Positive impact of a cooking skills intervention among Brazilian university students: Six months follow-up of a randomized controlled trial.

OBJECTIVES: The purpose of this study was to determine the effects of the Nutrition and Culinary in the Kitchen (NCK) Program to evaluate the improvement of cooking skills and healthy eating of university students. METHODS: A randomized controlled trial with six months follow-up was used incorporating an intervention group (IG) and a control group (CG). The IG participated in the NCK program over a six-week period, three hours weekly, based on five hands-on cooking classes and one food market visit, while CG continued their usual activities. Outcome measures included changes in relation to a) accessibility and availability of fruits and vegetables (AAFV); b) cooking attitudes (CA); c) cooking behaviors at home (CBH); d) cooking behaviors away from home (CBAH) e) produce consumption self-efficacy (SEPC); f) self-efficacy for using cooking techniques (SECT); g) self-efficacy for using fruits, vegetables, and seasonings (while cooking) (SEFVS); and h) knowledge of cooking terms and techniques (CTT). An online self-completed validated survey was answered, at three time points: baseline (T1), after intervention (T2) and six months after intervention (T3). Statistical analyses were conducted to evaluate changes in outcomes within and between groups over time. RESULTS: 76 students completed the online questionnaire at the 3 time points. Findings revealed a statistically significant increase (p < 0.05) in all outcomes evaluated in the IG, except for CBH and CBAH. This effect was sustained at T3 (p < 0.001). Results were similar to the adjusted model (p < 0.001), thus, indicating that IG changes, when compared to CG, were due to the intervention effect. CONCLUSION: NCK culinary intervention program demonstrated efficacy for the increased on AAFV, CA, SEPC, SECT, SEFVS and CTT with university students.

Nutrition and Culinary in the Kitchen Program: a randomized controlled intervention to promote cooking skills and healthy eating in university students - study protocol.

BACKGROUND: Community-based intervention studies that aim at developing cooking skills have increased in the scientific literature and are related to healthier food practices. However, methodological limitations are observed and only a few studies have university students as the target. The university entrance period has been related to negative changes in eating habits among young people and it represents an important period for developing interventions for health promotion. This study describes the study protocol and the evaluation framework for the Nutrition and Culinary in the Kitchen program. This program aims to develop cooking skills in university students, and is based on the Cooking with a Chef program in the United States. METHODS: This ongoing, randomized controlled intervention was designed with a six month follow-up study. The intervention consisted of three-hour weekly classes during a six week period with printed materials provided. Five of the classes were hands-on cooking and one was a tour to a popular food market. There were eight primary outcome measures: changes in relation to i) accessibility and availability of fruits and vegetables; ii) cooking attitudes; iii) cooking behaviors at home; iv) cooking behaviors away from home; v) produce consumption self-efficacy; vi) self-efficacy for using basic cooking techniques; vii) self-efficacy for using fruits, vegetables, and seasonings (while cooking); and viii) knowledge of cooking terms and techniques. Secondary outcomes included changes in body mass index and in personal characteristics related to cooking. Repeated measures were collected through the application of an online self-completed survey, at baseline, after intervention and six months after intervention. A sample of 80 university students (40: intervention group; 40: control group) was estimated to detect a mean change of 1.5 points in cooking knowledge, with study power of 80%, and 95% level of confidence, plus 20% for random losses and 10% for confounding factors. The control group participants have continued with their usual activities. Data analyses will evaluate the intervention effect on changes in outcomes within and between groups, as well as explore relations with personal characteristics. DISCUSSION: This method provides new evidence about whether or not a culinary intervention targeting university students has an impact on the improvement of cooking skills and healthy eating practices. TRIAL REGISTRATION: Brazilian Clinical Trials Registry - RBR-8nwxh5 ( http://www.ensaiosclinicos.gov.br/rg/RBR-8nwxh5/ ).

Availability and price of food products with and without trans fatty acids in food stores around elementary schools in low- and medium-income neighborhoods.

The purpose of this exploratory, descriptive, and cross-sectional study was to investigate the relationship between the price and availability of food products with and without trans fatty acids in food stores near elementary schools located in low- and medium-income neighborhoods of a Brazilian city. The supply of products containing trans fatty acids was higher in both regions, and these products were also cheaper. It is noteworthy that this availability may influence food choices and, consequently, the health status of children and adolescents, since this population is more likely to buy less-healthy foods when these are more available, accessible, and financially attractive.

[Financing and management: the technical efficiency in public health expenditures of small-scale municipalities in the state of Santa Catarina]. / Financiamento e gestão: a eficiência técnica dos municípios catarinenses de pequeno porte nos gastos públicos com saúde.

