Auriculoterapia para o controle da ansiedade em estudantes universitários: uma revisão integrativa / Auriculotherapy for anxiety control in university students: an integrative review

Introdução: A ansiedade é um problema recorrente entre universitários e a auriculoterapia como técnica reconhecida pela Organização Mundial de Saúde e parte da Política Nacional de Práticas Integrativas e Complementares no Brasil pode contribuir para seu controle. Objetivo: Realizar uma revisão sistemática sobre a redução da ansiedade de universitários por meio da auriculoterapia. Métodos: Realizou-se busca por ensaios clínicos randomizados entre fevereiro e março de 2020 em quatro bases de dados, sendo a qualidade metodológica avaliada pela Escala PEDro seguindo as recomendações PRISMA. Resultados: Foram encontradas 962 referências, participando da análise quatro estudos. Verificou-se que houve variação entre os protocolos de intervenção, tempo de tratamento, instrumentos de quantificação do nível de ansiedade e nomenclaturas dos pontos. Um estudo não apresentou redução significativa da ansiedade. Três estudos foram classificados como de boa qualidade e um de baixa qualidade. Conclusão: Os estudos sugerem que a auriculoterapia pode ser eficaz no controle da ansiedade em universitários. Devido à especificidade da amostra, o número de estudos encontrados foi baixo, o que indicou a necessidade de mais pesquisas.

Health literacy dimensions among public health service users with chronic diseases in Piracicaba, Brazil, 2019

Aim: This study analyzes factors associated with dimensions of health literacy (HL) functional, communicative and critical among public health service users with chronic non-communicable diseases. Methods: A cross-sectional analytical research was carried out in Piracicaba, São Paulo, Brazil, with adults and older adults attending Family Health Units (FHU). Data were collected by oral exam (CPOD and CPI) and a questionnaire on systemic conditions, sociodemographic factors, health behaviors and HLS (HLS-14). The outcomes consisted of functional, communicative, and critical HL dimensions dichotomized by median (high and low), which were analyzed by chi-square test (p<0.05) to find associations with the variables studied. Results: The study sample comprised 238 FHU users with 62.7 (± 10.55) mean age, of which 47.5% (n=113) showed high functional HL, 50.0% (n=119) high communicative HL, and 46.2% (n=110) high critical HL. High functional HL was associated with men (p<0.05). Functional and communicative HL were associated with having higher education (p<0.001 and p=0.018, respectively). High communicative and critical HL were associated with regular use of dental and medical services (p<0.05). Individuals with low functional HL were more likely to present poor tooth brushing (p=0.020). High HL (in all three dimensions) was associated with regular flossing and having more teeth (p<0.05). Conclusion: Functional, communicative and critical HL were associated with health behaviors and clinical outcomes, whereas the functional dimension was also associated with sociodemographic factors. HL dimensions allowed to differentiate health-related factors

A psychometric network perspective to oral health literacy: Examining the replicability of network properties across the general community and older adults from Brazil.

OBJECTIVES: To evaluate the replicability of oral health literacy (OHL) network models across the general community and a sample of older adults from Brazil. METHODS: Data were obtained from two oral health surveys conducted with a total of 1138 participants. OHL was measured using the short form Health Literacy in Dentistry scale (HeLD-14). A regularized partial correlation network was estimated for each sample. Dimensionality and structural stability were examined via exploratory graph analysis. Network properties compared included global strength, edge weights, and centrality estimates. Model replicability was examined fitting the general community model to the older participants' data. RESULTS: Six dimensions with the exact same item composition were detected in both network models. Only the Receptivity domain in the older adults sample yielded low structural stability. Strong correlations were observed between edge weights (τ: 0.68; 95% CI: 0.62-0.74) and between node strength estimates (τ: 0.63; 95% CI: 0.36-0.89). No statistically significant differences were found for global strength. The fit of the older adults sample to the HeLD-14 network structure of the general community sample was satisfactory. CONCLUSION: Network models OHL replicated across the general community and a sample of older adults. The psychometric network approach is a useful tool to evaluate the measurement equivalence of OHL instruments across populations.

