Alcohol consumption during pregnancy by women from southern Brazil: a cross-sectional study.

BACKGROUND: Some maternal characteristics are related to alcohol intake during pregnancy, which irreversibly compromises the maternal-fetal binomial integrity. OBJECTIVES: To identify the frequency, impact, and factors associated with alcohol consumption during pregnancy. DESIGN AND SETTING: A cross-sectional study was performed at the Hospital Materno Infantil Presidente Vargas (HMIPV) in Porto Alegre/RS between March and December 2016. METHODS: A structured questionnaire was administered along with a medical records review. They refer to the maternal sociodemographic and gestational status, alcohol consumption patterns, and characteristics of the fetus/newborn. In the statistical analysis, P values < 0.05 were considered significant. RESULTS: The frequency of alcohol intake was 37.3%; this was characterized by the consumption of fermented beverages (89.3%), especially during the first trimester (79.6%). Risky consumption (high and/or early) occurred for 30.2% of participants. Risk factors associated with maternal alcohol consumption during pregnancy were tobacco use (P < 0.001) and abortion attempt (P = 0.023). Living with a partner (P = 0.002) and planning pregnancy (P = 0.009) were protective factors. Risky consumption was related to all of the aforementioned variables as well as threatened abortion (P = 0.023). CONCLUSIONS: Alcohol intake during pregnancy is common and affects nearly one-third of pregnant women. Knowledge of the population at risk and protective factors is essential for the development of campaigns that seek to reduce consumption and, therefore, its consequences for the mother and fetus.

Longitudinal and transcultural assessment of the relationship between hallucinogens, well-being, and post-traumatic growth during the COVID-19 pandemic.

The COVID-19 pandemic has had a devastating impact on the health and wellbeing of the global population. This paper presents the results of a longitudinal transcultural study that was begun at the peak of the pandemic (in April, 2020). An online survey was used to collect data from English-, Spanish-, and Portuguese-speaking participants. The survey collected information about sociodemographics, lifestyle activities, COVID-19-related circumstances, and drug use (with an emphasis on hallucinogenic drugs), as well as involving psychometric questionnaires. Users of hallucinogenic drugs had higher psychological well-being and lower scores on psychopathology scales, both at baseline and during follow-ups. This difference was larger when users were distinguished by frequency of use, as regular users scored higher on psychological well-being and lower on psychopathology scales. Subjects with more psychological distress had lower scores for all scales of post-traumatic growth, but if they were regular hallucinogens users, they had higher scores for post-traumatic growth. When comparing the results between cultural contexts, heterogeneous results were obtained. There were more English-speaking regular users of hallucinogenic drugs. Further research should analyse the potential role of hallucinogens in large-scale catastrophes, with a special focus on post-traumatic growth.

Inequalities in the receipt of healthcare practitioner counseling for adults after COVID-19 in southern Brazil.

Health counseling is a prevention and health promotion action, especially in the context of a pandemic, for both preventing disease and maintaining health. Inequalities may affect receipt of health counseling. The aim was to provide an overview of the prevalence of receiving counseling and to analyze income inequality in the receipt of health counseling. METHODS: This was a cross-sectional telephone survey study with individuals aged 18 years or older with diagnosis of symptomatic COVID-19 using RT-PCR testing between December 2020 and March 2021. They were asked about receipt of health counseling. Inequalities were assessed using the Slope Index of Inequality (SII) and Concentration Index (CIX) measures. We used the Chi-square test to assess the distribution of outcomes according to income. Adjusted analyses were performed using Poisson regression with robust variance adjustment. RESULTS: A total of 2919 individuals were interviewed. Low prevalence of health counseling by healthcare practitioner was found. Participants with higher incomes were 30% more likely to receive more counseling. CONCLUSIONS: These results serve as a basis for aggregating public health promotion policies, in addition to reinforcing health counseling as a multidisciplinary team mission to promote greater health equity.

Socioeconomic inequities in specialized health services use following COVID-19 in individuals from Southern Brazil.

BACKGROUND: Evidence on inequalities in the health services use is important for public policy formulation, even more so in a pandemic context. The aim of this study was to evaluate socioeconomic inequities in the specialized health use services according to health insurance and income, following COVID-19 in individuals residing in Southern Brazil. METHODS: This was a cross-sectional telephone survey with individuals aged 18 years or older diagnosed with symptomatic COVID-19 using the RT-PCR test between December 2020 and March 2021. Questions were asked about attendance at a health care facility following COVID-19, the facilities used, health insurance and income. Inequalities were assessed by the following measures: Slope Index of Inequality (SII) and Concentration Index (CIX). Adjusted analyses were performed using Poisson regression with robust variance adjustment using the Stata 16.1 statistical package. RESULTS: 2,919 people (76.4% of those eligible) were interviewed. Of these, 24.7% (95%CI 23.2; 36.3) used at least one specialized health service and 20.3% (95%CI 18.9; 21.8) had at least one consultation with specialist doctors after diagnosis of COVID-19. Individuals with health insurance were more likely to use specialized services. The probability of using specialized services was up to three times higher among the richest compared to the poorest. CONCLUSIONS: There are socioeconomic inequalities in the specialized services use by individuals following COVID-19 in the far south of Brazil. It is necessary to reduce the difficulty in accessing and using specialized services and to extrapolate the logic that purchasing power transposes health needs. The strengthening of the public health system is essential to guarantee the population's right to health.

