O cuidado para pessoas com hiv/aids sob a ótica de agentes comunitários de saúde / Care for people with hiv/aids under the perspective of community health workers / El cuidado para personas con hiv/sida bajo la óptica de agentes comunitarios de salud

Resumo Este estudo buscou investigar a experiência de atuação dos agentes comunitários de saúde em relação aos indivíduos que vivem com HIV/Aids em áreas de risco social. Trata-se de uma pesquisa de natureza qualitativa, realizada no ano de 2015 com agentes comunitários atuantes em município de médio porte do estado de São Paulo, Brasil. A produção das narrativas foi realizada pelo método do grupo focal, interpretadas e analisadas por meio da análise temática de conteúdo. O preconceito apresentou-se como a principal causa das dificuldades de atuação dos agentes; porém, a criação do vínculo com os usuários, aliada à conquista da confiança, foi a principal potencialidade nas ações desses profissionais. Torna-se essencial o rompimento da barreira gerada pelo preconceito para uma efetiva atuação dos agentes comunitários de saúde nos territórios, para que possam colaborar com o acolhimento desses usuários e com a redução dos efeitos da vulnerabilidade existente.

Abstract The present study had the goal of investigating the work experience of community health workers with individuals who live with HIV/Aids in areas of social risk. It is a qualitative research performed in 2015 with community health workers of medium-sized municipalities in the state of Paulo, Brazil. The narratives were produced using the focus group method, and they were interpreted and analyzed through the thematic analysis of content. Prejudice was the main cause of difficulties in the work of these professionals; however, the establishment of bonds with the users, coupled with the fact that the workers gained their trust, was the main potentiality in the actions of those professionals. Therefore, it is essential that we break the barrier generated by prejudice in order to guarantee and effective work in the territories on the part of the community health workers, so they can contribute to the embracement of these users and to the reduction in the effects of the existing vulnerability.

Resumen Este estudio buscó investigar la experiencia de trabajo de los agentes comunitarios de salud en relación a los individuos que viven con HIV/Sida en áreas de riesgo social. Se trata de una investigación de naturaleza cualitativa realizada en el año 2015 con agentes comunitarios de un municipio de tamaño mediano del estado de São Paulo, Brasil. La obtención de las narraciones se realizó a través del método del grupo focal, ¿interpretadas y analizadas por medio del análisis temático de contenido?. El preconcepto se presentó como la principal causa de las dificultades de trabajo de los agentes; sin embargo, la creación de un vínculo con los usuarios combinado a la conquista de la confianza fueron las principales potencialidades en las acciones de estos profesionales. Se vuelve esencial la ruptura de la barrera generada por el preconcepto para un trabajo efectivo de los agentes comunitarios de salud en los territorios, para que puedan colaborar con la acogida de estos usuarios y la reducción de los efectos de la vulnerabilidad existente.

Neuroclusal rehabilitation and planas direct tracks in the posterior crossbite treatment / Reabilitação neuroclusal e pistas diretas de planas na correção da mordida cruzada posterior

ABSTRACT Objective: To evaluate the effectiveness of neuroclusal rehabilitation treatment using Planas Direct for posterior crossbite correction. Methods: This is a clinical study in which 43 children were selected, of both sexes, between 3 and 6 years old, diagnosed with posterior crossbite and midline deviation. Interviews were conducted with the parents in order to ascertain the practice of harmful habits. The treatment was based on neuroclusal rehabilitation in order to investigate and eliminate the occlusal obstacles which depreciate the stomatognathic system. The aim of the study was also to reprogram the affected neuromuscular activity. Planas direct were performed on crossed teeth in order to restructure the neuroclusal area and the stomatognathic system, as well. Epi Info software, 3.5.4 for Windows, through the distribution of frequencies and the Pearson chi-square test were used for statistical analysis. Results: Occlusal restoration in 79% of children was performed however 21% abandoned treatment. The crossbite and midline correction period ranged from from 14° to the 91° treatment. Significant associations of the variables were observed as follows: deleterious habits (p = 0.0001) and midline deviation (p = 0.0001) at the beginning or end of treatment. Conclusion: It was concluded that the neuroclusal rehabilitation and Direct Slopes Planas were effective in correcting the posterior crossbite.

RESUMO Objetivo: Avaliar a eficácia do tratamento da reabilitação neuroclusal com as Pistas Diretas Planas na correção das mordidas cruzadas posteriores. Métodos: Trata-se de um estudo clínico no qual foram selecionadas 43 crianças, de ambos os sexos, entre 3 e 6 anos de idade, diagnosticadas com mordida cruzada posterior funcional e desvio de linha média. Foram realizadas entrevistas com os responsáveis dos participantes, para averiguar a prática de hábitos deletérios. O tratamento baseou-se na reabilitação neuroclusal, no intuito de investigar e eliminar os empecilhos oclusais que depreciam o sistema estomatognático, e assim, reprogramar a atividade neuromuscular afetada. Foram confeccionadas as Pistas Diretas de Planas nos dentes cruzados, a fim de reestrutura os estímulos neuroclusais e o sistema estomatognático. Na análise estatística, utilizou-se o software Epi Info software, versão 3.5.4 for Windows, por meio da distribuição das frequências e o Teste do Qui-quadrado de Pearson. Resultados: Houve o restabelecimento oclusal em 79% das crianças, visto que 21% abandonaram o tratamento. O período de correção da mordida cruzada e linha média compreenderam-se ao 14° ao 91° de tratamento. Foram observadas associações significativas das variáveis: hábitos deletérios (p=0.0001) e desvio de linha média (p=0.0001) no início e final do tratamento. Conclusão: Conclui-se que a reabilitação neuroclusal e as Pistas Direta de Planas foram eficazes na correção das mordidas cruzadas posteriores.

