EVOLUTION OF POLICIES RELATED TO CHILD CARE WITHIN THE SCOPE OF PRIMARY HEALTH CARE (PHC) IN BRAZIL / EVOLUÇÃO DAS POLÍTICAS RELACIONADAS À SAÚDE DA CRIANÇA NO ÂMBITO DA ATENÇÃO PRIMÁRIA BRASILEIRA

Introdução: As políticas públicas são essenciais para reduzir a morbimortalidade infantil. Este estudo descreve a evolução das políticas relacionadas à atenção à criança no âmbito da Atenção Primária à Saúde (APS) no Brasil, implementadas desde a criação do Sistema Único de Saúde (SUS). Metodologia: Revisão narrativa da literatura com base nos principais marcos regulatórios com influência direta ou indireta na Atenção à Saúde da Criança (ACS) na APS, publicados entre 1990 e 2017. Resultados: Foram analisados ​​31 documentos oficiais, organizados em uma linha do tempo e classificados em três categorias: I) Normas do SUS e da APS; II) diretrizes para os serviços de saúde materno-infantil no âmbito da APS; e, III) políticas intersetoriais. Conclusão:A evolução das políticas de CSC no Brasil é marcada por uma série de conquistas em prol da ampliação dos direitos sociais e da garantia do direito à saúde que ampliou o acesso aos serviços de saúde e contribuiu para a melhoria das condições de vida e de vida das crianças. No entanto, as desigualdades sociais e os desafios no acesso e qualidade da atenção na APS são persistentes, com retrocessos causados ​​pela implementação de medidas de austeridade desde 2016.

Introdução: Políticas públicas são fundamentais para a redução da morbimortalidade na infância. O presente estudo descreve uma evolução política relacionada à Atenção Primária à Saúde da Criança no âmbito da Atenção Primária Saúde (APS) no Brasil, desde a criação do Sistema Único de Saúde (SUS). Metodologia: Revisão narrativa da literatura com base nos principais marcos normativos com influência na Atenção à Saúde da Criança no âmbito da APS, publicados entre 1990 e 2017. Resultados: Foram analisados 31 documentos oficiais, distribuídos numa linha do tempo, classificados em: I) normatização do SUS e da APS; II) orientação aos serviços de saúde materno-infantil no âmbito da APS e III) políticas intersetoriais. Conclusão: A evolução das políticas pensadas no Brasil está marcada para serviços e como soluções da série de direitos sociais e como possibilidades de vistas da vida. Porém, além das desigualdades sociais, desafios no acesso e na qualidade do cuidado na APS se fazem persistentes, com retrocessos são persistentes agravados com a capacidade de trabalhar1 em medidas de austeridade curso desde 206.

Brazilian Primary and Secondary Public Oral Health Attention: Are Dentists Ready to Face the COVID-19 Pandemic?

OBJECTIVE: To investigate knowledge and practice of Brazilian public primary and secondary health care dentists during the coronavirus disease (COVID-19) pandemic. METHODS: An online questionnaire with sociodemographic and COVID-19 knowledge questions was used. RESULTS: A total of 4048 dentists working in the Brazilian public primary and secondary health care system were investigated; 4024 (99.41%) believe that COVID-19 can be transmitted through dental procedures. A fair level of COVID-19 symptoms knowledge by these dentists was observed (3.76±1.27 of 6.00), as well as the skepticism in personal protective equipment (3382; 83.55%) and biosafety procedures (3278; 80.98%) used as an efficient form of COVID-19 transmission prevention. Country region, performance of social distancing, dental specialty, the use of personal protective equipment, and biosafety preventive measures influenced the likelihood of dentists to perform dental treatment, either elective or urgent, during the COVID-19 pandemic. CONCLUSION: The need of extra preventive barriers for dental treatment may bring an extra financial stress in the Brazilian public primary and secondary health care system, as well as in the patient-dentist relationship, which may have to be reframed. Internationally accepted public guideline policies regarding dental treatment safety, as well as the technological development of preventive tools, are needed to deal with the challenges brought by COVID-19.

Variation in primary health care services after implementation of quality improvement policy in Brazil.

BACKGROUND: Brazil is the most populous country with a public, universal and free health care system. The National Program for Access and Quality Improvement in Primary Care (PMAQ) was created to improve the quality of primary health care (PHC). OBJECTIVE: To evaluated whether progress generally has been made within Brazil's PHC since PMAQ implementation, and if changes occurred uniformly in the country, while also identifying municipal characteristics that may have influenced the improvement. METHODS: This is an observational study using data from PMAQ external evaluation (2012 and 2014), a 1200-item survey used to evaluate Brazilian PHC quality. After confirming the groupings of items using factor analysis, we created 23 composed indexes (CIs) related to infrastructure and work process. RESULTS: On average, the large majority of CIs showed improvements between 2012 and 2014. Region and city size moderated changes in the PHC indices differently. Overall, there were better improvements in infrastructure in the Northeast compared with other country regions, and in smaller cities (10 000-20 000 people). Infrastructure indices appear to have improved equitably across the country. Work process improvements varied with city size and region. CONCLUSION: Despite similar support of PMAQ across the country, improvements are not predictable nor homogeneous. Non-uniform improvements were seen in Brazil's PHC. Though we do not directly evaluate the effectiveness of the PMAQ (financial reward) method, these initial findings suggest that it is a potentially useful tool to improve health systems, but additional support may be needed in regions that lag behind in quality improvements.

The association of the Bolsa Familia Program with children's oral health in Brazil.

BACKGROUND: Several studies have demonstrated that Conditional Cash Transfer (CCT) programs reduce poverty/inequity and childhood mortality. However, none of these studies investigated the link between CCT programs and children's oral health. This study examines the association between receiving the Brazilian conditional cash transfer, Bolsa Familia Program (BFP), and the oral health of five-year-old children in the Northeast of Brazil. METHODS: We conducted a cross-sectional study with 230 caregivers/children randomly selected in primary health care clinics in the city of Fortaleza in 2016. Interviews and oral health examinations were performed. Descriptive statistics and multiple logistic regression analyses were conducted to identify factors associated with dental caries among five-year-old children enrolled in the BFP. RESULTS: Around 40% of children enrolled in the BFP had dental caries. However, those who received Bolsa Familia (BF) for a period up to two years (OR = 0.13, 95% CI 0.05-0.35) had substantially lower adjusted odds of having dental caries than those who had never received BF. In addition, the association of BF and dental caries was more prominent among extremely poor families (OR = 0.05, 95% CI 0.01-0.28). CONCLUSIONS: Although initial enrolment in the BFP predicted low dental caries among five-year-old children, the prevalence of dental caries in this population is still high, thus, public health programs should target BF children's oral health. An ongoing effort should be made to reduce oral health inequalities among children in Brazil.