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

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

Fluoride in Bottled Waters Consumed in Northeastern Brazil

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

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

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

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

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

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

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

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

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

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

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

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

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

Estresse, ansiedade e depressão em estudantes de graduação em Odontologia no contexto da pandemia da COVID-19 / Estrés, ansiedad y depresión en estudiantes de pregrado en Odontología en el contexto de la pandemia COVID-19 / Stress, anxiety and depression in undergraduate dental students in the context of the COVID-19 pandemic

O objetivo do estudo foi verificar a ocorrência de estresse, ansiedade e depressão em estudantes de graduação em Odontologia de Instituições Públicas do Estado da Paraíba e sua associação com variáveis relacionadas à pandemia do Coronavírus (SARS-CoV-2). Este estudo transversal e observacional utilizou dois questionários: um desenvolvido pelos pesquisadores para coleta de dados sociodemográficos e informações sobre a pandemia; e outro para identificar a ocorrência de depressão, ansiedade e estresse -o Depression, Anxiety and Stress Scale ­21 Items(DASS-21). A amostra foi composta por 488 graduandos e o nível de significância utilizado nas decisões dos testes estatísticos foi de 5%. Verificou-se uma prevalência de 60,0% para depressão, 59,8% para ansiedade e 60,9% para estresse. Observou-se na análise multivariada que a variável "mudança no estado de saúde pessoal" permaneceu associada aos três desfechosanalisados (p < 0,001): estresse, ansiedade e depressão. A variável "estar assustado para voltar aos atendimentos clínicos dentro do contexto da pandemia" se manteve no modelo final associada aos desfechos ansiedade (p = 0,031) e estresse (p = 0,002), e no que diz respeito apenas à depressão, a única variável que permaneceu associada foi a "autopercepção de impacto negativo na qualidade de suas relações interpessoais devido à pandemia" (p = 0,004). Houve uma alta prevalência dos desfechos estudados, e sua associação, na análise multivariada, a importantes variáveis da pandemia do Coronavírus. Tais associaçõesnos fazem refletir acerca da necessidade do debate sobre saúde mental frente ao momento pandêmico e em como esses estudantes estão sendo prejudicados pela COVID-19 (AU).

El objetivo del estudio fue verificar la ocurrencia de estrés, ansiedad y depresión en estudiantes de graduación en Odontología de Instituciones Públicas del Estado de Paraíba y su asociación con variables relacionadas a la pandemia del Coronavirus (SARS-CoV-2). Este estudio transversal y observacional utilizó dos cuestionarios: uno desarrollado por los investigadores para recolectar datos sociodemográficos e información sobre la pandemia; y otro para identificar la aparición de depresión, ansiedad y estrés -la Escala de Depresión, Ansiedad y Estrés -21 Ítems (DASS-21). La muestra estuvo compuesta por 488 estudiantes universitarios y el nivel de significancia utilizado en las decisiones de las pruebas estadísticas fue del 5%. Hubo una prevalencia del 60,0% para depresión, 59,8% para ansiedad y 60,9% para estrés. Se observó en el análisis multivariado que la variable "cambio en el estado de salud personal" permaneció asociada a los tres desenlaces analizados (p < 0,001): estrés, ansiedad y depresión. La variable "tener miedo de volver a la atención clínica en el contexto de la pandemia" permaneció, en el modelo, final asociada a los resultados ansiedad (p = 0,031) y estrés (p = 0,002), y con respecto solo a la depresión, la única variable Lo que permaneció asociado fue la "autopercepción de impacto negativo en la calidadde sus relaciones interpersonales debido a la pandemia" (p = 0,004). Hubo alta prevalencia de los desenlaces estudiados y su asociación, en el análisis multivariado, con variables importantes de la pandemia de Coronavirus. Este tipo de asociaciones nos hacen reflexionar sobre la necesidad de debatir la salud mental ante la pandemia y cómo estos estudiantes están siendo perjudicados por el COVID-19 (AU).

