Patellofemoral pain syndrome in children and adolescents: A cross-sectional study.

OBJECTIVES: To assess the prevalence and associated factors of Patellofemoral Pain Syndrome (PFPS) in children and adolescents. METHOD: A population-based cross-sectional study was conducted with children and adolescents aged 10 to 18 years, who presented a history of peripatellar and/or retropatellar pain, attending elementary or high school in urban public schools in Natal, Brazil. The sample size was calculated based on a minimum outcome prevalence of 22%. RESULTS: A prevalence of 24.7% of PFPS was found. There was a positive association of PFPS with active students (p < 0.01; PR: 2.5; CI: 1.4-4.5), low functional capacity (p < 0.01; PR: 8.0; CI: 5.0-12.8), and those classified as pubertal (p < 0.03; PR: 1.8; CI: 1.0-3.2). CONCLUSION: There was a considerable prevalence of PFPS in children and adolescents, as well as an association between the level of sexual maturation and adjustable determinants, such as the level of physical activity and low functional capacity in this group.

Indices for measurement of sustainable diets: A scoping review.

INTRODUCTION: The current food system is associated with negative impacts on health, food insecurity and environmental harm. Sustainable diets have attracted increasing interest and novel proposals with a global scope have emerged. This scoping review aims to give an overview of the analysis of all the available evidence related to the sustainable diet indices that have been developed based on the EAT-Lancet Commission. METHODS: Searches were conducted in the PubMed, Embase, Web of Science, Scopus and Science Direct databases. This review was conducted following the PRISMA-ScR guidelines. The target population were studies addressed the use of an index or metric for assessing sustainable diets based on the EAT-Lancet Commission Summary Report were included. PCC acronym was used in the design of the study to describe eligibility criteria: P (Population)-Indexes; C (Concept)-Sustainable diets; C (Context)-Knowledge on the structure and applicability of measurement indices of sustainable diets based on EAT-Lancet recommendations available in the literature. Study eligibility criteria were restricted to papers published in English, from January 2019 through October 2022, with no population restriction. RESULTS: A total of 1,458 papers were retrieved, 14 of which were included in the review. Seven measures of sustainable diets were identified as follow: EAT-Lancet diet score (ELD-I), New EAT-Lancet diet score (EAT), Planetary Health Diet Index (PHDI), Sustainable Diet Index (SDI), Sustainable-HEalthy-Diet (SHED), novel Nutrient-Based EAT index (NB-EAT) and World Index for Sustainability and Health (WISH). Most studies were conducted in developed countries, where greater adherence to this type of diet was found. Estimated greenhouse gas emissions was the most reported indicator of sustainability, followed by diet quality and the benefits of sustainable diets with regards to health outcomes. DISCUSSION: We identified barriers that hinder progress towards sustainable diets, including the difficulty of comparing different indices and the tendency to neglect social aspects and the lack of common definitions and metrics. Despite being challenge, we highlight the importance of using indices that assess sustainable diets that harmonize various indicators, as recommended by the EAT-Lancet Commission, in order to promote positive changes towards a more sustainable future.

Factor analysis and cronbach's alpha for studying the knowledge of adolescents on HIV/AIDS: a construct validation study

To analyze the efficacy and psychometric properties of the Knowledge, Attitudes, and Practices Questionnaire when applied to adolescents. It was a cross-sectional construct validation study. Ten questions on the knowledge of HIV/AIDS were selected from the questionnaire for further data analysis and applied to 623 adolescents attending high school. The Statistical Package for the Social Sciences (SPSS) 25.0™ and Stata 14.0 software processed the data. Cronbach's Alpha verified the reliability of items, and the mean of each value ranged from 0.198 to 0.379. Factor analysis assessed the structure of correlations between variables. The resulting factors were lifestyle/habits, preventive actions, and endogenous and exogenous transmission. The scale was reliable for the studied population, ensuring the quality of the instrument.

Dietary and Nutritional Profiles among Brazilian Adolescents.

(1) Background: The present study analyzed the prevalence of dietary and nutritional profiles among Brazilian adolescents and their associations with social determinants of health. (2) Methods: A population-based survey was administered to 16,409 adolescents assessed by the 2015 National School Health Survey. A multivariate model of dietary and nutritional profiles was estimated from correspondence analysis. (3) Results: The dietary and nutritional profiles more prevalent among Brazilian adolescents were "lower nutritional risk dietary pattern and eutrophic" (42.6%), "lower nutritional risk dietary pattern and overweight" (6.8%), and "higher nutritional risk dietary pattern and overweight" (6.0%). Healthier profiles were associated with less urbanized territories, health-promoting behaviors, and families with worse material circumstances. The less healthy profiles were associated with more urbanized environments, health risk behaviors, and families with better material circumstances. (4) Brazilian adolescents have different dietary and nutritional profiles that are characterized by sociopolitical and economic contexts, family material and school circumstances, and the behavioral and psychosocial health factors of the individuals. All of this points to the social determination of these health problems among adolescents in Brazil.

Social Determinants of Obesity and Stunting among Brazilian Adolescents: A Multilevel Analysis.

