Possible association between lithium intoxication and Takotsubo syndrome.

More than 25 years after being diagnosed with bipolar disorder and receiving continuous treatment with lithium, a woman develops Takotsubo syndrome.

Theorization about the limits to the inclusion of oral health teams in the Family Health Strategy. / Teorização sobre os limites à inserção da saúde bucal na Estratégia Saúde da Família.

This study aimed to theorize, by means of social actors' conception, about the reasons for the non-inclusion of oral health in the Family Health Strategy (FHS) in the city of Juiz de Fora, Minas Gerais, Brazil. This is a qualitative, exploratory, descriptive, and analytical study based on the grounded theory methodology and the National Oral Health Policy. Eleven interviews were performed with public managers, delegates who participate in the municipal health council, and dental surgeons who belong to the public health service. The theorization of the study was created through the data analysis process, which resulted in "a consequence of the dominant disease-centered oral health care model" as the main category. Data were categorized according to a methodological framework. The health concept set forth by local social actors contributed to the non-inclusion of oral healthcare teams (OHTs) in the FHS. This theorization identified the origins of the studied phenomenon and can aid in future policy decision-making carried out by local social actors.

Este estudo objetivou construir teorização a partir da concepção de atores sociais acerca das razões da não inserção da atenção à saúde bucal na Estratégia de Saúde da Família (ESF) no município de Juiz de Fora, Minas Gerais. Trata-se de um estudo qualitativo, fundamentado no referencial teórico construído com base na Política Nacional de Saúde Bucal e metodológico na Teoria Fundamentada nos Dados (TFD). Foram realizadas 11 entrevistas intensivas com atores sociais da gestão, do controle social e cirurgiões-dentistas do serviço público do município. Os dados foram categorizados segundo a TFD e a partir do processo de análise dos dados, construiu-se a teorização do estudo e obteve-se como categoria central "Consequência de uma concepção hegemônica doença-centrada da saúde para o modelo de atenção à saúde bucal". A concepção de saúde dos atores sociais do município contribuiu para a não inserção da atenção à saúde bucal na ESF. A teorização permitiu a identificação da origem das condições do fenômeno estudado e poderá contribuir para tomada de decisões dos atores sociais em futuras ações políticas.

Teorização sobre os limites à inserção da saúde bucal na Estratégia Saúde da Família / Theorization about the limits to the inclusion of oral health teams in the Family Health Strategy

Resumo Este estudo objetivou construir teorização a partir da concepção de atores sociais acerca das razões da não inserção da atenção à saúde bucal na Estratégia de Saúde da Família (ESF) no município de Juiz de Fora, Minas Gerais. Trata-se de um estudo qualitativo, fundamentado no referencial teórico construído com base na Política Nacional de Saúde Bucal e metodológico na Teoria Fundamentada nos Dados (TFD). Foram realizadas 11 entrevistas intensivas com atores sociais da gestão, do controle social e cirurgiões-dentistas do serviço público do município. Os dados foram categorizados segundo a TFD e a partir do processo de análise dos dados, construiu-se a teorização do estudo e obteve-se como categoria central "Consequência de uma concepção hegemônica doença-centrada da saúde para o modelo de atenção à saúde bucal". A concepção de saúde dos atores sociais do município contribuiu para a não inserção da atenção à saúde bucal na ESF. A teorização permitiu a identificação da origem das condições do fenômeno estudado e poderá contribuir para tomada de decisões dos atores sociais em futuras ações políticas.

Abstract This study aimed to theorize, by means of social actors' conception, about the reasons for the non-inclusion of oral health in the Family Health Strategy (FHS) in the city of Juiz de Fora, Minas Gerais, Brazil. This is a qualitative, exploratory, descriptive, and analytical study based on the grounded theory methodology and the National Oral Health Policy. Eleven interviews were performed with public managers, delegates who participate in the municipal health council, and dental surgeons who belong to the public health service. The theorization of the study was created through the data analysis process, which resulted in "a consequence of the dominant disease-centered oral health care model" as the main category. Data were categorized according to a methodological framework. The health concept set forth by local social actors contributed to the non-inclusion of oral healthcare teams (OHTs) in the FHS. This theorization identified the origins of the studied phenomenon and can aid in future policy decision-making carried out by local social actors.

User satisfaction with the secondary dental care services: Is there an association between structure and work process?

OBJECTIVE: To assess the association between user satisfaction in relation to secondary dental care services and the structure and process of Brazilian Dental Specialty Centers (CEO, in Portuguese). METHODS: This study used nationwide secondary data from two CEO evaluation cycles. Ten users from each CEO answered questions on the self-perception of healthcare quality and satisfaction with health services. Latent class analysis (LCA) was performed to identify subgroups of satisfied and dissatisfied users (outcome). The CEO structure included equipment, supplies, instruments, ambience and type of CEO (type I, II or III, according to the number of dental chairs and dental professionals). The work process referred to the planning/monitoring of actions, collaborative care, characteristics of the demand for medical care /the organization of scheduling, and continuing education for employees. Covariables concerned user profiles. A multilevel logistic regression model was used (p-value <.05). RESULTS: Seven thousand nine hundred and ninety-seven users in 794 CEOs, together with 10056 users in 911 CEOs, participated in the 1st and 2nd evaluation cycles, and satisfied users corresponded to 85.3% and 87.1%, respectively. In both cycles, the CEO's structural characteristics explained most of the variance in satisfaction. CEOs with more favourable structural characteristics showed higher satisfaction. Users from CEOs, type II and III, and those who received dental care where there was an interruption of services due to a lack of equipment or instruments reported a lower level of satisfaction. CEOs that organize their demand through referrals received from primary care dentists who have participated in continuing education actions for dental professionals presented a higher frequency of satisfied users. CONCLUSIONS: Characteristics of the process and structure were associated with user satisfaction, but a quality of care was perceived by users, mainly due to structural characteristics.

