Income Trajectories and Oral Health of Young People in a Life Course Study.

OBJECTIVE: To investigate the impact of the family's socioeconomic trajectory on the oral health status of young people in the city of Sobral, Ceará, Brazil, and test the hypotheses of the life course theory. METHODS: This is a cohort study conducted in 2000, 2006, and 2012. In the third wave, 482 individuals between 17 and 21 years of age were examined and interviewed. The outcomes analyzed were the trajectory of tooth decay (decayed teeth in 2012 and cavity reoccurrence) and the trajectory of dental assistance (immediate dental assistance and untreated caries). The socioeconomic trajectory was measured by the mobility of the family's income between childhood and youth and the number of episodes of poverty throughout life. RESULTS: The risk of developing decayed teeth in 2012 was greater for those who had always remained poor. Young people who were never poor had fewer decayed teeth in 2012, but more cavity reoccurrence. Downward mobility resulted in less access to immediate dental assistance. More experience of poverty throughout life implied more decayed teeth in 2012 and less immediate dental assistance. CONCLUSION: The life course hypotheses regarding an influence of socioeconomic mobility and cumulative risk on oral health outcomes in youth were confirmed.

The retention of physicians to primary health care in Brazil: motivation and limitations from a qualitative perspective.

BACKGROUND: This study analyzed the reasons why physicians migrated from the Program to Value Primary Healthcare Professionals (PROVAB) to the Mais Médicos (More doctors) Program in 2015, opting to become physicians of the Primary Health Care. METHODS: The focal group techniques were used consisting of six doctors that made the option to remain in the PHC, being the results analyzed through content monitoring as well as the respective categories, which were identified as theme analysis. RESULTS: It was evidenced that the physician's retention on primary care has a strong relationship with the acquisition of knowledge that is consistent with the context and the health needs of the population. Thus, appropriate competencies for the management of the different biopsychosocial characteristics of the territories, in consonance with abilities that use the communication centered on the patient as well as on the interdisciplinarity, producing health projects that include the uniqueness of the people, essential factor for the daily confrontation of the work of these physicians, strengthened by the training component of the program. Personal factors related to the empathetic profile with this level of care and the possibility of continuous improvement, besides the factors related to the adequate infrastructure and organizational climate with guaranteed salary in keeping with the complexity of Primary Care, positively influenced the permanence of these professionals and were drivers of changes in healthcare and management in the health units they were related to. The bond created with the team and patients was a great satisfaction factor for the professional, being identified by them as a possibility to make a difference in the treatment process of patients, strengthening the promotion of a healthier life through health education. CONCLUSIONS: PROVAB had an unparalleled contribution to the qualification of care in Primary Health Care, contributing to the birth of a new logic of medical training in Brazil. Its effective cooperation with the consolidation of the Mais Médicos Program, still in progress, is a great movement of resistance to the disarticulation and deconstruction of Unified Health System (SUS) which is in charge of public health in Brazil.

Analysis of professional training in Multiprofessional Health Residency Programs in Brazil from the perspective of residents. / Análise da formação em Programas de Residência Multiprofissional em Saúde no Brasil: perspectiva dos egressos.

The aim of this study was to analyze professional training in multiprofessional health residency programs (MHRPs) in primary care from the perspective of residents from 20 programs who had completed residency in the period 2015-2019. We undertook a cross-sectional study analyzing criteria in the dimensions Pedagogical Approach and In-Service Education Settings responded using a 10-point Likert scale. The study sample consisted of 365 graduates from MHRPs in 12 Brazilian states. The highest-scoring criteria in the dimension Pedagogical Approach (Cronbach's α=0.94) were broad concept of care and professional training oriented towards comprehensive care (P50=10). The lowest scoring criteria were those involving preceptorship (P50=7). With regard to the In-Service Education Settings dimension (Cronbach's α=0.90), the main strength was group educational activities (P50=9) and the main weaknesses were adequacy of the physical structure of health facilities (P50=6), participation of residents in local health committees (P50=6), and coordination with medical residency programs (P50=5). The findings show that professional training in MHRPs is aligned with the principles and guidelines underpinning Brazil's public health system, with emphasis on comprehensiveness and prevention. However, efforts are needed to improve preceptor training and address weaknesses in practice settings.

Objetivou-se analisar a formação em Programas de Residência Multiprofissional em Atenção Básica (PRMAB) no Brasil a partir dos egressos de 20 Programas no período de 2015 a 2019. Trata-se de um estudo transversal que analisou as dimensões Abordagem Pedagógica (AP) e Cenários de Educação em Serviço (CES) com escala do tipo Likert. Participaram do estudo 365 egressos de programas instalados em 12 estados da federação. Na dimensão AP (α de Cronbach=0,94) destacaram-se os critérios sobre a concepção ampliada do cuidado e formação pautada em cuidado integral (P50=10), enquanto os com pior desempenho se relacionavam à preceptoria (P50=7). Quanto aos CES (α de Cronbach=0,90), foram reveladas potencialidades para as atividades educativas em grupo (P50=9) e fragilidades para critérios relativos à suficiência de espaço físico nas unidades de saúde (P50=6), participação dos residentes em Conselhos (P50=6) e articulação com Programas de Residência Médica (P50=5). A formação nos PRMAB mostra-se sintonizada com os atuais paradigmas da atenção à saúde, com ênfase na integralidade e prevenção. Contudo, os Programas carecem de investimento na formação de preceptores e melhoria de fragilidades no âmbito dos cenários de prática.

