Perceptions of the oral health of their patients reported by Brazilian medical residents in psychiatry.

Persons with severe mental disorders have higher chances of presenting oral health problems than persons in the general population. Mental disorders are considered public-health problems worldwide. Interpreting statements on oral health made by medical students receiving instruction in psychiatry is essential to provide elements for reflection on their difficulties, barriers or limited knowledge in managing their patients' oral health. Based on the presupposition that doctors provide their patients with no instruction or support concerning oral complaints, because these do not symbolize the same challenges as those emerging from severe mental disorders. The aim of this study was to interpret symbolic meanings of statements expressed by medical residents in psychiatry at a specialized university outpatient clinic, about their patients' oral health. Qualitative research using the Qualitative-Clinical method was conducted, adopting the theoretical reference of medical psychology. Data were analyzed by the Clinical-Qualitative Content method and the Seven-Step technique. Based on 06 interviews analyzed, the following categories emerged: "What do I do? Psychiatrists' dilemmas about not understanding their role in patients' oral health; and "Dentists do not participate in Balint' so-called "collusion in anonymity". It was concluded that among others, the paradigm consisted of a sociological composition, therefore it was stronger than personal decisions that might eventually oppose the barriers to interdisciplinary work posed by the institutional model, which were intertwined with paradigmatic barriers. Thus, specialist training should include a dental perspective, so that oral examinations would always be included in the physical examinations, from an interdisciplinary perspective of the integrity of health-care.

Assessment of quality of life and associated factors in nursing students / Avaliação da qualidade de vida e fatores associados em graduandos de Enfermagem

ABSTRACT Objective: To assess the quality of life of nursing undergraduate students and factors associated with socioeconomic variables and internship field. Methods: A cross-sectional study was conducted in an educational institution located in the northern region of the state of Ceará, Brazil, involving 309 nursing undergraduates from the 1st to the 10th semester. The WHOQOL-bref instrument was used to evaluate the quality of life. Each domain and total score of the instrument were considered as outcome variables. Results: 69.3% of the individuals were women, the mean age of the sample was 28 years, and 67.7% defined their quality of life as "good" or "very good." Undergraduates who consumed well water and those with lower income had a higher chance of presenting lower scores in the physical domain and environmental domain of quality of life, respectively (p < 0.05), and of having a lower total quality of life score. Conclusion: The students considered their quality of life to be good/very good, and sociodemographic factors influenced the lower quality of life score.

RESUMO Objetivo: Avaliar a qualidade de vida de graduandos de enfermagem e fatores associados a variáveis socioeconômicas e campo de estágio. Métodos: Estudo transversal realizado em uma instituição de ensino localizada na região norte do estado do Ceará, Brasil, envolvendo 309 graduandos de enfermagem do 1º ao 10º semestre. O instrumento WHOQOL-bref foi utilizado para avaliar a qualidade de vida. Cada domínio e escore total do instrumento foram considerados como variáveis de desfecho. Resultados: 69,3% dos indivíduos eram mulheres, a média de idade da amostra foi de 28 anos e 67,7% definiram sua qualidade de vida como "boa" ou "muito boa". Universitários que consumiam água de poço e aqueles com menor renda tiveram maior chance de apresentar menores escores no domínio físico e meio ambiente de qualidade de vida, respectivamente (p < 0,05), e de ter menor escore total de qualidade de vida. Conclusão: Os estudantes consideraram sua qualidade de vida boa/muito boa, e fatores sociodemográficos influenciaram o menor escore de qualidade de vida.

Consequences of the pandemic on dental practices: a literature review / Consequências da pandemia nas práticas odontológicas: revisão de literatura

ABSTRACT SARS-CoV-2 is caused by an RNA virus responsible for the disease known as COVID-19. First diagnosed in 2019, in a human being in the city of Wuhan, China, this disease is classified as a severe respiratory disease. Propagation occurs through coughing, sneezing, inhalation of droplets, or even indirect contact with the nasal, oral, and ocular mucous membranes. Preventive measures involving social distancing, quarantine, and mask use were implemented to prevent its spread. Such measures challenge dental practices, since they depend on proximity and do not allow the use of personal protective equipment, which cover the patient's oral cavity. This integrative literature review sought to identify articles discussing preventive measures of adequate use in current dental practices, reducing the risk of COVID-19 contamination and spread. Results showed the importance of dentists acting on the disease transmission routes, following care protocols, implementing new dental clinic management practices, such as avoiding crowds, longer time between appointments, use of teledentistry, and adopting preventive measures inside the dental office like hand washing, use of N95 mask, face shield, and air filters. However, oral health professionals must be prepared to face any imminent challenge imposed by infectious diseases in dental practice, following protocol before, during, and after dental care.

RESUMO O SARS-CoV-2 é causado por um vírus RNA responsável pela doença conhecida como COVID-19. Essa doença foi diagnosticada pela primeira vez em 2019, em um humano na cidade de Wuhan, na China, sendo classificada como uma doença respiratória grave. A propagação da mesma se dá através da tosse, espirros, inalação de gotículas ou, então, contato indireto com as mucosas nasal, oral e ocular. Para evitar o avanço da doença, medidas preventivas foram implantadas, envolvendo o distanciamento social, quarentena e a utilização de máscaras. Tais medidas desafiam as práticas odontológicas, uma vez que os cirurgiões-dentistas dependem da proximidade; além do que a prática odontológica não permite o uso de equipamentos de proteção individuais que cubram a cavidade oral do paciente, obviamente. Este trabalho teve como objetivo reunir, através de uma revisão integrativa de literatura, artigos com medidas preventivas que possam ser utilizadas nas práticas odontológicas atuais, diminuindo o risco de contaminação e disseminação da COVID-19. Pôde-se observar a importância do cirurgião-dentista em atuar nas rotas de transmissão da doença, seguindo protocolos de atendimento, fazendo novo gerenciamento da clínica odontológica como por exemplo; evitando aglomerações, maior tempo entre uma consulta e outra, uso da teleodontologia e também medidas preventivas dentro do consultório, como: lavagem das mãos, uso de máscara N95, protetor facial e filtros de ar. Com tudo, os profissionais da saúde bucal devem estar preparados para enfrentar qualquer desafio iminente, imposto pelas doenças infecciosas na prática odontológica, seguindo protocolo, antes, durante e depois dos atendimentos odontológicos.