Role of management and human resource factors on matrix support in secondary oral health care in Brazil.

OBJECTIVES: To investigate the association between health management and human resource factors on matrix support (MS) in a nationally representative sample of Dental Specialty Centres (DSCs) in Brazil. METHODS: This survey included 1042 DSCs (Response rate = 94.99%) in the second cycle of the National Program for the Improvement of the Quality and Access to the Dental Specialty Centres (PMAQ-CEO, in Portuguese) in 2018. Previously trained interviewers extracted information on MS, health management and human resources of the DSC by using a structured instrument. An MS score was created by adding the number of positive answers to the 10 MS questions. Negative binomial regression models were used to estimate the unadjusted and adjusted rate ratios (RR) and corresponding 95% confidence interval (CI). RESULTS: Of all the DSCs (n = 1042), 116 (11.1%) performed all 10 MS procedures. Those DSCs with a manager who had a higher education degree in the area of Public Health or Public Management (RR = 1.01, 95% CI, 1.01-1.02) and with human resources that received incentives, bonuses or financial awards for performance related to the PMAQ-CEO result (RR = 1.01 95% CI 1.01-1.02) are more likely to perform MS, when compared to the reference categories. The DSCs that are more likely to perform MS include those that developed actions as a result of periodic planning and evaluation with confirmatory documentation (RR = 1.06, 95% CI; 1.01-1.10); those that received support for planning and organizing the work scheme (RR = 1.03, 95% CI; 1.01-1.05); those that monitored and analysed the goals set for each specialty offered at the DSC, with (RR = 1.06, 95% CI; 1.01-1.10) or without confirmatory documentation (RR = 1.06, 95%CI; 1.02-1.11); those whose team periodically performed self-assessment processes, using the Ministry of Health's formal self-assessment (AMAQ in Portuguese) (RR = 1.04, 95% CI; 1.02-1.05); those who followed clinical guidelines (with confirmatory documentation) regarding the referral of patients from primary care to the DSC (RR = 1.02, 95% CI; 1.01-1.04). On the contrary, DSCs that did not use the results achieved in previous PMAQ cycles in the organization of the DSC's team work scheme proved to be less likely to perform MS (RR = 0.98, 95% CI; 0.96-0.99). CONCLUSIONS: Matrix support is associated with human resources and management factors in secondary oral health care in Brazil. Continuing professional development and some management characteristics are important for secondary dental care quality and could be considered in health policy initiatives.

Mothers' perception about health education in brazilian primary health care: A qualitative study.

BACKGROUND: Health education actions are strategic actions aimed at health promotion. Moreover, better health education practices have been linked to comprehensive care developed by primary health services. AIM: To understand the perception of mothers about the health education developed by the Primary Health Care (PHC) services. DESIGN: We adopted a qualitative research approach, conducted using semi-structured interviews, and assuming, as the theoretical reference, the attributes derived from PHC. Pregnant women and mothers of children under 1 year old attended by Brazilian Family Health teams were included. RESULTS: Eight pregnant women and twelve mothers of children under 1 year of age participated in the study. These mothers perceive educational actions as necessary only for primiparous mothers. They value the guidance of informal networks and maternity hospitals to the detriment of primary services, and they do not adhere to care that conflicts with their previous knowledge. The evidence shows that the educational actions of the primary health services do not adequately respond to the attributes of community orientation, family focus, and cultural competence. CONCLUSION: It is necessary to modify the educational practices in order to incorporate and value the existing knowledge in the territory, thereby adapting the care guidelines to the local context.

Uma proposta para parametrização de ações especializadas em saúde bucal / A proposal for parametrization of actions on secondary oral health care / A proposal for parametrization of actions on secondary oral health care

Introdução A definição de parâmetros assistenciais é de relevância para a execução de ações de saúde pública. Objetivo Descrever um percurso para elaboração de parâmetros de produção e de cobertura para endodontia e periodontia. Método Parâmetros de cobertura foram calculados a partir das necessidades normativas identificadas no levantamento epidemiológico de saúde bucal em Minas Gerais. Parâmetros de produção per capita foram calculados a partir das necessidades normativas, dos dados de produção do SIA/SUS e da capacidade instalada nos serviços. A análise foi desenvolvida no módulo Complex Samples do Programa SPSS. Resultados 6,2% (IC 95% 5,2%-7,3%) e 2,9% (IC 95% 2,2%-3,9%) dos indivíduos apresentavam, pelo menos, uma necessidade de tratamento endodôntico e periodontal, respectivamente. Em relação à produção, tanto a capacidade potencial de produção dos serviços especializados quanto a produção média registrada no SIA/SUS são muito inferiores às necessidades normativas globais da população. Conclusão A endodontia apresentou cobertura populacional e média de procedimentos maiores do que a periodontia. Os parâmetros de cobertura populacional podem ser utilizados para a organização dos serviços.

