Cross-cultural adaptation of the Dental Neglect Scale for five-year-old children in Brazil.

The aim of this study was to perform a cross-cultural adaptation of the Brazilian version of the Dental Neglect Scale (DNS). The process included (i) Translation; ii) Synthesis; iii) Back translation; (iv) Critical analysis by a committee of experts; (v) Pilot studies (n1=30 + n2=30); and (6) Evaluation and refinement of the instrument. The validated DNS presented a Content Validity Index (CVI) equal to 1.0 for the total score, as well as for each item. In the pilot studies, a minimum agreement level of 80% in understanding was achieved. DNS was properly adapted for Brazilian Portuguese, and it needs further study in a representative sample for reliability and construct validity assessment.

[Face and construct validation of the Instrument of Evaluation of Maternal and Child Care Networks (IEMCN)]. / Validação de face e construto do Instrumento de Avaliação de Redes de Atenção Materno-infantil (IARAMI).

The organization of health systems in Health Care Networks (HCN) presents itself as a strategy to overcome the fragmentation of maternal and child health actions and services and to qualify care management. The objective of this study was to validate the Instrument for Evaluation of Maternal and Child Health Care Networks (IARAMI), adapted from the Evaluation Tool of Health Care Networks. The validation process comprised face and construct validation. The methodology used for face validation included the conceptual and semantic adaptation of the instrument and analysis by a panel of experts, through the modified consensus e-Delphi technique. After face validation, IARAMI was applied in a sample of 99 health managers of municipalities in the state of Paraná. The construct validation was conducted through the internal consistency analysis using Cronbach's alpha coefficient and factorial analysis. The factorial analysis technique was applied to each of the dimensions of the instrument, enabling the analysis of communalities. The results showed that IARAMI presented reliability and validity, proving to be a tool that can help managers and health workers in the planning, management, and evaluation of the degree of integration of the maternal and child care network.

A organização dos sistemas de saúde em redes de atenção à saúde (RAS) se apresenta como uma estratégia para superar a fragmentação das ações e serviços de saúde materno-infantil e qualificar a gestão do cuidado. O objetivo deste estudo foi validar o Instrumento de Avaliação de Redes de Atenção Materno-infantil (IARAMI), adaptado a partir do Instrumento de Avaliação de Redes de Atenção à Saúde. O processo de validação compreendeu a validação de face e construto. A metodologia utilizada para a validação de face incluiu a adaptação conceitual e semântica do instrumento e a análise por um painel de especialistas, por meio da técnica e-Delphi de consenso modificada. Após sua validação de face, o IARAMI foi aplicado em uma amostra de gestores de 99 municípios do estado do Paraná. A validação de construto foi conduzida por análise de consistência interna por meio do coeficiente alfa de Cronbach e de análise fatorial. A técnica de análise fatorial foi aplicada para cada uma das dimensões do instrumento, permitindo a análise de comunalidades. Os resultados evidenciaram que o IARAMI apresentou confiabilidade e validade, demonstrando ser uma ferramenta que pode auxiliar gestores e trabalhadores da saúde no planejamento, na gestão e na avaliação do grau de integração da rede de atenção à saúde materno-infantil.

Assessing oral health of crack users in Brazil: Perceptions and associated factors, findings from a mixed methods study.

This study explores associated factors and perceptions of oral health among crack users recruited in open drug scenes in Brazil. A mixed methods approach was used. The quantitative component analysed findings from a large (N = 7381), population-based survey. The outcomes under analysis were 'self-perception of oral health' and 'self-reporting of problems affecting the mouth, teeth and gingiva (gums)'. The qualitative component comprised a focus group, with 12 individuals recruited from a drug treatment clinic. Lower self-perception of oral health problems vis-à-vis a higher prevalence of problems affecting the mouth, teeth, and gingiva were found in users who had a lower level of education, used substances daily, had worse self-perception of physical health, did not receive health care and regularly used alcohol and/or tobacco. The results show an association between substance use and decline in oral health, as well as the lack of health services focusing on such issues. Oral health services should be emphasised as a gateway to the health system. So far, the putative cross-referral between services and professionals working in oral health and other health professionals working in the field of drug dependence has not been observed.

Methods for prevention of early childhood caries: Overview of systematic reviews.