[Perceptions and attitudes of public health service dentists in the face of family violence in 24 municipalities in the state of São Paulo, Brazil, 2013-2014]. / Percepção e atitude do cirurgião-dentista servidor público frente à violência intrafamiliar em 24 municípios do interior do estado São Paulo, 2013-2014.

OBJECTIVE: to describe the perceptions and attitudes of dentists working in Primary Healthcare Units in the face of family violence in 24 municipalities in the interior of São Paulo state, Brazil. METHOD: this is a descriptive study conducted between July 2013 and July 2014; the study population was comprised of 294 professionals; data were collected through a questionnaire containing objective and subjective questions. RESULTS: 111 dentists took part (37.8%), 67.5% of whom were unaware of existing legislation on cases of violence; 70.0% did not know how to report the occurrence of cases; 55.0% reported not having any responsibility for notification; 85.0% were unaware of the notification form; and 60.0% said they should intervene in cases of family violence. CONCLUSION: the perceptions and attitudes of dentists have shortcomings in relation to notification of family violence and this hinders early diagnosis of the victims of such violence.

Estigma do HIV positivo expresso por meio do preconceito velado / Stigma of HIV positive expressed through veiled prejudice

O termo estigma foi criado pelos gregos da Antiguidade para referirem sinais feitos no corpo que evidenciavam algo ruim sobre a moral de quem os apresentava. Objetivo: Objetivou-se verificar a presença de atitudes discriminatórias de usuários do sistema público de saúde em relação a indivíduos HIV positivo, além da percepção dos mesmos sobre a possibilidade de contraírem algum tipo de doença durante o tratamento odontológico. Métodos: O instrumento de coleta de dados consistiu de um questionário semiestruturado. Realizaram-se entrevistas com perguntas relacionadas à concordância do indivíduo ao atendimento por um cirurgião-dentista HIV positivo, após o atendimento de um paciente soropositivo, ou um presidiário; a percepção da possibilidade de se contrair alguma doença no consultório odontológico; preocupação com relação à esterilização dos materiais utilizados e conhecimento sobre a forma de esterilização. Resultados: Foram entrevistados 200 indivíduos, sendo que 142 afirmaram que aceitariam ser atendidos após um paciente HIV positivo e 160 após um presidiário. Ainda, 162 se disporiam ser tratados por um cirurgião-dentista HIV positivo. Entretanto, quando questionados em relação à preferência, 93 prefeririam o atendimento antes de um indivíduo soropositivo e 60 antes de um presidiário. Conclusão: Conclui-se que os pacientes apresentam atitudes discriminatórias em relação a pessoas soropositivas, expressa às vezes de maneira velada e a percepção sobre a possibilidade de contrair algum tipo de infecção durante o tratamento odontológico.

The term stigma was coined by the ancient Greeks to refer to signs made in the body meaning something bad on the morale of those who had them. Objective: To verify the presence of discriminatory attitudes of users of Unified Health System regarding HIV-positive individuals, as well as the perception about the possibility of acquiring some kind of disease during dental treatment. Methods: The data collection instrument consists of a semi-structured questionnaire. This study included interviews asking the following questions: individuals agree to be treated by a HIV-positive dentist, after the treatment of a HIV-positive patient or an inmate; the perception of the possibility of acquiring illnesses in a dental office; concern regarding sterilization of materials used and the manner of sterilization. Results: Two hundred individuals were interviewed, 142 would accept to be treated after a HIV-positive patient and 160 after an inmate. Moreover, 162 would be available for treatment by a HIV-positive dentist. However, when questioned about the preference, 93 would prefer to be treated before a HIV-positive patient and 60 before an inmate. Conclusion: Patients showed discriminatory attitudes toward seropositive people, expressed sometimes in a veiled manner, and the perception about the possibility of getting some kind of infection during dental treatment.

Musculoskeletal Disorders among Dentists in Northwest area of the state of São Paulo, Brazil

Objective: To determine the prevalence of musculoskeletal disorders in dentists who attend postgraduate courses in various specialties and establish possible relationships with sociodemographic and occupational factors. Methodology: This is a cross-sectional study where 91 professionals responded to validated instruments: "Work-related activities that may contribute to job-related pain and / or injury" and NMQ "Nordic Musculoskeletal Questionnaire", and variables were also collected regarding sociodemographic and occupational characteristics. Results: WMSDs were often reported in the neck, shoulder, lower/upper back, and hand/wrists. Logistic regression analysis revealed that there was a correlation between reports of WMSD in lower back and work related (OR=13.40). Moreover, associations were found between WMSDs and the occupational factors that can contribute to musculoskeletal disorders. Conclusion: There was a high prevalence of musculoskeletal disorders among brazilian dentists, and that the work-related activities contributed to musculoskeletal disorders in dentists. (AU)

Elderly victims of abuse: a five year document analysis / Idosos vítimas de maus-tratos: cinco anos de análise documental

Objective To verify the occurrence of maltreatment of the elderly and its characteristics (location, type, reason, involvement of alcohol/drugs, profile and family relationship of victims and perpetrators) from the police records of a specialized police station over a five year period. Method A cross-sectional, descriptive and documentary analytical study was performed. The police reports of a medium-sized municipality in the northwest of São Paulo were analyzed from 2008 to 2012. The sociodemographic characteristics of the perpetrators and victims and the data relating to the aggression investigated were: violence; location; reason; the presence of alcohol and drugs during the assault and victim-offender relationship. Data was tabulated using descriptive statistical analysis. Results Of a total of 572 cases, most of the perpetrators were men (69.2%), Caucasian (56.5%), aged 31-40 years (14.20%) with no information regarding occupation provided (50.70%); most of the victims were women (93.0%), Caucasian (71.5%), aged 60-65 years (46.30%), married (34.10%) and unemployed/retired (59.98 %). Emotional abuse was prevalent (57.0%), occurred in the home of the elderly person (81.3%) and the children of the elderly were the main perpetrators (25.3%). The motives were related to arguments in most cases (53.1%). Conclusion Women who were Caucasian, married, aged 60-65, unemployed/retired were the main victims, with the perpetrators most frequently their own children, also Caucasian, single and aged 31-40 years. Psychological violence was the most prevalent, primarily triggered by disagreements among those involved, and it occurred most frequently in the residence of the victim. Most of the attackers were not under the influence of alcohol/drugs.