A medicalização na prática de dentistas no SUS: um olhar qualitativo para os sentidos da prática / Dentistry medicalization at SUS: a qualitative practice-based perspective

Resumo Este artigo explora sentidos e significados do trabalho odontológico no SUS, no contexto da relação profissional-paciente. Pesquisa qualitativa com 20 cirurgiões-dentistas que atuavam em um município paulista de médio porte, abordada por meio de três grupos focais, com a pergunta disparadora "Qual é o sentido ou significado do seu trabalho, aqui na prefeitura, para você?". O material foi áudio-gravado, transcrito na íntegra e analisado pelo método de análise de conteúdo temática. Procedemos a realização de leitura flutuante, categorização e discussão dos achados junto aos pares de pesquisadores para validação final. Como resultados, aponta-se a construção das categorias 1) Estranheza às necessidades percebidas pelos pacientes e a consequente medicalização da vida, e 2) Poder e consumo como significados da prática. O trabalho do cirurgião dentista, nesse contexto, evidenciou as diferenças entre as necessidades percebidas pelo paciente e aquelas que o dentista considera. Além disso, revelou o poder que emana da assimetria entre paciente e profissional como dificultador da produção de autonomia do paciente. Tais significações parecem trazer sofrimento para esses profissionais no seu trabalho. Concluiu-se que há necessidade de reflexão sobre o trabalho em saúde como forma de se evitar sofrimento, e que a prática desses dentistas é carregada de sentidos e significados.

Abstract This study explores the senses and meanings attributed to dental work in the Brazilian National Health System (SUS) focusing on dentist-patient relations. A qualitative research was conducted with 20 dentists working in a medium-sized municipality in São Paulo, divided into three focus groups and asked the guiding question "What sense or meaning do you attribute to your work here in the city?" Data were audio-recorded, fully transcribed, and analyzed using thematic content analysis. Floating reading, categorization, and peer discussion of the findings were performed for the final validation, resulting in two categories: 1) Strangeness to patients' needs and the subsequent medicalization of life, and 2) Power and consumption as meanings of practice. In this context, the dental practices showed the differences between patients' needs and those considered relevant by dentists. It also showed the power imbalance between patients and professionals as a hindrance to patients' autonomy. Such meanings seem to cause suffering to these professionals. In conclusion, reflections on health work are paramount to avoid suffering and understand that the practice of these dentists bears many senses and meanings.

Percepções de mães adolescentes acerca das expectativas e experiências da maternidade na adolescência / Perceptions of teenage mothers about the expectations and experiences of motherhood in adolescence

Conhecer as percepções das mães adolescentes sobre a gravidez na adolescência é importante subsídio para uma abordagem efetiva e integral pelos profissionais de saúde e para políticas de saúde. O estudo analisou as percepções de mães de 15 a 19 anos que frequentaram a Unidade Básica de Saúde em Divinolândia-SP para realização do pré-natal entre janeiro de 2016 à outubro de 2017. A pesquisa qualitativa foi realizada por meio de 17 entrevistas semiestruturadas, utilizando amostragem por exaustão. As entrevistas foram gravadas e transcritas na íntegra, e o material tratado por análise de conteúdo na modalidade temática. Foram identificadas 5 categorias de análise: (1) gravidez planejada durante a adolescência; (2) imaginário e realidades da gravidez na adolescência; (3) modificação dos projetos de vida; (4) motivação para a gravidez associada ao desejo de mudança de vida e fuga e (5) rede de apoio e proteção. As adolescentes relataram os desafios da maternidade e surpreenderam-se frente a uma realidade distinta da qual imaginavam, com modificação nos projetos de vida, no entanto as mães se confortaram perante o apoio social e familiar recebido, e apresentaram formas de lidar com as dificuldades e complexidades inerentes à maternidade. Os resultados deste estudo podem colaborar com programas de saúde que visem não só prevenir a gravidez não planejada, como também oferecer suporte à adolescente e apoiar o período puerperal, visto que é sentido como um período crítico na vida das mães.

It is relevant to know the perceptions of adolescent mothers about teenage pregnancy because it is a support for an effective and comprehensive approach by health professionals and health policies.The study analyzed the perceptions of mothers aged 15 to 19 years old who attended the Basic Health Unit in Divinolândia-SP for prenatal care, between January 2016 and October 2017. The qualitative research was carried out through 17 semi-structured interviews, using exhaust sampling. The interviews were recorded and transcribed, and the material was treated by content analysis in the thematic mode. Five categories of analysis were identified: (1) intended pregnancy during adolescence; (2) imaginary and realities of teenage pregnancy; (3) modification of life projects; (4) motivation for pregnancy associated with the desire for life change and escape and (5) support and protection network. Adolescents reported challenges and were surprised by a reality different from what they imagined, with changes in life projects, however, mothers were comforted by the social and family support received, and presented ways of dealing with the inherent difficulties and complexities of motherhood. The results of this study can collaborate with health programs, which aim not only to prevent unintended pregnancy, but also to support adolescents and support the puerperal period, as it is felt as a critical period in the lives of mothers.