Systematic review on health care for transvestites and transsexuals in Brazil.

OBJECTIVE: To synthesize scientific evidence to characterize health care for transvestites and transsexuals in Brazil. METHODS: This is a systematic review, conducted from July 2020 to January 2021 and updated in September 2021, whose protocol is registered in the International Prospective Register of Systematic Reviews (PROSPERO) platform, under code CRD42020188719. The survey of evidence was carried out in four databases and eligible articles were evaluated for methodological quality, and those with a low risk of bias were included. RESULTS: Fifteen articles were selected and the findings were grouped into six categories according to their thematic approaches: Possibilities to transform health care; Transvestiphobia and transphobia: violations inside and outside the Brazilian Unified Health System (SUS); Professional unpreparedness to care for transvestites and transsexuals; Search for health care alternatives; Right to health for transvestites and transsexuals: utopia or reality?; The Transsexualization Process: advances and challenges. CONCLUSIONS: There is evidence that health care for transvestites and transsexuals in Brazil is still exclusive, fragmented, centered on specialized care and guided by curative actions, resembling the care models that preceded the SUS and which have been heavily criticized since the Brazilian Sanitary Reform.

[Training in Multi-Professional Primary Health Care Residency Programs: a systematic review of the literature]. / Formação na Residência Multiprofissional em Atenção Básica: revisão sistemática da literatura.

The scope of this study is to investigate how the training of health professionals has been provided in Multi-professional Primary Health Care Residency Programs in Brazil. A systematic review was conducted on Scielo, BVS and PubMed databases in 2019, under registration number CRD42019134350. The search was carried out using key words related to Multi-Professional Residency Programs and Primary Health Care, including empirical research on the theme with a low-level risk of bias. Of the 700 studies identified, 13 articles were included in this review. All the studies adopted a qualitative approach predominantly performed in São Paulo with a low risk of bias (69%). The main results were categorized as: Contribution of measures for occupational training; Definition of professional training strategies; Potential of Multi-Professional Primary Health Care Residency Programs for health professional training and difficulties experienced during the training process. Professional training on programs studied has provided a new profile of health providers, despite limitations in the training process. Investments in the qualification of the personnel involved in training were perceived as being necessary, since it was one of the main weaknesses reported.

Este estudo tem como objetivo investigar a formação de profissionais de saúde em programas de Residência Multiprofissional em Saúde (RMS) direcionados à atenção básica no Brasil. Trata-se de uma revisão sistemática da literatura conduzida nas bases de dados SciELO, BVS e PubMed no ano de 2019, registrada sob número CRD42019134350. A busca ocorreu utilizando descritores relacionados à RMS e à atenção básica, sendo incluídas pesquisas empíricas sobre o tema sem alto risco de viés. Dos 700 registros recuperados no processo de busca, 13 artigos foram incluídos na revisão. Todos os estudos apresentaram abordagem qualitativa, predominando estudos realizados no estado de São Paulo e com baixo risco de viés (69%). Os principais resultados foram categorizados em: contribuição de dispositivos para a formação pelo trabalho; estratégias balizadoras da formação; potencialidades da residência para a formação em saúde; e dificuldades experienciadas no processo de formação. A formação nos programas estudados tem proporcionado um novo perfil de profissional de saúde, apesar das limitações vivenciadas no processo. Torna-se necessário investimento na qualificação dos atores envolvidos na formação, uma vez que essa foi uma das principais dificuldades relatadas.

Advances and challenges of training in the Unified Health System based on teachers' experience in the area of Public Health in Dentistry courses. / Avanços e desafios da formação no Sistema Único de Saúde a partir da vivência dos docentes da área de Saúde Coletiva nos cursos de Odontologia.

The training directed at the Unified Health System (SUS) has been one of the most challenging assumptions in the development of Dentistry courses in Brazil. In this regard, public health educated teachers play a fundamental role in the curricular proposition favoring such an approach. This study aimed to identify the possible advances achieved in Dentistry courses and the challenges in training for the SUS. This is a quantitative, cross-sectional research with a sample of 119 teachers employing the probabilistic Snowball technique. Participants responded to a validated criteria matrix, and an exploratory factor analysis was performed for data analysis, which defined five factors responsible for training for the SUS: Primary Care; Social Responsibility and Teamwork; Health Management; Information Systems, and Continuing Education/Humanization. The study allowed identifying significant advances in the perspective of greater adequacy of the training proposal aimed at the SUS. However, some challenges to teachers require expanding the prospect to face the barriers still imposed by traditional health training.