Early childhood caries (ECC) is a global problem, disproportionately affecting disadvantaged populations. The aim of this study was to evaluate systematically the available scientific evidence on the effectiveness of methods for ECC prevention. Six electronic databases were searched. Two independent reviewers selected the publications and analysed the quality of the included systematic reviews. Thirteen studies were included. Overall, eight reviews were classified with methodological quality critically low using the AMSTAR 2, whereas five reviews achieved a high risk of bias using the ROBIS tool. The methods identified that were positively related to the prevention of ECC were as follows: preventive dental programmes for pregnant women; advice on diet and feeding; prenatal oral health care; integration of maternal and children's oral health promotion into nursing practice; maternal oral health programmes undertaken by non-dental health professionals; dental health education in combination with the use of fluoride for children; early preventive dental visits; and the use of fluoride varnish and toothpastes with more than 1000 ppm of fluoride. The currently available evidence supporting the effectiveness of methods for prevention of ECC, although suggesting some methods of greater potential, is still lacking due to the methodological quality of the systematic reviews and the included primary studies.

Cross-cultural adaptation of the Dental Neglect Scale for five-year-old children in Brazil

Abstract The aim of this study was to perform a cross-cultural adaptation of the Brazilian version of the Dental Neglect Scale (DNS). The process included (i) Translation; ii) Synthesis; iii) Back translation; (iv) Critical analysis by a committee of experts; (v) Pilot studies (n1=30 + n2=30); and (6) Evaluation and refinement of the instrument. The validated DNS presented a Content Validity Index (CVI) equal to 1.0 for the total score, as well as for each item. In the pilot studies, a minimum agreement level of 80% in understanding was achieved. DNS was properly adapted for Brazilian Portuguese, and it needs further study in a representative sample for reliability and construct validity assessment.

Desafios na implantação do modelo de atenção às condições crônicas na perspectiva de gestores no estado do paraná / Desafíos en la utilización del modelo de atención a las condiciones crónicas en la perspectiva de gestores en el estado de paraná / Challenges in implementing the care model for chronic conditions from the perspective of managers in the state of paraná

RESUMO Objetivo: descrever os enfrentamentos vivenciados pelos profissionais gestores no processo de implantação do Modelo de Atenção às Condições Crônicas no estado do Paraná/Brasil. Método: trata-se de um estudo descritivo com abordagem qualitativa. Foram realizadas entrevistas semiestruturadas, com sete gestores de diferentes instituições públicas que participaram do processo de implantação do Modelo de Atenção às Condições Crônicas. As entrevistas foram realizadas no local de trabalho do entrevistado, gravadas, transcritas e validadas pelos participantes. A coleta de dados ocorreu em agosto de 2018. A análise de dados foi conduzida por meio de análise de conteúdo. Resultados: a análise evidenciou as seguintes categorias de análise: a relevância da capitania dos gestores municipais e estaduais no processo de implantação do modelo; educação permanente como estratégia para a implantação do Modelo de Atenção às Condições Crônicas; e a atenção hospitalar como limitação para as redes de atenção. Considerações finais: a implantação do Modelo de Atenção às Condições Crônicas demanda apoio financeiro e político dos gestores municipais e estaduais, e exige uma equipe multidisciplinar capacitada e motivada para envolver-se no processo de mudança. A região de saúde não conseguiu expandir o Modelo de Atenção às Condições Crônicas no âmbito hospitalar.

RESUMEN Objetivo: describirlos enfrentamientos vividos por los profesionales gestores en el proceso de utilización del Modelo de Atencióna las Condiciones Crónicas en el estado de Paraná/Brasil. Método: se trata de un estudio descriptivo con abordaje cualitativo. Fueron realizadas entrevistas semiestructuradas, con siete gestores de diferentes instituciones públicas que participaron del proceso de utilización del Modelo de Atención a las Condiciones Crónicas. Las entrevistas fueron realizadas en el lugar de trabajo del entrevistado, grabadas, transcriptas y validadas por los participantes. La recolección de datos ocurrió en agosto de 2018. El análisis de datos fue conducido por medio de análisis de contenido. Resultados: el análisis evidenció las siguientes categorías de análisis: la relevancia del comando de los gestores municipales y estatales en el proceso de utilización del modelo; educación permanente como estrategia para la utilización del Modelo de Atención a las Condiciones Crónicas; y la atención hospitalaria como limitación para las redes de atención. Consideraciones finales: la utilización del Modelo de Atención a las Condiciones Crónicas demanda apoyo financiero y político de los gestores municipales y estaduales, y exige un equipo multidisciplinario capacitado y motivado para involucrarse en el proceso de cambios. La regional de salud no consiguió ampliar el Modelo de Atención a las Condiciones Crónicas en elámbito hospitalario.