The aim of the present study was to determine the occurrence of stress, anxiety and depression in undergraduate dental students at public institutions in the state of Paraíba, Brazil, and associations with aspects related to the coronavirus pandemic (SARS-CoV-2). An observational cross-sectional study was conducted with a sample of 488 dental students. Data collection involved the use of two questionnaires. One was developed by the researchers to collect sociodemographic data and information on thepandemic and the 21-item Depression, Anxiety and Stress Scale (DASS-21) was used to identify the occurrence of depression, anxiety and stress. The significance level on the statistical tests was set at 5% (p < 0.05). The prevalence of depression, anxiety and stress was 60.0%, 59.8% and 60.9%, respectively. The multivariate analysis revealed that the variable "change in personal health status" remained associated with all three outcomes (anxiety, depression and stress) (p < 0.001). The variable "afraid to return to clinical examinations/procedures within the context of the pandemic" remained associated with anxiety (p = 0.031) and stress (p = 0.002) in the final model. The only variable that remained associated with depression was "self-perceived negative impact on the quality of interpersonal relationships due to the pandemic" (p = 0.004). The prevalence of the outcomes studied was high and the multivariate analysis revealed associations with important aspects of the coronavirus pandemic. Such associations underscore the need to discuss the effect of the pandemic on mental health and how dental students are affected by COVID-19 (AU).

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

"A vida como ela é" e o desenvolvimento de competências e autonomia na integração ensino-serviço-comunidade / "Life as it is" and the development of skills and autonomy in the teaching-service-community integration

A formação em Odontologia alinhada às demandas atuais de saúde tem sido uma agenda importante. O objetivo desta pesquisa foi compreender os aprendizados a partir dos estágios supervisionados na perspectiva do desenvolvimento de competências e autonomia, a partir da voz de estudantes de Odontologia. Utilizou-se pesquisa qualitativa, com dois gruposfocais, com 13 estudantes, de ambos os sexos,de um curso de Odontologia, de uma instituição federal de ensino noNordeste do Brasil. Procedeu-se à análise temática de conteúdo. Os Estágios Supervisionados da Saúde Coletiva atuam como oportunidades de ensino-aprendizagemavaliação, permitindo vivência nos serviços públicos de saúdelocais e territórios, sensibilizando o estudante para o cuidado integral e para a compreensão ampliada do processo saúde-doença. As vivências partemsempre da premissa de que o aprendizado está vinculado aos serviços de saúde e a um percurso construído coletivamente por todos. Portanto, a compreensão dos estudantes sobre a integração entre o ensino, o serviço e a comunidade, permitiram a articulação entre a teoria e a prática da Saúde Coletiva e o desenvolvimento de competências "socio-lógicas" implicadas aos contextos do trabalho em saúde. Com esse entendimento, os participantes reconheceram o princípio da educação pelo/com o trabalho e a importância de todos para troca e produção de conhecimentos e de saberes em saúde (AU).

Dentistry education aligned with current health demands has been an important topic on the agenda. The objective of this research was to understand the acquired knowledge in supervised internships in terms of the development of skills and autonomy, from the point of view of dentistry students. Qualitative research was used, with two focus groups, with 13 students of both genders, from a dentistry course, from a Federal Educational Institution in Northeastern Brazil. A thematic content analysis was performed. The Collective Health Supervised Internships act as teaching-learning evaluation opportunities, allowing experience in local public health services and territories, creating student awareness of comprehensive care and a broader understanding of the health-disease process. The experiences are always based on the premise that learning is linked to health services and to a path built collectively by everyone. Therefore, the students' understanding of the integration between teaching, service and community allowed the articulation between theory and practice of Collective Health and the development of "socio-logical" competencies involved in the contexts of work in healthcare. With this understanding, the participants recognized the principle of education through/with work and the importance of everyone to exchange and produce knowledge and health education (AU).

