Income Trajectories and Oral Health of Young People in a Life Course Study.

OBJECTIVE: To investigate the impact of the family's socioeconomic trajectory on the oral health status of young people in the city of Sobral, Ceará, Brazil, and test the hypotheses of the life course theory. METHODS: This is a cohort study conducted in 2000, 2006, and 2012. In the third wave, 482 individuals between 17 and 21 years of age were examined and interviewed. The outcomes analyzed were the trajectory of tooth decay (decayed teeth in 2012 and cavity reoccurrence) and the trajectory of dental assistance (immediate dental assistance and untreated caries). The socioeconomic trajectory was measured by the mobility of the family's income between childhood and youth and the number of episodes of poverty throughout life. RESULTS: The risk of developing decayed teeth in 2012 was greater for those who had always remained poor. Young people who were never poor had fewer decayed teeth in 2012, but more cavity reoccurrence. Downward mobility resulted in less access to immediate dental assistance. More experience of poverty throughout life implied more decayed teeth in 2012 and less immediate dental assistance. CONCLUSION: The life course hypotheses regarding an influence of socioeconomic mobility and cumulative risk on oral health outcomes in youth were confirmed.

Advances and challenges of training in the Unified Health System based on teachers' experience in the area of Public Health in Dentistry courses. / Avanços e desafios da formação no Sistema Único de Saúde a partir da vivência dos docentes da área de Saúde Coletiva nos cursos de Odontologia.

The training directed at the Unified Health System (SUS) has been one of the most challenging assumptions in the development of Dentistry courses in Brazil. In this regard, public health educated teachers play a fundamental role in the curricular proposition favoring such an approach. This study aimed to identify the possible advances achieved in Dentistry courses and the challenges in training for the SUS. This is a quantitative, cross-sectional research with a sample of 119 teachers employing the probabilistic Snowball technique. Participants responded to a validated criteria matrix, and an exploratory factor analysis was performed for data analysis, which defined five factors responsible for training for the SUS: Primary Care; Social Responsibility and Teamwork; Health Management; Information Systems, and Continuing Education/Humanization. The study allowed identifying significant advances in the perspective of greater adequacy of the training proposal aimed at the SUS. However, some challenges to teachers require expanding the prospect to face the barriers still imposed by traditional health training.

A formação direcionada para o Sistema Único de Saúde (SUS) tem sido um dos pressupostos mais desafiadores no desenvolvimento dos cursos de Odontologia no Brasil. Para isso, docentes com formação em saúde coletiva desempenham papel fundamental na proposição curricular que privilegie tal abordagem. O objetivo do estudo foi identificar em cursos de Odontologia os possíveis avanços alcançados e os desafios a serem enfrentados na formação para o SUS. Trata-se de uma pesquisa quantitativa, com desenho transversal, cuja amostra foi composta por 119 docentes por meio da técnica probabilística do Snowball. Os participantes responderam a uma matriz de critériosvalidada, sendo realizada a análise fatorial exploratória para análise dos dados, a qual definiu cinco fatores responsáveis pela formação para o SUS: Atenção Básica; Responsabilidade Social e Trabalho em Equipe; Gestão em Saúde; Sistemas de Informação e Educação Permanente/Humanização.O estudo permitiu identificar avanços significativos na perspectiva de uma maior adequação da proposta formativa voltada para o SUS, todavia, existem desafios colocados para os professores que exigem um amplo aprofundamento na perspectiva de enfrentar as barreiras ainda impostas pela tradicional formação na área da saúde.

Validation of the criteria matrix about the generalist's education in Dentistry Undergraduate Courses.

The generalist training planned by Brazilian National Curriculum Guidelines for Dentistry undergraduate courses should provide actions for the development of health promotion in the field of public health, as well as disease prevention, diagnosis, planning, and dental treatment in the clinical field. Considering this complexity, the aim of the present study was to validate dimensions and sub-dimensions in dentistry training, allowing the identification of the main necessary competences and clinical skills for the generalist practice. For this, an evaluation study was carried out through the Delph's Method with the participation of 19 professors of Dentistry courses in Brazil working in the clinical area, considered "experts" in this theme. It was possible to identify clinical competences and skills in four dimensions and respective sub-dimensions: Transversal skills (biosafety, patient-team communication, humanization, ethical principles, dental documentation); Diagnosis and planning (diagnosis of dental caries, pulp and periapical changes, and periodontal diseases, clinical and imaging exam, and single treatment planning); Preventive activities (oral hygiene guidance and oral cancer prevention); and Dental care (anesthesia, basic oral surgery, drug prescription, subgingival scaling and root planing, dental restoration, minimally and non-invasive restoration treatment, and dental urgencies). The developed model represents a differentiated alternative for the construction of an innovative curriculum in Dentistry, aimed at the training of general practitioners to provide humanized, highly effective, and resolving care. The importance of clinical tutoring by professors on the essential clinical skills and abilities is highlighted in this study.

