Orthodontics in the oral health care network of the Unified Health System (SUS).

This observational study aimed to describe and analyze data from two external evaluations of the National Program for Improving Access to and Quality of Dental Specialty Centers (PMAQ CEO), held in 2014 and 2018 in Brazil, which evaluated Dental Specialty Centers (CEO) using a national and census approach. We selected questions through a search in the microdata of the first and second evaluations. The groups were analyzed independently. To compare the groups, nonparametric tests were performed (Mann Whitney U). The formulated hypotheses were: there would be no differences between the data of these groups (h0) and there would be differences between the data of these groups (h1). For qualitative nominal variables, frequency distribution was verified and association tests were performed (chi-square test). The significance level for this study was set at 5%. We observed that orthodontic treatments were found in about 13% of the CEO. Regarding human resources, most professionals were specialists or had MSc or PhD degrees; were civil servants; had been hired by direct administration; or had been hired via public tender. Regarding the work process and inclusion of the CEO in the health care network, we observed a greater number of services that use single and electronic medical records, greater presence of services monitoring and analyzing goals, greater knowledge about monthly average of absenteeism (for 2018); and larger number of services with referrals from primary health care centers (for 2014). Expanding the view on orthodontics and including preventive, interceptive, and corrective treatments at different points in health care networks are essential strategies for achieving comprehensive care in universal health systems.

Orthodontics in the oral health care network of the Unified Health System (SUS)

Abstract This observational study aimed to describe and analyze data from two external evaluations of the National Program for Improving Access to and Quality of Dental Specialty Centers (PMAQ CEO), held in 2014 and 2018 in Brazil, which evaluated Dental Specialty Centers (CEO) using a national and census approach. We selected questions through a search in the microdata of the first and second evaluations. The groups were analyzed independently. To compare the groups, nonparametric tests were performed (Mann Whitney U). The formulated hypotheses were: there would be no differences between the data of these groups (h0) and there would be differences between the data of these groups (h1). For qualitative nominal variables, frequency distribution was verified and association tests were performed (chi-square test). The significance level for this study was set at 5%. We observed that orthodontic treatments were found in about 13% of the CEO. Regarding human resources, most professionals were specialists or had MSc or PhD degrees; were civil servants; had been hired by direct administration; or had been hired via public tender. Regarding the work process and inclusion of the CEO in the health care network, we observed a greater number of services that use single and electronic medical records, greater presence of services monitoring and analyzing goals, greater knowledge about monthly average of absenteeism (for 2018); and larger number of services with referrals from primary health care centers (for 2014). Expanding the view on orthodontics and including preventive, interceptive, and corrective treatments at different points in health care networks are essential strategies for achieving comprehensive care in universal health systems.

Análise das urgências odontológicas durante a pandemia da covid-19 / Analysis of dental emergencies during the COVID-19 pandemic

Aim: to analyze, between 2019-2021, the quantitative changes in dental emergencies (DE) in Brazil and its regions. Materials and Methods: Data collected in the Primary Care Health Information System (SISAB) from 2019 to 2021. The DE represented by dentoalveolar abscess (DAA) and toothache (TA). 2019 was the control (non-pandemic), and 2020-21 the exposure year. Durbin-Conover's Friedman and Post-Hoc tests used a significance level of 5%. The data's organization used the percentage difference to facilitate analysis. Results: For Brazil in 2021, the percentage difference with 2019 suggests that DAA (-2.16%, p=1.0) and TA (+14.94%, p=0.064) returned to values after fall of 2020. The South region, in 2020, had no decrease in DAA (-5.48%, p=0.436) and TA (+3.7%, p<0.001) in 2020, and an increase in both in 2021 (DAA: +26.86%, p<0.001; TA: +51.06%, p<0.001). Discussion: In 2021, in Brazil, limited elective access and resumption of DAA and increase in TA suggest worsening the oral health and quality of life. The DAA and TA results in the South region do not provide plausible evidence to understand the unchanged values in 2020 and the considerable increase in 2021. Conclusion: Regardless of the pandemic, elective access still struggles to offer universal acessing, equitable, and the need of investments are essentials to prevent public services from becoming just gateways for relieving pain and suffering.

Objetivo: analisar, entre 2019-2021, as alterações quantitativas nas urgências odontológicas (UO) no Brasil e suas regiões. Materiais e Métodos: Dados coletados no Sistema de Informação em Saúde da Atenção Básica (SISAB) no período de 2019 a 2021. A representação das UO foi pelo abscesso dento-alveolar (ADA) e dor de dente (DD). O ano de 2019 foi o ano de controle (não pandêmico) e 2020-21 os de exposição. Os testes Friedman e Post-Hoc de Durbin-Conover utilizaram nível de significância de 5%. Os dados foram organizados pela diferença percentual para facilitar a análise. Resultados: Para o Brasil em 2021, a diferença percentual com 2019 sugerem que o ADA (-2,16%, p=1,0) e a DD (+14,94%, p=0,064) retomaram os valores, após a queda de 2020. A região Sul, em 2020, não teve queda em ADA (-5,48%, p=0,436) e DD (+3,7%, p<0,001) em 2020, e aumento em ambos em 2021 (ADA: +26,86%, p<0,001; DD: +51,06%, p<0,001). Discussão: Em 2021, no Brasil, o limitado acesso eletivo e a retomada da ADA e aumento da DD sugerem piora na saúde bucal e na qualidade de vida. Os resultados de ADA e DD na região Sul não apresentam evidências plausíveis para compreender a inalteração de valores em 2020 e o considerável aumento em 2021. Conclusão: Independentemente a pandemia, o acesso eletivo ainda luta para ser universal, equânime e os investimentos precisam ser retomados para evitar que os serviços públicos se tornem em apenas portas de entrada de alívio dor e sofrimento.

Oral health policies and decision-making process in Brazil, Colombia and Chile.