(1) Background: The purpose of this study was to identify the prevalence of obesity and stunting among Brazilian adolescents and its associations with social determinants of health (individual, family, and school), grounded on the necessity of investigating the determinants of nutritional problems within this population. (2) Methods: A population-based survey was administered to 16,556 adolescents assessed by the 2015 National School Health Survey. Multivariate models of obesity and stunting were estimated from Multilevel Poisson Regressions. (3) Results: The prevalence of obesity among Brazilian adolescents (10.0%; 95% CI: 9.4-10.6) was associated directly with indifference or dissatisfaction with body image, with eating breakfast four or fewer days a week, living with up to four people in the household, studying in private schools, and being from the South region, and was inversely associated with being female, 15 years old or older, with having the highest nutritional risk eating pattern, dining at fast-food restaurants, and eating while watching television or studying. The prevalence of stunting (2.3%; 95% CI: 2.0-2.8) was directly associated with the age of 15 years or older, and inversely associated with the lower number of residents living in the household, maternal education-decreasing gradient from literate to college level education, studying in urban schools, and being from the South and Central-West regions. (4) Conclusions: Obesity in adolescence presented behavioral determinants. Stunting and obesity have structural social determinants related, respectively, to worse and better socioeconomic position among Brazilian adolescents.

Social determinants of health associated with the experience of hunger among Brazilian adolescents. / Determinantes sociais em saúde associados à vivência da fome entre adolescentes do Brasil.

The aim of this study was to identify social determinants of health associated with the experience of hunger among school-age adolescents in Brazil. We conducted a cross-sectional study with a sample of 16,526 adolescents using data from the 2015 National School-based Student Health Survey. Experience of hunger was determined based on the answer to the question "In the last 30 days, how often have you been hungry because there wasn't enough food at home?" The social determinants of health were analyzed using Poisson regression with robust variance. The prevalence of the experience of hunger was 22.8% (95%CI: 21.9-23.7). The experience of hunger was directly associated with being male (PR = 1.12; 95%CI: 1.07-1.16); not being overweight (PR = 1.08; 95%CI: 1.04-1.13 ); irregular consumption of beans (PR = 1.20; 95%CI: 1.13-1.26), vegetables (PR=1.16; 95%CI: 1.09-1.22) and fruit (PR = 1.19; 95%CI: 1.13-1.24); body dissatisfaction (PR = 1.26; 95%CI: 1.18-1.35); and not regularly eating lunch or dinner with parents or guardians (PR = 1.41; 95%CI: 1.32-1.52). An inverse association was found between the experience of hunger and maternal education level and living in the Mid-West, Southeast and South. The findings show that the experience of hunger among Brazilian adolescents coexists with risky eating behaviors, body dissatisfaction, and social inequality.

Objetivou-se identificar determinantes sociais em saúde associados à vivência da fome entre adolescentes escolares brasileiros. Foi realizado um estudo transversal com microdados de 16.526 adolescentes da Pesquisa Nacional de Saúde do Escolar 2015. A vivência da fome foi estimada considerando a frequência com que o adolescente havia ficado com fome por não ter comida suficiente em casa no mês anterior à pesquisa. Para a análise dos determinantes sociais em saúde foi realizada Regressão de Poisson com variância robusta. Verificou-se, no Brasil, que a vivência da fome foi de 22,8% (IC95%: 21,9-23,7) entre adolescentes. Essa associou-se diretamente ao sexo masculino (RP=1,12; IC95%: 1,07-1,16), a não ter excesso de peso (RP=1,08; IC95%: 1,04-1,13), ao consumo irregular de feijão (RP=1,20; IC95%: 1,13-1,26), de legumes e verduras (RP=1,16; IC95%: 1,09-1,22) e de frutas (RP=1,19; IC95%: 1,13-1,24), à insatisfação corporal (RP=1,26; IC95%: 1,18-1,35) e ao consumo irregular de almoço ou jantar com os responsáveis (RP=1,41; IC95%: 1,32-1,52); e inversamente ao gradiente de escolaridade materna, e às macrorregiões do complexo Centro-Sul. Os resultados indicam a coexistência da fome, comportamentos alimentares de risco nutricional, insatisfação corporal e condições de iniquidade social entre adolescentes brasileiros.

Determinantes sociais em saúde associados à vivência da fome entre adolescentes do Brasil / Social determinants of health associated with the experience of hunger among Brazilian adolescents

Resumo Objetivou-se identificar determinantes sociais em saúde associados à vivência da fome entre adolescentes escolares brasileiros. Foi realizado um estudo transversal com microdados de 16.526 adolescentes da Pesquisa Nacional de Saúde do Escolar 2015. A vivência da fome foi estimada considerando a frequência com que o adolescente havia ficado com fome por não ter comida suficiente em casa no mês anterior à pesquisa. Para a análise dos determinantes sociais em saúde foi realizada Regressão de Poisson com variância robusta. Verificou-se, no Brasil, que a vivência da fome foi de 22,8% (IC95%: 21,9-23,7) entre adolescentes. Essa associou-se diretamente ao sexo masculino (RP=1,12; IC95%: 1,07-1,16), a não ter excesso de peso (RP=1,08; IC95%: 1,04-1,13), ao consumo irregular de feijão (RP=1,20; IC95%: 1,13-1,26), de legumes e verduras (RP=1,16; IC95%: 1,09-1,22) e de frutas (RP=1,19; IC95%: 1,13-1,24), à insatisfação corporal (RP=1,26; IC95%: 1,18-1,35) e ao consumo irregular de almoço ou jantar com os responsáveis (RP=1,41; IC95%: 1,32-1,52); e inversamente ao gradiente de escolaridade materna, e às macrorregiões do complexo Centro-Sul. Os resultados indicam a coexistência da fome, comportamentos alimentares de risco nutricional, insatisfação corporal e condições de iniquidade social entre adolescentes brasileiros.