Analysis of the prevalence in sugar consumption in child care consultations / Análise da prevalência do consumo de açúcar em consultas de puericultura

Abstract Objectives: to analyze the prevalence of sugar consumption and associated factors in childcare consultations. Methods: cross-sectional study with 599 children > six months to < 24 months of age, assisted by the Family Health Units. Outcomes: daily consumption of sweetened beverages, sweets/candies, recorded in the Food and Nutrition Surveillance System; independent variables: sociodemographic data. Multiple logistic regression test was applied. Results: 62.10% of the children consume sugary drinks and 42.23%, sweets/candies. Consuming sugary drinks was associated with the age of 12-17 months and 29 days (OR=2.525; CI95%=1.68-3.78) and 18-17 months and 29 days (OR=2.90; CI95%=1.90-4.43); children living with more than four people at home (OR=1.59; CI95%=1.11-2.26), aged 12-17 months and 29 days (OR=2.05; CI95%=1.34-3.13) and 18-23 months and 29 days (OR=2.51; CI95%=1.62-3.87) were more likely to consume sweets/candies than younger children. Maternal aspects, such as age (OR=0.66; CI95%=0.46-0.93), marital status (OR=1.67; CI95%=1.06-2.6), schooling (OR=2.14; CI95%=1.12-4.08), and presence of government assistance (OR=2.03; CI95%=1.41-2.93), were conditions associated with the consumption of sweets. Conclusions: the prevalence of sugar in children's diet was high and was associated with sociodemographic aspects. Health education actions should be carried out in childcare, in order to promote healthy food, minimizing the consumption of sugar.

Resumo Objetivos: analisar a prevalência do consumo de açúcar e fatores associados em consultas de puericultura. Métodos: estudo transversal com 599 crianças >seis a <24 meses de idade, assistidas por Unidades de Saúde da Família. Desfechos: consumo diário de bebidas adoçadas, doces/guloseimas, registrados no Sistema de Vigilância Alimentar e Nutricional; variáveis independentes: dados sociodemográficos. Aplicou-se teste de regressão logística múltipla. Resultados: 62,10% das crianças consomem bebidas açucaradas e 42,23% doces/guloseimas. Consumir bebidas açucaradas associou-se à idade de 12-17 meses e 29 dias (OR=2,525; IC95%=1,68-3,78) e 18-17 meses e 29 dias (OR=2,90; IC95%=1,90-4,43); crianças residirem com mais de quatro pessoas na casa (OR=1,59; IC95%:1,11-2,26), terem idade de 12-17 meses e 29 dias (OR=2,05; IC95%=1,34-3,13) e 18-23 meses e 29 dias (OR=2,51; IC95%=1,62-3,87) apresentaram maior chance de consumir doces/guloseimas que crianças mais novas. Aspectos maternos como idade (OR=0,66; IC95%=0,46-0,93), estado civil (OR=1,67; IC95%=1,06-2,6), escolaridade (OR=2,14; IC95%=1,12-4,08), e presença de auxílio do governo (OR=2,03;IC95%=1,41-2,93), foram condições associadas ao consumo de doces/guloseimas. Conclusão: foi alta a prevalência de açúcar na dieta das crianças e esteve associada a aspectos sociodemográficos. Ações de educação em saúde devem ser realizadas na puericultura, a fim de fomentar a alimentação saudável, minimizando o consumo de açúcar.

Uso de álcool associado aos transtornos mentais em homens adultos / Use of alcohol associated with mental disorders in adult men / Uso de alcohol asociado con trastornos mentales en hombres adultos

Introdução: Do ponto de vista da saúde pública, a população masculina adulta mostra-se vulnerável ao uso de álcool e as suas consequências. A detecção precoce, assim como a busca por fatores associados são necessárias e as unidades de Saúde da Família são importantes locais para esta abordagem. Objetivo: Este estudo teve como objetivo identificar o uso de álcool em homens adultos e verificar sua associação com fatores socioeconômicos, demográficos e transtornos mentais (episódio depressivo maior e transtorno de ansiedade generalizada). Métodos: Foi realizado um estudo transversal em adultos de 20 a 59 anos do município de Piracicaba, cadastrados nas Unidades de Saúde da Família (USF) no ano 2018. Após análises descritivas, as variáveis com p<0,20 nas análises simples foram estudas em modelos de regressão binomial negativa múltipla. Pelo modelo final, estimaram-se as razões de médias ajustadas com os intervalos de 95% de confiança. Resultados: Observou-se prevalência de 26,9% de consumo de álcool na população estudada. O escore do The Alcohol Use Disorders Identification Test (AUDIT) apresentou relação direta com a idade (razões de médias ­ RM=1,02; intervalo de confiança ­ IC95% 0,99­1,03). Quanto à religião, protestantes e evangélicos apresentaram escore médio de AUDIT menor que os demais (RM=1,78; IC95% 1,14­2,79). Pessoas com transtorno mental apresentam escore médio de AUDIT maior que os sem transtorno (RM=2,30; IC95% 1,28­4,11). Conclusões: Concluímos que o consumo de álcool na população adulta masculina é bastante prevalente, que seu consumo aumenta com a idade, que a religião tem efeito protetor e que pessoas com depressão e ansiedade apresentam maior propensão ao uso. Com base nesses dados, destacamos a importância da USF no desenvolvimento de estratégias que rastreiem as condições de risco de sua população, bem como discutam abordagens e possíveis intervenções.

Introduction: From the point of view of public health, the adult male population is vulnerable to alcohol use and its consequences. Early detection and the search for associated factors are necessary, and the Family Health Units are important places for this approach. Objective: This study aimed to identify the use of alcohol in adult men and to verify its association with socioeconomic and demographic factors and mental disorders (major depressive episode and generalized anxiety disorder). Methods: A cross-sectional analytical study was carried out on adults aged 20 to 59 years in the city of Piracicaba, Brazil, registered in Family Health Units in the year 2018. After descriptive analyses, variables with p<0.20 in simple analyses were studied in multiple negative binomial regression models. According to the final model, the adjusted ratios of means were estimated with 95% confidence intervals. Results: There was a high prevalence of alcohol consumption (26.9%) in the study population. Alcohol Use Disorders Identification Test (AUDIT) score increased with age (ratios of means ­ RoM=1.02; confidence interval ­ 95%CI 0.99­1.03). Concerning religion, Protestants and Evangelicals had an average AUDIT score lower than other religions (RoM=1.78; 95%CI 1.14­2.79). People with mental disorders have an average AUDIT score higher than those without disorders (RoM=2.30; 95%CI 1.28­4.11). Conclusions: The authors conclude that alcohol in the adult male population is prevalent, with consumption increasing with age; religion has a protective effect, and people with depression and anxiety are more likely to use it. Taking this into consideration, it is worth highlighting the importance of Family Health Units in the development of strategies to monitor the risk conditions of its population as well as the discussion and approach of interventions.