A formação direcionada para o Sistema Único de Saúde (SUS) tem sido um dos pressupostos mais desafiadores no desenvolvimento dos cursos de Odontologia no Brasil. Para isso, docentes com formação em saúde coletiva desempenham papel fundamental na proposição curricular que privilegie tal abordagem. O objetivo do estudo foi identificar em cursos de Odontologia os possíveis avanços alcançados e os desafios a serem enfrentados na formação para o SUS. Trata-se de uma pesquisa quantitativa, com desenho transversal, cuja amostra foi composta por 119 docentes por meio da técnica probabilística do Snowball. Os participantes responderam a uma matriz de critériosvalidada, sendo realizada a análise fatorial exploratória para análise dos dados, a qual definiu cinco fatores responsáveis pela formação para o SUS: Atenção Básica; Responsabilidade Social e Trabalho em Equipe; Gestão em Saúde; Sistemas de Informação e Educação Permanente/Humanização.O estudo permitiu identificar avanços significativos na perspectiva de uma maior adequação da proposta formativa voltada para o SUS, todavia, existem desafios colocados para os professores que exigem um amplo aprofundamento na perspectiva de enfrentar as barreiras ainda impostas pela tradicional formação na área da saúde.

Validation of the criteria matrix about the generalist's education in Dentistry Undergraduate Courses.

The generalist training planned by Brazilian National Curriculum Guidelines for Dentistry undergraduate courses should provide actions for the development of health promotion in the field of public health, as well as disease prevention, diagnosis, planning, and dental treatment in the clinical field. Considering this complexity, the aim of the present study was to validate dimensions and sub-dimensions in dentistry training, allowing the identification of the main necessary competences and clinical skills for the generalist practice. For this, an evaluation study was carried out through the Delph's Method with the participation of 19 professors of Dentistry courses in Brazil working in the clinical area, considered "experts" in this theme. It was possible to identify clinical competences and skills in four dimensions and respective sub-dimensions: Transversal skills (biosafety, patient-team communication, humanization, ethical principles, dental documentation); Diagnosis and planning (diagnosis of dental caries, pulp and periapical changes, and periodontal diseases, clinical and imaging exam, and single treatment planning); Preventive activities (oral hygiene guidance and oral cancer prevention); and Dental care (anesthesia, basic oral surgery, drug prescription, subgingival scaling and root planing, dental restoration, minimally and non-invasive restoration treatment, and dental urgencies). The developed model represents a differentiated alternative for the construction of an innovative curriculum in Dentistry, aimed at the training of general practitioners to provide humanized, highly effective, and resolving care. The importance of clinical tutoring by professors on the essential clinical skills and abilities is highlighted in this study.

Admission of alumni from Multiprofessional Residency Programs into the SUS.

INTRODUCTION: The Multiprofessional Health Residency Programs (PRMS) were set up as a strategy for training workforce for the Brazilian Unified Health System (SUS). OBJECTIVE: To investigate the proportion of alumni from Primary Health Care Multiprofessional Residency Programs admitted into the SUS and associated factors. METHODS: This is a sectional study developed with alumni from Primary Health Care Multiprofessional Residency Programs from all over Brazil, encompassing the period from 2015 to 2019. Participants answered an online questionnaire with general personal information, admission into stricto sensu graduate school, the labor market and, specifically, the SUS. We applied Pearson's chi-square test for bivariate analyses and Poisson's regression for multiple analysis. RESULTS: A total of 365 alumni from Programs from all Brazilian regions participated in the study. Of those, 80.2% reported entry into the labor market and 47.9% reported being employed in the SUS. Admission into the SUS has been associated with the professions that make up the Reference Team for Primary Health Care (PHC) (PR = 1.87; 95% CI 1.54-2.28) and non-admission into stricto sensu graduate programs (PR = 0.77; 95% CI 0.61-0.97). Regarding admission characteristics, the PHC scenario (47.4%) and work focused on health care (84.9%) were prevalent. Almost 40% of alumni who entered the SUS are working with unstable contracts. Besides, being a residency alumnus is often undervalued in recruitment (56.9%). Among those admitted into the SUS, 8.7% reported being selected to work in the Covid-19 pandemic effort. CONCLUSIONS: The results of this study reinforce the need for a policy to encourage the maintenance, creation and valorization of the PRMS. They also warn about the possibility that admission into the SUS for workers is increasingly difficult due to the current underfunding of the health system.

[Water fluoridation in Brazil: regional distribution and accuracy of information on surveillance in municipalities with more than 50,000 inhabitants]. / Fluoretação da água no Brasil: distribuição regional e acurácia das informações sobre vigilância em municípios com mais de 50 mil habitantes.

