Gender and Violence in the Daily Routine of Community Health Workers in Fortaleza, Brazil.

Community Health Workers (CHWs) are the link between the Brazilian primary health care system and the community. Since CHWs live in the same neighborhoods they work, they are involved in what happens in the community, including observants and or potential targets of violence. However, it is not known if female and male CHWs perceive and suffer violence similarly. This study aimed to investigate the violence to which CHWs are exposed and if female CHWs experience and or perceive violence the same way as male CHWs. A structured questionnaire was used to collect information from CHWs. Two periods (2019 [n=1402] and 2021 [n=364]) were compared. The data show that more than 80% of CHWs were exposed to violence, either as victims or witnesses within the community they served. In general, while the occurrence of violence towards CHWs decreased, their perception of community violence increased. Over time, the perception of urban/community violence remained constant among male CHWs, but increased among female CHWs, as shown by the significant rise between 2019 and 2021 in the percentage of female CHWs reporting witnessing or hearing about manifestations of violence (e.g., physical aggression; assault; stabbing; lethal gunshot; non-lethal gunshot; and gang violence). Among male CHWs, perception only increased with regard to the item assault. Given the complexity of violence and its repercussions on the daily routines of CHWs, intersectoral and interdisciplinary partnerships between health workers and other stakeholders are needed to create strategies capable of dealing with expressions of violence in the territories served.

A Novel Mobile App Intervention to Reduce Dental Anxiety in Infant Patients.

Introduction: Anxiety and fear are feelings routinely associated with the dental experience, especially in childhood and adolescence. These have been prominent in the world for many years and are currently considered a public health issue. Since the young population is an assiduous user of virtual inputs, it was sought to develop a mobile application (app) with the function of reducing the levels of dental anxiety in children before dental treatment and evaluate its effectiveness. Materials and Methods: An app, entitled "Hello, Dentist!", containing dental anticipation videos, was developed by a multidisciplinary team and evaluated. This app was tested in two children groups (dental and school settings), aged 6-10 years. Children and caregivers answered sociodemographic questions. In addition, to measure children's dental anxiety, they completed the Children's Fear Survey Schedule before and after app utilization. Control groups were utilized. A total of 100 children were included in this study. Results: Anxiety levels were statistically lower in the groups using the app when compared with their control groups (p < 0.05). The effectiveness in reducing anxiety was greater when the initial anxiety values were higher, as seen in the dental environment group (p = 0.029). Dental procedures previously experienced, as well as the environment (dental or school) in which children were inserted, were factors that influenced their initial anxiety levels. Conclusions: The creation and utilization of an app to reduce dental anxiety are feasible and effective. The app developed decreased children's anxiety, especially in the dental setting, by anticipating dental situation.

Subjective well-being and oral discomfort in older people.

ABSTRACTBackground:The study aims to assess the relationship between oral discomfort and subjective well-being (SWB) in older people. METHODS: A quantitative cross-sectional study was conducted in four Reference Centers for Social Welfare in Fortaleza, Northeastern Brazil. A census was held and individual interviews were carried out with all the older people (n = 246) enrolled in the centers. A questionnaire addressing sociodemographic data (age, gender, marital status, income, and education) and oral discomfort (dry mouth, difficulty in chewing and swallowing food, problems with the taste of food, burning mouth sensation, pain for no apparent reason, and mouth swelling) and the 62-item SWB scale were used. RESULTS: Participants were 246 people aged 60-89 years (mean of 69 ± 6.9 years). The majority were women (n = 199; 80.9%), had incomplete primary education (n = 161; 65.4%), had an income of up to one minimum wage (n = 182; 74%), were retired (n = 169; 68.7%), were white (n = 100; 40.7%), and had no partner (n = 177; 72%). The mean SWB score (subscale 1) was associated with age (p = 0.010), gender (p = 0.019), health in the previous year (p = 0.027), systemic diseases (p = 0.007), speech problems (p = 0.016), vision problems (p = 0.006), number of teeth (p = 0.010), and dry mouth (p = 0.044). SWB (subscale 2) was associated with gender (p = 0.029), skin color (p = 0.023), general health (p < 0.001), health in the previous year (p < 0.001), systemic diseases (p = 0.001), drinking (p = 0.022), soft tissue problems (p = 0.001), and pain for no apparent reason (p = 0.025). CONCLUSION: The relationship between oral discomfort and SWB reveals that older people's poor oral health leads to physical, psychological, and/or social problems that directly interfere with their well-being.

