Satisfação dos usuários com a qualidade da Atenção Primária à Saúde no estado da Paraíba: estudo transversal / User's satisfaction with the quality of Primary Health Care in the state of Paraíba: cross-sectional study

Resumo Objetivo Visa analisar a satisfação dos usuários em relação aos atributos essenciais da Atenção Primária à Saúde, no Estado da Paraíba, a partir de dados secundários do PMAQ- AB. Método Estudo transversal realizado entre 2020 e 2021, com dados de 5.347 usuários vinculados a 1.363 equipes de saúde na APS do Estado. Foram selecionadas questões do material utilizado na Avaliação Externa no 3º ciclo do PMAQ-AB referentes ao perfil demográfico, condição socioeconômica e instrumento elaborado pelos pesquisadores com 42 variáveis. As respostas dos usuários foram categorizadas por equipe de saúde: "Muito Bom" (valor 4), "Bom" (valor 3), "Regular" (valor 2), "Ruim" (valor 1) e "Muito Ruim" (valor 0). Os dados foram tabulados por meio de frequência, porcentagens simples e analisados sob forma de tabelas no Excel 2010. Resultado A classificação "Muito Bom" foi de 10.751 (52,5%) em Acesso de Primeiro Contato, 9757 (55,1%) em Longitudinalidade, 1.315 (48,2%) em Coordenação da Atenção; com menor, proporção 4.146 (25,3%) em Integralidade no Estado da Paraíba. Conclusão O estudo demonstrou classificação geral positiva com a satisfação dos usuários e a presença dos atributos, nas Macrorregiões e Estado. Todavia, verificou-se baixo desempenho no atributo Integralidade e piores avaliações atribuídas à Macrorregião I.

Abstract Objective To analyze user satisfaction in relation to the essential attributes of Primary Health Care, in the State of Paraíba, based on secondary data from the PMAQ-AB. Method Cross-sectional study carried out between 2020 and 2021, with data from 5,347 users linked to 1,363 health teams in the State's PHC. Questions were selected from the material used in the External Assessment in the 3rd cycle of the PMAQ-AB referring to the demographic profile, socioeconomic status and instrument prepared by the researchers with 42 variables. User responses were categorized by health team: "Very Good" (value 4), "Good" (value 3), "Regular" (value 2), "Bad" (value 1) and "Very Bad" (value 0). Data were tabulated using frequency, simple percentages and analyzed in the form of tables in Excel 2010. Result The "Very Good" classification was 10,751 (52.5%) in First Contact Access, 9757 (55.1%) in Longitudinality, 1,315 (48.2%) in Care Coordination; with a smaller proportion of 4,146 (25.3%) in Integrality in the State of Paraíba. Conclusion The study showed a positive general classification with user satisfaction and the presence of attributes, in the Macro-regions and State. However, there was low performance in the Comprehensiveness attribute and worse evaluations attributed to Macroregion I.

User satisfaction with Dental Specialty Centers in Brazil: Proposal of satisfaction index and associated factors.

OBJECTIVES: To investigate the satisfaction of users of Dental Specialty Centers (CEO) in Brazil employing the Service Satisfaction Index (SSI) and identify associated factors. METHODS: This quantitative, evaluative, and cross-sectional study used secondary data extracted from the Second External Evaluation of the Program for the Improvement of Access and Quality of Brazilian Dental Specialty Centers (PMAQ-CEO) held in 2018 in 901 municipalities, accounting for 1097 CEO, of which 1042 were investigated. A total of 10391 users participated in the study. Considering user satisfaction as an aggregate variable, SSI was classified into two categories: Lower Satisfaction (SSI < 20) and Maximum Satisfaction (SSI = 20). Data were analyzed by descriptive and inferential statistics using the SPSS® software. The exploratory factor analysis verified the statistical correlations between attributes and SSI. RESULTS: The maximum satisfaction with the service was 21.1%; factors that expressed the most significant influence on SSI were waiting time (OR = 1.17; CI 95%: 1.05-1.31), feeling that CEO has good conditions of use (OR = 7.05; CI 95%: 5.15-9.65), not wishing to be assisted at another CEO (OR = 4.17; CI 95%: 3.12-5.57), not having treatment interrupted due to lack of material (OR = 2.05; CI 95%: 1.70-2.47), age up to 40 years of users (OR = 1.31; CI 95%: 1.18-1.46) and higher education (OR = 1.30; CI 95%: 1.14-1.49). CONCLUSIONS: SSI appropriately described the user's satisfaction with the service. The maximum satisfaction with the service was influenced by age, education, waiting time, not having treatment interrupted, and considering CEO clean and hygienic environment.