Objetivo Verificar a ocorrência de maus-tratos contra idosos e suas características (local, tipo, motivo, envolvimento álcool/drogas, perfil e relação de parentesco entre vítimas e agressores), com base nos registros policiais de uma delegacia especializada, no período de cinco anos. Método Trata-se de estudo transversal, descritivo e retrospectivo, de análise documental. Foram analisadas as ocorrências policiais de um município de médio porte do noroeste paulista, no período de 2008 a 2012. Investigaram-se as características sociodemográficas de agressores e vítimas e dados relativos à agressão: tipo de violência; local; motivo; presença de álcool e drogas durante a agressão e relação vítima-agressor. Os dados foram tabulados e foi feita análise estatística descritiva. Resultados Do total, 572 casos, a maior parte dos agressores eram homens (69,20%), brancos (56,50%), faixa etária 31-40 anos (14,20%) e sem informação quanto à ocupação (50,70%); a maioria das vítimas eram mulheres (93%), brancas (71,50%), com idade entre 60-65 anos (46,30%), casadas (34,10%) e desempregadas/aposentadas (59,98%). Os maus-tratos emocionais foram prevalentes (57%), ocorridos na própria residência (81,30%) e os filhos foram os principais agressores (25,30%). O motivo foi relacionado a discussões (53,10%) na maior parte dos casos. Conclusão As mulheres da raça branca, casadas com idade entre 60-65, desempregadas/aposentadas são as principais vítimas, e os agressores são os próprios filhos, também da raça branca, solteiros, com idade entre 31-40 anos. A violência psicológica foi a mais prevalente, desencadeada principalmente por desentendimento entre os envolvidos e na própria residência da vítima. A maioria dos agressores não estava sob efeito de álcool/drogas.

Violência na população infantil: perfil epidemiológico dos abusos verificados no ambiente escolar / Violence in child population: epidemiological profile of abuses seen in the school environment

Introdução: A violência infantil é caracterizada como uma mazela de saúde pública, sendo que os abusos podem compreender desde agressões físicas, injúrias psicológicas, negligência no ato de cuidar e violência sexual. Logo, qualquer profissional que tenha contato com crianças, deve notificar casos suspeitos e/ou identificados. Dentre estes profissionais, destaca-se o educador de ensino infantil. Objetivo: Este estudo transversal objetivou verificar o perfil dos casos suspeitos e/ou confirmados de violência contra a criança em Escolas Municipais de Ensino Básico (EMEBS) do município de Araçatuba / SP, com o auxílio da equipe pedagógica. Métodos: A população pesquisada abrangeu 91 educadores. As escolas foram selecionadas por sorteio, sendo que o período de coleta de dados compreendeu o ano letivo de 2015. O instrumento de análise utilizado foi um relatório sobre suspeita e/ou confirmação de abusos, desenvolvido pelo Núcleo de Pesquisa em Saúde Coletiva da FOA Unesp. Essa ferramenta permite o registro do perfil da vítima, bem como do provável agressor, perfazendo ainda a anotação das formas de violência observadas e dos casos recidivantes. Resultados: 272 menores foram identificados como vítimas de violência pelos participantes, 51,1% eram do sexo masculino e 48,9% do sexo feminino. Os pais e/ou responsáveis foram apontados como os principais agressores (58,4%). Na descrição dos abusos, os casos mais verificados foram: presença de piolho (35,2%), agressividade (15,8%), roupas inadequadas (15,4%) e cárie (11%). Sendo assim, observa-se que a negligência foi o tipo de violência mais prevalente (92,6%). Dos casos identificados, 76,4% apresentaram recidivas. Conclusões: Portanto, ainda são elevados os índices de violência contra criança identificados em escolas de ensino infantil. Sugere-se assim melhor direcionamento das políticas públicas voltadas ao enfrentamento da violência, a fim de que se possa proteger os menores na melhor fase da vida, a infância (AU).

Introduction: The child violence is characterized as a public health problem, and abuse can comprehend from physical aggressions, psychological injuries, negligence in caring and sexual violence. Thus, any professional who has contact with children should notify suspects and / or identified cases. Among these professionals, it is possible to highlight the kindergarten educator. Objective: In this way, this cross-sectional study aimed to determine the profile of suspected and / or confirmed cases of violence against children in stated funded nursery schools of Araçatuba, São Paulo State, Brazil, with the help of the teaching staff. Methods: The surveyed population included 91 educators. The schools were selected by sortition, and the data collection period comprehend the school year of 2015. The analysis instrument used was a report related to suspected and / or confirmed abuses, developed by the Collective Health Research Center of Araçatuba Dental School, Unesp. This tool allows the register of the victim's profile as well as the likely perpetrator, even comprehending annotations of the observed forms of violence and recurrent cases. Results: 272 children have been identified as victims of violence by the participants, 51,1% were male and 48,9% were female. Parents and / or caregivers were identified as the main perpetrators (58,4%). In the description of the abuses, the most verified cases were presence of louse (35,2%), aggressiveness (15,8%), inappropriate clothing (15,4%) and decay (11%). Thus, it is observed that the neglect was the most prevalent type of violence (92,6%). In relation to the identified cases, 76,4% had recurrences. Conclusions: Between this and that, there are still high levels of violence against children identified in nursery schools. Therefore, it is suggested better targeting of public policies aimed at combating violence, in order to protect minors in the best stage of life, childhood (AU).