Access to health care among female prisoners in a penitentiary in Ceará, Brazil. / Acesso e cuidado a saúde de mulheres privadas de liberdade na penitenciária cearense.

This study investigated access to health care among female prisoners in the state of Ceará, Brazil, and screened for common mental disorders. We conducted an analytical cross-sectional study in the only female prison in the state. Ninety detainees participated in the study. All participants were either pregnant or postpartum women or had one or more of the following health problems: hypertension, diabetes mellitus, tuberculosis, syphilis, hepatitis B, HIV/AIDS. The data were collected using a structured questionnaire. The findings reveal that access to health care was limited, violating the fundamental rights of the prisoners. Screening for diseases on admission to prison was limited, especially among non-pregnant women. Differences in health care were found between health conditions, with priority being given to pregnant and postpartum women. Most of the inmates (68.24%) were found to be at risk for common mental disorders (SRQ score > 7). A positive correlation was found between age and mental health problems (p = 0.0002). Despite legislation guaranteeing access to health care in prisons, the prison system is unprepared to meet the health needs of female prisoners with comorbidities and pregnant and puerperal women.

O estudo analisa o acesso ao cuidado em saúde de mulheres encarceradas no estado do Ceará, rastreando transtornos mentais comuns. Estudo analítico, transversal, de natureza quantitativa, desenvolvido na única penitenciária feminina do Ceará. Participaram 90 detentas, todas com alguma das seguintes questões de saúde: gestantes, puérperas, portadoras de hipertensão arterial sistêmica, diabetes mellitus, tuberculose, sífilis, hepatite B ou HIV/Aids. Os dados foram coletados por entrevista estruturada. Evidenciou-se acesso limitado à atenção à saúde das detentas, violando direitos básicos sob tutela do Estado. Foram constatadas limitações de exames de rastreamento de doenças nas presidiárias na ocasião de seu acesso ao cárcere, principalmente as que não se encontravam grávidas no momento do encarceramento. Houve diferenças entre as distintas condições de saúde analisadas, com prioridade da atenção às gestantes e puérperas. Entre as detentas, 68,24% apresentavam risco de transtornos mentais comuns (SRQ > 7). Houve correlação positiva entre idade e saúde mental (p = 0,0002). Embora exista legislação pertinente de garantia de acesso à saúde no cárcere, o sistema prisional está despreparado para atender às necessidades de portadoras de comorbidades, gestantes e puérperas.

Quality of life and associated factors for community health workers in the context of the COVID-19 pandemic in northeastern Brazil.

In this study, we evaluated the quality of life (QoL) and associated factors of community health workers (CHWs) in different urban settings as a contributor to the preparedness of Brazilian primary care for future sanitary emergencies. The sample included 1935 CHWs from 4 state capitals and 4 inland municipalities in northeastern Brazil. Information was collected on QoL (WHOQOL-BREF), work routines, sociodemographics, direct and indirect exposure to violence, general self-efficacy, social support (MSPSS), mental health (SRQ-20) and coronavirus anxiety. The data were subjected to multiple linear regression analysis (α = 5%). In the state capitals, the factors associated with loss of QoL were poor mental health, lack of training, uncertainty about occupational biosafety, and lack of adaptation of services to tend to patients diagnosed with COVID-19. Among the inland municipalities, the main factors were coronavirus anxiety, poor mental health, lack of adaptation of services, lack of training, and lack of personal protective equipment (PPE). A high MSPSS (family and friends) score and self-efficacy had positive impacts on QoL in both urban settings. Our results highlight the need for investment in permanent education, PPE, social support, and mental health care for CHWs.

Domestic violence patterns in postpartum women who delivered during the COVID-19 pandemic.