Estratégias pedagógicas de inclusão e retenção de estudantes em tempos de pandemia: relato de experiência / Pedagogical strategies for the inclusion and retention of students in pandemic period: experience report

Trata-se de um artigo de relato de experiência que objetiva descrever o uso das ferramentas e estratégias adotadas pelas Faculdades Nova Esperança (Facene) visando àinclusão e retenção dos estudantesdurante a suspensão das atividades acadêmicas presenciais. A Facene disponibilizou uma plataforma de interface, o Ambiente Virtual de Aprendizagem, que possibilitou aos professores continuar com suas aulas teóricas em modalidade síncrona, no mesmo dia e horário da modalidade presencial, visando maior interaçãoe engajamento dos estudantes durante as aulas.Modalidades diferenciadas e adaptadas de avaliações e Trabalho de Conclusão de Curso, além de atendimento psicológico e pedagógico são descritas como fundamentais para que a Facene obtivesse uma evasão acumulada do semestre reduzida, diante da expectativa de maior evasão devido a suspensão das atividades presenciais decorrenteda pandemia. As medidas pedagógicas adotadas no Plano de Contingência Institucional da Facene tiveramêxito como estratégias de inclusão e retenção dos estudantes, além de minimizar as limitaçõespor elesvivenciadas na continuidade da sua rotina acadêmica, ajudando-os no processo remoto de ensino, aprendizagem e avaliação (AU).

This experience report describes technological tools and strategies adopted by Nova Esperança Faculty (Facene) and provides examples of inclusion and retention of students during suspension of in-person academic activities. Facene provided an interface platform, the Virtual Learning Environment, which enabled professors to continue with theoretical classes via synchronous modality onthe same day and time of in-person modality, enhancing interaction and engagement during classes. Different and adapted modalities of evaluations and undergraduate dissertation and psychological and pedagogical assistance helped decrease dropout rates of the semester, considering the pandemic context. Pedagogical strategies of the institutional contingency plan of Nova Esperança Faculty were successful in minimizing limitations experienced by students in the continuity of their academic routine, assisting in the remote teaching process, learning, and evaluation (AU).

[Resolvability of primary care in oral health in the State of Paraíba, Brazil]. / Resolutividade da atenção básica em saúde bucal em municípios do estado da Paraíba, Brasil.

Oral health resolvability in primary care of municipalities in the State of Paraíba, Brazil, was analyzed, and a cross-sectional study was conducted, using an inductive approach, comparative procedure and indirect documentation. The Resolvability Indicator (RI) consisted of the ratio between the number of Completed Treatments and First Programmatic Dental Consultations in municipalities in Paraíba (n = 223), between 2011 and 2014, by using data collected from the DATASUS/TABNET platform. The following explanatory variables were considered: Coverage of First Programmatic Dental Consultation (CFPDC), Coverage of Primary Care Teams (CPCT), Coverage of Oral Health Teams (COHT), Coverage of Family Health Teams (CFHT), Percentage of Tooth Extraction (PTE), Gross Domestic Product (GDP), Municipal Human Development Index (MHDI) and Gini Coefficient (GC). Descriptive statistics and negative binomial multiple regression were performed (α = 0.05). The median RI in 2011, 2012, 2013 and 2014 was, respectively, 20.4, 17.5, 15.2 and 15.7. There was a positive association between RI and CFPDC (PR = 1.14, CI = 1.02-1.28), CPCT (PR = 1.02, CI = 1.01-1.03), in addition to a negative association. between RI and year (PR = 0.83; IC = 0.74-0.94). The resolvability of oral health in primary care is influenced by coverage-related factors.

Analisou-se a resolutividade da atenção básica em saúde bucal nos municípios do estado da Paraíba, Brasil. Trata-se de um estudo transversal de abordagem indutiva, com procedimento comparativo e técnica de documentação indireta. O indicador de resolutividade (IR) constituiu da razão entre o número de tratamentos concluídos e primeiras consultas odontológicas programáticas dos municípios paraibanos (n = 223) entre 2011 e 2014, utilizando dados coletados da plataforma Datasus/TABNET. Foram consideradas variáveis explicativas: cobertura de primeira consulta odontoló gica programática (CPCOP), cobertura de equipes de atenção básica (CEAB), cobertura de equi pes de saúde bucal (CESB), cobertura de equipes de saúde da família (CESF), percentual de exodontia (PE), Produto Interno Bruto (PIB), Índice de Desenvolvimento Humano Municipal (IDHM) e coeficiente de Gini (CG). Os dados foram analisados por estatística descritiva e regressão múltipla binomial negativa (α = 0,05). As medianas do IR em 2011, 2012, 2013 e 2014 foram, respectivamente, 20,4, 17,5, 15,2 e 15,7. Houve associação positiva do IR com CPCOP (RP = 1,14; IC = 1,02-1,28), CEAB (RP = 1,02; IC = 1,01-1,03), e negativa com ano (RP = 0,83; IC = 0,74-0,94). A resolutividade em saúde bucal na atenção básica é influenciada por fatores relacionados à cobertura.

Assessment of Primary Health Care Attributes in Campina Grande, Paraíba, Brazil.