[Water fluoridation in Brazil: regional distribution and accuracy of information on surveillance in municipalities with more than 50,000 inhabitants]. / Fluoretação da água no Brasil: distribuição regional e acurácia das informações sobre vigilância em municípios com mais de 50 mil habitantes.

Sanitation data for 2008 indicated that 74.4% of Brazilian municipalities (counties) with more than 50,000 inhabitants were receiving fluoridated water, but no criteria were adopted to validate the information. The study aimed to verify the accuracy of information on water fluoridation, using as the reference water surveillance data from municipalities with more than 50,000 inhabitants in 2008 and during 2010-2015. Data from different sources were used, comparing the information pertaining to the period. Water samples were collected, and fluoride concentration was obtained by the electrometric method. Verification was performed by comparing the data obtained from different sources. Data were compared for 601 (97.9%) municipalities. The proportion of municipalities that performed surveillance based on external control increased from 39.4% to 48.5%. There was a high rate of false positives and false negatives (15.1%) in the data for 2008. Municipal coverage was 70.2%, or 4.2 percentage points below the published estimate (74.4%) for 2008. Surveillance records were observed in 54.3% of the fluoridated municipalities whose population coverage reached at least 50% of the population receiving treated water. There was an important improvement in fluoridation surveillance data, despite a high percentage of false positives and negatives. There are still wide interregional differences in the surveillance of water fluoridation in this sample of Brazilian municipalities, raising important public health challenges.

Dados de saneamento para 2008 indicavam que 74,4% dos municípios com mais de 50 mil habitantes recebiam água fluoretada, entretanto, critérios para a validação desta informação não foram adotados. O estudo objetivou verificar a acurácia da informação sobre a fluoretação da água, tomando-se por referência dados de vigilância da água em municípios com mais de 50 mil habitantes no ano de 2008 e no período de 2010-2015. Dados de diferentes fontes foram empregados comparando-se as informações relativas ao período. Amostras da água foram coletadas e a concentração de fluoreto foi obtida pelo método eletrométrico. O processo de verificação ocorreu pela confrontação dos dados obtidos por diferentes fontes. Seiscentos e um municípios (97,9%) tiveram os dados confrontados. A taxa de municípios que realizam vigilância com base no heterocontrole passou de 39,4% para 48,5%. Observou-se elevada taxa de falsos positivos ou negativos (15,1%) em relação aos dados de 2008. A cobertura municipal foi de 70,2%, 4,2 pontos abaixo da estimativa (74,4%) divulgada para 2008. Registros da prática da vigilância foram observados em 54,3% dos municípios fluoretados, cuja cobertura populacional alcança 50% ou mais da população que recebe água tratada. Houve sensível melhoria nos dados de vigilância em relação ao fluoreto, embora com porcentual importante de falsos positivos e negativos. Ainda são largas as diferenças inter-regionais relacionadas tanto à provisão da fluoretação da água quanto à implementação da vigilância nos municípios pesquisados, trazendo importantes desafios para a saúde pública.

Los datos de saneamiento en 2008 indicaban que un 74,4% de los municipios con más de 50 mil habitantes recibían agua fluorada, no obstante, no se adoptaron criterios para la validación de esta información. El estudio tuvo como objetivo verificar la exactitud de la información sobre la fluorización del agua, tomando como referencia datos de vigilancia del agua en municipios con más de 50 mil habitantes en el año 2008, y durante el período de 2010-2015. Se emplearon datos de diferentes fuentes comparando la información relativa a este período. Se recogieron muestras de agua y la concentración de fluoruro se obtuvo mediante un método electrométrico. El proceso de verificación se produjo por el contraste de datos obtenidos de diferentes fuentes. Se compararon los datos de 601 (97,9%) municipios. La tasa de municipios que realizan vigilancia en base al heterocontrol pasó de un 39,4% a un 48,5%. Se observó una elevada tasa de falsos positivos o negativos (15,1%), en relación con los datos de 2008. La cobertura municipal fue de un 70,2%, 4,2 puntos por debajo de la estimativa (74,4%) divulgada en 2008. Se observaron registros de la práctica de vigilancia en un 54,3% de los municipios fluorados, cuya cobertura poblacional alcanza a un 50% o más de la población que recibe agua tratada. Hubo una sensible mejoría en los datos de vigilancia respecto al fluoruro, a pesar de que había un porcentaje importante de falsos positivos y negativos. Todavía son grandes las diferencias interregionales relacionadas tanto respecto a la fluorización del agua, como a la implementación de vigilancia en los municipios investigados, implicando importantes desafíos para la salud pública.

[Use of dental care by children and associated factors in Sobral, Ceará State, Brazil]. / A utilização de serviços odontológicos entre crianças e fatores associados em Sobral, Ceará, Brasil.