Public health policies are crucial for the well-being of the general population; however, the health systems of developed countries still do not include oral health in its system. Thus, it is necessary to understand the process of decision-making in oral health policies to create opportunities for countries to achieve an overall positive health outcome, including oral health. This study aimed to identify the factors influencing the inclusion of oral health on the political agenda in Brazil, Colombia, and Chile. The study sample involved decision-makers at political, technical, and academic levels. The extracted data were analyzed using the software Maxqda® and Kingdon´s theoretical model; defining interactive variables that produce a "window of opportunity" to define the agenda and the insertion of theme in formulating public policies. The decision-making process regarding oral health is influenced by many factors like the need to improve the overall oral health of the population, identified through national epidemiological studies, and the importance of individuals in positions involving political decision-making, who advocate for oral health. Strategies were developed in partnership with the academy that focused on the health rights of the population provided by law; territorial and national programs were also developed. The inclusion and creation of oral health policies depend on actors who advocate for thematic and scientific evidence to support decision-making. A close relationship between academia and stakeholders and knowledge translation is important for the development of public policies that can be effective for health systems.

Geographic Distribution of Brazilian Dentists: Motivation and Perception for Migration / Distribuição Geográfica dos Dentistas Brasileiros: Motivação e Percepção para a Migração

The Human Resources for Health (HRH) are considered as being crucial for the organization of the health systems and for the population health conditions; in this context, the purpose of this work is 1) to identify the current geographic distribution situation of Brazilian dentists, 2) to identify and analyze the perception and motivations of Brazilian dentists who migrated to the interior of the country. A case study approach was used and the data were collected from different sources (Federal Council of Dentistry, Health Graduation Indicators System, Geocapes, Brazilian National Institute of Geography and Statistics) using the mixed method, from the quantitative-qualitative exploratory sequential model, the qualitative phase was analyzed by using the "grounded theory" approach. The findings point out that the county has a great stock of dentists and that it significantly increased in recent years; however, it is poorly distributed over the territory, particularly when the differences between the interior and the capitals of the country are analyzed. The main category of the grounded theory was "The opportunities changing the ways to consolidate the professional"; the interviews point out that the dentists' place of birth and the opportunities over their professional career were crucial to determine the distribution of dentists throughout the Brazilian territory. It's concluded that Brazil has a dentistry workforce stock; however, it faces the results of the lack of HRH regulation policies which include dentistry. Such reality enhances the health gaps in some country regions and market saturation in major urban centers.(AU)

Os Recursos Humanos em Saúde (RHS) são considerados fundamentais para a organização dos sistemas de saúde e para as condições de saúde de uma população, nesse contexto o objetivo desse trabalho é 1) identificar a situação atual da distribuição geográfica de dentistas brasileiros 2) identificar e analisar a percepção e motivações de dentistas brasileiros que migraram para o interior do país. Foi utilizada a abordagem de estudo de caso e os dados foram coletados a partir de diferentes fontes (Conselho Federal de Odontologia, Sistema de Indicadores das Graduações em Saúde, Geocapes, Instituto Brasileiro de Geografia e Estatística), utilizando o método misto, a partir do modelo exploratório sequencial quantitativo-qualitativo, a fase qualitativa foi analisada por meio da abordagem da "teoria fundamentada". Os achados apontam que o país apresenta um grande estoque de dentista, e que houve uma grande expansão nos últimos anos, no entanto este apresenta-se mal distribuídos pelo território, principalmente quando analisado as diferenças entre o interior e as capitais do país. A categoria central da teoria fundamentada foi "As oportunidades mudando os caminhos para consolidar o profissional", as entrevistas apontam que o local de nascimento dos dentistas e as oportunidades durante sua trajetória profissional foram decisivas para determinar a distribuição de dentistas no território brasileiro. Conclui-se, que o Brasil apresenta estoque de força de trabalho em odontologia, porém enfrenta os resultados da falta de políticas de regulação de RHS, que inclua a odontologia. Essa realidade acentua os vazios sanitários em algumas regiões do país e saturação do mercado nos grandes centros.(AU)

Odontologia do Trabalho: o estado da arte, indicando trilhas para a promoção da saúde em contextos contemporâneos de labor - revisão de escopo / Occupational Dentistry: the state of the art, indicating paths for health promotion in contemporary work contexts - scoping review

Resumo O campo da Odontologia do Trabalho tem considerado lastro teórico-científico. Esta revisão de escopo objetiva desvelar o estado da arte acerca do tema em sete bases de pesquisas indexadas, considerando quase 100 anos de publicações (1921-2020). Das 337 produções inicialmente identificadas, realizou-se recorte para os últimos seis anos (2015-2021/janeiro), aplicando-se metodologia proposta pela extensão do Prisma para revisões de escopo (Prisma-ScR). Contudo, plataformas de revisões rápidas usadas para tomada de decisões em formulações de políticas públicas ou em aperfeiçoamentos de sistemas de saúde responderam por apenas 20 publicações, enquanto a amostra de 34 produções revelou peculiaridades: pesquisas privilegiam regimes de trabalho; associam o campo de estudo e prática ao modelo stricto sensu da saúde ocupacional; desconsideram concepções amplas e humanizantes do campo da Saúde do Trabalhador; tendem a priorizar a própria saúde ocupacional odontológica e parecem reduzir o conceito do acidente de trabalho a doenças. Tais questões precisam ser superadas se a perspectiva for manter-se em vanguarda, promovendo saúd e e segurança em contextos contemporâneos de trabalho, pois, embora seja evidente a transversalidade desse campo de saberes e práticas, é necessário mais, é preciso ousar para retirá-la da invisibilidade, seja em organizações privadas ou públicas de trabalho.

Abstract The field of Occupational Dentistry has considered theoretical-scientific ballast. This scoping review aims to reveal the state of the art on the subject in seven indexed research bases, considering almost 100 years of publications (1921-2020). Of the 337 productions initially identified, a cut was made for the last six years (2015-2021/January), applying the methodology proposed by the PRISMA extension for scope reviews (PRISMA-ScR). However, rapid review platforms used for decision making in formulating public policies or in improving health systems accounted for only 20 publications, whereas the sample of 34 productions revealed peculiarities: research favors work regimes; associates the field of study and practice with the stricto sensu model of occupational health; disregards broad and humanizing concepts in the field of Worker's Health; tends to prioritize its own occupational dental health, and seems to reduce the concept of work accidents to illnesses. Such issues need to be overcome if the perspective is to remain at the forefront, promoting health and safety in contemporary work contexts, since, although the transversality of this field of knowledge and practices is evident, more is needed, daring to remove it from invisibility whether in private or public work organizations is necessary.