Literacia em saúde em adultos e idosos diabéticos usuários do serviço público de saúde em municípios de São Paulo / Health literacy in diabetic adults and elderly using the public health service in São Paulo municipalities

Objetivo Analisar a literacia em saúde de adultos e idosos com diabetes tipo 2 atendidos em unidades de saúde de dois municípios de São Paulo. Métodos Estudo transversal com adultos e idosos diabéticos acompanhados em duas unidades de saúde: uma localizada em Jundiaí e a outra em Piracicaba. Foram analisados: fatores socioeconômicos e demográficos, comportamentos em saúde, condições clínicas, uso do serviço de saúde, a literacia (por meio do Health Literacy Scale, aplicado através de entrevistas); e os índices de glicemia e hemoglobina glicada relatados nos prontuários dos participantes. Realizou-se teste Qui-Quadrado para verificar associação da literacia com as variáveis independentes (p<0,05). Resultados A maior parte da amostra era composta por mulheres, 67,6% dos participantes (n=48) apresentou glicemia alterada <127mg/dL, 59,1% (n=39) Hb1Ac <8% e um baixo nível de literacia foi observado em 51,6% (n=46) dos avaliados. A baixa literacia foi associada à moradia não própria, maior glicemia, baixa escolaridade, ao tabagismo e aos brancos (p<0,05). Conclusão No presente estudo houve associação da literacia com variáveis clínicas e comportamentos em saúde, indicando que a literacia em saúde deve ser considerada nas estratégias de promoção de saúde e na qualidade da atenção em saúde voltadas para a população com diabetes mellitus.

ObjectiveTo analyze health literacy in adults and elderly with diabetes type 2, in health units in two municipalities of São Paulo.MethodsCross-sectional study with 95 adults and elderly diabetics, followed up in two health units, in Jundiaí and Piracicaba. Were analyzed: socioeconomic and demographic factors, health behaviors, clinical conditions, use of health services, literacy through the Health Literacy Scale applied by interviews; and blood glucose levels and glycated hemoglobin by medical records of the participants. Chi-Square test was performed to verify the association between literacy and independent variables (p<0,05).ResultsMost of the sample were women, 67,6% (n=48) had blood glucose <127mg/dL, 59,1% (n=39) Hb1Ac<8%, and low literacy 51,6% (n=46). Low literacy was associated with non-owned housing, higher blood glucose, low schooling, smoking and whites (p<0,05).ConclusionIn the present study, literacy was associated with clinical variables and health behaviors, indicating that literacy should be considered in health promotion strategies in the quality of care and health services, aimed at the population with diabetes mellitus.

Distribuição espacial das Práticas Integrativas e Complementares em Saúde na Atenção Básica no Brasil / Spatial Distribution of Integrative and Complementary Health Practices in Primary Health Care in Brazil / Distribución espacial de las Prácticas Integrativas y Complementarias de Salud en la Atención Básica de Brasil

Objetivo: Analisar a distribuição espacial das Práticas Integrativas e Complementares em Saúde (PICS) na Atenção Básica (AB) brasileira para a ampliação da discussão sobre sua oferta. Métodos: Estudo ecológico transversal realizado em 2020, a partir do sistema público brasileiro de informação em saúde do ano de 2019. Para análise, analisou-se a variável dependente quantidade de atendimentos, enquanto as variáveis independentes deram-se por território, Índice de Desenvolvimento Humano (IDH) e a cobertura da AB. Para as comparações estatísticas utilizaram-se os testes de qui-quadrado de Pearson e correlação de Spearman. Resultados: Considerando AB, secundária e terciária do Sistema Único de Saúde (SUS), a prevalência total de atendimentos em 2019 apresentou-se por 1.593.128. Separando e analisando exclusivamente a AB (n=51.352; 3.2%), a maior prevalência de atendimentos apresentou-se nas regiões Sudeste (n=15.210; 29,7%) e Nordeste (n=12.559; 24.4%), com ocorrências maiores de sessões de eletroestimulação (n=6.397; 12,4%) e de práticas corporais em Medicina Tradicional Chinesa (n=4.588; 8,9%). As correlações deram-se positivas entre atendimentos e população (r=0,62), e entre atendimentos e IDH (r=0,24). Conclusão: Evidenciou-se que a distribuição espacial das PICS na AB é desigual ao se considerar as prevalências de cada região. Já as correlações positivas podem representar a procura por alternativas de cuidado frente a condições crônicas, queixas musculoesqueléticas e insatisfação com a Medicina Moderna; fatores que geralmente provocam o aumento pela procura de PICS, principalmente em regiões onde o desenvolvimento social mais elevado favorece a autonomia da pessoa.