Background The definition of care parameters is relevant to the implementation of public health actions. Objective Describe a methodologic route for the elaboration of parameters on population coverage and production in endodontics and periodontics. Method Coverage parameters were calculated from the normative needs identified in the epidemiological survey of oral health in Minas Gerais. Production parameters were calculated based on normative requirements, SIA/SUS production data and installed capacity in the services. The analysis was developed in the Complex Samples module of the SPSS Program. Results 6.2% (95% CI 5.2%-7.3%) and 2.9% (CI 95% 2.2%-3.9%) needed endodontic and periodontal treatment, respectively. Both the potential production capacity of the specialized services and the average production recorded in the SIA/SUS were much lower than the overall normative needs of the population. Conclusion Endodontics presented a population coverage and average of procedures greater than that of periodontics. Population coverage parameters can be used to organize services.

Organização e resolutividade dos serviços públicos odontológicos para a atenção em saúde bucal de pré-escolares: estudo em dois municípios brasileiros / Organization and resolubility of public dental services to the oral health care of preschool children: study of two Brazilian cities

Objetivo:Descrever a organização e a resolutividade da rede pública de saúde para a atenção em saúde bucal de crianças de zero a seis anos em dois municípios brasileiros. Métodos:Estudo transversal descritivo realizado com dados secundários dos prontuários de crianças atendidas pelos serviços de saúde bucal [convencional ou Equipes de Saúde Bucal (ESB)] nos municípios de Belo Horizonte, 2014, e Diamantina, em 2015, Minas Gerais, Brasil. A resolutividade foi avaliada pela relação entre os percentuais de Tratamento Odontológico Concluído (TC) e de Primeira Consulta (PC). Nos dois municípios, a Estratégia Saúde da Família (ESF) é o modelo de organização dos serviços da Atenção Primária à Saúde (APS). Em Belo Horizonte, amostra representativa das crianças foi selecionada entre aquelas examinadas no Levantamento de Necessidades pelas ESB em 18 das 147 Unidades Básicas de Saúde (UBS). Em Diamantina, a organização do atendimento odontológico é o convencional e se dá por livre demanda, sendo realizado em quatro das sete UBS. Análise descritiva dos dados foi realizada para obtenção de frequências absolutas e relativas. Resultados:Foram analisados 1.344 prontuários em Belo Horizonte, 595 deles de crianças (44,27%) tiveram PC. Destas, 295 (21,95%) tiveram TC, com resolutividade de 49,58%. No município de Diamantina, todos os 43 prontuários odontológicos de crianças encontrados nas UBS com atendimento odontológico foram avaliados. Destas, 29 crianças (67,44%) tiveram a PC e 11 (25,58%) TC, representando resolutividade de 37,93%. Conclusão:Há diferenças na organização e no modelo de atenção em saúde bucal para crianças nos municípios estudados. Para os dois municípios, o acesso e a resolutividade das crianças ao cuidado em saúde bucal se constituem em desafios para os serviços públicos de saúde na APS. (AU)

Objective: to describe the organization and resolution of the public health network for the oral health care of children from zero to six years of age in two Brazilian cities. Methods: a descriptive cross-sectional study was carried out with secondary data from the charts of children who received dental care by oral health services [conventional or Oral Health Teams] in the cities of Belo Horizonte, in 2014, and Diamantina, in 2015, Minas Gerais, Brazil. The resolution was evaluated by the ratio between the percentages of Completed Treatment and First Appointment. In both cities, the Family Health Strategy is the organizational model of PHC services. In Belo Horizonte, a representative sample of the children was selected among those examined by the Oral Health Teams' survey of needs in 18 of the 147 Health Centers. In Diamantina, the dental care organization is conventional and occurs on demand, and is performed in four of the seven Health Centers. Descriptive data analysis was performed to obtain absolute and relative frequencies. Results: A total of 1,344 medical records were analyzed in Belo Horizonte, 595 of which were children (44.27%) who had their First Dental Appointment. Of these, 295 (21.95%) presented Completed Dental Treatment, with a resolution of 49.58%. In the municipality of Diamantina, all 43 children's dental records found in the Health Center that contained dental care were evaluated. Of these, 29 children (67.44%) had their First Dental Appointment and 11 (25.58%) Completed Dental Treatments, representing a resolution of 37.93%. Conclusion: Differences were found in the organization and model of oral health care for children in the studied municipalities. For both municipalities, children's access and resolution in Oral Health constitute challenges for public health services in Primary Health Care. (AU)

Biossegurança em Odontologia: conduta dos estudantes antes e após uma ação educativa / Biosafety in Dentistry: conduct of students before and after an educational intervention