O cidadão usuário do serviço odontológico do Sistema Único de Saúde sabe onde reclamar? O controle social na saúde / The user of dental service in Unified Health System knows where to complain? Social control in health

Objetivo ­ Verificar o conhecimento de usuários do serviço odontológico do SUS sobre o sistema de ouvidoria e a sua capacidade resolutiva e como objetivo secundário relacionar a satisfação do usuário com a resolubilidade do serviço. Um dos eixos norteadores do Sistema Único de Saúde (SUS) é o controle social, que garante a participação dos cidadãos na gestão da saúde. As ouvidorias públicas de saúde são um importante instrumento para auxiliar a administração pública. Método ­ Trata-se de uma pesquisa transversal, tipo inquérito, cuja população de estudo foi composta por 461 usuários do serviço odontológico do SUS. Realizou-se entrevista com questionário estruturado. Resultados ­ Houve predomínio de usuários do gênero feminino (70,5%), solteiros (57,0%), com renda de 1 a 2 salários mínimos (49,2%) e ensino médio incompleto (39,3%). O principal motivo para a procura ao serviço de 50,8% dos entrevistados foi a busca por tratamento. Quanto ao sistema de ouvidorias, 76,4% não sabiam onde reclamar; 4,8% fizeram algum tipo de reclamação ou sugestão, e 43% deles tiveram algum retorno. Do total de entrevistados, 73,3% afirmaram terem todos os seus problemas de saúde bucal resolvidos na Unidade de Saúde e 72,6% estavam satisfeitos. A satisfação esteve associada com a percepção sobre a resolubilidade do serviço (p< 0,0001). Conclusões ­ Os usuários do SUS não sabem onde podem reclamar, entretanto, estão satisfeitos com o serviço e com a resolutividade de seus problemas bucais pela equipe de saúde bucal.

Objective ­ Check the knowledge of users SUS dental service on the ombudsman system and its response capacity and as a secondary objective relate to user satisfaction with the resolution of the service. One of the principles of the Unified Health System (SUS) is social control, which guarantees user participation in health management. Health public ombudsmen are an important instrument to help the public administration. Method ­ It is a cross-sectional survey, survey type, whose study population consisted of 461 users of the SUS dental service. An interview was conducted with structured questionnaire. Results ­ Users predominance was female (70.5%), single (57.0%), earning 1-2 minimum salary (49.2%) and incomplete secondary education (39.3%). The main reason for seeking to 50.8% of respondents service was seeking treatment. As the ombudsman system, 76.4% did not know where to complain; 4.8% had some type of complaint or suggestion, and 43% of them had some return. Of the total respondents, 73.3% said they had all their oral health problems resolved at the Health Unit and 72.6% were satisfied. The satisfaction was associated with the perception of the solvability of service (p< 0.0001). Conclusion ­ SUS users do not know where they can complain, however, are satisfied with the service and the resoluteness of their oral problems for the oral health team.

Saúde bucal e o emprego de medidas preventivas por pacientes gestantes / Oral health and the use of preventive methods for pregnant patients

Objetivo ­ Verificar o conhecimento e a aplicação de medidas preventivas de saúde bucal por gestantes. Métodos ­ Foi realizada análise documental de 777 prontuários de pacientes atendidas no período de 1999 à 2012 no Programa de Atenção Odontológica à Gestante de uma universidade pública paulista. As variáveis estudadas foram: o acesso ao tratamento odontológico, as orientações recebidas sobre saúde bucal durante a gestação, a percepção de alterações bucais, o emprego de medidas preventivas e a dieta. Resultados ­ Do total, 58,2% era da faixa etária de 18 a 28 anos; 58% apresentavam-se no segundo trimestre de gestação. Em relação à demanda, 42% dos motivos da procura pelo serviço odontológico deram-se em razão de tratamento de rotina; 29% tinham como principal causa a dor/urgência; 63% relataram o sangramento gengival, entretanto, apenas 53% perceberam alguma alteração na cavidade bucal. O emprego das medidas de auto cuidado mostrou que 92,7% escovavam os dentes duas ou mais vezes ao dia e 57% raramente faziam uso do fio dental. Mais da metade relatou não ter recebido orientações sobre saúde bucal durante a gestação. Conclusão ­ Conclui-se que grande parte das gestantes não realizavam a higiene bucal de forma completa, e a necessidade de procedimentos curativos revelam a importância de estratégias educativas e de assistência odontológica durante o pré-natal, com o intuito de proporcionar melhores condições de saúde para o binômio mãe-filho.

Objective ­ To verify the knowledge and the application of preventive methods of oral health by pregnant women. Methods ­ The documentary analysis of 777 records of patients attended in the period of 1999 to 2012 at the Dental Care Program to Pregnant Women of a public university. The variables studied were: access to dental care, received guidance on oral health during pregnancy, the perception of oral changes, the use of preventive methods and diet. Results ­ Of the total, 58,2% were the age group 18-28 years; 58% appeared in the second trimester of pregnancy. In relation to demand, 42% of the reasons for the demand for dental service for routine dental treatment; 29% were the main cause pain / urgency, 63% reported gum bleeding, however, only 53% noticed changes in the oral cavity. The use of self care methods showed that 92,7% brusched their teeth twice or more a day and 57% rarely made flossing. More than half reported not having received guidance on oral health during pregnancy. Conclusions ­ It concludes that many of pregnant women didn't performing oral hygiene completely and the need for curative procedures show the importance of educational strategies and dental care during the prenatal in order to provide better health for mother and child.