Objective:To analyze the spatial distribution of Integrative and Complementary Health Practices (Práticas Integrativas e Complementares em Saúde ­ PICS) in Brazil's Primary Health Care (PHC) to broaden the discussion about its offer. Methods: A cross-sectional ecologic study was carried out in 2020 using data from the Brazilian public health care information system dating from 2019. For the analysis, the dependent variable was the number of visits, and the independent variables were the territory, the Human Development Index (HDI) and PHC coverage. Pearson's chi-square and Spearman's correlation tests were used for statistical comparisons. Results: Thetotal prevalence rate of visits in 2019 was 1,593,128 in primary, secondary and tertiary care within the Unified Health System (Sistema Único de Saúde ­ SUS). When we analyzed exclusively and separately PHC (n=51,352; 3.2%), the highest rate of visits was found in the Southeast (n=15,210; 29.7%) and Northeast (n=12,559; 24.4%) regions, with higher rates of electrical stimulation sessions (n=6,397; 12.4%) and body practices in Traditional Chinese Medicine (n=4,588; 8.9%). Correlations were positive between visits and population (r=0.62) and between visits and HDI (r=0.24). Conclusion:It was evident that the spatial distribution of PICS in PHC is uneven when considering the prevalence rate of each region. The positive correlations may represent the search for alternative care in the face of chronic conditions, musculoskeletal complaints, and dissatisfaction with Modern Medicine. These factors generally cause an increase in the demand for PICS, especially in regions where higher social development favors individual autonomy.

Objetivo: Analizar la distribución espacial de las Prácticas Integrativas y Complementarias de Salud (PICS) de la Atención Básica (AB) brasileña para la ampliación de la discusión de su oferta. Métodos: Estudio ecológico transversal realizado en 2020 a partir del sistema público brasileño de información en salud del año 2019. Se analizó la variable dependiente "cantidad de consultas" mientras las variables independientes se dieron por el territorio, el Índice de Desarrollo Humano (IDH) y la cobertura de la AB. Para las comparaciones estadísticas se ha utilizado las pruebas de chi-cuadrado de Pearson y la correlación de Spearman. Resultados: Considerando la AB, secundaria y terciaria del Sistema Único de Salud (SUS), la prevalencia total de las consultas en 2019 ha sido de 1.593.128. Separando y analizando exclusivamente la AB (n=51.352; 3.2%), la mayor prevalencia de consultas se dio en las regiones Sudeste (n=15.210; 29,7%) y Noreste (n=12.559; 24.4%), con ocurrencias de más sesiones de electroestimulación (n=6.397; 12,4%) y de prácticas corporales de la Medicina Tradicional China (n=4.588; 8,9%). Las correlaciones han sido positivas entre las consultas y la población (r=0,62) y entre las consultas y el IDH (r=0,24). Conclusión: Se ha evidenciado que la distribución espacial de las PICS en la AB es desigual respecto las prevalencias de cada región. Las correlaciones positivas pueden representar la búsqueda de alternativas de cuidado para las condiciones crónicas, las quejas musculo esqueléticas y la insatisfacción con la Medicina Moderna; factores que, en general, llevan al mayor interés por las PICS, sobre todo en las regiones donde el desarrollo social más alto favorece la autonomía de la persona.

Seroepidemiological investigation of COVID-19: A cross-sectional study in Jundiai, São Paulo, Brazil.

The dramatic increase in the number of COVID-19 cases has been a threat to global health and a challenge for health systems. Estimating the prevalence of infection in the population is essential to provide support for action planning. Within this scenario, the aim of the present study was to analyze the seroprevalence and associated factors of COVID-19 Jundiaí, São Paulo, Brazil. This cross-sectional study was conducted from June 1st to June 19th, 2020. The participants were patients with respiratory symptoms who sought Primary Care Units (UBS) (n = 1,181) and subjects recruited from randomly selected households by probability sampling (n = 3,065), as screening strategy. All participants, in both phases, were submitted to SARS-CoV-2 rapid antigen tests (IgG and IgM) and responded to a questionnaire including sociodemographic characteristics based on Behavioural Insights for COVID-19. Total seroprevalence (positive/negative) was the outcome and the independent variables were sociodemographic variables, health behavior and signs/symptoms. The chi-squared test was used for association analysis (p<0.05) and variables with p<0.20 were entered into the logistic regression model (p<0.05). A total of 1,181 subjects from the UBS and 3,065 from the selected households participated in the study. The seroprevalence was 30.8% in the UBS and 3.1% in the households. The adjusted logistic regression identified that lower educational level (OR 2.68; 95%CI 1.59-4.54), household member testing positive (OR 1.67; 95%CI 1.16-2.39), presence of anosmia (OR 3.68, 95%CI 2.56-5.28) and seeking UBS (OR 3.76; 95%CI 2.08-6.82) was risk factors to test positive for SARS-CoV-2. Estimating the seroprevalence in the population was important to know the disease extension that was higher than the notified cases. These results showed socioeconomic aspects associated with COVID-19 even adjusted by symptoms. Populational epidemiologic studies that investigate the associated factors of COVID-19 are relevant to plan strategies to control the pandemic.

