Implementation and Assessment of an Informal Virtual Elective for Medical Student Radiation Oncology Exploration During the COVID19 Pandemic: a Brief Report.

Subspecialty exposure during medical school can be limited. Moreover, the COVID19 pandemic prevented most onsite elective medical student (MS) rotations during 2020. Therefore, we sought to create and assess the efficacy of an informal virtual elective (IVE) for MSs to explore radiation oncology (RO) at our institution. We created IVE activities including invitations to resident didactics, a faculty lecture series, and interactive virtual events with residents and faculty. MSs were offered RO resident and faculty mentors and the opportunity to deliver a lecture. Pre- and post-IVE evaluation surveys were sent to 27 4th year MSs. Surveys utilized importance ordering (1=most important; reported as median (interquartile range), free response, and Likert-type questions (5 = extremely, 1=not at all). Our IVE, held from July to October 2020, had a median of 11 students (range 7-18) attend each activity. Pre- and post-IVE surveys were completed by 22/27 (81%) and 20/27 (74%) MSs, respectively. In pre-IVE, MSs reported participating in the IVE for faculty/resident interaction (1.5 [1, 2]), networking (3 [2, 3]), and learning (4 [3-5]). In post-IVE, MSs reported benefit from faculty mentors (5 [4, 5]), delivering a presentation (5 [3-5]), and faculty lectures (4.5 [4, 5]). In post-IVE, MSs preferred a full onsite away elective (16, 80%) over an official virtual elective (1, 5%) or IVE (3, 15%). Overall, MSs reported that the IVE provided an adequate introduction to RO at our institution (4 [4, 5]). Alternative virtual elective experiences allow MSs to informally evaluate medical subspecialties and could be offered even if formal elective opportunities are available.

Linguistic Biases in Letters of Recommendation for Radiation Oncology Residency Applicants from 2015 to 2019.

We aimed to investigate whether implicit linguistic biases exist in letters of recommendation (LORs) for applicants to radiation oncology (RO) residency. LORs (n = 487) written for applicants (n = 125) invited to interview at a single RO residency program from the 2015 to 2019 application cycles were included for analysis. Linguistic Inquiry and Word Count (LIWC) software was used to evaluate LORs for length and a dictionary of predetermined themes. Language was evaluated for gender bias using a publicly available gender bias calculator. Non-parametric tests were used to compare linguistic domain scores. The median number of the LORs per applicant was 4 (range 3-5). No significant differences by applicant gender were detected in LIWC score domains or gender bias calculator (P > 0.05). However, LORs for applicants from racial/ethnic backgrounds underrepresented in medicine were less likely to include standout descriptors (P = 0.008). Male writers were less likely to describe applicant characteristics related to patient care (P < 0.0001) and agentic personality (P = 0.006). LORs written by RO were shorter (P < 0.0001) and included fewer standout descriptors (P = 0.014) but were also more likely to include statements regarding applicant desirability (P = 0.045) and research (P = 0.008). While language was globally male-biased, assistant professors were less likely than associate professors (P = 0.0064) and full professors (P = 0.023) to use male-biased language. Significant linguistic differences were observed in RO residency LORs, suggesting that implicit biases related to both applicants and letter writers may exist. Recognition, and ideally eradication, of such biases are crucial for fair and equitable evaluation of a diverse applicant pool of RO residency candidates.

Ethnobotany and Management of Dimorphandra gardneriana in a Protected Area of Chapada do Araripe Semiarid Ceará, Northeastern Brazil.

The development of conservation strategies for nontimber forest products requires the characterization of the management systems and ethnoecological knowledge of the used species, as well as the analysis of the biological impacts of these processes. This study aimed to evaluate management systems and extractivist areas and related ethnoecological knowledge of Dimorphandra gardneriana (fava d'anta) in the semiarid region of Ceará, Northeast of Brazil. Fava d'anta produces fruits with high concentration of bioflavonoids, substances with various pharmacological properties, being exploited by extractivist communities in the mosaic of protected areas in Chapada do Araripe, Ceará. Ethnoecological knowledge has been concentrated on collectors who have been in activity for a longer time and/or plant the species. We identified three management systems that can impact in different ways on fava d'anta populations, depending on the area and level of human interference with the species. The extractivists respect the zoning of protected areas and do not enter in the full protection area, choosing areas with the highest tree density. The different systems produce a mosaic that creates different extraction opportunities and modifications to the local landscape and to fava d'anta populations. Factors that may have effects on the conservation of the species are the lack of supervision and overexploitation of the resource in native areas, while the factors that affect the health of extractivists are the infrastructure of the work and exposure to wild environments.

Effects of different levels of exploration on the ecological processes of Dimorphandra gardneriana, a tropical savanna tree.