Sanitation data for 2008 indicated that 74.4% of Brazilian municipalities (counties) with more than 50,000 inhabitants were receiving fluoridated water, but no criteria were adopted to validate the information. The study aimed to verify the accuracy of information on water fluoridation, using as the reference water surveillance data from municipalities with more than 50,000 inhabitants in 2008 and during 2010-2015. Data from different sources were used, comparing the information pertaining to the period. Water samples were collected, and fluoride concentration was obtained by the electrometric method. Verification was performed by comparing the data obtained from different sources. Data were compared for 601 (97.9%) municipalities. The proportion of municipalities that performed surveillance based on external control increased from 39.4% to 48.5%. There was a high rate of false positives and false negatives (15.1%) in the data for 2008. Municipal coverage was 70.2%, or 4.2 percentage points below the published estimate (74.4%) for 2008. Surveillance records were observed in 54.3% of the fluoridated municipalities whose population coverage reached at least 50% of the population receiving treated water. There was an important improvement in fluoridation surveillance data, despite a high percentage of false positives and negatives. There are still wide interregional differences in the surveillance of water fluoridation in this sample of Brazilian municipalities, raising important public health challenges.

Dados de saneamento para 2008 indicavam que 74,4% dos municípios com mais de 50 mil habitantes recebiam água fluoretada, entretanto, critérios para a validação desta informação não foram adotados. O estudo objetivou verificar a acurácia da informação sobre a fluoretação da água, tomando-se por referência dados de vigilância da água em municípios com mais de 50 mil habitantes no ano de 2008 e no período de 2010-2015. Dados de diferentes fontes foram empregados comparando-se as informações relativas ao período. Amostras da água foram coletadas e a concentração de fluoreto foi obtida pelo método eletrométrico. O processo de verificação ocorreu pela confrontação dos dados obtidos por diferentes fontes. Seiscentos e um municípios (97,9%) tiveram os dados confrontados. A taxa de municípios que realizam vigilância com base no heterocontrole passou de 39,4% para 48,5%. Observou-se elevada taxa de falsos positivos ou negativos (15,1%) em relação aos dados de 2008. A cobertura municipal foi de 70,2%, 4,2 pontos abaixo da estimativa (74,4%) divulgada para 2008. Registros da prática da vigilância foram observados em 54,3% dos municípios fluoretados, cuja cobertura populacional alcança 50% ou mais da população que recebe água tratada. Houve sensível melhoria nos dados de vigilância em relação ao fluoreto, embora com porcentual importante de falsos positivos e negativos. Ainda são largas as diferenças inter-regionais relacionadas tanto à provisão da fluoretação da água quanto à implementação da vigilância nos municípios pesquisados, trazendo importantes desafios para a saúde pública.

Los datos de saneamiento en 2008 indicaban que un 74,4% de los municipios con más de 50 mil habitantes recibían agua fluorada, no obstante, no se adoptaron criterios para la validación de esta información. El estudio tuvo como objetivo verificar la exactitud de la información sobre la fluorización del agua, tomando como referencia datos de vigilancia del agua en municipios con más de 50 mil habitantes en el año 2008, y durante el período de 2010-2015. Se emplearon datos de diferentes fuentes comparando la información relativa a este período. Se recogieron muestras de agua y la concentración de fluoruro se obtuvo mediante un método electrométrico. El proceso de verificación se produjo por el contraste de datos obtenidos de diferentes fuentes. Se compararon los datos de 601 (97,9%) municipios. La tasa de municipios que realizan vigilancia en base al heterocontrol pasó de un 39,4% a un 48,5%. Se observó una elevada tasa de falsos positivos o negativos (15,1%), en relación con los datos de 2008. La cobertura municipal fue de un 70,2%, 4,2 puntos por debajo de la estimativa (74,4%) divulgada en 2008. Se observaron registros de la práctica de vigilancia en un 54,3% de los municipios fluorados, cuya cobertura poblacional alcanza a un 50% o más de la población que recibe agua tratada. Hubo una sensible mejoría en los datos de vigilancia respecto al fluoruro, a pesar de que había un porcentaje importante de falsos positivos y negativos. Todavía son grandes las diferencias interregionales relacionadas tanto respecto a la fluorización del agua, como a la implementación de vigilancia en los municipios investigados, implicando importantes desafíos para la salud pública.

[Use of dental care by children and associated factors in Sobral, Ceará State, Brazil]. / A utilização de serviços odontológicos entre crianças e fatores associados em Sobral, Ceará, Brasil.

The aim of this study was to analyze the use of dental services by children in Sobral, Ceará State, Brazil, relating such use to socioeconomic factors and patterns of service consumption. An analytical cross-sectional study was performed, interviewing parents or guardians of 3,425 children. The relationship between independent variables and use of dental services was analyzed using tests of association (chi-squared), odds ratios (OR) and respective confidence intervals, and multiple logistic regression. 50.9% of children had used dental services at least once in their lives. Of these, 65.3% had used such services in the previous year and 85.4% in public dental services. The importance of the Brazilian Unified National Health System is highlighted by the response in terms of access to dental services, considering that the vast majority of treatment was provided by this public system. The factors that most affected use of dental services were socioeconomic status, health plan coverage, owning a toothbrush, regular garbage collection, maternal knowledge, sewage treatment, and malnutrition.