ABSTRACT Objective: to describe the confrontations experienced by professional managers in the process of implementing the Modelo de Atenção às Condições Crônicas (Care Model for Chronic Conditions) in the state of Paraná/Brazil. Method: this is a descriptive study with a qualitative approach. Semi-structured interviews were carried out with seven managers from different public institutions who participated in the process of implementing the Care Model for Chronic Conditions. The interviews were conducted at the interviewee's workplace, recorded, transcribed, and validated by the participants. Data collection took place in August 2018. Data analysis was performed through content analysis. Results: the analysis showed the following categories of analysis: the relevance of the command of municipal and state managers in the process of implementing the model; permanent education as a strategy for the implementation of the Care Model for Chronic Conditions; and hospital care as a limitation for care networks. Final considerations: the implementation of the Care Model for Chronic Conditions demands financial and political support from municipal and state managers and requires a trained and encouraged multidisciplinary team to be involved in the change process. The health area was unable to improve the Model of Attention to Chronic Conditions in the hospital environment.

Acesso de migrantes haitianos à saúde pública: uma questão bioética / Access of Haitian migrants to public healthcare: a bioethical question / Accesibilidad de los migrantes haitianos a la salud pública: una cuestión bioética

Resumo As vulnerabilidades intrínsecas à migração despertam o olhar bioético no que concerne às iniquidades em saúde, que muitas vezes comprometem o acesso a serviços sanitários. Com isso, esta pesquisa avalia o acesso à saúde de migrantes haitianos, buscando reconhecer situações que geram maior vulnerabilidade, com vistas ao aperfeiçoamento de políticas públicas. O estudo utilizou abordagem qualitativa, coletando dados por meio de grupo focal formado por haitianos de ambos os sexos. Conclui-se que é preciso sensibilizar profissionais de saúde em relação a diferenças culturais, combater a xenofobia e o racismo e conscientizar quanto à vulnerabilidade de migrantes e refugiados. A partir disso, será possível repensar políticas e ações em saúde de modo a alcançar a universalidade, a integralidade e a equidade fomentadas pelo Sistema Único de Saúde.

Abstract The vulnerabilities of migrants arouse the bioethical view of health inequities that often affect the access to health. This research evaluates the access to healthcare of Haitian migrants, recognizing the situations that generate greater vulnerability, aiming at the improvement of public health policies. The study used a qualitative approach by conducting a focus group with adult Haitians of both sexes. We verified the need for raising health professionals' awareness of cultural differences, migrants and refugees' vulnerability and the fight against xenophobia and racism. Only after this it will be possible to rethink health policies and actions to achieve the universality, integrality and equity promoted by the Brazilian Unified Health System.

Resumen Las vulnerabilidades intrínsecas a la migración despiertan la mirada bioética referente a las inequidades en salud, que a menudo comprometen la accesibilidad a los servicios sanitarios. Esta investigación evalúa el acceso a la salud de migrantes haitianos, buscando reconocer cuáles son las situaciones con más vulnerabilidad para el grupo, con miras a mejorar las políticas de salud pública. Se utilizó un enfoque cualitativo mediante la recolección de datos de un grupo focal con haitianos adultos de ambos sexos. Es necesario sensibilizar a los profesionales de la salud en cuanto a las diferencias culturales, al combate a la xenofobia y el racismo, y a la vulnerabilidad de los migrantes y refugiados. Esto posibilita repensar las políticas y acciones en salud para cumplir con el papel de universalidad, integralidad y equidad fomentado por el Sistema Único de Salud brasileño.

Atenção secundária em saúde bucal materno-infantil / Secondary Care in maternal and child oral health

Este artigo apresenta os resultados de análise sobre a atenção secundária em saúde bucal na Rede de Atenção Materno-infantil em 136 municípios no estado do Paraná. Para avaliação do perfil dessa rede foi utilizado o Instrumento de Avaliação de Rede de Atenção Materno-infantil (IARAMI). Os participantes da pesquisa responderam a um questionário composto por 131 perguntas, sendo duas delas sobre saúde bucal. A organização da atenção secundária em saúde bucal foi identificada na maioria dos municípios avaliados (80,80%), porém falta integração com a atenção primária. Dos municípios avaliados apenas 13,13% apresentaram ótima integração entre esses pontos. A atenção à saúde bucal para gestantes e crianças deve ser organizada em redes de atenção integrada para garantir a qualificação da atenção. (AU)

This article presents the results of analysis of secondary care in oral health in the Maternal and Child Care Network in 136 municipalities in the state of Paraná. To evaluate the profile of this network, the Maternal and Child Care Network Assessment Instrument (IARAMI) was used. The participants answered a questionnaire consisting of 131 questions, two of them about oral health. The organization of secondary care in oral health was identified in most municipalities evaluated (80.80%), but there is notintegration with primary care. Of the municipalities evaluated, only 13.13% presented good integration between these points of attention. Oral health care for pregnant women and children should be organized into integrated care networks to ensure the qualification of care. (AU)

The feminization of dentistry and the perceptions of public service users about gender issues in oral health / A feminização da odontologia e as percepções dos usuários do serviço público sobre as questões de gênero em saúde bucal

