Self-perception of oral health among tertiary-care users: quanti-qualitative analysis with chronic kidney disease patients

Chronic kidney disease (CKD) has become a global public health challenge. The objective of this study was to analyze the relationship between self-perception of oral health and clinical condition among patients with CKD. This isa quanti-qualitative survey conducted in a CKD specialized service. The sample consisted of 60 patients who underwent oral examinations to have their severity of caries (DMFT) and need for dental prosthesis checked. Age, sex, time on dialysis, marital status, skin color, education and pre-existing diseases were also analyzed. Among the kidney patients who agreed to undergo the clinical examinations and showed communication skills, some were selected, and three focus groups were created, with the participation of a moderator and six to 10 kidney patients in each group. Their speeches were processed in the IRAMUTEQ software and analyzed through the similarity analysis and word cloud techniques. As for profile, the patients were aged 60.23 ± 10.87 years old; were male (73.33%); were on dialysis for 41.90 ± 56.57 months; were married (61.67%); were white (76.67%); had incomplete primary education (41.66%); had arterial hypertension (76.67%); had a DMFT index of 22.55 ± 8.39; 43.33% needed an upper complete denture; and 30.00% needed a lower complete denture. The similarity analysis revealed many doubts and uncertainties about current health services, which can be proven by the words 'no' and 'treatment'. The quanti-qualitative analysis showed a high rate of dental loss and the need for complete dentures and suggests inequities in oral health care for chronic kidney disease patients, especially in tertiary care. There was a positive representation regarding oral health, but the lexicographical analyses of the textual corpusconfirmed the self-perception of lack of dental care.

Dispensação de medicamentos na atenção primária do Sistema Único de Saúde / The dispensation of drugs in the primary health care of the Single Health System

Objetivo:analisar a dispensação de medicamentos na atenção primária do Sistema Único de Saúde em um município do Estado de São Paulo. Metodologia:realizou-se análise documental dos boletins de movimentação de medicamentos das farmácias das 19 Unidades Básicas de Saúde do município de Araçatuba-SP, sede do Departamento Regional de Saúde II-SP, durante 12 meses. Os medicamentos foram agregados segundo o sistema de classificação Anatomical Therapeutic Chemicale ação farmacológica. Analisou-se o total de medicamentos dispensados e o saldo final dos principais tipos de fármacos. Resultados:foram dispensados 60.479.959 medicamentos, sendo 53,10% antibióticos, 15,42% anti-hipertensivos, 5,09% antidepressivos, 4,81% hipoglicemiantes, 3,16% ansiolíticos, 2,82% complexos vitamínicos e minerais, 2,17% antipsicóticos, 1,99% analgésicos, dentre outros tipos (11,45%). Permaneceram disponíveis 8.778.863medicamentos, sendo os anti-hipertensivos, antidepressivos e ansiolíticos os que representam a maior proporção entre estes. Os antibióticos apresentaram a menor proporção de unidades disponíveis, com aproximadamente 2%. Os hipoglicemiantes apresentaram maior diversidade de fármacos sem unidades disponíveis para dispensação. Conclusão:os principais tipos de medicamentos dispensados foram antibióticos, anti-hipertensivos, antidepressivos e hipoglicemiantes. A dispensação de medicamentos foi satisfatória, considerando que mesmo os medicamentos que não apresentaram saldo residual positivo foram substituídos por outros de propriedades farmacológicas similares

Objective: to analyze the dispensation of drugs in the primary health care of the Single Health System in a city in the State of São Paulo.Methodology: a document analysis was carried out in the reports of how the movement of drugs took place in the 19 Primary Health Care Units in the city of Araçatuba-SP, head office of the Regional Health Department II-SP, for 12 months. The medications were classified according with the Anatomical Therapeutic Chemical system and with their pharmacological action. The total number of drugs dispensed and the remaining amount of the main types of drugs were analyzed.Results: 60,479,959 medications were dispensed, among which 53.10% were antibiotics, 15.42% antihypertensive, 5.09% antidepressant, 4.81% hypoglycemic, 3.16% anxiolytic, 2.82% vitamin and mineral complexes, 2.17% antipsychotics, 1.99% analgesics, among others (11.45%). 8,778,863 drugs were still available, among which the most numerous were hypertensive, antidepressants, and anxiolytics. Antibiotics represented the lowest percentage of available units, with approximately 2%. Hypoglycemic drugs were the ones that showed that highest diversity of unavailable medications.Conclusion: the main types of medications dispensed were antibiotics, antihypertensives, antidepressants, and hypoglycemic drugs. Drug dispensation was satisfactory,considering that even medications that did not have a positive residual supply were replaced by drugs with similar pharmacological properties

Percepción de los inmigrantes: consentimiento informado y acceso a servicios de salud / Perception of immigrants: free consent and access to health services / Percepção dos imigrantes: consentimento livre e acesso aos serviços de saúde

Resumen En este estudio se propone conocer la percepción de los inmigrantes cubanos sobre el formulario de consentimiento informado y el acceso a tratamientos médicos y odontológicos. Este es un estudio descriptivo transversal, tipo encuesta. La muestra se compuso de inmigrantes de un municipio de mediano porte del estado de São Paulo, Brasil. Los participantes respondieron a un formulario con preguntas relacionadas al conocimiento del formulario de consentimiento informado y la accesibilidad a tratamientos médicos y odontológicos en Brasil y en su país de origen, instrumento que también recogía información sociodemográfica sobre los encuestados. Los participantes tenían accesibilidad a la atención médica y odontológica, pero poco conocimiento sobre ese formulario durante los tratamientos. Los médicos y los odontólogos deben adoptar medidas para una práctica profesional segura, pues un formulario de consentimiento informado bien preparado y de conocimiento del paciente favorece la realización exitosa de los procedimientos.