The exploitation of forest resources, especially non-timber forest products, has effects on different biological levels, from the biochemical level of an organism to the ecosystem level. The present study addresses the effects of different management strategies (protected area, managed area, and an area where the species is cultivated in agroforestry systems) in reproductive phenology, fruit features, and phytochemical profiles of Dimorphandra gardneriana (Leguminosae), a tree species, pioneer, and socioeconomically important plant of the Brazilian Savanna. Its fruits are exploited by extractivist communities to obtain rutin and quercetin, which are internationally traded bioflavonoids (two of the ten most exported phytochemicals in Brazil). The results showed that the effects on these parameters were characterized as positive, increasing according to the level of exploitation. The agroforestry system had higher yields of flavonoids of economic interest, viable fruits and seeds, followed by the management area and the protected area. Finally, knowledge about the planting effects on fava d'anta fruit production can be a great ally for effectively managing forest resources. A varied system of exploitation implies greater and more stable economic returns for extractive communities, favoring the conservation of the species in protected areas.

Staphylococcus aureus skin infection recurrences among household members: an examination of host, behavioral, and pathogen-level predictors.

BACKGROUND: Many patients suffer from recurrent Staphylococcus aureus infections, but there are few data examining recurrence predictors. METHODS: We followed adults and children after treatment for S. aureus skin infections and their household contacts in Los Angeles and Chicago. We surveyed subjects for S. aureus body colonization, household fomite contamination, and behavioral and clinical factors at baseline and 3 and 6 months later. Using repeated measures modeling, we examined host, pathogen, behavioral, and clinical factors associated with recurrence. RESULTS: Among 330 index subjects, 182 (55%) were infected with an isolate of the USA300 methicillin-resistant S. aureus (MRSA) genetic background. Recurrences occurred in 39% by month 3 and 51% by month 6. Among 588 household contacts, 10% reported a skin infection by month 3 and 13% by month 6. Among index subjects, recurrence was associated with (P < .05) Los Angeles site, diabetes, recent hospitalization, recent skin infection, recent cephalexin use, and household S. aureus or MRSA fomite contamination; recurrence was inversely associated with recent contact sports participation. In the multivariate model, independent predictors of recurrence in index patients were recent hospitalization, household MRSA fomite contamination, and lack of recent contact sports participation. Among household contacts, independent predictors of subsequent skin infection were Chicago site, antibiotic use in the prior year, and skin infection in the prior 3 months. CONCLUSIONS: In our longitudinal study, patients with a S. aureus skin infection were more likely to suffer a recurrence if household fomites were MRSA contaminated. Interventions to prevent recurrence may be enhanced by decontamination of household fomites.

Patient Interest in Exploring Nonsurgical Treatment Approaches for Early-Stage Breast Cancer: A Qualitative Study.

PURPOSE: Advances in radiation therapy have enabled the ability to deliver ablative treatments, but there has been limited application of these treatments to early-stage breast cancers with a goal of omitting surgery. The purpose of this study was to explore patient interest in pursuing nonsurgical treatment approaches for their early-stage breast cancer. METHODS AND MATERIALS: We conducted a qualitative study involving interviews with 21 patients with early-stage breast cancer who were eligible for participation in a phase 2 clinical trial offering omission of definitive surgery. Interviews were transcribed and an inductive, thematic analysis was performed by 3 independent reviewers to generate themes and subthemes. RESULTS: Data analysis revealed the following factors that affected patient willingness and desire to explore nonsurgical treatment options: (1) perceptions and feelings about their cancer; (2) current quality of life and the level of support available in their daily life; (3) external conversations focusing on family members' and friends' experiences with cancer and/or cancer treatments; (4) personal health care experiences, including their current breast cancer diagnosis; (5) perceptions and feelings about their physicians; (6) conversations with their physicians about their treatment options; and (7) self-identified desire to direct care decisions. Specifically, patients verbalized fearing surgery and surgical recovery; wanting to preserve their breast(s); the prior negative surgical experiences of friends, family, and themselves; a desire to receive treatment per the latest research; wanting to match the level of treatment with the severity of their cancer; and other comorbidities as reasons for wanting to explore omitting surgery. CONCLUSIONS: Our findings demonstrate an unmet need directed by patient interest to explore nonsurgical options for early-stage, biologically favorable breast cancer. These results may shape conversations around shared decision-making and clinical trial design, and result in more personalized treatment options for women with early-stage breast cancer.

Applicant and Program Director Perceptions of Second Look Events During the 2023 Radiation Oncology Residency Match.