Abstract The aim of this study was to identify social determinants of health associated with the experience of hunger among school-age adolescents in Brazil. We conducted a cross-sectional study with a sample of 16,526 adolescents using data from the 2015 National School-based Student Health Survey. Experience of hunger was determined based on the answer to the question "In the last 30 days, how often have you been hungry because there wasn't enough food at home?" The social determinants of health were analyzed using Poisson regression with robust variance. The prevalence of the experience of hunger was 22.8% (95%CI: 21.9-23.7). The experience of hunger was directly associated with being male (PR = 1.12; 95%CI: 1.07-1.16); not being overweight (PR = 1.08; 95%CI: 1.04-1.13 ); irregular consumption of beans (PR = 1.20; 95%CI: 1.13-1.26), vegetables (PR=1.16; 95%CI: 1.09-1.22) and fruit (PR = 1.19; 95%CI: 1.13-1.24); body dissatisfaction (PR = 1.26; 95%CI: 1.18-1.35); and not regularly eating lunch or dinner with parents or guardians (PR = 1.41; 95%CI: 1.32-1.52). An inverse association was found between the experience of hunger and maternal education level and living in the Mid-West, Southeast and South. The findings show that the experience of hunger among Brazilian adolescents coexists with risky eating behaviors, body dissatisfaction, and social inequality.

Redução do déficit de estatura e a compra de alimentos da agricultura familiar para alimentação escolar no Brasil / Reduction of stature deficit and purchase of family agriculture produce for school meals in Brazil / Reducción del déficit de estatura y de la agricultura familiar en la alimentación escolar en Brasil

O objetivo do artigo é analisar o efeito da compra direta de alimentos da agricultura familiar para alimentação escolar sobre o déficit de estatura em crianças menores de cinco anos, entre 2013 e 2017, no Brasil. O método utilizado é o estudo ecológico e longitudinal, em que a coleta de dados ocorreu em diferentes bancos de dados. A análise foi realizada por meio do teste t para amostras independentes, a fim de comparar as médias entre as variáveis déficit de estatura e compras da agricultura familiar. Além disso, uma análise multivariável foi feita por meio da regressão linear múltipla. Verificou-se uma diferença de médias na prevalência do déficit de estatura significativa entre os municípios que compraram menos de 30% e aqueles que adquiriram 30% ou mais de alimentos da agricultura familiar para alimentação escolar, com 1,47 pontos de diferença. O modelo de regressão linear mostrou que a cada ponto percentual de aumento na compra de alimentos da agricultura familiar para a alimentação escolar pelo município, haverá, em média, uma diminuição 0,55 pontos na prevalência do déficit de estatura, independentemente das demais variáveis. Assim, conclui-se que a compra de alimentos da agricultura familiar para alimentação escolar no Brasil pode contribuir para a redução da prevalência do déficit de estatura em crianças menores de cinco anos.

The objective of this work is to analyze the effect of direct purchase of food from family farms for school meals on the deficit of stature in children under 5 years of age between 2013 and 2017 in Brazil. Method: Ecological and longitudinal study in which data collection occurred in different databases. The analysis was performed using the t-test for independent samples in order to compare the means between the variables stature deficit and purchases from family agriculture. In addition, a multivariable analysis was conducted through multiple linear regression. Results: There was a difference in means in the prevalence of significant stature deficit between the municipalities that bought < 30% and ≥30% of food from family farms for school feeding, with 1.47 points of difference. The linear regression model showed that for each percentage point of increase in the purchase of food from family farms for school feeding by the municipality, there will be on average a decrease of 0.55 points in the prevalence of stature deficit, independent of the other variables. Conclusion: the purchase of food from family agriculture for school feeding in Brazil may contribute to the reduction of the prevalence of stature deficit in children under five years old.

Objetivo: Analizar el efecto de la compra directa de alimentos de las granjas familiares para la alimentación escolar en el déficit de estatura de los niños menores de cinco años entre 2013 y 2017 en Brasil. Método: Estudio ecológico y longitudinal en el que se recogieron datos en diferentes bases de datos. El análisis se llevó a cabo mediante la prueba t para muestras independientes con el fin de comparar las medias entre las variables déficit de estatura y compras de la agricultura familiar. Además, se hizo un análisis multivariable a través de una regresión lineal múltiple. Resultados: Se produjo una diferencia de medias en la prevalencia del déficit de estatura significativo entre los municipios que compraron < 30% y ≥ 30% de los alimentos de las granjas familiares para la alimentación escolar, con 1,47 puntos de diferencia. El modelo de regresión lineal mostró que por cada punto porcentual de aumento en la compra de alimentos de las granjas familiares para la alimentación escolar por parte del municipio, habrá, en promedio, una disminución de 0,55 puntos en la prevalencia del déficit de estatura, independientemente de las demás variables. Conclusión: la compra de alimentos de las granjas familiares para la alimentación escolar en el Brasil puede contribuir a reducir la prevalencia del déficit de estatura en los niños menores de cinco años.