Abstract This study aims to identify the perception of Cuban immigrants about the free and informed consent form and access to dental and medical care. This is a cross-sectional descriptive survey conducted with a sample of immigrants from a medium-sized municipality in the state of São Paulo. Data were collected by means of a questionnaire addressing the form and the access to dental and medical care both in Brazil and in their country of origin, as well as sociodemographic aspects. The results indicate that immigrants have access to medical and dental care, but little knowledge about the consent form during treatment. Considering that a well-designed consent term and patient knowledge promotes the successful performance of procedures, physicians and dentists need to adopt measures for a safe professional practice.

Resumo Este estudo visa conhecer a percepção dos imigrantes cubanos sobre o termo de consentimento livre e esclarecido e o acesso a tratamentos médicos e odontológicos. Trata-se de um estudo descritivo transversal, tipo inquérito. A amostra foi composta por imigrantes de um município de médio porte do estado de São Paulo. Os participantes responderam a um formulário com questões relacionadas ao conhecimento desse termo e ao acesso a tratamentos médicos e odontológicos no Brasil e no país de origem, instrumento que também coletou dados sociodemográficos. Os participantes tinham acesso à assistência médica e odontológica, mas pouco conhecimento sobre o termo de consentimento durante os tratamentos. Os médicos e odontólogos devem tomar medidas para uma prática profissional segura, pois um termo de consentimento bem elaborado e de conhecimento do paciente promove a realização bem-sucedida dos procedimentos.

Characterization of the self-perception of oral health in the Brazilian adult population.

This article aims to perform an analysis of the factors that determine the self-perception of oral health of Brazilians, based on a multidimensional methodology basis. This is a cross-sectional study with data from a national survey. A household interview was conducted with a sample of 60,202 adults. Self-perception of oral health was considered the outcome variable and sociodemographic characteristics, self-care and oral health condition, use of dental services, general health and work condition as independent variables. The dimensionality reduction test was used and the variables that showed a relationship were submitted to logistic regression. The negative oral health condition was related to difficulty feeding, negative evaluation of the last dental appointment, negative self-perception of general health condition, not flossing, upper dental loss, and reason for the last dental appointment. The use of a multidimensional methodological basis was able to design explanatory models for the self-perception of oral health of Brazilian adults, and these results should be considered in the implementation, evaluation, and qualification of the oral health network.

Atuação do cirurgião-dentista no serviço público e o direito à aposentadoria especial / Performance of the dentist in the public service and the right to special retirement

No Brasil, devido ao crescente número de idosos, aumento da longevidade da vida e diminuição da natalidade, novas propostas foram sugeridas para mudanças no requerimento da aposentadoria. O Instituto Nacional do Seguro Social (INSS) é a organização pública brasileira responsável pelos serviços previdenciários. Entretanto, alguns profissionais devido a riscos físicos, biológicos e químicos de sua ocupação, podem requerer uma aposentadoria especial, mediante alguns requisitos determinados por leis. Com isso, o objetivo desta pesquisa foi verificar processos de cirurgiões-dentistas contra o INSS, investigar as principais mudanças propostas para a reforma previdenciárias e suas interferências para estes profissionais. Foi realizada pesquisa transversal, por meio de busca no endereço eletrônico do Tribunal de Justiça do Estado de São Paulo (TJSP): https://esaj.tjsp.jus.br/cjpg/, julgados em 1° grau, no ano de 2016. Para verificar as mudanças propostas com a reforma da previdência foi realizada consulta de leis vigentes no Brasil e material disponibilizado pela previdência social. Foram encontrados 73 processos de cirurgiões-dentistas do serviço público de saúde, destes, 64, 38% foram para requisição da aposentadoria especial e 28,77% foram de aposentados. Do total, 82,19% dos processos obtiveram o parecer procedente. Com relação à reforma da previdenciária, foi visto que a aposentadoria poderá sofrer alterações com relação a idade mínima para obter o benefício. A aposentadoria especial sofrerá algumas alterações no que diz respeito ao recolhimento mensal para a previdência social. Apesar de garantida a aposentadoria especial, alguns cirurgiões-dentistas necessitaram buscar judicialmente este direito. Sobre as mudanças propostas para a reforma previdenciária, algumas poderão levar a prejuízos para os cirurgiões-dentistas.

