Condição de saúde bucal entre indígenas Kaingang com diabetes mellitus / Oral health condition among Kaingang indigenous people with diabetes mellitus / Estado de salud bucal de los indígenas Kaingang con diabetes mellitus

Objetivo: analisar as condições de saúde bucal de indígenas com diabetes. Método: estudo transversal, realizado na Terra Indígena na região norte do Paraná. Os dados foram coletados mediante entrevista, exame intraoral e consulta a prontuários de indígenas da etnia Kaingang e submetidos à análise descritiva e inferencial. Resultados: participaram 45 indígenas, com idade média de 56,3 ± 12,4 anos, sendo 53,3% do sexo feminino. Em relação ao risco em saúde bucal, 31,1% apresentaram alto risco sendo que 95,6% deles tinham índice muito alto e alto (≥ 5) de dentes cariados, perdidos e obturados, 42,2% referiram xerostomia, 66,7% diagnóstico de doença periodontal e 24,4% eram edêntulos totais. Conclusão: a condição de saúde bucal de indígenas com diabetes reflete a necessidade de priorizar ações de educação preventiva em saúde bucal pelas equipes de saúde da família

Objective: to analyze the oral health conditions of indigenous people with diabetes. Method: cross-sectional study, carried out in the Indigenous Land in the northern region of Paraná. Data were collected through interviews, intraoral examinations and con-sultation of medical records of indigenous people of the Kaingang ethnic group and subjected to descriptive and inferential analysis. Results: 45 indigenous people participated, with an average age of 56.3 ± 12.4 years, 53.3% of whom were female. In relation to the risk in oral health, 31.1% presented a high risk, with 95.6% of them having a very high and high rate (≥ 5) of decayed, lost and filled teeth, 42.2% reported xerostomia, 66.7 % diagnosed with periodontal disease and 24.4% were completely edentulous. Conclusion:the oral health condition of indigenous people with diabetes reflects the need to prioritize preventive oral health education actions by family health teams

Objetivo: analizar las condiciones de salud bucal de indígenas con diabetes. Método: estudio transversal, realizado en Tierra Indíge-na de la región norte de Paraná. Los datos fueron recolectados a través de entrevistas, exámenes intraorales y consulta de historias clínicas de indígenas de la etnia Kaingang y sometidos a análisis descriptivo e inferencial. Resultados: Participaron 45 indígenas, con una edad promedio de 56,3 ± 12,4 años, de los cuales el 53,3% eran mujeres. En relación al riesgo en salud bucal, el 31.1% presentó riesgo alto, teniendo el 95.6% de ellos un índice muy alto y alto (≥ 5) de dientes cariados, perdidos y obturados, el 42.2% reportó xerostomía, el 66.7% diagnosticado con enfermedad periodontal. enfermedad y el 24,4% eran completamente edéntulos. Conclusión: la condición de salud bucal de los indígenas con diabetes refleja la necesidad de priorizar acciones de educación preventiva en salud bucal por parte de los equipos de salud de la familia

Explaining income inequities in tooth loss among Brazilian adults.

OBJECTIVE: To determine the extent to which individual and contextual variables explain income inequities in tooth loss in Brazilian adults. METHODS: A nationally representative sample of 65,784 Brazilian adults aged 18-59 who participated in the Brazilian National Health Survey 2019 was analyzed. Self-reported tooth loss was the outcome. Per capita income was the main exposure, and minimum wage was the cutoff point. Individual covariates included sex, race, and schooling, dental visits, smoking status, use of dental floss, and self-reported chronic conditions. Contextual covariates included access to treated water and geographic region of residence. Blinder-Oaxaca decomposition analysis was used to estimate the share of each factor in income-related tooth loss inequities by age groups. RESULTS: Age-standardized tooth loss showed large income inequities. The average difference in tooth loss related to income inequities in the 18-34-year-old group was 0.50 (95% CI 0.39; 0.60), increasing to 4.51 (95% CI 4.09; 4.93) in the 45-59 years. Individual and contextual covariates explained almost 90% of income inequities in the 45-59 year group. Use of dental floss, schooling, and geographic region of residence (a proxy for human development level) had a higher proportion of contribution to the inequities examined. CONCLUSIONS: Individual and contextual covariates (proxy for human development level and water fluoridation coverage) explained a large share of income-related tooth loss inequities. Tailored strategies to act at both levels can help reduce tooth loss inequities among Brazilian adults.

Tooth loss severity and core and non-core food consumption among older Brazilian adults.

OBJECTIVE: To investigate the association between tooth loss severity and core and non-core food consumption in the older Brazilian population. METHODS: We analysed data from 20 756 people aged 60 years or older who participated in the 2019 Brazilian National Health Survey. The average consumption days a week of core (8-item) and non-core (4-item) foods were the outcomes, measured using a Food Frequency Questionnaire. Tooth loss severity was the main exposure, using a four-category ordinal variable: mild (1-12 teeth missing), moderate (13-22), severe (23-31) and edentulous (all 32). Sociodemographic, tobacco smoking, use of dental prosthesis, difficulty in chewing and systemic conditions were among the covariates. Linear regression models estimated the association between tooth loss and food consumption. RESULTS: Almost two-thirds of participants had moderate or worse levels of tooth loss. Older adults with more severe tooth loss reported an overall lower consumption of core and higher non-core foods than those with mild tooth loss. Worse tooth loss severity was associated with lower consumption of vegetables and/or legumes and fruits, and higher consumption of beans, artificial fruit juices and confectionery. CONCLUSIONS: Older Brazilian adults with more severe tooth loss are consuming lower core and higher non-core foods. Our findings reinforce the importance of the common risk factor approach to tackle the adverse effects of tooth loss on diet.