OBJECTIVE: To longitudinally assess domestic violence (DV) during the postpartum period, identifying types, patterns and determinants of DV, according to mothers' reports in Fortaleza, Brazil. METHODS: Data from the Iracema-COVID cohort study interviewed at home mothers who gave birth in the first wave of COVID-19, at 18 and 24 months after birth. Patterns of reported DV were classified as follows: no DV, interrupted DV, started DV and persistent DV. Adjusted multinomial logistic regressions were used to assess factors associated with persistent DV. RESULTS: DV was reported by 19 and 24% of the mothers at 18 and 24 months postpartum, respectively, a 5 percentage points increase. Persistent DV was present in 11% of the households in the period. The most frequent forms of DV were verbal aggression, reported by 17-20% of the mothers at 18 and 24 months, respectively; drunkenness or use of drugs at home, present in 3-5% of the households; physical aggression, reported by 1.2-1.6% of the mothers. Households with two or more forms of DV increased from 2 to 12% in the period. Adjusted factors associated with persistent DV were maternal common mental disorder, family headed by the mother and head of family's poor schooling. Food insecurity was associated with starting DV. CONCLUSION: Prevalence of DV was considerably high in the postpartum period. DV prevention policies should rely on improving care to women's mental health; preventing food insecurity; and fostering the educational level of young people of both sexes.

Does the use of universal adhesive systems improve the durability of the bond strength of orthodontic brackets to enamel?

Background: Universal adhesive systems used for restorative clinical procedures are like orthodontics and may be a viable option. This study evaluated the effectiveness of universal adhesive systems in enhancing the durability of the shear bond strength (SBS) and adhesive remnant index (ARI) of orthodontic brackets to enamel. Material and Methods: 100 bovine incisors were divided into five groups (n=20), according to the applied adhesive systems: Primer Transbond XT; Ambar; Ambar Universal; Single Bond Universal; Adper Single Bond 2. Bracket from each tooth were submitted to SBS test after 24 hours, and 12 months later. The amount of remaining adhesive was evaluated through ARI. Results: After 24 hours, there was no difference in BS between the control and the other groups (p>0.05). However, there were difference between TOTALETCHING1 group and the Ambar Universal (p=0.015) and Single Bond Universal groups (p=0.011). After 12 months, Primer Transbond XT, Ambar, Ambar Universal and Adper Single Bond 2 showed no differences in the SBS (p>0.05). Nonetheless, Single Bond Universal presented superior result when compared to Primer Transbond XT (p=0.046) and Ambar (p=0.011) groups. The SBS of all groups reduced significantly after 12 months (p<0.05). There was no difference between ARI scores in each individually assessed group (p>0.05), for both periods. Following 24 hours, a difference was observed between the groups (p=0.043), fact that didn't occur after 12 months (p=0.109). Conclusions: Adhesive systems, such as Ambar Universal and Single Bond Universal are efficient in bonding orthodontic brackets to enamel when associated with Transbond XT adhesive paste. Key words:Bond strength; Primer Transbond XT, orthodontic brackets, adhesive systems.

Oral health in childhood: construction and validation of an instrument on knowledge, attitude, and practice of caregivers. / Saúde bucal na infância: construção e validação de instrumento sobre conhecimento, atitude e prática de cuidadores.

The objective of this article is to develop and validate a KAP (knowledge, attitude, and practice) instrument for caregivers of children up to 36 months of age monitored by the Family Health Strategy. This methodological study was conducted in three stages: an integrative review, preparation of the initial version, and content validation by 29 judges. The instrument was validated for content and appearance. The Content Validity Index (CVI) and the FINN and Gwe-AC1 coefficients were calculated to assess inter-judge agreement. The overall CVI values of the 39-item instrument were: Clarity (0.91) and Relevance (0.95). The final version was obtained through 19 knowledge, 10 attitude, and 10 practice questions on caries, diet, oral hygiene, fluoride, breastfeeding, artificial feeding, milk teeth, and the need to take the baby to the dentist. The instrument produced can be used because it has the potential for use depending on the more global assessment of its psychometric properties.

O objetivo deste artigo é construir e validar um instrumento do tipo instrumento CAP (conhecimento, atitude e prática) de cuidadores, acompanhados pela Estratégia Saúde da Família, para promoção da saúde bucal de crianças até 36 meses. Estudo metodológico realizado em três etapas: revisão integrativa, elaboração da versão inicial e validação de conteúdo por 29 juízes. O instrumento foi validado quanto ao conteúdo e aparência. Foram calculados o Índice de Validade de Conteúdo (IVC) e os coeficientes FINN e Gwe-AC1 para avaliação da concordância entre juízes. Os valores do IVC global do instrumento de 39 itens foram: IVC (Clareza) igual a 0,91 e IVC (Relevância) igual a 0,95. A versão final foi obtida mediante 19 questões (conhecimento), 10 (atitude) e 10 (prática), envolvendo os temas: cárie, dieta, higiene bucal, flúor, amamentação, bicos artificiais, dentes de leite e necessidade de levar o bebê ao dentista. O instrumento produzido poderá ser utilizado por apresentar potencial de utilização a depender da avaliação mais global de suas propriedades psicométrica.