The role of health literacy as a factor associated with tooth loss.

OBJECTIVE: The objective was to analyze the role of health literacy (HL) as a factor associated with tooth loss among users of the Brazilian Health System with chronic non-communicable diseases. METHODS: The cross-sectional analytical study was conducted with adult and elderly users chosen at ten Family Health Clinics in a draw in the town of Piracicaba, São Paulo State, Brazil. A questionnaire was applied with sociodemographic data (sex, age, skin color and education), behavioral data (brushing and flossing), determinants in health (type of dental health services and how often) and clinical data (pain). Mouth conditions were collected by intraoral examination of visible dental biofilm and community Pediodontal Index. The systemic clinical conditions (blood glucose, glycated hemoglobin and blood pressure) were extracted from the medical records. The explanatory variable was HL (low, medium and high), measured with the Health Literacy Scale (HLS-14). RESULTS: The outcome was tooth loss measured by the index of decayed, missing and filled teeth. Logistic regression was performed using a conceptual model for HL (p < 0.05). For the 238 subjects, the mean age was 62.7 years (± 10.55). Tooth loss was associated with HL in regression models adjusted by type of dental service, dental frequency, and dental floss. In the final model, the factors associated with tooth loss are older age (OR = 1,12; 95%CI: 1,07-1,17), a lower education (OR = 3,43; 95%CI: 1,17-10,10), irregular use of dental floss (OR = 4,58; 95%CI: 1.75 in-7,31), irregular use of dental services (n = 2,60; 95% 1,32-5,12), periodontal pocket (> 4 mm) (n = 0,31; 95%CI: 0,01-0,08), having visible dental biofilm (OR = 7,23; 95%CI: 3,19-16,41) and a higher level of blood sugar (glucose) (n = 1,98; 95%CI: 1.00-3,92). CONCLUSIONS: tooth loss was associated with HL when adjusted by health behaviors; when sociodemographic variables and clinical conditions were included, it was less significant. In the final model, behaviors, determinants in health and clinical conditions were risk indicators of tooth loss, showing the multifactorial nature of this phenomenon.

COVID-19 in Jundiaí/SP: temporal dynamics of notifications and spatial analysis of seroepidemiological prevalence / COVID-19 em Jundiaí/SP: dinâmica temporal das notificações e análise espacial da prevalência soroepidemiológica / COVID-19 em Jundiaí/SP: dinâmica temporal de notificaciones y análisis espacial de prevalencia seroepidemiológica

Justificativa e Objetivos: A pandemia pela COVID-19 trouxe um cenário desafiador para a saúde pública em todo o mundo, devido ao pouco conhecimento sobre a infecção e seu aumento exponencial. O objetivo é analisar a tendência temporal e a distribuição espacial dos casos positivos para COVID-19 na cidade de Jundiaí/SP, Brasil, bem como sua correlação com a renda e densidade populacional dos bairros. Métodos: Estudo transversal, conduzido no período de fevereiro a junho de 2020. Os dados foram obtidos a partir dos casos confirmados pela Vigilância Epidemiológica e por levantamento soroepidemiológico realizado em duas etapas: 1) com usuários sintomáticos para Síndrome Respiratória Aguda Grave que buscaram atendimento nas Unidades de Saúde; 2) amostragem probabilística dos domicílios. Realizou-se análise da série temporal dos casos confirmados pela Vigilância Epidemiológica e foram elaborados mapas com a densidade de Kernel e Índice de Moran Local (p < 0,05) dos casos diagnosticados no levantamento soroepidemiológico. Resultados: Houve aumento do número de casos no período estudado (2,35%), bem como distribuição heterogênea no território, com concentração em áreas periféricas da cidade. Houve autocorrelação espacial fraca entre média da renda per capita (I = 0.11; valor de p < 0,001) e densidade populacional por bairros (I = 0.05; valor de p = 0,03). Conclusão: A análise do comportamento da infecção no tempo e espaço podem contribuir com ações de enfrentamento com base nas necessidades locais.(AU)