Abstract It was investigated the perception of service users in relation to the professional practice of dentists, based on gender differences. The Primary Care Assessment Tool (PCATool) was applied to 900 users of the Public Service in Curitiba, PR, Brazil. Sixty clinics were selected using random sampling, divided between conventional Primary Health Care (PHC) Units and PHC with Family Health System Units. The attributes of PHC that compound the PCATool were analyzed. A question was added about user preference regarding the gender of the dental professional, thus generating four dyads derived from user gender/dentist gender (FF, FM, MM, MF). The attributes were linked to the dyads by applying the independent sample t test. Using logistic regression, the dyads were linked to 23 factors relating to scaled-up care in PHC. Many users showed a clear preference for being attended by female dentists. Users who prefer to be cared for by women tend to better evaluate PHC on issues related to "active listening", while those who prefer to be cared for by male dentists highlight the attributes of "care integration" and "community guidance". In other factors and attributes studied, there is no difference between the care given by men or women, regardless the unit.

Resumo Investigou-se a percepção dos usuários do serviço quanto à prática profissional dos dentistas, com base em diferenças de gênero. O Primary Care Assessment Tool (PCATool) foi aplicado a 900 usuários do Serviço Público de Curitiba, PR, Brasil. Sessenta clínicas odontológicas foram selecionadas usando amostragem aleatória, divididas entre unidades de Atenção Primária à Saúde (APS) convencional e unidades de APS com Estratégia Saúde da Família. Os atributos da APS no PCATool foram analisados. Uma questão foi adicionada acerca da preferência do usuário em relação ao gênero do dentista, gerando quatro díades derivadas da combinação do gênero do usuário/gênero do dentista (FF, FM, MM, MF). Os atributos foram ligados às díades pelo teste t para amostras independentes. Por regressão logística, as díades foram relacionadas a 23 fatores referentes aos cuidados ampliados na APS. Muitos usuários mostraram preferência por dentistas mulheres. Esses tendem a avaliar melhor os cuidados de saúde primários quanto à "escuta ativa e qualificada", enquanto aqueles que preferem ser atendidos por homens destacam os atributos de "integração do cuidado" e "orientação comunitária". Em outros fatores e atributos estudados, não há diferença entre o atendimento prestado por homens ou mulheres, independentemente da unidade.

The feminization of dentistry and the perceptions of public service users about gender issues in oral health.

It was investigated the perception of service users in relation to the professional practice of dentists, based on gender differences. The Primary Care Assessment Tool (PCATool) was applied to 900 users of the Public Service in Curitiba, PR, Brazil. Sixty clinics were selected using random sampling, divided between conventional Primary Health Care (PHC) Units and PHC with Family Health System Units. The attributes of PHC that compound the PCATool were analyzed. A question was added about user preference regarding the gender of the dental professional, thus generating four dyads derived from user gender/dentist gender (FF, FM, MM, MF). The attributes were linked to the dyads by applying the independent sample t test. Using logistic regression, the dyads were linked to 23 factors relating to scaled-up care in PHC. Many users showed a clear preference for being attended by female dentists. Users who prefer to be cared for by women tend to better evaluate PHC on issues related to "active listening", while those who prefer to be cared for by male dentists highlight the attributes of "care integration" and "community guidance". In other factors and attributes studied, there is no difference between the care given by men or women, regardless the unit.

Self-Perception of Gerontoism according to Social Support and Family Functionality.

BACKGROUND: The gerontoism, a neologism adopted here, is a form of discrimination regarding age and can occur in rational, emotional, and behavioral contexts, and could be influenced by many factors. This study aimed to identify if the social support and the family functionality interfere in the self-perception of gerontoism. METHODS: Participants were 376 elderly in good physical and mental condition. They participated in the Group Living organization in the Municipality of Curitiba, State of Paraná, Brazil, in 2012. Information was collected about sociodemographic profile using a structured questionnaire. The social support, the family functionality, and the self-perception of gerontoism were defined by the Medical Outcomes Study, the Family APGAR index, and Ageism Survey, respectively. The variables were analyzed by Pearson's correlation coefficient, One Way ANOVA, Tukey's HSD test, and the Student's t-test. RESULTS: Most of the participants came from small cities from the interior (48.7%), were female (94.4%), with age ranging 60-69 yr-old (45.5%), whites (76.1%), widowers (47.1%), with children (93.9%), with low schooling (55.3%), with family income from 1-2 minimum wage (31.4%), and retirees not working (44.1%). It was not observed correlation between sociodemographic variables and self-perception of gerontoism. Statistical significance was observed between self-perception of gerontoism and social support (r= -0.26, P=0.00), and between the self-perception and family functionality (r = -0.28, P=0.00). Once the scores of self-perception of gerontoism increased, the ones from social support and family functionality, decreased. CONCLUSION: Lower self-perception of gerontoism was observed in elderly with higher social support and family functionality.