O objetivo do estudo foi avaliar o conhecimento e a adesão dos estudantes de graduação em Odontologia da Universidade Federal de Minas Gerais quanto às normas de biossegurança e controle da infecção. Trata-se de um estudo transversal descritivo realizado com alunos do 4° ao 10° período, matriculados no segundo semestre de 2017. Houve uma intervenção que buscou reforçar os conhecimentos de biossegurança por meio da distribuição de folhetos informativos aos estudantes e afixação de pôsteres em locais de maior circulação. Foram coletadas informações sociodemográficas e relativas à biossegurança antes e após a intervenção, por meio de um questionário validado. Foram realizadas análises descritivas e bivariada por meio do teste qui-quadrado. A amostra constituiu de 653 estudantes, a maioria do sexo feminino, cursando entre o 7° e o 10° períodos, com média de idade de 22,6 anos. Quanto à proteção mecânica dos instrumentos de trabalho, tanto antes quanto após a ação, mais de 80% responderam sempre utilizar barreiras. Houve redução das frequências de desinfecção do ambiente e uso de equipamentos de proteção individual. A frequência de lavagem dos instrumentais aumentou de 95,4% para 96,6% após a intervenção, enquanto a esterilização reduziu de 100% para 98,8%. Houve associação entre o uso de equipamentos de proteção individual com o sexo feminino e os períodos iniciais do curso (p<0,001). Conclui-se que os estudantes do sexo feminino e dos períodos iniciais aderem com maior frequência às normas de biossegurança. Os conhecimentos sobre biossegurança não foram satisfatórios para o controle da infecção, mesmo após a ação educativa (AU).

The objective of this study was to evaluate the knowledge of and adherence to biosafety and infection control norms of dental students. This was a cross-sectional descriptive study carried out with students from 4th to 10th semester, enrolled in the second half of 2017. Na educational intervention to reinforce biosafety knowledge was implemented through the distribution of information flyers to students and poster placement in areas of high pedestrian circulation. Sociodemographic and biosafety information was collected before and after the intervention using a validated questionnaire. Descriptive and bivariate analyses were performed with the chi-square test using SPSS software, version 19. The research was approved by the Research Ethics Committee. The sample consisted of 653 students, most of them female, between the 7th and 10th semesters, with a mean age of 22.6 years. Before and after the intervention, more than 80% always used physical protection barriers. The frequency of environment disinfection and use of personal protection equipment decreased after the intervention. Always performing instrument washing increased from 95.4% to 96.6% after the intervention, while sterilization decreased from 100% to 98.8%. There was an association between the use of personal protection equipment with being women and with semestre (p <0.001). We conclude that students in initial semesters more often adhere to biosafety standards. Knowledge about biosafety was not satisfactory for infection control even after the educational intervention (AU).

Socioeconomic Factors and Caries in People between 19 and 60 Years of Age: An Update of a Systematic Review and Meta-Analysis of Observational Studies.

This study is aimed to perform an update of a systematic review and meta-regression to evaluate the effect modification of the socioeconomic indicators on caries in adults. We included studies that associated social determinants with caries, with no restriction of year and language. The Newcastle-Ottawa Scale was used to evaluate the risk of bias. With regard to the meta-analysis, statistical heterogeneity was evaluated by I², and the random effect model was used when it was high. A subgroup analysis was conducted for socioeconomic indicators, and a meta-regression was performed. Publication bias was assessed through Egger's test. Sixty-one studies were included in the systematic review and 25 were included in the meta-analysis. All of the studies were published between 1975 and 2016. The most frequent socioeconomic indicators were schooling, income, and socioeconomic status (SES). In the quantitative analysis, the DMFT (decayed, missing, filled teeth) variation was attributed to the studies' heterogeneity. The increase of 10.35 units in the proportion of people with lower SES was associated with an increase of one unit in DMFT, p = 0.050. The findings provide evidence that populations with the highest proportions of people with low SES are associated with a greater severity of caries. The results suggest the need for actions to reduce the inequalities in oral health (PROSPERO [CRD42017074434]).

Tratamento odontológico durante a gestação: conhecimentos e percepções de estudantes de Odontologia / Dental care during pregnancy: knowledge and perceptions among Dentistry students

O tratamento odontológico durante a gestação envolve mitos e incertezas, perpetuados pelo medo dos profissionais em atender gestantes. Poucos cursos de odontologia no Brasil possuem algum tipo de disciplina, projeto, programa ou ação que proporcione a capacitação do graduando para o cuidado dessa paciente. O objetivo deste trabalho foi avaliar o conhecimento dos acadêmicos de um curso de graduação em Odontologia sobre o atendimento odontológico à gestante e conhecer as necessidades desse grupo quanto ao aprendizado desse tema. Foi aplicado um questionário semiestruturado a todos os alunos matriculados no segundo semestre de 2016 na Faculdade de Odontologia da Universidade Federal de Minas Gerais. O questionário abordou questões como conhecimentos e expectativas sobre o atendimento odontológico à gestante. Os resultados foram analisados pela técnica de Análise de Conteúdo, e calculadas estimativas de prevalência. Dentre os 303 alunos que responderam ao questionário, apenas 14% atenderam gestantes durante a graduação. Somente 43% dos estudantes consideraram-se preparados para atender gestante, e 62% relataram ter recebido alguma orientação sobre o pré-natal odontológico durante a graduação, não existindo um conteúdo formal associado a alguma disciplina. Quanto à técnica, os principais problemas encontrados referiram-se ao desconhecimento sobre o uso de medicamentos, anestésicos e procedimentos permitidos. Em conclusão, os estudantes apresentaram deficiências no conhecimento sobre o atendimento odontológico à gestante, e demonstraram interesse em melhorar seu aprendizado nessa área. O ensino da graduação não está preparando adequadamente os alunos para o pré-natal odontológico, reforçando o ciclo de medos e adágios que envolvem esse cuidado (AU).