Background and Objectives: The COVID-19 pandemic brought a challenging scenario for public health worldwide, due to little knowledge about the infection and the exponential increase in new cases. This study aims to analyze the temporal trend and the spatial distribution of the positive cases for COVID-19 in the city of Jundiaí/SP, Brazil, as well as its correlation with the income and population density of the neighborhoods. Methods: Cross-sectional study, conducted from February to June 2020. Data were obtained from cases confirmed by the Epidemiological Surveillance and by a seroepidemiological survey carried out in two stages: 1) with symptomatic users for Severe Acute Respiratory Syndrome who sought care in Basic Health Units; 2) probabilistic sampling of households. An analysis of the time series of the cases confirmed by the Epidemiological Surveillance was carried out and maps with Kernel density and Local Moran Index (p <0.05) of the cases diagnosed in the seroepidemiological survey were prepared. Results: There was an increase in the number of cases in the period studied (2.35%), as well as the heterogeneous distribution in the territory, with a concentration in peripheral areas of the city. There was weak spatial autocorrelation between average per capita income (I = 0.11; p value <0.001) and population density by neighborhood (I = 0.05; p value = 0.03). Conclusion: The analysis of infection behavior in time and space can contribute to coping actions based on local needs.(AU)

Justificación y Objetivos: La pandemia por COVID-19 trajo un escenario desafiante para la salud pública a nivel mundial, debido al escaso conocimiento sobre la infección y su aumento exponencial. El objetivo es analizar la tendencia temporal y la distribución espacial de casos positivos para COVID-19 en la ciudad de Jundiai/SP, Brasil, así como su correlación con el ingreso per cápita y la densidad poblacional de los barrios. Métodos: Estudio transversal, realizado de febrero a junio de 2020. Se obtuvieron datos de casos confirmados por la Vigilancia Epidemiológica y por encuesta seroepidemiológica realizada en dos etapas: 1) con usuarios sintomáticos por Síndrome Respiratorio Agudo Severo que acudieron a las Unidades de Salud; 2) muestreo probabilístico de hogares. Se realizó un análisis de la serie temporal de los casos confirmados por la Vigilancia Epidemiológica y, se elaboraron mapas con densidad de kernel e índice de Moran local (p <0.05) de los casos diagnosticados en la encuesta seroepidemiologica. Resultados: hubo un incremento en el número de casos en el período estudiado (2,35%), así como una distribución heterogénea de casos en el territorio, con concentración en áreas periféricas de la ciudad. Hubo una autocorrelación espacial débil entre el ingreso per cápita promedio (I = 0.11; valor de p <0.001) y la densidad de población por vecindario (I = 0.05; valor de p = 0.03). Conclusión: El análisis del comportamiento de la infección en el tiempo y el espacio puede contribuir a acciones de afrontamiento basadas en las necesidades locales.(AU)

Factors associated with poor oral health-related quality of life among non-institutionalized Brazilian older adults: Oral health and quality of life in older adults.

AIMS: To investigate the factors associated with poor oral health-related quality of life (OHRQoL) in a sample of Brazilian older adults. METHODS AND RESULTS: A cross-sectional study was conducted with 535 non-institutionalized elders aged 60 years or older from Piracicaba, São Paulo, Brazil. OHRQoL was measured using the Geriatric Oral Health Assessment Index (GOHAI). Data on sociodemographic characteristics, self-perceived general health status, and health-related behaviors were obtained through a structured questionnaire. Data on chronic diseases were obtained from health records. Associations between exploratory factors and low OHRQoL (% GOHAI score <30) were evaluated using multivariate Poisson regression models to estimate adjusted prevalence ratios (PRs) and confidence intervals. The mean OHRQoL score was 30 (± 4.4). In bivariate analysis, being not married, smoking, and self-rated "fair/poor" general health status were associated with lower OHRQoL. In the adjusted model, self-rated "fair/poor" general health (PR: 1.25; 95% CI: 1.05-1.48), presence of chronic diseases (PR: 1.88; 95% CI: 1.37-2.58), smoking (PR: 1.25; 95% CI: 1.02-1.53), and reason for last dental appointment (PR: 1.34; 95% CI: 1.13-1.59) were associated with poor OHRQoL. CONCLUSION: Non-institutionalized older adults with a history of chronic diseases, who smoke, have a negative perception of their general health, and had the last dental appointment motivated by pain present significantly higher prevalence rates of poor OHRQoL.

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

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

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

Knowledge, attitudes, and practices of primary health care professionals in coping with COVID-19 in Brazil: a cross-sectional study.

Introduction: The coronavirus disease 2019 (COVID-19) pandemic has posed challenges to healthcare professionals, who needed to quickly adjust impacts on their work processes. Primary health care has become key to fighting the pandemic, as most mild cases seek primary care services as their point of first contact. Objectives: To ascertain the knowledge, attitudes, and practices of health professionals working in primary health care in Brazil early in the COVID-19 pandemic. Methods: Cross-sectional study of a convenience sample. An online questionnaire was made available from May 1 through May 31, 2020. The sole criterion for inclusion was a response rate greater than 30 respondents per Brazilian state. Data were treated descriptively and statistically. Results: Overall, 293 responses were obtained, and the states of Paraná (n = 86), Mato do Grosso do Sul (n = 50) and São Paulo (n = 48) were included in the study. There was a predominance of female respondents (89.1%). Physical therapy (31.6%) and nursing (12.4%) were the most represented occupations. Respondents generally reported moderate knowledge (54.3%) and preparedness (57.6%), with daily information seeking (63.5%) in handbooks and technical guidance publications (89.6%). There was no statistically significant difference between states for the variables knowledge (p = 0.28) and preparedness (p = 0.19). Conclusions: The participating states showed similar, positive results regarding knowledge, attitudes, and practices. Previous experiences seem to generate cumulative knowledge; however, greater readiness in training professionals is needed in emergency situations.