In Brazil, because of the increasing number of elderly people, increased longevity of life and declining birth rates, new proposals were suggested for changes in the requirement for retirement. The Brazilian National Social Security Institute (INSS) is the public organization responsible for social security services. However, some workers due to the physical, biological and chemical risks of their occupation may require a special retirement, according to some requirements determined by laws. Therefore, the objective of this research was to verify dentists' processes against the INSS, to investigate the main changes proposed for social security reform and their interference for these professionals. A cross-sectional survey was carried out by searching the electronic address of the Court of Justice of the State of São Paulo (TJSP): https://esaj.tjsp.jus.br/cjpg/, judged in 1st degree, in the year of 2016. To verify the changes proposals with the reform of the social security was made consultation of laws in force in Brazil and available material by social security. A total of 73 dentists of the public health service were found, of which 64, 38% went to special retirement and 28.77% were retired. Of the total, 82.19% of the cases obtained the relevant opinion. With regard to the pension reform, it was seen that the retirement may change with respect to the minimum age to obtain the benefit. The special retirement will have some changes as regards the monthly payment for social security. Although special retirement was guaranteed, some dental surgeons needed to apply this right in court. On the proposed changes to the pension reform, some may lead to losses for dentists.

Case-resolving capacity of dental care of the Unified Health System: the perception of users in a city in the state of São Paulo, Brazil.

The aim of this study was to learn about the users' perceptions concerning the case-resolving capacity of dental care in the Unified Health System and to analyze the associations between solving capacity and both sociodemographic characteristics and access to the service. This was a cross-sectional study with a quantitative approach, in which 461 users responded to individual interviews. The outcome variable was the case-resolving capacity of dental care, obtained through the question: "In your opinion, is the dentist of this health center managing to solve all your oral health problems (Yes/No)". Independent variables were grouped into the following: sociodemographic and related to the access to the service. Most participants reported that their oral health problems were being solved. By using the Poisson regression, the lack of case-resolving capacity was found to be associated to the patients' not considering the dental surgeon's working hours convenient; to the long time they had to wait to get an appointment in the health center; and to the long time they had to wait in the waiting room. The results showed the positive view that users have about the case-resolving capacity of public dental care, and the relationship between access to the service and the said solving capacity.

Case-resolving capacity of dental care of the Unified Health System: the perception of users in a city in the state of São Paulo, Brazil / Resolutividade do serviço odontológico no Sistema Único de Saúde: a percepção de usuários de um município paulista, Brasil

Abstract The aim of this study was to learn about the users' perceptions concerning the case-resolving capacity of dental care in the Unified Health System and to analyze the associations between solving capacity and both sociodemographic characteristics and access to the service. This was a cross-sectional study with a quantitative approach, in which 461 users responded to individual interviews. The outcome variable was the case-resolving capacity of dental care, obtained through the question: "In your opinion, is the dentist of this health center managing to solve all your oral health problems (Yes/No)". Independent variables were grouped into the following: sociodemographic and related to the access to the service. Most participants reported that their oral health problems were being solved. By using the Poisson regression, the lack of case-resolving capacity was found to be associated to the patients' not considering the dental surgeon's working hours convenient; to the long time they had to wait to get an appointment in the health center; and to the long time they had to wait in the waiting room. The results showed the positive view that users have about the case-resolving capacity of public dental care, and the relationship between access to the service and the said solving capacity.

Resumo O objetivo neste estudo foi conhecer a percepção do usuário sobre a resolutividade do serviço odontológico no Sistema Único de Saúde, e analisar as associações entre resolutividade e características sociodemográficas e de acesso ao serviço. Tratou-se de uma pesquisa transversal com abordagem quantitativa, na qual 461 usuários responderam a entrevistas individuais. A variável desfecho foi a resolutividade do serviço odontológico, obtida através da seguinte pergunta: "Em sua opinião, o dentista desta unidade de saúde está conseguindo resolver todos os seus problemas de saúde bucal? (sim/não)". As variáveis independentes foram agrupadas em: sociodemográficas, e de acesso ao serviço. A maioria dos participantes relatou que seus problemas de saúde bucal estavam sendo resolvidos. Por meio da regressão de Poisson, observou-se que a falta de resolutividade esteve associada a não considerar o horário de trabalho do cirurgião-dentista conveniente; à grande demora para conseguir realizar o agendamento para a unidade de saúde; e ao tempo na sala de espera ser muito demorado. Os resultados revelaram a percepção positiva que o usuário teve sobre a resolutividade do serviço público odontológico, e a relação existente entre o acesso ao serviço e a capacidade resolutiva referida.

Hidden violence against the institutionalized elderly / Violência oculta contra idosos institucionalizados

The aim of this study was to investigate the occurrence of violent actions performed by caregivers against the institutionalizedelderly. This cross-sectional study, deals with an analytical, qualitative, and quantitative research carried out with thecaregivers of 38 elderly residents of long-term care facilities in the cities of São Paulo State, Brazil. A questionnaire basedon the Caregiver Abuse Screen (CASE) was used. Only one trained researcher performed the study, and all ethical andlegal aspects were respected. The quantitative data were analyzed by Epi-Info software, version 3.5.4, and Fisher’s testsand ANOVA were applied. The qualitative data were analyzed by content categorization. Among the results, all the CASE’squestions showed some affirmative answers, indicating the occurrence of violence, and only 21.1% of caregivers said thatthey had never committed any violent act. In that sense, the main caregivers actions were “to act in a coarse way” (21%)or “to do nothing that they were able to do for the elderly” (39.5%) to help seniors, aiming to obtain control of situationsregarding their aggressiveness and behavior. Additionally, a majority (87%) of the caregivers realized that violence existsin the caregivers physical, psychosocial and negligence domains regarding the institutionalized elderly, mainly in hiddenforms(AU)