In a context of budget constraints and fiscal austerity measures, the discussion of issues related to the efficient management of public resources is a major challenge. The scope of this study was to assess the technical efficiency of municipalities of the State of Santa Catarina in public health expenditures and its relationship with health management conditions in the years 2009 and 2015. In order to measure efficiency, the decision was made to use Data Envelopment Analysis. The G Index was used to analyze the spatial efficiency autocorrelation. For the evaluation of the conditions for health management, the model proposed by Calvo et al. was adopted. Of the total number of municipalities analyzed, 35.5% and 29% were considered efficient, for the years 2009 and 2015, respectively. The results suggest that there is no association between the conditions for health management and technical efficiency in the State of Santa Catarina. The study revealed the need to move forward in the quest for better results in terms of efficiency in the State of Santa Catarina, taking into consideration the spatial distribution of these results over the territory, focusing on clusters of inefficiency that may explain the poor performance in health of some regions of the state.

Em um contexto de restrição orçamentária e de medidas de austeridade fiscal, discutir aspectos relacionados à gestão eficiente dos recursos públicos é um desafio. O objetivo deste estudo foi avaliar a eficiência técnica de municípios catarinenses nos gastos públicos com saúde e sua relação com as condições para a gestão em saúde nos anos de 2009 e 2015. Para medir a eficiência, optou-se pela Análise Envoltória de Dados. O Índice G foi empregado para analisar a autocorrelação espacial da eficiência. Para a avaliação das condições para a gestão em saúde, adotou-se o modelo proposto por Calvo et al. Do total de municípios analisados, 35,5% e 29% foram considerados eficientes, respectivamente para os anos de 2009 e 2015. Os resultados sugerem não haver associação entre as condições para a gestão em saúde e a eficiência técnica no estado de Santa Catarina. O estudo revelou a necessidade de se avançar na busca por melhores resultados de eficiência em Santa Catarina, devendo ser considerada a distribuição espacial destes resultados sobre o território, com enfoque sobre os clusters de ineficiência que podem explicar o fraco desempenho em saúde de algumas regiões do estado.

Access to high-priced medicines: inequalities in the organization and the results among Brazilian states. / Acesso a medicamentos de alto preço: desigualdades na organização e resultados entre estados brasileiros.

This case study aimed to characterize the Specialized Component of Pharmaceutical Services (CEAF) organization in four Brazilian states from diverse regions of the country. Data were collected with representatives of CEAF management from states in different regions, who answered a 21-question questionnaire on scope, organization, financing, hurdles, and facilitators. This information was complemented with data from national health surveys, DataSUS, the applied resources, and socioeconomic indicators. Differences were observed between states on issues such as the proportion of users and the decentralization of services. These characteristics seem to be related to the level of development concerning the socioeconomic indicators used. Advances in access to medicines were highlighted, despite the difficulties complying with the CEAF's objectives, such as insufficient resources, the qualification of human resources, and the provision of necessary visits and exams. The results point to advances, different forms of organization and highlight the need for more in-depth studies on the clinical and economic outcomes achieved as a strategy to outline solutions to achieve the comprehensive and equal care for users.

Este estudo de caso visou caracterizar a organização do Componente Especializado da Assistência Farmacêutica (CEAF) em quatro estados, de diferentes regiões do país. A coleta de dados foi realizada junto a representantes da gestão do CEAF, os quais responderam um questionário com 20 perguntas sobre: abrangência, organização, financiamento, barreiras e facilitadores. Essas informações foram complementadas com dados de inquéritos nacionais de saúde, do DataSUS, os valores investidos e indicadores socioeconômicos. Observaram-se diferenças entre os estados em questões como a proporção de usuários e a descentralização dos serviços. Estas características parecem estar relacionadas com o grau de desenvolvimento em termos dos indicadores socioeconômicos utilizados. Destacaram-se avanços no acesso a medicamentos, apesar das dificuldades para o cumprimento dos objetivos do CEAF, como a insuficiência de recursos, de qualificação da força de trabalho e da oferta de consultas e exames necessários. Os resultados indicam avanços, diferentes formas de organização e destacam a necessidade de estudos mais aprofundados relativos aos resultados clínicos e econômicos alcançados, como uma estratégia para traçar soluções para o atendimento integral e equânime dos usuários.

Structure and work process for food and nutrition actions in Primary Health Care in Brazil, 2014. / Estrutura e processo de trabalho para as ações de alimentação e nutrição na Atenção Primária à Saúde no Brasil, 2014.

OBJECTIVE: To evaluate the conditions of structure and work process for food and nutrition actions in Primary Health Care in Brazil. METHODS: This was a cross-sectional study with secondary data from the Program for Primary Health Care Access and Quality Improvement. The proportions of Primary Health Care Center (PHCC) and health team adequacy were described according to organizational variables, using prevalence ratios and Poisson regression. RESULTS: 19,793 PHCCs and 24,549 teams were analyzed; 35.0% (n=6,928) of PHCCs were considered adequate in relation to structure and 7.9% (n=1,934) of the teams had adequate work process. Standing out in the analyses of association are PHCCs in the Southern region (44.7%) and teams in the Southeastern region (10.9%), in addition to municipalities with more than 300,000 inhabitants. CONCLUSION: The PHCCs and teams analyzed presented a low proportion of adequacy for structure and work process for food and nutrition actions.

