Quality of life and associated factors for community health workers in the context of the COVID-19 pandemic in northeastern Brazil.

In this study, we evaluated the quality of life (QoL) and associated factors of community health workers (CHWs) in different urban settings as a contributor to the preparedness of Brazilian primary care for future sanitary emergencies. The sample included 1935 CHWs from 4 state capitals and 4 inland municipalities in northeastern Brazil. Information was collected on QoL (WHOQOL-BREF), work routines, sociodemographics, direct and indirect exposure to violence, general self-efficacy, social support (MSPSS), mental health (SRQ-20) and coronavirus anxiety. The data were subjected to multiple linear regression analysis (α = 5%). In the state capitals, the factors associated with loss of QoL were poor mental health, lack of training, uncertainty about occupational biosafety, and lack of adaptation of services to tend to patients diagnosed with COVID-19. Among the inland municipalities, the main factors were coronavirus anxiety, poor mental health, lack of adaptation of services, lack of training, and lack of personal protective equipment (PPE). A high MSPSS (family and friends) score and self-efficacy had positive impacts on QoL in both urban settings. Our results highlight the need for investment in permanent education, PPE, social support, and mental health care for CHWs.

Which factors influenced the adoption of interprofessionality in health based on the reports of the PET-Health Interprofessionality projects in Brazil? A document analysis.

The Program of Education through Work - Health (PET-Health) Interprofessionality is one of the strategic actions of the "Plan for the Strengthening of Interprofessionality" in healthcare in Brazil. Based on the experience of the program, this paperexamines the aspects that impact the adoption and strengthening of interprofessional education and collaborative practices, and issues recommendations for the strengthening of interprofessionality as a guiding principle of training and working in healthcare. This is a document analysis of partial reports from the six- and 12-months of execution of 120 PET-Health Interprofessionality projects in Brazil. The data were analyzed based on content analysis and the categories elaborated a priori. The aspects that impact the adoption and strengthening of interprofessionality in training and working in healthcare, and future recommendations, were organized in the relational, processual, organizational, and contextual dimensions, according to the framework by Reeves et al. The PET-Health Interprofessionality expanded the understanding of elements of interprofessional education and practice and showed that the discussion must take on a more political, critical, and reflexive character. The analysis points to the need for continuity of teaching-learning activities as a strategy to foster interprofessional capacity in healthcare services and consequent strengthening of the Unified Healthcare System in Brazil.

Fluoride in Bottled Waters Consumed in Northeastern Brazil

ABSTRACT Objective: To assess the fluoride concentration of bottled waters from municipalities in northeastern Brazil. Material and Methods: Bottled mineral waters were purchased in two periods at different commercial places of four large municipalities (João Pessoa, Campina Grande, Patos, and Cajazeiras) in the Paraíba state. The municipalities selected to present the following annual average temperature: João Pessoa 26.5 °C, Campina Grande 23.3 °C, Patos and Cajazeiras 27.5 °C. Fluoride concentration was determined using a combined ion-specific electrode. Readings (in mV) were conducted in triplicates for each standard solution and converted into fluoride concentration (mg F/L) using the Excel® software. Results: A total of 72 samples from six brands of bottled water were analyzed. The fluoride concentrations of all samples were low (0.11-0.21mg/L) but higher than those reported on the label and varied among different batches of the same brand. Conclusion: The fluoride levels in bottled water vary among brands, and these actual values are not stated in the labels.

Level of natural fluoride in public water supply: geographical and meteorological factors in Brazil's Northeast.

This study analyzed the relationships between the concentration of natural fluoride in public water supply and meteorological and hydrographic factors in a northeastern region of Brazil. This was a descriptive, analytical, ecological, longitudinal, and field study conducted by collecting water in 23 municipalities (2019 to 2020) of four macroregions of Paraíba (Brazil): coast (1), borborema (2), agreste (3), and outback (4). Four collection sites were selected per municipality: two near and two distant from the water treatment plant. Fluoride concentration was determined using a combined ion-specific electrode and classified according to the Collaborating Center of the Ministry of Health in Oral Health Surveillance. Meteorological, hydrographic, and population characteristics were also collected. All analyzed samples showed natural fluoride; macroregions 2 and 4 showed the highest mean fluoride concentration, macroregion 4 presented the highest mean temperature, and all macroregions showed a similar pattern of precipitation. The mean fluoride concentration of the four macroregions was below the appropriate value to prevent caries. An increase in precipitation would decrease the fluoride concentration in water. In conclusion, the concentration of natural fluoride varied according to meteorological and hydrographic factors. The concentration in surface waters increased during periods of low precipitation. Therefore, this study provided important information to support implementation of community water fluoridation in this region.