The aim of this study was to analyze the use of dental services by children in Sobral, Ceará State, Brazil, relating such use to socioeconomic factors and patterns of service consumption. An analytical cross-sectional study was performed, interviewing parents or guardians of 3,425 children. The relationship between independent variables and use of dental services was analyzed using tests of association (chi-squared), odds ratios (OR) and respective confidence intervals, and multiple logistic regression. 50.9% of children had used dental services at least once in their lives. Of these, 65.3% had used such services in the previous year and 85.4% in public dental services. The importance of the Brazilian Unified National Health System is highlighted by the response in terms of access to dental services, considering that the vast majority of treatment was provided by this public system. The factors that most affected use of dental services were socioeconomic status, health plan coverage, owning a toothbrush, regular garbage collection, maternal knowledge, sewage treatment, and malnutrition.

[Inequalities in dental care during the life course of young people: a cohort study]. / Iniquidades na assistência odontológica ao longo do curso de vida de jovens: um estudo de coorte.

The scope of this study was to investigate dental care from the life course perspective and its determinant factors among young people in the city of Sobral, State of Ceará, Brazil. A cohort study was conducted with waves in 2000, 2006 and 2012 with 482 young people aged between 17 and 21 years. Two outcomes were investigated: immediate dental care and the lack of dental care, based on the dental trajectory in relation to restorative treatment. Socioeconomic conditions and recourse to oral health services and actions in the three waves investigated were used as independent variables. It was found that low socioeconomic status throughout life presented itself as a risk factor for lack of dental care and the inverse effect was observed with immediate dental care. Participation in groups of teenagers was also related to dental care, as well as receiving information on oral health. This study revealed the presence of inequalities in dental care throughout the life course of the population assessed.

O objetivo deste estudo foi investigar a assistência odontológica sob a perspectiva do "life course", bem como seus fatores determinantes, em jovens no município de Sobral, Ceará, Brasil. Realizou-se um estudo de coorte com ondas em 2000, 2006 e 2012 com 482 jovens atualmente entre 17 e 21 anos. Foram investigados dois desfechos: a assistência odontológica imediata e a ausência de assistência odontológica, baseados na trajetória dentária em relação ao tratamento restaurador. E como variáveis independentes, utilizaram-se as condições socioeconômicas e utilização de serviços e ações de saúde bucal nas três ondas investigadas. Observou-se que piores condições socioeconômicas ao longo da vida apresentaram-se como fator de risco para ausência da assistência odontológica e o efeito inverso foi observado com a imediata. A participação em grupos de adolescentes também apresentou relação com a maior assistência odontológica, bem como receber informação sobre saúde bucal. Este estudo revelou a presença de iniquidades na assistência odontológica ao longo da vida da população estudada.

Indicators for teenager's oral health's surveillance. / Proposição de indicadores para vigilância da saúde bucal de adolescentes.

The existence of a few indicators that could guide the evaluation of oral health surveillance in the primary health care attention, mainly in adolescence life cycle, raised the realization of this study. To develop indicators to this end, it was conducted: document analysis to guide the development of a logic model and selection of data to compose indicators. This selection and validation of the logic model were performed by a group of four experts that, from the perspective of the modified Delphi method, analyzed if the model illustrated the activities, results and expected impact of a primary oral health service to enable the adolescents oral health surveillance and assigned points (0-10) to each data proposed. Then, those data judged important by the consensus of experts (média≥7; standard deviation <3) were used to construct indicators. After individual analysis and group discussions, the logical model and 36 of the 48 data, initially proposed, were consensually important, resulting in 26 indicators. The indicators matrix intends to be a situational diagnostic tool to assess, plan and manage health actions to adolescents, but it can be used in other life cycles by its adaptation.

A existência de poucos indicadores que pudessem orientar a avaliação das ações de vigilância à saúde bucal da atenção básica em nível local, sobretudo no ciclo da adolescência, suscitou a realização deste estudo. Para desenvolver indicadores com este fim, procedeu-se: análise documental para guiar a elaboração de um modelo lógico e seleção de dados para compor indicadores. Esta seleção e validação do modelo realizaram-se por um grupo de quatro experts que, sob a ótica do método Delfos modificado, analisaram se o modelo ilustrava as atividades, os resultados e os impactos esperados de um serviço primário de saúde bucal para efetivar a vigilância da saúde do adolescente e atribuíram pontos (0-10) a cada dado proposto de modo que os consensualmente importantes (média ≥ 7; desvio-padrão < 3) orientassem a construção de indicadores. Após análise individual e discussões em grupo, o modelo lógico e 36 dos 48 dados inicialmente propostos foram consensualmente importantes, resultando em 26 indicadores. A matriz de indicadores pretende constituir-se em ferramenta de diagnóstico situacional para avaliar, planejar e gerenciar ações em saúde voltadas aos adolescentes, mas que com adaptação poderá englobar outros ciclos de vida.

PET-Health as inducer of professional education to Unified Health System. / PET-Saúde como indutor da formação profissional para o Sistema Único de Saúde.