Formação em saúde mental pelas residências multiprofissionais: contexto de contrarreforma psiquiátrica e defesa da atenção psicossocial / Training in mental health with multidisciplinary residencies: context of psychiatric counter-reform and defense of psychosocial care

Resumo Neste ensaio teórico acerca dos desmontes da política nacional de saúde mental entre os anos de 2016 e 2022, objetivamos discutir sobre a formação em saúde mental pelas residências multiprofissionais neste contexto de contrarreforma psiquiátrica. Abordamos as alterações na Política Nacional de Saúde Mental, a análise sobre os Programas de Residência Multiprofissional em Saúde desde seus proponentes, os impasses na formação em Saúde Mental e a defesa do paradigma psicossocial na formação em saúde mental. Problematizamos que esse período significou um grave retrocesso da Política Nacional de Saúde Mental, impactando na continuidade e no fortalecimento das estratégias de formação em saúde mental em diálogo com a luta antimanicomial, produzindo tensionamentos com a atenção psicossocial, norteadora da formação no Sistema Único de Saúde. Analisamos que a política e a formação em saúde mental envolvem interesses corporativistas e mercadológicos em constante disputa com o paradigma psicossocial, inserindo-se em um processo dialético na luta por hegemonia. Concluímos que olhar sobre este ponto de vista possibilita compreender o papel estratégico da formação em saúde mental na efetivação da Reforma Psiquiátrica brasileira, tendo como norte a desinstitucionalização na perspectiva da desconstrução de como a sociedade lida com a loucura e a diversidade.

Abstract In this theoretical essay on the about the dismantling of the national mental health policy between 2016 and 2022, we aim to discuss training in mental health with multidisciplinary residencies in this context of psychiatric counter-reform. We address the changes in the National Mental Health Policy, the analysis of the Multiprofessional Residency Programs in Health since their proponents, the impasses in Mental Health training, and the defense of the psychosocial paradigm in mental health training. We problematize that this period meant a serious setback of the National Mental Health Policy, impacting the continuity and strengthening of mental health training strategies in dialogue with the anti-asylum struggle, producing tensions with psychosocial care, which guides training in the Brazilian National Health System. We analyze that politics and training in mental health involve corporatist and market interests in constant dispute with the psychosocial paradigm, inserting themselves in a dialectical process in the struggle for hegemony. We conclude that looking at it from this point of view makes it possible to understand the strategic role of training in mental health in the implementation of the Brazilian Psychiatric Reform, with deinstitutionalization as its guideline in the perspective of deconstruction of how society deals with madness and diversity.

[Inequalities in dental care during the life course of young people: a cohort study]. / Iniquidades na assistência odontológica ao longo do curso de vida de jovens: um estudo de coorte.

The scope of this study was to investigate dental care from the life course perspective and its determinant factors among young people in the city of Sobral, State of Ceará, Brazil. A cohort study was conducted with waves in 2000, 2006 and 2012 with 482 young people aged between 17 and 21 years. Two outcomes were investigated: immediate dental care and the lack of dental care, based on the dental trajectory in relation to restorative treatment. Socioeconomic conditions and recourse to oral health services and actions in the three waves investigated were used as independent variables. It was found that low socioeconomic status throughout life presented itself as a risk factor for lack of dental care and the inverse effect was observed with immediate dental care. Participation in groups of teenagers was also related to dental care, as well as receiving information on oral health. This study revealed the presence of inequalities in dental care throughout the life course of the population assessed.

O objetivo deste estudo foi investigar a assistência odontológica sob a perspectiva do "life course", bem como seus fatores determinantes, em jovens no município de Sobral, Ceará, Brasil. Realizou-se um estudo de coorte com ondas em 2000, 2006 e 2012 com 482 jovens atualmente entre 17 e 21 anos. Foram investigados dois desfechos: a assistência odontológica imediata e a ausência de assistência odontológica, baseados na trajetória dentária em relação ao tratamento restaurador. E como variáveis independentes, utilizaram-se as condições socioeconômicas e utilização de serviços e ações de saúde bucal nas três ondas investigadas. Observou-se que piores condições socioeconômicas ao longo da vida apresentaram-se como fator de risco para ausência da assistência odontológica e o efeito inverso foi observado com a imediata. A participação em grupos de adolescentes também apresentou relação com a maior assistência odontológica, bem como receber informação sobre saúde bucal. Este estudo revelou a presença de iniquidades na assistência odontológica ao longo da vida da população estudada.