Curitiba Statement on Health Promotion and Equity: voices from people concerned with global inequities.

This Statement represents the voice of participants in the 22nd IUHPE World Conference on Health Promotion, held in Curitiba, Brazil, in May 2016. The Brazilian political context at that time greatly influenced the drafting of the Curitiba Statement, which was considered by many participants as an opportunity to categorically express that Brazilian democracy was threatened, as well as the danger of fiscal austerity implemented by many governments of the world. The conference organizers also perceived the launching of this Statement as an opportunity to influence the WHO Shanghai Declaration, since it very strongly stated the influence of commercial interests and corporate practices of the market that are harmful to health. The Curitiba Statement gathers 120 suggestions made by conference participants and focuses on how strengthening health promotion and equity can improve people's lives. The 21 recommendations were summarized and resulted in appeals to International Organizations, all levels of Governments, Health Sector, Citizens, Health Professionals and Researchers. Unlike a declaration from government summit that are restricted by governments negotiations from different ideological spectrum, the Curitiba Statement was developed in a free environment to foster professional activism. We reaffirm that the objectives of Health Promotion in the Sustainable Development will only be fully achieved by incorporating these four fundamental principles: democracy, social justice, social mobilization and equity. Health Promotion in the twenty-first century needs new narratives and inputs from professional associations, which can be more assertive and to influencing the official declarations of government.

Exploring challenges, threats and innovations in global health promotion.

Global health faces a broad spectrum of old and new challenges. Besides epidemiological problems, political conflicts, economic crisis and austerity policies are jeopardizing progress towards Universal Health Coverage (UHC), affecting the most vulnerable populations. During the 22nd International Union for Health Promotion and Education (IUHPE) World Conference on Health Promotion held in Curitiba, Brazil, in 2016, challenges and threats for global health, in addition to a wide range of innovative experiences in health promotion, were discussed with participants from 65 countries. At the end of the conference, a public statement was approved claiming for Democracy and Human Rights in all countries around the world as essential conditions for the promotion of health and equity. In this paper, we explore challenges, threats and innovations in global health promotion. We use scientific literature, analysis of the current situation of the Brazilian health system, and material presented during the 22nd IUHPE World Conference. Also, we discuss strategies to strengthen health systems, policies and practices through the approach of STI and illustrative local experiences presented at the congress mentioned above, including examples developed in the city of Curitiba. We conclude that STI is crucial to support strengthening local health systems, design effective intersectoral public policies, scaling up innovative initiates, and skilling staff in addressing the contemporary challenges. Finally, the Declaration of the 22nd World Conference on Health Promotion of the IUHPE is a fundamental policy statement based on the prioritization of democracy and human rights as essential conditions for the promotion of health and equity.

Training and evaluation of professors of dentistry in postgraduate programmes in Brazil.

INTRODUCTION: In Brazil, the undergraduate dental education still remains fragmented and dissociated from its social context, with emphasis on the individualistic and private aspects of dental health. This study aimed to analyze the training and development of university professors of dentistry in stricto sensu postgraduate programs in Brazil. MATERIALS AND METHODS: Delphi electronic methodology was used within a qualitative-quantitative design to gather data from a panel of 58 experts. Discussions representing the analytic axis focused on: (i) the evaluative processes of higher education, in particular stricto sensu postgraduate programs, and their influence on academic activities in undergraduate dentistry courses and (ii) policies for training and developing university professors. RESULTS: Of the experts, 30 participated in the first round, 24 in the second, and 19 in the third. They considered the training of university professors in dentistry to be highly specialized and technologically focused and indicated the review of political-pedagogic aspects of the educational sphere, as well as the social, economic, cultural, epidemiologic, and professional aspects of training and preparation prescribed by the National Curricular Guides for graduate courses in dentistry. An adequate process of evaluating the official organs and regulators of postgraduate stricto sensu programs, as well the programs themselves, should be implemented. CONCLUSION: The experts stated that changes to the university teaching system are necessary, even in the field of dentistry. Mechanisms for evaluating areas and professors were inadequate, and the training was overly specialized and not consistent with the social reality of the country.

Assessment of public oral healthcare services in Curitiba, Brazil: a cross-sectional study using the Primary Care Assessment Tool (PCATool).