Dimensão técnico-pedagógica na atuação dos Núcleos Ampliados de Saúde da Família e da Atenção Básica / Technical-pedagogical dimension in the performance of Amplified Family Health Nucleus and Primary Care

RESUMO Este estudo tem como objetivo analisar a atuação dos Núcleos Ampliados de Saúde da Família e da Atenção Básica (Nasf-AB) na perspectiva da dimensão técnico-pedagógica, a partir dos níveis contextuais definidos por Hinds, Chaves e Cypress. Desenvolvido de 2016 a 2017, trata-se de estudo de casos múltiplos, realizado em três municípios pertencentes à macrorregião de saúde de Sobral, Ceará, Brasil. Teve como fontes de informação dados documentais (relatórios de planejamento de atividades e registros fotográficos), observação do processo de trabalho do Nasf, seguindo roteiro estruturado, e seis grupos focais com equipes de Saúde da Família (eSF) e Nasf. Verificou-se a necessidade de reorganização da gestão do trabalho das equipes, a fim de superar desafios como comunicação e reconhecimento dos seus papéis, de forma a melhorar a operacionalização das ações, objetivando fortalecer a integração e avançar na construção de políticas e serviços resolutivos e de qualidade.

ABSTRACT This study aim to analyze the performance of the Amplified Family Health Nucleus and Primary Care (Nasf-AB) from the perspective of the technical-pedagogical dimension, based on the contextual levels defined by Hind, Chaves and Cypress (1992). Conducted from 2016 to 2017, this is a multiple case study, carried out in three municipalities belonging to the health macro-region of Sobral, Ceará, Brazil. Information sources were documentary data (activity planning reports and photographic records), observation of the Nasf work process, following a structured script, and six focus groups with the Family Health (eSF) and Nasf teams. There was the need to reorganize the work management of teams, in order to overcome challenges such as communication and recognition of their roles, in order to improve the operationalization of actions, with the aim of strengthening integration and making progress in the construction of resolutive and quality policies and services.

Influence of sociodemographic factors and Family Health Strategy coverage on oral health promotion procedures: an analysis of Brazilian municipalities in 2019.

Background: The aim of the study was to investigate associations between sociodemographic factors and municipal Family Health Strategy (FHS) coverage and oral health promotion (OHP) procedures in Brazil. Material and Methods: Data were obtained using public information systems and by direct request to the Ministry of Health. Clinical and collective OHP procedures performed in 2019 were analyzed, and sociodemographic covariates were associated with FHS coverage (population covered by FHS teams [FHST] and oral health teams [OHT]). Negative binomial regression models associated outcomes with covariates and estimated the prevalence ratio (PR) and confidence intervals (95%CI). Results: A total of 4,913 municipalities were included. Municipalities with low-income inequality (PR=1.04, 95%CI 1.01 to 1.08), high illiteracy rate (RP=1.06, 95%CI 1.00 to 1.13), and population size of 10,001 to 50,000 inhabitants (PR=1.07, 95%CI 1.02 to 1.12) and 50,001 to 100,000 (PR=1.21, 95%CI 1.12 to 1.30) showed a higher frequency of clinical procedures. In contrast, a low frequency of clinical procedures was associated with reduced vulnerability to poverty (PR=0.83, 95%CI 0.78 to 0.89) and low OHT coverage (PR=0.39, 95%CI 0.33 to 0.45). Regarding collective procedures, the final model showed associations between low frequency and reduced income inequality (PR=0.91, 95%CI 0.87 to 0.95), low per capita income (PR=0.84, 95%CI 0.81 to 0.88), and low (PR=0.53, 95%CI 0.35 to 0.80) and medium Human Development Index (PR=0.79, 95%CI 0.71 to 87). Conclusions: Clinical and collective OHP procedures were associated with sociodemographic conditions and OHT coverage in the FHS. Key words:Health Promotion, Oral Health, Social Determinants of Health, Universal Health Coverage.

Mental health of community health workers in the COVID-19 context. / Saúde mental de agentes comunitários de saúde no contexto da COVID-19.

This study aimed to analyze the factors related to the mental health of Community Health Workers (ACS) in the COVID-19 context. A total of 1,935 ACS from four Northeastern capitals and four cities in the inland region of Ceará participated. The following data were collected: sociodemographic; professional; SRQ-20; WHOQOL-Bref, exposure to violence, General Self-Efficacy Scale (EAEG), Multidimensional Scale of Perceived Social Support (MSPSS), COVID-19-related information, and the coronavirus anxiety scale (EAC). Approximately 40.5% had SRQ > 7, signaling high levels of Common Mental Disorders (CMD)/mental health issues. We adopted the Multiple linear (backward) regression. We observed that the increased risk of CMD was influenced by exposure to violence, EAC, not knowing they had COVID-19, not knowing the variables that reduced the risk, the physical and psychological domains of the WHOQOL-Bref, not having increased working hours, and not having had COVID-19. The data reveal the multidimensional dynamics of mental health and help understand the relationship between community violence, COVID-19, quality of life, age, and ESF working time with the mental health of ACS.