O objetivo deste estudo foi investigar a ocorrência de ações violentas realizadas por cuidadores contra idososinstitucionalizados. Trata-se de um estudo transversal, de pesquisa analítica, qualitativa e quantitativa realizado com os 38cuidadores de idosos residentes em unidades de longa permanência nas cidades do Estado de São Paulo. Utilizou-se umquestionário baseado no Caregiver Abuses Screen (CASE). Apenas um pesquisador treinado realizou o estudo, e todos osaspectos éticos e legais foram respeitados. Os dados quantitativos foram analisados pelo software Epi-Info, versão 3.5.4,e os testes de Fisher e ANOVA foram aplicados. Os dados qualitativos foram analisados por categorização de conteúdo.Dentre os resultados, todas as questões do CASE mostraram algumas respostas afirmativas, indicando a ocorrência deviolência, e apenas 21,1% dos cuidadores disseram que nunca haviam cometido nenhum ato violento. Nesse sentido,as principais ações dos cuidadores foram “agir de forma grosseira” (21%) ou “não fazer nada que pudessem fazer pelosidosos” (39,5%) para ajudar idosos, visando obter controle De situações de agressividade e comportamento. Além disso,a maioria (87%) dos cuidadores percebeu que existe violência nos domínios físico, psicossocial e de negligência doscuidadores em relação aos idosos institucionalizados, principalmente em formas ocultas(AU)

Inequalities in Oral Health among Older Brazilians: A Cross-Sectional Analysis of a National Survey

Objective: To investigate the association of tooth loss and periodontal disease with socioeconomic and demographic factors, the need for and use of health services, and the effect of oral health on the daily lives of older Brazilians. Material and Methods: We abstracted data from a nation-wide, representative, cross-sectional survey of 7619 Brazilians aged between 65 to 74 years. Poisson regression models were created to investigate associations between oral diseases and income, education level, gender, ethnicity, region of residence, and use of dental services; statistical significance was set at 5%. Results: The mean age of the 7619 subjects studied was 69 years (95% Confidence Interval, 68.9­69.1); 61.9% were women. Regarding ethnicity, 46.95% were White, 38.90% were Brown, 11.54% were Black and 2.53% belonged to other ethnic groups. Bleeding on probing or dental calculus was present in 26.67% of subjects, whereas LOA was present in 87.27%. The loss of at least one tooth was observed in 48.90% of subjects, while 47.03% were completely edentulous. Low educational status increased the prevalence ratio (PR) of all diseases (loss of attachment, PR=5.54; bleeding on probing, PR=3.93; tooth loss, PR=2.24; edentulousness, PR=3.34). The prevalence of tooth loss was 2.58 times higher in subjects who reported a monthly income of less than 301 USD. The effect on daily life was occasionally a protective factor and occasionally increased the likelihoods of diseases. Conclusion: These findings substantiate the association of socioeconomic conditions, demographic features, and use of dental services with bleeding on probing, presence of dental calculus, loss of periodontal attachment, tooth loss, and edentulousness among older Brazilian subjects.

Análise documental dos serviços de saúde bucal ofertados à população indígena no brasil / Documentary analysis of the oral health services offered to the brazilian indigenous population

Introdução: Os povos indígenas do Brasil compõem um cenário diversificado do ponto de vista cultural. A garantia de assistência à saúde geral e bucal indígena, atualmente, foi estabelecida pelo Subsistema de Atenção à Saúde Indígena, integrado ao Sistema Único de Saúde. Objetivos: Analisar a política de saúde bucal inserida no subsistema de saúde indígena, evidenciando a sua evolução no processo histórico e legal. Metodologia: Trata-se de um estudo descritivo e exploratório, em que foram consultados decretos, leis e portarias, já com as recentes e respectivas mudanças na legislação. Discussão: Apesar dos avanços, há recorrentes disparidades ao analisarmos a saúde bucal indígena em comparação à população brasileira não indígena. Essa diferença é observada nos perfis de saúde indígena, os quais são relativos aos âmbitos nacionais e regionais, em uma combinação de fatores socioeconômicos, ambientais e políticos. Ao longo do tempo, a saúde indígena esteve sob responsabilidade de distintas instituições. Recentemente, um projeto de lei propôs a criação do Instituto Nacional de Saúde Indígena, com intuito de simplificar os processos administrativos. Conclusão: A trajetória da saúde bucal indígena brasileira é marcada por dissidências e existem bases jurídicas que garantem o acesso aos cuidados de saúde deste grupo, embora a descontinuidade das políticas impeça a integralidade das ações de saúde bucal (AU).