Manual instrutivo - uma problemática em saúde pública: violência infantil / Public health issue: child violence

Este guia tem como objetivo trazer informações que auxiliem na identificação de casos de violência contra crianças, bem como apontem modos de prevenção, cuidados e notificação após a ocorrência de fatos desta natureza. Público Alvo: Toda sociedade, especialmente profissionais da área da saúde

The role of health literacy as a factor associated with tooth loss / O papel da literacia em saúde como fator associado às perdas dentárias

ABSTRACT OBJECTIVE The objective was to analyze the role of health literacy (HL) as a factor associated with tooth loss among users of the Brazilian Health System with chronic non-communicable diseases. METHODS The cross-sectional analytical study was conducted with adult and elderly users chosen at ten Family Health Clinics in a draw in the town of Piracicaba, São Paulo State, Brazil. A questionnaire was applied with sociodemographic data (sex, age, skin color and education), behavioral data (brushing and flossing), determinants in health (type of dental health services and how often) and clinical data (pain). Mouth conditions were collected by intraoral examination of visible dental biofilm and community Pediodontal Index. The systemic clinical conditions (blood glucose, glycated hemoglobin and blood pressure) were extracted from the medical records. The explanatory variable was HL (low, medium and high), measured with the Health Literacy Scale (HLS-14). RESULTS The outcome was tooth loss measured by the index of decayed, missing and filled teeth. Logistic regression was performed using a conceptual model for HL (p < 0.05). For the 238 subjects, the mean age was 62.7 years (± 10.55). Tooth loss was associated with HL in regression models adjusted by type of dental service, dental frequency, and dental floss. In the final model, the factors associated with tooth loss are older age (OR = 1,12; 95%CI: 1,07-1,17), a lower education (OR = 3,43; 95%CI: 1,17-10,10), irregular use of dental floss (OR = 4,58; 95%CI: 1.75 in-7,31), irregular use of dental services (n = 2,60; 95% 1,32-5,12), periodontal pocket (> 4 mm) (n = 0,31; 95%CI: 0,01-0,08), having visible dental biofilm (OR = 7,23; 95%CI: 3,19-16,41) and a higher level of blood sugar (glucose) (n = 1,98; 95%CI: 1.00-3,92). CONCLUSIONS tooth loss was associated with HL when adjusted by health behaviors; when sociodemographic variables and clinical conditions were included, it was less significant. In the final model, behaviors, determinants in health and clinical conditions were risk indicators of tooth loss, showing the multifactorial nature of this phenomenon.

RESUMO OBJETIVO O objetivo foi analisar o papel da Literacia em Saúde (LS) como fator associado às perdas dentárias entre usuários do Sistema Único de Saúde com doenças crônicas não transmissíveis. MÉTODOS O estudo transversal e analítico foi conduzido com usuários adultos e idosos selecionados em dez Unidades de Saúde da Família sorteadas, em Piracicaba - SP, Brasil. Foi aplicado um questionário com dados sociodemográficos (sexo, idade, cor da pele e escolaridade), comportamentais (escovação e uso de fio dental), determinantes em saúde (tipo e frequência de uso de serviço de saúde médico e odontológico) e clínica (dor). As condições bucais foram coletadas por exame intrabucal do biofilme dental visível e Índice Pediodontal Comunitário. As condições clínicas sistêmicas (glicemia, hemoglobina glicada e pressóricas) foram extraídas dos prontuários. A variável explanatória foi a LS (baixa, média e alta), medida pelo Health Literacy Scale (HLS-14). RESULTADOS O desfecho foi à perda dentária medida pelo Índice de dentes permanentes cariados, perdidos e obturados. Foi realizada regressão logística com uso de um modelo conceitual para a LS (p < 0,05). Para os 238 indivíduos, a média de idade foi 62,7 anos (± 10,55). A perda dentária esteve associada à LS nos modelos de regressão ajustados por tipo de serviço odontológico, frequência odontológica e uso de fio dental. No modelo final, a perda dentária teve como fatores associados a maior idade (OR = 1,12; IC95% 1,07-1,17), menor escolaridade (OR = 3,43; IC95% 1,17-10,10), ao uso irregular de fio dental (OR = 4,58; IC95% 1,75-7,31), uso irregular do serviço odontológico (OR = 2,60; IC95% 1,32-5,12), bolsa periodontal (> 4mm) (OR = 0,31; IC95% 0,01-0,08), ter biofilme dental visível (OR = 7,23; IC95% 3,19-16,41) e maior índice de glicemia (OR = 1,98; IC95% 1,00-3,92). CONCLUSÕES A perda dentária esteve associada à LS quando ajustada por comportamentos em saúde, a partir da inclusão das variáveis sociodemográficas e condições clínicas ela perdeu a significância. No modelo final, comportamentos, determinantes em saúde e condições clínicas foram indicadores de risco da perda dentária, demonstrando a multifatorialidade envolvida neste fenômeno.