Systematic review on health care for transvestites and transsexuals in Brazil / Revisão sistemática sobre a atenção à saúde para travestis e transexuais no Brasil

ABSTRACT OBJECTIVE To synthesize scientific evidence to characterize health care for transvestites and transsexuals in Brazil. METHODS This is a systematic review, conducted from July 2020 to January 2021 and updated in September 2021, whose protocol is registered in the International Prospective Register of Systematic Reviews (PROSPERO) platform, under code CRD42020188719. The survey of evidence was carried out in four databases and eligible articles were evaluated for methodological quality, and those with a low risk of bias were included. RESULTS Fifteen articles were selected and the findings were grouped into six categories according to their thematic approaches: Possibilities to transform health care; Transvestiphobia and transphobia: violations inside and outside the Brazilian Unified Health System (SUS); Professional unpreparedness to care for transvestites and transsexuals; Search for health care alternatives; Right to health for transvestites and transsexuals: utopia or reality?; The Transsexualization Process: advances and challenges. CONCLUSIONS There is evidence that health care for transvestites and transsexuals in Brazil is still exclusive, fragmented, centered on specialized care and guided by curative actions, resembling the care models that preceded the SUS and which have been heavily criticized since the Brazilian Sanitary Reform.

RESUMO OBJETIVO Sintetizar evidências científicas para caracterizar a atenção à saúde para travestis e transexuais no Brasil. MÉTODOS Trata-se de uma revisão sistemática, conduzida de julho de 2020 a janeiro de 2021 e atualizada em setembro de 2021, cujo protocolo está registrado na plataforma International Prospective Register of Systematic Reviews (PROSPERO), sob o código CRD42020188719. O levantamento das evidências foi realizado em quatro bases de dados e os artigos elegíveis foram avaliados perante a qualidade metodológica, sendo incluídos aqueles com baixo risco de viés. RESULTADOS 15 artigos foram selecionados e os achados, de acordo com as suas aproximações temáticas, foram agrupados em seis categorias: Possibilidades para transformar a atenção à saúde; Travestifobia e transfobia: violações dentro e fora do Sistema Único de Saúde (SUS); Despreparo profissional para a atenção às travestis e transexuais; Busca por alternativas para a atenção à saúde; Direito à saúde para travestis e transexuais: utopia ou realidade?; O Processo Transexualizador: avanços e desafios. CONCLUSÕES As evidências revelam que a atenção à saúde para travestis e transexuais no Brasil ainda é excludente, fragmentada, centralizada no cuidado especializado e pautada por ações curativas, assemelhando-se aos modelos de atenção que antecedem o SUS e que são fortemente criticados desde a Reforma Sanitária Brasileira.

Indicators for teenager's oral health's surveillance. / Proposição de indicadores para vigilância da saúde bucal de adolescentes.

The existence of a few indicators that could guide the evaluation of oral health surveillance in the primary health care attention, mainly in adolescence life cycle, raised the realization of this study. To develop indicators to this end, it was conducted: document analysis to guide the development of a logic model and selection of data to compose indicators. This selection and validation of the logic model were performed by a group of four experts that, from the perspective of the modified Delphi method, analyzed if the model illustrated the activities, results and expected impact of a primary oral health service to enable the adolescents oral health surveillance and assigned points (0-10) to each data proposed. Then, those data judged important by the consensus of experts (média≥7; standard deviation <3) were used to construct indicators. After individual analysis and group discussions, the logical model and 36 of the 48 data, initially proposed, were consensually important, resulting in 26 indicators. The indicators matrix intends to be a situational diagnostic tool to assess, plan and manage health actions to adolescents, but it can be used in other life cycles by its adaptation.

A existência de poucos indicadores que pudessem orientar a avaliação das ações de vigilância à saúde bucal da atenção básica em nível local, sobretudo no ciclo da adolescência, suscitou a realização deste estudo. Para desenvolver indicadores com este fim, procedeu-se: análise documental para guiar a elaboração de um modelo lógico e seleção de dados para compor indicadores. Esta seleção e validação do modelo realizaram-se por um grupo de quatro experts que, sob a ótica do método Delfos modificado, analisaram se o modelo ilustrava as atividades, os resultados e os impactos esperados de um serviço primário de saúde bucal para efetivar a vigilância da saúde do adolescente e atribuíram pontos (0-10) a cada dado proposto de modo que os consensualmente importantes (média ≥ 7; desvio-padrão < 3) orientassem a construção de indicadores. Após análise individual e discussões em grupo, o modelo lógico e 36 dos 48 dados inicialmente propostos foram consensualmente importantes, resultando em 26 indicadores. A matriz de indicadores pretende constituir-se em ferramenta de diagnóstico situacional para avaliar, planejar e gerenciar ações em saúde voltadas aos adolescentes, mas que com adaptação poderá englobar outros ciclos de vida.