Assessment of health-related quality of life and related factors in patients with chronic liver disease

ABSTRACT BACKGROUND AND OBJECTIVES: Assessing health-related quality of life is an important aspect of clinical practice. Thus, the present study attempts to assess the health-related quality of life of patients with chronic liver disease. METHODS: A cross-sectional survey was conducted on 133 chronic liver disease patients, using three instruments: a demographic questionnaire, the Chronic Liver Disease Questionnaire, and Model for End-Stage Liver Disease index. Variables were expressed as frequencies, percentages, means, and standard deviations. The statistical analysis included Pearson's correlation, Student's t-test, and analysis of variance (p < 0.05 was considered significant). RESULTS: The mean age of included subjects was 50.5 ± 13.3 years. The majority were male (66.2%), Caucasian (70.7%), and had a family income of US$329-US$658.2. Over half of the patients (56.4%) were infected by hepatitis C virus and 93.2% had low Model for End-Stage Liver Disease scores. Model for End-Stage Liver Disease score was related to age (r = 0.185;p = 0.033). Higher mean Chronic Liver Disease Questionnaire scores were obtained for emotional function (39.70/SD ± 12.98) and while lower scores were obtained for abdominal symptoms (16.00/SD ± 6.25). Fifty-two patients (39.1%) presented overall low (<5) Chronic Liver Disease Questionnaire scores. Furthermore, Chronic Liver Disease Questionnaire score was related to family income (r = 0.187, p = 0.031). CONCLUSION: Most individuals presented high mean Chronic Liver Disease Questionnaire scores, indicating low health-related quality of life, especially individuals with low family income.

Evaluation of injury cases for dental intervention described in legal dentistry reports / Evaluación de casos con lesiones de intervención dental descrita en los informes legales odontológicos

The dentist responsibility on dental interventions during the exercise of his/her activity guides in civil, ethical, administrative and criminal obligations. When a harmful result occurs on a patient whether by recklessness, malpractice and / or negligence, the examination of the injury can be ordered by a judicial authority and held at the expert level, thus making the dentist subject to the Brazilian Penal Code and its penalties. The dentist might be forced to repair the damage and compensate according to the caused consequence, based on the Civil Code, or both and may suffer a double action. With the increase of Dentistry-related processes, the focus of this research is to give greater visibility to the subject, emphasizing the ethical and legal aspects involved in professional practice. To meet this end, we carried out a survey on reports of maxillofacial injuries from the "Instituto Médico Legal Nina Rodrigues", Salvador-BA-Brazil, from January 2007 to December 2013, analyzing the data on the procedures performed, the reason for the expert's report and its result, the professional responsibility and the conclusion given by the expert. It was noticed that from the total of personal injury examinations made by dentists, most of the complaints are in the area of surgery (42.9%), followed by Endodontics and Orthodontics with 14.3% each, and in 96 % of cases involved one or more elements of professional liability and 47.4% were classified by experts as minor injuries. It is concluded that the increase in injuries lawsuits generated in service is due to the fact that the dentist does not take responsibility to protect himself/herself from poor results and to perform procedures without having the proper skill. It is therefore suggested, professional training for the acquisition of technical and scientific knowledge in their area, enabling them to act with utmost in care and professionalism.

La responsabilidad del dentista acerca de las intervenciones dentales realizadas en el ejercicio de sus actividades tienen responsabilidades civil, ética, administrativa y penal. Cuando se prueba que un resultado es perjudicial para el paciente, por imprudencia, mal praxis o negligencia, el examen de la lesión puede ser ordenado por una autoridad judicial y se analiza por peritos, haciendo que el dentista este sujeto a las sanciones previstas en el Código Penal brasileño, siendo forzado a reparar el daño e indemnizar de acuerdo a la consecuencia causada, con base en el Código Civil, o ambos, pudiendo sufrir una doble acción. Debido al incremento de los procesos legales relacionados con la odontología, el objetivo de esta investigación es dar mayor visibilidad al tema, haciendo hincapié en los aspectos éticos y legales relacionados con la práctica profesional. Para ello, llevamos a cabo un estudio de los informes odontológicos legales de lesiones maxilofaciales en el Instituto de Medicina Legal Nina Rodrigues, Salvador-BA-Brasil, durante los meses de enero 2007 a diciembre 2013. Se analizó la información de los procedimientos realizados, la razón para el informe del perito y su resultados, la responsabilidad profesional y la conclusión propuesta por el peritos. Se encontró que del total de exámenes por injurias a pacientes, la mayoria correspondió al área de cirugía (42,9%), seguido por endodoncia y ortodoncia con 14,3% en cada uno; en el 96% de los casos se involucraron uno o más elementos de responsabilidad profesional, siendo el 47,4% clasificados por los peritos como lesiones menores. Se concluye que el aumento de los litigios por lesiones generadas por la atención odontológica se deben a que el dentista no toma responsabilidad sobre los malos resultados y realiza procedimientos sin tener la habilidad adecuada. Se sugiere realizar una adecuada formación profesional para la adquirir los conocimientos técnicos y científicos de cada área (especialización), lo que permitiria actuar con el máximo cuidado y profesionalismo.

Oral health and quality of life: an epidemiological survey of adolescents from settlement in Pontal do Paranapanema/SP, Brazil.