Dental treatment during pregnancy is surrounded by myths and uncertainties, perpetuated by the fear of treating pregnant women. Few dental schools in Brazil include some disciplines, projects, programs, or actions that prepare undergraduate students for providing dental care to pregnant women. The aim of this study was to assess the knowledge of undergraduate dental students about the dental care of pregnant women and the needs of these students to learn about this topic. A semistructured questionnaire was applied to all students enrolled for the second semester of 2016 at the Dental School of Universidade Federal de Minas Gerais. The questionnaire contained questions about knowledge and expectations of dental treatment of pregnant women. The results were evaluated by content analysis and prevalence estimates were calculated. Among the 303 students who answered the questionnaire, only 14% attended to pregnant women during their undergraduate course. Only 43% of the students thought they were prepared to treat pregnant women and 62% reported having been given some guidelines on prenatal dental care during their undergraduate studies, with no formal syllabus dealt with in any discipline. Regarding technical qualification, the major problems were lack of knowledge about the use of medications, anesthetics, and procedures. In conclusion, students lacked knowledge about dental treatment of pregnant women, but they showed interest in improving their learning in this field. Undergraduate courses do not properly qualify students for prenatal dental care, strengthening the fears and aphorisms surrounding this healthcare service (AU).

Assessment of the way in which entries are filled out in Child Health Records and the quality of the entries according to the type of health services received by the child. / Avaliação do preenchimento da Caderneta de Saúde da Criança e qualidade do preenchimento segundo o tipo de serviço de saúde usado pela criança.

The scope of this study was to assess the way Child Health Records (CHRs) are filled out and the association between the quality of entries and type of service used to monitor the health of children. It involved a cross-sectional study with a stratified sample - proportional for the nine Health Districts of Belo Horizonte, State of Minas Gerais - of 3- to 5-year-old children selected on Child Vaccination Campaign Day in 2014. Interviews with parents including observation of the 21 CHR items were conducted. The dependent variable was defined by the quality of the CHR entry (satisfactory/unsatisfactory), where satisfactory entries were > 60%. The independent variables were the type of service for monitoring child health, demographic and health conditions of the mother and child and healthcare treatment received by the child, with the participation of 367 (96.10%) parents. The prevalence of unsatisfactory entries was 55.5%. No significant association was found between quality of entry and type of healthcare. Unsatisfactory entries were associated with gestational age < 37 weeks, lack of access to information about the CHR and the absence of parental entries on the CHR. The CHR has been unsatisfactorily employed as a tool for monitoring health, irrespective of the type of service used by the child.

Objetivou-se avaliar o preenchimento da Caderneta de Saúde da Criança (CSC) e a associação entre qualidade do preenchimento e o tipo de serviço usado para o acompanhamento da saúde das crianças. Estudo transversal com amostra estratificada e proporcional aos 9 Distritos Sanitários de Belo Horizonte, selecionada entre crianças de 3 a 5 anos, no Dia da Campanha de Vacinação Infantil 2014. Realizou-se entrevista com os pais e observação de 21 itens da CSC. A variável dependente foi definida pela qualidade (satisfatória/insatisfatória) do preenchimento da CSC, sendo considerado satisfatório o preenchimento > 60%. As variáveis independentes foram o tipo de serviço para acompanhamento da saúde da criança, características demográficas e condições de saúde da mãe e da criança, e atenção em saúde recebida pela criança. Participaram 367 pais. A proporção de preenchimento insatisfatório foi 55,5%. Não houve associação significativa entre qualidade de preenchimento e tipo de serviço de saúde. O preenchimento insatisfatório esteve associado à idade gestacional < 37 semanas, falta de acesso a informações sobre a CSC e ausência de anotações dos pais na CSC. A CSC tem sido insatisfatoriamente empregada como um instrumento de vigilância da saúde independentemente do tipo de serviço usado pela criança.

Filling process of the Child Health Record in health care services of Belo Horizonte, Minas Gerais, Brazil. / Preenchimento da Caderneta de Saúde da Criança nos serviços de saúde em Belo Horizonte, Minas Gerais, Brasil.

OBJECTIVE: to describe the filling process of the Child Health Record (CHR) in health care services. METHODS: descriptive study held in Belo Horizonte, Minas Gerais, Brazil; an interview was conducted with parents/guardians of children aged 3-5 years old; 21 essential items to child monitoring were observed in the CHR during the 2014 Multi-vaccination Day; fields that should be filled in maternity wards, Primary Health Care (PHC), and other services were assessed separately. RESULTS: 367 children (96.1%) were included; 44.5% of CHR presented ≥60% of completeness; among the items that should be recorded in maternity wards, birth weight showed the highest proportion of completeness (64.5%); for those that should be filled in PHC/other services, records of vaccines (94.0%) presented the highest completeness; there was more filling in maternity wards than in PHC and other services (p<0.001). CONCLUSION: a low proportion of filling was observed, especially in PHC and other services.