Estratégia de implementação de apoio por pares no contexto da Atenção Primária à Saúde: revisão de escopo / Estrategia de implementación de apoyo de pares en el contexto de la Atención Primaria de Salud: revisión de alcance / Peer support implementation strategy in the Primary Health Care setting: scoping review

Resumo Objetivo Este estudo teve como objetivo mapear, por meio de uma revisão de escopo de ensaios clínicos randomizados, a utilização da estratégia de implementação do apoio por pares em contextos da Atenção Primária à Saúde (APS), para tanto, relatando seus resultados na saúde e no processo de implementação. Métodos Foi utilizada como guia para a revisão de escopo a metodologia do Joanna Briggs Institute (JBI). As bases Scopus, Scielo, Pubmed, Web of Science e literatura cinzenta foram pesquisadas. Artigos publicados nos últimos 7 anos (2017 a 2023), relacionados ao contexto da Atenção Primária à Saúde e que reportam desfechos de saúde e ao menos um desfecho de implementação foram selecionados. Resultados Inicialmente, foram mapeados 259 artigos e, após remoção de duplicatas e aplicação dos critérios, 15 foram selecionados. Os problemas de saúde abordados foram, em sua maioria, relacionados ao vírus da imunodeficiência humana (HIV) e outras infecções sexualmente transmissíveis e doenças crônicas não transmissíveis. Os principais desfechos de implementação apresentados envolveram adoção, aceitabilidade, alcance, fidelidade, viabilidade, sustentabilidade e adequação. Poucos estudos utilizaram-se de modelos teóricos de implementação para condução e reporte dos achados. Conclusão A estratégia de apoio por pares tem sido empregada em alguns cenários da Atenção Primária à Saúde, com mapeamento que abrange áreas como saúde mental, infecções sexualmente transmissíveis e doenças crônicas não transmissíveis. Os impactos positivos na saúde incluíram a supressão viral do HIV, a redução significativa da pressão arterial sistólica e a diminuição na quantidade de álcool consumido. Todavia, ainda, faltam estudos para analisar a efetividade em outros cenários da APS, sobretudo, quanto à fidelidade, viabilidade, sustentabilidade, adequação e custo. Protocolo do estudo: PROTOCOL INTEGER ID 81603

Resumen Objetivo Este estudio tuvo como objetivo mapear, mediante una revisión de alcance de ensayos clínicos aleatorizados, la utilización de la estrategia de implementación del apoyo de pares en contextos de la Atención Primaria de Salud (APS), para lo cual se relataron los resultados en la salud y en el proceso de implementación. Métodos Se utilizó la metodología del Joanna Briggs Institute (JBI) como guía para la revisión de alcance. Las bases consultadas fueron Scopus, Scielo, Pubmed, Web of Science y literatura gris. Se seleccionaron artículos publicados en los últimos siete años (2017 a 2023), relacionados con el contexto de la Atención Primaria de Salud, que relatan resultados en la salud y al menos un resultado sobre la implementación. Resultados Inicialmente se mapearon 259 artículos y, después de eliminar los duplicados y aplicar los criterios, se seleccionaron 15. Los problemas de salud tratados fueron, en su mayoría, relacionados con el virus de la inmunodeficiencia humana (VIH) y otras infecciones de transmisión sexual y enfermedades crónicas no transmisibles. Los principales resultados de implementación presentados incluyeron adopción, aceptabilidad, alcance, fidelidad, viabilidad, sustentabilidad y adecuación. Pocos estudios utilizaron modelos teóricos de implementación para conducir e informar los resultados. Conclusión La estrategia de apoyo de pares se ha empleado en algunos escenarios de la Atención Primaria de Salud, con un mapeo que incluye áreas como salud mental, infecciones de transmisión sexual y enfermedades crónicas no transmisibles. Los impactos positivos en la salud incluyeron la supresión viral del VIH, la reducción significativa de la presión arterial sistólica y la disminución de la cantidad de alcohol consumido. Sin embargo, aún faltan estudios para analizar la efectividad en otros escenarios de la APS, sobre todo con relación a la fidelidad, viabilidad, sustentabilidad, adecuación y costo.

Abstract Objective To map the use of the peer support implementation strategy in the Primary Health Care (PHC) setting through a scoping review of randomized clinical trials, reporting its results in health and the implementation process. Methods The development of this scoping review was guided by the Joanna Briggs Institute (JBI) methodology. Scopus, SciELO, PubMed, Web of Science databases and gray literature were searched. Articles published in the seven previous years (2017 to 2023) related to the Primary Health Care setting, and reporting health outcomes and at least one implementation outcome were selected. Results Initially, 259 articles were mapped. After removing duplicates and applying the criteria, 15 were selected. The health problems addressed were mostly related to the human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs) and chronic non-communicable diseases. The main implementation outcomes presented involved adoption, acceptability, reach, fidelity, feasibility, sustainability and appropriateness. Few studies adopted theoretical implementation frameworks to conduct and report the findings. Conclusion The peer support strategy has been used in some PHC settings, with mapping that covers areas such as mental health, STIs and chronic non-communicable diseases. Positive health impacts included viral suppression of HIV, significant reduction in systolic blood pressure, and a decrease in the amount of alcohol consumed. However, studies analyzing effectiveness in other PHC scenarios are still lacking, especially regarding fidelity, feasibility, sustainability, appropriateness and cost.

Factors associated with physical activity levels in adolescents / Factores asociados a los niveles de actividad física en adolescentes / Fatores associados ao nível de atividade física em adolescentes

ABSTRACT Objective: to analyze the factors associated with physical activity levels in adolescents. Method: cross-sectional, quantitative study, conducted with adolescents enrolled in two educational institutions in a capital of the midwest region of Brazil. Data collection occurred from April to October 2021, through a self-administered questionnaire composed of validated scales. The association between the variables was verified by logistic regression. Results: 219 adolescents participated in the study, with a mean age of 15.7 years, more than half were girls (52.5%) from medium economic class (51.1%); 55.3% were very active/active; 39.3% had low self-esteem; 17.8% were at risk for developing an eating disorder; 12.3% at risk for severe anxiety symptoms; and 13.3% at risk for moderate depression symptoms. The factors associated with the level of physical activity were self-esteem and risk for depression. Conclusion: Early screening of adolescents with low self-esteem and risk for symptoms of depression is proposed as an initial strategy to direct actions that encourage the practice of physical activity.

RESUMEN Objetivo: analizar los factores asociados a los niveles de actividad física en adolescentes. Método: estudio transversal, cuantitativo, realizado con adolescentes matriculados en dos instituciones educativas de una capital de la región Centro-Oeste de Brasil. La recolección de datos ocurrió de abril a octubre de 2021, a través de un cuestionario autoadministrado compuesto por escalas validadas. La asociación entre las variables se verificó por regresión logística. Resultados: Participaron del estudio 219 adolescentes, con una edad media de 15,7 años, más de la mitad eran niñas (52,5%) de clase económica media (51,1%); el 55,3% eran muy activos/activos; el 39,3% tenía baja autoestima; el 17,8% tenían riesgo de desarrollar un trastorno alimentario; 12,3% en riesgo de síntomas de ansiedad severa; y 13,3% en riesgo de síntomas de depresión moderada. Los factores asociados al nivel de actividad física fueron la autoestima y el riesgo de depresión. Conclusión: El cribado precoz de adolescentes con baja autoestima y riesgo de síntomas depresivos puede constituir una estrategia inicial para encaminar acciones que incentiven la práctica de actividad física.