Oral health policies and decision-making process in Brazil, Colombia and Chile

Abstract Public health policies are crucial for the well-being of the general population; however, the health systems of developed countries still do not include oral health in its system. Thus, it is necessary to understand the process of decision-making in oral health policies to create opportunities for countries to achieve an overall positive health outcome, including oral health. This study aimed to identify the factors influencing the inclusion of oral health on the political agenda in Brazil, Colombia, and Chile. The study sample involved decision-makers at political, technical, and academic levels. The extracted data were analyzed using the software Maxqda® and Kingdon´s theoretical model; defining interactive variables that produce a "window of opportunity" to define the agenda and the insertion of theme in formulating public policies. The decision-making process regarding oral health is influenced by many factors like the need to improve the overall oral health of the population, identified through national epidemiological studies, and the importance of individuals in positions involving political decision-making, who advocate for oral health. Strategies were developed in partnership with the academy that focused on the health rights of the population provided by law; territorial and national programs were also developed. The inclusion and creation of oral health policies depend on actors who advocate for thematic and scientific evidence to support decision-making. A close relationship between academia and stakeholders and knowledge translation is important for the development of public policies that can be effective for health systems.

Response to college students' mental health needs: a rapid review.

OBJECTIVE: To present strategic options to support the adoption of mental health strengthening policies for university students in the field of health, to be implemented by university institutions. METHODS: Rapid review, without period delimitation, with searches carried out from May to June 2020, in 21 sources of bibliographic data, including gray literature. The following keywords were used: mental health, students and university. The selection process prioritized systematic reviews of mental health interventions for university students in health care courses, and also considered other types of review and relevant primary studies. RESULTS: Forty-five studies were included: 34 systematic reviews, an evidence synthesis, an overview, a scope review, three narrative reviews, three experience reports and two opinion articles. The evidence from these studies supported the development of four options: 1) to establish and support policies to strengthen the mental health of students in health care courses; 2) to integrate mental health care programs, expand their offer and facilitate access by students; 3) to promote educational programs and communication strategies related to contemporary psychic suffering and its confrontation, so that students can get to know the services and resources and identify strengthening practices; 4) to continuously monitor and assess the mental health needs of students in health care courses. CONCLUSIONS: The options are challenging and require universities to establish institutional commissions to implement a policy to strengthen the mental health of university students in the health area, with the ability to recognize the different health needs, including manifestations of psychic suffering ; to integrate the university's internal actions with each other and with the services of the Unified Health System; to implement and monitor the actions that make up the mental health policy.

Diálogo deliberativo sobre ações para enfrentamento do sofrimento psíquico de universitários / Deliberative dialogue on coping with the psychological distress of university students

Diálogo Deliberativo (DD) ou diálogo de políticas é um recurso utilizado para propiciar o compartilhamento de saberes e experiências entre pesquisadores, formuladores de política e de- mais interessados sobre uma temática a ser discutida. É uma reunião que tem como objetivo revisar o conteúdo de uma síntese de evidências, articular as evidências científicas com as experiências dos participantes para melhor esclarecimento sobre as opções para abordar o problema, esclarecer as áreas de incerteza e desenvolver um entendimento comum sobre os prós e contras das estratégias de implementação relevantes para apoiar a tomada de decisão de gestores. Este DD foi organizado pelo Departamento de Enfermagem em Saúde Coletiva, da Escola de Enfermagem da Universidade de São Paulo e realizado em 8 de outubro de 2021, por meio de ambiente virtual. O foco do DD foi a "Síntese rápida para o enfrentamento do sofrimento psíquico de universitários: é tempo de uma política".

Deliberative Dialogue (DD) or policy dialogue is a resource used to facilitate the sharing of knowledge and experiences between researchers, policy makers and other stakeholders on a topic to be discussed. It is a meeting that aims to review the content of a synthesis of evidence, articulate the scientific evidence with the experiences of the participants to better clarify the options to address the problem, clarify the areas of uncertainty and develop a common understanding about the pros and cons of relevant implementation strategies to support managers' decision making. This DD was organized by the Department of Nursing in Collective Health, of the School of Nursing at the University of São Paulo and carried out on October 8, 2021, through a virtual environment. The focus of the DD was the "Síntese rápida para o enfrentamento do sofrimento psíquico de universi- tários: é tempo de uma política".

O processo de trabalho em saúde bucal coletiva em tempos de pandemia: a contribuição da teleducação com a teleodontologia / The work process in collective oral health in times of a pandemic: the contribution of tele-education with teledentistry

A pandemia da COVID-19 impôs ações assertivas em todos os níveis da sociedade. Aqui se relata o apoio emergencial na Resposta Rápida do Núcleo de Evidências e Análises Econômicas da Faculdade de Odontologia da Universidade de São Paulo (EvipOralHealth) para a coordenadoria estadual de saúde bucal de São Paulo, em prol da tomada de decisão e ressignificação do processo de trabalho. Foram implementadas duas estratégias de teleodontologia para a educação permanente (EP) dos trabalhadores de saúde bucal: 1. Lives com pesquisadores, estudantes, gestores e trabalhadores das diversas áreas da saúde pública e da Odontologia para estabelecer marcos teóricos; 2. Ambulatórios virtuais - via webconferência. Reuniu-se gestores e trabalhadores para a condução de diálogos de políticas sobre o dia a dia do enfrentamento e de adaptações e condições de trabalho de cada região. A experiência revela a importância da relação ensino-serviço-comunidade efetiva, pautada na tradução do conhecimento e na construção de espaços de troca possibilitando a implementação de práticas, programas e políticas. Precisamos repensar as estratégias de EP, sermos mais ágeis, mais flexíveis, menos acadêmicos e capazes de adaptar conteúdos e formatos às necessidades. A teleodontologia e a teleducação podem conferir escala e fazer chegar mais facilmente o conhecimento aos que necessitam.