Avaliação do preenchimento da Caderneta de Saúde da Criança e qualidade do preenchimento segundo o tipo de serviço de saúde usado pela criança / Assessment of the way in which entries are filled out in Child Health Records and the quality of the entries according to the type of health services received by the child

Resumo Objetivou-se avaliar o preenchimento da Caderneta de Saúde da Criança (CSC) e a associação entre qualidade do preenchimento e o tipo de serviço usado para o acompanhamento da saúde das crianças. Estudo transversal com amostra estratificada e proporcional aos 9 Distritos Sanitários de Belo Horizonte, selecionada entre crianças de 3 a 5 anos, no Dia da Campanha de Vacinação Infantil 2014. Realizou-se entrevista com os pais e observação de 21 itens da CSC. A variável dependente foi definida pela qualidade (satisfatória/insatisfatória) do preenchimento da CSC, sendo considerado satisfatório o preenchimento > 60%. As variáveis independentes foram o tipo de serviço para acompanhamento da saúde da criança, características demográficas e condições de saúde da mãe e da criança, e atenção em saúde recebida pela criança. Participaram 367 pais. A proporção de preenchimento insatisfatório foi 55,5%. Não houve associação significativa entre qualidade de preenchimento e tipo de serviço de saúde. O preenchimento insatisfatório esteve associado à idade gestacional < 37 semanas, falta de acesso a informações sobre a CSC e ausência de anotações dos pais na CSC. A CSC tem sido insatisfatoriamente empregada como um instrumento de vigilância da saúde independentemente do tipo de serviço usado pela criança.

Abstract The scope of this study was to assess the way Child Health Records (CHRs) are filled out and the association between the quality of entries and type of service used to monitor the health of children. It involved a cross-sectional study with a stratified sample - proportional for the nine Health Districts of Belo Horizonte, State of Minas Gerais - of 3- to 5-year-old children selected on Child Vaccination Campaign Day in 2014. Interviews with parents including observation of the 21 CHR items were conducted. The dependent variable was defined by the quality of the CHR entry (satisfactory/unsatisfactory), where satisfactory entries were > 60%. The independent variables were the type of service for monitoring child health, demographic and health conditions of the mother and child and healthcare treatment received by the child, with the participation of 367 (96.10%) parents. The prevalence of unsatisfactory entries was 55.5%. No significant association was found between quality of entry and type of healthcare. Unsatisfactory entries were associated with gestational age < 37 weeks, lack of access to information about the CHR and the absence of parental entries on the CHR. The CHR has been unsatisfactorily employed as a tool for monitoring health, irrespective of the type of service used by the child.

Use and resolubility of the oral health public services offered to children in a large municipality / Uso e resolutividade de serviços públicos de saúde bucal ofertados a crianças em município de grande porte

ABSTRACT Objective: To evaluate the effect of caries severity and socioeconomic conditions on use of oral health services and treatment situations (completed treatment, evasion, referral) among children with dental treatment needs, using the Unified Health System. Methods: Cross sectional study performed among children up to six years old, with dental treatment needs, coming from public schools in Belo Horizonte, Brazil, examined by the Oral Health Teams in the annual survey of oral health, in 2014. Variables were collected by consulting the medical records and information systems. Services were used by children who had attended the dental appointment at least once. The severity of caries considered the number of cavitated teeth. The socioeconomic variables were: age, sex, skin color and family socioeconomic classification. Resolubility was assessed by the ratio between completed treatment and first appointment. Evasion was defined by absence in more than two consecutive unjustified appointments. Association was tested by chi-square test and Poisson regression. Results: The frequency of services use was 44.3% and there was greater use by children with treatment needs in 4 to 8 teeth (PR=1.48, 1.23-1.78) and in more than 9 teeth (PR=1.80, 1.32-2.46) and lower in those with very high socioeconomic risk (PR = 0.79, 0.63-0.99). The resolubility was of 49.6% and 5.2% abandoned the treatment. Children with lower socioeconomic status presented lower resolubility and greater avoidance. Conclusion: The results suggested a persistent iniquity, with less use and resolubility of oral health services among children presenting worse socioeconomic status.

RESUMO Objetivo: Avaliar o efeito da gravidade da cárie e das condições socioeconômicas no uso dos serviços de saúde bucal e nas situações de atendimento (tratamento concluído, evasão, encaminhamento) entre crianças com necessidade de tratamento odontológico usuárias do Sistema Único de Saúde. Métodos: Estudo transversal entre crianças de até 6 anos de escolas públicas infantis, de Belo Horizonte, examinadas pelas Equipes de Saúde Bucal no levantamento anual de necessidades em saúde bucal de 2014. Foram incluídas as crianças com necessidade de tratamento odontológico. Variáveis foram coletadas por consulta ao prontuário e sistemas de informação. Usaram os serviços as crianças que compareceram pelo menos uma vez, em 2014, à consulta odontológica. A gravidade da cárie considerou o número de dentes cavitados e as variáveis socioeconômicas foram: idade, sexo, cor da pele e classificação socioeconômica da família. Resolutividade foi avaliada pela razão entre tratamento concluído e primeira consulta. Evasão foi definida pela ausência por > 2 consultas consecutivas sem justificativa. Associação foi testada por teste chi-quadrado e Regressão de Poisson. Resultados: A frequência de uso de serviços foi 44,3% e houve maior uso nas crianças com necessidade de tratamento em 4 a 8 dentes (RP=1,48; 1,23-1,78) e em > 9 dentes (RP=1,80; 1,32-2,46) e menor naquelas com muito elevado risco socioeconômico (RP=0,79; 0,63-0,99). A resolutividade foi de 49,6% e 5,2% evadiram. Crianças com pior nível socioeconômico apresentaram menor resolutividade e maior evasão. Conclusão: Sugere-se uma iniquidade persistente, com menor uso e resolutividade dos serviços de saúde bucal entre crianças com pior condição socioeconômica.