RESUMO Objetivo: analisar os fatores associados ao nível de atividade física em adolescentes. Método: estudo transversal, de abordagem quantitativa, realizado com adolescentes matriculados em duas instituições de ensino de uma capital da região Centro-Oeste brasileira. A coleta de dados ocorreu no período de abril a outubro de 2021, por meio de questionário autoaplicado composto por escalas validadas. A associação entre as variáveis foi verificada por meio de regressão logística. Resultados: participaram do estudo 219 adolescentes, com média de idade de 15,7 anos, mais da metade eram meninas (52,5%) e de classe econômica média (51,1%); 55,3% eram muito ativo/ativo; 39,3%, com autoestima baixa; 17,8% apresentaram risco para desenvolver transtorno alimentar; 12,3% risco para sintomas de ansiedade grave; e 13,3%, risco para sintomas de depressão moderada. Os fatores associados ao nível de atividade física foram a autoestima e o risco para depressão. Conclusão: O rastreamento precoce de adolescentes com baixa autoestima e risco para sintomas de depressão pode constituir estratégia inicial para direcionar ações de estímulo à prática de atividade física.

Validation of pairs of antagonist teeth for the evaluation of shortened dental arch in epidemiological studies

Abstract The aim of this study was to evaluate the accuracy of pairs of antagonist teeth (epidemiological criterion) for defining pairs of teeth in occlusal contact (clinical criterion) and to estimate the agreement between the prevalence of "shortened dental arch" (SDA) and "functional dentition" (FD) when occlusal units (OUs) or posterior occluding pairs (POPs) are defined by the epidemiological or clinical criterion. Data were collected in an epidemiological oral health survey conducted in a municipality in Minas Gerais, Brazil. OUs and POPs were defined by the epidemiological criterion (dental crown status) or clinical criterion "gold standard" (carbon paper record of occlusal contacts during habitual maximum intercuspation). SDA corresponded to the presence of an intact anterior region and three to five OUs. FD was based on the concomitant presence of ≥ 1 tooth in each arch, 10 teeth in each arch, 12 anterior teeth, ≥ 3 premolar POPs, and ≥ 1 molar POP bilaterally. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of the epidemiological criterion were calculated. The study included 197 adults. Sensitivity, specificity, PPV, and NPV were 88.5, 87.9, 92.5, and 81.9%, respectively, and accuracy was 88.3%. The epidemiological criterion proved to be valid and could be used in epidemiological studies to calculate the prevalence of reduced dental configurations that consider POPs. The assessment of oral functionality is an aspect that should be included in the diagnosis of the clinical condition of patients, contributing to a more effective individual and collective oral health care plan.

Inadequate distribution of dietary protein and muscle mass in older adults

Objective: To assess protein intake, protein distribution across meals, and a possible association between protein distribution and muscle mass in older adults. Methods: This cross-sectional study included 47 older adults attending a community center in Campo Grande, MS, Brazil. A sociodemographic questionnaire was used to characterize the population. Dietary intake data were collected using two 24-hour dietary recalls on nonconsecutive days. Anthropometric measures, such as weight, height, and body circumferences, and measures of handgrip strength were collected. Skeletal muscle mass was calculated from the anthropometric measures. Descriptive statistics were used to derive means and standard deviations. Analysis of variance and Tukey tests were performed, with a significance level of 5% (p < 0.05). Results:The older adults, mostly Caucasian, female, physically active, at risk of malnutrition, and with a low level of education, had an energy intake of 1,305.28 kcal/day. Protein intake was 65.19 g/day, with a mean of 0.93 g/kg/day. Lunch was the meal with the highest protein intake (33.85 ± 2.47 g). The lowest protein intake was observed at breakfast (8.56 ± 0.82 g). All meals were below the recommendation of 40 g of protein/meal. Protein intake at breakfast was associated with calf circumference (p = 0.04). Conclusions: The older adults consumed a low amount of total and per-meal protein. Breakfast showed the lowest protein intake, and this was associated with calf circumference in the study sample.

Objetivo: Avaliar o consumo proteico, sua distribuição nas principais refeições e sua possível associação com a massa muscular de idosos. Metodologia: Estudo transversal realizado com 47 idosos frequentadores de um centro de convivência em Campo Grande (MS). Aplicou-se um questionário sociodemográfico e dois recordatórios de 24 horas, em dias alternados, para a avaliação do consumo alimentar, e realizou-se avaliação antropométrica por meio da aferição de medidas como peso, estatura, circunferências corporais e a força de pressão palmar. Com as medidas antropométricas, foi calculada a quantidade de massa muscular esquelética. Realizou-se estatística descritiva e, para as análises de associação, aplicaram-se os testes de variância (ANOVA) e de Tukey, com significância estatística quando p < 0,05. Resultados: Os idosos, majoritariamente caucasianos, do sexo feminino, fisicamente ativos, em risco de desnutrição e com escolaridade reduzida apresentaram consumo energético de 1.305,28 kcal/dia e consumo proteico 65,19 g/dia, sendo 0,93 g de proteína/kg/dia. O almoço foi a refeição com maior aporte proteico (33,85 ± 2,47 g). O menor consumo proteico foi observado no café da manhã (8,56 ± 0,82 g). Todas as refeições ficaram abaixo da recomendação de 40 g de proteína/refeição. O consumo proteico no café da manhã associou-se à circunferência da panturrilha (p = 0.04). Conclusões: Os idosos consumiram baixa quantidade de proteínas totais e nas principais refeições. O café da manhã foi a refeição com menor aporte proteico e este associou-se à circunferência da panturrilha em idosos da amostra.

Multimorbidity and tooth loss: the Brazilian National Health Survey, 2019.