O objetivo deste estudo foi analisar os fatores relacionados à saúde mental dos agentes comunitários de saúde (ACS) no contexto da COVID-19. Participaram 1.935 ACS de quatro capitais nordestinas e de quatro cidades do interior do Ceará. Foram coletados dados sociodemográficos e profissiográficos; SRQ-20; WHOQOL-Bref; exposição à violência; Escala de Autoeficácia Geral (EAEG); Escala Multidimensional de Suporte Social Percebido (MSPSS); informações relacionadas à COVID-19 e Escala de Ansiedade para Coronavírus (EAC). 40,5% exibiram SRQ > 7, sinalizando altos níveis de transtornos mentais comuns (TMC)/problemas de saúde mental. Utilizou-se a regressão linear múltiplas (backward). Observou-se que o aumento de risco de TCM foi influenciado pelos seguintes fatores: exposição à violência; EAC; não saber se teve COVID-19; desconhecer as variáveis que diminuíam o risco; os domínios físico e psicológico do WHOQOL-Bref; não ter aumento da jornada de trabalho; e não ter tido COVID-19. Os dados revelam a dinâmica multidimensional da saúde mental e ajudam a compreender a relação entre violência comunitária, COVID-19, qualidade de vida, idade e tempo de atuação na ESF com a saúde mental dos ACS.

Community health workers perspective on the COVID-19 impact on primary health care in Northeastern Brazil.

This article evaluates the COVID-19 pandemic impacts on the Family Health Strategy (FHS) team's work routines across a range of northeast Brazilian cities as perceived by community health workers (CHW). Data on COVID-19, CHW activities, and FHS teams were collected in 2021 by a structured questionnaire. A total of 1,935 CHWs from four state capitals (Fortaleza - Ceará State, João Pessoa - Paraíba State, Recife - Pernambuco State, Teresina - Piauí State) and four hinterland cities (Crato, Juazeiro do Norte, Barbalha, Sobral - Ceará State) participated in the study. Most CHWs were women (82.42%), with mean age 46.25±8.54 years. Many (39.92%) were infected with COVID-19, of which 70.78% believed they were infected in the workplace. A total of 77.82% defined their role as frontline in the fight against COVID-19, 16.07% reported receiving training for COVID-19, and 13.74% had access to sufficient protective equipment. Most (90.27%) believed their work routines were modified by the pandemic, either strengthening (41.46%) or weakening (44.41%) the team spirit. Home visits (60.55%), health promotion actions in schools (75.66%) and in specific community groups (93.96%), and other on-site community services (66.01%) showed a reduction in frequency. The sampled cities revealed a significant heterogeneity regarding responses to the COVID-19 pandemic, possibly associated with a lack of coordination by the Federal Government. Regardless of context, the pandemic led to a reconfiguration of local health systems, workflows, and primary care protocols for FHS teams. The importance of the Brazilian Unified National Health System (SUS) and its potential for reorganization during crisis should be acknowledged while preserving the headway made thus far.

Temporomandibular disorders: knowledge, competency, and attitudes of predoctoral dental students.

OBJECTIVE: To evaluate knowledge, competency, and attitudes related to temporomandibular disorders (TMD) among predoctoral dental students, and to investigate the curricular organization of contents related to TMD and occlusion. METHODS: Predoctoral dental students (n = 147) answered a questionnaire with topics related to TMD. Another questionnaire evaluated the organization of TMD and occlusion courses. RESULTS: Contents related to TMD and occlusion were taught in the same course in all dental schools. The students' responses showed low agreement with the current gold standards pertaining to TMD. Most students declared that they did not feel confident to treat patients with TMD (62.6%), were not satisfied with the content pertaining to TMD (55.8%), and considered a lack of clinical practice to be the primary limitation in their training (59.2%). DISCUSSION: Students' knowledge of basic concepts related to TMD was limited, highlighting the need for readjustment of the dental curriculum to increase clinical experience.

Community health workers perspective on the COVID-19 impact on primary health care in Northeastern Brazil / Perspectiva dos agentes comunitários de saúde sobre o impacto da COVID-19 na atenção primária à saúde no Nordeste do Brasil / Perspectiva de los agentes comunitarios de la salud sobre el impacto de pandemia de COVID-19 en la atención primaria a la salud en el Nordeste de Brasil

Abstract: This article evaluates the COVID-19 pandemic impacts on the Family Health Strategy (FHS) team's work routines across a range of northeast Brazilian cities as perceived by community health workers (CHW). Data on COVID-19, CHW activities, and FHS teams were collected in 2021 by a structured questionnaire. A total of 1,935 CHWs from four state capitals (Fortaleza - Ceará State, João Pessoa - Paraíba State, Recife - Pernambuco State, Teresina - Piauí State) and four hinterland cities (Crato, Juazeiro do Norte, Barbalha, Sobral - Ceará State) participated in the study. Most CHWs were women (82.42%), with mean age 46.25±8.54 years. Many (39.92%) were infected with COVID-19, of which 70.78% believed they were infected in the workplace. A total of 77.82% defined their role as frontline in the fight against COVID-19, 16.07% reported receiving training for COVID-19, and 13.74% had access to sufficient protective equipment. Most (90.27%) believed their work routines were modified by the pandemic, either strengthening (41.46%) or weakening (44.41%) the team spirit. Home visits (60.55%), health promotion actions in schools (75.66%) and in specific community groups (93.96%), and other on-site community services (66.01%) showed a reduction in frequency. The sampled cities revealed a significant heterogeneity regarding responses to the COVID-19 pandemic, possibly associated with a lack of coordination by the Federal Government. Regardless of context, the pandemic led to a reconfiguration of local health systems, workflows, and primary care protocols for FHS teams. The importance of the Brazilian Unified National Health System (SUS) and its potential for reorganization during crisis should be acknowledged while preserving the headway made thus far.