Tendência de desigualdades na realização de mamografia nas capitais brasileiras nos últimos dez anos / Trend of inequalities in the performance of mammography in Brazilian capitals in the last ten years

Resumo O objetivo foi verificar a tendência de desigualdade na realização de mamografia de acordo com a posse de plano de saúde e escolaridade a partir de dados do período de 2011 a 2020 do VIGITEL. Estudo de base populacional com dados provenientes do Sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (VIGITEL) entre 2011 e 2020. Desfecho: exame de mamografia nos últimos dois anos em mulheres de 50 a 69 anos. A magnitude das desigualdades do desfecho em relação às exposições (plano de saúde e escolaridade) foi estimada por meio de dois índices: slope index of inequality (SII) e concentration index (CIX). A prevalência de cobertura da realização de mamografia (2011-2020) passou de 74,4% para 78,0%, com tendência estável. As prevalências de quem possuía plano de saúde foram 85,7% e 86,4%, e de quem não possuía, 63,4% e 71,2%, com tendência crescente. De acordo com a escolaridade, em mulheres com 0-8 anos de estudo a prevalência passou de 68,2% para 72,6%; 9-11 anos, de 80,4% para 80,0% (tendência decrescente); 12 anos ou mais, de 88,0% para 86,6% (tendência decrescente). Quanto aos índices de desigualdade absoluta (SII) e relativa (CIX) da escolaridade e plano de saúde, mostram que há uma diminuição na desigualdade nos últimos dez anos.

Abstract The objective was to verify the trend of inequality in the realization of mammography exam according to the possession of health insurance plan and schooling from data from the period 2011 to 2020 of VIGITEL. Population-based study with data from the Surveillance System of Risk and Protection Factors for Chronic Diseases by Telephone Survey (VIGITEL) between 2011 and 2020. Outcome: mammography exam in the last 2 years in women aged 50 to 69 years. The magnitude of inequalities of outcome in relation to exposures (health insurance plan and education) was estimated using two indices: inequality slope index (SII) and concentration index (CIX). The prevalence of mammography exam (2011-2020) increased from 74,4% to 78,0%, with a stable trend. The prevalence of those with health insurance plan were 85,7% and 86,4%, and without 63.4% and 71.2%, with an increasing trend. According to education, women with 0-8 years of schooling the prevalence increased from 68,2% to 72,6%, 9-11 years from 80,4% to 80,0% (decreasing trend), 12 years or more 88,0% to 86,6% (decreasing trend). As for the absolute (SII) and relative (CIX) inequality indices of schooling and health insurance plan show that there is a decrease in inequality over the last 10 years.

[Trend of inequalities in the performance of mammography in Brazilian capitals in the last ten years]. / Tendência de desigualdades na realização de mamografia nas capitais brasileiras nos últimos dez anos.

The objective was to verify the trend of inequality in the realization of mammography exam according to the possession of health insurance plan and schooling from data from the period 2011 to 2020 of VIGITEL. Population-based study with data from the Surveillance System of Risk and Protection Factors for Chronic Diseases by Telephone Survey (VIGITEL) between 2011 and 2020. Outcome: mammography exam in the last 2 years in women aged 50 to 69 years. The magnitude of inequalities of outcome in relation to exposures (health insurance plan and education) was estimated using two indices: inequality slope index (SII) and concentration index (CIX). The prevalence of mammography exam (2011-2020) increased from 74,4% to 78,0%, with a stable trend. The prevalence of those with health insurance plan were 85,7% and 86,4%, and without 63.4% and 71.2%, with an increasing trend. According to education, women with 0-8 years of schooling the prevalence increased from 68,2% to 72,6%, 9-11 years from 80,4% to 80,0% (decreasing trend), 12 years or more 88,0% to 86,6% (decreasing trend). As for the absolute (SII) and relative (CIX) inequality indices of schooling and health insurance plan show that there is a decrease in inequality over the last 10 years.

O objetivo foi verificar a tendência de desigualdade na realização de mamografia de acordo com a posse de plano de saúde e escolaridade a partir de dados do período de 2011 a 2020 do VIGITEL. Estudo de base populacional com dados provenientes do Sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (VIGITEL) entre 2011 e 2020. Desfecho: exame de mamografia nos últimos dois anos em mulheres de 50 a 69 anos. A magnitude das desigualdades do desfecho em relação às exposições (plano de saúde e escolaridade) foi estimada por meio de dois índices: slope index of inequality (SII) e concentration index (CIX). A prevalência de cobertura da realização de mamografia (2011-2020) passou de 74,4% para 78,0%, com tendência estável. As prevalências de quem possuía plano de saúde foram 85,7% e 86,4%, e de quem não possuía, 63,4% e 71,2%, com tendência crescente. De acordo com a escolaridade, em mulheres com 0-8 anos de estudo a prevalência passou de 68,2% para 72,6%; 9-11 anos, de 80,4% para 80,0% (tendência decrescente); 12 anos ou mais, de 88,0% para 86,6% (tendência decrescente). Quanto aos índices de desigualdade absoluta (SII) e relativa (CIX) da escolaridade e plano de saúde, mostram que há uma diminuição na desigualdade nos últimos dez anos.