Smoking Cessation therapy is a cost-effective intervention to avoid tooth loss in Brazilian subjects with periodontitis: an economic evaluation.

BACKGROUND: Smokers present a higher prevalence and severity of periodontitis and, consequently, higher prevalence of tooth loss. Smoking cessation improves the response to periodontal treatment and reduces tooth loss. So, the aim of this study was to evaluate the efficiency in resources allocation when implementing smoking cessation therapy vs. its non-implementation in smokers with periodontitis. METHODS: We adopted the Brazilian public system perspective to determine the incremental cost-effectiveness (cost per tooth loss avoided) and cost-utility (cost per oral-related quality-adjusted life-year ([QALY] gained) of implementing smoking cessation therapy. Base-case was defined as a 48 years-old male subject and horizon of 30 years. Effects and costs were combined in a decision analytic modeling framework to permit a quantitative approach aiming to estimate the value of the consequences of smoking cessation therapy adjusted for their probability of occurrence. Markov models were carried over annual cycles. Sensitivity analysis tested methodological assumptions. RESULTS: Implementing the therapy saved approximately US$ 100 over the time horizon accompanied by a slightly better effect, both in CEA and CUA. Considering uncertainties, the therapy could be cost-effective in the most part of simulated cases, even being cheaper and more effective in 35% of cases in which the oral-health related outcome is used as effect. Considering a willingness-to-pay of US$100 per health effect, smoking cessation therapy was cost-effective, respectively, in 72% and 99% of cases in cost-utility and cost-effectiveness analyses. CONCLUSIONS: Implementation of smoking cessation therapy may be cost-effective, considering the avoidance of tooth loss and oral health-related consequences to patients.

Processo de mentoring: análise da percepção do estudante da disciplina de Gestão e Planejamento em Odontologia da FOUSP / Mentoring process: analysis of students' perception of the discipline of Management and Planning in Dentistry at FOUSP

O objetivo da presente pesquisa foi analisar a percepção dosestudantesde graduação do último ano do Curso de Odontologia da Faculdade de Odontologia da Universidade de São Paulo (FOUSP) em relação ao processo de mentoring. A amostra foi de 122 estudantes que estavam matriculados na disciplina de Gestão e Planejamento daFOUSP, os quais foram divididos em grupos de 8 integrantese, durante o semestre, as reuniões de tutoria eram realizadas pelos pós-graduandos, para debater questões pessoais e profissionais. Ao final do semestre os estudantes responderam a um questionário sobreoprocesso dementoringrealizado e a respeito de pontos positivos e negativos da disciplina. O treinamento dos tutores foi realizado no semestre anterior, juntamente com um estudo piloto com 20 graduandos. Foi realizada uma análise de correspondência para a avaliação da disciplina com o mentoringe uma análisequantitativa textual por meio do softwareIramuteq para avaliação das respostas da questão aberta. Dos estudantes incluídos, 96,7% participaram da pesquisa.Quanto àavaliação da disciplina, 55,1% dos respondentes aconsideraram boa e 33,9%como ótima. Em relação ao processo de mentoring, 62,7% consideraram ótimo e 32,2% bom. Quando questionados quais eram os pontos positivos da disciplina, 48,3% dos estudantes destacaram a tutoria. Ao verificar a coocorrência e conectividade das palavras, foi constatada uma forte relação entre os termos reunião, grupo, aluno e futuro. Diante disso, é possível concluir que a percepção do aluno de graduação é positiva em relação ao processo de mentoring, no qual além de ser um processo de instrução, serve também de apoio para o aluno do último ano (AU).

This study aimed to analyze the perception of graduate students in the last year of the Dentistry Course at the University of São Paulo School of Dentistry (FOUSP) ofthe mentoring process implemented in the discipline of Management and Planning. The sample comprised 122 students enrolled in the Management and Planning discipline at FOUSP. During mentoring, students were divided into groups of eight members, and tutoring meetings were held by post-graduate students to discuss personal and professional issues. At the end of the semester, students answered a questionnaire about the mentoring process and the positive and negative aspects of the discipline. Tutors were trained in the previous semesteralongsidea pilot study with 20 graduate students. A correspondence analysis was conducted to evaluate the discipline, and a quantitative textual analysis using the Iramuteq software was used to assess the responsesto the open questions. Approximately 97% of the students participated in the survey. The majority rated the discipline as good (55.1%) and excellent (33.9%). Regarding the mentoring process, 62.7% considered the activities excellent and 32.2% good. When asked about the strengths of the discipline, 48.3% of students highlighted tutoring. When verifying the co-occurrence and connectivity of the words, a strong relationship was found between the terms "meeting," "group," "student," and "future." Thus, graduate students' perception ofthe mentoring processis positive, which in addition to being aninstructional process,also serves as support for the final year at the university (AU).

Brazilian Oral health teams in primary care and oral cancer: Results of a national evaluation.

Oral cancer is one of the most prevalent cancers in Brazil. An understanding of how public policies are implemented to address this problem can contribute to the construction of solutions. The "Programa de Melhoria do Acesso e da Qualidade" (PMAQ-AB and PMAQ-CEO) at the level of primary and secondary care are evaluations that also collect data on prevention and monitoring strategies for oral cancer. This study aimed to analyze the results of the incorporation of oral health teams to evaluate the strategies adopted by Brazil regarding the impact on the diagnosis of oral cancer. Of the 17,202 family health teams evaluated, 72.10% had oral health teams (OHT). Considering the strategies for prevention, screening, campaign, and follow-up of suspected cases, 72.27% of the campaign teams and 59.09% of the teams who accompanied suspected cases had OHT. In secondary care, more than 65% of the teams in the Southeast and South regions registered cases of oral cancer, and the referral network was more represented. The inclusion of OHT had a positive impact on campaign actions, follow-up, referral to specialists, and registration of suspected cases throughout Brazil.