Purpose: Virtual radiation oncology (RO) residency interviews may impair applicant and program evaluation. Second look events (SLEs) exist; however, the frequency, nature, and implications are unknown. We surveyed applicants and program directors (PDs) to characterize the 2023 RO Match SLEs and assess perspectives. Method and Materials: An online, anonymous survey was distributed to 2023 RO Match applicants and American College of Graduate Medical Education-accredited RO PDs post-Match. Number and percentage are reported as response per question. Likert-type scores (1, strongly agree; 5, strongly disagree) are reported as median, IQR. Results: Responses were received from 51 of 246 applicants (21%) and 52 of 88 PDs (59%). Forty applicants (87%) were offered in-person and virtual SLEs; 20 (51%) and 17 (44%) applicants were invited to 1 to 3 and 4 to 6 events, respectively. Most invited applicants attended none (21, 54%). Applicants reported that all (21, 54%) or some (16, 41%) programs communicated intentions to finalize rank order lists (ROLs) before SLEs. Most applicants (29, 74%) agreed that SLEs were optional without ROL consequences (median, 2, IQR 1-3). Applicants declined in-person SLEs due to city/facility indifference (10, 43%), finances (10, 43%), and logistics (9, 39%). Most (12, 86%) in-person SLE attendees agreed that SLEs influenced their ROL (median, 2, IQR 1-2). Nineteen PDs (40%) reported offering SLEs, with 18 of 19 being in-person. PDs who did not offer SLEs cited ethical concerns (13, 45%) and institutional policies (11, 38%). All PDs reported that SLEs were optional, and 18 of 19 explained that the SLE would be without ROL consequences. SLEs mostly occurred in February before (11, 58%) and after (15, 79%) ROL submission. Conclusions: In-person SLEs occurred during Match 2023. All PDs considered SLEs optional which was trusted by most applicants. Attendance at in-person SLEs influenced applicants' ROLs; however, finances and logistics impaired applicant attendance. Further work is needed to appreciate SLE implications and ensure equitable residency recruitment.

The effect of temperature on the germination of Melocactus violaceus Pfeiff. (Cactaceae), a threatened species in restinga sandy coastal plain of Brazil.

Melocactus violaceus is an endangered species due to habitat destruction and the overcollection of this species for ornamental use. The aim of this study was to test the effect of different temperatures on the germination of M. violaceus. Three treatments were conducted: a constant temperature of 25ºC, a 20-35ºC alternating temperature, both inside germination chamber, and an alternating temperature under room temperature (mean temperature ranged from 25-37ºC). The final seed germination rates at the alternating temperature treatments were not significantly different (65% in the seed germinator and 62.5% at room condition). However, both treatments with alternating temperatures had significantly higher germination rates compared to the treatment kept at the constant temperature (8%). Our study showed that alternating temperatures between 20 and 37ºC provides satisfactory conditions to induce a high percentage of seed germination of M. violaceus, without the passage of seeds through the digestive tract of its natural disperser, the lizard Tropidurus torquatus. This condition contributes to efficiently producing seedlings that can be reintroduced into conservation areas or used as ornamentals that may help reduce the overcollection of the remaining native populations.

Surveillance and high vaccination coverage: how Portugal overcame the collapse and regained control of the pandemic. / Vigilância e elevada cobertura vacinal: como Portugal superou o colapso e retomou o controle da pandemia.

The uncertainties about COVID-19 require evaluating national responses to identify successes and failures in the pandemic control. This article analyzes Portugal´s response, particularly the contribution of its health and surveillance systems in dealing with the pandemic. An integrative literature review was conducted, including consultations of observatories, documents, and institutional websites. Portugal´s response was agile and showed unified technical and political coordination, including surveillance structure using telemedicine. The reopening was supported by high testing and low positivity rates and strict rules. However, the relaxation of measures as of November/2020 resulted in an increase in cases, collapsing the health system. The response involved a consistent surveillance strategy with innovative monitoring tools, which, combined with high population adherence to vaccination, led to overcoming that moment and kept hospitalization and death rates at new disease waves at low levels. Thus, the Portuguese case discloses the risks of disease resurgence with the flexibility of measures and the population´s exhaustion in the face of restrictive measures and new variants, but also the importance of articulation between technical coordination, the political sphere, and the scientific committee.