Análise da formação em Programas de Residência Multiprofissional em Saúde no Brasil: perspectiva dos egressos / Analysis of professional training in Multiprofessional Health Residency Programs in Brazil from the perspective of residents

Resumo Objetivou-se analisar a formação em Programas de Residência Multiprofissional em Atenção Básica (PRMAB) no Brasil a partir dos egressos de 20 Programas no período de 2015 a 2019. Trata-se de um estudo transversal que analisou as dimensões Abordagem Pedagógica (AP) e Cenários de Educação em Serviço (CES) com escala do tipo Likert. Participaram do estudo 365 egressos de programas instalados em 12 estados da federação. Na dimensão AP (α de Cronbach=0,94) destacaram-se os critérios sobre a concepção ampliada do cuidado e formação pautada em cuidado integral (P50=10), enquanto os com pior desempenho se relacionavam à preceptoria (P50=7). Quanto aos CES (α de Cronbach=0,90), foram reveladas potencialidades para as atividades educativas em grupo (P50=9) e fragilidades para critérios relativos à suficiência de espaço físico nas unidades de saúde (P50=6), participação dos residentes em Conselhos (P50=6) e articulação com Programas de Residência Médica (P50=5). A formação nos PRMAB mostra-se sintonizada com os atuais paradigmas da atenção à saúde, com ênfase na integralidade e prevenção. Contudo, os Programas carecem de investimento na formação de preceptores e melhoria de fragilidades no âmbito dos cenários de prática.

Abstract The aim of this study was to analyze professional training in multiprofessional health residency programs (MHRPs) in primary care from the perspective of residents from 20 programs who had completed residency in the period 2015-2019. We undertook a cross-sectional study analyzing criteria in the dimensions Pedagogical Approach and In-Service Education Settings responded using a 10-point Likert scale. The study sample consisted of 365 graduates from MHRPs in 12 Brazilian states. The highest-scoring criteria in the dimension Pedagogical Approach (Cronbach's α=0.94) were broad concept of care and professional training oriented towards comprehensive care (P50=10). The lowest scoring criteria were those involving preceptorship (P50=7). With regard to the In-Service Education Settings dimension (Cronbach's α=0.90), the main strength was group educational activities (P50=9) and the main weaknesses were adequacy of the physical structure of health facilities (P50=6), participation of residents in local health committees (P50=6), and coordination with medical residency programs (P50=5). The findings show that professional training in MHRPs is aligned with the principles and guidelines underpinning Brazil's public health system, with emphasis on comprehensiveness and prevention. However, efforts are needed to improve preceptor training and address weaknesses in practice settings.

Training and work of speech-language-hearing public health professors in public higher education institutions in Brazil / Formação e atuação de docentes de saúde coletiva fonoaudiólogos de instituições de educação superior públicas no Brasil

ABSTRACT Purpose: to analyze the training and work profile of speech-language-hearing professors responsible for public health curricular components in speech-language-hearing undergraduate programs in Brazil. Methods: a documentary analysis addressing Lattes curricula of 50 professors identified with the snowball technique. Extracted information was classified into variables, which were analyzed with descriptive statistics and multiple correspondence analysis. Results: most professors graduated in the Southeast Region, have a doctoral degree, wrote their theses or dissertations on speech-language-hearing clinics, conduct research and public outreach projects on public health, and produce scientific literature on speech-language-hearing clinics. Moreover, some professors do not have a postgraduate degree in public health. Conclusion: the scenario indicates possibly weakened scientific research and teaching on public health in speech-language-hearing programs, as the training and work of an important part of the professors identified in this study are not specifically focused on this field.

RESUMO Objetivo: analisar o perfil da formação e atuação dos docentes fonoaudiólogos responsáveis por componentes curriculares de saúde coletiva nas graduações em fonoaudiologia do Brasil. Métodos: foi realizada análise documental dos currículos lattes dos cinquenta docentes identificados por meio da técnica "bola de neve". As informações extraídas foram classificadas em variáveis, analisando-as por meio da estatística descritiva e análise de correspondência múltipla. Resultados: identificou-se que a maioria dos docentes se graduou na região Sudeste, possui título de doutor, tese ou dissertação na área de clínica fonoaudiológica, projetos de extensão e pesquisa em saúde coletiva e produção científica na clínica fonoaudiológica. Observou-se, ainda, existência de docentes que não possuíram uma formação pós-graduada em saúde coletiva. Conclusão: o cenário aponta para uma possibilidade de fragilização do ensino e da pesquisa científica da saúde coletiva nos cursos de fonoaudiologia, visto que a formação e a atuação de uma parte importante dos docentes identificados neste estudo não estão voltadas especificamente para esse campo.

PET-Health as inducer of professional education to Unified Health System. / PET-Saúde como indutor da formação profissional para o Sistema Único de Saúde.

PET-Health is configured as a program developed by health courses guided by the principle Unified Health System (SUS), with the preceptorship of a professional from health public service. The aim of the research was to compare the performance between PET-Health undergraduate of Dentistry, Medical and Nursing courses by the results of National Student Performance Exam (ENADE) in 2010 with those who did not participate in the program. The study population consisted of 49,758 students, which 761 participated in PET-Health. To analyze the performance of students in 2010 were considered the mean scores in general education, expertise skill and public health. Students who participated in PET-Health had superior performance in all means (55.48) when compared to those who did not (50.96). The shared investment between the Ministries of Health and Education in PET-Health, strategy involving students, professionals from public services and professor, contribute to the reorientation of health training, producing a great relationship between public health services and university.