Introducion: From a cultural point of view the Brazilian indigenous peoples compose a diversified cultural scenario. The guarantee of general and oral health assistance of indigenous people has been established by the Subsystem of Attention to Indigenous Health, integrated into the Brazilian Unified Health System. Objectives: To analyze the oral health policy inserted in the subsystem of indigenous health, evidencing its evolution in the historical and legal process. Methodology: It was a descriptive and exploratory study, in which decrees, laws and rules were consulted, with recent and relevant changes in legislation. Discussion: Despite the advances there are recurrent disparities when analyzing indigenous oral health in comparison to the nonindigenous Brazilian population. This difference is observed in indigenous health profiles, which are related to national and regional levels, in a combination of socioeconomic, environmental and political factors. Over the years, indigenous health has been under the responsibility of different institutions. Recently, a bill proposed the creation of the National Institute of Indigenous Health, in order to simplify administrative processes. Conclusion: The trajectory of Brazilian indigenous oral health is marked by dissidents and there are legal bases that guarantee the access to health care of this group, although the discontinuity of the policies blocks the integrality of oral health actions (AU).

Determinants of oral self-care in the Brazilian adult population: a national cross-sectional study.

This study aims to investigate variables related to adherence to oral self-care in the Brazilian adult population. It is an exploratory study, using secondary data from a population-based survey on a representative sample of the adult population of the entire Brazilian territory (n=60202). The sample was selected using a multiple stage approach. The oral self-care indicator was defined by grouping the variables: periodicity of dentist appointments, use of dental floss, toothbrush and toothpaste, frequency of brushing and replacement of the toothbrush. The scores obtained from the indicator were categorized into adequate, partially adequate, and inadequate care. Statistical analysis consisted of dimensionality reduction, and oral self-care-related variables were submitted to logistic regression. The variables mostly related to inadequate or partially adequate oral self-care were: illiteracy (OR = 11.20, OR = 4.81), low educational level (OR = 3.50, OR = 1.96), negative oral health self-concept (OR=3.73, OR=1.74), absence of natural teeth (OR = 4.98, OR=2.60), edentulous lower arch (OR = 3.09; _____), number of missing upper teeth (OR=1.14, OR=1.05), absence of health insurance (OR=2.23, OR=2.07), sedentary lifestyle (OR=2.77, OR=1.51), and smoking (OR=2.18, OR=1.40). It was concluded that the individual's level of education is one of the main factors for adherence to adequate oral self-care, followed by level of oral health self-concept and tooth loss. Likewise, lifestyle also bears a significant influence.

Hepatite B e Exposição Ocupacional no Cenário Odontológico. A Valoração do Saber e das Atitudes dos Profissionais / Hepatitis B and occupational Exposure in the Dental Setting. The Valuation of the Knowledge and Professionals Attitudes

A Hepatite B é uma doença pandemica e infecciosa de grande impacto à saúde pública, visto sua alta infectividade e elevados índices de morbidade e mortalidade. O presente estudo teve como objetivo avaliar o conhecimento dos cirurgiões-dentistas sobre o tema hepatite B e as suas atitudes frente aos acidentes ocupacionais. Trata-se de um estudo epidemilógico exploratório, transversal, quantitativo, realizado com cirurgiões-dentistas da rede pública nos níveis de atenção primária e secundária de três municípios do Estado de São Paulo. Para a coleta dos dados foi elaborado um inquérito semiestruturado, exclusivamente, para este estudo. Os dados foram procesados e tabulados com auxílio do pacote estatístico Epi Info 7.1. Do total de 133 profissionais cadastrados, obteve-se participação de 101 (75,96%) cirurgiões-dentistas. Verificou-se que, embora grande parte dos participantes afirmassem ter conhecimento sobre hepatite B (69,31%), apenas metade deles acertou o agente etiológico da doença. Em relação à vacinação, 91,1% diseram ter tomado as 3 doses da vacina, entretanto, somente 50% dos mesmos garantiram estarem imunizados contra o vírus. Sobre os acidentes, a maioria dos incidentes ocorreram apenas uma vez (68,75%) e a agulha da seringa carpule (56,25%) foi o principal agente causador do incidente. Além do mais, dentre os cirugiões-dentistas que já se acidentaram, os quais os pacientes se recusaram realizar os exames de comprovação imunológica, não fizeram as medidas profiláticas pós-exposição. O conhecimento dos cirugiões-dentistas sobre o tema hepatite B se mostra como uma questão, que ainda apresenta falhas, e as medidas protetivas, que devem ser tomadas após acidentes ocupacionais foram totalmente negligenciadas. (AU).

Hepatitis B is a pandemic and infectious disease with a great public health impact due to its high infectivity and high morbidity and mortality rates. This study aimed to evaluate the knowledge of dentists on the topic regarding hepatitis B and their attitudes towards occupational accidents. This is a quantitative cross-sectional exploratory epidemiological study, carried out with dental surgeons of the public network at the primary and secondary care levels from three municipalities in the State of São Paulo. For data collection, a semi-structured survey was designed exclusively for this study. The data were processed and tabulated using the Epi Info 7.1 statistical package. Ou of the total of 133 registered professionals, 101 (75.96%) dentists participated. It was found that, although a large part of the participants claimed to have knowledge about hepatitis B (69.31%), only half of them agreed on the etiological agent of the disease. Regarding vaccination, 91.1% said they had taken all three doses of the vaccine, however, only 50% of them had been immunized against the virus. About the accidents, most incidents occurred only once (68.75%) and the carpule syringe needle (56.25%) was the main causative agent of the incident. In addition, among those dental surgeries who have already experienced accidents, when the patients refused to perform the immunological tests, they did not take the prophylactic measures after exposure. The knowledge of dentists on the topic of hepatitis B is an issue that still presents flaws, and the protective measures that must be taken after occupational accidents have been totally neglected. (AU).