COVID-19 in Brazilian cities: Impact of social determinants, coverage and quality of primary health care.

BACKGROUND: Brazil, as many other countries, have been heavily affected by COVID-19. This study aimed to analyze the impact of Primary health care and the family health strategy (FHS) coverage, the scores of the National Program for Improving Primary Care Access and Quality (PMAQ), and socioeconomic and social indicators in the number of COVID-19 cases in Brazilian largest cities. METHODS: This is an ecological study, carried out through the analysis of secondary data on the population of all Brazilian main cities, based on the analysis of a 26-week epidemiological epidemic week series by COVID-19. Statistical analysis was performed using Generalized Linear Models with an Autoregressive work correlation matrix. RESULTS: It was shown that greater PHC coverage and greater FHS coverage together with an above average PMAQ score are associated with slower dissemination and lower burden of COVID-19. CONCLUSION: It is evident that cities with less social inequality and restrictions of social protection combined with social development have a milder pandemic scenario. It is necessary to act quickly on these conditions for COVID-19 dissemination by timely actions with high capillarity. Expanding access to PHC and social support strategies for the vulnerable are essential.

Risco de Morte em Idosos com Sonolência Excessiva Diurna, Insônia e Depressão: Estudo de Coorte Prospectiva em População Urbana no Nordeste Brasileiro / Risk of Death in the Elderly with Excessive Daytime Sleepiness, Insomnia and Depression: Prospective Cohort Study in an Urban Population in Northeast Brazil

Resumo Fundamento A íntima relação entre a regulação do sono e os eventos cardiovasculares é um dos principais focos de investigação na medicina contemporânea. Hábitos e características do sono interferem na ritmicidade cardíaca e também na expectativa de vida, principalmente em idosos. Objetivo Estimar o risco de óbito e de eventos cardiovasculares em idosos comunitários que apresentam queixa de insônia e sonolência excessiva diurna ao longo de oito anos de seguimento. Método Foi desenhada uma coorte prospectiva com 160 idosos, a primeira onda em 2009 e a segunda em 2017. Os grupos de seguimento foram determinados pela exposição ou não às queixas de insônia primária e a sonolência excessiva diurna, com ou sem ronco. As covariáveis sexo, estado conjugal, depressão, hipertensão e diabetes foram controladas. O desfecho primário foi o óbito e o secundário, os eventos cardiocerebrovasculares (ECV). As probabilidades dos desfechos foram estimadas pelo risco relativo (RR), através da regressão de Poisson, adotando-se α ≤ 0,05. Resultados Registraram-se 40 mortes no período (25,97%:19,04-32,89) e 48 ECVs (30,76%:23,52-38,01). Os homens apresentaram maior risco (RR = 1,88;1,01-3,50) de óbito. A depressão (RR = 2,04;1,06-3,89), a gravidade da insônia (RR = 2,39;1,52-4,56) e a latência do sono entre 16-30 minutos (RR = 3,54;1,26-9,94) e 31-60 minutos (RR = 2,23;1,12-4,47) aumentaram independentemente o risco de óbito em idosos comunitários. Os ECVs foram preditos apenas por idosos hipertensos e/ou diabéticos (RR = 8,30; 1,98-34,82). Conclusão A mortalidade em idosos é influenciada pelo estado emocional e pela dificuldade de dormir, diferentemente dos ECVs, condicionados apenas pelas condições pressóricas arteriais e metabólicas.

Abstract Background The close relationship between sleep regulation and cardiovascular events is one of the main focuses of research in contemporary medicine. Sleep habits and characteristics interfere with the cardiac rhythm and also with life expectancy, especially in the elderly. Objective To estimate the risk of death and cardiovascular events in community-dwelling elderly individuals complaining of insomnia and excessive daytime sleepiness over eight years of follow-up. Method A prospective cohort was designed with 160 elderly, with the first wave occurring in 2009 and the second in 2017. Follow-up groups were determined by exposure or not to complaints of primary insomnia and excessive daytime sleepiness with or without snoring. The covariates gender, marital status, depression, hypertension and diabetes were controlled. The primary outcome was death and the secondary outcome was cardio-cerebrovascular events (CCV). Outcome risks were estimated by relative risk (RR) through Poisson regression, adopting α≤0.05. Results There were 40 (25.97%: 19.04-32.89) deaths over the period and 48 (30.76%: 23.52-38.01) CCV. Men had a higher risk (RR = 1.88; 1.01-3.50) of death. Depression (RR = 2.04; 1.06-3.89), insomnia severity (RR = 2.39; 1.52-4.56) and sleep latency between 16-30 minutes (RR = 3, 54; 1.26-9.94) and 31-60 minutes (RR = 2.23; 1.12-4.47) increased the risk of death independently in community-dwelling elderly. CCV were predicted only in the hypertensive and / or diabetic elderly (RR = 8.30; 1.98-34.82). Conclusion Mortality in the elderly is influenced by the emotional state and difficulty in falling asleep, unlike CCVs, which are conditioned only by arterial and metabolic blood pressure conditions.

Validation of the criteria matrix about the generalist's education in Dentistry Undergraduate Courses.