Comparative analysis between cytomorphology and flow cytometry methods in central nervous system infiltration assessment in oncohematological patients.

INTRODUCTION: Oncohematological patients require the evaluation for possible infiltration of the central nervous system (CNS) by neoplastic cells at diagnosis and/or during the monitoring of the chemotherapeutic treatment. Morphological analysis using conventional microscopy is considered the method of choice to evaluate the cerebrospinal fluid (CSF) samples, despite technical limitations. OBJECTIVE: This study aimed to compare the performance of the cytomorphology and flow cytometric immunophenotyping (FC) in the detection of CNS infiltration. METHOD: We evaluated 520 CSF samples collected from 287 oncohematological patients for whom the detection of neoplastic cells was simultaneously requested by cytomorphology and FC. RESULTS: Laboratory analyses revealed 435/520 (83.7%) conclusive results by the two methods evaluated, among which 385 (88.5%) were concordant. Discordance between the methods was observed in 50/435 (11.5%) samples, 45 (90%) being positive by FC. Furthermore, the FC defined the results in 69/72 (95.8%) inconclusive samples by cytomorphology. The positivity of FC was particularly higher among hypocellular samples. Among 431 samples with a cell count of < 5/µL, the FC identified neoplastic cells in 75 (17.4%), while the cytomorphology reported positive results in 26 (6%). Among the samples that presented adequate cell recovery for evaluation by both methods (506/520), the comparative analysis between FC and cytomorphology revealed a Kappa coefficient of 0.45 (CI: 0.37-0.52), interpreted as a moderate agreement. CONCLUSION: The data showed that the CSF analysis by FC helps in the definition of CNS infiltration by neoplastic cells, particularly in the cases with dubious morphological analysis or in the evaluation of samples with low cellularity.

Comparative analysis between cytomorphology and flow cytometry methods in central nervous system infiltration assessment in oncohematological patients

ABSTRACT Introduction Oncohematological patients require the evaluation for possible infiltration of the central nervous system (CNS) by neoplastic cells at diagnosis and/or during the monitoring of the chemotherapeutic treatment. Morphological analysis using conventional microscopy is considered the method of choice to evaluate the cerebrospinal fluid (CSF) samples, despite technical limitations. Objective This study aimed to compare the performance of the cytomorphology and flow cytometric immunophenotyping (FC) in the detection of CNS infiltration. Method We evaluated 520 CSF samples collected from 287 oncohematological patients for whom the detection of neoplastic cells was simultaneously requested by cytomorphology and FC. Results Laboratory analyses revealed 435/520 (83.7%) conclusive results by the two methods evaluated, among which 385 (88.5%) were concordant. Discordance between the methods was observed in 50/435 (11.5%) samples, 45 (90%) being positive by FC. Furthermore, the FC defined the results in 69/72 (95.8%) inconclusive samples by cytomorphology. The positivity of FC was particularly higher among hypocellular samples. Among 431 samples with a cell count of < 5/μL, the FC identified neoplastic cells in 75 (17.4%), while the cytomorphology reported positive results in 26 (6%). Among the samples that presented adequate cell recovery for evaluation by both methods (506/520), the comparative analysis between FC and cytomorphology revealed a Kappa coefficient of 0.45 (CI: 0.37-0.52), interpreted as a moderate agreement. Conclusion The data showed that the CSF analysis by FC helps in the definition of CNS infiltration by neoplastic cells, particularly in the cases with dubious morphological analysis or in the evaluation of samples with low cellularity.

Atenção à saúde da criança na estratégia em saúde da família / Children's health care in the family health strategy

Avaliação é uma ferramenta que se insere no processo de gestão interna de melhoria contínua das ações e práticas da atenção à saúde da criança, visando atingir níveis de qualidade em sintonia com as demandas sociais e os avanços técnicos científicos em saúde. Objetivo: avaliar o Programa de Atenção à Saúde da Criança de duas Unidades Saúde da Família de Colombo-PR, com base no Protocolo Municipal de Saúde da Criança: Nascer Colombo. Metodologia: trata-se de um estudo de caráter descritivo e analítico exploratório. Os dados foram coletados nas Unidades de Saúde Jardim das Graças e Fátima, com Estratégia em Saúde da Família. Para a coleta de dados foram analisadas as Fichas de Acompanhamento da Criança. Foram avaliados os seguintes critérios: adesão ao programa, monitoramento de crescimento e desenvolvimento, vacinação, suplementação de ferro, atendimento odontológico e sua conclusão e a avaliação de risco. Resultados: apenas 43% e 52% das crianças da Unidade Jardim das Graças e Fátima aderiram ao Programa de Atenção à Saúde da Criança, respectivamente. A taxa de imunização foi maior de 90% para as duas unidades. A proporção de suplementação de ferro ficou entre 17 e 24% nas duas unidades. 64,1% do total das crianças foram ao dentista, sendo que destas, mais de 90% concluíram o tratamento. Observou- se deficiência no registro das informações. Conclusão: alguns valores encontrados estavam abaixo do esperado. Para melhorar o programa haverá a necessidade de que as equipes trabalhem em conformidade com o Protocolo Municipal de Saúde da Criança.