Sedentary behavior, unhealthy food consumption and dental caries in 12-year-old schoolchildren: a population-based study.

This study analyzed the association between sedentary behavior (SB), unhealthy food consumption, and dental caries amongst 12-year-old schoolchildren. An epidemiological survey was carried out in the five largest cities (> 80,000 inhabitants) of the State of Mato Grosso do Sul, Brazil. Data were collected on decayed, missing and filled teeth index (DMFT), sociodemographic characteristics, SB, unhealthy food consumption, and water fluoridation status. The analysis was based on the theoretical framework established by J Sisson. Structural equation models were performed to test the association of dental caries experience with sociodemographic, contextual, and behavioral factors. The mean DMFT index in the five cities was 1.02 (95%CI: 0.39-1.66). Higher sedentary behavior (more than 2 hours/day) [standardized coefficient (SC) = 0.21 95%CI: 0.07-0.39] and higher unhealthy food consumption (more than 4 times/week) [SC = 0.23 (0.10-0.45)] were associated with higher DMFT index than their counterparts. Also, cities with fluoridated water were associated with lower DMFT index [SC = -0.85 (-1.20--0.50)]. Families who had a per capita income above the poverty line had a direct association with unhealthy food consumption [SC = -0.24 (-0.38--0.11)]. Unhealthy food consumption mediated the association of sedentary behavior on DMFT index [SC=0.07 (0.02-0.13)]. Sensitivity analysis confirmed the findings. Sedentary behavior mediated by unhealthy food consumption had a significant association with dental caries experience. Public policies must address transdisciplinary actions to reduce sedentary behavior and unhealthy food consumption and promote water fluoridation.

Diagnosis of mucosal changes and hospitalized oral cancer patients in Brazil: influence of socioeconomic factors.

This study aimed to analyze the influence of socioeconomic factors on the frequency of diagnoses of oral mucosal changes and the number of hospitalized patients with oral and oropharyngeal cancer in Brazil. This cross-sectional study analyzed data from all Brazilian cities in the period 2011-2017. The frequency of diagnoses of oral mucosal changes and the number of hospitalized patients of oral and oropharyngeal cancer in Brazil were extracted from the Primary Care Information System (SIAB) and Brazilian National Cancer Institute (INCA) databases. The socioeconomic factors evaluated were the Gini coefficient of inequality, municipal Human Development Index (MHDI), inadequate basic sanitation rate, employment rate, illiteracy rate and expected years of schooling. Associated factors were examined using bivariate Spearman's correlations and multivariate Poisson regressions, and statistically significant (p < 0.05) correlations between study variables and regression coefficients were obtained. A higher frequency of diagnoses of mucosal changes was observed in cities with a higher Gini coefficient (B = 11.614; p < 0.001), higher MHDI (B = 11.298; p < 0.001), and higher number of hospitalized patients with oral and oropharyngeal cancer (B = 0.001, p < 0.002). Cities with higher Gini coefficients (B = 8.159, p < 0.001), higher inadequate basic sanitation rates (B = 0.09, p = 0.001), lower expected years of schooling (B = -0.718, p < 0.001), and higher illiteracy rates (B = 0.191, p < 0.001) had a higher frequency of hospitalized patients with oral and oropharyngeal cancer. In conclusion, more developed cities showed a higher frequency of diagnoses of mucosal changes. Greater inequality and worse socioeconomic conditions are associated with a higher frequency of hospitalized patients with oral and oropharyngeal cancer in Brazil.

Diagnosis of mucosal changes and hospitalized oral cancer patients in Brazil: influence of socioeconomic factors

Abstract This study aimed to analyze the influence of socioeconomic factors on the frequency of diagnoses of oral mucosal changes and the number of hospitalized patients with oral and oropharyngeal cancer in Brazil. This cross-sectional study analyzed data from all Brazilian cities in the period 2011-2017. The frequency of diagnoses of oral mucosal changes and the number of hospitalized patients of oral and oropharyngeal cancer in Brazil were extracted from the Primary Care Information System (SIAB) and Brazilian National Cancer Institute (INCA) databases. The socioeconomic factors evaluated were the Gini coefficient of inequality, municipal Human Development Index (MHDI), inadequate basic sanitation rate, employment rate, illiteracy rate and expected years of schooling. Associated factors were examined using bivariate Spearman's correlations and multivariate Poisson regressions, and statistically significant (p < 0.05) correlations between study variables and regression coefficients were obtained. A higher frequency of diagnoses of mucosal changes was observed in cities with a higher Gini coefficient (B = 11.614; p < 0.001), higher MHDI (B = 11.298; p < 0.001), and higher number of hospitalized patients with oral and oropharyngeal cancer (B = 0.001, p < 0.002). Cities with higher Gini coefficients (B = 8.159, p < 0.001), higher inadequate basic sanitation rates (B = 0.09, p = 0.001), lower expected years of schooling (B = -0.718, p < 0.001), and higher illiteracy rates (B = 0.191, p < 0.001) had a higher frequency of hospitalized patients with oral and oropharyngeal cancer. In conclusion, more developed cities showed a higher frequency of diagnoses of mucosal changes. Greater inequality and worse socioeconomic conditions are associated with a higher frequency of hospitalized patients with oral and oropharyngeal cancer in Brazil.