As incertezas sobre a COVID-19 requerem avaliação das respostas nacionais, visando identificar sucessos e fracassos no seu controle. Este artigo analisou a resposta portuguesa, particularmente a contribuição dos seus sistemas de saúde e de vigilância no enfrentamento à pandemia. Foi realizada uma revisão integrativa da literatura, sendo incluídas consultas a observatórios, documentos e sites institucionais. A resposta portuguesa foi ágil e revelou uma coordenação técnica e política unificada. Contou com estrutura de vigilância e uso de telemedicina. A reabertura foi amparada na alta testagem, baixa positividade e regras rígidas. Contudo, o relaxamento das medidas a partir de novembro/2020 resultou em aumento de casos com colapso do sistema de saúde. A resposta a esta situação envolveu estratégia de vigilância consistente, com instrumentos de monitoramento inovadores, que, aliados à alta adesão da população à vacinação, levaram à superação daquele momento e mantiveram baixos índices de hospitalizações e óbitos em novas ondas. Nesse sentido, o caso português evidenciou os riscos de recrudescimento com a flexibilização, a exaustão da população em relação a medidas restritivas e novas variantes, mas também a importância da articulação entre a coordenação técnica, a esfera política e o comitê científico.

Staphylococcus aureus colonization among household contacts of patients with skin infections: risk factors, strain discordance, and complex ecology.

BACKGROUND: The USA300 methicillin resistant Staphylococcus aureus (MRSA) genetic background has rapidly emerged as the predominant cause of community-associated S. aureus infections in the U.S. However, epidemiologic characteristics of S. aureus household transmission are poorly understood. METHODS: We performed a cross-sectional study of adults and children with S. aureus skin infections and their household contacts in Los Angeles and Chicago. Subjects were surveyed for S. aureus colonization of the nares, oropharynx, and inguinal region and risk factors for S. aureus disease. All isolates underwent genetic typing. RESULTS: We enrolled 1162 persons (350 index patients and 812 household members). The most common infection isolate characteristic was ST8/SCCmec IV, PVL+ MRSA (USA300) (53%). S. aureus colonized 40% (137/350) of index patients and 50% (405/812) of household contacts. A nares-only survey would have missed 48% of S. aureus and 51% of MRSA colonized persons. Sixty-five percent of households had >1 S. aureus genetic background identified and 26% of MRSA isolates in household contacts were discordant with the index patients' infecting MRSA strain type. Factors independently associated (P < .05) with the index strain type colonizing household contacts were recent skin infection, recent cephalexin use, and USA300 genetic background. CONCLUSIONS: In our study population, USA300 MRSA appeared more transmissible among household members compared with other S. aureus genetic backgrounds. Strain distribution was complex; >1 S. aureus genetic background was present in many households. S. aureus decolonization strategies may need to address extra-nasal colonization and the consequences of eradicating S. aureus genetic backgrounds infrequently associated with infection.

The Impact of COVID-19 on Radiation Oncology Residency Applicant Away Rotations, Interviews, and Rank Lists: A Comparison Between the 2020 Match and 2021 Match.

PURPOSE: The COVID-19 pandemic modified the Residency Match process for fourth-year medical students. In-person away rotations were discouraged, interviews were virtual, and traditional factors used to rank programs were absent. Here, we compare survey results administered to both the 2020 and 2021 Match applicants to assess the influence of the pandemic on the radiation oncology (RO) Match process. METHODS: An institutional review board-approved prospective cross-sectional study was conducted. The 2020 and 2021 RO Match applicants at a large RO program were invited to participate. Descriptive summary statistics were assessed. RESULTS: The 2020 and 2021 Matches each had 76 applicants complete the survey with response rates of 54% and 57%, respectively. The 2 groups were predominantly white, cisgender male, single, and without children. Whereas 11% of 2020 applicants did not complete away rotations, 45% of 2021 applicants did not. For 2021 Match applicants, 65% of away rotations were performed virtually, whereas 51% were not for medical school credit. Of the applicants, 84% were satisfied with virtual interviews and 72% felt cost savings were worth not having in-person interviews. Whereas 49% of Match 2020 applicants spent >$5000 in interview costs, 0% of the Match 2021 applicants did so, with 45% spending <$100. Postinterview communications from programs increased during the pandemic from 36% to 42% in 2020 Match and 2021 Match, respectively. Although program culture was the most common factor influencing 2021 Match applicants program rankings, half of applicants did not gain a sense of program culture during virtual interviews. CONCLUSIONS: We found 2021 Match applicants completed fewer away rotations, were satisfied with virtual interviews/reduced costs, and did not gain a sense of program culture through virtual rotations/interviews despite it being the most important ranking factor reported. This study supports further exploration of virtual away rotations and virtual interviews moving forward beyond the pandemic.

Away Rotations, Interviews, and Rank Lists: Radiation Oncology Residency Applicant Perspectives on the 2020 Match Process.

