal das crianças e não crenças e comportamentos maternos. A legitimação do conhecimento de cuidadoras e seu empoderamento podem melhorar a saúde bucal no nordeste brasileiro.

This anthropological study critically evaluates Brazilian caregivers' symbolic production and significance of their malnourished offspring's primary teeth, as well as their own, and describes popular dental practices. From January to June 2004, ethnographic interviews of 27 poor, low-literacy mothers were conducted at a public Malnutrition Treatment Center in Fortaleza, Ceará State. Participant observation of clinical pathways and home environments supplemented the data. Content analysis was performed. Results confirm that primary teeth are imbued with cultural significance in Northeast Brazil. Mothers examine mouths, perceive signs of decay, associate primary with permanent tooth healthiness, identify ethnodental illnesses, seek assistance, and perform rituals with exfoliated teeth. The mother's motivation to care for primary teeth is sparked by her memories of past toothache and attempts to avoid stigma and discrimination. Social determinants, not mothers' beliefs or behaviors, are the most critical obstacles to effective dental care. Legitimizing lay knowledge and empowering caregivers and children can improve oral health in Northeast Brazil.

"Fraqueza de nascença": sentidos e significados culturais de impressões maternas na saúde infantil no Nordeste brasileiro / Birth weakness: cultural meanings of maternal impressions for infant health in Northeast Brazil

A gestação abrange dimensões sócio-culturais, históricas e afetivas, que processam no corpo das mulheres diversos sentidos e significados. Cada sociedade constrói concepções, práticas ou modelos explicativos populares, que se diferenciam do modelo biomédico e visam a proteger a mãe-feto, promovendo uma gravidez saudável. Esta pesquisa qualitativa, baseada na antropologia interpretativa, desvela as experiências vivenciadas por 27 mulheres pobres e suas repercussões na desnutrição dos filhos atendidos num Centro de Desnutrição Infantil em Fortaleza, Nordeste brasileiro. De janeiro a junho de 2004, foram realizadas entrevistas etnográficas e narrativas sobre fraqueza de nascença e observação-participante de cuidados no ambulatório, enfermaria e domicílios. Conforme se argumenta, as mães acreditam que seus sofrimentos físicos, emocionais e a precária condição nutricional é "impressa" no feto, resultando na desnutrição do filho. Enquanto a etnoetiologia da "fraqueza" aponta fatores externos do corpo que involuntariamente atingem a gestante, a visão médica relatada tende a culpabilizar a mãe. É preciso compreender a narrativa das mães, sensibilizar-se com o seu sofrimento e aproximar as concepções populares e biomédicas.

Pregnancy encompasses socio-cultural, historical, and affective dimensions that process various meanings in women's bodies. Each society constructs popular concepts, practices, and explanatory models that differ from the biomedical model and aim to protect the mother and fetus and foster a healthy pregnancy. This qualitative study, based on interpretative anthropology, unveils the experiences of 27 poor women and their repercussions on the malnutrition of their infants, treated at a Childhood Malnutrition Treatment Center in Fortaleza, Northeast Brazil. From January to June 2004, ethnographic and narrative interviews were conducted on so-called "birth weakness", in addition to participant observation of outpatient, nursing, and home childcare. The mothers believed that their own physical and emotional suffering and precarious nutritional status were "imprinted" on the fetus, resulting in the child's malnutrition. While the ethno-etiology of "weakness" points to factors outside the body that involuntarily affect the pregnant mother, the medical view tended to incriminate the mother herself. It is necessary to understand the mothers' narratives, sympathize with their suffering, and spawn a closer approach between the popular and biomedical concepts.

A aliança na terapia periodontal de suporte: avaliando a motivação e o autocuidado na periodontite crônica / The therapeutic alliance in the supportive periodontal treatment: evaluating the motivation for self care in chronic periodontitis

A terapia periodontal de suporte (TPS) é definido como a base de procedimentos terapêuticos, garantido por meio de visitas regulares ao cirurgião-dentista, o qual deve estabelecer uma aliança terapêutica que possibilite o desenvolvimento de habilidades e conhecimentos próprios nos pacientes motivando-os na manutenção da saúde periodontal. O presente estudo tem como objetivo investigar o autocuidado e a motivação dos pacientes das clínicas de Periodontia do curso de Odontologia da Universidade de Fortaleza durante a TPS. A abordagem metodológica qualitativa foi usada numa relação de complementariedade com os aspectos quantificáveis, dezoito pacientes portadores de periodontite crônica que estavam em manutenção foram entrevistados e examinados. O índice de sangramento gengival de Ainamo, Bay (1975) foi usado para avaliar a situação gengival dos entrevistados. A coleta de informações deu-se no período de outubro de 2005 a março de 2006. As categorias empíricas emergentes das entrevistas foram agrupadas e analizadas, assim como os resultados individuais dos índices de sangramento gengival. Os resultados apontaram que apesar dos sujeitos da pesquisas e sentirem motivados para o autocuidado em saúde bucal, o quadro clínico inflamatório persiste. Portanto, a subjetividade individual dos participantes diverge dos achados biológicos. Este estudo sugere que pacientes em manutenção encontram vários problemas para desenvolver o autocuidado dentre eles a falta de consciência do caráter crônico da doença periodontal. Portanto, se faz necessário que os profissionais de saúde desenvolvam uma aliança terapêutica com os paciente com periodontite.

Supportive periodontal treatment (SPT) represents the basic support of therapeutic procedures, guaranteed bymeans of regular visits to the dentist, which must establish a therapeutic alliance that enables the development of abilities and proper knowledge for the patients, motivating them in the maintenance of periodontal health. The present study aims to investigate the subjective narratives of self care andmotivation of patients from the periodontics clinics of dentistry’s course of the University of Fortaleza (UNIFOR)during the supportive periodontal treatment. We interviewed and examined 18 patients who had chronic periodontitis and were in clinical maintenance and assessed patient ‘gingival status using Ainamo & Bay (1975) gingival index. Data weregathered between October 2005 and March 2006. The qualitative methodological approach was used,complementarily to quantified measures. Theme analysis of speech was used from the constitution of empirical categories emergent within the study, as well as the individual results of Greene & Vermillion (1964) index to illustrate the identified cases. In conclusion, despite the carriers of chronic periodontite of this study felt motivated to take care of their oral health, especially when called for the maintenance consultations; inflammatory clinical markers remained among patients with chronic periodontitis. Therefore, individual’subjectivity were divergent from the biological findings.