OBJECTIVES: To compare two different models of public oral health in primary care services, a so-called family health strategy (FHS), as opposed to non-FHS services designated as 'conventional' healthcare (CHC), regarding the presence and extent of the attributes of 'good' primary healthcare (PHC). The null hypothesis of this study is that the attributes do not differ between the FHS and CHC. DESIGN: Cross-sectional. SETTING: Public PHC services in Curitiba, the state capital of Paraná. PARTICIPANTS: PHC users of the public oral health network (n=900) and dentists active in this municipal network (n=203). PRIMARY AND SECONDARY OUTCOME MEASURES: The Primary Care Assessment Tool (PCATool)-Dentists and PCATool-Users were used to analyse the primary outcomes ('essential' attributes) and secondary outcomes ('derived' attributes) in the PHC. RESULTS: Overall, the primary care services in oral health were well evaluated, both by users and by dentists, with mean scores ascribed to PHC attributes mostly above the cut-off point (6.6). The exception for users were affiliation (6.36; 95% CI 6.11 to 6.60) and accessibility (5.83; 95% CI 5.78 to 5.89); and for dentists the accessibility (5.80; 95% CI 5.63 to 5.96). When comparing FHS and CHC, there was a superiority of the FHS model, which reached a general mean score of 7.53 (95% CI 7.48 to 7.58) among users and 7.56 (95% CI 7.45 to 7.67) among dentists; on the other hand, the CHC general mean score was of 6.61 (95% CI 6.49 to 6.73) and 6.68 (95% CI 6.56 to 6.80) respectively for users and dentists. CONCLUSIONS: The results reveal a reasonable level of attainment of PHC attributes in the services investigated. Nevertheless, public health managers should make efforts to reduce the difficulties faced by users in accessing dental care. The more positive results achieved by FHS services indicate that the provision of oral healthcare under this strategy should be expanded.

Redes sociales en la producción científica en administración pública de la salud en Brasil / Social Networks in the scientific production on public health administration in Brazil / Redes sociais na produção científica em administração pública da saúde no brasil

Resumo A reforma administrativa no Brasil, iniciada com a Constituição de 1988, permitiu a efetivação de políticas públicas descentralizadas, incluindo a municipalização do setor saúde e participação popular. Objetivando apreender como essas mudanças democráticas ecoaram na literatura internacional, o artigo analisou a produção científica da administração pública da saúde no Brasil, adotando o estudo de redes sociais. A pesquisa foi feita na base do Web of Science, utilizando termos relacionados com administração, delimitada por "Brazil" e "health", e softwares auxiliares BibExcel e Ucinet. A rede de publicações da administração se mostrou coesa, com práticas de democracia deliberativa e participação social. Ao incluir o termo "saúde", houve maior variação de temas, com destaque para a Reforma Sanitária e descentralização do Sistema Único de Saúde, de forma crítica e reflexiva, e notada ausência do controle social.

Resumen La reforma administrativa en Brasil, iniciada con la Constitución de 1988, permitió la efectuación de políticas públicas descentralizadas, tales como la municipalización del área de salud previendo mayor abertura para la participación popular. Objetivando aprehender como la efectuación de esos cambios tuvo eco en la literatura internacional, el presente artículo analizó la producción científica a respecto de la administración pública de la salud en Brasil, adoptando el estudio de redes sociales. La investigación se realizó con base en la Web of Science, utilizando los términos relacionados a la administración, delimitada por "Brazil" y "health", y los programas BibExcel e Ucinet. La red de publicaciones de la administración se mostró coherente, conteniendo prácticas de democracia deliberativa y participación social. Al incluir el término "salud", hubo una mayor variación de temas, con destaque para la Reforma Sanitaria Brasileña y la descentralización del Sistema Único de Salud, con enfoque más crítico y reflexivo, e importante laguna relativa al control social.

Abstract The Brazilian administrative reform was included in the 1988 Constitution, and it has promoted decentralized policies, including the municipalization of health and popular participation. The objective of this article is to understand how the implementation of these democratic changes were studied in the international literature. The scientific production on Brazilian public health administration was analyzed by studying social networks. The search was conducted in the Web of Science database, using administration terms, delimited by "Brazil" and "health," and using BibExcel and Ucinet software. The network of publications in administration was cohesive, containing practices of deliberative democracy and social participation. By including the term "health," more variations were found, particularly on the Brazilian Health Reform and on the decentralization of the National Health System, with a more critical and reflexive focus, albeit with a clear gap on social accountability.

Noncommunicable diseases and their common risk factors in Curitiba, Brazil: results of a cross-sectional, population-based study