PURPOSE: Using 2020 match applicants, the purpose of this study was to identify baseline applicant perspectives on the match process surveying (1) away rotations, (2) interview/postinterview communications, and (3) factors influencing applicant rank order lists. METHODS AND MATERIALS: Applicants in the 2020 match cycle at a large radiation oncology (RO) residency program received a questionnaire covering demographics and the match process: away rotations, interview/postinterview communications, and ranking. Univariable and multivariable logistic regression analyses were used to identify factors associated with completing fewer away rotations. RESULTS: Of 141 surveys sent, 76 were completed, for a response rate of 54%. Most applicants were White, male, and matched into RO. One in 3 applicants did not have a home RO program. Most applicants completed 2 RO rotations (ie, a home rotation and an additional away rotation; range, 0-4 total rotations); RO rotations influenced the applicant rank order lists and the ultimate match result for 94% and 79% of applicants, respectively. Forty-seven percent of applicants reported being asked inappropriate questions during the interview (eg, parental or marital status). Applicants did not perceive a consistent message regarding postinterview communications from program directors. Most applicants were contacted postinterview. Interviews cost most applicants more than $5000. Thirty-seven percent of respondents reported submitting a letter of interest after the interview, hoping to improve their rank. When applying to programs, general reputation and location were the most common influential factors mentioned. When ranking programs, informal conversations with residents and program culture observations were the most common influential factors mentioned. Based on multivariable analysis, applicants who completed fewer RO rotations (including away rotations) had greater odds of matching to their home program (odds ratio [OR], 12.05; 95% CI, 1.27-206.69), lower odds of program location influencing where to apply (OR, 0.04; 95% CI, 0.003-0.37), and lower odds of the program's general reputation affecting their rank list (OR, 0.04; 95% CI, 0.001-0.47). CONCLUSIONS: The results suggest that medical students perceive away rotations as an important influencer of their match process. Although applicants and program directors both participate in postinterview communications, interactions with residents influence rank order lists. These data may serve as an up-to-date baseline to evaluate the influence of the COVID-19 pandemic on the RO match process.

Temporal assessment of the medicinal plants trade in public markets of the state of Paraíba, northeastern Brazil.

BACKGROUND: Open and public markets are the main providers of medicinal plants in urban environments. The present study evaluated the medicinal plants sold in public markets in different municipalities in the mesoregions of the state of Paraíba, northeast of Brazil, and the possible variations in the supply of these plants in the markets over the course of a year. METHODS: Interviews with medicinal plant traders were conducted in four mesoregions of different climatic and phytophysiognomic characteristics (ranging from Caatinga to Atlantic Forest). The versatility of the species sold was elucidated using the relative importance (RI) index, and the set of species sold by each informant in each mesoregion was compared with each other by one-way Anosim  and by the analysis of main coordinates. RESULTS: Thirty-five plant traders identified 163 medicinal plant species (151 genders and 76 families) and more 17 non identified species. The most frequent families were Fabaceae (19 species), Asteraceae (12), Lamiaceae (11), and Myrtaceae (6). Punica granatum, Zingiber officinale, and Myracrodruon urundeuva were the species with the highest RI. The analysis of similarity showed distinct differences between the Sertão and all other mesoregions. The Agreste, an ecotone area, was also the area where more species of other regions was found. The absence of 88 species in at least one of the trading locations at some stage of the fieldwork was recorded. CONCLUSIONS: The presence and absence of the commercialized species do not seem to be related to the period of the year or the mesoregion. There were differences in the inventory of plants commercialized in markets in recent years. We identified an intermediate zone of knowledge and use of species commercialized between the studied localities.

Vigilância e elevada cobertura vacinal: como Portugal superou o colapso e retomou o controle da pandemia / Surveillance and high vaccination coverage: how Portugal overcame the collapse and regained control of the pandemic

Resumo As incertezas sobre a COVID-19 requerem avaliação das respostas nacionais, visando identificar sucessos e fracassos no seu controle. Este artigo analisou a resposta portuguesa, particularmente a contribuição dos seus sistemas de saúde e de vigilância no enfrentamento à pandemia. Foi realizada uma revisão integrativa da literatura, sendo incluídas consultas a observatórios, documentos e sites institucionais. A resposta portuguesa foi ágil e revelou uma coordenação técnica e política unificada. Contou com estrutura de vigilância e uso de telemedicina. A reabertura foi amparada na alta testagem, baixa positividade e regras rígidas. Contudo, o relaxamento das medidas a partir de novembro/2020 resultou em aumento de casos com colapso do sistema de saúde. A resposta a esta situação envolveu estratégia de vigilância consistente, com instrumentos de monitoramento inovadores, que, aliados à alta adesão da população à vacinação, levaram à superação daquele momento e mantiveram baixos índices de hospitalizações e óbitos em novas ondas. Nesse sentido, o caso português evidenciou os riscos de recrudescimento com a flexibilização, a exaustão da população em relação a medidas restritivas e novas variantes, mas também a importância da articulação entre a coordenação técnica, a esfera política e o comitê científico.