Introducción: Desde el punto de vista de la salud pública, la población masculina adulta es vulnerable al consumo de alcohol y sus consecuencias. La detección precoz, así como la búsqueda de factores asociados son necesarios y las unidades de Salud de la Familia son lugares importantes para ese abordaje. Objetivo: Este estudio tuvo como objetivo identificar el uso de alcohol en hombres adultos y verificar la asociación con trastornos socioeconómicos, demográficos y mentales (episodio depresivo mayor y trastorno de ansiedad generalizada). Métodos: Se realizó un estudio analítico transversal en adultos de 20 a 59 años de edad en la ciudad de Piracicaba registrados en las Unidades de Salud Familiar en el año 2018. Después de los análisis descriptivos, se estudiaron las variables con valor p<0,20 en análisis simples en modelos de regresión, binomio negativo múltiple. El modelo final estimó las razones medias ajustadas con los intervalos de confianza del 95%. Resultados: Hubo una alta prevalencia de consumo de alcohol, 26,9%. El puntaje AUDIT aumentó con la edad (RM=1,02; IC95% 0,99­1,03). Los protestantes y los evangélicos tuvieron un puntaje promedio de AUDIT más bajo que otras religiones (RM=1,78; IC95% 1,14­2,79). Las personas con trastornos mentales tienen un puntaje AUDIT promedio más alto que aquellos sin trastornos (RM=2,30; IC95% 1,28­4,11). Conclusiones: Concluimos que el alcohol en la población masculina adulta es prevalente, con la edad hay un aumento en el consumo, la religión tiene un efecto protector y que las personas con depresión y ansiedad tienen más probabilidades de usarlo, destacando la importancia de la USF en el desarrollo de estrategias que rastrean las condiciones población, así como la discusión y el enfoque de las intervenciones.

Quality of life and adherence to dental treatment in adolescents: a longitudinal analytical study

The study aimed to analyze the quality of life, oral health impact on daily activities and its association with adherence to dental treatment, and other factors, among vulnerable adolescents. It is a longitudinal analytical study performed with 15- to 19-year-old adolescents in the city of Piracicaba, São Paulo, from 2014 to 2015. The sample consisted of 476 adolescents referred for the treatment of caries and/or periodontal disease in family health units (initial phase). After 18 months, 325 individuals were assessed to investigate the dental treatment provided (final phase). The response variables considered in the final phase were the Quality of Life (WHOQOL-bref) and the Oral Impacts on Daily Performances (OIDP) questionnaires. The independent variables analyzed were sex, age, treatment adherence, and family cohesion and adaptability. A multiple regression model was used. The data on the physical (p<0.0001), social (p=0.0003), environmental (p<0.0001), and psychological (p<0.0001) domains of the WHOQOL collected in the initial phase had a positive relationship with the same domains assessed in the final phase. The WHOQOL data of the initial phase were associated with the WHOQOL data of the final phase (p=0.0341). The OIDP data of the initial phase were associated with the OIDP data of the final phase (p<0.0001). The OIDP of volunteers who did not adhere to dental treatment showed a higher impact (p=0.0234). The quality of life and impacts on daily performances of adolescents improved between the evaluation periods.

Representações cotidianas da prática para o cirurgião-dentista na atenção primária: uma revisão de escopo da literatura / Day-to-day representations about practice by dentists in primary care: a scope review of the literature

Embora se saiba muito sobre os dados mensuráveis da Saúde Bucal na Atenção Primária à Saúde (APS), pouco se sabe sobre os aspectos individuais e subjetivos do profissional da odontologia. No desempenho de suas funções, o cirurgião-dentista entra em contatocom ambientes, tecnologias e pessoas em sua total complexidade, desencadeando, como resposta, uma série de emoções do organismo, as quais se expressam de forma consciente através dos sentimentos.Diante desse cenário, o presente trabalho partiu do pressuposto de que os dentistas têm muito a dizer sobre as representações cotidianas que possuem sobre seu trabalho. O objetivo deste estudo foi identificar -a partir do que se tem produzido na literatura -os sentimentos expressos pelos dentistas na sua práticana APS. Optou-se por conduzir uma revisão de escopo por ser um campo pouco pesquisado. O presente estudo foi elaborado obedecendo os vinte itens essenciais e os dois itens opcionais da Extensão Prisma para revisões de escopo apresentado por Tricco et al.em 2018. As buscas foram realizadas no período de agosto a outubro de 2020, utilizando-se para a construção da pergunta da pesquisa do mnemônico que representa População, Conceito e Contexto, definido assim: P = cirurgiões-dentistas, C = sentimento e C = atenção básica. Por meiodeste estudo percebe-secomo a prática odontológica está sujeita a emoções e sentimentos muitas vezes antagônicos e, assim, necessários de elaboração (AU).