The challenge of the approach to oral cancer in primary health care.

The aim of this study was to understand the performance of dentists in public health about mouth cancer. A cross-sectional study was performed whit 121 dentists from Fortaleza Health Department, interviewed through a semi-structured questionnaire. The study did not identify statistically significant difference regarding the ability to perform biopsy by gender, year of graduation, expertise or time of public service. Only 22 professionals (18.2%) reported being able to perform biopsies and 13 (10.7%) would do so at the Family Health Unit. The reference and counter-reference system, by including another stage in patient care, increase the possibility of absenteeism from patient to health service. Although clearly identify the relevance of oral cancer mortality in the population, the vast majority of dentists is not equipped to perform the biopsy as a routine activity. Whereas the vast majority of biopsies of the oral tissues is performed as an outpatient, low technological complexity to perform the procedure and the effectiveness of biopsy in the early diagnosis of oral cancer, it is essential to hold this procedure in primary care, what can effectively contribute to decreasing mortality from oral cancer.

Formação na Residência Multiprofissional em Atenção Básica: revisão sistemática da literatura / Training in Multi-Professional Primary Health Care Residency Programs: a systematic review of the literature

Resumo Este estudo tem como objetivo investigar a formação de profissionais de saúde em programas de Residência Multiprofissional em Saúde (RMS) direcionados à atenção básica no Brasil. Trata-se de uma revisão sistemática da literatura conduzida nas bases de dados SciELO, BVS e PubMed no ano de 2019, registrada sob número CRD42019134350. A busca ocorreu utilizando descritores relacionados à RMS e à atenção básica, sendo incluídas pesquisas empíricas sobre o tema sem alto risco de viés. Dos 700 registros recuperados no processo de busca, 13 artigos foram incluídos na revisão. Todos os estudos apresentaram abordagem qualitativa, predominando estudos realizados no estado de São Paulo e com baixo risco de viés (69%). Os principais resultados foram categorizados em: contribuição de dispositivos para a formação pelo trabalho; estratégias balizadoras da formação; potencialidades da residência para a formação em saúde; e dificuldades experienciadas no processo de formação. A formação nos programas estudados tem proporcionado um novo perfil de profissional de saúde, apesar das limitações vivenciadas no processo. Torna-se necessário investimento na qualificação dos atores envolvidos na formação, uma vez que essa foi uma das principais dificuldades relatadas.

Abstract The scope of this study is to investigate how the training of health professionals has been provided in Multi-professional Primary Health Care Residency Programs in Brazil. A systematic review was conducted on Scielo, BVS and PubMed databases in 2019, under registration number CRD42019134350. The search was carried out using key words related to Multi-Professional Residency Programs and Primary Health Care, including empirical research on the theme with a low-level risk of bias. Of the 700 studies identified, 13 articles were included in this review. All the studies adopted a qualitative approach predominantly performed in São Paulo with a low risk of bias (69%). The main results were categorized as: Contribution of measures for occupational training; Definition of professional training strategies; Potential of Multi-Professional Primary Health Care Residency Programs for health professional training and difficulties experienced during the training process. Professional training on programs studied has provided a new profile of health providers, despite limitations in the training process. Investments in the qualification of the personnel involved in training were perceived as being necessary, since it was one of the main weaknesses reported.

Scientific production of nutrition courses in food and nutrition in collective health: contributions to the debate on professional performance

This study aims to analyze the scientific production of Nutrition courses on knowledge core Food and Nutrition in Collective Health (FNCH) and its associations with institutional characteristics and advisor's academic degree. A bibliometric study was performed on 195 final projects of five nutrition courses in Rio Grande do Nortestate (Brazil) from the year 2013. Information related to higher education institutions and academic degree of advisor were collected. From the reading of sections of final projects, screening was performed on final project involvement with knowledge core FNCH, being collected general methodological characteristics, classification on sub cores of FNCH, and theme approached. Pearson's chi-square test was used with a significance level at p-value ≤ 0.05 and 95% confidence interval in a univariate and bivariate way.From the total of analyzed final projects, 54 (27.7%) were related to knowledge core FNCH, prevailing final projects with a quantitative approach (61%), presented as scientific articles (57%), and performed in public services (45%). There was an emphasis on the sub-core of Nutritional Epidemiology (63%) [p < 0.001], with the theme Nutritional Assessment (57%) [p < 0.001]. There was no significant association between FNCH final projectsproportion and institutional characteristics or advisor's academic degree. Thinking about nutritionists' practice, limitations were identified on FNCH scientific production, with an emphasis on nutritional diagnosis researches, with less involvement in public health policies and human and social sciences.