Gestão em Saúde Pública, enfrentamentos cotidianos: direitos e deveres / Management in public health, daily confrontations: rights and duties

O guia tem a finalidade de informar e orientar profissionais, estudantes e todos os envolvidos na saúde do país, quanto à Gestão em Saúde Pública e seu enfrentamento cotidiano

Psychometric properties of Health Literacy in Dentistry scale in an elderly Brazilian population.

This study aimed to assess the reliability and validity of Brazilian-Portuguese versions of the Health Literacy in Dentistry (HeLD) scale in a sample of elderly Brazilian participants. HeLD was initially translated into and cross-culturally adapted to the Brazilian Portuguese language. The reliability and validity of HeLD were then assessed in a sample of 535 non-institutionalized older persons who also completed a questionnaire containing sociodemographic and health information. Data were then randomly separated into two sub-datasets, and Confirmatory Factor Analysis was performed through structural equation modelling, with a maximum likelihood estimate to test the fit of the data to the factor structure of the long-and short-form HeLD (HeLD-29 and HeLD-14) versions of the instrument. The models were compared using the Akaike Information Criterion to assess goodness-of-fit and to determine which models were preferred. Internal consistency of HeLD was evaluated using Cronbach´s coefficient α. Both versions of HeLD were observed to demonstrate high internal reliability (Cronbach´s α ≥ 0.87 for all seven subscales), acceptable convergent (estimates of ≥ 0.50 for AVE and ≥ 0.70 for CR) and discriminant validity. However, the goodness-of-fit of the confirmatory factor analysis models demonstrated satisfactory results only for HeLD-14 subsamples (x2/df = 1.8-2.3; CFI = 0.97-0.98; GFI/NFI = 0.98-0.99; RMSEA = 0.05 and SRMR = 0.03). In conclusion, HeLD-14 was shown to be a reliable and valid instrument to measure oral health literacy in elderly Brazilian participants.

Influence of oral health literacy on dissatisfaction with oral health among older people.

OBJECTIVE: To investigate the influence of oral health literacy (OHL) and associated factors on dissatisfaction with oral health (DOH) among older people. BACKGROUND: Oral health literacy is a recent field of research that has been considered an important mediator between socioeconomic variables and oral health outcomes. However, there are few studies with older people. MATERIALS AND METHODS: A cross-sectional study was conducted with 535 non-institutionalised older people aged 60-100 years from Brazil. Individuals completed a questionnaire on general health, sociodemographic information and usual reason for dental visit. OHL was assessed using the Health Literacy in Dentistry questionnaire (HeLD-14), validated in Brazil. DOH was the outcome of interest. Poisson regression with robust standard errors was applied as a statistical model to estimate bivariate and multivariable relationships of DOH with OHL after adjusting for sex, age, social characteristics and general health using the P-value of ≤ .05. RESULTS: The overall prevalence of DOH was 21.1%. Multivariable regression analysis showed that older people with low OHL (HeLD-14 score ≤35) had 1.28 times the odds of having DOH than those with high OHL (HeLD14 score >46), after adjusting for sociodemographic, economic and health outcomes. CONCLUSIONS: Dissatisfaction with oral health in older people is a complex issue associated with OHL, social and behavioural factors. Health services should give greater attention to developing health literacy competences in older adults in order to empower them to achieve optimal oral health.