BACKGROUND: Little is known about the presence of two or more chronic conditions (multimorbidity) on tooth loss between adults and older adults. Understanding the mechanisms of multimorbidity on tooth loss is essential to inform policy development. This study aims to investigate the association between multimorbidity and severity of tooth loss in Brazilian adults and older adults. METHODS: We analysed data from a nationally representative sample of 88,531 Brazilian individuals aged 18 and over who participated in the 2019 Brazilian Health Survey. Tooth loss was the outcome by two different classifications: functional dentition (lost 1-12 teeth) and severe tooth loss (lost 23-32 teeth). The presence of multimorbidity was the main exposure and based on 13 self-reported doctor-diagnosed chronic diseases that were further categorised into two groups, i.e., ≥2 or ≥ 3 comorbidities. Sociodemographic covariates included sex, age, race, income, level of education and tobacco smoking and geographic region of residency. Multivariate logistic regression models estimated the OR (Odds Ratios) and 95%CI of the associations between multimorbidity and tooth loss. RESULTS: For 65,803 adults (aged 18 to 59), the presence of multimorbidity (≥2) was associated with 32% higher odds of having severe tooth loss (95% CI, 1.17; 1.49) and 33% lower odds of having functional dentition (95% CI, 0.60; 0.75). For the 22,728 older adults (aged 60 and older), multimorbidity (≥2) was associated with a 17% higher odds of severe tooth loss (95% CI, 1.06; 1.29) and 23% lower odds of having functional dentition (95% CI 0.70; 0.85). The sensitivity analysis, excluding hypertension, confirmed our findings. CONCLUSIONS: Brazilian adults and older adults with multimorbidity are more likely to have severe tooth loss and less likely to have functional dentition.

Racial inequities in tooth loss among older Brazilian adults: A decomposition analysis.

OBJECTIVE: To determine the extent to which racial inequities in tooth loss and functional dentition are explained by individual socioeconomic status, smoking status and frequency/reason for the use of dental services. METHODS: Data came from the Brazilian Longitudinal Study of Ageing, a nationally representative sample of community-dwelling people aged 50 years and over. Tooth loss and functional dentition (ie 20+ natural teeth) were the outcomes. The main explanatory variable was self-classified race. Covariates included dental visits in the past 12 months, dental visits for check-ups only, smoking status, self-reported chronic conditions, depression and cognitive function. Logistic regression and Blinder-Oaxaca decomposition analysis were used to estimate the share of each factor in race-related tooth loss inequities. RESULTS: The analytical sample comprised of 7126 respondents. While the prevalence of functional dentition in White Brazilians was 37% (95% CI: 33.5;40.9), it was 29% (95% CI: 26.4;31.6) among Browns and 30% (95% CI: 25.1;35.4) among Blacks. The average number of lost teeth among Whites, Browns and Blacks were 18.7 (95% CI: 17.8;19.6), 20.4 (95% CI: 19.7;21.1) and 20.8 (95% CI: 19.5;22.0), respectively. Decomposition analysis showed that the selected covariates explained 71% of the racial inequalities in tooth loss. Dental visits in the previous year and smoking status explained nearly half of race-related gaps. Other factors, such as per capita income, education and cognitive status, also had an important contribution to the examined inequalities. The proportion of racial inequities in tooth loss that was explained by dental visits (frequency and reason) and smoking status decreased from 40% for those 50-59 years of age to 22% among participants aged 70-79 years. CONCLUSIONS: Frequency and reason for dental visits and smoking status explained nearly half of the racial inequity in tooth loss among Brazilian older adults. The Brazilian Family Health Strategy Program should target older adults from racial groups living in deprived areas.

Cobertura de equipes de saúde bucal na Estratégia Saúde da Família e uso de serviços odontológicos em adolescentes de Mato Grosso do Sul, 2019: estudo transversal / Cobertura de salud bucal en la Estrategia de Salud de la Familia y uso de servicios dentales en adolescentes en Mato Grosso do Sul, Brasil, 2019: estudio transversal / Oral health coverage in the Family Health Strategy and use of dental services in adolescents in Mato Grosso do Sul, Brazil, 2019: cross-sectional study

Objetivo: Analisar a associação entre a cobertura de equipes de saúde bucal na Estratégia Saúde da Família (ESF-SB) e a utilização de serviços odontológicos entre adolescentes de 12 anos, em Mato Grosso do Sul, Brasil, 2019. Métodos: Trata-se de um estudo transversal, cujo desfecho foi a utilização de serviços odontológicos. Modelos de equações estruturais foram construídos para testar a associação das covariáveis com o desfecho. Resultados: Dos 615 participantes, 74,0% utilizaram os serviços odontológicos nos últimos três anos. A cobertura de ESF-SB ≥50% associou-se a maior uso de serviços públicos [coeficiente padronizado (CP) = 0,10 - IC95% 0,01;0,18], menor uso para prevenção (CP = -0,07 - IC95% -0,17;0,01) e maior consumo de alimentos não saudáveis (CP = 0,19 - IC95% 0,11;0,26). Conclusão: Maiores coberturas de ESF-SB associaram-se a menor utilização de serviços para prevenção e maior consumo alimentar não saudável. As equipes devem organizar o acesso e qualificar o processo de trabalho.

Objetivo: Analizar la asociación entre la cobertura de los equipos de salud bucal en la Estrategia Salud de la Familia (ESF-SB) y el uso de servicios odontológicos en 12 años en Mato Grosso do Sul, 2019. Métodos: Este es un estudio transversal. El resultado fue el uso de servicios dentales. Se realizaron modelos de ecuaciones estructurales para asociación de covariables con el resultado. Resultados: De los 615 participantes, el 74,0% utilizó servicios dentales en los últimos tres años. La cobertura de ESF-SB ≥50% se asoció con mayor uso público [coeficiente estandarizado (CE) = 0,10 - IC95% 0,01;0,18], menor uso para prevención (CE = -0,07 - IC95% -0,17;0,01) y mayor consumo de alimentos no saludables (CE = 0,19 - IC95% 0,11;0,26). Conclusión: Mayor cobertura de ESF-SB se asoció con un menor uso para la prevención y un mayor consumo de alimentos no saludables. Los equipos de salud bucal deben organizar el proceso de trabajo.