Resumo: Este artigo avalia as repercussões da pandemia da COVID-19 no cotidiano de trabalho da equipe da Estratégia Saúde da Família (ESF) em diversos municípios do Nordeste brasileiro, na perspectiva dos agentes comunitários de saúde (ACS). Um questionário estruturado foi utilizado para coletar informações sobre a COVID-19, atividades dos ACS e equipes da ESF em 2021. Participaram 1.935 ACS de quatro capitais (Fortaleza - Ceará, João Pessoa - Paraíba, Recife - Pernambuco e Teresina - Piauí) e quatro cidades do interior (Crato, Juazeiro do Norte, Barbalha e Sobral, Ceará). A idade média dos ACS era de 46,25±8,54 anos, sendo a maioria mulheres (82,42%). Muitos (39,92%) estavam infectados com COVID-19, dos quais 70,78% acreditavam ter sido infectados no ambiente de trabalho. Ao todo, 77,82% definiam seu papel como linha de frente no combate à COVID-19, 16,07% relataram receber treinamento para a COVID-19 e 13,74% tinham acesso a equipamentos de proteção suficientes contra a COVID-19. A maioria (90,27%) acredita que suas rotinas de trabalho foram modificadas pela pandemia, fortalecendo o espírito de equipe (41,46%) ou enfraquecendo-o (44,41%). Houve uma redução na promoção da saúde nas escolas (75,66%) e na frequência de visitas domiciliares (60,55%), de grupos específicos na comunidade (93,96%) e outros serviços comunitários locais (66,01%). Nos municípios avaliados, observou-se uma heterogeneidade significativa em relação à resposta à pandemia de COVID-19, possivelmente associada à falta de coordenação do Governo Federal. A pandemia levou a uma reconfiguração dos sistemas locais de saúde, fluxos de trabalho e protocolos de atenção primária para as equipes da ESF. A importância do Sistema Único de Saúde (SUS) e seu potencial de reorganização durante as crises devem ser reconhecidos, preservando-se os avanços alcançados até o momento.

Resumen: Este artículo evalúa las repercusiones de la pandemia de COVID-19 en el trabajo cotidiano del equipo de la Estrategia Salud de la Familia (ESF) en diversos municipios del Nordeste brasileño, desde la perspectiva de los agentes comunitarios de salud (ACS). Se utilizó un cuestionario estructurado para recopilar información sobre COVID-19, actividades de los ACS y equipos de la ESF en el 2021. Participaron 1.935 ACS de cuatro capitales (Fortaleza - Ceará, João Pessoa - Paraíba, Recife - Pernambuco y Teresina - Piauí) y cuatro ciudades del interior (Crato, Juazeiro do Norte, Barbalha y Sobral - Ceará). La edad media de los ACS era de 46,25±8,54 años, y la mayoría eran mujeres (82,42%). Muchos (39,92%) estaban infectados con COVID-19, de los cuales el 70,78% creía haberse contagiado en el entorno laboral. En total, el 77,82% definió su papel como línea de frente en el combate a la COVID-19, el 16,07% informó haber recibido capacitación para la COVID-19 y el 13,74% tuvo acceso a equipos de protección suficiente contra la COVID-19. La mayoría (90,27%) cree que sus rutinas de trabajo se vieron modificadas por la pandemia, fortaleciendo el espíritu de equipo (41,46%) o debilitándolo (44,41%). Hubo una reducción en la promoción de la salud en las escuelas (75,66%) y en la frecuencia de las visitas domiciliarias (60,55%), de grupos específicos en la comunidad (93,96%) y otros servicios comunitarios locales (66,01%). En los municipios analizados, se observó una heterogeneidad significativa con relación a la respuesta a la pandemia de COVID-19, posiblemente asociada a la falta de coordinación del Gobierno Federal. La pandemia condujo a una reconfiguración de los sistemas locales de salud, los flujos de trabajo y los protocolos de atención primaria para los equipos de la ESF. Se debe reconocer la importancia del Sistema Único de Salud y (SUS) su capacidad de reorganización durante las crisis, preservando los avances logrados hasta el momento.