Evaluation is a tool that fits into the internal management process for continuous improvement of the actions and practices of children's health care in order to reach quality levels in line with the social demands and the scientific technical advances in health. Objective: this study evaluated the Children's Health Care Program of two Family Health Units in Colombo, PR, based on the Municipal Children's Health Protocol: Nascer Colombo. Methodology: this is a descriptive and exploratory analytical study. Data were collected at the Jardim das Graças and Fátima Health Units, with the Family Health Strategy. For data collection, Child Health Monitoring Records were analyzed. The following criteria were evaluated: program adherence, growth and development monitoring, vaccination, iron supplementation, dental care, and risk assessment. Results: only 43% and 52% of the children of the Jardim das Graças and Fátima units participated in the Children's Health Care Program, respectively. The immunization rate was greater than 90% for both units. The proportion of iron supplementation was between 17 and 24% in both units. Fully 64.1% of the children went to the dentist, and of these, more than 90% completed the treatment. There was observable deficiency in the recording of information. Conclusion: some values found were lower than expected. To improve the program the teams will have to work in accordance with the Municipal Children's Health Protocol.

Determinants of Dental Care Attendance during Pregnancy: A Systematic Review.

Despite the fact that dental care attendance during pregnancy has been recommended by guidelines and institutions, the demand for dental services is still low among pregnant women. The aim of this study was to identify and analyze the determinants of dental care attendance during pregnancy. We performed a systematic literature search in the electronic databases PubMed, Scopus, Web of Science, Latin American and Caribbean Health Sciences Literature, Brazilian Library in Dentistry, Cumulative Index to Nursing and Allied Health Literature, and Medline using relevant keywords. Studies were filtered by publication year (2000-2016) and language (English, Portuguese, Spanish, and French). The included studies were assessed for quality. Their characteristics and statistically significant factors were reported. Fourteen papers were included in the review. The prevalence of dental service usage during pregnancy ranged from 16 to 83%. Demographic factors included women's age, marital status, parity, and nationality. The socioeconomic factors were income, educational level, and type of health insurance. Many psychological and behavioral factors played a role, including oral health practices, oral health and pregnancy beliefs, and health care maintenance. Referred symptoms of gingivitis, dental pain, or dental problems were perceived need. Demographic, socioeconomic, psychological, behavioral factors and perceived need were associated with the utilization of dental services during pregnancy. More well-designed studies with reliable outcomes are required to confirm the framework described in this review.

Vivência dos egressos do Programa de estágio extracurricular em enfermagem / Experiences of the egresses graduates of the extracurricular training program in nursing

Introdução: O estágio extracurricular é uma opção de aprendizagem e desenvolvimento de prática profissional, não obrigatório e possibilita a aquisição de conhecimento sobre o campo de trabalho da enfermagem, podendo contribuir para o aprimoramento da formação dos alunos de graduação em enfermagem. Considerando o impacto que o estágio extracurricular possui para os esses alunos, esta pesquisa torna-se importante para ampliar o conhecimento sobre esta prática. Objetivos: Caracterizar o estágio extracurricular na perspectiva dos estagiários; descrever e analisar as experiências vividas pelos egressos do programa de estágio extracurricular a partir de pressupostos de Pierre Bourdieu. Método: Este estudo é de natureza histórico-social, qualitativa e exploratória. A coleta de dados foi realizada a partir de entrevistas com os egressos do programa de estágio extracurricular do Hospital Alemão Oswaldo Cruz, obtidas por meio da técnica Snowball Sampling. Esta instituição oferece o estágio extracurricular há muitos anos e tem aprimorado o programa ao longo do tempo. Foi utilizado o método da História Oral Temática para realização de entrevistas semiestruturadas, e a análise temática estabelecida por Minayo, que permitiu realizar uma reflexão geral sobre a apreensão da significação de textos produzidos. O referencial teórico de Pierre Bourdieu foi utilizado para análise dos resultados, permitindo a compreensão das relações sociais, analisando o campo social e o habitus que são incorporados pelos individuos e que são direcionados por um simbolismo intencional que determina o que Bourdieu denomina de "violência simbólica". Resultados: Foram entrevistadas 12 egressas do programa de estágio extracurricular entre os anos de 1979 a 1993. Emergiram das entrevistas, très categorias compostas por 10 subcategorias: Categoria 1. Motivação para o estágio extracurricular: a aquisição de capitais, retrata os principais motivos que levaram as participantes a procurarem o estágio extracurricular durante a graduação de enfermagem. Categoria 2. O estágio extracurricular: descrevendo o campo social, descreve, sob o ponto de vista das participantes, como era o estágio extracurricular no periodo analisado e como este campo social permitia a incorporação de novos habitus. Categoria 3: A percepção do estágio extracurricular para o egresso, nesta categoria emergiram diversos significados sobre a percepção que as egressas tinham em relação ao estágio extracurricular. Conclusão: Esta pesquisa possibilitou ampliar o conhecimento a respeito da história do estágio extracurricular em enfermagem, especialmente no Hospital Alemão Oswaldo Cruz, cenário escolhido, além de caracterizá-lo, sob a óptica de egressas que participaram do programa, no contexto analisado. Dentre os principais achados destaca-se a influência que o estágio extracurricular pode exercer sobre o desenvolvimento de competências comportamentais que são projetadas pela instituição, e que podem definir a aquisição de um dos troféus deste campo social, que é a contratação profissional do estagiário, ao término do programa. A possibilidade de inserção profissional e a influência do estágio extracurricular para a trajetória profissional são outros pontos que se destacaram, pois evidenciam o quanto o estágio pode facilitar a transição entre a escola e a vida profissional dos alunos de graduação em enfermagem.