[Evaluability study of the Multicenter Program for Professional Qualification in Distance Home Care (PMQPAD)]. / Estudo de avaliabilidade do Programa Multicêntrico de Qualificação Profissional em Atenção Domiciliar a Distância (PMQPAD).

With the implementation of home care in the Brazilian Unified National Health System (SUS), the need to train administrators and health workers led to the creation of the Multicenter Program for Professional Qualification in Distance Home Care (PMQPAD) in a partnership between the SUS Open University and the General Coordinating Division for Home Care, of the Brazilian Ministry of Health. Through courses in specialization, improvement, and self-instruction, the program achieved wide capillarity and scope in the country, with nearly 300,000 enrollments across all states of Brazil. The current study aimed to structure a model to assess the PMQPAD through an evaluability study with participation by the program's administrators. We used the methodology developed by Thurston & Ramaliu, the stages of which allowed describing the program, representing it with a log frame model, and developing a evaluation matrix. We conducted document analysis, semi-structured interviews, and consensus workshops for the model's validation. The process resulted in the development of three evaluation matrices, one for each of the program's course modalities, with four analytical dimensions in common (Course characteristics and educational resources; Institutional aspects; Results; Impacts). The primary data sources for the evaluation indicators were the students, tutors, and administrators. The study drew on stakeholders' participation and proved appropriate for the development of the evaluation proposal. The results highlight the potential for use of evaluation matrices developed for the assessment of other distance training programs under the SUS.

Com a implantação da atenção domiciliar no âmbito do Sistema Único de Saúde (SUS), diante da necessidade de capacitação de gestores e profissionais, criou-se o Programa Multicêntrico de Qualificação Profissional em Atenção Domiciliar a Distância (PMQPAD) numa parceria entre a Universidade Aberta do SUS e a Coordenação Geral de Atenção Domiciliar do Ministério da Saúde. Por meio de cursos de especialização, aperfeiçoamento e autoinstrucionais, o programa teve grande capilaridade e alcance no país, com quase 300 mil matrículas distribuídas em todos os estados brasileiros. O objetivo do presente estudo foi estruturar um modelo avaliativo do PMQPAD, por meio de um estudo de avaliabilidade, com a participação dos gestores do programa. Foi utilizada a metodologia desenvolvida por Thurston & Ramaliu, cujas etapas permitiram descrever o programa, representá-lo por meio de um modelo lógico e desenvolver uma matriz avaliativa. Foram realizadas análise documental, entrevistas semiestruturadas e oficinas de consenso para validação do modelo. O processo resultou no desenvolvimento de três matrizes avaliativas, uma para cada modalidade de curso do programa, com quatro dimensões de análise em comum (Características do curso e recursos educacionais; Aspectos institucionais; Resultados; Impactos). Os indicadores avaliativos tiveram, como fontes de dados primários, os alunos, os tutores e os gestores do curso. O estudo contou com a participação dos stakeholders e mostrou-se apropriado para o desenvolvimento da proposta avaliativa. Destaca-se o potencial de utilização das matrizes avaliativas desenvolvidas para a avaliação de outros programas de formação a distância no âmbito do SUS.

Con la implantación de la atención domiciliaria en el ámbito del Sistema Único de Salud (SUS), ante la necesidad de la capacitación de gestores y profesionales, se creó el Programa Multicéntrico de Cualificación Profesional en Atención Domiciliaria a Distancia (PMQPAD), en una colaboración entre la Universidad Abierta del SUS y la Coordinación General de Atención Domiciliaria del Ministerio de Salud de Brasil. A través de cursos de especialización, perfeccionamiento y de autoaprendizaje, el programa tuvo una gran capilaridad y alcance en el país, con casi 300 mil matrículas, distribuidas por todos los estados brasileños. El objetivo del presente estudio fue estructurar un modelo evaluativo del PMQPAD, a través de un estudio de disponibilidad, con la participación de los gestores del programa. Se utilizó la metodología desarrollada por Thurston & Ramaliu, cuyas etapas permitieron describir el programa, representarlo a través de un modelo lógico, y desarrollar una matriz evaluativa. Se realizó un análisis documental, entrevistas semiestructuradas y talleres de consenso para la validación del modelo. El proceso resultó en el desarrollo de tres matrices evaluativas, una para cada modalidad de curso del programa, con cuatro dimensiones de análisis en común (Características del curso y recursos educacionales; Aspectos institucionales; Resultados; Impactos). Los indicadores evaluativos tuvieron como fuentes de datos primarios los alumnos, los tutores y los gestores del curso. El estudio contó con la participación de los stakeholders, y se mostró apropiado para el desarrollo de la propuesta evaluativa. Se destaca el potencial de utilización de las matrices evaluativas desarrolladas para la evaluación de otros programas de formación a distancia en el ámbito del SUS.

The prosthetic need WHO index: a comparison between self-perception and professional assessment in an elderly population.