Saúde mental de agentes comunitários de saúde no contexto da COVID-19 / Mental health of community health workers in the COVID-19 context

Resumo O objetivo deste estudo foi analisar os fatores relacionados à saúde mental dos agentes comunitários de saúde (ACS) no contexto da COVID-19. Participaram 1.935 ACS de quatro capitais nordestinas e de quatro cidades do interior do Ceará. Foram coletados dados sociodemográficos e profissiográficos; SRQ-20; WHOQOL-Bref; exposição à violência; Escala de Autoeficácia Geral (EAEG); Escala Multidimensional de Suporte Social Percebido (MSPSS); informações relacionadas à COVID-19 e Escala de Ansiedade para Coronavírus (EAC). 40,5% exibiram SRQ > 7, sinalizando altos níveis de transtornos mentais comuns (TMC)/problemas de saúde mental. Utilizou-se a regressão linear múltiplas (backward). Observou-se que o aumento de risco de TCM foi influenciado pelos seguintes fatores: exposição à violência; EAC; não saber se teve COVID-19; desconhecer as variáveis que diminuíam o risco; os domínios físico e psicológico do WHOQOL-Bref; não ter aumento da jornada de trabalho; e não ter tido COVID-19. Os dados revelam a dinâmica multidimensional da saúde mental e ajudam a compreender a relação entre violência comunitária, COVID-19, qualidade de vida, idade e tempo de atuação na ESF com a saúde mental dos ACS.

Abstract This study aimed to analyze the factors related to the mental health of Community Health Workers (ACS) in the COVID-19 context. A total of 1,935 ACS from four Northeastern capitals and four cities in the inland region of Ceará participated. The following data were collected: sociodemographic; professional; SRQ-20; WHOQOL-Bref, exposure to violence, General Self-Efficacy Scale (EAEG), Multidimensional Scale of Perceived Social Support (MSPSS), COVID-19-related information, and the coronavirus anxiety scale (EAC). Approximately 40.5% had SRQ > 7, signaling high levels of Common Mental Disorders (CMD)/mental health issues. We adopted the Multiple linear (backward) regression. We observed that the increased risk of CMD was influenced by exposure to violence, EAC, not knowing they had COVID-19, not knowing the variables that reduced the risk, the physical and psychological domains of the WHOQOL-Bref, not having increased working hours, and not having had COVID-19. The data reveal the multidimensional dynamics of mental health and help understand the relationship between community violence, COVID-19, quality of life, age, and ESF working time with the mental health of ACS.

Level of natural fluoride in public water supply: geographical and meteorological factors in Brazil's Northeast

Abstract This study analyzed the relationships between the concentration of natural fluoride in public water supply and meteorological and hydrographic factors in a northeastern region of Brazil. This was a descriptive, analytical, ecological, longitudinal, and field study conducted by collecting water in 23 municipalities (2019 to 2020) of four macroregions of Paraíba (Brazil): coast (1), borborema (2), agreste (3), and outback (4). Four collection sites were selected per municipality: two near and two distant from the water treatment plant. Fluoride concentration was determined using a combined ion-specific electrode and classified according to the Collaborating Center of the Ministry of Health in Oral Health Surveillance. Meteorological, hydrographic, and population characteristics were also collected. All analyzed samples showed natural fluoride; macroregions 2 and 4 showed the highest mean fluoride concentration, macroregion 4 presented the highest mean temperature, and all macroregions showed a similar pattern of precipitation. The mean fluoride concentration of the four macroregions was below the appropriate value to prevent caries. An increase in precipitation would decrease the fluoride concentration in water. In conclusion, the concentration of natural fluoride varied according to meteorological and hydrographic factors. The concentration in surface waters increased during periods of low precipitation. Therefore, this study provided important information to support implementation of community water fluoridation in this region.

Interprofissionalidade, formação e trabalho colaborativo no contexto da saúde da família: pesquisa-ação / Interprofessionality, training, and collaborative work in the context of family health: action-research

RESUMO Objetivou-se construir Práticas Colaborativas Interprofissionais (PCI) e avaliá-las sob a perspectiva de docentes e discentes de cursos da área da saúde de uma Instituição de Ensino Superior (IES) federal e de uma equipe de Saúde da Família (eSF). Realizou-se pesquisa-ação, com abordagem qualitativa, em um território de uma eSF de uma capital do Nordeste, visando à construção de PCI em prol da saúde da criança. Esta envolveu 15 participantes: profissionais da eSF; docentes e discentes dos cursos de enfermagem, odontologia e nutrição de uma IES. Efetuaram-se três etapas: diagnóstico sobre educação interprofissional e PCI a partir de entrevistas; planejamento e realização de ações de saúde da criança; avaliação mediante grupo focal. As entrevistas e o grupo focal foram gravados, transcritos, e interpretados pela análise temática. A intervenção favoreceu reencontro entre os sujeitos, troca de experiência e aprendizado coletivo, e reconhecimento de papéis, constituindo-se em espaço dialógico e participativo de produção de saberes e fazeres. A ação só foi possível pela intencionalidade envolvida em seu planejamento, e o desenvolvimento das ações foi permeado de escuta e criação em torno da saúde da criança nesse território. A interação proporcionou a ressignificação da produção de cuidado interprofissional centrado nas crianças e suas famílias.