OBJECTIVE: to assess the presence and extent of Primary Health Care attributes in Campina Grande, Paraíba. METHOD: this is a cross-sectional study with 202 professionals from the Basic Health Units. The Primary Care Assessment Tool, Brazil, was used, which includes eight attributes of primary care whose scores were converted into a scale from 0 to 10, with those considered satisfactory > 6.60. RESULT: the general score mean was 7.6, but First contact access obtained a score of 3.7. Dental surgeons attributed the worst scores for all attributes (p <0.05). Permanent education activity was associated with a high general score (p <0.01). CONCLUSION: with the exception of First contact access, the other attributes are present, but initiatives by teams and managers are necessary for its expansion, with permanent education being the main strategy in this process.

Access to oral health in primary care before and after the beginning of the COVID-19 pandemic in Brazil / Acesso em saúde bucal na atenção básica antes e após o início da pandemia de COVID-19 no Brasil

This study compared the access to oral health in primary care, before and after the beginning of the COVID-19 pandemic in Brazil. An observational study with a cross-sectional ecological design was carried out, using data from the Health Information System for Primary Care (SISAB). Data regarding the number of Oral Health Teams (OHT), Oral Health Coverage in Primary Care (OHC), number of First Programmatic Dental Consultations (FPDC), and number of visits due to dental abscess and toothache were collected. Data were collected by state as consolidated of the first quarter (January to April) of 2019 and of 2020. The median of the difference (MD) and the percentage of variation (%V) were obtained for each variable. Data were compared by Wilcoxon test (α<0,05). An increase in the number of OHT was observed in 25 states (MD=45, %V=6.13%, p<0.001), whilst the OHC increased in 17 states (MD=1.01, %V=1.62%, p=0.035) between the 2019 and 2020. We also verified a significant reduction in the number of FPDC (MD=- 42,806, %V=-38.70%, p<0.001), as well as in the number of visits due to dental abscess (MD=-1,032, % V=-29.04%, p=0.002) and due to toothache (MD=-14,445, %V=-32.68%, p<0.001). Although an expansion of OHT and OHC between 2019 and 2020 was verified, access to oral health in primary care has decreased due to the COVID-19 pandemic.

Este estudo analisou acesso em saúde bucal na atenção básica, antes e após o início da pandemia do COVID-19 no Brasil. Realizou-se um estudo observacional, com delineamento ecológico transversal, que utilizou dados do Sistema de Informação em Saúde para a Atenção Básica (SISAB). Foram coletados dados referentes ao número de Equipes de Saúde Bucal (ESB), Cobertura de Saúde Bucal na Atenção Básica (CobSB), número de Primeiras Consultas Odontológicas Programadas (PCOP), e número de atendimentos devido abscesso dento-alveolar e dor de dente. Os dados foram coletados por estado como um consolidado do primeiro quadrimestre (Janeiro a Abril) de 2019 e 2020. A mediana da diferença (MD) e o percentual de variação (%V) dos valores foram obtidos para cada variável em estudo. Os dados foram comparados por meio do teste Wilcoxon (α<0,05). Um aumento do número de ESB foi observado em 25 estados (MD=45, %V=6,13%, p<0,001), enquanto a CobSB aumentou em 17 estados (MD=1,01, %V=1,62%, p=0,035), entre 2019 e 2020. Observou-se ainda redução significativa no número de PCOP (MD=-42.806, %V=-38,70%, p<0,001), bem como no número de atendimentos devido abscesso dento-alveolar (MD=-1.032, %V=-29,04%, p=0,002) e a dor de dente (MD=-14.445, %V=-32,68%, p<0,001). Embora tenha sido verificada ampliação de ESB e CobSB entre 2019 e 2020, o acesso à saúde bucal na atenção básica foi reduzido devido a pandemia do COVID-19.

Assessment of Primary Health Care Attributes in Campina Grande, Paraíba, Brazil / Evaluación de los atributos de la Atención Primaria de Salud en Campina Grande, Paraíba, Brasil / Avaliação dos atributos da atenção primária à saúde em Campina Grande, Paraíba, Brasil

ABSTRACT Objective: to assess the presence and extent of Primary Health Care attributes in Campina Grande, Paraíba. Method: this is a cross-sectional study with 202 professionals from the Basic Health Units. The Primary Care Assessment Tool, Brazil, was used, which includes eight attributes of primary care whose scores were converted into a scale from 0 to 10, with those considered satisfactory > 6.60. Result: the general score mean was 7.6, but First contact access obtained a score of 3.7. Dental surgeons attributed the worst scores for all attributes (p <0.05). Permanent education activity was associated with a high general score (p <0.01). Conclusion: with the exception of First contact access, the other attributes are present, but initiatives by teams and managers are necessary for its expansion, with permanent education being the main strategy in this process.