Objective: To analyze the association between the coverage by oral health teams in the Family Health Strategy (FHS-OH) and the use of dental services among 12-year-old adolescents in the state of Mato Grosso do Sul, Brazil, 2019. Methods: This is a cross-sectional study involving school-based research, which adopted the use of dental services as its outcome. Structural equation modeling was used to test the association between covariates and the outcome. Results: Of the 615 participants, 74.0% used dental services in the last three years. ESF-SB (oral health coverage by family health strategy, acronym in Portuguese)≥50% was associated with a greater use of public dental services [standardized coefficient (SC) = 0.10 -95%CI 0.01;0.18], a lower use of these services for prevention (SC = -0.07 -95%CI -0.17;0.01) and higher unhealthy food consumption (SC = 0.19 -95%CI 0.11;0.26). Conclusion: Higher ESF-SB coverage was associated with a lower use of dental services for prevention and higher unhealthy food consumption. Teams must organize the access to oral health service and qualify the work process.

Impact of continuing education on maternal and child health indicators.

OBJECTIVE: This study investigated whether the presence of care workers who completed a specialization course on family health was associated with improved care and maternal and child health indicators in municipalities in the state of Mato Grosso do Sul, Brazil. METHODS: Negative binomial regression models with fixed effects were used for the 79 municipalities in the state of Mato Grosso do Sul, with repeated observations for the period 2009-2015. For our reference, the parameter "number of professionals who completed the course" calculated the proportion of professionals who completed the course, and was divided by the total number of primary health care professionals in the municipality to create a ratio. The cutoff points used represented tertile distribution: T3: high (0.35-1.00), T2: intermediate (0.02-0.33) and T1: low (0.00-0.01); to avoid biased results, the analysis was also performed for the years prior to the beginning of the course in question (2009 and 2010). RESULTS: During the study period, enrollment of pregnant women, exclusive breastfeeding for children under 4 months, and up-to-date vaccinations in children younger than 1 year to 23 months increased (high to intermediate categories) in municipalities where professionals who completed the specialization course worked. Growth in the intermediate ratio was also observed in indicators related to cervical cancer screening and new diagnoses of congenital syphilis in infants under one year of age. CONCLUSIONS: The presence of care workers who completed a specialization course on family health was seen to be associated with improved care and indicators for maternal and child health in municipalities in the state of Mato Grosso do Sul, Brazil. These findings reaffirm the importance and effectiveness of policies on training and continuing education for the Brazilian Unified Health System.

Adaptação transcultural e propriedades psicométricas da versão em português (Brasil) do questionário Prontidão Organizacional para Implementação de Mudança para implementação de mudança em serviços de saúde / Cross-cultural adaptation and psychometric properties of the Brazilian-Portuguese version of the Organizational Readiness for Implementing Change questionnaire

RESUMO: Objetivo: Avaliar o grau em que profissionais da atenção primária e organizações de saúde estão prontos para implementar mudanças nos serviços de saúde, principalmente no que se refere à implementação de novas tecnologias, políticas públicas ou programas de inovação, que merecem especial atenção. Os objetivos deste estudo foram: conduzir a adaptação transcultural do questionário Organizational Readiness for Implementing Change (ORIC) para o português (Brasil); e iniciar a mensuração de suas propriedades psicométricas. Métodos: Por meio de estudo transversal, realizou-se a tradução do questionário ORIC, com 12 questões, e posterior aplicação numa amostra de trabalhadores de unidades primárias de saúde tradicionais em transformação para unidades de saúde da família. A análise estatística incluiu o coeficiente alfa de Cronbach, análise fatorial exploratória e confirmatória por modelo de equação estrutural e seguiu o checklist Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN). Resultados: Participaram do estudo 150 trabalhadores de 10 unidades de saúde em transformação. A análise confirmou dois fatores principais (Eficácia e Comprometimento), com autovalores > 1. A rotação pelo método ortogonal mostrou que as questões do instrumento confirmaram os fatores analisados pelo instrumento original. O alfa de Cronbach total do ORIC foi 0,94, mostrando ótima confiabilidade. Conclusão: A versão portuguesa (Brasil) do questionário ORIC-Br apresentou boas propriedades psicométricas, podendo ser utilizado em serviços de saúde para medição da prontidão organizacional, considerada um indicador do potencial alcance de sucesso na implementação de mudança em serviços de saúde.

ABSTRACT: Objective: The assessment of the degree to which health professionals, workers and organizations are ready to implement changes in health services deserves special attention, especially related to new technologies, public policies and innovation. The objectives of this study were to conduct a Brazilian Portuguese Brazil cross-cultural adaptation of the ORIC questionnaire and to initiate the study of its psychometric properties. Methods: Through a cross-sectional study, the Organizational Readiness for Implementing Change (ORIC) questionnaire, containing 12 questions, was translated and later applied to a sample of workers from traditional primary health care units undergoing transformation to family health units. Statistical analysis included Cronbach's alpha, exploratory and confirmatory factor analysis by structural equation model using the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist. Results: Workers from ten health units participated in the study (n = 150). The analysis confirmed two main factors (Effectiveness and Commitment) with Eigenvalues > 1. Rotation by the orthogonal method showed that the instrument questions confirmed the factors analyzed by the original instrument. The total Cronbach's Alpha of ORIC was 0.94, showing excellent reliability. Conclusion: The Brazilian Portuguese Brazil version of the ORIC-Br questionnaire showed good psychometric properties and can be used in health services to measure organizational readiness, considered as an indicator of the potential success in implementing change.

Integração ensino-serviço-comunidade, metodologias ativas e Sistema Único de Saúde: percepções de estudantes de Odontologia / Teaching-service-community integration, active methodologies and Unified Health System: perceptions of Dentistry students

Resumo Introdução O modelo tradicional de formação em saúde hegemônico e tecnicista limita as respostas às demandas atuais do Sistema Único de Saúde (SUS). Para superar essas fragilidades, a integração ensino-serviço-comunidade (IESC) e as metodologias ativas (MAs) se apresentam como estratégias de reorientação da formação profissional. Objetivo Este estudo analisou as percepções de estudantes de Odontologia da Universidade Federal de Mato Grosso do Sul (UFMS) acerca das práticas pedagógicas à luz das MAs e da IESC no e para o SUS. Método Trata-se de pesquisa qualitativa, realizada entre 2012 e 2013, com 73 estudantes que estavam matriculados e cursando a disciplina de Estágio Obrigatório de Odontologia em Saúde Coletiva II (EOOSC II). O convite para participar da pesquisa foi feito após o encerramento da disciplina, quando as notas já haviam sido lançadas. Utilizou-se de um roteiro contendo questões norteadoras, que versavam sobre a opinião dos estudantes acerca: (1) da disciplina; (2) das potencialidades e fragilidades da metodologia de ensino-aprendizagem utilizada e das unidades de saúde frequentadas; e (3) da intenção de, após a formatura, trabalhar no SUS/Estratégia Saúde da Família. Após a coleta, os dados foram transcritos, e, na sequência, foi processado o discurso do sujeito coletivo (DSC). Resultados A IESC, articulada com as MAs, propiciou aos estudantes conectar teoria e prática, integrada à realidade do SUS. Conclusão Os participantes da pesquisa relataram a relevância da educação permanente em saúde e as dificuldades/potencialidades da utilização de MAs integradas à IESC na formação profissional, apontando o SUS como real possibilidade de trabalho ao se formarem.