PET-Health is configured as a program developed by health courses guided by the principle Unified Health System (SUS), with the preceptorship of a professional from health public service. The aim of the research was to compare the performance between PET-Health undergraduate of Dentistry, Medical and Nursing courses by the results of National Student Performance Exam (ENADE) in 2010 with those who did not participate in the program. The study population consisted of 49,758 students, which 761 participated in PET-Health. To analyze the performance of students in 2010 were considered the mean scores in general education, expertise skill and public health. Students who participated in PET-Health had superior performance in all means (55.48) when compared to those who did not (50.96). The shared investment between the Ministries of Health and Education in PET-Health, strategy involving students, professionals from public services and professor, contribute to the reorientation of health training, producing a great relationship between public health services and university.

The challenge of the approach to oral cancer in primary health care.

The aim of this study was to understand the performance of dentists in public health about mouth cancer. A cross-sectional study was performed whit 121 dentists from Fortaleza Health Department, interviewed through a semi-structured questionnaire. The study did not identify statistically significant difference regarding the ability to perform biopsy by gender, year of graduation, expertise or time of public service. Only 22 professionals (18.2%) reported being able to perform biopsies and 13 (10.7%) would do so at the Family Health Unit. The reference and counter-reference system, by including another stage in patient care, increase the possibility of absenteeism from patient to health service. Although clearly identify the relevance of oral cancer mortality in the population, the vast majority of dentists is not equipped to perform the biopsy as a routine activity. Whereas the vast majority of biopsies of the oral tissues is performed as an outpatient, low technological complexity to perform the procedure and the effectiveness of biopsy in the early diagnosis of oral cancer, it is essential to hold this procedure in primary care, what can effectively contribute to decreasing mortality from oral cancer.

Avanços e limitações das redes sociais como estratégia de comunicação no Sistema Único de Saúde: relatode experiências em Unidades deSaúde daFamília / Advancements and limitations of social networking as communicationstrategy in SUS: experience report in Family Health Units

As redes sociais podem representar importante papel na Atenção Básica do Sistema Único de Saúde no acesso e divulgação de informações. É objetivo desse estudo relatar as experiências desenvolvidas por estagiários e professores do curso de Odontologia da UFRNe preceptores das USF Panatise Parque das Dunas, Natal/RN. As atividades realizadas foram planejadas em disciplina anterior ao estágio e contaram com a participação desses mesmos atores. Considerando o contexto da pandemia da COVID-19, as atividades foram adaptadas para serem desenvolvidas em formato virtual. A partir do Instagram, WhatsApp e Google Meet foi possível divulgar informações sobre o funcionamento e ações desenvolvidas nas USF, criar posts informativos sobre saúde bucal, envolver gestantes em ações educativas, promover maior aproximação com a comunidade, criação de respostas automáticas às perguntas mais frequentes, entre outras atividades. As redes sociais são potente ferramenta na comunicação e divulgação em saúde, permitindo estabelecimento de vínculos, como mais uma via no acesso às informações e relação de diálogo permanente com a população, sinalizando possíveis avanços no controle social. O conhecimento prévio de estagiários e preceptores sobre as redes sociais viabilizou o desenvolvimento de ações que não fazem parte do contexto tradicional da formação em Odontologia, trazendo benefícios ao aprendizado de todos e avanços na relação das USF com a comunidade. É fundamental que o poder público viabilize infraestrutura e logística necessárias para a inclusão das redes sociais no processo de trabalho das equipes da Atenção Básica, incorporando-as como elemento de sua política de comunicação em saúde (AU).

Social networks can perform animportant role in Unified Health System (SUS)regarding access and dissemination of information. This study aims to report the experiencesdeveloped by interns and professors of UFRN's Dentistrycourse, and by preceptors of USF Panatis and USF Parque das Dunas, at Natal/RN. The activities were planned in a discipline previous to the internship, and the same actors participated in them. Considering the COVID-19 pandemic context, the activities were adapted into virtual format. From Instagram, WhatsApp, and Google Meet, it was possible to disseminate information on the functioning and actions developed at the USF, to create informative posts onoral health, to involve pregnant peoplein educational actions, to promote closeness with the community, to give automated responses to the most frequent questions, among other activities. Social networks are a powerful tool in communication and dissemination on health care, allowing links to be established asyetanother way of accessing information and keeping a permanent dialogue with the population, indicating possible advancements in social control. The priorknowledge that interns and preceptors had on social networking enabled the development of actions which are not part of the traditional context of dental training, so it benefited everyone's learning and allowed advancementsinthe relationship between the USF and the community. It is crucial for the government to enable the necessary infrastructure and logistics for the inclusion of social networking in the work process of Primary Careteams, incorporating it as element of its policy onhealth communication (AU).

Factors related to the dental caries incidence in youth: a cohort study in Brazilian Northeastern.