[ABSTRACT]. Objective. To describe the estimated prevalence of noncommunicable diseases and their common risk factors among the adult population of Curitiba, Paraná, Brazil, based on results of the EPIdemiology of CURitiba: EvaluAtion of Noncommunicable diseases (EPICUREAN) study. Methods. This was a cross-sectional, population-based survey of 1 103 residents of Curitiba, grouped by age (18 – 39 years of age, 40 – 59, and ≥ 60 years), conducted in August 2013 – August 2014. Household interviews, anthropometry, blood pressure measurements, and fasting capillary glycemia were performed during two visits to each participant. The analyses included frequency distribution and prevalence estimates of main outcomes. Prevalence estimates, weighted by age and sex, were presented as absolute numbers and percentages. Results. Prevalence estimates for self-reported depression were 21.2%; hypertension, 31.2%; diabetes, 9.1%; self-reported dyslipidemia, 21.7%; obesity, 21.2%; current smoking, 16.1%; binge drinking, 23.4%; and insufficient physical activity, 35.1%. Prevalences of diabetes and hypertension were higher among individuals with less schooling and the elderly. Binge drinking and leisure-time physical activity were more prevalent in young adults. Men presented higher prevalences of overweight, current smoking, and harmful use of alcohol. Obesity and moderate- to-severe risk of depression were more frequent among women and those with lower income. Conclusions. The prevalence of NCDs and common risk factors among the adult population of Curitiba are high and reveal a gradient of vulnerabilities by age, sex, education level, and income. To address health inequities and meet the needs of different population groups, the health system should monitor NCDs and risk factors and implement equitable public health policies.

[RESUMEN]. Objetivo. Describir la prevalencia estimada de las enfermedades no transmisibles (ENT) y sus factores de riesgo comunes en los habitantes adultos de Curitiba (Paraná, Brasil), con base en los resultados del estudio sobre las características epidemiológicas de Curitiba en el que se evaluaron las ENT (conocido como EPICUREAN por su acrónimo en inglés). Métodos. Encuesta transversal, basada en la población, de 1 103 habitantes de Curitiba, agrupados por edades (de 18 a 39 años, de 40 a 59 años y de 60 años en adelante), efectuada entre agosto del 2013 y agosto del 2014. Se realizaron entrevistas domiciliarias, antropometría y mediciones de presión arterial y glucemia capilar en ayunas en dos visitas a cada participante. Los análisis incluyeron distribución de frecuencias y cálculos de prevalencia de los principales resultados. Los cálculos de prevalencia, ponderados por edad y sexo, se presentaron como números absolutos y porcentajes. Resultados. Las cifras de prevalencia de la depresión autonotificada fueron de 21,2%; hipertensión, 31,2%; diabetes, 9,1%; dislipidemia autonotificada, 21,7%; obesidad, 21,2%; consumo actual de tabaco, 16,1%; consumo compulsivo de bebidas alcohólicas, 23,4%; y actividad física insuficiente, 35,1%. La prevalencia de la diabetes y la hipertensión fue mayor en las personas con menor escolaridad y las de edad avanzada. El consumo compulsivo de bebidas alcohólicas y la actividad física en el tiempo libre fueron más prevalentes en los adultos jóvenes. Los hombres presentaron prevalencias más altas de consumo de tabaco, sobrepeso y consumo nocivo de alcohol. La obesidad y el riesgo de moderado a grave de depresión fueron más frecuentes en las mujeres y las personas de menores ingresos. Conclusiones. La prevalencia de las ENT y los factores de riesgo comunes entre los habitantes adultos de Curitiba es alta y muestra un gradiente de vulnerabilidad por edad, sexo, nivel educativo e ingresos. Para abordar las inequidades en materia de salud y satisfacer las necesidades de diferentes grupos de población, el sistema de salud debe vigilar las ENT y sus factores de riesgo, y ejecutar políticas de salud pública equitativas.

[RESUMO]. Objetivo. Descrever a prevalência estimada de doenças não transmissíveis e principais fatores de risco associados na população adulta da cidade de Curitiba (PR), Brasil, de acordo com os resultados do estudo EPIdemiology of CURitiba: EvaluAtion of Noncommunicable diseases (EPICUREAN). Métodos. Foi realizado estudo transversal de base populacional com 1.103 residentes da cidade de Curitiba, por faixas etárias (18–39, 40–59 e ≥60 anos), em agosto de 2013 a agosto 2014. Foram conduzidas entrevistas domiciliares com medidas antropométricas e de pressão arterial e teste da glicemia capilar de jejum em duas visitas a cada participante. Foi analisada a distribuição da frequência e estimada a prevalencia dos principais desfechos. As estimativas de prevalência, ponderadas por idade e sexo, foram apresentadas como números absolutos e porcentagens. Resultados. Foram obtidas as seguintes estimativas de prevalência: 21,2% para depressão autorreferida, 31,2% para hipertensão, 9,1% para diabetes, 21,7% para dislipidemia autorreferida, 21,2% para obesidade, 16,1% para tabagismo atual, 23,4% para uso excessivo de álcool e 35,1% para nível insuficiente de atividade física. A prevalencia de diabetes e hipertensão foi maior nos indivíduos com menor escolaridade e idosos. O uso excessivo de álcool e atividade física no lazer foram mais prevalentes em jovens adultos. Os indivíduos do sexo masculino apresentaram prevalência mais elevada de sobrepeso, tabagismo atual e uso prejudicial de álcool. Obesidade e risco moderado a grave de depressão foram mais frequentes no sexo feminino e em indivíduos de baixa renda. Conclusões. Existe alta prevalência de doenças não transmissíveis e dos principais fatores de risco na população adulta de Curitiba, demonstrando um gradiente de vulnerabilidade por idade, sexo, nível de escolaridade e renda. Para abordar as iniquidades em saúde e suprir as necessidades dos diferentes grupos populacionais, o sistema de saúde deve monitorar as doenças não transmissíveis e os fatores de risco e implementar políticas de saúde pública equitativas.