Abstract Background The traditional model of hegemonic and technicist health training limits the answers to the current demands of the Unified Health System (USH). To overcome these weaknesses, Teaching-Service-Community Integration (TSCI) and Active Methodologies (AM) are presented as strategies for reorienting vocational training. Objective This study analyzed the perceptions of dentistry students of Federal University of Mato Grosso do Sul (UFMS), related to pedagogical practices in light of AM and TSCI for and in the USH. Method It was a qualitative research, which was carried out between 2012 and 2013, with 73 students, who were enrolled and attending the Compulsory Internship in Collective Health Dentistry II (CICHD II). The invitation was made after the course end, when the grades had already been released. A script was used containing guiding questions, which dealt with students' opinions about: (1) the course; (2) the potentialities and weaknesses of the teaching-learning methodology used and the Health Units attended; And (3) the intention to, after graduation, work in the USH /Family Health Strategy. After the data collection, they were transcribed and, subsequently, the Collective Subject Discourse (CSD) was processed. Results The TSCI, which was articulated to the AM, allowed students to connect theory and practice, integrated to the realities of USH. Conclusion They noted the relevance of the permanent education in health and the difficulties/potentialities of using active methodologies integrated to the TSCI in the professional formation, pointing the UHS as a real possibility of work when they will be graduate.

Excesso de peso influencia negativamente a capacidade funcional de idosos em atividades cotidianas / Overweight negatively influences functional capacity of older people in daily activities

OBJETIVO: Avaliar o estado nutricional, as condições de saúde e suas influências na capacidade funcional de idosos de um centro de convivência em Campo Grande, Mato Grosso do Sul. MÉTODOS: Trata-se de um estudo transversal, de base populacional, com 47 idosos de ambos os sexos, com idade entre 60 e 96 anos. A capacidade funcional foi definida por meio das atividades básicas e instrumentais da vida diária, operacionalizadas pelo índice de Katz e pela escala de Lawton e Brody. Foram aplicados um questionário sociodemográfico e dois recordatórios de 24 horas para avaliação do consumo alimentar; e foram avaliados a força de preensão manual e o estado nutricional. Um modelo de equação estrutural foi empregado para analisar a relação e as associações entre as variáveis. RESULTADOS: A amostra mostrou boa funcionalidade para as atividades básicas da vida diária, mas uma frequência alta de prejuízos nas atividades instrumentais, principalmente para tarefas como cuidar das finanças, preparar a própria refeição, limpar e realizar pequenos reparos domésticos. A baixa funcionalidade vai ao encontro da baixa força de preensão palmar encontrada. A maior parte dos idosos foi classificada como eutrófica (51,06%). Ao aplicar o modelo de equação estrutural, obteve-se um coeficiente padronizado de 0,45; indicando efeito médio e significativo (p = 0,02) do índice de massa corporal sobre a dependência para as atividades básicas, com efeito direto. CONCLUSÃO: O excesso de peso influencia negativamente a capacidade funcional de idosos para desempenhar atividades básicas da vida diária.

OBJECTIVE: To evaluate nutritional status, health conditions, and their impact on the functional capacity of aging adults in a community center in Campo Grande, state of Mato Grosso do Sul. METHODS: This is a cross-sectional, population-based study with 47 participants of both sexes, aged 60-96 years. Functional capacity was defined by the basic and instrumental activities of daily living, operationalized by the Katz index and the Lawton and Brody scale. A sociodemographic questionnaire and two 24-hour reminders were used to evaluate food consumption; hand grip strength and nutritional status were also evaluated. A structural equation model was used to analyze the relationship and associations between variables. RESULTS: The sample showed good functional capacity for the basic activities of daily living, but there was a high frequency of losses in instrumental activities, especially for tasks such as managing finances, cooking, cleaning and performing small domestic repairs. Low functional capacity is in agreement with the low hand grip strength found. Most participants were classified as eutrophic (51.06%). When applying the structural equation model, a standardized coefficient of 0.45 was obtained; indicating a mean and significant effect (p = 0.02) of body mass index on dependence for basic activities, with direct effect. CONCLUSION: Overweight negatively influences the functional capacity of older adults to perform basic activities of daily living.

Do food intake and food cravings change during the menstrual cycle of young women? / A ingestão de alimentos e os desejos por comida mudam durante o ciclo menstrual das mulheres jovens?

Abstract Objective The aim of the present study was to assess the anthropometric measures, food intake and food cravings during the menstrual cycle of undergraduate students of the faculty of nutrition. Methods A cross-sectional study was performed with 27 students from a public university in the state of Mato Grosso do Sul, Brazil, who had their food intake evaluated through a 24-hour food recall, their nutritional status evaluated based on anthropometric measures, and food cravings evaluated using the Food Desire Questionnaire. Data were collected during an evaluation in the follicular phase (between the 5th and the 9th day of the menstrual cycle) and another in the luteal phase (LP) (between the 20th and the 25th day of the menstrual cycle). For food intake variables, the analysis of variance (ANOVA) test was used, followed by the Tukey test. The Mann-Whitney test was used for the analysis of food cravings, considering a significance level of 5% (p< 0.05). Results The desire for foods rich in sugar, salt, and fat, such as chocolate, pastries, snacks and desserts were higher (p< 0.05) during the premenstrual period, although it did not reflect neither a higher energy intake nor an alteration in the distribution of macronutrients. A higher intake of carbohydrates, proteins, fibers, and calcium was observed during the LP; however, without statistical difference between the groups. There were no differences either in the intake of any food group or in the anthropometric measurements (p> 0.05). Conclusion Food cravings of nutrition students differed between the phases of the menstrual cycle; however, with no difference in food intake and in anthropometric measures.