The conceptual model of the life course considers that health-disease is a dynamic process that is also affected by previous and current lifelong experiences. The aim of the study was to investigate the incidence of caries and its determinants in young people in Sobral-Ceará, Brazil. This was a cohort study of oral health started in 2000, with waves in 2006 and 2012. 482 young people aged 17-21 years were examined and interviewed. The incidence of caries between 2006 and 2012 was the outcome analyzed and the independent variables were socioeconomic conditions and use of oral health actions and services. The average incidence of caries was 2.95 teeth from the adolescence to the youth. It was found that social deprivation throughout life and deny access to the dentist during infancy implies a greater incidence of caries in youth, therefore, the use of services and oral health actions during the adolescence and youth have not been sufficient to reduce inequities in oral health.

Factors associated with malocclusion in youth in a municipality of Northeastern Brazil.

The aim of the study was to identify factors associated with severe malocclusion in young people in Sobral, Ceará, Northeastern Brazil. This is cross-sectional study nested in a cohort study with a sample of 569 young people aged from 17 - 21 years who participated in the survey on oral health. The rate of categorized dental aesthetics of Dental Aesthetic Index < 31 and Dental Aesthetic Index ≥ 31 was used. The independent variables were: data from the beginning of the cohort (socioeconomic conditions in childhood and exposure factors) and the last survey (sociodemographic data, use of dental services and self-perceived oral health). Poisson regression was performed to determine the best explanatory model of related factors. The prevalence of severe malocclusion was 20.0%. Private school was a protective factor, while the use of a pacifier for more than 36 months was a risk factor. Malocclusion was associated with all measures of self-perception and dental trauma. Socioeconomic factors in childhood stimulated prolonged use of harmful habits and these were risks for the components of Dental Aesthetic Index factors. Socioeconomic conditions were associated with occlusal condition of the youth.

Avanços e desafios da formação no Sistema Único de Saúde a partir da vivência dos docentes da área de Saúde Coletiva nos cursos de Odontologia / Advances and challenges of training in the Unified Health System based on teachers' experience in the area of Public Health in Dentistry courses

Resumo A formação direcionada para o Sistema Único de Saúde (SUS) tem sido um dos pressupostos mais desafiadores no desenvolvimento dos cursos de Odontologia no Brasil. Para isso, docentes com formação em saúde coletiva desempenham papel fundamental na proposição curricular que privilegie tal abordagem. O objetivo do estudo foi identificar em cursos de Odontologia os possíveis avanços alcançados e os desafios a serem enfrentados na formação para o SUS. Trata-se de uma pesquisa quantitativa, com desenho transversal, cuja amostra foi composta por 119 docentes por meio da técnica probabilística do Snowball. Os participantes responderam a uma matriz de critériosvalidada, sendo realizada a análise fatorial exploratória para análise dos dados, a qual definiu cinco fatores responsáveis pela formação para o SUS: Atenção Básica; Responsabilidade Social e Trabalho em Equipe; Gestão em Saúde; Sistemas de Informação e Educação Permanente/Humanização.O estudo permitiu identificar avanços significativos na perspectiva de uma maior adequação da proposta formativa voltada para o SUS, todavia, existem desafios colocados para os professores que exigem um amplo aprofundamento na perspectiva de enfrentar as barreiras ainda impostas pela tradicional formação na área da saúde.

Abstract The training directed at the Unified Health System (SUS) has been one of the most challenging assumptions in the development of Dentistry courses in Brazil. In this regard, public health educated teachers play a fundamental role in the curricular proposition favoring such an approach. This study aimed to identify the possible advances achieved in Dentistry courses and the challenges in training for the SUS. This is a quantitative, cross-sectional research with a sample of 119 teachers employing the probabilistic Snowball technique. Participants responded to a validated criteria matrix, and an exploratory factor analysis was performed for data analysis, which defined five factors responsible for training for the SUS: Primary Care; Social Responsibility and Teamwork; Health Management; Information Systems, and Continuing Education/Humanization. The study allowed identifying significant advances in the perspective of greater adequacy of the training proposal aimed at the SUS. However, some challenges to teachers require expanding the prospect to face the barriers still imposed by traditional health training.

Validation of the criteria matrix about the generalist's education in Dentistry Undergraduate Courses

Abstract The generalist training planned by Brazilian National Curriculum Guidelines for Dentistry undergraduate courses should provide actions for the development of health promotion in the field of public health, as well as disease prevention, diagnosis, planning, and dental treatment in the clinical field. Considering this complexity, the aim of the present study was to validate dimensions and sub-dimensions in dentistry training, allowing the identification of the main necessary competences and clinical skills for the generalist practice. For this, an evaluation study was carried out through the Delph's Method with the participation of 19 professors of Dentistry courses in Brazil working in the clinical area, considered "experts" in this theme. It was possible to identify clinical competences and skills in four dimensions and respective sub-dimensions: Transversal skills (biosafety, patient-team communication, humanization, ethical principles, dental documentation); Diagnosis and planning (diagnosis of dental caries, pulp and periapical changes, and periodontal diseases, clinical and imaging exam, and single treatment planning); Preventive activities (oral hygiene guidance and oral cancer prevention); and Dental care (anesthesia, basic oral surgery, drug prescription, subgingival scaling and root planing, dental restoration, minimally and non-invasive restoration treatment, and dental urgencies). The developed model represents a differentiated alternative for the construction of an innovative curriculum in Dentistry, aimed at the training of general practitioners to provide humanized, highly effective, and resolving care. The importance of clinical tutoring by professors on the essential clinical skills and abilities is highlighted in this study.