Abstract The uncertainties about COVID-19 require evaluating national responses to identify successes and failures in the pandemic control. This article analyzes Portugal´s response, particularly the contribution of its health and surveillance systems in dealing with the pandemic. An integrative literature review was conducted, including consultations of observatories, documents, and institutional websites. Portugal´s response was agile and showed unified technical and political coordination, including surveillance structure using telemedicine. The reopening was supported by high testing and low positivity rates and strict rules. However, the relaxation of measures as of November/2020 resulted in an increase in cases, collapsing the health system. The response involved a consistent surveillance strategy with innovative monitoring tools, which, combined with high population adherence to vaccination, led to overcoming that moment and kept hospitalization and death rates at new disease waves at low levels. Thus, the Portuguese case discloses the risks of disease resurgence with the flexibility of measures and the population´s exhaustion in the face of restrictive measures and new variants, but also the importance of articulation between technical coordination, the political sphere, and the scientific committee.

Local botanical knowledge of native food plants in the semiarid region of Brazil.

BACKGROUND: This study aimed to investigate the local botanical knowledge of native food plants in three rural communities, located in the semiarid region of Paraíba State, Brazil, verifying possibilities of differences of knowledge among communities and between men and women. METHODS: Semi-structured interviews about native plant knowledge and use were conducted with all householders in each community, totaling 117 informants. The species similarity among the communities of Pau D'Arco, Várzea Alegre, and Barroquinha was compared with Jaccard index, and the use value index (UVgeneral, UVcurrent, UVpotential) was used to determine the most important species. The Kruskal-Wallis test was used to compare the use values among communities and genders. The consensus factor among the informants was calculated according to the uses cited, and the Wilcoxon test was used to compare the use values between men and women. RESULTS: We recorded 9 species belonging to 8 genera and 8 families in Várzea Alegre; 10 species, 9 genera, and 9 families in Barroquinha; and 7 species, 7 genera and 7 families in Pau D'Arco. Spondias tuberosa Arruda (Anacardiaceae) in Várzea Alegre, Spondias sp. (Anacardiaceae) in Barroquinha, and Ximenia americana L. (Olacaceae) in Pau D'Arco were the most prominent species. Preparation methods are slightly different in the three communities, and there is low similarity about species use among the communities. Regarding gender, the analysis of use value among the communities evidenced significant differences only for UVgeneral among women, specifically between Barroquinha and Pau D'Arco. For men and women within each community, there is a difference only for UVpotential in Barroquinha. CONCLUSION: This study showed that the residents of the three rural communities have limited knowledge of native food plants found in their communities, but they know where to find them, which parts they may use and how to consume them. The fact is that men know plants that are more distant from the residences and women know those that are next to them.

The Group Oral Health Movement in Brazil. / O movimento da Saúde Bucal Coletiva no Brasil.

Group Oral Health (GOH) is a specific phenomenon in time, separate from other "Alternative Odontology", and a theoretical reference for dental practice in healthcare services. This study is an attempt to understand how long "Alternative Odontology" will remain with the social context of struggling for oral health in Brazil, based on the positions of the founding agents and their precursors, bearing in mind the concepts of GOH, GH (Group Health) and the SUS (Unified Healthcare System). We started out with Pierre Bourdieu's Practice Theory, complemented with Gramsci's concept of hegemony and counter-hegemony. We completed 12 in-depth interviews, reviewed the literature and analyzed the scientific output. We also looked at the trajectories of the agents and their capital between 1980 and 2013. The results show that the concept of GOC and GH as a breach with health practices, which gave rise to "Alternative Odontology", prevailed among those with the political will to defend democracy and Healthcare Reforms. Although GOC is a critical proposal, the older "Odontology" remains in scientific journals, and in the practice of oral care.

Saúde bucal índice de desenvolvimento humano, Bahia, 2001-2014 / Oral health and human development index, Bahia, Brazil, 2001-2014 / Índice de salud oral y desarrolo humano, Bahia, Brasil, 2001-2014