This study aimed to verify oral health, treatment needs, dental service accessibility, and impact of oral health on quality of life (QL) of subjects from settlement in Pontal do Paranapanema/SP, Brazil. In this epidemiological survey, 180 10-to 19- years old adolescents enrolled in the school that attend this population in settlement underwent oral examination, to verify caries index (DMFT- decayed, missing and filled teeth) and periodontal condition (CPI), and were interviewed using the World Health Organization Quality of Life (WHOQOL-Bref) and Oral Impact Daily Performance (OIDP) instruments to evaluate QL, and the Global School-Based Health Survey (GSHS) about dental service accessibility. DMFT average was 5.49 (± 3.33). Overall, 37.2% of participants showed periodontal problems, mainly CPI = 1 (77.7%). Treatment needs were mainly restorations. GSHS showed that the last dental consultation occurred > 1 year previously for 58.3% of participants at a public health center (78.9%). The average WHOQOL-Bref was 87.59 (± 15.23). Social relationships were related to dental caries and health service type. The average OIDP was 6.49 (± 9.15). The prevalence of caries was high and observed periodontal problems were reversible. The social relationships of adolescents from settlement were influenced by caries and health services type.

Oral health and quality of life: an epidemiological survey of adolescents from settlement in Pontal do Paranapanema/SP, Brazil / Saúde bucal e qualidade de vida: um estudo epidemiológico de adolescentes de assentamento no Pontal do Paranapanema/SP, Brasil

This study aimed to verify oral health, treatment needs, dental service accessibility, and impact of oral health on quality of life (QL) of subjects from settlement in Pontal do Paranapanema/SP, Brazil. In this epidemiological survey, 180 10-to 19- years old adolescents enrolled in the school that attend this population in settlement underwent oral examination, to verify caries index (DMFT- decayed, missing and filled teeth) and periodontal condition (CPI), and were interviewed using the World Health Organization Quality of Life (WHOQOL-Bref) and Oral Impact Daily Performance (OIDP) instruments to evaluate QL, and the Global School-Based Health Survey (GSHS) about dental service accessibility. DMFT average was 5.49 (± 3.33). Overall, 37.2% of participants showed periodontal problems, mainly CPI = 1 (77.7%). Treatment needs were mainly restorations. GSHS showed that the last dental consultation occurred > 1 year previously for 58.3% of participants at a public health center (78.9%). The average WHOQOL-Bref was 87.59 (± 15.23). Social relationships were related to dental caries and health service type. The average OIDP was 6.49 (± 9.15). The prevalence of caries was high and observed periodontal problems were reversible. The social relationships of adolescents from settlement were influenced by caries and health services type.

O objetivo deste trabalho foi verificar a saúde bucal, as necessidades de tratamento, o acesso aos serviços odontológicos e o impacto da saúde bucal na qualidade de vida (QV) de adolescentes de assentamento no Pontal do Paranapanema/SP, Brasil. Neste estudo epidemiológico, foram examinados 180 jovens entre 10 e 19 anos matriculados na escola que atende a esta comunidade para verificar o índice de cárie (CPOD – cariados, perdidos e obturados) e a condição periodontal (IPC); e entrevistados, utilizando-se os instrumentos World Health Organization Quality of Life (WHOQOL-Bref) e Oral Impact Daily Performance (OIDP) para avaliar qualidade de vida e o Global School-based Health Survey (GSHS-WHO) visando o acesso. O CPOD médio foi 5,49 (± 3,33) e 37,2% tinham problemas periodontais, predominando IPC = 1 (77,7%). As necessidades de tratamento concentraram-se nas restaurações. O GSHS mostrou que a última consulta odontológica foi realizada nos últimos 12 meses (58,3%), e 78,9% no serviço público. A média WHOQOL-Bref foi 87,59 (± 15,23). O domínio relações sociais teve associação com a cárie e o local do atendimento. A média OIDP foi 6,49 (± 9,15). A prevalência de cárie foi alta e os problemas periodontais ainda eram reversíveis. As relações sociais foram influenciadas pela presença de cárie e pelo local do atendimento.

Assessment of health-related quality of life and related factors in patients with chronic liver disease.

BACKGROUND AND OBJECTIVES: Assessing health-related quality of life is an important aspect of clinical practice. Thus, the present study attempts to assess the health-related quality of life of patients with chronic liver disease. METHODS: A cross-sectional survey was conducted on 133 chronic liver disease patients, using three instruments: a demographic questionnaire, the Chronic Liver Disease Questionnaire, and Model for End-Stage Liver Disease index. Variables were expressed as frequencies, percentages, means, and standard deviations. The statistical analysis included Pearson's correlation, Student's t-test, and analysis of variance (p<0.05 was considered significant). RESULTS: The mean age of included subjects was 50.5±13.3 years. The majority were male (66.2%), Caucasian (70.7%), and had a family income of US$329-US$658.2. Over half of the patients (56.4%) were infected by hepatitis C virus and 93.2% had low Model for End-Stage Liver Disease scores. Model for End-Stage Liver Disease score was related to age (r=0.185; p=0.033). Higher mean Chronic Liver Disease Questionnaire scores were obtained for emotional function (39.70/SD±12.98) and while lower scores were obtained for abdominal symptoms (16.00/SD±6.25). Fifty-two patients (39.1%) presented overall low (<5) Chronic Liver Disease Questionnaire scores. Furthermore, Chronic Liver Disease Questionnaire score was related to family income (r=0.187, p=0.031). CONCLUSION: Most individuals presented high mean Chronic Liver Disease Questionnaire scores, indicating low health-related quality of life, especially individuals with low family income.