The purpose of this study was to consider the criteria for establishing the need for prosthesis, by comparing the need perceived subjectively by a patient (self-perception) with that assessed by an examiner according to the WHO diagnosis criteria. The proposed domiciliary sample comprised 270 elderly (aged 60 years or older) residents in a municipality in southern Brazil. The interviews and oral examinations were conducted by two dentists following a period of training and calibration. The criteria used conformed to the WHO and FDI standards. Statistical treatment of data included bivariate and multivariate analysis using SPSS 10.0. Only five patients identified the need for a prosthesis when not identified by the examiner. In the case of 172 elderly subjects, there was agreement in the self-perceived and observed treatment needs. The need for prosthesis was found in 93 elderly subjects who did not perceive any need for prosthetic treatment. The multivariate analysis showed that the variables age, gender, residential area and form of service most sought after during their lives were significantly associated with a better self-perception of oral health. The professional criteria based on WHO guidelines differed from the self-perceived need. Elderly male subjects who lived in a rural area and were 70 years of age or more, who did not participate in third age groups, and who had not sought dental services for most of their lives were the least likely to perceive the need for prosthetic treatment, thereby underestimating their oral health needs.

Analysis of the supply of specialized oral health care services in the Brazilian National Health System: Brazil, 2014. / Análise da oferta de serviços na atenção especializada em saúde bucal no Sistema Único de Saúde, Brasil, 2014.

OBJECTIVE: to analyze the availability of public specialized dental care services at Dental Specialties Centers (CEO) in Brazil in 2014. METHODS: secondary data on the CEO ratio and dental surgeon ratio were analyzed by population as well as the adequacy of the quantity of complete dental consulting rooms per CEO type, the adequacy of the ratio between the working hours of dental auxiliaries /technicians and those of dental surgeons and the adequacy of the availability of recommended minimum specialties. Possible statistical differences between macro-regions were verified. RESULTS: we found a ratio of one CEO per 217,797 inhabitants and one dental surgeon per 26,811 inhabitants; 97% of CEOs had the recommended number of dental consulting rooms; 26% had equivalent working hours between dental auxiliaries /technicians and dental surgeons; 60% offered the recommended minimum specialties. CONCLUSION: there were limitations in the provision of National Health System specialized oral health care services as well as regional differences.

Feasibility evaluation of a mindfulness-based stress reduction program for primary care professionals in Brazilian national health system.

BACKGROUND AND PURPOSE: In the last decades, an increasing body of scientific studies has shown mindfulness-based interventions as efficacious for reducing stress, including among primary care professionals. Despite the strength of the evidence, mindfulness-based interventions still are not widely adopted as a clinical practice in national health systems. The aim of the present study was to conduct a feasibility evaluation of a mindfulness-based stress reduction program for primary care professionals in Brazilian national health system. MATERIALS AND METHODS: A pilot mindfulness program was conducted through the course of four weekly encounters in the municipality of Biguaçu with the participation of 26 primary care professionals. Data was collected through direct observations and four self-report questionnaires. The information was used to complete an evaluation matrix and reach a value judgment about the feasibility level of the components of the mindfulness-based program. RESULTS: The subdimensions Integration, Demand, and Acceptability were judged as "Highly Feasible", the subdimension Practicality was judged as "Feasible" and the subdimension Adaptation was judged as "Lowly Feasible". The results indicated that there is a high demand for stress-reduction interventions within the context of primary care and the acceptability by the stakeholders (participants and management) was excellent. However, the two main barriers found were the need for a brief version of the program to accommodate the restrictive timetable of the primary care professionals and the low retention rates. CONCLUSION: The implementation of a mindfulness-based program for primary care professionals in Brazilian national health system was judged as "Feasible". Further studies need to conduct the feasibility evaluation in other municipalities and with larger sample sizes to ensure the generalizability of these results.

Feasibility evaluation of a mindfulness-based intervention for primary care professionals: Proposal of an evaluative model.

A critical issue in the contemporary field of public health is the organizational stress experienced by healthcare professionals. An integrative and complementary therapy that research has shown as efficacious in helping healthcare professionals to cope with stress is mindfulness meditation. An intervention, however, can't merely be efficacious, it also needs to be feasible to be implemented in a specific political and organizational context. This paper proposes a theoretical logical model and evaluation matrix of the feasibility of a mindfulness-based stress reduction program for primary care professionals. The literature review about the topic was the source for the construction of the theoretical logical model and evaluation matrix, and the validation of those was given by consensus methods, gathering data from experts in the field.

Estudo de avaliabilidade das ações para detecção precoce do câncer de mama na atenção primária / Evaluability study of actions for early detection of breast cancer in primary care

RESUMO O artigo tem como objetivo desenvolver um modelo avaliativo das ações de detecção precoce do câncer de mama na atenção primária. Trata-se de um estudo de avaliabilidade, realizado pelas etapas de análise documental, revisão de literatura e reunião de consenso para elaboração da matriz avaliativa. O resultado obtido foi o desenvolvimento da Matriz de Análise e Julgamento, composta por 14 indicadores, agregados em duas dimensões. A aplicação do modelo avaliativo permitirá a identificação das fragilidades e potencialidades das ações de detecção precoce do câncer de mama.