Estudo ecológico de série histórica que avaliou indicadores de saúde bucal em relação a cobertura da Estratégia Saúde da Família (ESF), o porte populacional e Índice de Desenvolvimento Humano Municipal (IDH-M), entre 2001-2014, nos municípios da Bahia. As informações foram obtidas nas bases de dados do DATASUS e IBGE. Inicialmente, procedeu-se a compatibilização das informações das diferentes bases de dados e cálculo dos indicadores. A análise foi realizada através do Minitab 17, utilizando-se o teste de Pearson para correlação com um nível de significância de 5%. Observou-se consistência no registro de informações ambulatoriais e aumento das coberturas da ESF e de Equipes de Saúde Bucal (ESB), não proporcional à cobertura de 1ª consulta odontológica, que apresentou crescimento menor até 2012, seguido de declínio. A média de escovação supervisionada apresentou grande variação. Entre 2001 e 2007, a média de procedimentos básicos apresentou crescimento, enquanto as ações especializadas, apesar do aumento até 2005, caíram em 2006 e 2007. A análise de correlação evidenciou associação positiva entre porte populacional e coberturas da ESF e de ESB (menor porte populacional, maior cobertura), assim como entre IDH-M e estes indicadores (menor IDH-M, maior cobertura). Na Bahia, a implantação da ESF e das ESB tem representado um grande desafio para os municípios de grande porte populacional e melhor IDH. (AU)

Historical series ccological study that evaluated oral health indicators in relation to the estimated coverage of Family Health Strategy (FHS), population size and Municipal Human Development Index (HDI), from 2001 to 2014 in municipalities of Bahia, Brazil. The data was obtained from health information systems maintained by the Department of Informatics of SUS (DATASUS) and of the Brazilian Institute of Geography and Statistics (IBGE). The collected data were organized in electronic spreadsheets to make compatible the information of different databases and calculation of indicators. Analysis was performed in Minitab 17 statistical package and the Pearson test was used for correlation with significance level of 5%. It was observed consistency in the information record in the SIA/SUS for the analyzed period and a significant increase in the coverage of the FHS and Oral Health Teams (OHT), that was not proportional to that observed to coverage of 1st dental consultation, smaller until 2012, and followed by a decline. The average of supervised brushing had great variation. Between 2001 and 2007, the average number of basic procedures presented growth while the average number of specialized actions, despite the significant increase until 2005, fell dramatically in 2006 and 2007. The correlation analysis showed positive association between population size and coverage of the FHS and OHT (lower population size, higher coverage), as well as between HDI-M and these indicators (lower HDI-M, higher coverage). In Bahia, implementation of FHS and OHT has been a major challenge for municipalities with large populations and better HDI. (AU)

Estudio ecológico de series históricas que evaluó los indicadores de salud bucal en relación con la cobertura de la Estrategia de Salud de la Familia (FHS), el tamaño de la población y el Índice de Desarrollo Humano Municipal (IDH-M), entre 2001-2014, en los municipios de Bahía. La información se obtuvo de las bases de datos DATASUS e IBGE. Inicialmente, la información de las diferentes bases de datos se hizo compatible y se calcularon los indicadores. El análisis se realizó con Minitab 17, con la prueba de correlación de Pearson con un nivel de significación del 5%. Se observó consistencia en el registro de información ambulatoria y un aumento en la cobertura de los Equipos de Salud Oral y FHS (BHS), no proporcional a la cobertura de la primera cita dental, que mostró un menor crecimiento hasta 2012, seguido de una disminución. El cepillado medio supervisado varió ampliamente. Entre 2001 y 2007, el promedio de los procedimientos básicos aumentó, mientras que las acciones especializadas, a pesar del aumento hasta 2005, cayeron en 2006 y 2007. El análisis de correlación mostró una asociación positiva entre el tamaño de la población y la cobertura de ESF y ESB (tamaño más pequeño). así como entre HDI-M y estos indicadores (menor HDI-M, mayor cobertura). En Bahía, la implementación del FSE y el ESB ha sido un gran desafío para los municipios de gran población y un mejor IDH. (AU)

A política de saúde bucal em um município baiano: os agentes da burocracia estatal / The oral health policy in a municipality of Bahia: the agents of state bureaucracy

RESUMO Este estudo buscou caracterizar os Coordenadores de Saúde Bucal (CSB) envolvidos na implantação da Política Nacional de Saúde Bucal (PNSB) em um município baiano, caso exemplar, entre 1997 e 2015. Foi realizado um estudo de caso com abordagem qualitativa, baseado no referencial bourdieusiano, por meio de entrevistas em profundidade com seis CSB, com média de 45 anos. Foram analisadas as suas trajetórias profissionais a partir das categorias: origem social, formação profissional, trajetória e inserção profissional e trajetória no campo burocrático. A maioria graduou-se em instituições públicas e apresentou trajetória ascendente no campo burocrático. A inserção na gestão foi influenciada pelas disposições, pela rede de relações e pelo desempenho profissional na Estratégia Saúde da Família (ESF). A qualificação profissional parece ser aspecto diferenciador. A pós-graduação em saúde coletiva representou maior possibilidade de inserção na ESF. A equipe gestora manteve o exercício da clínica. O apoio da gestão municipal e da saúde foi ressaltado por quase todos os entrevistados. A PNSB contribuiu para expansão da rede de saúde bucal, contudo, as principais proposições já estavam implantadas anteriormente. Evidencia-se a importância da gestão na implantação da PNSB e recomenda-se a realização de análise semelhante de outros casos para identificação de regularidades que contribuam para a explicação dos diferentes graus de implementação dessa política.