RESUMEN Objetivo: evaluar la presencia y extensión de los atributos de la Atención Primaria de Salud em Campina Grande, Paraíba. Método: se trata de em rocess transversal em 202 profesionales de las Unidades Básicas de Salud. Se rocess la herramienta de evaluación de atención primaria, Brasil, que incluye ocho atributos de atención primaria cuyas puntuaciones se convirtieron em em escala de 0 a 10, considerándose aquellos> 6.60 son satisfactorios. Resultado: el promedio de la puntuación general fue de 7,6, pero la accesibilidad al primer contacto obtuvo em puntuación de 3,7. Los cirujanos dentales atribuyeron las peores puntuaciones para todos los atributos (p <0.05). El desempeño de la actividad de educación permanente se asoció em em puntaje general alto (p <0.01). Conclusión: em la excepción de Accesibilidad para el primer contacto, los otros atributos están presentes, pero las iniciativas de los equipos y gerentes son rocessoa para su expansión, siendo la educación permanente la rocessoa principal em este rocesso.

RESUMO Objetivo: avaliar a presença e extensão dos atributos da Atenção Primária à Saúde de Campina Grande, Paraíba. Método: trata-se de um estudo transversal, com 202 profissionais das Unidades Básicas de Saúde. Foi utilizado o instrumento Primary Care Assessment Tool, Brasil, que contempla oito atributos da atenção primária cujos escores foram convertidos em escala de 0 a 10, sendo considerados satisfatórios aqueles ≥6,60. Resultado: a média do Escore Geral foi de 7,6, mas a Acessibilidade de primeiro contato obteve escore de 3,7. Os cirurgiões dentistas atribuíram piores escores para todos os atributos (p<0,05). A realização de atividade de educação permanente esteve associada ao Escore Geral alto (p<0,01). Conclusão: com exceção da Acessibilidade de primeiro contato, os demais atributos estão presentes, mas iniciativas das equipes e gestores são necessárias para sua ampliação, sendo a educação permanente a principal estratégia nesse processo.

Offer and Use of Oral Health in Primary Care Before and After the Beginning of the COVID-19 Pandemic in Brazil

Abstract Objective: To compare the offer and use of oral health services in primary care, before and after the beginning of the COVID-19 pandemic in Brazil. Material and Methods: An observational study with a cross-sectional ecological design, using data from the Health Information System for Primary Care. Data regarding the number of Oral Health Teams (OHT), Oral Health Coverage in Primary Care (OHC), number of First Programmatic Dental Consultations (FPDC), and number of visits due to dental abscess and toothache were collected. Data regarding the 26 Brazilian states and Federal District were collected, as consolidated of the first quarter (January to April) of 2019 and of 2020. The median of the difference (MD) and the percentage of variation (%V) were obtained for each variable and were compared by Wilcoxon test (α<0.05). Results: An increase in the number of OHT was observed in 25 states (MD=45; %V=6.13; p<0.001), whilst the OHC increased in 17 states (MD=1.01; %V=1.62; p=0.035) between the 2019 and 2020. We also verified a significant reduction in the number of FPDC (MD=- 42.806; %V=-38.70; p<0.001), as well as in the number of visits due to dental abscess (MD=-1.032; %V=-29.04; p=0.002) and due to toothache (MD=-14.445; %V=-32.68; p<0.001). Conclusion: Although an expansion of OHT and OHC between 2019 and 2020 was verified, the offer and use of oral health services in primary care has decreased due to the COVID-19 pandemic.

In Vitro Evaluation of Fluoride in Saliva After Topical Application of Professional Use Products

Objective: To evaluate in vitro the presence of fluoride in saliva after applying professional use products on the surface of dental enamel. Material and Methods: Experimental groups were composed by: Cariostatic 12% (CA), Fluoridated Varnish 5% (FV), Fluorine Acidulate Gel 1.23% (AG) and Fluorine Neutral Gel 2% (NG). Fluoridated dentifrice (FD) and Artificial Saliva (AS) were used as controls. Products (10 µL) were applied to the surface of bovine enamel blocks (4×4×1 mm, n = 18) and immersed in 10 mL of artificial saliva at room temperature. Aliquots of artificial saliva (750 µL) of each sample were collected 1, 2, 4, 8, 24 and 48 hours after application of the products. Analyses were performed in triplicate, using a fluoride ion-specific electrode coupled to a potentiometer. The equipment was calibrated using a standard curve for fluoride analysis from 0.125 to 64 µgF-/mL. Results: Greater fluoride concentration (µgF-/mL) was observed after 1h application, as follows: 197.40 (NG), 172.21 (AG), 20.25 (CA), 14.49 (FV) e 11.81 (FD). Fluoride concentration increased overtime for all groups. After 48h, the following fluoride concentrations were assessed: 428.12 (AG), 267.25 (NG), 65.36 (FV), and 62.52 (CA). Conclusion: Greater fluoride release was observed for AG and NG groups, mostly after 1h application.