ABSTRACT The article aims to develop an evaluative model of actions for the early detection of breast cancer in primary care. This evaluability study was conducted through document analysis, literature review, and consensus meeting stages to prepare the evaluative matrix. The result was the development of the Analysis and Judgment Matrix, composed of 14 indicators aggregated into two dimensions. Applying the evaluative model will allow the identification of the weaknesses and strengths of actions for the early detection of breast cancer.

How Brazilian oral health care workers face COVID-19: surveillance, biosafety, and education strategies

Aim: To investigate surveillance, biosafety, and education strategies of Brazilian oral health care workers (OHCWs) during the first wave of the COVID-19 outbreak. Methods: This was a cross-sectional study covering OHCWs from a single multicenter research centre. A self-administered and validated online questionnaire was used for data collection, including the following variables: sociodemographic, medical history, biosafety, professional experience, surveillance, and education. Results: The sample consisted of 644 OHCWs (82.5% dentists, 13.2% dental assistants and 4.3% technicians), most without comorbidities (84.8%), from the public (51.7%) and private (48.3%) health systems, in 140 cities of a southern state. The most prominent measures of surveillance were waiting room distancing and visual alerts, symptom assessment, and availability of guidelines on COVID-19. Regarding biosafety measures, the lowest adherence was related to intraoral radiographs (2.7±1.4; 95%CI: 2.6­2.9), use of dental dams (2.1±1.4; 95%CI: 2.0­2.2), and availability of high-power suction systems (2.5±1.7; 95%CI: 2.3­2.6). Among OHCWs, 52.6% received guidance on measures to take during dental care in the workplace. Continuing education was mainly through documents from non-governmental health authorities (77.4%). Conclusion: Surveillance and biosafety measures were adopted, but activities that reduce the spread of aerosols had less adherence. These findings underscore the importance of considering dental practices, and surveillance and education strategies to formulate policies and relevant support to address health system challenges during the COVID-19 pandemic. A coordinated action of permanent education by policymakers is necessary

Evaluation of the performance of actions and outcomes in primary health care.

OBJECTIVE: The objective of this study has been to evaluate the performance of the primary care of Brazilian municipalities in relation to health actions and outcomes. METHODS: This is an evaluative, cross-sectional research, with a quantitative approach, aimed at the identification of the efficiency frontier of the primary care in health actions and outcomes in Brazilian municipalities. Secondary data have been collected from the Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (National Program for Improving Access and Quality of Primary Care) and the Department of Informatics of the Brazilian Unified Health System, in 2012. The data envelopment analysis tool has been used for variable returns to scale with product orientation. RESULTS: Municipalities have been analyzed by population size, and small municipalities have presented a high percentage of inefficiency for both models. CONCLUSIONS: The analysis of efficiency has indicated the existence of a higher percentage of effective municipalities in the model of health actions than in the model of health outcomes.

OBJETIVO: Avaliar o desempenho da atenção básica dos municípios brasileiros quanto a ações e resultados em saúde. MÉTODOS: Pesquisa avaliativa, transversal, com abordagem quantitativa, para identificar a fronteira de eficiência da atenção básica em ações e resultados em saúde nos municípios brasileiros. Foi realizada coleta de dados secundários a partir do Programa Nacional de Melhoria do Acesso e da qualidade da Atenção Básica e do Departamento de Informática do Sistema Único de Saúde, no ano de 2012. Utilizou-se a ferramenta análise envoltória de dados para retornos variáveis de escala com orientação para produto. RESULTADOS: Os municípios foram analisados por porte populacional e verificou-se que para ambos os modelos, os municípios de pequeno porte apresentaram alto percentual de ineficiência. CONCLUSÕES: A análise da eficiência indicou a existência de um percentual maior de municípios eficientes no modelo de ações em saúde do que no modelo de resultados em saúde.

Percepção dos estudantes de odontologia sobre o abuso infantil na cidade de Florianópolis (SC), Brasil / Perception of dental students about child abuse in the city of Florianópolis (SC), Brazil

O abuso infantil é, ainda, um dos grandes problemas de saúde pública no Brasil e no mundo, sendo que em 2020, houve o registro de mais de 75 mil notificações no Brasil. É de suma importância que os profissionais de saúde, sobretudo, cirurgiões-dentistas, estejam capacitados para fazer a identificação e notificação de suspeitas e casos de abuso infantil. Esta pesquisa analisou a percepção dos estudantes de odontologia da Universidade Federal de Santa Catarina (UFSC) sobre o abuso infantil e instrução destes para a realização da notificação compulsória às autoridades na cidade de Florianópolis. Foi aplicado um questionário eletrônico com dezesseis questões abertas e fechadas, previamente estabelecidas pelos autores, tendo como base estudos anteriores sobre o tema. A amostra não-probabilística composta por 69 participantes de todas as fases do curso de graduação em odontologia da UFSC por meio de um estudo transversal. Mais de 97% (n=67) dos entrevistados afirmaram saber o que é abuso infantil, no entanto, aproximadamente 80% (n=54) afirmaram não saber proceder frente a um caso, cerca de 90% (n=62) afirmaram não conhecer a legislação sobre notificação compulsória e 80% (n=57) afirmaram haver interesse em buscar informações sobre o tema. É imprescindível que estudantes de odontologia e cirurgiões-dentistas sejam capazes não só identificar casos de abuso infantil, mas como proceder e mitigar o ciclo de violência no qual esta criança está inserida