Introduction. Extracurricular training is an option to learn and develop the professional practice. It is not mandatory and enables knowledge acquisition about the work in the nursing field, and may contribute to the improvement of undergraduate nursing students. Considering the impact that the extracurricular stage has on these students, this research becomes important to increase the knowledge about this practice. Objectives. To analyze the experiences lived by the extracurricular internship program egresses according the assumptions of Pierre Bourdieu. Method. Present study is of historical and social, qualitative and exploratory nature. Data collection, were based on interviews with the undergraduates of the extracurricular training program of the German Hospital "Oswaldo Cruz", obtained through the Snowball Sampling technique. This institution offers the extracurricular internship for many years and has enhanced the program over time. The Thematic Oral History method was used to conduct semi-structured interviews and the thematic analysis established by Minayo who allowed performing a general reflection on the apprehension of the produced texts meaning. The theoretical framework of Pierre Bourdieu was applied for results analysis, allowing the understanding of social relationships, analyzing the social field and the habitus that are incorporated by the individuals and that are directed by an intentional symbolism that determines what Bourdieu called as "symbolic violence". Results. Twelve egressed students of the extracurricular internship program between 1979 and 1993 were interweaved. Three categories comprised of 10 subcategories emerged from the interviews: Category 1. Motivation for the extracurricular stage: the capital acquisition depicts the main reasons that led the participants to seek the extracurricular training during the nursing graduation: Category 2. The extracurricular stage: depicts the social field from the point of view of the participants; how the extracurricular stage was like during this period and how the social field allowed the incorporation of the new habitus. Category 3. The perception of the extracurricular stage for the egressed students. In this category, several meanings emerged about the perception that the egresses had due to the extracurricular stage. Conclusion. This study allows extending the knowledge about the history of extracurricular training course in nursing, especially in the German Hospital "Oswaldo Cruz", the chosen scenario. In addition, characterize it from the perspective of the egressed students who participated in the program, in the analyzed context. Among the main findings, we highlight the influence that the extracurricular stage can exert on the development of behavioral skills designed by the institution, and which can define the acquisition of one of the awards in this social field, which is the professional hiring of the trainee at the end of the program. The possibility of professional insertion and the influence of extracurricular internship to the professional career are other highlighted points since it is evident how much the internship can facilitate the transition between the school and the professional life of undergraduate students in nursing.

Assessing the role of appropriate primary health care on the use of dental services by Brazilian low-income preschool children.

This cross-sectional study aimed to assess the association between the quality of primary health care (PHC) and the use of dental services by preschoolers served by the Family Health Strategy (FHS), controlling for socio-demographic determinants and perceived need. The sample encompassed 438 children aged 3-5 years, enrolled in 19 FHS facilities in Ponta Grossa, Paraná State, Brazil. Individual level variables were collected by interviewing parents or caregivers at home. They answered a questionnaire on socioeconomic conditions, oral hygiene habits and use of dental services. Parental perception of child's oral health related quality of life, as perceived need, was assessed by the Brazilian version of Early Childhood Oral Health Impact Scale (ECOHIS). Normative need was assessed by oral examinations, according to guidelines standardized by the World Health Organization. The contextual level factor was defined as the extent of implementation of PHC in the facilities. Managers responded to PCATool-Brazil, a validated questionnaire which measures the extent of PHC. Dentists answered to a version of PCATool, which was adapted and pretested for dental services. Multilevel analysis, based on Andersen's behavioral model, fitted the adjustment of "having ever consulted a dentist" to contextual and individual covariates. We observed high prevalence of dental caries. Almost half of the sample had had dental appointments in life. Social gradients were observed for the use of dental services. Although it was not able to eliminate the impact of adverse social conditions, higher levels of PHC attributes in dental services favored the effective use of such services by low-income children.