Factors Associated with the Caregivers' Perception of the Oral Health of Individuals with Cerebral Palsy

Abstract Objective: To evaluate factors associated with the caregivers' perception of the oral health of children and adolescents with cerebral palsy. Material and Methods: A cross-sectional study was carried out with 80 children and adolescents with cerebral palsy aged 2-18 years, registered at a reference institution and their respective caregivers. Caregivers provided socioeconomic, systemic and health perception and access to dental services data. A calibrated researcher (Kappa=0.75-0.98) performed oral examinations using DMF-T, dmf-t, dental trauma, gingival bleeding index, community periodontal index, malocclusion index and the dental aesthetic index. The Poisson Regression was used (α=0.05) Results: According to the caregivers' perception, the oral health reports of children and adolescents with cerebral palsy considered good and poor was 73.8% and 26.3%, respectively. The poor oral health perception is associated with the presence of dental caries in anterior teeth (PR 1.34, 95% CI=1.11-1.63) and bleeding during tooth brushing (PR 1.20, 95% CI=1.04-1.40) Conclusion: Children and adolescents with cerebral palsy who presented lesions of caries in the anterior teeth and gingival bleeding during tooth brushing, more frequently, had poor oral health by their caregivers.

Occupational Violence against Brazilian Nurses.

BACKGROUND: We evaluated the prevalence and risk factors of workplace violence against Brazilian nurses in 2014. METHODS: The study's population comprised of 112 nurses working in teams of Family Primary Care Units and Primary Care Health Centers. Those nurses were asked to answer a questionnaire that addressed the socio-demographic information, the professional routine and the occupational violence faced (types, frequency and characteristics of perpetrators). Data were analyzed using the SPSS software. RESULTS: Most of nurses were female (94.6%), aged between 34-43 yr (38.4%), living with a partner (60.7%) and having a weekly workload of 40 h (90.1 %). The prevalence of violence was 73.2%. Predominantly, occupational violence comprised of verbal violence (67.0%) and psychological harassment (bullying -27.1%). Patients (81.1%) and caregivers (83.1%) were responsible for verbal violence, whilst the heads of teams (78.3%) and other health professionals (41.7 %) practiced bullying. The risk factors more frequently reported were the lack of safety in the workplace (73.2%) and the aggressive behavior of patients (67%). The occupational violence was not statistically associated with the gender, professional experience, experience at primary health care, weekly working hours, or working shift. The type of violence faced was not either statistically associated with gender, marital status, professional experience, weekly working hours, or working shift. CONCLUSION: Occupational violence has high prevalence among Brazilian nurses working at primary health care system. Verbal violence is more prevalent and frequently practiced by patients. The lack of safety in the workplace is the main risk factor associated with occupational violence faced by nurses.

Factors associated with health and oral health-related quality of life of children and adolescents with cerebral palsy.

AIMS: To verify factors associated with impact on Health-Related Quality of Life (HRQoL) and Oral Health-Related Quality of Life (OHRQoL) of children and adolescents with cerebral palsy (CP). METHODS AND RESULTS: Sample of 149 individuals with CP aged 2 to 18 years and their caregivers, who provided information regarding HRQoL (PedsQL 4.0), OHRQoL (PedsQL 3.0 Oral Health, and socioeconomic factors. A calibrated investigator performed dental examinations, with dental caries, traumatic dental injury, periodontal, and occlusal evaluation. HRQoL and OHRQoL scores were transformed into a 0 to 100 scale, dichotomized in absence or presence of impact (score < 50) and analyzed by Mann-Whitney test and Poisson regression (α = .05). The mean HRQoL score was 50.3 ± 10.2. Impact on HRQoL was observed in 51.7% and associated with gender, general health perception, and communication skills. The mean OHRQoL score was 78.0 ± 24.6. The presence of impact on OHRQoL (12.1%) was associated with age, presence of gastroesophageal reflux, dental caries, and periodontal diseases. CONCLUSION: Individuals with CP had low HRQoL and OHRQoL scores. The impact on HRQoL was shown to be associated with gender, health perception. and communication skills. Regarding OHRQoL, the presence of impact was associated with age, gastroesophageal reflux, dental caries. and periodontal diseases.

Efficacy of red propolis hydro-alcoholic extract in controlling Streptococcus mutans biofilm build-up and dental enamel demineralization.