Child abuse is still a major public health problem in Brazil and worldwide, with more than 75,000 notifications in Brazil in 2020. It is of utmost importance that health professionals, especially dentists, are trained to identify and report suspected and reported cases of child abuse. This study analyzed the perception of dental students at the Federal University of Santa Catarina (UFSC) about child abuse and their instruction to make the compulsory notification to the authorities in the city of Florianópolis. An electronic questionnaire with sixteen open and closed questions previously established by the authors based on previous studies on the subject was applied to a non-probabilistic sample consisting of 69 participants from all stages of the undergraduate dental course at UFSC. More than 97% (n=67) of the participants said they knew what child abuse was, however, approximately 80% (n=54) said they did not know how to proceed when faced with a case and about 90% (n=62) said they did not know the legislation about compulsory notification and 80% (n=57) said they were interested in seeking information on the subject. It is essential that dental students and dentists are able not only to identify cases of child abuse, but how to proceed and mitigate the cycle of violence in which this child is inserted

Financiamento e gestão: a eficiência técnica dos municípios catarinenses de pequeno porte nos gastos públicos com saúde / Financing and management: the technical efficiency in public health expenditures of small-scale municipalities in the state of Santa Catarina

Resumo Em um contexto de restrição orçamentária e de medidas de austeridade fiscal, discutir aspectos relacionados à gestão eficiente dos recursos públicos é um desafio. O objetivo deste estudo foi avaliar a eficiência técnica de municípios catarinenses nos gastos públicos com saúde e sua relação com as condições para a gestão em saúde nos anos de 2009 e 2015. Para medir a eficiência, optou-se pela Análise Envoltória de Dados. O Índice G foi empregado para analisar a autocorrelação espacial da eficiência. Para a avaliação das condições para a gestão em saúde, adotou-se o modelo proposto por Calvo et al. Do total de municípios analisados, 35,5% e 29% foram considerados eficientes, respectivamente para os anos de 2009 e 2015. Os resultados sugerem não haver associação entre as condições para a gestão em saúde e a eficiência técnica no estado de Santa Catarina. O estudo revelou a necessidade de se avançar na busca por melhores resultados de eficiência em Santa Catarina, devendo ser considerada a distribuição espacial destes resultados sobre o território, com enfoque sobre os clusters de ineficiência que podem explicar o fraco desempenho em saúde de algumas regiões do estado.

Abstract In a context of budget constraints and fiscal austerity measures, the discussion of issues related to the efficient management of public resources is a major challenge. The scope of this study was to assess the technical efficiency of municipalities of the State of Santa Catarina in public health expenditures and its relationship with health management conditions in the years 2009 and 2015. In order to measure efficiency, the decision was made to use Data Envelopment Analysis. The G Index was used to analyze the spatial efficiency autocorrelation. For the evaluation of the conditions for health management, the model proposed by Calvo et al. was adopted. Of the total number of municipalities analyzed, 35.5% and 29% were considered efficient, for the years 2009 and 2015, respectively. The results suggest that there is no association between the conditions for health management and technical efficiency in the State of Santa Catarina. The study revealed the need to move forward in the quest for better results in terms of efficiency in the State of Santa Catarina, taking into consideration the spatial distribution of these results over the territory, focusing on clusters of inefficiency that may explain the poor performance in health of some regions of the state.

Estrutura e processo de trabalho para as ações de alimentação e nutrição na Atenção Primária à Saúde no Brasil, 2014 / Estructura y proceso de trabajo para las acciones de alimentación y nutrición en la Atención Primaria de Salud en Brasil, 2014 / Structure and work process for food and nutrition actions in Primary Health Care in Brazil, 2014

Objetivo: Avaliar as condições de estrutura e de processo de trabalho para as ações de alimentação e nutrição na Atenção Primária à Saúde, no Brasil. Métodos: Estudo transversal, sobre dados secundários do Programa de Melhoria do Acesso e da Qualidade da Atenção Básica. Foram descritas as proporções de adequação das unidades básicas de saúde (UBS) e equipes de saúde segundo variáveis organizacionais, pela razão da prevalência e regressão de Poisson. Resultados: Foram analisadas 19.793 UBS e 24.549 equipes; 35,0% (n=6.928) das UBS mostraram-se adequadas na estrutura e 7,9% (n=1.934) das equipes adequadas ao processo de trabalho. Nas análises de associação, destacaram-se as UBS da região Sul (44,7%) e as equipes da região Sudeste (10,9%), além de municípios com mais de 300 mil habitantes. Conclusão: As UBS e equipes analisadas apresentaram baixas proporções de adequação de estrutura e de processo de trabalho para as ações de alimentação e nutrição.