Evaluación comparativa del conocimiento sobre salud oral entre equipos pedagógicos que recibieron y no recibieron promoción en salud / Comparative evaluation of oral health knowledge among pedagogical teams receiving and not receiving health promotion

Este estudio tuvo como objetivo evaluar, comparativamente, las diferencias en el conocimiento sobre salud oral de equipos pedagógicos que recibieron y que no recibieron el Programa de Salud Oral, promovido por la Facultad de Odontología de Araçatuba (FOA), en las escuelas de enseñanza infantil del municipio de Araçatuba, São Paulo, Brasil. Participaron de esta investigación transversal 76 profesores de 10 escuelas municipales de enseñanza infantil (EMEB). Los equipos pedagógicos del grupo experimental recibieron las actividades del Programa de Salud Oral de la FOA (n=38); en cambio, los equipos establecidos en el grupo de control no las recibieron (n=37). Se recolectaron los datos por medio de un cuestionario que trazaba el perfil del profesor (sexo, función en la escuela, edad, nivel de escolaridad) y evaluaba su conocimiento sobre salud oral (placa dental, caries dental, cepillo de dientes, almacenamiento de cepillos, dentífrico, chupete, hábitos de higiene oral). Se compararon las variables independientes entre los grupos por medio de tests estadísticos. El 76,6 % de la muestra eran de profesores de enseñanza infantil y solo uno era del sexo masculino. La media de edad de los dos grupos fue de 41 años y el grado de escolaridad fue de posgrado completo (88,1 %). La investigación identificó comportamiento muy semejante en las respuestas del cuestionario en ambos los grupos encuestados, siendo sus respuestas muy cerca a las del sentido común. Esta investigación concluye que no hay diferencias significativas en el conocimiento sobre salud oral entre los grupos evaluados.

This study's goal was to comparatively evaluate the differences between the oral health knowledge of two teaching staff groups: those that were part of the oral health promotion programs and those that were not. Seventy six (76) teachers at ten nursery schools participated in this transversal study. The teaching staff of the intervention group were part of the activities of the "Oral Health Promotion Program in state-funded nursery schools of Araçatuba, São Paulo State" of the Araçatuba Dental School (Faculdade de Odontologia de Araçatuba - FOA/UNESP) (n=38), however, the teachers from the control group were not part of the activities (n=37). The data were collected through questionnaire with the goal of identifying the educator (sex; function at the school; age; years of schooling), and to evaluate the educator's knowledge regarding oral health (dental plaque, dental caries, toothbrush, storage of toothbrushes, tooth paste, pacifier, oral hygiene habits). The independent variables were compared between the groups through statistical tests. 76.6 % of the sample was of teachers of the nursery schools and only one participant was male. The average age between both groups was 41 and the average education level was of graduation (88.1 %). The research identified a very similar behavior in the questionnaire answers from both groups, and the knowledge identified on the evaluation was close to common sense. This study concluded that there were not significant differences on the oral health knowledge between the evaluated groups.

Longitudinal study into the determining factors of dental caries in children aged 4: socio-behavioral aspects and oral health of pregnant women / Estudo longitudinal sobre determinantes da cárie aos 4 anos de idade: aspectos sócio-comportamentais e saúde bucal da gestante

ABSTRACT Objective: To analyze the influence of oral health conditions and socio-behavioral characteristics of pregnant women on the development of caries and their children's experiences, after 4 years of follow-up. Methods: It was conducted a longitudinal study of mother/child pairs by interview and oral clinical examination during pregnancy. Regular observations were made until the child had reached four years of age, at which time we performed a clinical examination of the children (n=73). The variables studied were: presence of caries in pregnancy (DMFT) and the child (deft), visit to the dentist, oral hygiene habits, diet, socioeconomic and behavioral factors, and were related to two study outcomes: presence of caries during the examination and experience of caries (deft≥1) in children of 4 years of age. Bivariate and logistic regression analyses were conducted with the variables (p<0.05 and 95% CI). Results: The average DMFT index of mothers during pregnancy was 12.09 (±2.88) and average deft index of children at 4 years was 1.79 (± 6.1). In the multiple logistic regression analysis, the presence of caries in children was associated with the presence of harmful habits (p=0.04). Caries in the child was statistically associated with brush sharing among family members (p=0.02). Conclusion: The results suggest that behavioral aspects are related to the presence and experience of caries in childhood.

RESUMO Objetivo: Analisar a influência das condições de saúde bucal e das características sócio-comportamentais de gestantes no desenvolvimento e na experiência de cárie em seus filhos, após 4 anos de acompanhamento. Métodos: Foi realizado um estudo longitudinal com pares de mães e filhos, mediante entrevista e exame clínico bucal na gestação. Observações periódicas foram realizadas até os quatro anos completos de idade da criança, momento em que foi realizado o exame clínico na criança (n=73). As variáveis estudadas foram: presença de cárie na gestante (CPOD) e na criança (ceod), visita ao cirurgião-dentista, hábitos de higiene bucal, dieta, fatores socioeconômicos e comportamentais, sendo relacionadas com dois desfechos do estudo: presença de cárie no momento do exame e experiência de cárie (ceod≥1) em crianças aos 4 anos de idade. Foram conduzidas análises bivariadas e multivariada com auxílio do Programa Bioestat (p<0,05 e IC 95%). Resultados: O CPOD médio das mães durante a gestação foi 12,09 (±2,88) e ceod médio das crianças aos 4 anos foi 1,79 (±6,1). Na análise de regressão logística múltipla, a presença de cárie nos filhos esteve associada com a presença de hábitos deletérios (p=0,04). A experiência de cárie no filho foi associada estatisticamente com o compartilhamento de escova entre os membros da família (p=0.02). Conclusão: Os resultados sugerem que aspectos comportamentais estão relacionados à presença e experiência de cárie na infância.