Although much is known about measurable data on Oral Health in Primary Health Care (PHC), little is known about the individual and subjective aspects of the dental professional. In the performance of their functions, dentists keep in touch with some environmental and technological aspects, and with people in their total complexity. In response, these conditions trigger a series of emotions in the [dentist's] body, which are consciously expressed through their feelings. Given this scenario, the present studyarose from the assumption that dentists have a great deal to say about the everyday representations they have about their job. The objective of this study was to identify the feelings expressed by dentists in their practice in PHC, based on the data that has been produced in the. The scope of the review was chosen due to the limited number of researches in this field. The present study was conducted taking into consideration the twenty essential items and the two optional items of the Prisma Extension for scope reviews presented by Tricco et al. in 2018. The search was conducted in the period from August to October 2020, by using the construction of the mnemonic research question that represented Population, Concept and Context, which was defined as follows: P = Dentists, C = feeling and C = primary care. Based on this study, we were able to perceive the extent to which dental practice was subject to emotions and feelings that were frequently antagonistic and, therefore, it was necessary to examine them in greater depth (AU).

Indicators for dental appointment scheduling in primary health care: a national cross-sectional study.

BACKGROUND: Integrated dental services within the Health System, particularly at primary health care, are crucial to reverse the current impact of oral diseases, which are among the most prevalent diseases worldwide. However, the use of dental services is determined by complex phenomena related to the individual, the environment and practices in which care is offered. Therefore, factors associated with dental appointments scheduling can affect positively or negatively the use of dental services. The aim of the present study was to evaluate the indicators for dental appointment scheduling in Primary Health Care (PHC). METHODS: The present is a cross-sectional analytical study that used data from the external assessment of the third cycle of the National Program for Improving Access and Quality in Primary Care (PMAQ-AB), carried out between 2017 and 2018, in Brazil. The final sample consisted of 85,231 patients and 22,475 Oral Health teams (OHTs). The outcome variable was the fact that the user sought for a dental appointment at the Primary Health Care Unit. A multilevel analysis was carried out to verify the association between individual variables (related to users) and contextual variables (related to the OHTs) in relation to the outcome. RESULTS: Only 58.1% of the users interviewed at these Primary Health Care Units seek the available dental care. The variables with the greatest effect on the outcome were the patient's age up to 42 years old (OR = 2.03, 95% CI: 1.96-2.10), at individual level, and 'oral health teams that assisted no more than a single family health team (FHT)' (OR = 1.29, 95% CI: 1.23-1.36) at contextual level. Other variables were also associated with the outcome, but with a smaller effect size. CONCLUSION: In conclusion, users' age and work process of OHT were indicators for dental appointment scheduling. Our results suggest that when OHT put the National Oral Health Policy guidelines into practice, by assisting only one FHT, the chance for PHC users seeking dental appointments is higher than OHTs that assist more than one FHT. Regarding age, patients aged up to 42 years are more likely to seek an appointment with a dentist.

Caries experience in children under 5 years old in the Xingu indigenous park in Brazil

Aim: The present study sought to investigate dental caries experience and its association with sociodemographic, postnatal and breastfeeding variables in children in the agerange from 6 to 71 months of age, in the Xingu Indigenous Park, Mato Grosso, Brazil. Methods: This was an analytical cross-sectional study that used secondary data pertaining to 402 indigenous children of the Low, Middle and Eastern Xingu regions, who participated in the Oral Health Epidemiological Survey in 2013. The dependent variable was dental caries, dichotomized by the median (dmf-t≤1 and dmf-t>1). The data of independent variables were obtained by means of instruments of the Local Health Information System of the Xingu Indigenous Special Sanitary District (DSEI). Raw analyses were performed to test the association of the independent variables with the dependent variable. The variables were tested in the multiple logistic regression model. Results: The mean value of the dmf-t index was 2.60 and the prevalence of affected children was 51%. In the multiple analysis, only children older than 36 months (OR: 6.64; CI95%: 4.11 to 10.73) and those that were breastfed for a longer period of time (OR: 1.88; CI95%: 1.16 to 3.02) showed significant association with the dmf-t>1 index. Conclusion: Childhood dental caries among indigenous children was associated with age and breastfeeding prolonged for over 26 months, therefore, pointing out the need to offer dental follow-up care at earlier ages

Ultra-processed foods consumption among children and associated socioeconomic and demographic factors.

OBJECTIVE: To evaluate the consumption of ultra-processed foods among children, and to investigate associations with socioeconomic and demographic factors. METHODS: An analytical cross-sectional study with 599 children aged 6 months to 2 years, and listed as users of Family Health Units, in a medium-size city. Mothers were approached at home by researchers and community health workers from the Family Health Units, for data collection. Two questionnaires were used: the socioeconomic and demographic questionnaire, and the form Sistema de Vigilância Alimentar e Nutricional of Ministério da Saúde do Brasil , for children aged 6 months to 2 years. Ultra-processed food consumption and socioeconomic and demographic factors were defined as dependent and independent variables, respectively. Multiple regression analysis with a significance level of 5% was used to test associations between ultra-processed food consumption and socioeconomic and demographic variables. RESULTS: Ultra-processed food consumption was associated with child age between 1 and 2 years (OR=3.89; 95%CI: 2.32-6.50 and OR=3.33; 95%CI: 2.00-5.56, respectively), number of people living in the same household (OR=1.94; 95%CI: 1.23-3.05), and recipients of government benefits (OR=1.88; 95%CI: 1.15-3.04). CONCLUSION: Ultra-processed food consumption among children undergoing complementary feeding may be influenced by socioeconomic and demographic factors.

Perceptions about the Therapeutic Itinerary after stroke: a qualitative research.

OBJECTIVES: to analyze the understanding of the Therapeutic Itinerary of people affected by stroke in the Unified Health System context of a medium-sized city in the state of São Paulo. METHODS: this is a clinical-qualitative, using in-depth semi-structured interviews, conducted in 2019 with 6 patients, a number determined by theoretical saturation. RESULTS: qualitative content analysis allowed the construction of four categories that emerged from the data: a) You are having a stroke! - Identifying the problem; b) Anguish and expectations in waiting for assistance; c) Helplessness and guidance for rehabilitation after hospital discharge; d) Spirituality in rehabilitation after stroke. FINAL CONSIDERATIONS: the affected people expressed feelings and meanings, such as fear, anguish, sadness, beliefs and uncertainties, in order to shed light on the complexity inherent to the experiences of Therapeutic Itinerary of stroke.