OBJECTIVE: The efficacy of a red propolis hydro-alcoholic extract (RP) in controlling Streptococcus mutans biofilm colonization was evaluated. The effect of RP on dental demineralization was also investigated. METHODS: Chemical composition was determined by High Performance Liquid Chromatography (HPLC). Minimum Inhibitory and Bactericidal Concentration (MIC and MBC, respectively) were investigated against Streptococcus mutans (ATCC 25175). The cytotoxic potential of 3% RP in oral fibroblasts was observed after 1 and 3 min. Bovine dental enamel blocks (N = 24) were used for S. mutans biofilm formation (48 h), simulating 'feast or famine' episodes. Blocks/biofilms were exposed 2×/day, for 3 days, to a cariogenic challenge with sucrose 10% (5 min) and treated (1 min) with: 0.85% saline solution (negative control), 0.12% Chlorhexidine (CHX, positive control for biofilm colonization), 0.05% Sodium Fluoride (NaF, positive control to avoid demineralization) and 3% RP. Biofilms were assessed for viability (CFU/mL), and to observe the concentration of soluble and insoluble extracellular polysaccharides (SEPS and IEPS). Dental demineralization was assessed by the percentage of surface hardness loss (%SHL) and through polarized light microscopy (PLM). RESULTS: The RP presented 4.0 pH and ºBrix = 4.8. The p-coumaric acid (17.2 µg/mL) and luteolin (15.23 µg/mL) were the largest contents of phenolic acids and flavonoids, respectively. MIC and MBC of RP were 293 µg/mL and 1172 µg/mL, respectively. The 3% RP showed 43% of viably cells after 1 min. Lower number (p < 0.05) of viable bacteria (CFU/mL) was observed after CHX (1.8 × 105) followed by RP (1.8 × 107) treatments. The lowest concentration (µg/CFU) of SEPS (12.6) and IEPS (25.9) was observed in CHX (p < 0.05) followed by RP (17.1 and 54.3), and both differed from the negative control (34.4 and 63.9) (p < 0.05). Considering the %SHL, all groups differed statistically (p < 0.05) from the negative control (46.6%); but NaF (13.9%), CHX (20.1%) and RP (20.7%) did not differ among them (p > 0.05). After all treatments, suggestive areas of caries lesions were observed by PLM, which were lower for CHX and NaF. CONCLUSION: The 3% RP reduced S. mutans colonization, decreased concentration of extracellular polysaccharides and reduced dental enamel demineralization.

Impact of the anatomical location, alcoholism and smoking on the prevalence of advanced oral cancer in Brazil

BACKGROUND: To evaluate the prevalence of oral cancer in Brazil according to the clinical stage, anatomical location, alcoholism and smoking. MATERIAL AND METHODS: Data referring to 31,217 cases of oral cancer, from 2000 to 2010, were obtained from the Integrator Module of the Hospital Registry of Cancer. Inconsistent data ("non-classified" cases) was eliminated and 21,160 cases were analyzed. The frequency distribution according to clinical stage, anatomical location, alcoholism and smoking was analyzed descriptively and through a binary logistic regression model (α<0.05). The clinical stage (dependent variable) was dichotomized in early stage (I and II) or advanced stage (III and IV). The year of diagnosis, anatomical location and deleterious habits (alcoholism and smoking) were considered independent variables. RESULTS: The most frequent characteristics were: oropharynx location (n=3856, 18.41%), clinical stage IV (n=11924, 56.09%) and combined use of alcohol and tobacco (n=19226; 61.59%). The year 2009 (p < 0.01, PR = 1.162, CI- 95%=1.053-1.283) and location at the base of tongue (p < 0.01, PR = 2.485, CI-95% = 2.182-2.807) presented a higher prevalence ratio for advanced stage oral cancer. The combined use of alcohol and tobacco showed a higher prevalence rate for the advanced clinical stage of cancer (p < 0.01, PR =1.449, CI-95%=1.382-1.520) if compared to individuals without habits, or just alcoholics. CONCLUSIONS: Higher prevalence of advanced stage of oral cancer is related to the localization at the base of the tongue and to the concomitant use of alcohol and tobacco. Therefore, it can be suggested that all these characteristics lead to a worse prognosis of oral cancer

The fluoride concentration of the public water supply in the urban zone and indigenous villages of Baía da Traição, Paraíba, Brazil

Introduction: It is known that the municipality of Baía da Traição, Brazil, has a system for fluoridation of the water supply. Objective: To evaluate the fluoride concentration (F-) of the public water supply in the city of Baía da Traição-PB. Methods: Public water samples were collected in 13 sites, being one in the urban zone (downtown) and 12 in the rural zone (indigenous villages). In each site, three distinct collection points were selected for convenience between November 2015 and January 2016. The analysis was performed in duplicate using a fluoride ion- specific electrode coupled to a potentiometer, previously calibrated. The samples (750 µL) were added to 750 µL of TISAB II solution, considered on a calibration curve with concentrations of 0.2 to 1 mg/L. Results: In November, December and January, respectively, concentrations of F- in the downtown area were 0.32, 0.11 and 0.09 mg/L, while the average concentrations in the indigenous villages were 0.08 (± 0.02), 0.08 (± 0.03) and 0.07 (± 0.02) mg/L. All samples had concentrations below the recommended levels (<0.60 mg/L) by the Ministry of Health for the anticaries benefit. Conclusion: The public water supply of Baía da Traição presented concentrations of F- insufficient to prevent dental caries at the population level.