Resumo Objetivo Verificar alterações de medidas corporais, consumo e desejos alimentares durante o ciclo menstrual de acadêmicas de nutrição. Métodos Estudo transversal com 27 estudantes de uma universidade pública do Mato Grosso do Sul, as quais tiveram seu consumo alimentar avaliado por meio de recordatório alimentar de 24 horas, estado nutricional avaliado com base em medidas antropométricas, e desejos alimentares avaliados utilizando-se o Questionário de Desejo Alimentar. Os dados foram coletados durante uma avaliação na fase folicular (entre o 5° e o 9° dia do ciclo menstrual) e outra na fase lútea (entre o 20° e o 25° dia do ciclo menstrual). Para as variáveis de consumo alimentar, utilizou-se o teste análise de variância (ANOVA, na sigla em inglês), seguido pelo teste de Tukey. Já para a análise dos desejos alimentares, utilizou-se o teste de Mann-Whitney. Foi considerado o nível de significância de 5% (p< 0,05). Resultados Os desejos por alimentos ricos em açúcar, sal e gordura, como chocolates, produtos de pastelaria, lanches e sobremesas foram maiores (p< 0,05) no momento pré-menstrual, apesar de não refletirem em maior consumo energético e tampouco em alteração na distribuição de macronutrientes. Observou-se maior consumo de carboidratos, proteínas, fibras e cálcio na fase lútea; no entanto, sem diferença estatística entre os grupos. Não foram encontradas diferenças no consumo de nenhum grupo alimentar, tampouco nas medidas antropométricas (p> 0,05). Conclusão Os desejos alimentares das acadêmicas de nutrição diferiram entre as fases; no entanto, sem diferença no consumo alimentar e nas medidas corporais.

Fatores associados às necessidades de tratamento odontológico em idosos brasileiros: uma análise multinível / Factors associated with the need for oral treatment of elderly Brazilians: a multilevel analysis

Resumo Este estudo teve como objetivos estimar a prevalência da necessidade de prótese e tratamento dental em idosos brasileiros, e verificar a associação entre essas necessidades e fatores contextuais e individuais. Realizou-se estudo com dados (n = 7.619) da Pesquisa Nacional de Saúde Bucal - SB Brasil 2010. Modelos de regressão logística multinível foram utilizados para estimar odds ratio e intervalos de 95% de confiança entre as necessidades de tratamento e as variáveis contextuais (Índice de Desenvolvimento Humano Municipal, Coeficiente de Gini e cobertura de saúde bucal na Estratégia de Saúde da Família) e individuais (sexo, renda, escolaridade e cor da pele). Para a necessidade de tratamento dental, ser homem, apresentar menor escolaridade, menor renda, cor da pele autorrelatada como não branca e residir em municípios com menor IDH -M foram fatores que aumentaram as chances de os indivíduos necessitarem de tratamento; para a necessidade de prótese, a cor da pele autorreferida como não branca, menor renda e menor escolaridade também aumentaram as chances dos idosos necessitarem de prótese. Os resultados indicaram associação entre as necessidades de tratamento e determinantes individuais e contextuais.

Abstract The aims of this study were to estimate the prevalence of prosthetic requirements and dental treatment needs among the elderly Brazilian population and the associations with contextual and individual determinants. Data were taken from the Brazilian Oral Health Survey (SB Brasil 2010) and a sample of 7,619 Brazilian people aged 65-74 years were investigated. Multilevel logistic regression models were used to estimate the odds ratio (OR) and 95% confidence intervals between treatment needs and contextual variables (Municipal Human Development Index, Gini coefficient and oral health coverage in the Family Health Strategy) and individual (gender, income, education and skin color). The prevalence of treatment need ranged from municipalities (p < 0.05). Of the individual variables, gender was associated with dental treatment need (OR = 1.18, 95% CI 1.05 to 1.31); lower education and non-white skin were risk factors (OR = 1.18; 95% CI 1.05 to 1.31 and OR = 1.28, 95% CI 1.15 to 1.43); the non-white skin color represented a risk factor (OR = 1.83; 95% CI 1,38- 2,42) and for the need for prosthesis income was a protection factor (OR = 0.39; 95% CI 0, 30-.51). The results showed an association between the individual factors and treatment needs.

Fatores associados à autopercepção da necessidade de tratamento odontológico e de prótese em idosos brasileiros / Factors behind self-perceived need for dental treatment and prosthesis in Brazilian elderly people

Resumo Este estudo teve como objetivo identificar fatores individuais e contextuais associados à autopercepção da necessidade de tratamento odontológico e de prótese em idosos brasileiros. Foram utilizados dados secundários de 7.619 indivíduos idosos do levantamento epidemiológico SB Brasil 2010. As associações entre as variáveis dependentes e os fatores individuais e contextuais foram estimadas através da razão de chances (odds ratio - OR) e intervalo de confiança de 95%, obtidas por regressão logística multinível. Dos idosos avaliados pelo SB Brasil 2010, 3.848 (50,5%) afirmaram necessitar de tratamento odontológico e 4.236 (55,6%) acreditavam necessitar de prótese. Os resultados da regressão logística multinível mostraram que sexo, cor da pele autorreferida, renda e cobertura pelas equipes de saúde bucal na Estratégia de Saúde da Família estiveram associados à autopercepção. O presente trabalho evidenciou maior influência de fatores individuais na autopercepção da necessidade de tratamento odontológico e de prótese entre idosos brasileiros. Essas informações podem auxiliar na identificação de desigualdades que afetam essa parcela da população e na definição de prioridades para o planejamento dos serviços de saúde.

Abstract The scope of this study was to identify individual and contextual factors associated with the self-perceived need for dental treatment and for prostheses among elderly Brazilians. An analysis was performed with data from the SB Brazil 2010 epidemiological survey conducted by the Ministry of Health with a sample of 7,619 elderly individuals. Multilevel logistic regression models of mixed random and fixed effects were used to the estimate odds ratio (OR) with 95% confidence interval (95% CI) between the dependent variables and individual and contextual factors. Of the individuals assessed, 3,848 (50.5%) reported a need for dental treatment and 4,236 (55.6%) believed they have the need for prostheses. The results of multilevel logistic regression showed that gender, self-reported skin color, income and coverage by the oral health teams in the Family Health Program were associated with self-perception. This study revealed a greater influence of individual factors on the self-perceived need for dental treatment and prostheses by elderly Brazilians. This information can help to identify the inequalities that affect this population group and in setting priorities for the planning of health services.