Violence in the neighborhood and mental health of community health workers in a Brazilian metropolis.

Violence is a major social problem in Brazil, with severe repercussions on the health care sector. Primary health care professionals, especially community health workers (CHWs), are at high risk of violence at facilities and in the socially vulnerable area where they work. This study analyzed the relationships between adverse working conditions and dimensions of localized violence on the prevalence of common mental disorders (CMD) among CHWs in Fortaleza, a state capital in Northeastern Brazil. Information was collected with a self-report questionnaire containing items on sociodemographic data, work-related violence, psychoemotional signs and symptoms (Self-Reporting Questionnaire-20), mental health care, and absence from work due to general or mental health issues. Based on the responses of 1,437 CHWs, the prevalence of CMD (32.75%) was associated with perceived, witnessed, or suffered violence in the work area. In the hierarchical analysis, CMD were associated with age, sex, religious identity, years of experience as a CHW with the Family Health Strategy (FHS), work neighborhood, activities in the community, considering the lack of bonding with families as an obstacle, having suffered domestic violence, use of medication for emotional dysregulation, identifying the neighborhood as violent, considering violence a physical or mental health determinant, and identifying impunity as a cause of violence. Thus, the work and mental health of CHWs were significantly affected by violence dimensions. Our findings are relevant to the adoption of strategies to mitigate the effects of violence on the work and mental health of CHWs.

Mental health of community health workers in the COVID-19 context. / Saúde mental de agentes comunitários de saúde no contexto da COVID-19.

This study aimed to analyze the factors related to the mental health of Community Health Workers (ACS) in the COVID-19 context. A total of 1,935 ACS from four Northeastern capitals and four cities in the inland region of Ceará participated. The following data were collected: sociodemographic; professional; SRQ-20; WHOQOL-Bref, exposure to violence, General Self-Efficacy Scale (EAEG), Multidimensional Scale of Perceived Social Support (MSPSS), COVID-19-related information, and the coronavirus anxiety scale (EAC). Approximately 40.5% had SRQ > 7, signaling high levels of Common Mental Disorders (CMD)/mental health issues. We adopted the Multiple linear (backward) regression. We observed that the increased risk of CMD was influenced by exposure to violence, EAC, not knowing they had COVID-19, not knowing the variables that reduced the risk, the physical and psychological domains of the WHOQOL-Bref, not having increased working hours, and not having had COVID-19. The data reveal the multidimensional dynamics of mental health and help understand the relationship between community violence, COVID-19, quality of life, age, and ESF working time with the mental health of ACS.

O objetivo deste estudo foi analisar os fatores relacionados à saúde mental dos agentes comunitários de saúde (ACS) no contexto da COVID-19. Participaram 1.935 ACS de quatro capitais nordestinas e de quatro cidades do interior do Ceará. Foram coletados dados sociodemográficos e profissiográficos; SRQ-20; WHOQOL-Bref; exposição à violência; Escala de Autoeficácia Geral (EAEG); Escala Multidimensional de Suporte Social Percebido (MSPSS); informações relacionadas à COVID-19 e Escala de Ansiedade para Coronavírus (EAC). 40,5% exibiram SRQ > 7, sinalizando altos níveis de transtornos mentais comuns (TMC)/problemas de saúde mental. Utilizou-se a regressão linear múltiplas (backward). Observou-se que o aumento de risco de TCM foi influenciado pelos seguintes fatores: exposição à violência; EAC; não saber se teve COVID-19; desconhecer as variáveis que diminuíam o risco; os domínios físico e psicológico do WHOQOL-Bref; não ter aumento da jornada de trabalho; e não ter tido COVID-19. Os dados revelam a dinâmica multidimensional da saúde mental e ajudam a compreender a relação entre violência comunitária, COVID-19, qualidade de vida, idade e tempo de atuação na ESF com a saúde mental dos ACS.

Community health workers perspective on the COVID-19 impact on primary health care in Northeastern Brazil.