Assessing the role of appropriate primary health care on the use of dental services by Brazilian low-income preschool children / Avaliação do papel da atenção primária adequada no uso de serviços de saúde bucal por pré-escolares brasileiros de baixa renda / Evaluación del papel de la atención primaria apropiada en el uso de los servicios de salud bucal por parte de preescolares brasileños de baja renta

Abstract: This cross-sectional study aimed to assess the association between the quality of primary health care (PHC) and the use of dental services by preschoolers served by the Family Health Strategy (FHS), controlling for socio-demographic determinants and perceived need. The sample encompassed 438 children aged 3-5 years, enrolled in 19 FHS facilities in Ponta Grossa, Paraná State, Brazil. Individual level variables were collected by interviewing parents or caregivers at home. They answered a questionnaire on socioeconomic conditions, oral hygiene habits and use of dental services. Parental perception of child's oral health related quality of life, as perceived need, was assessed by the Brazilian version of Early Childhood Oral Health Impact Scale (ECOHIS). Normative need was assessed by oral examinations, according to guidelines standardized by the World Health Organization. The contextual level factor was defined as the extent of implementation of PHC in the facilities. Managers responded to PCATool-Brazil, a validated questionnaire which measures the extent of PHC. Dentists answered to a version of PCATool, which was adapted and pretested for dental services. Multilevel analysis, based on Andersen's behavioral model, fitted the adjustment of "having ever consulted a dentist" to contextual and individual covariates. We observed high prevalence of dental caries. Almost half of the sample had had dental appointments in life. Social gradients were observed for the use of dental services. Although it was not able to eliminate the impact of adverse social conditions, higher levels of PHC attributes in dental services favored the effective use of such services by low-income children.

Resumo: Este estudo transversal procurou avaliar a associação entre a qualidade da atenção primária em saúde e o uso de serviços de saúde bucal por pré-escolares atendidos pela Estratégia Saúde da Família (ESF), ajustada por determinantes sócio-demográficos e necessidade percebida. A amostra compreendia 438 crianças entre 3 e 5 anos de idade, cadastradas em 19 serviços da ESF em Ponta Grossa, Paraná, Brasil. As variáveis de nível individual foram coletadas através de entrevistas domiciliares com os pais ou responsáveis, que responderam um questionário sobre condições socioeconômicas, hábitos de higiene bucal e uso de serviços odontológicos. A percepção dos pais sobre a qualidade de vida do filho relacionada à saúde bucal, ou necessidade percebida, foi avaliada com a versão brasileira da Early Childhood Oral Health Impact Scale (ECOHIS). A necessidade normativa foi avaliada pelo exame bucal, de acordo com as diretrizes padronizadas pela Organização Mundial da Saúde. O fator de nível contextual foi definido como o grau de implementação da atenção primária em saúde pelas unidades de saúde. Os coordenadores responderam o PCATool-Brasil, um questionário validado que mede o grau de atenção primária em saúde. Os cirurgiões-dentistas responderam uma versão do PCATool, adaptada e pré-testada em serviços odontológicos. A análise multinível, baseada no modelo comportamental de Andersen, ajustou a variável de "ter consultado um dentista alguma vez na vida" às covariáveis contextuais e individuais. O estudo mostrou alta prevalência de cárie dentária. Quase a metade da amostra tinha história de consulta odontológica alguma vez na vida. Observamos gradientes sociais no uso de serviços de saúde bucal. Embora não tenha conseguido eliminar o impacto das condições sociais adversas, níveis maiores de atributos de atenção primária em saúde em serviços de saúde bucal favoreceram o uso efetivo desses serviços por crianças de famílias de baixa renda.

Resumen: Este estudio transversal tuvo como objetivo evaluar la asociación entre la calidad de la atención primaria en salud y el uso de servicios de salud bucal por parte de los preescolares, atendidos por el esquema Estrategia Salud de la Familia (ESF), ajustado por determinantes sociodemográficos y necesidad percibida. La muestra comprendía a 438 niños entre 3 y 5 años de edad, registrados en 19 servicios de la ESF en Ponta Grossa, Paraná, Brasil. Las variables de nivel individual se recogieron a través de entrevistas domiciliarias con los padres o responsables, que respondieron un cuestionario sobre condiciones socioeconómicas, hábitos de higiene bucal y uso de servicios odontológicos. La percepción de los padres sobre la calidad de vida del hijo, relacionada con la salud bucal, o necesidad percibida, fue evaluada con la versión brasileña de la Early Childhood Oral Health Impact Scale (ECOHIS). La necesidad normativa se evaluó mediante el examen bucal, de acuerdo con las directrices estandarizadas por la Organización Mundial de la Salud. El factor de nivel contextual se definió como el grado de implementación de la atención primaria en salud en las unidades de salud. Los gestores respondieron el PCATool-Brasil, un cuestionario validado que mide el grado de asistencia primaria a la salud. Los odontólogos respondieron una versión del PCATool, adaptada y pre-testeada en servicios odontológicos. El análisis multinivel, basado en el modelo comportamental de Andersen, ajustó la variable de "haber consultado a un dentista alguna vez en la vida" a las co-variables contextuales e individuales. El estudio mostró una alta prevalencia de caries dental. Casi la mitad de la muestra tenía un historial de consulta odontológica alguna vez en la vida. Observamos gradientes sociales en el uso de servicios de salud bucal. A pesar de que no se haya conseguido eliminar el impacto de las condiciones sociales adversas, unos mayores niveles de atribuciones a la atención primaria en salud en servicios de salud bucal favorecieron el uso efectivo de esos servicios por parte de hijos de familias de baja renta.