Determinants of adherence to dental treatment of socially vulnerable adolescents: a cohort study.

OBJECTIVE: Different studies with adolescents address the difficulty they have to adhere to oral dental treatments. Therefore, better understanding the processes involved in adherence to treatment in this population is necessary. The aim of this study was to investigate the factors that influence adherence to dental treatment in socially underprivileged adolescents in primary care. RESULTS: Non-adherence to treatment showed high rate in the studied sample (49.5%). Family income (p = 0.039) and number of individuals in the family (p = 0.003) were associated with non-adherence to dental treatment. It is concluded that the adolescents' social vulnerability condition resulted in situations that are incompatible with adherence, which hinders dental treatment and health service planning.

Estudo qualitativo da percepção de usuários hipertensos e diabéticos sobre saúde na Atenção Primária / A qualitative study of hypertensive and diabetic users' perceptions of health in primary care

Objetivo O estudo descreveu a percepção dos usuários hipertensos e diabéticos sobre atenção à saúde prestada em Unidades Básicas de Saúde. Métodos Métodos básicos adotados: estudo qualitativo ocorreu no município de Itapeva (SP), no ano de 2015. Foram realizadas entrevistas semiestruturadas com 12 usuários acima de 18, durante mês e uma análise temática para interpretação. Resultados Foram identificados 2 eixos principais, a saber: 1) "Vivência do cuidado em Saúde" e 2) "Acessibilidade na atenção à Saúde". No eixo 1, foram identificados subeixos: acolhimento, dificuldade de atendimento, agenda programada, atendimento a demanda espontânea, concentração nas especialidades médicas, acesso ao serviço de urgência. Já no eixo 2, os seguintes subeixos: dificuldade e facilidade de transporte do paciente ao serviço de urgência. Conclusão No cenário estudado, os usuários que se sentiram acolhidos perceberam como resolutiva a atenção. Esse cenário propõe que, nos espaços estudados, há limitações na execução de tarefas que são da competência da Atenção Primária à Saúde, e o modo como estão efetivando a atenção não favoreceu o entendimento correto do funcionamento da Atenção Primária à Saúde proposto pelo Ministério da Saúde. Priorizar a educação em saúde e o empoderamento do usuário perante sua condição crônica são estratégias possíveis, consolidando a clínica ampliada. A necessidade de continuar estudos que explorem a percepção dos usuários com relação à atenção à saúde é relevante para compreender as barreiras e pontos positivos do serviço, e assim auxiliar no seu planejamento estratégico de ações, programas e atividades destinados aos usuários com doenças crônicas não-transmissíveis.

Objective The study describes the perceptions of hypertensive and diabetic users regarding the health care provided in Basic Health Units. Methods The basic methods adopted were a qualitative study that took place in the city of Itapeva (SP) in 2015, semi-structured interviews that were conducted with 12 users older than 18 during the course of one month, and, finally, a thematic analysis for interpretation. Results Two main axes were identified, namely: 1) Experience of health care and 2) Accessibility in health care. In the first axis, six sub-axes were identified: reception, difficulties in service, scheduled agenda, meeting spontaneous demand, concentration on medical specialties, access to emergency services. On the second axis, the sub-axes discussed were the difficulty and ease of transporting the patient to the emergency department. Conclusion In the studied scenario, users who felt welcome perceived the attention received as resolving. This scenario suggests that there are limitations in the studied spaces as to the execution of tasks that are the competence of Primary Health Care and that the way that care is being provided has not favored the correct understanding of the functioning of Primary Health Care as proposed by the National Ministry of Health. Health education and user empowerment in the face of their chronic conditions are possible strategies consolidating the expanded clinic. There is a relevant need to further study and explore the users' perception of health care in order to understand the barriers and positive points of the service, and thus assist in their strategic planning of actions, programs, and activities aimed at users with chronic non-communicable diseases.

Perceptions about the Therapeutic Itinerary after stroke: a qualitative research / Percepciones sobre el Itinerario Terapéutico después del ictus: investigación cualitativa / Percepções sobre o Itinerário Terapêutico após acidente vascular cerebral: pesquisa qualitativa

ABSTRACT Objectives: to analyze the understanding of the Therapeutic Itinerary of people affected by stroke in the Unified Health System context of a medium-sized city in the state of São Paulo. Methods: this is a clinical-qualitative, using in-depth semi-structured interviews, conducted in 2019 with 6 patients, a number determined by theoretical saturation. Results: qualitative content analysis allowed the construction of four categories that emerged from the data: a) You are having a stroke! - Identifying the problem; b) Anguish and expectations in waiting for assistance; c) Helplessness and guidance for rehabilitation after hospital discharge; d) Spirituality in rehabilitation after stroke. Final Considerations: the affected people expressed feelings and meanings, such as fear, anguish, sadness, beliefs and uncertainties, in order to shed light on the complexity inherent to the experiences of Therapeutic Itinerary of stroke.

RESUMEN Objetivos: analizar la comprensión del Itinerario Terapéutico de personas afectadas por ictus en el contexto del Sistema Único de Salud de una ciudad mediana del estado de São Paulo. Métodos: clínico-cualitativo, mediante entrevistas semiestructuradas en profundidad, realizadas en 2019, con 6 pacientes, número determinado por saturación teórica. Resultados: el análisis de contenido cualitativo permitió la construcción de cuatro categorías que surgieron de los datos: a) ¡Estás sufriendo un derrame cerebral! - La identificación del problema; b) Angustia y expectativa en espera de asistencia; c) Desamparo y orientación para la rehabilitación después del alta hospitalaria; d) Espiritualidad en la rehabilitación después de un ictus. Consideraciones Finales: las personas afectadas expresaron sentimientos y significados, como miedo, angustia, tristeza, creencias e incertidumbres, con el fin de arrojar luz sobre la complejidad inherente al Itinerario Terapéutico de las experiencias del ictus.