Admission of alumni from Multiprofessional Residency Programs into the SUS / Inserção de egressos de Programas de Residência Multiprofissional no SUS

ABSTRACT INTRODUCTION: The Multiprofessional Health Residency Programs (PRMS) were set up as a strategy for training workforce for the Brazilian Unified Health System (SUS). OBJECTIVE: To investigate the proportion of alumni from Primary Health Care Multiprofessional Residency Programs admitted into the SUS and associated factors. METHODS: This is a sectional study developed with alumni from Primary Health Care Multiprofessional Residency Programs from all over Brazil, encompassing the period from 2015 to 2019. Participants answered an online questionnaire with general personal information, admission into stricto sensu graduate school, the labor market and, specifically, the SUS. We applied Pearson's chi-square test for bivariate analyses and Poisson's regression for multiple analysis. RESULTS: A total of 365 alumni from Programs from all Brazilian regions participated in the study. Of those, 80.2% reported entry into the labor market and 47.9% reported being employed in the SUS. Admission into the SUS has been associated with the professions that make up the Reference Team for Primary Health Care (PHC) (PR = 1.87; 95% CI 1.54-2.28) and non-admission into stricto sensu graduate programs (PR = 0.77; 95% CI 0.61-0.97). Regarding admission characteristics, the PHC scenario (47.4%) and work focused on health care (84.9%) were prevalent. Almost 40% of alumni who entered the SUS are working with unstable contracts. Besides, being a residency alumnus is often undervalued in recruitment (56.9%). Among those admitted into the SUS, 8.7% reported being selected to work in the Covid-19 pandemic effort. CONCLUSIONS: The results of this study reinforce the need for a policy to encourage the maintenance, creation and valorization of the PRMS. They also warn about the possibility that admission into the SUS for workers is increasingly difficult due to the current underfunding of the health system.

RESUMO INTRODUÇÃO: Os Programas de Residência Multiprofissional em Saúde (PRMS) configuram-se como estratégia para a formação de força de trabalho para o Sistema Único de Saúde (SUS). OBJETIVO: Investigar a proporção de egressos de PRMS voltados à Atenção Primária à Saúde (APS) inseridos no SUS e fatores associados. MÉTODOS: Trata-se de um estudo seccional desenvolvido com egressos de PRMS voltados à APS de todo o Brasil, referente ao período de 2015 a 2019. Os participantes responderam a um questionário on-line com informações pessoais gerais, inserção na pós-graduação stricto sensu, no mercado de trabalho e especificamente no SUS. Foram aplicados o teste qui-quadrado de Pearson, para análises bivariadas, e Regressão de Poisson, para a análise múltipla. RESULTADOS: Participaram do estudo 365 egressos de Programas de todas as regiões brasileiras. Destes, 80,2% relataram inserção no mercado de trabalho e 47,9% informaram estar trabalhando no SUS. A inserção no SUS esteve associada às profissões que compõem a Equipe de Referência para a APS (RP = 1,87; IC95% 1,54-2,28) e à não inserção em programas de pós-graduação stricto sensu (RP = 0,77; IC95% 0,61-0,97). Quanto às características de inserção, prevaleceram o cenário da APS (47,4%) e o trabalho voltado à atenção à saúde (84,9%). Quase 40% dos egressos inseridos no SUS estão trabalhando por intermédio de vínculos instáveis, além de frequente não valorização do título da residência no recrutamento (56,9%). Entre os inseridos no SUS, 8,7% relataram terem sido selecionados para o enfrentamento da pandemia de covid-19. CONCLUSÕES: Os resultados deste estudo reforçaram a necessidade de política de incentivo à manutenção, criação e valorização dos PRMS e alertaram para possível aumento da dificuldade de inserção das categorias profissionais, frente ao cenário de desfinanciamento da saúde.

Contribution of cohort studies in the analysis of oral health in children and adolescents in Sobral, Ceará.

The main objective of this study was to identify the oral health status of the child population in a northeastern Brazilian municipality as a strategy to carry out subsequent longitudinal studies to investigate the main determinants of oral diseases in the specific age groups of teenagers and young adults. Epidemiological investigations and interviews were conducted in households by research teams. In the first study, a DMFT (decayed, missing, and filled teeth) score of 1.66 was found for 9-year-olds; although only 23% children aged between 5 and 6 years were caries-free, 32.7% had gingival bleeding and 9.5% were diagnosed with severe malocclusion problems. The second wave of the cohort indicated that the incidence of caries increased progressively according to age, from 1.60 in 12-year-old adolescents to 2.28 in those aged 15. Toothache in the past 6 months, maternal income and school meals, adjusted for the perception of need for treatment, maternal education, and dental visit at least once were the variables associated with high incidence of dental caries. Data collection for the third wave of the cohort is currently underway. Socioeconomic factors and access to health services were associated with the incidence of caries.