User Satisfaction with the Public Oral Health Services in the Different Dimensions of Health Care

Objective: To verify user satisfaction with the public oral health services in its different dimensions of care and relate them to the socioeconomic and demographic conditions. Material and Methods: Cross-sectional survey, developed with users interviewed of the public oral health services under the Primary Health Care of a Brazilian city (n=461). The associations of satisfaction with the socioeconomic and demographic conditions were analyzed using the chi-square test. Questions concerning satisfaction with the service were grouped into five domains - 'physical structure', 'relation and communication', 'information and support', 'health care' and 'organization of services' - analyzed using the Kruskal-Wallis Test. Results: Elderly individuals with low education and male, tended to be more satisfied with the services. The users reported being satisfied with the service, that were unhappy, referred to the time and the form to schedule a consultation, the time expected to be attended and the resolving capacity of oral health problems, as the causes. The overall satisfaction index was 0.8. The top rated domains were 'physical structure' (0.9) and 'relation and communication' (0.85). The 'service organization' domain received the worst evaluation (0.71) and when compared to the others domain presenting a significant difference. The 'physical structure' domain was significantly highlighted from the domains of 'oral health care' (0.78) and 'information and support' (0.78). The 'relation and communication' domain, also significantly excelled over the areas of 'oral health care'. Conclusion: The users rated the aspects of health care in a very positive way. The areas of highest user satisfaction were 'physical structure' and 'relation and communication'. However, the need for directing production processes in health became evident, especially regarding the organization of services, the domain with the worst rating.

[User evaluation on dental care in the Unified Health System: an approach from the standpoint of humanization]. / Avaliação do usuário sobre o atendimento odontológico no Sistema Único de Saúde: uma abordagem à luz da humanização.

The scope of this study was to assess user evaluation about dental care in the Unified Health System and analyze the associations between this evaluation, sociodemographic characteristics, and aspects related to humanization of the services. It involved a cross-sectional survey with a quantitative approach, in which 461 users responded to individual interviews. The outcome variable was obtained by means of the question: "How do you consider the care given by the dentist and by the team in this health unit?" Responses were grouped into "positive evaluation" and "negative evaluation." The independent variables integrated two groups: sociodemographic, and related to the humanization of care. The positive evaluation (90.4%) prevailed over the negative. Using Poisson regression, it was found that the negative evaluation was statistically associated with not having felt confidence in the dentist and staff, and not being able to talk to these professionals after the end of treatment. The results showed the preponderantly positive user evaluation of the service, and suggest that the evaluation may be more related to the humanization in services than to sociodemographic characteristics of the population.

Demand organization in public oral health services: analysis of a traditional model / Organização da demanda em serviços públicos de saúde bucal: análise de um modelo tradicional

ABSTRACT Objective: To discuss the municipal experience of the organization and the demand for dental services, based on the guidelines of the Unified Health System (UHS), which point to the structuring of an assistance model based on universality and integrality of care and equity in access to services. Methods: The research, realized in Araçatuba/SP, was based on documentary analysis and interviews with key-informants of the UHS dental service. The traditional court model has a care system for schoolchildren and a basic network with priority for pregnant women. Results: In total, the network has 59 dental surgeons, 31 oral health auxiliaries and 17 Oral Health Teams; however, the school attendance model persists, with 10 professionals attending public schools. Based on the discussions, it is concluded that there are no established criteria for the organization of demand. Conclusion: Most of the attendance occurs by free demand, and the reference and counter-referral system is incipient, damaging the service's resoluteness.

RESUMO Objetivo: Discutir a experiência municipal da organização a demanda de serviços odontológicos, com base nas diretrizes do Sistema Único de Saúde (SUS), as quais apontam para a estruturação de um modelo assistencial com base na universalidade e na integralidade da atenção e na equidade no acesso aos serviços. Métodos: A pesquisa, realizada em Araçatuba (SP), teve como base a análise documental e entrevistas com informantes-chave do serviço odontológico do SUS. O modelo de corte tradicional, conta com um sistema de assistência para escolares e uma rede básica com prioridade para gestantes. Resultados: No total, a rede conta com 59 cirurgiões-dentistas, 31 auxiliares em saúde bucal e 17 Equipes de Saúde Bucal, entretanto persiste o modelo de atendimento a escolar, com 10 profissionais atendendo em escolas públicas. A partir das discussões colocadas, conclui-se que, não há critérios estabelecidos para organização da demanda. Conclusão: A maioria dos atendimentos ocorre por livre demanda, e o sistema de referência e contra-referência é incipiente, prejudicando a resolutividade do serviço.