ABSTRACT The study aimed to collectively build Interprofessional Collaborative Practices (PCI) and evaluate them from the perspective of professors and students of healthcare courses of a Federal Higher Education Institution (IES) and a Family Health team (eSF). An action-research was carried out with a qualitative approach in an eSF territory of Northeastern capital in Brazil, aiming to build PCIs towards children's health. It involved 15 participants: eSF professionals; professors and students from nursing, dentistry, and nutrition courses from an IES. Three phases were carried out: diagnosis about Interprofessional Education and the PCIs, through interviews; planning and execution of child healthcare actions; and evaluation, through a focus group. The interviews and the focus group were recorded, then transcribed and interpreted using thematic analysis. The intervention favored the meeting between the subjects, the exchange of experiences and common learning, the recognition of roles, constituting a communicative and participatory space for the promotion of knowledge and actions. The action was only possible because of the intentionality involved in its implementation and the development of actions were permeated with listening and creation around children's healthcare in this territory. The interaction enabled the resignification of the production of interprofessional healthcare centered on children and their families.

A Política Nacional de Educação Permanente em Saúde e sua relação com a odontologia / The National Policy for Permanent Education in Health and its correlation with dentistry

Resumo Introdução O Sistema Único de Saúde tem passado por diversas mudanças, assim, diante do desafio de formação dos profissionais da saúde, o Ministério da Saúde instituiu a Política Nacional de Educação Permanente em Saúde (PNEPS), e a Educação Permanente em Saúde (EPS) passou a ser uma estratégia de transformação. Objetivo Analisar a percepção dos cirurgiões-dentistas (CD) sobre a PNEPS. Método Trata-se de um estudo epidemiológico, transversal e qualitativo, realizado no município de Fortaleza-CE. A população-alvo foram os CDs da Estratégia Saúde da Família (n = 173). Os dados foram coletados por meio de um questionário. A caracterização dos sujeitos da pesquisa foi realizada através do cálculo de frequência absoluta e percentual. Para avaliar as questões discursivas utilizou-se a análise de conteúdo de Bardin. Resultados A idade média da amostragem foi de 38.8 anos (±8.6), e o tempo de formação de 16.0 anos (±7.4). A maioria dos entrevistados eram do gênero feminino (74,6%) e casados (72,8%). As categorias encontradas foram: necessidade de atividades de EPS, aprendizagem significativa, trabalho em equipe, e Tecnologias Digitais de Informação e Comunicação (TDICs). Conclusão A EPS deve ser significativa, discutindo as dificuldades referentes ao trabalho em equipe. Dessa forma, sugere-se a utilização das TDICs para o desenvolvimento das atividades.

Abstract Background The Brazilian Unified Health System has undergone several changes, and accordingly, when confronted with the challenge of training health professionals, the Brazilian Ministry of Health instituted the National Policy for Permanent Education in Health (PNEPS, Portuguese acronym for Política Nacional de Educação Permanente em Saúde), hence, the Permanent Education in Health (EPS) became a transformational strategy. Objective To analyze the perception of dental surgeons (DS) regarding the PNEPS. Method This is an epidemiological, cross-sectional and qualitative study, carried out in the city of Fortaleza-Ce. The target population were the DSs of the Family Health Strategy (n=173). The data were collected by means of a questionnaire. The characterization of the research subjects was performed through absolute and relative frequency. To assess the discursive questions, Bardin's content analysis was used. Results: The average age was 38.8 years (±8.6), and the average years of schooling was 16.0 years (±7.4). Most respondents were female (74.6%) and married (72.8%). The categories found were: demand for EPS activities, meaningful learning, teamwork, and Digital Information and Communication Technologies (DICTs). Conclusion The EPS should be substantial, discussing the difficulties related to teamwork. Therefore, the use of the DICTs is recommended for the development of activities.

Coordination between Primary Care Teams and Family Health Support Units and influence on Primary Care delivery. / Articulação entre a EqSF/AB e o NASF/AB e sua influência na produção do cuidado no contexto da Atenção Primária à Saúde.

This article aims to compare the implementation of coordinated actions by family health/primary care (FH/PC) teams and extended family health and primary care units (NASF-ABs) in the Northeast and rest of Brazil, and the influence of implementation on collaborative working. The independent variables were 19 coordinated actions assessed by Module II of the 3rd Cycle of the National Program for Improving Primary Care Access and Quality (PMAQ-AB). The three collaborative working outcomes were "FH/PC team readiness to work jointly with the NASF-AB", "support received by the FH/PC team from the NASF-AB", and "The NASF-AB's contribution to resolving patients" needs. The implementation of coordinated actions by the Northeast and at national level was compared using the two-proportions z-test and the influence of these actions on the outcomes was assessed using hierarchical linear regression models: The Northeast implemented more actions that at national level (p<0.05). The implemented actions that had the most positive influence on the three outcomes were "Case conferences", "Joint development of singular therapy plans for complex cases", "Shared appointments" and "Results monitoring". The Northeast implemented more actions and the implemented actions had a positive influence on collaborative working.