Pathways for graduation evaluation in Dentistry: logical model building and validation criteria.

The need for universal access to health care and the failure of the pedagogical model centered on only the transmission of knowledge has led to changes in the training of health professionals. The aim of this study was to provide a new alternative for evaluation of Dentistry courses based on the National Curriculum Guidelines (NCG) of the area. For this, a logical model was formulated on the need for training in the oral health pathway which allowed for the construction of a criteria matrix, validated by Delphi consensus technique and modified by the participation of 33 "experts." The matrix dimensions presented as a pedagogical approach the profile of graduates, the teaching-service integration and orientation of health care. The detailing of these dimensions into sub-dimensions and of measurable criteria allowed for deepening structural elements of the NCG unexplored in other studies evaluating undergraduate courses in Dentistry. The final instrument proposed in this study is differentiated alternative assessment training, for both dentists and other professionals, considering that the NCG of all healthcare courses provide for the training focused on the health needs of the population, integrated to Unified Health System (SUS) and based on student-centered learning.

Formação em Odontologia: desafios para o desenvolvimento docente e efetiva inclusão do Sistema Único de Saúde / Dentistry training: challenges for teacher development and effective inclusion in the Unified Health System

As dificuldades enfrentadas para a efetivação das Diretrizes Curriculares Nacionais dos cursos de graduação de Odontologia são reflexos da dificuldade de operar mudanças num sistema educacional que permaneceu por décadas refém do currículo mínimo e com resistência ideológica em aderir a propostas que se baseiem na produção do cuidado. Visando enfrentar essas dificuldades, o presente estudo buscou verificar a aplicabilidade de critérios de avaliação da formação em Odontologia com foco na formação voltada para o Sistema Único de Saúde (SUS) e na abordagem pedagógica. Realizou-se estudo documental dos Projetos Pedagógicos dos Cursos, aplicação de matriz de critérios e entrevista com os coordenadores de quatro cursos de Odontologia de instituições públicas e privadas. A percepção dos coordenadores configurou-se espaço privilegiado para reflexão sobre os avanços e limitações do projeto pedagógico, servindo como processo de autoavaliação sobre os principais desafios a serem enfrentados. É nítida a necessidade de nova regulamentação prevendo a obrigatoriedade de vínculo formal com o SUS, em especial no estágio curricular, assim como estratégias que contribuam efetivamente para o desenvolvimento docente permanente, viabilizando a construção de currículos integrados e incorporação efetiva de metodologias ativas de aprendizagem (AU).

The difficulties faced in implementing the National Curriculum Guidelines for undergraduate Dentistry courses are reflections of the difficulty of operating changes in an educational system that has remained hostage to the minimum curriculum for decades and with ideological resistance in adhering to proposals based on the production of care. To face these difficulties, the present study sought to verify the applicability of evaluation criteria for training in Dentistry with a focus on training focused on Brazil's Unified Health System and the pedagogical approach. A documentary study of the Pedagogical Projects of the Courses, application of a matrix of criteria, and an interview with the coordinators of four Dentistry courses from public and private institutions was carried out. The coordinators' perception became a privileged space for reflection on the advances and limitations of the pedagogical project, serving as a self-assessment process on the main challenges to be faced. There is a clear need for new regulations providing for the mandatory formal bond with SUS, especially in the curricular internship, as well as strategies that effectively contribute to the permanent teaching development, enabling the construction of integrated curricula and effective incorporation of active learning methodologies (AU).

Desafios à ampliação da cobertura da fluoretação da água em municípios brasileiros com mais de 50 mil habitantes na primeira metade do século XXI / Challenges to spreading water fluoridation coverage in Brazilian municipalities with 50 thousand inhabitants or more at first half of XXI century / Desafíos para el aumento de la cobertura de la fluoruración del agua en municipios brasileños com más de 50 mil habitantes en la primera mitad del siglo XXI