This article evaluates the COVID-19 pandemic impacts on the Family Health Strategy (FHS) team's work routines across a range of northeast Brazilian cities as perceived by community health workers (CHW). Data on COVID-19, CHW activities, and FHS teams were collected in 2021 by a structured questionnaire. A total of 1,935 CHWs from four state capitals (Fortaleza - Ceará State, João Pessoa - Paraíba State, Recife - Pernambuco State, Teresina - Piauí State) and four hinterland cities (Crato, Juazeiro do Norte, Barbalha, Sobral - Ceará State) participated in the study. Most CHWs were women (82.42%), with mean age 46.25±8.54 years. Many (39.92%) were infected with COVID-19, of which 70.78% believed they were infected in the workplace. A total of 77.82% defined their role as frontline in the fight against COVID-19, 16.07% reported receiving training for COVID-19, and 13.74% had access to sufficient protective equipment. Most (90.27%) believed their work routines were modified by the pandemic, either strengthening (41.46%) or weakening (44.41%) the team spirit. Home visits (60.55%), health promotion actions in schools (75.66%) and in specific community groups (93.96%), and other on-site community services (66.01%) showed a reduction in frequency. The sampled cities revealed a significant heterogeneity regarding responses to the COVID-19 pandemic, possibly associated with a lack of coordination by the Federal Government. Regardless of context, the pandemic led to a reconfiguration of local health systems, workflows, and primary care protocols for FHS teams. The importance of the Brazilian Unified National Health System (SUS) and its potential for reorganization during crisis should be acknowledged while preserving the headway made thus far.

[Violence and vulnerability of the Community Health Worker in the territory: implications for tackling COVID-19]. / Violência e vulnerabilidade no território do agente comunitário de saúde: implicações no enfrentamento da COVID-19.

The scope of the study was to investigate the relationship between COVID-19 and social vulnerability variables in Fortaleza, as well as to verify the influence of violence on the work of the Community Health Worker (ACS) and the implications for tackling COVID-19. Primary quantitative data (e.g., questionnaires with the ACS) and secondary data (e.g., HDI, homicide, illiteracy, Bolsa Família [PBF] coverage and Family Health Strategy [ESF] coverage) were used. There was a relationship between COVID-19 and indicators of social vulnerability, where cases had a negative relationship with HDI and illiteracy; and deaths had a positive relationship with the homicide rate and PBF coverage. Regions with high death rates due to COVID-19 and social vulnerability have greater FHS coverage and less home visits by the CHA. The latter's role in tackling COVID-19 is limited by the violence in the territory. The thorough performance of the ACS in confronting this pandemic is dependent on intersectoral policies. Thus, the creation of a policy to tackle COVID-19 with the participation of the ACS needs to consider intersectoral actions for curtailing and preventing violence in the territory, in addition to adequate training in the prevention and detection of COVID-19.

Objetivou-se averiguar a relação da COVID-19 com variáveis de vulnerabilidade social em Fortaleza e verificar a influência da violência no trabalho do ACS e suas implicações no enfrentamento da COVID-19. Dados quantitativos primários (e.g., questionários com ACS) e secundários (e.g., IDH, homicídio, analfabetismo, cobertura do Programa Bolsa Família [PBF] e da Estratégia Saúde da Família [ESF]) foram utilizados. Observou-se relação da COVID-19 com indicadores de vulnerabilidade social, onde os casos têm relação negativa com IDH e analfabetismo; e os óbitos relação positiva com taxa de homicídios e cobertura do PBF. Regiões com altas taxas de óbito por COVID-19 e vulnerabilidade social possuem maior cobertura da ESF e menor realização de visita domiciliar pelo ACS. A atuação deste, no enfrentamento da pandemia, é limitada pela violência do território. A plena atuação do ACS, no enfrentamento da COVID-19, é dependente de políticas intersetoriais. Assim, a construção de uma política de enfrentamento da COVID-19, com participação do ACS, precisa levar em consideração, além de seu adequado treinamento na prevenção e detecção de COVID-19, ações intersetoriais para o enfrentamento e prevenção da violência no território.

Medical hiring formats in the Family Health Strategy and the performance of their core attributes. / Formatos de contratação médica na Estratégia Saúde da Família e o desempenho de seus atributos essenciais.