Objetivo: Evaluar las condiciones de estructura y proceso de trabajo de las acciones de alimentación y nutrición en la Atención Primaria de Salud en Brasil. Métodos: Estudio transversal con datos del Programa de Mejoramiento del Acceso y la Calidad en la Atención Primaria. Se describieron las proporciones de adecuación de las Unidades Básicas de Salud (UBS) y equipos de salud según variables organizacionales por la razón de prevalencia y regresión de Poisson. Resultados: Se analizaron 19.793 UBS y 24.549 equipos. El 35,0% (n=6.928) de las UBS se consideraron adecuadas en la estructura y el 7,9% (n=1.934) de los equipos adecuados al proceso de trabajo. En los análisis asociativos se destacaron las UBS de la región Sur (44,7%) y los equipos de la región Sudeste (10,9%), además de los municipios con más de 300 mil habitantes. Conclusión: Las UBS y los equipos analizados presentaron bajas proporciones de adecuación para la estructura y el proceso de trabajo para las acciones de alimentación y nutrición.

Objective: To evaluate the conditions of structure and work process for food and nutrition actions in Primary Health Care in Brazil. Methods: This was a cross-sectional study with secondary data from the Program for Primary Health Care Access and Quality Improvement. The proportions of Primary Health Care Center (PHCC) and health team adequacy were described according to organizational variables, using prevalence ratios and Poisson regression. Results: 19,793 PHCCs and 24,549 teams were analyzed; 35.0% (n=6,928) of PHCCs were considered adequate in relation to structure and 7.9% (n=1,934) of the teams had adequate work process. Standing out in the analyses of association are PHCCs in the Southern region (44.7%) and teams in the Southeastern region (10.9%), in addition to municipalities with more than 300,000 inhabitants. Conclusion: The PHCCs and teams analyzed presented a low proportion of adequacy for structure and work process for food and nutrition actions.

[Municipalities Stratification for Health Performance Evaluation]. / Estratificação de municípios brasileiros para avaliação de desempenho em saúde.

OBJECTIVE: to propose and present a stratification of Brazilian municipalities into homogeneous groups for evaluation studies of health management performance. METHODS: this was a methodological study, with selected indicators which classify municipalities according to conditions that influence the health management and population size; data for the year 2010 were collected from demographic and health databases; correlation tests and factor analysis were used. RESULTS: seven strata were identified - Large-sized; Medium-sized with favorable, regular or unfavorable influences; and Small-sized with favorable, regular or unfavorable influences -; there was a concentration of municipalities with favorable influences in strata with better purchasing power and funding, as well as a concentration of municipalities with unfavorable influences in the North and Northeast regions. CONCLUSION: the proposed classification grouped similar municipalities regarding influential factors in health management, which allowed the identification of comparable groups of municipalities, setting up a consistent alternative to performance evaluation studies.

Acesso a medicamentos de alto preço: desigualdades na organização e resultados entre estados brasileiros / Access to high-priced medicines: inequalities in the organization and the results among Brazilian states

Resumo Este estudo de caso visou caracterizar a organização do Componente Especializado da Assistência Farmacêutica (CEAF) em quatro estados, de diferentes regiões do país. A coleta de dados foi realizada junto a representantes da gestão do CEAF, os quais responderam um questionário com 20 perguntas sobre: abrangência, organização, financiamento, barreiras e facilitadores. Essas informações foram complementadas com dados de inquéritos nacionais de saúde, do DataSUS, os valores investidos e indicadores socioeconômicos. Observaram-se diferenças entre os estados em questões como a proporção de usuários e a descentralização dos serviços. Estas características parecem estar relacionadas com o grau de desenvolvimento em termos dos indicadores socioeconômicos utilizados. Destacaram-se avanços no acesso a medicamentos, apesar das dificuldades para o cumprimento dos objetivos do CEAF, como a insuficiência de recursos, de qualificação da força de trabalho e da oferta de consultas e exames necessários. Os resultados indicam avanços, diferentes formas de organização e destacam a necessidade de estudos mais aprofundados relativos aos resultados clínicos e econômicos alcançados, como uma estratégia para traçar soluções para o atendimento integral e equânime dos usuários.

Abstract This case study aimed to characterize the Specialized Component of Pharmaceutical Services (CEAF) organization in four Brazilian states from diverse regions of the country. Data were collected with representatives of CEAF management from states in different regions, who answered a 21-question questionnaire on scope, organization, financing, hurdles, and facilitators. This information was complemented with data from national health surveys, DataSUS, the applied resources, and socioeconomic indicators. Differences were observed between states on issues such as the proportion of users and the decentralization of services. These characteristics seem to be related to the level of development concerning the socioeconomic indicators used. Advances in access to medicines were highlighted, despite the difficulties complying with the CEAF's objectives, such as insufficient resources, the qualification of human resources, and the provision of necessary visits and exams. The results point to advances, different forms of organization and highlight the need for more in-depth studies on the clinical and economic outcomes achieved as a strategy to outline solutions to achieve the comprehensive and equal care for users.