Embora a fluoretação da água de abastecimento público seja um importante determinante para explicar o declínio da cárie dentária nos países que implementaram sua provisão, é grande o desafio para assegurar sua expansão para todas as regiões e territórios. O objetivo do estudo foi determinar as características dos municípios brasileiros com mais de 50 mil habitantes correlacionadas com a cobertura da fluoretação da água. Estudo ecológico transversal com 614 municípios cujo desfecho é representado pela cobertura populacional da política pública e as variáveis independentes referem-se a indicadores municipais socioeconômicos, de saneamento e de serviços de atenção primária à saúde. As relações foram analisadas por meio de regressão linear múltipla. Na análise ajustada (R2=0,39), a cobertura populacional correlacionou-se positivamente com a renda familiar percapita e negativamente com desigualdade da renda, água e esgoto inadequados, cobertura potencial da saúde bucal na estratégia saúde da família. Nas regiões Sudeste, Sul e Centro-Oeste (R2=0,33), analfabetismo e nível de desenvolvimento humano mostraram correlação positiva, enquanto desigualdade de renda e saneamento inadequado apresentaram correlação negativa. Já nas regiões Norte e Nordeste (R2=0,40), saneamento inadequado e nível de desenvolvimento humano mostraram correlação negativa. As desigualdades na expansão dos serviços de saneamento e dos sistemas de vigilância da concentração do fluoreto entre as regiões brasileiras trazem importantes desafios nas próximas décadas que vão requerer sua inclusão na agenda regulatória dos respectivos setores e a implementação de mecanismos de coordenação intersetorial da política pública. (AU)

Although fluoridation of public water is an important determinant to explain the decline in dental caries in countries that have implemented it, the challenge to ensure its expansion to all regions and territories is great. The objective of this study was to determine the characteristics of Brazilian municipalities with more than 50,000 inhabitants correlated with water fluoridation coverage. Method: Cross-sectional ecological study encompassing Brazilian municipalities with more than 50,000 inhabitants in which the outcome is represented by population coverage of the public policy and the independent variables refer to municipal socioeconomic, sanitation and primary health care services indicators. Relations were analyzed by multiple linear regression. Results: 614 municipalities were analyzed. In the adjusted analysis (R2 = 0.39), population coverage correlated positively with per capita household income and negatively correlated with income inequality, inadequate water and sewage, potential oral health coverage in the family health strategy. While illiteracy and human development level showed positive correlation and income inequality and inadequate sanitation, negative correlation in the Southeast, South and Central West (R2 = 0.33) Brazilian regions; in the North and Northeast (R2 = 0.40) regions, inadequate sanitation and human development level showed a negative correlation. Inequalities in the expansion of sanitation services and fluoride concentration adjustment systems among Brazilian regions pose important challenges in the coming decades that will require their inclusion in the regulatory agenda of the corresponding sectors and the implementation of intersectoral coordination mechanisms for public policy. (AU)

Aunque la fluoruración del agua proveniente del abastecimiento público sea un determinante importante del declive de la prevalencia de caries en los países que han implementado su provisión, es grande el desafío para garantizar su expansión a todas las regiones y territorios. El objetivo de este estudio fue determinar las características de los municipios brasileños con más de 50.000 habitantes en relación con la cobertura de fluoruración del agua. Estudio ecológico transversal que abarcó 614 municipios. La variable dependiente es la población cubierta por la política pública y las variables independientes se refieren a los indicadores municipales socioeconómicos, de saneamiento y de servicios de atención primaria de salud. Las relaciones se analizaron utilizando una regresión lineal múltiple. En el análisis ajustado (R2 = 0,39), la cobertura de la población mostró una correlación positiva con el ingreso familiar per cápita y negativa con la insuficiencia de ingresos, la desigualdad de agua y alcantarillado, y la cobertura potencial de salud bucal en la estrategia de salud familiar. En las regiones Sureste, Sur y Centro Oeste (R2 = 0,33), el analfabetismo y el nivel de desarrollo humano mostraron una correlación positiva, mientras que la desigualdad de ingresos y el saneamiento inadecuado presentaron una correlación negativa. Por otro lado, las regiones Norte y Noreste (R2=0,40) mostraron una correlación negativa entre el saneamiento inadecuado y el nivel de desarrollo humano. Las desigualdades tanto en la expansión de los servicios de saneamiento cuanto en los sistemas de vigilancia de concentración de fluoruro entre las regiones brasileñas plantean retos importantes en las próximas décadas que requerirán su inclusión en la agenda reguladora de los sectores respectivos, así como la implementación de mecanismos de coordinación intersectorial de esa política pública. (AU)

Toothache and social and economic conditions among adolescents in Northeastern Brazil.

The scope of this study was to correlate toothache with social and economic conditions, access to oral health facilities and the lifestyle of adolescents in Sobral in the state of Ceará. It was conducted as a cross-sectional analytical study with a sample composed of 688 adolescents. The prevalence of toothache in the study group was 31.8%. A chi-square test of association was performed to measure the relationship between independent variables and toothache, estimating the prevalence ratio by Poisson regression. The factors that demonstrated the closest relationship with toothache were cavity severity, the reason for dental treatment being related to urgency, frequency of dental appointments and the distribution of toothbrushes at school. It was observed that the high prevalence of dental pain in adolescents is directly linked to the access conditions, as well as the characteristics of the actions developed by the health services. Just as there is a need for the deployment of services related to health promotion, based on equity and integration, it is necessary to introduce emergency services to intervene not just to curtail crippling pain, but also as a mechanism to stimulate the development of procedures for the prevention of oral diseases.