The study aimed to investigate the perception of doctors about the different hiring methods and their influence on the performance of the PHC essential attributes to analyze the formats that best contribute to its implementation and strengthening. This is a quantitative, cross-sectional research using a semi-structured form with 268 doctors from the ESF in Fortaleza, Ceará, Brazil. A unique sociodemographic profile was identified for each group evaluated, influencing the work process and opinions about hiring formats. The development of the essential PHC attributes was positively evaluated, but different perceptions were observed by professional hiring method assessed. The work performed by doctors in the ESF is influenced by how they are hired (p<0.001). Better performance of the statutory (4.4) was noted, followed by scholarship holders of the Mais Médicos Program/Primary Care Valorization Program (3.7), Consolidated Labor Laws (3.5), and, finally, those working with Self-Employed Payment Receipt (RPA) (2.4). We analyzed that hiring through the Brazilian Statutory Regime and RPA are, respectively, the best (85%) and the worst (96.6%) hiring formats.

O estudo tem o objetivo de investigar a percepção dos médicos sobre as diversas formas de contratação e sua influência sobre o desempenho dos atributos essenciais da APS, afim de analisar as formas de vínculo que melhor contribuem à sua implantação e fortalecimento. Pesquisa quantitativa e transversal, utilizando-se da aplicação de formulário semiestruturado junto a 268 médicos da ESF de Fortaleza, Ceará. Verificou-se perfil sociodemográfico singular para cada grupo avaliado, que podem influenciar o processo de trabalho e opiniões sobre as formas de contratação. O desenvolvimento dos atributos essenciais da APS foi avaliado positivamente, mas houve diferença nesta percepção de acordo com o vínculo avaliado. O trabalho realizado pelos médicos na ESF é influenciado pela forma de contratação destes (p<0,001). Percebeu-se melhor desempenho dos estatutários (4,4), seguidos dos bolsistas do Programa Mais Médicos/Programa de Valorização da Atenção Básica (3,7), Consolidação das Leis do Trabalho (3,5) e, por último, os atuantes por Recibo de Pagamento Autônomo-RPA (2,4). Analisou-se que a contratação via Regime Estatutário e RPA, são, respectivamente, a melhor (85%) e a pior (96,6%) forma de contratação.

Planning and support in the work process of PHC teams in the Northeast: analysis of the PMAQ-AB (3rd cycle). / Planejamento e apoio no processo de trabalho das equipes de atenção básica no Nordeste: análise do PMAQ-AB (3º ciclo).

This paper aims to describe the indicators related to planning and support in the work process reported by the Family Health Teams, from the 3rd cycle of the National Program for Improving Access and Quality of Primary Care (PMAQ-AB) in the Brazilian Northeast. This cross-sectional study employed secondary data from the external evaluation of the 3rd cycle of the PMAQ-AB. Sixteen indicators were used to ascertain the teams' work process actions, and 14,489 family health teams that adhered to the program were evaluated. Among the indicators assessed, we found that the teams held a meeting and planned actions and self-evaluated, monitored, and analyzed health indicators to reorganize the work process, highlighting the determining and conditioning factors. Health surveillance and the Extended Family Health Center (NASF) stand out in the indicators of institutional support and multidisciplinary support for solving complex cases. We identified improvements in the work process of the teams in the Northeast region, but the reality of fragmented and vertical work still requires a change to promote an outlook of shared teamwork, directly influencing the work process.

O objetivo deste artigo é descrever os indicadores referentes ao planejamento e apoio no processo de trabalho reportados pelas Equipes de Saúde da Família, a partir do 3º ciclo do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB) na região Nordeste do Brasil. Estudo transversal, utilizando dados secundários da avaliação externa do 3º ciclo do PMAQ-AB. Dezesseis indicadores foram utilizados para averiguar as ações do processo de trabalho das equipes. Avaliaram-se 14.489 equipes de saúde da família que aderiram ao programa. Dentre os indicadores avaliados, verificou-se que as equipes realizaram reunião e planejamento das ações, autoavaliação, monitoramento e análise dos indicadores de saúde para reorganização do processo de trabalho, evidenciando os fatores determinantes e condicionantes. Nos indicadores de apoio institucional e apoio matricial para resolução de casos complexos, destacam-se a vigilância em saúde e o Núcleo Ampliado de Saúde da Família (NASF). Identificou-se que ocorreram melhorias no processo de trabalho das equipes na região Nordeste, porém, ainda precisa mudar a realidade de trabalho fragmentada e verticalizada, favorecendo um panorama de trabalho em equipe e compartilhado, influenciando diretamente no processo de trabalho.

Dependence in instrumental activities of daily living and its implications for older adults' oral health.