Psychometric properties of Health Literacy in Dentistry scale in an elderly Brazilian population

Abstract This study aimed to assess the reliability and validity of Brazilian-Portuguese versions of the Health Literacy in Dentistry (HeLD) scale in a sample of elderly Brazilian participants. HeLD was initially translated into and cross-culturally adapted to the Brazilian Portuguese language. The reliability and validity of HeLD were then assessed in a sample of 535 non-institutionalized older persons who also completed a questionnaire containing sociodemographic and health information. Data were then randomly separated into two sub-datasets, and Confirmatory Factor Analysis was performed through structural equation modelling, with a maximum likelihood estimate to test the fit of the data to the factor structure of the long-and short-form HeLD (HeLD-29 and HeLD-14) versions of the instrument. The models were compared using the Akaike Information Criterion to assess goodness-of-fit and to determine which models were preferred. Internal consistency of HeLD was evaluated using Cronbach´s coefficient α. Both versions of HeLD were observed to demonstrate high internal reliability (Cronbach´s α ≥ 0.87 for all seven subscales), acceptable convergent (estimates of ≥ 0.50 for AVE and ≥ 0.70 for CR) and discriminant validity. However, the goodness-of-fit of the confirmatory factor analysis models demonstrated satisfactory results only for HeLD-14 subsamples (x2/df = 1.8-2.3; CFI = 0.97-0.98; GFI/NFI = 0.98-0.99; RMSEA = 0.05 and SRMR = 0.03). In conclusion, HeLD-14 was shown to be a reliable and valid instrument to measure oral health literacy in elderly Brazilian participants.

Avaliação da prática de prescrição de antibióticos pelos cirurgiões-dentistas da Rede Pública de um município de médio porte / Evaluation of the practice of prescribing antibiotics by dentists of the Public Network of a mid-sized municipality

Objetivo:O objetivo deste estudo foi conhecer a conduta para as prescrições de antimicrobianos pelos cirurgiões-dentistas (CDs) da rede pública, de um município de médio porte do interior do estado de São Paulo. Métodos: todos CDs da rede pública do município de Piracicaba, São Paulo, foram convidados a participar (n = 79). A coleta de dados foi realizada em 2015, por meio de uma entrevista, questionário estruturado, como entrevista, nas unidades de saúde. O questionário continha questões sobre as características dos CDs, condições clínicas e sistêmicas que levariam ou não a prescrição de antibiótico, droga de escolha e forma de prescrição. Foi realizada a análise descritiva, utilizando o programa SPSS® (Statistical Package for the Social Sciences) versão 20.0 para Microsoft Windows.Resultados: no total, 74 CDs aceitaram participar da pesquisa, e 68,9% (n = 51) relataram prescrever antimicrobianos para abscesso localizado, alveolite seca, pulpite aguda. Situações sistêmicas que necessitam de profilaxia antibiótica eram desconhecidas pelos CDs, sendo que 56,8% (n = 42) não sabiam a conduta correta com a prescrição em casos de pacientes que fazem uso de bisfosfonatos e 35,0% (n = 26) após a quimioterapia. A droga de escolha de 97,3% dos CDs foi a amoxicilina. Conclusão: os resultados obtidos pelos relatos das condutas terapêuticas permitiram concluir que houve um excesso de prescrição de antibióticos, inclusive para situções clínicas que não havia necessidade, sendo o mais receitado a amoxicilina. Deve-se pensar no desenvolvimento de estratégias públicas de educação permanente, voltadas para os profissionais de odontologia, para o controle da resistência bacteriana. (AU)

Aim: This study sought to comprehend the conduct of antimicrobial prescriptions by dental surgeons (DSs) of the public network of a mid-sized municipality in the countryside of the state of São Paulo. Methods: All DSs of the public network of Piracicaba, São Paulo, were invited to participate (n = 79). Data collection was performed in 2015, through an interview, structured questionnaire, as an interview, in the health units. The questionnaire contained questions about the characteristics of DSs, clinical and systemic conditions that would or would not lead to antibiotic prescription, drug of choice, and prescription form. The descriptive analysis was performed using the SPSS ® software (Statistical Package for the Social Sciences) version 20.0 for Microsoft Windows. Results: A total of 74 DSs chose to participate in the study, and 68.9% (n = 51) reported prescribing antimicrobials for localized abscesses, dry alveolitis, and acute pulpitis. Systemic conditions requiring antibiotic prophylaxis were unknown by the DSs, and 56.8% (n = 42) did not know the correct conduct to be taken with the prescription in cases of patients taking bisphosphonates and 35.0% (n = 26) after chemotherapy. The drug of choice for 97.3% of the DSs was amoxicillin. Conclusion:The results from the reports of the therapeutic procedures led to the conclusion that there was an excess of antibiotic prescriptions, even for clinical situations that were not necessary, with amoxicillin being the most commonly prescribed. The development of public strategies of permanent education, aimed at dental professionals, to control bacterial resistance should be considered. (AU)