[Assessment of Urinary Incontinence in Pregnancy and Postpartum: Observational Study]. / Avaliação da Incontinência Urinária na Gravidez e no Pós-Parto: Estudo Observacional.

INTRODUCTION: The urinary incontinence can affect up to 50% of women at some stage of their lives, particularly during pregnancy and postpartum. This study was designed in order to identify and assess the prevalence and risk factors for urinary incontinence during the third trimester of pregnancy and three months postpartum. MATERIAL AND METHODS: Observational and cross-sectional study. The population of the study was composed of 268 women who delivered and were admitted to the Centro Hospitalar Tâmega e Sousa in the years 2013 and 2014, and who agreed to participate in this study. Postpartum women were asked to fill out a questionnaire adapted from the International Consultation on Incontinence Questionnaire - Short Form, for urinary incontinence research in the third trimester of pregnancy. Three months after delivery, they were contacted by telephone and asked to answer the same questions about the urinary incontinence postpartum. RESULTS: Of the 268 women interviewed, 31 were excluded from the study, taking into account the defined inclusion and exclusion criteria. In total (n = 237), 51.89% of women included in the study, reported the occurrence of urinary incontinence during pregnancy. The prevalence of urinary incontinence in pregnancy by parity (primiparous versus multiparous) was statistically significant (p = 0.006). At postpartum (n = 237), 28.69% of women with urinary incontinence had vaginal delivery and 5.91% of women underwent cesarean delivery (p = 0.001). In these group of women with postpartum urinary incontinence (n = 82), 31.69% have had urinary incontinence only in the postpartum and 68.31% of women have had symptoms during pregnancy (p < 0.001). DISCUSSION: This study demonstrates the high prevalence of urinary incontinence in pregnancy and the respective decrease in postpartum. CONCLUSION: Multiparity and occurrence of urinary incontinence in pregnancy appear as potential risk factors in the emergence of the urinary incontinence.

Introdução: A incontinência urinária pode afetar até 50% das mulheres em alguma fase das suas vidas, nomeadamente durante a gravidez. Este estudo foi desenhado com a finalidade de identificar e avaliar a prevalência e fatores de risco para incontinência urinária durante o terceiro trimestre da gravidez e três meses após o parto. Material e Métodos: Estudo observacional e transversal. A população do estudo incluiu 268 puérperas, que tiveram parto no Centro Hospitalar Tâmega e Sousa, em 2013 e 2014. Foram avaliadas durante o período de internamento após o parto. As parturientes foram convidadas a preencher um questionário adaptado, International Consultation on Incontinence Questionnaire - Short Form, para investigação da incontinência urinária no terceiro trimestre da gravidez, para o qual deram consentimento. Três meses após o parto, foram contactadas telefonicamente e convidadas a responder às mesmas questões acerca da incontinência urinária no pós-parto. Resultados: Das 268 mulheres entrevistadas, 31 foram excluídas do estudo, tendo em conta os critérios de inclusão e exclusão definidos. No total (n = 237), 51,89% das mulheres incluídas no estudo, relataram a ocorrência de incontinência urinária durante a gravidez. A prevalência da incontinência urinária na gravidez, segundo a paridade (primíparas versus multíparas), foi estatisticamente significativa (p = 0,006). No pós-parto (n = 237), 28,69% das mulheres com incontinência urinária tiveram parto vaginal e 5,91% das mulheres foram submetidas a cesariana (p = 0,001). Neste grupo de mulheres com incontinência urinária pós-parto (n = 82), 31,69% apresentaram incontinência urinária de novo e 68,31% das mulheres já apresentavam sintomatologia durante a gravidez (p < 0,001). Discussão: Este estudo demonstra a elevada prevalência da incontinência urinária na gravidez e a respetiva redução no pós-parto. Conclusão: A multiparidade e a ocorrência de incontinência urinária na gravidez surgem como possíveis fatores de risco no aparecimento da incontinência urinária.

The importance of the evaluation of expectations and perceptions to improve the dental service quality.

Purpose The purpose of this paper is to evaluate the use of SERVQUAL to assess service quality in Dentistry, by evaluating patients' expectations and perceptions of dental care and their association to patients' sociodemographic data. Design/methodology/approach The sample constituted of 379 subjects in the first assessment and 155 in the second phase. All employees of the companies that were clients of the dental insurance participated, a total of four companies in two states (São Paulo and Minas Gerais) of Brazil. SERVQUAL questionnaires about expectations and sociodemographic data were dispatched in the first phase, and in a second phase SERVQUAL questionnaires about perceptions. Those who had not yet received dental treatment and had agreed to participate filled out their survey in the first phase. In the second phase, the respondents had to have completed their treatment. Findings When the value gap is considered, Reliability (as a dimension) had the smallest score (-3.71). This means that it was the worst result, i.e. there is a higher difference between expectations and perceptions, and problems can be identified here. t-test confirmed that all the dimensions had some statistically significant difference with p<0.05 in relation to expectations and perceptions. Women presented higher prevalence of dissatisfaction (Tangible and Reliability dimensions), as well as the oldest participants (Empathy dimension) and those with lower parental literacy (Assurance and Empathy dimensions). The only dimension that was not significantly associated was Responsiveness. Originality/value This research suggests that the patients evaluated the physical characteristics of the premises and the interaction with the staff as the priority issues that need special attention in this service. Moreover, the use of SERVQUAL was extremely relevant for the oral health service, because it assessed the users' subjective perceptions.