We aimed to assess the association between dependence in instrumental activities of daily living (IADL) and oral health in older adults. We conducted a cross-sectional study of 280 people aged ≥60 years served at public primary health care centers in Northeastern Brazil. Sociodemographic, oral discomfort and general health data were collected. The Lawton and Brody scale were used to assess IADL. This research adheres to the STROBE checklist. Most participants were married (n = 139; 49.6%), women (n = 182; 65.0%) and retired (n = 212; 75.7%). A total of 37 (13.2%) older adults had some degree of dependence in IADL. Dependence in IADL was associated with: retirement (p<0.040), poor general health (p = 0.002), speech problems (p = 0.014), use of medications (p = 0.021), difficulty chewing and swallowing food (p = 0.011), voice changes (p = 0.044), edentulism (p = 0.011), use of toothbrush (p<0.001), use of toothpaste (p<0.001), and visit to the dentist in the previous year (p = 0.020). Functional disability was associated with older age, cardiovascular diseases, speech problems, chewing and swallowing difficulties, use of medication and brushing deficiency. The functional dependence in IADL can be considered an indicator of oral health status in older adults.

Health promotion actions in the School Health Program in Ceará: nursing contributions.

OBJECTIVES: to compare health promotion actions carried out by Family Health teams in Ceará, linked to the School Health Program. METHODS: a cross-sectional study involving the first and second cycles of an external assessment of 910 and 1,626 teams from 184 municipalities, which joined the Brazilian National Program for Improvement of Access and Quality of Primary Care. Eight clinical assessment and seven health promotion indicators were assessed, together with health professionals working in schools. RESULTS: the interviewees were nurses (95.6% and 98.3%). Between the cycles, there was an increase in clinical assessment (78.7% and 91.3%), health promotion and disease prevention (82.5% and 89.3%) and survey of students for follow-up (41.4% and 66.4%) in schools. CONCLUSIONS: health actions at school advanced between cycles, with nurses as protagonists in school health, which can reduce vulnerabilities in children and adolescents and qualify Primary Care.

Family Health Postgraduate Program in the Brazilian northeast: repercussions in the professional exercise of postgraduates. / Programa de Pós-Graduação em Saúde da Família no nordeste brasileiro: repercussões no exercício profissional dos egressos.

Brazilian postgraduate education has grown in recent years, but there is a knowledge gap regarding whether the course's planned educational objective is being achieved. We aimed to evaluate the contribution of the Postgraduate Program in Family Health for the postgraduates' professional practice. This is a cross-sectional study conducted with 225 postgraduates from October 2019 to July 2020. Data were collected by an online questionnaire containing different sociodemographic and educational variables and competencies developed in the master's degree program and identifying the domains of Health Promotion Competencies. Most of the participants were female (78.2%), nurses (58.2%), public servants (64%), and SUS workers (93.3%). Two hundred and twenty-two (98.7%) postgraduates' final paper theme built on a practice-related issue. A high mean score was observed for all competencies analyzed. The mean scores for domains in Health Promotion competencies were high. We can conclude that the postgraduate program has contributed satisfactorily to the formation of critical, active masters, with competencies developed and being realized in professional practice.

A pós-graduação no Brasil tem crescido nos últimos anos, porém há uma lacuna do conhecimento em saber se o objetivo formativo planejado do curso está sendo alcançado. Com isso, objetivou-se avaliar a contribuição do Programa de Pós-graduação em Saúde da Família, no exercício profissional de seus egressos. Trata-se de estudo transversal, realizado nos meses de outubro de 2019 a julho de 2020, com 225 egressos. A coleta de dados se deu por meio de questionário on-line contendo distintas variáveis sociodemográficas e de formação, além de competências desenvolvidas no mestrado e identificação dos domínios das Competências de Promoção da Saúde. A maioria dos participantes era do sexo feminino (78,2%), enfermeiros (58,2), concursados (64%) e trabalhadores do SUS (93,3). Notou-se que 222 (98,7%) egressos tiveram a temática do trabalho de conclusão oriunda de uma questão relacionada à prática. Observou-se média elevada nos escores para todas as competências avaliadas. Foram elevados os escores médios dos domínios de Competências de Promoção da Saúde. Conclui-se que o programa de pós-graduação tem contribuído de forma satisfatória na formação de mestres críticos, atuantes, com competências desenvolvidas e sendo realizadas na prática profissional.

[Quality of primary care for child health in states in the Northeast region]. / Qualidade da Atenção Primária à Saúde infantil em estados da região Nordeste.