Avaliação de um curso de Odontologia com base nas Diretrizes Curriculares Nacionais: um estudo seccional / Evaluation of a Dentistry course based on the National Curricular Guidelines: a sectional study

O estudo teve por objetivo avaliar, a partir da visão de professores e estudantes, um curso de graduação em Odontologia, com base nasDiretrizes Curriculares Nacionais(DCN). Trata-se de um estudo observacional e transversal, com metodologia exploratória, descritiva e de avaliação. A abordagem utilizada foi quantitativa, por meio da aplicação de questionário online, por meio de instrumento com critérios validados. A amostra de professores e estudantes do curso foi censitária. A Integração ensino-serviço obteve o melhor desempenho relativo entre as dimensões avaliadas tanto por estudantes quanto por professores. A maior parte dos estudantes considerou o curso adequado às DCN (50,2%), enquanto a maioria dos professores o consideraram parcialmente adequado (56,36%). Os estudantes mostraram-se mais satisfeitos com a formação ofertada no curso atribuindo maiores valores de média para todas as dimensões e subdimensões. Referente ao perfil do egresso, professores e estudantes atribuíram o pior desempenho à subdimensão "Autônomo", o melhor desempenho foi atribuído às subdimensões "Generalista" e "Capaz de compreender a realidade social". Na dimensão Orientação do cuidado em saúde professores e estudantes atribuíram melhor desempenho àsubdimensão "Tratamento odontológico", enquanto o pior desempenho foi atribuído à "Multiprofissionalidade" e "Enfoque epidemiológico". Na dimensão Abordagem pedagógica, o melhor desempenho foi atribuído às subdimensões "Papel do professor" e "Articulação ensino-pesquisa-extensão", o pior desempenho foi atribuído por professores e estudantes àsubdimensão "Flexibilização curricular". A dimensão Integração ensino-serviço e subdimensões relacionadas foram bem avaliadastanto por professores quanto por estudantes. As principais fragilidades encontradas estão relacionadas com dimensões que abordam as relações profissional/paciente e a as relações entre o cirurgião-dentista e a equipe de saúde durante a formação profissional. Faz-se necessária a criação de estratégias de reorientação da formação direcionadas a novos conceitos metodológicos de ensino e aprendizagem para a efetivação das DCN no curso de Odontologia avaliado (AU).

The study had the purpose of evaluating, from thepoint of view of teachers and students, an undergraduate course in Dentistry, based on the National Curriculum Guidelines (NCG). This is an observational and cross-sectional study, with exploratory, descriptive and evaluative methodology. The approach used was quantitative, through the application of an online survey, by means of an instrument with validated criteria. The sample of teachers and students was a census. The "Teaching-service Integration" dimension obtained the best relative performance amongthose evaluated by both students and professors. Most students considered the course adequate to the NCG (50.2%), while most professors considered it partially adequate (56.36%). Students showed themselves to be more satisfied with the training offered inthe course, assigning higher average ratings for all dimensions and subdimensions. Regarding the "Graduate Profile", professors and students gave the worst performance to the subdimension "Autonomous"; the best performance was attributed to the subdimensions "Generalist" and "Able to Understand the Social Reality". In the dimension "Healthcare Orientation", both teachers and students evaluated the best results in the subdimension "Dental Treatment", while the worst results were attributed to the subdimensions "Multiprofessionalism" and "Epidemiological Approach". In the "Pedagogical Approach" dimension, the best performance was attributed to thesubdimensions "Professor's Role" and "Teaching-research-extension Articulation", and the worst performance was attributed by professors and students to the subdimension "Curricular Flexibility". The "Teaching-service Integration" dimension and related subdimensions were well assessed by both professors and students.The main weaknesses found are related to dimensionsthat address the professional/patient relationships and the relationships between the dental surgeon and the healthcare team during professional qualification. It is necessary to develop strategies for the reorientation of training focused on new methodological concepts of teaching and learning for the implementation of the NCG in the evaluated Dentistry course (AU).

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

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