Síntese rápida para enfrentamento do sofrimento psíquico de universitários: é tempo de uma política / Rapid synthesis to cope with psychic distress in university students: it is time for a policy

O conteúdo deste livro é resultado do estudo que teve como objetivo formular respostas institucionais ao sofrimento psíquico de estudantes universitários de cursos da área da saúde, no contexto do campus do Quadrilátero da Universidade de São Paulo (USP). O tema da saúde mental dos universitários é complexo, dado que se conjuga com a dinâmica social como um todo e particularmente com a sociabilidade na universidade. Nos dias atuais, observa-se aumento da preocupação com o problema, que tem sido tratado sob diferentes ângulos, em âmbito nacional e internacional. O estudo foi realizado na modalidade de Resposta Rápida (do Inglês Rapid Response) elaborado em 90 dias, conforme proposto pelo McMaster Health Forum2. Trata-se de uma modalidade de síntese de evidência para política e foi desenvolvida como parte das atividades de estágio sanduíche da doutoranda do Programa de Pós-Graduação da Escola de Enfermagem da USP, Emiliana Maria Grando Gaiotto, no McMaster Health Forum, da McMaster University, no Canadá, com financiamento CAPES/USP/Print. Este trabalho foi desenvolvido por professoras e pesquisadores de diversas instituições - Escola de Enfermagem da USP (EEUSP), da Faculdade de Odontologia da USP (FOUSP), do Curso de Terapia Ocupacional da Faculdade de Medicina da Universidade Federal de Pelotas, RS, da Fundação Oswaldo Cruz de Brasília, DF, do Laboratório de Implementação do Conhecimento em Saúde, do Hospital do Coração, do Instituto de Saúde da Secretaria de Estado da Saúde de São Paulo (IS), que integram a EVIPNET Brasil, uma rede para políticas informadas por evidências. Para delinear o problema, foram identificados na literatura elementos envolvidos na produção de sofrimento psíquico entre universitários. No contexto da USP, identificou-se também serviços/programas de apoio à saúde mental disponíveis aos universitários e os do Sistema Único de Saúde (SUS). Enquetes com informantes-chave, estudantes de graduação e pós-graduação de cursos da área da saúde da USP, possibilitaram melhor compreensão das dificuldades e necessidades dos estudantes e orientaram as buscas de estratégias para enfrentar o problema. O problema foi equacionado por meio de um protocolo que estabeleceu a pergunta de pesquisa e os objetivos da revisão da literatura, bem como o processo de busca da literatura e as fontes a serem pesquisadas. As buscas foram realizadas entre maio e junho de 2020, em 21 fontes de dados bibliográficos, incluindo literatura cinzenta. O relatório em Português foi finalizado em setembro de 2020 e traduzido para o inglês, recebendo feedback do McMaster Health Forum em outubro. A partir desse feedback foram feitos ajustes no texto e as versões em Português e Inglês estão reunidas neste E-book, com a finalidade de apoiar a implementação de política de fortalecimento dos estudantes da área da saúde. As evidências desses estudos embasaram a elaboração de quatro opções que convergem para o estabelecimento de uma política universitária de fortalecimento da saúde mental de estudantes dos cursos da área da saúde, e indicam integrar programas oferecidos pela universidade entre si e aos serviços do SUS, bem como monitorar as necessidades em saúde mental e avaliar continuamente as ações oferecidas. A literatura na área, a escuta de informantes chave e o levantamento dos recursos de atenção em saúde mental da USP e do SUS permitiram compreender a multiplicidade de elementos que estão nas bases do sofrimento psíquico de universitários dos cursos da área da saúde e identificar respostas a elas, o que permitiu mostrar a complexidade do problema e a insuficiência atual das respostas institucionais oferecidas. A síntese rápida da literatura identificou um conjunto expressivo de evidências sobre intervenções, majoritariamente indicadas por estudos classificados como de alta qualidade. Esses resultados podem embasar a implementação de medidas consistentes para dar respostas ao sofrimento psíquico, que vem acometendo os estudantes na atualidade e comprometendo seu futuro. É possível, sob a responsabilidade da universidade, estabelecer uma política sólida, com ações coordenadas, contínuas e integradas ao SUS, para o fortalecimento de jovens universitários. Equacionar e levar a cabo as ações previstas em cada uma das opções é um desafio, e requer da Universidade envolvimento e compromisso institucional com planejamento, desenvolvimento e implementação de uma política para o fortalecimento da saúde mental de universitários da área da saúde. Para isso, é imprescindível a adoção de instrumentos capazes de reconhecer as necessidades em saúde e as manifestações de sofrimento psíquico de estudantes, estabelecer comissões institucionais para a elaboração, implementação, avaliação e ampla divulgação de ações/programas internos à universidade, integrando-os entre si e com os serviços do Sistema Único de Saúde. A adoção das opções para uma política de fortalecimento da saúde mental de estudantes, ou de parte delas pela Universidade, com vistas a superar a atual condição de fragmentação e escassez das ações, tratá proteção aos estudantes, bem como confiança para finalizar seus estudos, com a garantia de ter suas necessidades atendidas Embora as opções tenham sido elaboradas para apoiar o equacionamento do problema na USP, elas podem ser estendidas para diferentes universidades brasileiras. As autoras reconhecem que os desafios são enormes e que extrapolam os muros das universidades. No período em que este livro foi editado, no final de 2020, a Política Nacional de Saúde Mental, Álcool e Outras Drogas sofria pesada ameaça do Ministério da Saúde, por meio de mudanças que, se efetivadas, resultarão no desmonte da Rede de Atenção Psicossocial (RAPS), conquistada em processo histórico e político-legislativo, com ampla mobilização e participação social. A política de saúde mental de caráter antimanicomial efetivou avanços na atenção à saúde mental pública e gratuita, que promoveu a dignidade daqueles que enfrentam o adoecimento psíquico. Em meio a mais um ataque ao Sistema Único de Saúde, é necessário que as universidades se posicionem para reafirmar seus compromissos com a causa pública e com a ciência.