Neck Circumference and its Correlation to Other Anthropometric Parameters and Finnish Diabetes Risk Score (FINDRISC).

BACKGROUND: The Neck Circumference (NC) is an anthropometric measure to evaluate obesity. The FINDRISC predicts the risk of developing type 2 diabetes mellitus. Our aims were to identify the mean value of NC in individuals with higher (≥15 points) and lower FINDRISC and to establish cutoff values that indicate individuals with higher FINDRISC. METHODS: It is a population-based, cross-sectional study representative of the city of Curitiba, Brazil. We studied individuals (>18 years), without diabetes mellitus, between August 2013 and August 2014. We evaluated anthropometric parameters, glycaemia, socioeconomic situation, chronic conditions, and their risk factors. In a sex-specific analysis, data are presented as mean and standard deviation. We performed Pearson's and Spearman's correlation between NC and the waist circumference, body mass index and FINDRISC. Receiver Operating Characteristic curves were estimated for NC and higher FINDRISC. Logistic regression models were built to analyze the association between higher FINDRISC and 1-SD increase in NC. RESULTS: We studied 950 individuals (621 women) with a mean age of 47.4 ± 17.6 years and body mass index of 26.2 ± 5.6 kg/m2. The mean NCs were 34.1 ± 3.1 cm in women and 38.2 ± 3.5 cm in men. Mean NC was lower in women (33.7 ± 2.9 cm vs. 35.8 ± 3.2 cm) and men (37.7 ± 3.4 cm vs. 41 ± 3.6 cm) with lower FINDRISC (p <0.001). All the correlations with NC were significant (p ≤ 0.001). The area under the curve for NC and the higher FINDRISC was 0.702 (95% CI 0.653 - 0.752) for women and 0.762 for men (95% CI 0.679 - 0.845), determining the best cutoff value of 34.5 cm for women and 39.5 cm for men to discriminate individuals with higher FINDRISC. Fully adjusted odds ratios for higher FINDRISC per 1-SD increase in NC in women and men were, respectively 1.89 (95% CI 1.53 - 2.33) and 2.86 (95% CI 1.91 - 4.29). CONCLUSION: NC is positively correlated to the body mass index, waist circumference, glycaemia, and FINDRISC scores in a population-based sample of adults. We identified the mean values of NC in higher and lower FINDRISC and established cutoff values for NC and higher FINDRISC.

Noncommunicable diseases and their common risk factors in Curitiba, Brazil: results of a cross-sectional, population-based study.

OBJECTIVE: To describe the estimated prevalence of noncommunicable diseases and their common risk factors among the adult population of Curitiba, Paraná, Brazil, based on results of the EPIdemiology of CURitiba: EvaluAtion of Noncommunicable diseases (EPICUREAN) study. METHODS: This was a cross-sectional, population-based survey of 1 103 residents of Curitiba, grouped by age (18 - 39 years of age, 40 - 59, and ≥ 60 years), conducted in August 2013 - August 2014. Household interviews, anthropometry, blood pressure measurements, and fasting capillary glycemia were performed during two visits to each participant. The analyses included frequency distribution and prevalence estimates of main outcomes. Prevalence estimates, weighted by age and sex, were presented as absolute numbers and percentages. RESULTS: Prevalence estimates for self-reported depression were 21.2%; hypertension, 31.2%; diabetes, 9.1%; self-reported dyslipidemia, 21.7%; obesity, 21.2%; current smoking, 16.1%; binge drinking, 23.4%; and insufficient physical activity, 35.1%. Prevalences of diabetes and hypertension were higher among individuals with less schooling and the elderly. Binge drinking and leisure-time physical activity were more prevalent in young adults. Men presented higher prevalences of overweight, current smoking, and harmful use of alcohol. Obesity and moderate- to-severe risk of depression were more frequent among women and those with lower income. CONCLUSIONS: The prevalence of NCDs and common risk factors among the adult population of Curitiba are high and reveal a gradient of vulnerabilities by age, sex, education level, and income. To address health inequities and meet the needs of different population groups, the health system should monitor NCDs and risk factors and implement equitable public health policies.