Elderly caregivers at long-stay institutions: quality of life and temporomandibular dysfunction

Abstract Aim: To assess the profile, quality of life and the presence of Temporomandibular Disorders (TMD) in elderly caregivers. Methods: Thirty-nine caregivers who worked in six long-stay institutions for the elderly in three different municipalities participated in the study. The research instruments were the WHOQOL-BREF, the Fonseca questionnaire and the socio-demographic questionnaire. The Kruskal-Wallis test with the Dunn's correction was performed at a level of 5%. Results: Females accounted for 94.9% of the sample. The average monthly wage was R$ 832.00. The average working week was 39 hours. The WHOQOL dominions showed the following averages: 74.25 Physical; 70.33 Psychological; 65.79 Social Affairs; 58.38 Environment. Mild DTM was present in 43.6% of the caregivers, of which 7.7% were moderate, 5.2% severe, 23.0% of the professionals were asymptomatic and 20.5% did not answer. The association between TMD and the quality of life showed p=0.6752. Conclusions: It was concluded that there was no relationship between the quality of life and symptoms of temporomandibular dysfunction among the caregivers of elderly in this study.

[Challenges facing health professionals in the notification of violence: mandatory implementation and follow-up procedures]. / Desafios do profissional de saúde na notificação da violência: obrigatoriedade, efetivação e encaminhamento.

The notification of the occurrence or suspicion of violence is mandatory for health professionals and is a key tool for epidemiological surveillance and the definition of public policies for prevention and intervention. However, professionals feel unprepared for this assignment, which renders underreporting prevalent. To address this issue, the objective is to identify the means available to the professional to submit notification as well as ensure due process follow-up. For this purpose, research and document analysis was conducted in Brazilian legislation, ordinances, and government programs, codes of ethics and consultation of the literature in databases on the subject over a period of five years to establish a brief comparative analysis with other countries. The conclusion drawn is that while some measures are inapplicable, knowledge about the appropriate process for the notification and routing to specific organs will enable healthcare professionals to make the appropriate decisions for the protection and safety of the victim, besides the measures in order to change this situation of violence in the country.

A Responsabilidade Socioambiental naFormação Acadêmica / Social and Environmental Responsibility in Academic Education

Os profissionais da saúde devem preocupar-se com os resíduos gerados por suas atividades, e desenvolver competênciase habilidades específicas desde a graduação, exigindo dos mesmos um posicionamento consciente e disponibilidade paracolaborar na busca de soluções. Verificar o conhecimento dos graduandos do curso de odontologia de uma FaculdadePública do Estado de São Paulo que estavam em atividade clínica no primeiro semestre de 2012, sobre o gerenciamento deresíduos de serviço de saúde. Foi realizado um estudo descritivo, de caráter transversal. O instrumento de coleta de dadosfoi um questionário auto administrado, e após a coleta foi feita a tabulação dos resultados por meio do programa Epi Info6.04. Os valores foram expressos, por meio de frequências, na forma de gráficos e tabelas. Dos 140 acadêmicos participantes,a maioria (96,4%) diz saber o que são RSS. No entanto, 45,7% responderam de forma incorreta como descartar osresíduos do grupo A (sugadores e luvas infectados) e 6,4% sobre o descarte do grupo E (perfurocortantes). Em relação àssoluções utilizadas para revelação e fixação e as lâminas de chumbo das películas de RX, 30% e 48,6%, respectivamente,não souberam responder qual a forma correta. Conclui-se que o conhecimento dos graduandos sobre o tema ainda é falho,refletindo a necessidade das metodologias de ensino buscarem meios de sensibilizar os futuros cirurgiões-dentistas, para queos mesmos desenvolvam o senso de responsabilidade e compromisso ético com a saúde da sociedade e o meio ambiente.

Health professionals should be concerned with the waste generated by their activities, and develop specific abilities andskills since graduation, requiring the same conscious positioning and willingness to collaborate in finding solutions. Verifythe knowledge of dental undergraduate students of a Public Faculty in the State of São Paulo who were in clinical activityin the first half of 2012 about waste management of health service. We performed a cross-sectional descriptive study. Thedata collection instrument was a self-administered questionnaire, and after the collection was made tabulating the resultsthrough the Epi Info 6.04. Values were expressed by means of frequency in the form of graphs and tables. Of the 140 academicparticipants, the majority (96.4%) claims to know what RSS is. However, 45.7% answered incorrectly about disposingwaste group A (suction system and gloves infected) and 6.4% on the disposal of the group E (sharps waste). Regarding thedeveloper and fixer solutions and lead blades of the dental X-rays, 30% and 48.6%, respectively, not answered correctly. Itis concluded that the knowledge of the students on the theme is still flawed, reflecting the need of teaching methodologiesseek ways to sensitize future professionals, so that they develop a sense of responsibility and ethical commitment to thehealth of society and the environment.

Musculoskeletal pain and ergonomic aspects of dentistry / Musculoskeletal pain and ergonomic aspects of dentistry

ABSTRACT BACKGROUND AND OBJECTIVES: Dentists are considered professionals highly vulnerable to occupational problems and such injuries are sometimes caused by adopted postures and repetitive efforts during their work. This study aimed at checking the prevalence of musculoskeletal pain and to observe whether the work of dentists acting in both public and private sectors was carried out ergonomically. METHODS: This is a cross-sectional, descriptive and observational study with dentists (n=80). A self-applicable questionnaire was used to check the frequency of musculoskeletal pain and occupational injuries, as well as to record labor activities, practice of physical activity and their frequencies. Professionals were observed while carrying out dental assistance based on recommendations of the document “Adopting a healthy sitting working posture during patient treatment”, which is part of the International Standards Organization standardization 106/SC 6 N 411 from 2006. RESULTS: There has been job-related pain in at least 65.67% of dentists. The number of individuals adopting incorrect and inadequate positions during assistance was high, such as: head rotation (73.13%); spine rotation (47.76%) and legs angle less than 90o (91.04%). Medical leaves related to occupational injuries were found in a greater proportion among public service professionals (64%). CONCLUSION: There has been high prevalence of musculoskeletal pain related to inadequate postures adopted during clinical assistance and to long working hours without pause. .