Introdução: É sabido que o município de Baía da Traição possuía sistema de fluoretação de águas de abastecimento. Objetivo: Avaliar a concentração de fluoreto (F-) na água de abastecimento público do município de Baía da Traição-PB. Métodos: Amostras de água de abastecimento público foram coletadas em 13 locais, sendo um na zona urbana (Centro) e 12 distribuídas na zona rural (aldeias indígenas). Para cada local, três pontos de coleta distintos foram selecionados por conveniência entre novembro de 2015 e janeiro de 2016. A análise foi realizada em duplicata, utilizando-se um eletrodo íon-específico para fluoreto acoplado a um potenciômetro, previamente calibrados. As amostras (750 µL) foram adicionadas a 750 µL de solução TISAB II, consideradas a uma curva de calibração com concentrações de 0,2 a 1 mg/L. Resultados: Em novembro, dezembro e janeiro, respectivamente, as concentrações de F- no Centro foram 0,32, 0,11 e 0,09 mg/L, e a média das aldeias indígenas, 0,08 (±0,02), 0,08 (±0,03) e 0,07 (±0,02) mg/L. Todas as amostras apresentaram concentrações abaixo do recomendado (<0,60 mg/L) pelo Ministério da Saúde para o benefício anticárie. Conclusão: Portanto, as águas de abastecimento público de Baía da Traição apresentaram concentrações de F- insuficientes para prevenir a cárie dentária em nível populacional.

Satisfaction, Resolution and Social Participation of users of Centers for Dental Specialties in Brazil: A PMAQ-CEO Analysis

Objective: To describe satisfaction, resolution and social participation of users regarding the service offered in Brazilian Centers for Dental Specialties (CEOs). Material and Methods: An analysis was made of the first phase of PMAQ-CEO, developed during 2014, in which 8,897 users were interviewed. Module III of the instrument external evaluation was used, considering the socio-demographic characterization of the assisted population, and an analysis of satisfaction, resolution and social control of Brazilian CEOs. The bivariate and multivariate Poisson regression analysis with robust variance was used (α<0.05). Results: The profile of interviewed users is female, from the Northeastern region, brown color, living in the urban zone, incomplete elementary school, income of up to two minimum wages and resident of area covered by the family health strategy. The overall CEO rating is "good" (46.1%) or "very good" (49.2%). The score (0 to 10) given to reception staff and dentists was, respectively, 9.31±1.32 and 9.52±1.02. Among subjects who completed treatment (33.3%), the resolution was 95.3%. Although 89.1% stated they never needed to file a complaint, 68.4% did not know the Unified Health System ombudsman. The positive evaluation of CEO was associated with the good evaluation of professionals involved (p<0.05) and the absence of treatment interruption due to lack of material (p=0.037). Conclusion: The satisfaction of users with the services of Centers for Dental Specialties is high and treatments offered are resolutive. Social control tools need to be better known by users.

Theoretical and Methodological Aspects of the External Evaluation of the Improvement, Access and Quality of Centers for Dental Specialties Program

Objective: To introduce the main theoretical and methodological aspects of the external evaluation of the 1st cycle National Program for Quality Evaluation (AEPMAQ/ CEO). Material and Methods: This is an evaluative and quantitative research carried out in all Centers for Dental Specialties - CEO of Brazil, and macro-geographical regions were taken into account for analysis. The general AE-PMAQ/CEO coordination was from the Collaborative Centre for Oral Health Surveillance of the Ministry of Health - Federal University of Pernambuco and Department for Primary Health Care of the Ministry of Health. A collaborative network was established to offer a scientific and technical support for the Project among different higher education institutions around the country, state oral health coordination and quality researchers of AE-PMAQ/CEO. Data collection was carried out through interviews with managers, dentists and users. In addition, researchers used an observation template to check for infrastructure and a questionnaire to register previously discussed quality standards. Conclusion: The external evaluation of the 1st cycle National Program for Quality Evaluation offered data to demonstrate and give recognition to CEO services and municipalities' managers to assure quality for specialized dental care.

The Regulation of Services in Secondary Oral Health Care in Brazil

Objective: To analyze the regulation of access to Centers for Dental Specialties (CEO) in the 1st cycle of Program for Improving Access and Quality of Centers for Dental Specialties (PMAQ-CEO), specifically the waiting time for the first consultation in association with socioeconomic and demographic factors of users and the characteristics of services. Material and Methods: The quantitative database of the 1st cycle PMAQCEO external evaluation was used, with question directed to the CEO user (Module III - 3.1 and 3.2), which sought to identify user characteristics and access to CEO. To obtain data, a field phase was carried out between months of February to June 2014 in 930 CEOs in all Brazilian states. Results: Users who obtained the first appointment within thirty days of waiting were those who had family incomes above 10 minimum wages; which showed higher schooling; appointment scheduling by telephone made directly to the CEO; and that the consultation was accomplished by "squeeze in" option. Conclusion: It was observed that aspects related to schooling, family income and primary health care coverage influence the waiting time to obtain the first consultation in CEO. There were several ways of referencing of users, and those who performed better were those who shared accountability for the appointments between service and user.