The content of this book is the result of a study1 that aimed to formulate institutional responses to the psychic distress of university students in health courses, in the context of the health quad campus of the University of São Paulo (USP). The theme of university students' mental health is complex, given that it combines with the social dynamics as a whole and particularly with sociability at the university. Nowadays, an increase in the concern about the problem is observed, which has been treated from different angles, both nationally and internationally. The study was carried out in the Rapid Response modality and prepared in 90 days, as proposed by the McMaster Health Forum2 . This is a modality of synthesis of evidence for policy and was developed as part of the sandwich internship activities of PhD student at the Graduate Program of the Nursing School of the USP, Emiliana Maria Grando Gaiotto, at the McMaster Health Forum, McMaster University, in Canada, with CAPES/USP/Print funding. This paper was developed by professors and researchers from different institutions: USP Nursing School (Escola de Enfermagem da USP, EEUSP), USP Dentistry School (Faculdade de Odontologia da USP, FOUSP), Occupational Therapy Course at the Medical School of the Federal University of Pelotas, RS, Oswaldo Cruz Foundation from Brasília, DF, Laboratory for the Implementation of Knowledge in Health, Hospital do Coração, and Health Institute (Instituto de Saúde, IS) of the São Paulo State Health Secretariat, which are part of EVIPNET Brasil, a network for evidence-informed policies. To outline the problem, elements involved in the production of psychic distress among university students were identified in the literature. In the context of the USP, mental health support services/programs available to university students and those of the Unified Health System (Sistema Único de Saúde, SUS) were also identified. Polls with key informants, undergraduate and graduate students in courses in the health area at the USP, enabled a better understanding of the students' difficulties and needs and guided the search for strategies to face the problem. The problem was equationed by means of a protocol that established the research question and the objectives of the literature review, as well as the literature search process and the sources to be researched. The searches were carried out between May and June 2020, in 21 sources of bibliographic data, including the gray literature. The report in Portuguese was finalized in September 2020 and translated into English, receiving feedback from the McMaster Health Forum in October. Based on this feedback, adjustments were made to the text and the Portuguese and English versions are included in this E-book, in order to support the implementation of a policy to strengthen students in the health area. The evidence from these studies supported the development of four options that converge for the establishment of a university policy to strengthen the mental health of students in health courses, and indicate integrating programs offered by the university with each other and with the services provided by the SUS, as well as monitoring mental health needs and continuously evaluating the actions taken. The literature in the area, listening to key informants and surveying the resources for mental health care of the USP and the SUS allowed us to understand the multiplicity of elements that underlie the psychic distress of university students in health courses and identify responses to them, which allowed showing the complexity of the problem and the current insufficiency of the institutional responses offered. The rapid synthesis of the literature identified a significant body of evidence on interventions, mostly indicated by studies classified as of high quality. These results can support the implementation of consistent measures to respond to psychic distress, which has been affecting students today and compromising their future. Under the responsibility of the university, it isRapid possible to establish a solid policy, with coordinated and continuous actions integrated to the SUS, for the strengthening of young university students. Equating and carrying out the actions provided for in each of the options is a challenge, and requires the University's involvement and institutional commitment to planning, developing and implementing a policy to strengthen the mental health of university students in the health area. To such an end, it is indispensable to adopt instruments capable of recognizing the needs in the health area and the manifestations of the students' psychic distress, to establish institutional commissions to elaborate, implement, evaluate and widely disseminate internal university actions/programs, integrating them with each other and with the services offered by the Unified Health System. The adoption of the options for a policy to strengthen the students' mental health, or of part of them by the University, with a view to overcoming the current condition of fragmentation and scarcity of actions, provides protection to the students, as well as confidence to finish their studies, with the guarantee of having their needs met. Although the options have been designed to support equationing the problem at the USP, they can be extended to different Brazilian universities. The authors recognize that the challenges are enormous and that they go beyond the walls of universities. In the period when this book was published, at the end of 2020, the National Policy on Mental Health, Alcohol and Other Drugs suffered a heavy threat from the Ministry of Health, through changes that, if implemented, will result in the dismantling of the Psychosocial Care Network (Rede de Atenção Psicossocial, RAPS), an achievement in a historical and political-legislative process, with ample social mobilization and participation. The anti-asylum mental health policy made advances in public and free mental health care, which promoted the dignity of those who face psychic illness. In the midst of yet another attack on the Unified Health System, it is necessary for universities to position themselves to reassert their commitments to the public cause and to science.

Response to college students' mental health needs: a rapid review / Resposta a necessidades em saúde mental de estudantes universitários: uma revisão rápida

ABSTRACT OBJECTIVE To present strategic options to support the adoption of mental health strengthening policies for university students in the field of health, to be implemented by university institutions. METHODS Rapid review, without period delimitation, with searches carried out from May to June 2020, in 21 sources of bibliographic data, including gray literature. The following keywords were used: mental health, students and university. The selection process prioritized systematic reviews of mental health interventions for university students in health care courses, and also considered other types of review and relevant primary studies. RESULTS Forty-five studies were included: 34 systematic reviews, an evidence synthesis, an overview, a scope review, three narrative reviews, three experience reports and two opinion articles. The evidence from these studies supported the development of four options: 1) to establish and support policies to strengthen the mental health of students in health care courses; 2) to integrate mental health care programs, expand their offer and facilitate access by students; 3) to promote educational programs and communication strategies related to contemporary psychic suffering and its confrontation, so that students can get to know the services and resources and identify strengthening practices; 4) to continuously monitor and assess the mental health needs of students in health care courses. CONCLUSIONS The options are challenging and require universities to establish institutional commissions to implement a policy to strengthen the mental health of university students in the health area, with the ability to recognize the different health needs, including manifestations of psychic suffering ; to integrate the university's internal actions with each other and with the services of the Unified Health System; to implement and monitor the actions that make up the mental health policy.