ABSTRACT This study aimed to characterize Oral Health Coordinators (OHC) involved in the implantation of the Brazilian Oral Health Policy (BOHP) in a municipality of Bahia, exemplary case, between 1997-2015. A qualitative approach case study was carried out, based on the Bourdieu theoretical, through in-depth interviews with six OHC, with an average of 45 years of age. Their professional trajectories were analyzed from the following categories: social origin, professional training, professional trajectory and insertion, and trajectory in the bureaucratic field. The majority of them graduated from public institutions and presented an upward trajectory in the bureaucratic field. The insertion in management was influenced by dispositions, network relations, and professional performance in Family Health Strategy (FHS). Professional qualification seems to be a differentiating aspect. Post-graduation in public health represented a greater possibility of insertion in the FHS. The management team maintained clinical practice. The support of municipal management and health was highlighted by almost all interviewees. The BOHP contributed to the expansion of the oral health network, however, the main propositions were implanted previously. The importance of management in the BOHP implementation is evident and it is recommended to carry out similar analysis of other cases to identify regularities that contribute to the explanation of the different degrees of BOHP implementation.

O movimento da Saúde Bucal Coletiva no Brasil / The Group Oral Health Movement in Brazil

Introdução: A Saúde Bucal Coletiva (SBC) pode designar um fenômeno histórico especifico, distinto das outras "Odontologias Alternativas" e um referencial teórico para as práticas odontológicas em serviços de saúde. Objetivos: Este estudo buscou compreender a permanência das "Odontologias Alternativas" no espaço social de luta pela saúde bucal no Brasil, a partir de posições dos agentes fundadores e precursores, levando em consideração as concepções de SBC, Saúde Coletiva (SC) e SUS. Material e métodos: Partiu-se da teoria das práticas de Pierre Bourdieu, complementada pelos conceitos de hegemonia e contra-hegemonia em Gramsci. Realizaram-se 12 entrevistas em profundidade, revisão documental e análise da produção científica, além das trajetórias dos agentes e seus capitais em 1980 e 2013. Resultados: Os resultados indicam que a concepção de SBC e SC como ruptura com as práticas de saúde oriundas às "Odontologias Alternativas" prevaleceu entre aqueles com disposições políticas em defesa da democracia e da Reforma Sanitária. Conclusão: Embora a SBC tenha proposta crítica, permanecem antigas "Odontologias" na produção científica e nas práticas de saúde bucal.

Introduction: Group Oral Health (GOH) is a specific phenomenon in time, separate from other "Alternative Odontology", and a theoretical reference for dental practice in healthcare services. Objectives: This study is an attempt to understand how long "Alternative Odontology" will remain with the social context of struggling for oral health in Brazil, based on the positions of the founding agents and their precursors, bearing in mind the concepts of GOH, GH (Group Health) and the SUS (Unified Healthcare System). Material e methods: We started out with Pierre Bourdieu's Practice Theory, complemented with Gramsci's concept of hegemony and counter-hegemony. We completed 12 in-depth interviews, reviewed the literature and analyzed the scientific output. We also looked at the trajectories of the agents and their capital between 1980 and 2013. Results: The results show that the concept of GOC and GH as a breach with health practices, which gave rise to "Alternative Odontology", prevailed among those with the political will to defend democracy and Healthcare Reforms. Conclusion: Although GOC is a critical proposal, the older "Odontology" remains in scientific journals, and in the practice of oral care.

[Characteristics of the access and utilization of public dental services in medium-sized cities]. / Características do acesso e utilização de serviços odontológicos em municípios de médio porte.

This cross-sectional study sought to describe the main characteristics of access and utilization of primary and specialized public dental services in two medium-sized cities in Bahia with 100% coverage of the Family Health Program. A survey of 952 households and 2.539 individuals aged over 15 years was conducted. The main variables analyzed were: perceived oral health needs, demand for the service, barriers of organizational access and the type of service and procedure utilized. The use of specialized public dental services was of 11.7% and primary care was 26%. In the city where there was greater use of public dental services, there was less use of private services. The main barrier to access remained in primary care (from 5.0% to 15.2%). There was little interface between secondary care a primary care, as only 16.6% of users returned to this level of care. In conclusion, the main barrier to access in cities with specific organizational and geographic realities appears to be in primary dental care. Individual preventive actions were little reported. It is recommended that barriers to access in primary care be eliminated, and also that a protocol (clinical guides) be established to foster the continuity and longitudinality of primary dental care.