Estudo de avaliabilidade do Programa Multicêntrico de Qualificação Profissional em Atenção Domiciliar a Distância (PMQPAD) / Evaluability study of the Multicenter Program for Professional Qualification in Distance Home Care (PMQPAD) / Estudio de disponibilidad del Programa Multicéntrico de Cualificación Profesional en la Atención Domiciliaria a Distancia (PMQPAD)

Resumo: Com a implantação da atenção domiciliar no âmbito do Sistema Único de Saúde (SUS), diante da necessidade de capacitação de gestores e profissionais, criou-se o Programa Multicêntrico de Qualificação Profissional em Atenção Domiciliar a Distância (PMQPAD) numa parceria entre a Universidade Aberta do SUS e a Coordenação Geral de Atenção Domiciliar do Ministério da Saúde. Por meio de cursos de especialização, aperfeiçoamento e autoinstrucionais, o programa teve grande capilaridade e alcance no país, com quase 300 mil matrículas distribuídas em todos os estados brasileiros. O objetivo do presente estudo foi estruturar um modelo avaliativo do PMQPAD, por meio de um estudo de avaliabilidade, com a participação dos gestores do programa. Foi utilizada a metodologia desenvolvida por Thurston & Ramaliu, cujas etapas permitiram descrever o programa, representá-lo por meio de um modelo lógico e desenvolver uma matriz avaliativa. Foram realizadas análise documental, entrevistas semiestruturadas e oficinas de consenso para validação do modelo. O processo resultou no desenvolvimento de três matrizes avaliativas, uma para cada modalidade de curso do programa, com quatro dimensões de análise em comum (Características do curso e recursos educacionais; Aspectos institucionais; Resultados; Impactos). Os indicadores avaliativos tiveram, como fontes de dados primários, os alunos, os tutores e os gestores do curso. O estudo contou com a participação dos stakeholders e mostrou-se apropriado para o desenvolvimento da proposta avaliativa. Destaca-se o potencial de utilização das matrizes avaliativas desenvolvidas para a avaliação de outros programas de formação a distância no âmbito do SUS.

Abstract: With the implementation of home care in the Brazilian Unified National Health System (SUS), the need to train administrators and health workers led to the creation of the Multicenter Program for Professional Qualification in Distance Home Care (PMQPAD) in a partnership between the SUS Open University and the General Coordinating Division for Home Care, of the Brazilian Ministry of Health. Through courses in specialization, improvement, and self-instruction, the program achieved wide capillarity and scope in the country, with nearly 300,000 enrollments across all states of Brazil. The current study aimed to structure a model to assess the PMQPAD through an evaluability study with participation by the program's administrators. We used the methodology developed by Thurston & Ramaliu, the stages of which allowed describing the program, representing it with a log frame model, and developing a evaluation matrix. We conducted document analysis, semi-structured interviews, and consensus workshops for the model's validation. The process resulted in the development of three evaluation matrices, one for each of the program's course modalities, with four analytical dimensions in common (Course characteristics and educational resources; Institutional aspects; Results; Impacts). The primary data sources for the evaluation indicators were the students, tutors, and administrators. The study drew on stakeholders' participation and proved appropriate for the development of the evaluation proposal. The results highlight the potential for use of evaluation matrices developed for the assessment of other distance training programs under the SUS.

Resumen: Con la implantación de la atención domiciliaria en el ámbito del Sistema Único de Salud (SUS), ante la necesidad de la capacitación de gestores y profesionales, se creó el Programa Multicéntrico de Cualificación Profesional en Atención Domiciliaria a Distancia (PMQPAD), en una colaboración entre la Universidad Abierta del SUS y la Coordinación General de Atención Domiciliaria del Ministerio de Salud de Brasil. A través de cursos de especialización, perfeccionamiento y de autoaprendizaje, el programa tuvo una gran capilaridad y alcance en el país, con casi 300 mil matrículas, distribuidas por todos los estados brasileños. El objetivo del presente estudio fue estructurar un modelo evaluativo del PMQPAD, a través de un estudio de disponibilidad, con la participación de los gestores del programa. Se utilizó la metodología desarrollada por Thurston & Ramaliu, cuyas etapas permitieron describir el programa, representarlo a través de un modelo lógico, y desarrollar una matriz evaluativa. Se realizó un análisis documental, entrevistas semiestructuradas y talleres de consenso para la validación del modelo. El proceso resultó en el desarrollo de tres matrices evaluativas, una para cada modalidad de curso del programa, con cuatro dimensiones de análisis en común (Características del curso y recursos educacionales; Aspectos institucionales; Resultados; Impactos). Los indicadores evaluativos tuvieron como fuentes de datos primarios los alumnos, los tutores y los gestores del curso. El estudio contó con la participación de los stakeholders, y se mostró apropiado para el desarrollo de la propuesta evaluativa. Se destaca el potencial de utilización de las matrices evaluativas desarrolladas para la evaluación de otros programas de formación a distancia en el ámbito del SUS.