Trends in social security benefits for oral and oropharyngeal cancer from 2006 to 2013 in Brazil. / Tendências dos benefícios previdenciários por câncer bucal e de orofaringe de 2006 a 2013 no Brasil.

OBJECTIVE: to analyze the trends in the concession of social security sick pay for oral and oropharyngeal cancer, from 2006 to 2013, in Brazil. METHODS: time series study using data of workers insured by the Brazilian National Institute of Social Security (INSS); Prais-Winsten generalized linear regressions were used to calculate the annual percentage change (APC). RESULTS: social security benefits for oral and oropharyngeal cancer presented significant increase (APC=9.0%; 95%CI 1.4; 17.4); benefits for other parts of the mouth, nasopharynx, oropharynx, floor of mouth and palate have also shown significant increase; the areas of trade (5.5%) and manufacturing (5.2%) were the most prevalent activities; there was a high proportion of fields in blank in the information systems (average of 72.9%). CONCLUSION: trends in occupational benefits for oral and oropharyngeal cancer showed significant increase.

Desigualdades no comprometimento da renda domiciliar dos brasileiros com gastos privados em assistência odontológica / Inequalities in Brazilian families' income commitment to out-of-pocket spending on dental care / Desigualdades respecto a la renta domiciliaria en el desembolso de los brasileños con gastos privados de asistencia odontológica

O objetivo foi investigar as desigualdades no comprometimento da renda domiciliar com gastos privados em assistência odontológica no Brasil. Foram analisados dados de 55.970 domicílios brasileiros que participaram da Pesquisa de Orçamentos Familiares, de abrangência nacional, no período de 2008-2009. O comprometimento dos gastos privados com assistência odontológica na renda familiar foi calculado pela divisão do gasto médio domiciliar per capita anual pela renda familiar per capita anual e estimado segundo quatro categorias: > 0%, ≥ 5%, ≥ 10% e ≥ 20%. A análise do comprometimento na renda foi realizada apenas para os domicílios com gasto positivo. Apenas 2.961 (7%) dos domicílios reportaram gastos positivos com assistência em odontologia. No geral, o gasto médio per capita anual foi de R$ 42,19 e, de R$ 602,47 entre aqueles com gasto positivo. Os domicílios que possuem os maiores gastos absolutos com assistência odontológica são aquelas pertencentes à área urbana e ao quinto mais rico. Em contrapartida, os domicílios com maior comprometimento na renda pertencem à área rural e ao quinto mais pobre. Entre os que informaram gasto positivo, 55% dos domicílios do quinto mais pobre comprometeram ≥ 20% de sua renda com assistência odontológica. O percentual é de apenas 6% no grupo mais rico da população. Os domicílios mais pobres das regiões mais ricas (Centro-oeste, Sul e Sudeste) apresentaram os maiores comprometimentos de renda. As desigualdades socioeconômicas nos gastos e no comprometimento de renda com assistência odontológica são evidentes. A avaliação dessas desigualdades torna-se relevante para avaliação e orientação de políticas públicas em saúde.

The study aimed to investigate inequalities in the commitment of family income to private expenditures on dental care in Brazil. Data were analyzed from 55,970 Brazilian households that participated in the nationwide Family Budgets Survey in 2008-2009. The commitment of family income to private spending on dental care was calculated by dividing the mean annual per capita household spending on dental care by the mean annual per capita income, classified in four categories: > 0%, ≥ 5%, ≥ 10%, and ≥ 20%. Analysis of income commitment only included households with positive spending. Only 2,961 households (7%) reported positive spending on dental care. Mean annual per capita spending was BRL 42.19 (USD 12.78) overall and BRL 602.47 (USD 182.57) among those with positive spending. Households with the highest absolute expenditures on dental care were those from urban areas and the wealthiest quintile. Meanwhile, households with the highest proportional income commitment were from rural areas and the poorest quintile. Among those that reported positive spending, 55% of the households in the poorest quintile committed ≥ 20% of their income to dental care. The proportion was only 6% in the wealthiest quintile of the population. The poorest households in the wealthiest regions of Brazil (Central, South, and Southeast) showed the highest income commitments. There were striking socioeconomic inequalities in spending and income commitment to dental care. The evaluation of these inequalities is relevant for the evaluation and orientation of public health policies.

El objetivo de este trabajo fue investigar las desigualdades en el desembolso de renta domiciliaria con gastos privados en asistencia odontológica en Brasil. Se analizaron datos de 55.970 domicilios brasileños que participaron en la Encuesta de Presupuestos Familiares, de alcance nacional, durante el período de 2008-2009. El desembolso económico privado en asistencia odontológica, respecto a la renta familiar, se calculó mediante la división del gasto medio domiciliario per cápita anual por la renta familiar per cápita anual y estimado según cuatro categorías: > 0%, ≥ 5%, ≥ 10% y ≥ 20%. El análisis del desembolso económico se realizó sólo para los domicilios con gasto positivo. Sólo 2.961 (7%) de los domicilios informaron de gastos positivos con asistencia en odontología. En general, el gasto medio per cápita anual fue BRL 42,19 y, BRL 602,47 entre quienes contaban con un gasto positivo. Los domicilios que cuentan con los mayores gastos absolutos respecto a la asistencia odontológica son los pertenecientes al área urbana y a la quinta parte más rica. En contrapartida, los domicilios con mayor desembolso de renta pertenecen al área rural y a la quinta parte más pobre. Entre los que informaron de gasto positivo, un 55% de los domicilios de la quinta parte más pobre desembolsaron un ≥ 20% de su renta en asistencia odontológica. El porcentaje es de apenas un 6% en el grupo más rico de la población. Los domicilios más pobres de las regiones más ricas (Centro-oeste, Sur y Sudeste) presentaron los mayores desembolsos de renta. Las desigualdades socioeconómicas en los gastos y en el desembolso de renta con la asistencia odontológica son evidentes. La evaluación de estas desigualdades es relevante para la evaluación y orientación de las políticas públicas en salud.