Oral health assessment from the perspective of the municipal manager / Avaliação da saúde bucal na ótica do gestor municipal

ABSTRACT Objective: The aim of this study was to conduct a situational diagnosis related to the organization of oral health services in 40 municipalities of São Paulo State, Brazil. Methods: This is a cross-sectional, quantitative and qualitative, descriptive study performed through document analysis and application of a semi-structured questionnaire to oral health coordinators, in 2014. The following items were defined: dental infrastructure, access and regulation, work organization and assessment strategies. Although the Basic Health Unit is the main gateway to the system, dental care was also conducted in schools; the main service access of the population was the spontaneous demand and there have been production data inconsistencies in the information systems. Results: It was observed that, 60% answered that the health planning process included oral health; 47.5% performed risk assessment; 47.5% did not perform evaluation and monitoring of results. Conclusion: It is concluded that municipalities present different moments in the structuring of the service and that managers should improve the access organization, the work process and service evaluation in order to consolidate the universality and comprehensiveness of health care.

RESUMO Objetivo: Realizar um diagnóstico situacional relacionado à organização dos serviços de saúde bucal de 40 municípios do Estado de São Paulo, Brasil. Métodos: Trata-se de um estudo transversal, quanti-qualitativo, descritivo, realizado em 2014, por meio de análise documental e aplicação de um questionário semiestruturado nos coordenadores de saúde bucal. As seguintes dimensões foram definidas: infraestrutura odontológica, acesso e regulação, organização do processo de trabalho e estratégias de avaliação. Apesar da Unidade Básica de Saúde ser a principal porta de entrada para o Sistema, o atendimento odontológico ainda era realizado em escolas; a principal forma de acesso da população aos serviços foi a demanda espontânea e havia inconsistências nos dados de produção nos sistemas de informações. Resultados: Do total, 60% responderam que o processo de planejamento em saúde envolveu a área de saúde bucal; 47,5% realizavam avaliação de risco; 47,5% não realizavam avaliação e o acompanhamento dos resultados alcançados. Conclusão: Conclui-se que os municípios apresentam diferentes momentos na estruturação do serviço e que os gestores devem aprimorar a organização do acesso, do processo de trabalho e da avaliação dos serviços para a consolidação da universalidade e integralidade da atenção em saúde.

Socioeconomic level and the parents' perception of the impact of oral diseases on their children's quality of life

Aim: To analyze how parents of different socioeconomic levels perceive the impact of oral diseases on their children's quality of life. Methods: All parents or guardians of students aged 11 to 14 years old, regularly enrolled in fundamental schooling at public schools of two towns in the northwestern region of the State of São Paulo, Brazil, were enrolled in the study. The questionnaire of "Socioeconomic Assessment Tool" was used to classify the families with regards to socioeconomic class and the "Parental-Caregiver Perceptions Questionnaire (P-CPQ)" was used to verify the parents' perception of the impact of oral diseases on their children's quality of life. Results: 172 (41.8%) individuals answered the survey. Among them, most belonged to the Upper Low Class (61%). 21.5% of the individuals answered that they considered their children's oral health "regular or bad" and 71.5% answered that their child's general well-being was not or was little affected by the condition of his/her teeth, lips, jaws or mouth. There was an association between the quality of life sub-scales, especially "oral symptoms", with all socioeconomic classes. Conclusions: There is a relationship between parents' socioeconomic class and the perception of the impact of oral disease on their children's quality of life (Au)

Considerações de profissionais e usuários sobre o serviço público odontológico: um aporte para o planejamento em saúde / Professional and users considerations on the public dental service: subsidies to health planning

Este estudo tem como objetivo verificar a percepção de profissionais e usuários acerca da necessidade de melhorias no serviço público odontológico. Trata-se de uma pesquisa qualitativa desenvolvida junto a usuários do serviço odontológico (n=240), profissionais da saúde bucal (n=51) e agentes comunitários da saúde (n=126). Os dados foram coletados por meio de entrevista individual e tratados pela Técnica de Análise de Conteúdo. Os resultados mostram que os diferentes sujeitos indicaram a necessidade das seguintes melhorias: estrutura física; sistema de agendamento de consultas; tempo de espera e filas para o atendimento e número de atendimentos diários. Observou-se também, a falta de humanização, de acolhimento e a baixa cobertura da atenção odontológica. Conclui-se que os resultados apontaram para ajustes efetivos nos campos da infraestrutura, recursos materiais e organização dos serviços. Sugere-se que os mesmos sejam considerados em um projeto de implantação da gestão compartilhada das ações e serviços de saúde bucal no âmbito da Atenção Primária à Saúde no Brasil.

The aim is verify the perception of professionals and users about the need for improvements in public dental services. Qualitative research was conducted with users of dental service (n=240), oral health professionals (n=51) and community health workers (n=126). Data were collected through individual interviews and processed by the Content Analysis Technique. The results shows the different subjects indicated the need for the following improvements: physical structure; appointment scheduling system; waiting time and queues for the service and number of daily calls. There was also a lack of humanization, the host and the low coverage of dental care. Concludes that the results showed necessary adjustments in the fields of infrastructure, material resources and services organization. It is suggested that they are considered in a deployment project of the shared management of stock and oral health services within the primary health care in Brazil.