The generalist training planned by Brazilian National Curriculum Guidelines for Dentistry undergraduate courses should provide actions for the development of health promotion in the field of public health, as well as disease prevention, diagnosis, planning, and dental treatment in the clinical field. Considering this complexity, the aim of the present study was to validate dimensions and sub-dimensions in dentistry training, allowing the identification of the main necessary competences and clinical skills for the generalist practice. For this, an evaluation study was carried out through the Delph's Method with the participation of 19 professors of Dentistry courses in Brazil working in the clinical area, considered "experts" in this theme. It was possible to identify clinical competences and skills in four dimensions and respective sub-dimensions: Transversal skills (biosafety, patient-team communication, humanization, ethical principles, dental documentation); Diagnosis and planning (diagnosis of dental caries, pulp and periapical changes, and periodontal diseases, clinical and imaging exam, and single treatment planning); Preventive activities (oral hygiene guidance and oral cancer prevention); and Dental care (anesthesia, basic oral surgery, drug prescription, subgingival scaling and root planing, dental restoration, minimally and non-invasive restoration treatment, and dental urgencies). The developed model represents a differentiated alternative for the construction of an innovative curriculum in Dentistry, aimed at the training of general practitioners to provide humanized, highly effective, and resolving care. The importance of clinical tutoring by professors on the essential clinical skills and abilities is highlighted in this study.

Advances and challenges of training in the Unified Health System based on teachers' experience in the area of Public Health in Dentistry courses. / Avanços e desafios da formação no Sistema Único de Saúde a partir da vivência dos docentes da área de Saúde Coletiva nos cursos de Odontologia.

The training directed at the Unified Health System (SUS) has been one of the most challenging assumptions in the development of Dentistry courses in Brazil. In this regard, public health educated teachers play a fundamental role in the curricular proposition favoring such an approach. This study aimed to identify the possible advances achieved in Dentistry courses and the challenges in training for the SUS. This is a quantitative, cross-sectional research with a sample of 119 teachers employing the probabilistic Snowball technique. Participants responded to a validated criteria matrix, and an exploratory factor analysis was performed for data analysis, which defined five factors responsible for training for the SUS: Primary Care; Social Responsibility and Teamwork; Health Management; Information Systems, and Continuing Education/Humanization. The study allowed identifying significant advances in the perspective of greater adequacy of the training proposal aimed at the SUS. However, some challenges to teachers require expanding the prospect to face the barriers still imposed by traditional health training.

A formação direcionada para o Sistema Único de Saúde (SUS) tem sido um dos pressupostos mais desafiadores no desenvolvimento dos cursos de Odontologia no Brasil. Para isso, docentes com formação em saúde coletiva desempenham papel fundamental na proposição curricular que privilegie tal abordagem. O objetivo do estudo foi identificar em cursos de Odontologia os possíveis avanços alcançados e os desafios a serem enfrentados na formação para o SUS. Trata-se de uma pesquisa quantitativa, com desenho transversal, cuja amostra foi composta por 119 docentes por meio da técnica probabilística do Snowball. Os participantes responderam a uma matriz de critériosvalidada, sendo realizada a análise fatorial exploratória para análise dos dados, a qual definiu cinco fatores responsáveis pela formação para o SUS: Atenção Básica; Responsabilidade Social e Trabalho em Equipe; Gestão em Saúde; Sistemas de Informação e Educação Permanente/Humanização.O estudo permitiu identificar avanços significativos na perspectiva de uma maior adequação da proposta formativa voltada para o SUS, todavia, existem desafios colocados para os professores que exigem um amplo aprofundamento na perspectiva de enfrentar as barreiras ainda impostas pela tradicional formação na área da saúde.

Avanços e desafios da formação no Sistema Único de Saúde a partir da vivência dos docentes da área de Saúde Coletiva nos cursos de Odontologia / Advances and challenges of training in the Unified Health System based on teachers' experience in the area of Public Health in Dentistry courses

Resumo A formação direcionada para o Sistema Único de Saúde (SUS) tem sido um dos pressupostos mais desafiadores no desenvolvimento dos cursos de Odontologia no Brasil. Para isso, docentes com formação em saúde coletiva desempenham papel fundamental na proposição curricular que privilegie tal abordagem. O objetivo do estudo foi identificar em cursos de Odontologia os possíveis avanços alcançados e os desafios a serem enfrentados na formação para o SUS. Trata-se de uma pesquisa quantitativa, com desenho transversal, cuja amostra foi composta por 119 docentes por meio da técnica probabilística do Snowball. Os participantes responderam a uma matriz de critériosvalidada, sendo realizada a análise fatorial exploratória para análise dos dados, a qual definiu cinco fatores responsáveis pela formação para o SUS: Atenção Básica; Responsabilidade Social e Trabalho em Equipe; Gestão em Saúde; Sistemas de Informação e Educação Permanente/Humanização.O estudo permitiu identificar avanços significativos na perspectiva de uma maior adequação da proposta formativa voltada para o SUS, todavia, existem desafios colocados para os professores que exigem um amplo aprofundamento na perspectiva de enfrentar as barreiras ainda impostas pela tradicional formação na área da saúde.