RESUMO JUSTIFICATIVA E OBJETIVOS: O cirurgião-dentista é apontado como um profissional muito vulnerável a problemas ocupacionais e essas lesões às vezes ocorrem devido a posturas adotadas e esforços repetitivos durante seu trabalho. O objetivo deste estudo foi verificar a prevalência de dores osteomusculares e observar se o trabalho dos cirurgiões-dentistas que atuam no setor público e privado foi realizado de forma ergonômica. MÉTODOS: Trata-se de um estudo com desenho transversal, descritivo e observacional, com cirurgiões-dentistas (n=80). Com um questionário autoaplicável verificou-se a frequência de dores musculoesqueléticas e lesões ocupacionais, bem como o registro das atividades laborais, prática de atividade física e suas frequências. Os profissionais foram observados enquanto realizavam o atendimento odontológico baseado nas recomendações contidas no documento “Adopting a healthy sitting working posture during patient treatment”, que é parte da normatização da International Standards Organization, 106/SC 6 N 411 de 2006. RESULTADOS: Houve experiência de dor relacionada ao trabalho em pelo menos 65,67% dos cirurgiões-dentistas. O número de indivíduos que adotam posições incorretas e inadequadas durante os atendimentos foi elevado, tais como: rotação da cabeça (73,13%); rotação da coluna (47,76%) e angulação das pernas menor que 90º (91,04%). Afastamentos relacionados a lesões ocupacionais foram encontrados numa proporção maior entre os profissionais do serviço público (64%). CONCLUSÃO: Houve alta prevalência de dores osteomusculares relacionadas com as posturas inadequadas adotadas durante os atendimentos clínicos e a longas jornadas de trabalho sem pausas. .

Desafios do profissional de saúde na notificação da violência: obrigatoriedade, efetivação e encaminhamento / Challenges facing health professionals in the notification of violence: mandatory implementation and follow-up procedures

A notificação da ocorrência ou suspeita da violência é obrigatória aos profissionais de saúde, instrumento fundamental para a vigilância epidemiológica e a definição de políticas públicas de prevenção e intervenção. Neste trabalho objetivou-se instruir o profissional de saúde quanto ao reconhecimento da obrigatoriedade de notificação da violência e aos meios disponíveis para sua efetivação e devido encaminhamento. Com esta finalidade foi desenvolvido um estudo exploratório por meio de análise documental: na legislação brasileira, portarias, programas governamentais e códigos de ética, além de consulta bibliográfica sobre o tema, na base de dados do SciELO, num período de cinco anos; e para estabelecer uma breve análise comparativa com outros países, foram selecionados artigos internacionais no PubMed. Esta pesquisa demonstra a existência de uma série de recursos para o combate à violência, com pouca aplicabilidade, em decorrência da falta de conhecimento e insegurança dos profissionais de saúde, assim como, das debilidades estruturais do próprio sistema. Os serviços disponíveis para a notificação da violência, relatados desde o diagnóstico até as providências cabíveis, permitirão ao profissional conduzir os casos com segurança e habilidade.

The notification of the occurrence or suspicion of violence is mandatory for health professionals and is a key tool for epidemiological surveillance and the definition of public policies for prevention and intervention. However, professionals feel unprepared for this assignment, which renders underreporting prevalent. To address this issue, the objective is to identify the means available to the professional to submit notification as well as ensure due process follow-up. For this purpose, research and document analysis was conducted in Brazilian legislation, ordinances, and government programs, codes of ethics and consultation of the literature in databases on the subject over a period of five years to establish a brief comparative analysis with other countries. The conclusion drawn is that while some measures are inapplicable, knowledge about the appropriate process for the notification and routing to specific organs will enable healthcare professionals to make the appropriate decisions for the protection and safety of the victim, besides the measures in order to change this situation of violence in the country.

The stigma and prejudice of leprosy: influence on the human condition.

INTRODUCTION: To analyze the knowledge, feelings and perceptions involving patients affected by leprosy, as a better understanding of these factors may be useful to decrease the stigma and prejudice associated with the condition. METHODS: The study cohort consisted of 94 patients who underwent treatment for leprosy at the Health Units in the City of Cuiabá, Mato Grosso (MT), Brazil. The study questionnaire included items to collect information on socio-demographic data, knowledge about the disease, stigma, prejudice, self-esteem and quality of life of leprosy patients. Bivariate analyses were used to assess the data based on the chi-square test with a 5% significance threshold. RESULTS: The results revealed that the study population consisted predominantly of males (55.3%) with an income between 1 and 3 times the minimum wage (67%). The survey respondents reported that the most significant difficulties related to the treatment were the side effects (44.7%) and the duration of the treatment (28.7%). A total of 72.3% of the subjects were knowledgeable about the disease, of whom 26.6% had the leprosy reaction. Stigma and prejudice were cited by 93.6% of the participants. Based on the responses, 40.4% of patients reported being depressed and sad, and 69.1% of the subjects encountered problems at work after being diagnosed. A total of 45.7% of the patients rated their quality of life between bad and very bad. CONCLUSIONS: Our results suggest that leprosy causes suffering in patients beyond pain and discomfort and greatly influences social participation.