Pré-natal odontológico: assistência às gestantes na rede pública de atenção básica em saúde / Prenatal dental care: dental care for pregnant woman in the public primary healthcare network

Objetivo: avaliar como se dá a assistência odontológica a pacientes gestantes na rede pública de atenção básica em saúde, através das práticas descritas pelos cirurgiões-dentistas que compõe essa rede.Métodos: trata-se de um estudo transversal, em que os dados foram coletados por meio de questionário estruturado, entre maio e julho/2017 com cirurgiões-dentistas da rede pública de atenção básica em saúde do município de Belo Horizonte (MG). A análise foi por meio de cálculo de prevalência, utilizando o pacote estatístico STATA.Resultados: participaram deste estudo 260 cirurgiões-dentistas. Dentre eles, 98,5% atendiam gestantes, com média mensal de 1 a 4 atendimentos, havendo adesão ao tratamento em 54,5% dos casos. O acesso se deu, majoritariamente, através de encaminhamentos do médico e enfermeiro, ou livre demanda. Quase todos os dentistas (94,9%) sentem-se seguros para o atendimento da gestante. As principais dificuldades referiram-se à encaminhamento para tomadas radiográficas e falta de informação dos profissionais envolvidos no pré-natal e das gestantes sobre o atendimento odontológico.Conclusão: As gestantes estão recebendo assistência odontológica na rede pública de atenção básica e os cirurgiões-dentistas neste estudo não apresentaram receio em atende-as. O acesso facilitado aos serviços odontológicos disponíveis nos Centros de Saúde está sendo executada; pelas informações prestadas pelos cirurgiões-dentistas pôde-se ver que o encaminhamento das gestantes feito pelos profissionais de saúde envolvidos no pré-natal, seja ele médico, enfermeiro, Agente Comunitário de Saúde, está sendo realizado.

Aim: To evaluate the prenatal dental care provided for pregnant women in the public primary healthcare network, based on the perception of dentists who work in this service.Methods: This study was cross-sectional with a quantitative approach. The data were collected through a structured questionnaire between May and July 2017 with dentists who provide dental care in the public primary healthcare network in Belo Horizonte (MG). Data were analyzed using prevalence estimates calculated using the STATA statistics package. Results: Two hundred sixty dental surgeons participated in this study. Among them, 98.5% provided dental care for pregnant women in their healthcare center, with a monthly average of 1 to 4 visits and with treatment adherence in 54.5% of the cases. The access was mainly through referral given by the doctor or nurse or by free application. Almost all of the dentists (94.9%) considered themselves prepared to provide dental care to pregnant women. The main difficulties were related to the use of radiography and the lack of information of healthcare professionals involved in providing prenatal dental care and dental care for pregnant women during this period. Conclusion: The pregnant women are receiving dental care in the public primary healthcare network, and the dentists in this study were not afraid to attend to them. The facilitated access to the dental care services available at the Health Centers is being carried out; through the information provided by the dentists, it was possible to see that the referral of the pregnant women by the healthcare professionals involved in prenatal dental care, whether they are a doctor, a nurse, or a Community Healthcare Agent, is being carried out.

Preenchimento da Caderneta de Saúde da Criança nos serviços de saúde em Belo Horizonte, Minas Gerais, Brasil / Llenado del Libro de Salud del Niño en los servicios de salud en Belo Horizonte, Minas Gerais, Brasil / Filling process of the Child Health Record in health care services of Belo Horizonte, Minas Gerais, Brazil

Objetivo: descrever o preenchimento da Caderneta de Saúde da Criança (CSC) nos serviços de saúde. MÉTODOS: estudo descritivo, desenvolvido em Belo Horizonte, Minas Gerais, Brasil; realizou-se entrevista com os pais/responsáveis de crianças de 3 a 5 anos de idade e observaram-se 21 itens essenciais ao acompanhamento infantil na CSC, no Dia de Multivacinação de 2014; considerou-se separadamente os campos a serem preenchidos nas maternidades e na Atenção Primária à Saúde (APS) e outros serviços. Resultados: foram incluídas 367 crianças (96,1%); 44,5% das CSC apresentaram ≥60% dos itens preenchidos; dos itens a serem registrados nas maternidades, o peso ao nascer apresentou maior proporção de preenchimento (64,5%); daqueles a serem registrados na APS e outros serviços, os campos das vacinas foram os mais preenchidos (94,0%); houve maior preenchimento na maternidade do que na APS e outros serviços (p<0,001). Conclusão: observou-se baixa proporção de preenchimento, especialmente na APS e outros serviços.