Abstract The training directed at the Unified Health System (SUS) has been one of the most challenging assumptions in the development of Dentistry courses in Brazil. In this regard, public health educated teachers play a fundamental role in the curricular proposition favoring such an approach. This study aimed to identify the possible advances achieved in Dentistry courses and the challenges in training for the SUS. This is a quantitative, cross-sectional research with a sample of 119 teachers employing the probabilistic Snowball technique. Participants responded to a validated criteria matrix, and an exploratory factor analysis was performed for data analysis, which defined five factors responsible for training for the SUS: Primary Care; Social Responsibility and Teamwork; Health Management; Information Systems, and Continuing Education/Humanization. The study allowed identifying significant advances in the perspective of greater adequacy of the training proposal aimed at the SUS. However, some challenges to teachers require expanding the prospect to face the barriers still imposed by traditional health training.

Risk of Death in the Elderly with Excessive Daytime Sleepiness, Insomnia and Depression: Prospective Cohort Study in an Urban Population in Northeast Brazil. / Risco de Morte em Idosos com Sonolência Excessiva Diurna, Insônia e Depressão: Estudo de Coorte Prospectiva em População Urbana no Nordeste Brasileiro.

BACKGROUND: The close relationship between sleep regulation and cardiovascular events is one of the main focuses of research in contemporary medicine. Sleep habits and characteristics interfere with the cardiac rhythm and also with life expectancy, especially in the elderly. OBJECTIVE: To estimate the risk of death and cardiovascular events in community-dwelling elderly individuals complaining of insomnia and excessive daytime sleepiness over eight years of follow-up. METHOD: A prospective cohort was designed with 160 elderly, with the first wave occurring in 2009 and the second in 2017. Follow-up groups were determined by exposure or not to complaints of primary insomnia and excessive daytime sleepiness with or without snoring. The covariates gender, marital status, depression, hypertension and diabetes were controlled. The primary outcome was death and the secondary outcome was cardio-cerebrovascular events (CCV). Outcome risks were estimated by relative risk (RR) through Poisson regression, adopting α≤0.05. RESULTS: There were 40 (25.97%: 19.04-32.89) deaths over the period and 48 (30.76%: 23.52-38.01) CCV. Men had a higher risk (RR = 1.88; 1.01-3.50) of death. Depression (RR = 2.04; 1.06-3.89), insomnia severity (RR = 2.39; 1.52-4.56) and sleep latency between 16-30 minutes (RR = 3, 54; 1.26-9.94) and 31-60 minutes (RR = 2.23; 1.12-4.47) increased the risk of death independently in community-dwelling elderly. CCV were predicted only in the hypertensive and / or diabetic elderly (RR = 8.30; 1.98-34.82). CONCLUSION: Mortality in the elderly is influenced by the emotional state and difficulty in falling asleep, unlike CCVs, which are conditioned only by arterial and metabolic blood pressure conditions.

FUNDAMENTO: A íntima relação entre a regulação do sono e os eventos cardiovasculares é um dos principais focos de investigação na medicina contemporânea. Hábitos e características do sono interferem na ritmicidade cardíaca e também na expectativa de vida, principalmente em idosos. OBJETIVO: Estimar o risco de óbito e de eventos cardiovasculares em idosos comunitários que apresentam queixa de insônia e sonolência excessiva diurna ao longo de oito anos de seguimento. MÉTODO: Foi desenhada uma coorte prospectiva com 160 idosos, a primeira onda em 2009 e a segunda em 2017. Os grupos de seguimento foram determinados pela exposição ou não às queixas de insônia primária e a sonolência excessiva diurna, com ou sem ronco. As covariáveis sexo, estado conjugal, depressão, hipertensão e diabetes foram controladas. O desfecho primário foi o óbito e o secundário, os eventos cardiocerebrovasculares (ECV). As probabilidades dos desfechos foram estimadas pelo risco relativo (RR), através da regressão de Poisson, adotando-se α ≤ 0,05. RESULTADOS: Registraram-se 40 mortes no período (25,97%:19,04-32,89) e 48 ECVs (30,76%:23,52-38,01). Os homens apresentaram maior risco (RR = 1,88;1,01-3,50) de óbito. A depressão (RR = 2,04;1,06-3,89), a gravidade da insônia (RR = 2,39;1,52-4,56) e a latência do sono entre 16-30 minutos (RR = 3,54;1,26-9,94) e 31-60 minutos (RR = 2,23;1,12-4,47) aumentaram independentemente o risco de óbito em idosos comunitários. Os ECVs foram preditos apenas por idosos hipertensos e/ou diabéticos (RR = 8,30; 1,98-34,82). CONCLUSÃO: A mortalidade em idosos é influenciada pelo estado emocional e pela dificuldade de dormir, diferentemente dos ECVs, condicionados apenas pelas condições pressóricas arteriais e metabólicas.

Use of rehabilitation services by persons with disabilities in Brazil: A multivariate analysis from Andersen's behavioral model.