RESUMO Objetivos: analisar a compreensão sobre o Itinerário Terapêutico de pessoas acometidas por acidente vascular cerebral no contexto do Sistema Único de Saúde de município de médio porte do estado de São Paulo. Métodos: clínico-qualitativo, com uso de entrevistas semiestruturadas em profundidade, realizadas em 2019, com 6 pacientes, número determinado pela saturação teórica. Resultados: a análise qualitativa de conteúdo permitiu a construção de quatro categorias que emergiram dos dados: a) Você está tendo um derrame! - A identificação do problema; b) Angústias e expectativas na espera por atendimento; c) O desamparo e a orientação para reabilitação após a alta hospitalar; d) A espiritualidade na reabilitação após Acidente Vascular Cerebral. Considerações Finais: as pessoas acometidas expressaram sentimentos e significados, como medo, angústias, tristezas, crenças e incertezas, de forma a jogar luz sobre a complexidade inerente às experiências de Itinerário Terapêutico do acidente vascular cerebral.

Ultra-processed foods consumption among children and associated socioeconomic and demographic factors / Consumo de alimentos ultraprocessados por crianças e fatores socioeconômicos e demográficos associados

ABSTRACT Objective To evaluate the consumption of ultra-processed foods among children, and to investigate associations with socioeconomic and demographic factors. Methods An analytical cross-sectional study with 599 children aged 6 months to 2 years, and listed as users of Family Health Units, in a medium-size city. Mothers were approached at home by researchers and community health workers from the Family Health Units, for data collection. Two questionnaires were used: the socioeconomic and demographic questionnaire, and the form Sistema de Vigilância Alimentar e Nutricional of Ministério da Saúde do Brasil , for children aged 6 months to 2 years. Ultra-processed food consumption and socioeconomic and demographic factors were defined as dependent and independent variables, respectively. Multiple regression analysis with a significance level of 5% was used to test associations between ultra-processed food consumption and socioeconomic and demographic variables. Results Ultra-processed food consumption was associated with child age between 1 and 2 years (OR=3.89; 95%CI: 2.32-6.50 and OR=3.33; 95%CI: 2.00-5.56, respectively), number of people living in the same household (OR=1.94; 95%CI: 1.23-3.05), and recipients of government benefits (OR=1.88; 95%CI: 1.15-3.04). Conclusion Ultra-processed food consumption among children undergoing complementary feeding may be influenced by socioeconomic and demographic factors.

RESUMO Objetivo Avaliar a ingestão de alimentos ultraprocessados em crianças, e verificar se há associação com o contexto socioeconômico e demográfico. Métodos Trata-se de estudo analítico, do tipo transversal, com 599 crianças entre 6 meses e 2 anos de idade, cadastradas em Unidades de Saúde da Família, de um município de médio porte. Para a realização da coleta, as mães das crianças foram abordadas em seus domicílios pelas pesquisadoras e por um Agente Comunitário de Saúde da Unidade Saúde da Família e responderam dois questionários, o socioeconômico e demográfico e o marcador do Sistema de Vigilância Alimentar e Nutricional do Ministério da Saúde do Brasil para crianças entre 6 meses e 2 anos. A variável dependente do estudo foi a ingestão de alimentos ultraprocessados pela criança e as independentes foram as socioeconômicas e demográficas. Foi realizada análise de regressão múltipla, no nível de significância de 5%, para testar a associação entre a ingestão de alimentos ultraprocessados com as variáveis socioeconômicas e demográficas. Resultados A ingestão de ultraprocessados esteve associada com a idade da criança entre 1 e 2 anos (RC=3,89; IC95%: 2,32-6,50 e RC=3,33; IC95%: 2,00-5,56, respectivamente), com o número de pessoas que residiam na mesma casa (RC=1,94; IC95%: 1,23-3,05) e com as famílias que recebiam auxílio do governo (RC=1,88; IC95%: 1,15-3,04). Conclusão A ingestão de alimentos ultraprocessados por crianças no período da alimentação complementar pode ser influenciada por fatores socioeconômicos e demográficos.

Motivos apresentados por usuários para a utilização inadequada de Unidades de Pronto Atendimento / Reasons given by patients for inappropriate use of emergency medical services / Razones dadas por los usuarios para la utilización inadecuada de servicios de urgencia

RESUMO Objetivo Investigar os motivos para procura dos serviços de urgência por usuários classificados com risco não urgente em duas Unidades de Pronto Atendimento de um município de médio porte do Estado de São Paulo. Metodologia Os dados qualitativos, utilizando a técnica de análise de conteúdo, foram obtidos por meio de entrevistas semiestruturadas com 756 indivíduos que procuraram os serviços das Unidades de Pronto Atendimento. Destes, 417 (55%) foram classificados com risco não urgentes e elegíveis para o estudo. Resultados Foram detectadas seis categorias principais de motivos para a busca de atendimento nas Unidades de Pronto Atendimento: falta de infraestrutura da unidade de saúde mais próximo; percepção de dor e sintomas de emergência; proximidade casa/trabalho; demora de agendamento e atendimento na Atenção Primária à Saúde; qualidade do atendimento nas Unidades de Pronto Atendimento; hábito de frequentar o serviço. Tais categorias foram agrupadas em quatro eixos temáticos referentes a: a) percepção de urgência; b) comodidade; c) dificuldade de acesso; d) qualidade do serviço. Conclusão Conclui-se a partir destes achados a necessidade de se fortalecer cada vez mais a atenção básica a fim de garantir acesso facilitado aos usuários e maior resolutividade dos casos que podem ser atendidos neste seguimento, em articulação com toda a rede de atenção à saúde.