Organização da atenção na saúde bucal em um município da região metropolitana de Curitiba: percepção do usuário / Organization of oral health care in a city in the Curitiba metropolitan area: user perception

Objetivo: O objetivo deste estudo foi avaliar a organização da atenção em saúde bucal nas Unidades de Saúde da Família (USF) com Equipes de Saúde Bucal (ESB), em relação ao acesso e à resolubilidade no município de Colombo-PR, na percepção do usuário. Material e Métodos: Estudo de abordagem quantitativa, aplicou-se em forma de entrevista um questionário semiestruturado e adaptado aos 136 usuários das USF com ESB. A análise estatística foi descritiva, com o auxílio do programa Excel e BioEstat 5.3, realizando o teste do Qui-quadrado (p<0,05). Resultados: Entre os entrevistados, 51,5% nunca foram ao cirurgião-dentista na USF, sendo que a maioria destes procura o atendimento privado. Já entre aqueles que procuraram atendimento no serviço público, 74,7% frequentaram há menos de um ano a USF, destes 27,3% conseguiram atendimento por agendamento semanal e 37,9% pelo agendamento mensal. Dos usuários que procuraram o atendimento, 56,1% foram atendidos no mesmo dia. Somente 27,3% necessitaram de encaminhamento ao serviço especializado e 50% dos usuários concluíram seu tratamento. Não houve relação estatisticamente significante entre a opinião sobre o acesso em relação ao sexo, renda ou escolaridade. Conclusão: A dificuldade no acesso e a própria limitação dos serviços ofertados no setor público faz com que muitos usuários procurem atendimento privado. A porta de entrada na USF continua a demanda espontânea. Apesar da resolubilidade da atenção primária, houve apenas conclusão parcial dos casos atendidos. Ainda persistem entraves na organização do serviço no município.

Objective: The aim of this study was to evaluate, from a user perspective, the organization of oral health care in Family Health Units (FHUs) with Oral Health Teams (OHTs), regarding access and resolution capacity, in the city of Colombo, PR. Methods: This quantitative study, in interview form, applied a semi-structured questionnaire adapted to the 136 users at the FHUs with OHTs. The statistical analysis was descriptive, with the help of the Excel program and BioEstat 5.3, performing the chisquare test (p <0.05). Results: Among the respondents, 51.5% had never gone to the dentist at the FHU, with most having opted for private care. While among those who sought care at the public service, 74.7% were attended at the FHU within the past year, and of these 27.3% received care on a weekly schedule and 37.9% on a monthly schedule. Among the users who sought care, 56.1% were attended on the same day. Only 27.3% required referral to specialized services and 50% of the users completed their treatment. There was no statistically significant relationship between the opinion about access and gender, income, or education. Conclusion: The difficulty of access and the actual limited services offered in the public sector makes many users search for a substitute for public services. The gateway to the FHU continues to be spontaneous demand. Despite the resolution capacity of primary care, there was only partial completion of the cases treated. Barriers in the organization of the service persist in this city.

Information-theoretic analysis and prediction of protein atomic burials: on the search for an informational intermediate between sequence and structure.

MOTIVATION: It has been recently suggested that atomic burials, as expressed by molecular central distances, contain sufficient information to determine the tertiary structure of small globular proteins. A possible approach to structural determination from sequence could therefore involve a sequence-to-burial intermediate prediction step whose accuracy, however, is theoretically limited by the mutual information between these two variables. We use a non-redundant set of globular protein structures to estimate the mutual information between local amino acid sequence and atomic burials. Discretizing central distances of or atoms in equiprobable burial levels, we estimate relevant mutual information measures that are compared with actual predictions obtained from a Naive Bayesian Classifier (NBC) and a Hidden Markov Model (HMM). RESULTS: Mutual information density for 20 amino acids and two or three burial levels were estimated to be roughly 15% of the unconditional burial entropy density. Lower estimates for the mutual information between local amino acid sequence and burial of a single residue indicated an increase in mutual information with the number of burial levels up to at least five or six levels. Prediction schemes were found to efficiently extract the available burial information from local sequence. Lower estimates for the mutual information involving single burials are consistently approached by predictions from the NBC and actually surpassed by predictions from the HMM. Near-optimal prediction for the HMM is indicated by the agreement between its density of prediction information and the corresponding density of mutual information between input and output representations. AVAILABILITY: The dataset of protein structures and the prediction implementations are available at http://www.btc.unb.br/ (in 'Software').