BACKGROUND: For many years, discussions about health care for people with disabilities (PwD) in Brazil have not been treated as a priority; however, based on the advances made at the beginning of this century, new policies have been developed with the aim of improving access of these people to health services. Therefore, the aim of this study was to analyze how individual characteristics and contextual indicators are associated with access to rehabilitation services for PwD in Brazil. METHODS: A multivariate analysis was performed based on data from the National Health Survey 2013, considering access to rehabilitation services by PwD as the primary outcome and individual and contextual factors selected from Andersen's behavioral model as independent variables. The contextual variables were reduced to two composite indicators (1-primary health care coverage and unfavorable socioeconomic conditions, and 2-economic inequality) from the analysis of the principal components. Poisson regression analysis with robust variance was performed to estimate the prevalence ratio (PR) and the respective 95% confidence interval (95%CI). RESULTS: Access to rehabilitation services by PwD was more prevalent in people aged 0 to 17 years (PR = 3.28; 95%CI 2.85-3.78), who are illiterate (PR = 1.24; 95%CI 1.09-1.40), whose socioeconomic level is A or B (PR = 1.60; 95%CI 1.35-1.88), who have health insurance (PR = 1.31; 95%CI 1.15-1.49), who have severe limitations (PR = 3.09; 95%CI 2.64-3.62), who live in states with a good offer of Specialized Rehabilitation Centers, both type II (PR = 1.20; CI95% 1.08; 1.33) and type IV (PR = 1.29; CI95% 1.15; 1.44), and who have greater coverage of primary health care, but unfavorable socioeconomic conditions (PR = 1.15; CI95% 1.03-1.28). CONCLUSION: The results clarify the social inequities that exist regarding access to rehabilitation services for PwD in Brazil and highlight the need to formulate and implement public policies that guarantee the realization of the rights of these people.

Prevalence of malocclusions in children with microcephaly associated with the Zika virus.

INTRODUCTION: The objectives of this study were to determine the prevalence of malocclusion among children with Zika virus-associated microcephaly (MZV) and to describe the most common malocclusion in this population. METHODS: This was a cross-sectional study including patients aged between 30 and 36 months diagnosed with MZV. Healthy children were randomly selected with the same sociodemographic characteristics as the control group. Information about arch-type, primate spaces, arch form, overbite, overjet, midline deviation, anterior crossbite, anterior open bite, and the posterior crossbite was recorded. The statistical analysis used descriptive analysis, Pearson chi-square test, and multivariate logistic regression. RESULTS: Forty children comprised the MZV group, and 40 comprised the control group. Our results demonstrated a significantly higher prevalence of malocclusions in children who had MZV than the control group (P <0.001). Patients with MZV were more likely to have late eruption (P <0.001), hypoplastic maxillary arch (P <0.001), hypoplastic mandibular arch (P <0.001), excessive overjet (P <0.001), and posterior crossbite (P = 0.004). CONCLUSIONS: The prevalence of malocclusion was higher among children with MZV. Late eruption, hypoplastic maxillary arch, hypoplastic mandibular arch, excessive overjet, and posterior crossbite were the most common characteristics for this population.

Validation of the criteria matrix about the generalist's education in Dentistry Undergraduate Courses

Abstract The generalist training planned by Brazilian National Curriculum Guidelines for Dentistry undergraduate courses should provide actions for the development of health promotion in the field of public health, as well as disease prevention, diagnosis, planning, and dental treatment in the clinical field. Considering this complexity, the aim of the present study was to validate dimensions and sub-dimensions in dentistry training, allowing the identification of the main necessary competences and clinical skills for the generalist practice. For this, an evaluation study was carried out through the Delph's Method with the participation of 19 professors of Dentistry courses in Brazil working in the clinical area, considered "experts" in this theme. It was possible to identify clinical competences and skills in four dimensions and respective sub-dimensions: Transversal skills (biosafety, patient-team communication, humanization, ethical principles, dental documentation); Diagnosis and planning (diagnosis of dental caries, pulp and periapical changes, and periodontal diseases, clinical and imaging exam, and single treatment planning); Preventive activities (oral hygiene guidance and oral cancer prevention); and Dental care (anesthesia, basic oral surgery, drug prescription, subgingival scaling and root planing, dental restoration, minimally and non-invasive restoration treatment, and dental urgencies). The developed model represents a differentiated alternative for the construction of an innovative curriculum in Dentistry, aimed at the training of general practitioners to provide humanized, highly effective, and resolving care. The importance of clinical tutoring by professors on the essential clinical skills and abilities is highlighted in this study.

Relação da saúde bucal com reações hansênicas em município hiperendêmico para hanseníase / Relation between oral health and hansen's disease reactions in a hyperendemic city for hansen's disease

Resumo Introdução Péssimas condições de saúde bucal vêm sendo apontadas como prejudiciais às pessoas acometidas pela hanseníase, pois contribuem para a piora do quadro clínico desses indivíduos. Objetivo Este trabalho objetiva avaliar as condições de saúde bucal dos indivíduos atendidos por um serviço especializado no município de Sobral, no Ceará, e comparar dois grupos (com e sem reação hansênica) quanto às condições orais. Método Trata-se de um estudo transversal realizado no Ambulatório de Hanseníase do município de Sobral, no Ceará, com 56 pacientes em tratamento. Foram realizados um levantamento epidemiológico em saúde bucal e uma entrevista que coletaram informações sobre condições de saúde bucal, dados socioeconômicos, utilização dos serviços odontológicos e percepção entre doença e saúde bucal. Para a análise estatística entre os grupos, foi realizada uma análise bivariada, seguida por uma análise multivariada. Resultados Houve predomínio de sexo masculino, baixa escolaridade e diagnóstico multibacilar. Apesar da relação estatisticamente significante entre reação hansênica e cárie dentária, necessidade de exodontia e/ou endodontia, sangramento gengival, cálculo dentário e bolsa periodontal, apenas esta última apresentou associação significativa (p = 0,019) na análise multivariada. Conclusão Os participantes deste estudo apresentaram precárias condições de saúde bucal, sendo piores naqueles com reações hansênicas.