ABSTRACT Objective The aim of this study was investígate the reasons for the demand for these services by users rated on two non-urgent emergency care units of a medium-sized municipality of São Paulo. Methodology Qualitative data were collected through semi-structured interviews with 756 individuals who sought the services of emergency care units and, of these, 417 (55%) users were classified as non-urgent risk and were eligible for the study. Results It was observed six major categories of motives among that seeking care in emergency care units: lack of infrastructure of the nearest health unit; perception of pain and symptoms of emergency; home/work proximity; takes care of scheduling and primary health care; quality of care in the emergency care units; habit of attending services. These categories were grouped into four themes concerning: a) perception of urgency; b) convenience; c) difficulty of access and d) quality of service. Conclusion It was concluded from these findings the need to strengthen primary care system in order to ensure facilitated access for users and better resolution of cases that can be seen treated in this level, in conjunction with the entire network of health care.

RESUMEN Objetivo Investigar las razones por las cuales usuarios clasificados como riesgos "no urgentes" buscan servicios de urgencia en dos lugares de pronto atención de un municipio de meso porte del Estado de São Paulo. Metodología Los datos cualitativos, utilizando la técnica de análisis de contenido, fueron obtenidos por medio de entrevistas semiestruturadas con 756 individuos que buscaron atención en dos servicios de pronto atención. De estos, 417 (55%) fueron clasificados con riesgo no urgentes y elegibles para el estudio. Resultados Se destacaron seis categorías principales de razones para la búsqueda de atención en los servicios de pronto atención: falta de infraestructura de la unidad de salud más cercana; percepción de dolor y síntomas de emergencia; proximidad entre la casa y el trabajo; retraso para agendar cita y lograr atendimiento en la atención primaria; calidad de atendimiento en los servicios de pronto atención; hábito de asistir a los servicios. Las categorías fueron agrupadas en cuatro ejes temáticos referentes a; a) percepción de urgencia; b) comodidad; c) dificultad de acceso y d) calidad del servicio. Conclusión Se concluye a partir de estos hallazgos que es necesario fortalecer cada vez más la atención básica a fin de garantizarles a los usuarios un acceso que les facilite una mayor resolución de los casos que pueden ser atendidos en este seguimiento, en conexión con toda la red de atención a la salud.

Factors associated with the need for a complete denture in one arch or both arches among the elderly population.

This study aimed to identify factors associated with the need for complete dentures in one dental arch or both, among the elderly population. The cross-sectional household study was conducted with a representative sample of elderly people (65 years or older) in the state of São Paulo, Brazil, in 2015. The dependent variable was the need for complete dentures (in one arch or both), and independent variables were socioeconomic and demographic conditions, social capital, self-perception of oral health and access to dental services. Simple and multinomial logistic regression models tested effect measures (p < 0.05). A total of 5,948 elderly people participated. Results indicated that those with greater chances of needing a complete denture in one arch were male (OR = 1.54; CI95%:1.04-2.29), with fewer household goods (OR = 2.25; CI95%:1.50-3.38), lower monthly household income: R$501-1500 (OR = 3.44; CI95%:1.27-9.35), R$1501-2500 (OR = 4.11; CI95%:1.50-11.27), R$2501-4500 (OR = 2.76; CI95%:1.10-6.95), self-reported need for a complete denture (OR = 4.75; CI95%:3.08-7.35), ≥3 years since last dental appointment (OR = 1.80; CI95%:1.06-3.05), and dissatisfaction with last dental appointment (OR = 1.80; CI95%:1.06-3.05). There were more chances of the need for complete dentures in both arches among older elders (OR = 1.44; CI95%:1.06-1.88), with lower monthly household income: R$ < 501 (OR = 4.45; CI95%:1.71-11.60), R$501-1500 (OR = 4.01; CI95%:2.14-7.51), R$1501-2500 (OR = 2.95; CI95%:1.64-5.32), < 3 years of education (OR = 1.45; CI95%:1.13-1.85), feeling unhappy (OR = 2.74; CI95%:1.35-5.57), self-reported need for a complete denture (OR = 8.48; CI95%:5.75-12.50), dissatisfaction with their mouth (OR = 2.38; CI95%:1.64-3.46), ≥3 years since last dental appointment (OR = 4.28; CI95%:2.85-6.43), and dissatisfaction with last dental appointment (OR = 4.28; CI95%:2.85-6.43). The several dimensions of the determinants of the need for a complete denture reflect the influence of both demographic and socioeconomic aspects, social capital, self-perception of oral health and access to dental services.

BABY-LED WEANING, AN OVERVIEW OF THE NEW APPROACH TO FOOD INTRODUCTION: INTEGRATIVE LITERATURE REVIEW.

OBJECTIVE: To analyze the scientific literature on Baby-Led Weaning with an integrative literature review to identify risks and benefits. DATA SOURCE: The databases used were: National Library of Medicine (MEDLINE), Latin American and Caribbean Literature in Health Sciences (LILACS - Literatura Latino-Americana e do Caribe em Ciências da Saúde), US National Library of Medicine (PubMed), and Virtual Health Library (BVS - Biblioteca Virtual em Saúde) in December 2017. The inclusion criteria established were publications in English with the descriptor "baby-led weaning" in the heading, abstract, or keywords, classified as original articles, of primary nature, and available online and in full. We excluded review articles, editorials, letters to the editor, critical commentaries, and books on the subject, as well as articles not available in full and duplicates. DATA SUMMARY: We identified 106 articles, of which 17 met the selection criteria. The Baby-Led Weaning method was significantly associated with the baby's satiety, the start of complementary feeding, and adequacy of weight gain. On the other hand, choking and the intake of micronutrients were negatively associated, however with no statistical differences. CONCLUSIONS: Despite the benefits found, the risks still deserve attention and should be investigated with longitudinal randomized controlled studies to ensure the safety of the method when practiced exclusively.