O objetivo deste artigo é comparar a realização de ações de articulação entre as equipes EqSF/AB e NASF/AB entre a região Nordeste e Brasil e sua influência no trabalho conjunto das equipes. As variáveis independentes foram 19 ações de articulação investigadas pelo módulo II do 3º Ciclo do PMAQ-AB. Os três desfechos referentes ao trabalho conjunto foram a disponibilidade da EqSF/AB em trabalhar com o NASF/AB, o apoio recebido do NASF/AB e a contribuição do trabalho deste para a resolutividade das ações para os usuários. A comparação entre o Nordeste e o Brasil na realização das ações de articulação foi realizada pelo Teste Z e a influência final de tais ações nos desfechos foi avaliada por Modelo Hierárquico de Regressão Linear. A região Nordeste realizou mais ações de integração entre a EqSF/ AB e o NASF/AB (p<0,05). As ações realizadas que apresentaram maior influência positiva nos três desfechos foram "discussão de casos", "elaboração conjunta do Projeto Terapêutico Singular", "realização de consultas compartilhadas" e "monitoramento dos resultados". A região Nordeste realizou mais ações de articulação, e elas apresentaram influências positivas no trabalho conjunto.

Articulação entre a EqSF/AB e o NASF/AB e sua influência na produção do cuidado no contexto da Atenção Primária à Saúde / Coordination between Primary Care Teams and Family Health Support Units and influence on Primary Care delivery

Resumo O objetivo deste artigo é comparar a realização de ações de articulação entre as equipes EqSF/AB e NASF/AB entre a região Nordeste e Brasil e sua influência no trabalho conjunto das equipes. As variáveis independentes foram 19 ações de articulação investigadas pelo módulo II do 3º Ciclo do PMAQ-AB. Os três desfechos referentes ao trabalho conjunto foram a disponibilidade da EqSF/AB em trabalhar com o NASF/AB, o apoio recebido do NASF/AB e a contribuição do trabalho deste para a resolutividade das ações para os usuários. A comparação entre o Nordeste e o Brasil na realização das ações de articulação foi realizada pelo Teste Z e a influência final de tais ações nos desfechos foi avaliada por Modelo Hierárquico de Regressão Linear. A região Nordeste realizou mais ações de integração entre a EqSF/ AB e o NASF/AB (p<0,05). As ações realizadas que apresentaram maior influência positiva nos três desfechos foram "discussão de casos", "elaboração conjunta do Projeto Terapêutico Singular", "realização de consultas compartilhadas" e "monitoramento dos resultados". A região Nordeste realizou mais ações de articulação, e elas apresentaram influências positivas no trabalho conjunto.

Abstract This article aims to compare the implementation of coordinated actions by family health/primary care (FH/PC) teams and extended family health and primary care units (NASF-ABs) in the Northeast and rest of Brazil, and the influence of implementation on collaborative working. The independent variables were 19 coordinated actions assessed by Module II of the 3rd Cycle of the National Program for Improving Primary Care Access and Quality (PMAQ-AB). The three collaborative working outcomes were "FH/PC team readiness to work jointly with the NASF-AB", "support received by the FH/PC team from the NASF-AB", and "The NASF-AB's contribution to resolving patients" needs. The implementation of coordinated actions by the Northeast and at national level was compared using the two-proportions z-test and the influence of these actions on the outcomes was assessed using hierarchical linear regression models: The Northeast implemented more actions that at national level (p<0.05). The implemented actions that had the most positive influence on the three outcomes were "Case conferences", "Joint development of singular therapy plans for complex cases", "Shared appointments" and "Results monitoring". The Northeast implemented more actions and the implemented actions had a positive influence on collaborative working.

Dimensions of interprofessional collaboration in the dynamics of the expanded family health and primary care centers: A qualitative study.

Primary health care (PHC) in Brazil is based on Family Health Strategy (FHS) teams. These teams are supported by Expanded Family Health and Primary Care Centers (Nuclei) (NASF-AB) whose services are backbone elements for comprehensive health care within PHC. NASF-AB encompass several professional groups that aim to increase the responsiveness and scope of actions of the FHS teams. The objective of this study was to identify the dimensions of collaboration in the work dynamics of NASF-AB in the capital of Northeast Brazil. The study was a descriptive and exploratory research using a qualitative approach through semi-structured interviews with nine NASF-AB workers and three district health managers. Three analytical categories were identified following content analysis: "Interprofessional and inter-organizational collaboration," "Mainstays of collaboration in the relationship between NASF-AB and FHS," and "Challenges for a culture of collaboration in health care work." The results revealed important characteristics for interprofessional collaboration, including recognition of the attributions of the different teams and the key role of communication and planning. Participants highlighted roadblocks for interprofessional collaboration that hampered comprehensive care, such as the shortage of manpower and material resources, work overload, and lack of availability of professionals for effective teamwork.