RESUMO OBJETIVO Apresentar opções estratégicas para apoiar a adoção de políticas de fortalecimento da saúde mental de universitários da área da saúde, a serem implementadas por instituições universitárias. MÉTODOS Revisão rápida, sem delimitação de período, com buscas realizadas de maio a junho de 2020, em 21 fontes de dados bibliográficos, incluindo literatura cinzenta. Utilizaram-se as palavras-chave: saúde mental, estudantes e universidade. O processo de seleção priorizou revisões sistemáticas sobre intervenções em saúde mental para estudantes universitários em cursos da área da saúde, e considerou, também, outros tipos de revisão e estudos primários relevantes. RESULTADOS Foram incluídos 45 estudos: 34 revisões sistemáticas, uma síntese de evidências, um overview, uma revisão de escopo, três revisões narrativas, três relatos de experiência e dois artigos de opinião. As evidências desses estudos apoiaram a elaboração de quatro opções: 1) estabelecer e apoiar políticas de fortalecimento da saúde mental de estudantes dos cursos da área da saúde; 2) integrar programas de atenção à saúde mental, ampliar sua oferta e facilitar seu acesso pelos estudantes; 3) promover programas educacionais e estratégias de comunicação relacionadas ao sofrimento psíquico contemporâneo e ao seu enfrentamento, para que os estudantes conheçam os serviços e recursos e identifiquem práticas de fortalecimento; 4) monitorar e avaliar continuamente as necessidades em saúde mental dos estudantes dos cursos da área da saúde. CONCLUSÕES As opções são desafiadoras e exigem que as universidades estabeleçam comissões institucionais para implementar uma política de fortalecimento da saúde mental dos estudantes universitários da área da saúde, com capacidade de reconhecer as diversas necessidades em saúde, incluindo as manifestações de sofrimento psíquico; integrar ações internas da universidade entre si e aos serviços do Sistema Único de Saúde; implementar e monitorar as ações que compõem a política de saúde mental.

Brazilian Oral health teams in primary care and oral cancer: Results of a national evaluation

Abstract Oral cancer is one of the most prevalent cancers in Brazil. An understanding of how public policies are implemented to address this problem can contribute to the construction of solutions. The "Programa de Melhoria do Acesso e da Qualidade" (PMAQ-AB and PMAQ-CEO) at the level of primary and secondary care are evaluations that also collect data on prevention and monitoring strategies for oral cancer. This study aimed to analyze the results of the incorporation of oral health teams to evaluate the strategies adopted by Brazil regarding the impact on the diagnosis of oral cancer. Of the 17,202 family health teams evaluated, 72.10% had oral health teams (OHT). Considering the strategies for prevention, screening, campaign, and follow-up of suspected cases, 72.27% of the campaign teams and 59.09% of the teams who accompanied suspected cases had OHT. In secondary care, more than 65% of the teams in the Southeast and South regions registered cases of oral cancer, and the referral network was more represented. The inclusion of OHT had a positive impact on campaign actions, follow-up, referral to specialists, and registration of suspected cases throughout Brazil.

Acesso e cobertura populacional à saúde bucal após a implementação da Política Nacional de Saúde Bucal "Brasil Sorridente" / Access and oral health population coverage after implementation of the National Oral Health Policy "Smiling Brazil" / Acceso y cobertura de la salud oral después de la implementación de la Política Nacional de Salud Oral "Brasil Sonriente"

O objetivo foi analisar a Política Nacional de Saúde Bucal, na perspectiva do acesso e cobertura das ações desenvolvidas na odontologia do Sistema Único de Saúde, entre 2002 e 2016. A partir do quadro conceitual da Organização Mundial da Saúde, que se divide em blocos para garantir acesso, cobertura e qualidade dos sistemas de saúde, foi realizado um estudo de caso do Brasil Sorridente referentes à implantação e financiamento das equipes. O bloco "força de trabalho" revelou um crescimento superior a 470% no número de equipes de saúde bucal no Brasil; no bloco "financiamento" fica evidente o grande aporte financeiro destinado à política, com ênfase ao papel indutor deste processo nos municípios; o bloco "tecnologia" evidenciou o incremento tecnológico para viabilizar os serviços de saúde bucal em todo o Brasil; já no bloco "disponibilidade dos serviços de saúde" observa-se uma ampliação de 4% na atenção básica e os serviços especializados essas porcentagens ultrapassam os 200% entre 2001 e 2015, finalmente, no bloco "acesso e cobertura" foi possível verificar o aumento de cobertura populacional de 9% para 43% no Brasil. Os dados apontam que a política permitiu um avanço referente aos blocos estruturantes do framework e melhorou o acesso e a cobertura em saúde bucal. (AU)

The objective was to analyze the National Oral Health Policy, from the perspective of access and coverage of dentistry actions in the Unified Health System, between 2002 and 2016. Based on the World Health Organization conceptual framework, which is divided into blocks to guarantee access, coverage and quality of health systems, a case study was carried out in the Smiling Brazil considering the implementation and financing. As a result, the "workforce" block revealed a growth rate superior than 470% in the number of oral health teams in Brazil. In the "financing" block, the great financial support to the policy is evident, with emphasis on the role of this process in the municipalities. The "technology" block evidenced the technological increase to make oral health services viable in Brazil. Furthermore, in the block "availability of health services" was observed an increase of 4% in primary care. On the other hand, between 2001 and 2015, in the specialized services this percentage exceed 200%. Finally, in the block "access and coverage" was possible to verify the increase of population coverage from 9% to 43% in Brazil. The data indicate that the policy allowed an advance regarding the framework structuring blocks, as well as improved the access and coverage in oral health. (AU)

El objetivo fue analizar la Política Nacional de Salud Oral, desde la perspectiva de acceso y cobertura de las acciones desarrolladas en la odontología del Sistema Único de Salud, entre 2002 y 2016. Desde el marco conceptual de la Organización Mundial de la Salud, que se divide en bloques para garantizar el acceso, la cobertura y la calidad de los sistemas de salud, se realizó un estudio de caso de Smiling Brazil sobre la implementación y el financiamiento de los equipos. El bloque de "fuerza laboral" reveló un crecimiento de más del 470% en el número de equipos de salud bucal en Brasil; En el bloque de "financiamiento", la gran contribución financiera a la política es evidente, con énfasis en el papel inductivo de este proceso en los municipios; el bloque "tecnología" evidenció el aumento tecnológico para habilitar los servicios de salud bucal en todo Brasil; En el bloque "disponibilidad de servicios de salud" hay un aumento del 4% en atención primaria y servicios especializados, estos porcentajes superan el 200% entre 2001 y 2015, finalmente, en el bloque "acceso y cobertura" fue posible verificar el aumento Cobertura poblacional del 9% al 43% en Brasil. Los datos indican que la política permitió un avance con respecto a los componentes básicos del marco y un mejor acceso y cobertura en salud bucal. (AU)