Desafios da Regulação Assistencial na Organização do Sistema Único de Saúde / Challenges for Managed Care Regulations in the Organization of the Brazilian Healthcare System

Introdução: a regulação assistencial é um local de observação e ordenamento da rede de serviços e de gerenciamento do fluxo do usuário. Os constantes incrementos de novos procedimentos especializados devido às evoluções em ciência e tecnologias, e ao mercado de serviços em saúde requerem um planejamento dinâmico e uma gestão focada em melhorias de eficiência e eficácia. A identificação de problemas comuns às regulações pode colaborar para a prática dos gestores desta atividade. Objetivo: descrever os principais desafios enfrentados pela regulação assistencial. Materiais e Métodos: trata-se de um estudo de revisão integrativa da literatura com consulta a base SciELO scielo. Utilizou-se os assuntos "regulação de redes e sistemas de saúde", "regulação de serviços de saúde" e "regulação em saúde" sem definição de filtros, e com a opção AND entre as palavras dos assuntos. Após leitura dos títulos fez-se um segundo filtro com leitura de resumos. Resultados: foram categorizados os seguintes desafios: 1. limitada oferta de consultas e exames na rede assistencial. 2. precariedade da referência e contrarreferência. 3. dificuldades na organização das atividades de regulação. 4. baixa utilização / inexistência de protocolos para encaminhamentos. 5. precariedade de sistemas de informação e comunicação. 6. significativa influência política na gestão das unidades de saúde. 7. desorganização da rede de serviços. Conclusão: os desafios elencados sintetizam uma agenda estratégica de gestão, podendo auxiliar os gestores na tomada de decisão, no monitoramento e avaliação. (AU)

Introduction: Managed care regulation is a strategy for observation and ordering of the service network and user flow management. The steady increase in new specialized procedures due to developments in science and technology and the health services market, require dynamic planning and management focused on efficiency and effectiveness improvements. The identification of problems common to regulations can contribute to the practice of managers involved with this activity. Objective: to describe the main challenges faced by health care regulation. Material and Methods: This was an integrative review of the literature based on searches in SciELO databases. The topics "regulation of health systems and networks", "regulation of health services" and "regulation of health" without definition of filters, and with the option "AND" between the words of the subjects, were used. After reading the titles, a second screening was performed by reading the abstracts. Results: The following challenges were categorized: 1. limited offer of appointments and examinations in the care network. 2. Precariousness of reference and counter-reference. 3. difficulties in the organization of regulatory activities. 4. low usage / lack of protocols for referrals. 5. precariousness of information and communication systems. 6. significant political influence in the management of facilities. 7. disorganization of the service network. Conclusion: The challenges listed synthesize a strategic management agenda, which can assist managers in decision-making, monitoring and evaluation. (AU)

Bullying: prevalência e fatores associados à vitimização e à agressão no cotidiano escolar / Bullying: prevalence and factors associated with vitimization and aggression in the school quotidian

RESUMO Objetivo: analisar a prevalência de vitimização e agressão por bullying e tipologias associadas aos fatores sociodemográficos e comportamentos de risco em estudantes. Método: estudo transversal, desenvolvido em escolas municipais de ensino fundamental em Campina Grande, Paraíba, Brasil, sendo a amostra representada por 678 adolescentes matriculados do 6º ao 9º ano escolar. Os dados foram atualizados com o programa escolar estatístico Statistical Package for the Social Sciences, sendo utilizado nível de significância de 5% e intervalo de confiança de 95% para realização do teste qui-quadrado de Person. Resultados: a prevalência de vitimização de bullying alcançou 29,5%, com predomínio do bullying psicológico, 23,3% e envolvimento majoritário do sexo masculino. Quanto à prática de bullying, 8,4% dos estudantes afirmaram praticarem bullying contra os pares. Conclusão: pode-se observar associação entre agressores de bullying com comportamento de risco na escola.

ABSTRACT Objective: to analyze the prevalence of bullying victimization and aggression and the typologies associated with the sociodemographic factors and risk behaviors in students. Method: cross-sectional study, developed in municipal schools of elementary education in Campina Grande, Paraíba, Brazil, with the sample being comprised of 678 adolescents enrolled in the 6th to 9th school years. The data were processed using the statistical school program Statistical Package for the Social Sciences, considering a significance level of 5% and a confidence interval of 95% for carrying out the Person's chi-squared test. Results: the prevalence of bullying victimization reached 29.5%, with a predominance of psychological bullying, 23.3%, with the majority involved being male. Regarding the practice of bullying, 8.4% of the students said they practiced bullying against their peers. Conclusion: an association between bullying aggressors and risk behavior in school was observed.