Acolhimento na Estratégia Saúde da Família: análise de sua implantação em município de grande porte do nordeste brasileiro / Acogida en la Estrategia Salud de la Familia: análisis de la implantación en un municipio de gran porte del Nordeste brasileño / User Embracement in the Family Health Strategy: analysis of implementation in a large municipality of Northeast Brazil

O acolhimento requer postura ética e política na reorganização do processo de trabalho na Atenção Primária à Saúde (APS). O estudo objetivou analisar a implantação do acolhimento em uma Unidade de Saúde da Família (USF) de um município de grande porte do nordeste brasileiro. Trata-se de um estudo de caso com método qualitativo realizado por meio de entrevista semiestruturada com dez profissionais. Os dados qualitativos foram submetidos à análise de conteúdo, sob o paradigma da produção social da saúde. Da percepção positiva dos profissionais emergiu categorias relacionadas a: facilitação do acesso à USF, resolutividade, processo de trabalho otimizado e humanização. A implantação do projeto proporcionou mudanças significativas e sustentáveis, com impacto na gestão e cuidado na APS.(AU)

La acogida requiere una postura ética y política en la reorganización del proceso de trabajo en la Atención Primaria de la Salud (APS). El objetivo fue analizar la implantación de la acogida en una Unidad de Salud de la Familia (USF) de un municipio de gran porte del Nordeste brasileño. Estudio de caso con método cualitativo por medio de entrevista semiestructurada con diez profesionales. Los datos cualitativos se sometieron al análisis de contenido, bajo el paradigma de la producción social de la salud. De la percepción positiva de los profesionales surgieron categorías relacionadas a la facilitación del acceso a la USF, resolución, proceso de trabajo optimizado y humanización. La implantación proporcionó cambios significativos y sostenibles, con impacto en la gestión y cuidado en la APS.(AU)

User embracement requires an ethical and political posture in the reorganization of the work process in Primary Health Care (PHC). The objective was to analyze the implementation of user embracement in a Family Health Unit (FHU) in a large municipality of northeast Brazil. Case study with a qualitative method using semi-structured interviews with ten professionals. Qualitative data submitted to content analysis, under the paradigm of social production of health. The positive perception of professionals emerged from categories related to: facilitating access to the FHU, resolutivity, optimized work process and humanization. The implementation provided significant and sustainable changes, with an impact on the management and care of the PHC.(AU)

Grupo de idosos como dispositivo de empoderamento em saúde: uma pesquisa-ação / Grupo de ancianos como dispositivo de empoderamiento en salud: una investigación-acción / Elderly people social groups as a tool for health empowerment: action research

O estudo teve por objetivo construir, coletivamente, ações de promoção de saúde com idosos e profissionais de saúde e avaliar, na perspectiva dos idosos, os significados para o empoderamento em saúde. Realizou-se uma pesquisa-ação com uma equipe de Saúde da Família (eSF), núcleo ampliado de Saúde da Família e 26 idosos, em uma perspectiva dialógica e participativa. Ao final, 17 idosos foram entrevistados. Utilizou-se a técnica de análise temática. Emergiram na voz dos idosos os significados atribuídos ao grupo por meio de socialização, vínculos significativos, compartilhamento e aprendizagens. Compreende-se a potencialidade do grupo como espaço de escuta, de criação e compartilhamento de experiências e de valorização das histórias de vida dos idosos nesse território. A interação impulsionou a ressignificação do processo de envelhecimento e os projetos de vida, gerando maior satisfação com a saúde e a vida.(AU)

El objetivo del estudio fue construir colectivamente con ancianos y profesionales de la salud acciones de promoción y evaluar, desde la perspectiva de los ancianos, los significados para el empoderamiento en salud. Se realizó una investigación-acción con un equipo de salud de la familia, núcleo ampliado salud de la familia y 26 ancianos en una perspectiva dialógica y participativa. Al final, fueron entrevistados 17 ancianos. Se utilizó la técnica de análisis temático. En la voz de los ancianos surgieron los significados atribuidos al grupo, a partir de la socialización, vínculos significativos, compartición y aprendizajes. Se entiende la potencialidad del grupo como espacio de escucha, de creación y compartición de experiencias y de la valorización de las historias de vida de los ancianos en ese territorio. La interacción dio impulso a la resignificación del proceso de envejecimiento y los proyectos de vida, generando una mayor satisfacción con la salud y la vida.(AU)

This study aimed to build health promotion and prevention actions with elderly people and health professionals and evaluate the meaning of health empowerment for older people. An action research was conducted with a family health team, the Family Health Support Center, and 26 older individuals from a dialogic perspective. Seventeen older individuals were interviewed, and the content analysis technique was used. The elderly people expressed the meaning of the social group based on socialization, meaningful bonds, sharing, learning, and redefinition of life projects. The social group was a space for listening, creating, sharing experiences, and valuing life stories. This interaction redefined the aging process and life projects and increased satisfaction with health and life.(AU)