Abstract Background Poor oral health conditions are being considered as harmful for people affected by Hansen's disease, since they contribute to worsening the clinical condition of these individuals. Objective This study aims to evaluate the oral health conditions of individuals attended by a specialized service in the city of Sobral, Ceará, and to compare two groups (with and without Hansen's disease reaction) regarding oral conditions. Method A cross-sectional study was carried out at the Ambulatório de Hanseníase in the city of Sobral, Ceará, Brazil, with 56 patients being treated. An epidemiological survey was conducted on oral health and an interview that collected information on oral health conditions, socioeconomic data, use of dental services and perception between the disease and oral health. For the statistical analysis between the groups, a bivariate analysis was performed, followed by a multivariate analysis. Results Predominance was the male gender, low level of schooling and multibacillary diagnosis. Despite the statistically significant relationship between presence of Hansen's disease reaction and the presence of dental caries, need for exodontia and / or endodontics, gingival bleeding, dental calculus and periodontal pocket, only the latter had a significant association (p = 0.019) in the multivariate analysis. Conclusion The participants of this study presented poor oral health conditions, being worse in those who presented Hansen's disease reactions.

Correlation of Radiomorphometric Indices of the Mandible and Biochemical Parameters in Patients with Secondary Hyperparathyroidism Due to Chronic Kidney Disease.

OBJECTIVE: The aim was to correlate radiomorphometric indices and biochemical analyses as an auxiliary method in bone evaluation in male and female patients with chronic kidney disease-mineral and bone disorder (CKD-MBD) and controls. MATERIALS AND METHODS: Nine radiomorphometric indices and four biochemical parameters were obtained: mental index (MI), height at the mental foramen, total mandibular height (THM), panoramic mandibular index (PMI), original height of the mandible, alveolar bone resorption, distance from the mental foramen to the alveolar bone crest (MF-ABC), mandibular cortical index (MCI), trabecular bone pattern, parathyroid hormone (PTH), calcium (Ca), phosphorus (P), and Ca × P product (Ca × P). STATISTICAL ANALYSIS: The Mann-Whitney U-test, chi-squared test, and Spearman's correlation were applied at a significance level of 95%. RESULTS: There was a moderate negative and significant correlation between MI, PMI, and PTH in female patients with CKD-MBD as well as between THM, MF-ABC, and Ca × P. The MCI and trabecular bone pattern indicated altered bone quality in male patients. CONCLUSIONS: The radiomorphometric evaluation was an auxiliary, noninvasive method to detect possible alterations in the cortex and mandibular bone trabeculation in male and female patients with CKD-MBD.

Spatial correlation between excess weight, purchase of ultra-processed foods, and human development in Brazil. / Correlação espacial entre o excesso de peso, aquisição de alimentos ultraprocessados e o desenvolvimento humano no Brasil.

The aim of this study was to analyze the spatial distribution of excess weight in Brazil and its correlation with household food insecurity, purchase of foods by type of processing, and Human Development Index (HDI). An ecological study was undertaken using data from three surveys conducted by the Brazilian Institute of Geography and Statistics. Spatial analysis techniques were used to perform univariate and bivariate analysis. The prevalence of excess weight was 34.2% (CI 95% 33.8-34.6%). Excess weight showed a moderate and significant spatial autocorrelation (0.581; p = 0.01), with higher prevalence in states in the South, Southeast and Center-West regions. A positive moderate spatial correlation was shown between the prevalence of excess weight and HDI (0.605; p < 0.05) and purchase of ultra-processed foods (0.559; p < 0.05), while a negative moderate spatial correlation was observed between prevalence of excess weight and household food insecurity (-0.561; p < 0.05). It can be concluded that there is an unequal distribution of excess weight across Brazil. The highest prevalence rates were found in states in the Southeast, South, and Center-West regions, associated with higher HDI values and higher ultra-processed food purchases as a proportion of overall household food purchases.

O objetivo foi analisar a distribuição espacial da prevalência de excesso de peso e sua correlação com insegurança alimentar, aquisição de alimentos por tipo de processamento e Índice de Desenvolvimento Humano (IDH), no Brasil. Estudo ecológico, com dados de três inquéritos do Instituto Brasileiro de Geografia e Estatística (IBGE). Utilizou-se técnicas de estatística espacial para análise univariada e bivariada. A prevalência de excesso de peso encontrada para o Brasil foi de 34,2% (IC95% 33,8-34,6%). O excesso de peso apresentou autocorrelação espacial moderada (0,581; p = 0,01) e maiores prevalências nos estados das regiões Sul, Sudeste e Centro-Oeste. As prevalências de excesso de peso apresentaram correlação espacial positiva e moderada com o IDH (0,605; p< 0,05), proporção de aquisição domiciliar de produtos alimentícios ultraprocessados (0,559; p< 0,05); e correlação negativa e moderada com a prevalência de domicílios em insegurança alimentar (-0,561; p< 0,05). Conclui-se que a ocorrência de excesso de peso encontrava-se desigualmente distribuída no território brasileiro. As prevalências mais elevadas foram encontradas nos estados do Sudeste, Sul e Centro-Oeste, associadas a maiores valores de IDH e proporções de aquisição de produtos alimentícios ultraprocessados.