Objetivo: describir el llenado del Libro de Salud del Niño (LSN) en los servicios de salud. Métodos: estudio descriptivo con niños de 3 a 5 años de Belo Horizonte, Minas Gerais, Brasil; se entrevistó a los padres y fueron analizados 21 partes esenciales del acompañamiento infantil en la LSN, en el Día de Multivacunación de 2014; se consideró por separado los campos que debían ser llenados en las maternidades y en la Atención Primaria de Salud (APS)/otros servicios. Resultados: se incluyeron 367 niños (96,1%); 44,5% del LSN presentaron ≥60% de las partes llenadas; en las maternidades, el peso al nacer presentó mayor proporción de llenado (64,5%); ya en las APS/otros el registro de vacunas fue el mayor (94,0%); el llenado fue mayor en maternidades que en las APS y otros servicios (p<0,001). Conclusión: se observó baja proporción de llenado, especialmente en los servicios de APS y otros.

Objective: to describe the filling process of the Child Health Record (CHR) in health care services. Methods: descriptive study held in Belo Horizonte, Minas Gerais, Brazil; an interview was conducted with parents/guardians of children aged 3-5 years old; 21 essential items to child monitoring were observed in the CHR during the 2014 Multi-vaccination Day; fields that should be filled in maternity wards, Primary Health Care (PHC), and other services were assessed separately. Results: 367 children (96.1%) were included; 44.5% of CHR presented ≥60% of completeness; among the items that should be recorded in maternity wards, birth weight showed the highest proportion of completeness (64.5%); for those that should be filled in PHC/other services, records of vaccines (94.0%) presented the highest completeness; there was more filling in maternity wards than in PHC and other services (p<0.001). Conclusion: a low proportion of filling was observed, especially in PHC and other services.

Exodontias no Sistema Único de Saúde em Minas Gerais: uma série temporal de 15 anos / Tooth extraction in the Brazilian Health System, Minas Gerais state: a 15-year time-series

Objetivo: Avaliar a tendência histórica de extrações dentárias no Estado de Minas Gerais entre os anos de 1998 e 2012. Métodos: Trata-se de um estudo de série temporal de exodontias de dentes permanentes no Estado de Minas Gerais, tendo sido os dados coletados no Sistema de Informações Ambulatoriais do Sistema Único de Saúde em 2013. Duas taxas de exodontias foram calculadas, ano a ano. A primeira refere-se à razão entre número total de exodontias de dentes permanentes dividida por todos os procedimentos preventivos, restauradores e cirúrgicos da atenção primária. A segunda foi a razão entre o número total de exodontias de dentes permanentes pelo número de habitantes. A análise estatística envolveu a construção de curvas de tendência histórica. Resultados: As duas taxas de exodontias comportaram-se de maneira errática no período avaliado. Houve uma ligeira tendência de aumento na taxa de exodontias por procedimentos da atenção primária e ligeira tendência de redução na taxa de exodontias pela população do Estado de Minas Gerais. Conclusão: As ligeiras tendências de aumento ou redução das taxas de exodontias revelam que as mesmas permaneceram constantes no período avaliado no Estado de Minas Gerais.(AU)

Aim: To evaluate the time-series of permanent tooth extraction in the state of Minas Gerais between the years 1998 and 2012. Methods: This is a timeseries study of permanent tooth extraction in the state of Minas Gerais. Data were collected in the Brazilian National Health Information System in 2013. Two annual rates of tooth extraction were calculated. The first was the ratio of the extractions of permanent teeth in relation to the total number of individual dental procedures in primary care. The second was the ratio of the number of extractions of permanent teeth divided by the total population. The statistical analysis of the time series was performed. Results: The two extractions rates behaved erratically during the study period. There was a slight tendency to increase in tooth extraction rate via primary care procedures and slight downward trend in tooth extraction rate in Minas Gerais state population. Conclusions: The slightly tendency in increase or decrease of the tooth extraction rates reveal that they remained constant in this period in the state of Minas Gerais.(AU)

A 15-Year Time-series Study of Tooth Extraction in Brazil.

Tooth loss is considered to be a public health problem. Time-series studies that assess the influence of social conditions and access to health services on tooth loss are scarce.This study aimed to examine the time-series of permanent tooth extraction in Brazil between 1998 and 2012 and to compare these series in municipalities with different Human Development Index (HDI) scores and with different access to distinct primary and secondary care.The time-series study was performed between 1998 and 2012, using data from the Brazilian National Health Information System. Time-series study was performed between 1998 and 2012. Two annual rates of tooth extraction were calculated and evaluated separately according to 3 parameters: the HDI, the presence of a Dental Specialty Center, and coverage by Oral Health Teams. The time-series was analyzed using a linear regression model.An overall decrease in the tooth-loss tendencies during this period was observed, particularly in the tooth-extraction rate during primary care procedures. In the municipalities with an HDI that was lower than the median, the average tooth-loss rates were higher than in the municipalities with a higher HDI. The municipalities with lower rates of Oral Health Team coverage also showed lower extraction rates than the municipalities with higher coverage rates.In general, Brazil has shown a decrease in the trend to extract permanent teeth during these 15 years. Increased human development and access to dental services have influenced tooth-extraction rates.