The scope of this article is to compare the assessment of users of health services who participated in the PMAQ-AB on child health in the states of the Brazilian Northeast. It is a cross-sectional study conducted with secondary data based on interviews with 5,116 users of 4,190 Family Health Teams in the nine states of the Northeast macroregion. Fourteen questions on the medical monitoring of children from 0 to 2 years old were evaluated. Proportions and 95% confidence intervals were calculated for each Unit of the Federation of the Brazilian Northeast. The indicators with the highest proportions were the Guthrie PKU test performed within seven days of life (84.4%), children always accompanied by the same professionals (79.1%), monitoring expected growth and development for age (84.9%), dietary guidance (86.3%) and up-to-date vaccination (95.3%). The indicators with the lowest proportions were guidance on the best position for the child to sleep in (45.7%) and whether or not the child's health handbook (46.9%) was received. In all indicators, there were significant differences between the states analyzed. There are differences in the quality of child health care on offer according to the evaluation of users participating in the PMAQ-AB between states in the Northeast.

O objetivo deste artigo é comparar a avaliação das usuárias que participaram do PMAQ-AB acerca da saúde infantil entre os estados da macrorregião Nordeste do Brasil. Estudo transversal, realizado com dados secundários, a partir de entrevista com 5.116 usuárias de 4.190 Equipes de Saúde da Família que atuam nos nove estados da macrorregião nordeste. Quatorze perguntas acerca do acompanhamento da criança de 0 a 2 anos de idade foram avaliadas. Foram calculados proporções e intervalos de confiança de 95% segundo Unidade da Federação da região Nordeste do Brasil. Os indicadores com maiores proporções foram teste do pezinho realizado em até sete dias de vida (84,4%), criança sempre consultada pelos mesmos profissionais (79,1%), acompanhamento do crescimento e desenvolvimento esperado para a idade (84,9%), orientação alimentar (86,3%), vacinação em dia (95,3%). Os indicadores com as menores proporções foram orientação sobre a melhor posição para a criança dormir (45,7%) e se recebeu a caderneta de saúde da criança (46,9%). Em todos os indicadores, houve diferenças significativas entre os estados analisados. Existem divergências na qualidade do cuidado ofertado à saúde infantil segundo a avaliação das usuárias participantes do PMAQ-AB entre estados do Nordeste.

Orthodontic treatment and aesthetic rehabilitation in a patient with Turner syndrome: A case report.

AIMS: This case report describes an orthodontic and aesthetic rehabilitation in a patient with Turner syndrome. METHODS AND RESULTS: Careful anamnesis was performed to find the patient's medical history. Based on dental casts, radiographies and photographies it was observed alterations in the craniofacial complex, in the occlusion and in the dental morphology. For the orthodontic treatment, rapid maxillary expansion was performed, followed by the use of fixed orthodontic appliance. At the end, aesthetic rehabilitation, with direct composite resin veneers, was utilized for the correction of existing diastema. Treatment goals were achieved by observing an improvement in facial and smile harmony. CONCLUSION: The orthodontic treatment followed by aesthetic rehabilitation of dental morphology showed to be feasible in a patient with Turner syndrome based on an early diagnosis and craniofacial growth follow-up.

Infrastructure and work process in primary health care: PMAQ in Ceará.

OBJECTIVE To analyze the quality of the infrastructure and work process of the Family Health Strategy in the municipalities of Ceará between 2012 and 2014. METHODS Cross-sectional study, using secondary data from the external evaluation of the 1st (2012) and 2nd (2014) cycle of the National Program for Improvement of Access and Quality of Primary Care in Ceará. A total of 20 composite indicators were used to verify the quality of infrastructure and work process. RESULTS Data from 183 (99.4%) of the 184 municipalities of Ceará were collected in both cycles. A total of 1,441 teams were evaluated for the infrastructure and 800 for the work process. Among the 20 composite indicators evaluated, 18 presented an improvement, but in a non-homogeneous way, ranging between 0.0 and 413.5%. We observed that the lower the initial value of the indicator, the greater the variation in quality between 2012 and 2014. The indicators of infrastructure and work process were influenced by the regional health system and population size of the municipality, being more evident the influence on the variables of the work process. CONCLUSIONS We identified that quality improvements related to infrastructure and work process occurred in the period of implementation of the program in the state of Ceará in an equitable manner, being influenced by population size and regional health system, showing the influence of the context in the implementation of public policies of this nature.