Rede de formação em saúde da família: a experiência do nordeste brasileiro / Red de formación en salud de la familia: la experiencia del nordeste brasileño / Family healt training network: The Brazilian northeast experience

Resumo: A Rede Nordeste de Formação em Saúde da Família (RENASF), fruto de movimento entre instituições de ensino superior e técnico, secretarias de saúde e de ciência e tecnologia situadas no nordeste brasileiro, apoiada pela Fundação Oswaldo Cruz/Ministério da Saúde, foi constituída em 2009. A RENASF tem como finalidades potencializar o ensino e fomentar a pesquisa no campo Saúde da Família visando melhorar o desenvolvimento dos trabalhadores da Saúde, reforçar as relações entre formação e gestão em saúde e criar instâncias colegiadas para o diálogo e pactuação interinstitucional.  Organiza-se sob a forma de um Colegiado Gestor, eleito pelos pares e um colegiado geral que se reúne semestralmente para fins de planejamento e avaliação de ações. O ingresso de Instituições à Rede ocorre por solicitação da interessada, a qualquer momento, mediante apreciação, análise e parecer do Colegiado. Sua primeira ação estruturante foi a oferta de Mestrado Profissional em Saúde da Família, em rede e descentralizado em seis polos formadores. Foram titulados 94 mestres e 130 estão em formação. Há colaboração interinstitucional para a gestão administrativa e pedagógica da rede e desenvolvimento de pesquisas interinstitucionais. Conclui-se que um processo de construção coletiva, democrática e participativa exige um esforço significativo de todos os participantes. Uma rede com tantas e diferentes instituições faz do trabalho em conjunto, mesmo com um objetivo em comum, um grande desafio. Palavras-chave: rede, formação em saúde, saúde da família, colaboração interinstitucional. Resumen: La Formación noreste Red en Salud (RENASF), fruto del movimiento entre las instituciones de educación superior y los departamentos técnicos de la salud y la ciencia y la tecnología se encuentra en el noreste de Brasil, apoyados por la Fundación Oswaldo Cruz / Ministerio de la Salud se creó en el 2009. La RENASF tiene como finalidad mejorar la enseñanza y promover la investigación en el campo de la Salud de la Familia; enfocándose en mejorar el desarrollo de los trabajadores de la salud, fortalecer los vínculos entre la educación y la gestión de la salud y la creación de órganos colegiados para el diálogo y pacto interinstitucional. Se organiza en forma de un Consejo de Administración, elegido por sus compañeros y una junta general que se reúne cada seis meses para los fines de la planificación y evaluación de las acciones. El ingreso de instituciones a la Red, se produce conforme a lo solicitado por el titular, en cualquier momento, mediante una apreciación, análisis y opinión de la Junta. Su primera acción estructurante fue la oferta de Maestría Profesional en Salud de la Familia, en red y descentralizado en seis polos formadores. Fueron titulados 94 maestres y 130 están en formación. Hay colaboración interinstitucional para la gestión administrativa y pedagógica de la red y el desarrollo de la investigación interinstitucional. Se concluye que un proceso de construcción colectiva, democrática y participativa requiere un esfuerzo significativo de todos los participantes. Una red con tantas y diferentes instituciones, hacen del trabajo en conjunto, aun con un mismo objetivo, un grande desafío. Palabras clave: red, formación en salud, salud de la familia, colaboración interinstitucional. Abstract: The Northeast Family Health Training Network (RENASF), backed up by the Oswaldo Cruz Foundation / Ministry of Health, was established in 2009 and is fruit of a movement gathering technical and higher education institutions, as well as health and science & technology public officers located in northeastern Brazil. The RENASF purposes is to enhance teaching and promote research in the Family Health field; to improve the development of health workers, strengthening the links between education and health management and creating collegiate bodies for dialogue and inter-institutional pactuation. It is organized in the form of a Management Board, elected by peers and a general board that meets every six months for the purpose of actions planning and evaluation. Admission of institutions into the Network occurs as requested by the interested institution, at any time, upon examination, analysis and opinion of the Board. RENASF first action was to offer a Professional Master Program in Family Health, which was estructurated within the networking and decentralized in six trainers poles. This program already graduated 94 master students and currently has 130 in training. There is interagency collaboration for the administrative and pedagogical management of the network and development of inter-institutional research. It was concluded that a process of collective, democratic and participatory construction requires significant effort from all participants. To have a network with so many different institutions to work together is a challenge, even when a common goal is established. Keywords: Network, health education, family health, inter-institutional collaboration

Brazilian adolescents’ oral health trends since 1986: an epidemiological observational study

Oral health is part of general health, and in adolescence, it represents a good individual health indicator. Three country-based oral health epidemiological studies have been developed in Brazil (1986, 2003 and 2010). The objective of this study was to analyze oral disease trends among Brazilian adolescents and to compare these trends to the World Health Organization's goals with a focus on public health policies implemented between 1986 and 2010. This is an epidemiological observational study performed with secondary data from Brazilian Oral Health surveys (1986, 2003 and 2010). The DMFT (number of decayed, missing and filled teeth) index was used for the 12-year-old and 15- to 19-year-old groups, and periodontal disease (CPI) and the percentage of individuals who needed and/or had prostheses were evaluated in the 15- to 19-year-old group. Between 1986 and 2010, DMFT decreased from 6.65 to 2.07 (68.9 % reduction) in the 12-year-old group and from 12.68 to 4.25 (66.5 % reduction) in the 15- to 19-year-old group. In all groups, the missing component had the strongest decrease. Adolescents had a reduction of 20.3 % in access to dental care. In 2003, in the 15- to 19-year-old group, 89.5 % of teenagers had at least one decayed tooth, while in 2010, the value was 76.1 %. In 2010, the percentage of adolescents without gingival problems varied among different regions of Brazil, with 30.8 % in the North and 56.8 % in the Southeast. Regarding DMFT, the difference between the North and Southeast Regions was 84 %. Improvement trends regarding adolescent oral health were observed, which seem to be supported by health education and promotion activities along with the reorganization of the Brazilian health system.855

Dependence in instrumental activities of daily living and its implications for older adults’ oral health

We aimed to assess the association between dependence in instrumental activities of daily living (IADL) and oral health in older adults. We conducted a cross-sectional study of 280 people aged �60 years served at public primary health care centers in Northeastern Brazil. Sociodemographic, oral discomfort and general health data were collected. The Lawton and Brody scale were used to assess IADL. This research adheres to the STROBE checklist. Most participants were married (n = 139; 49.6%), women (n = 182; 65.0%) and retired (n = 212; 75.7%). A total of 37 (13.2%) older adults had some degree of dependence in IADL. Dependence in IADL was associated with: retirement (p<0.040), poor general health (p = 0.002), speech problems (p = 0.014), use of medications (p = 0.021), difficulty chewing and swallowing food (p = 0.011), voice changes (p = 0.044), edentulism (p = 0.011), use of toothbrush (p<0.001), use of toothpaste (p<0.001), and visit to the dentist in the previous year (p = 0.020). Functional disability was associated with older age, cardiovascular diseases, speech problems, chewing and swallowing difficulties, use of medication and brushing deficiency. The functional dependence in IADL can be considered an indicator of oral health status in older adults.info:eu-repo/semantics/publishedVersio

Programa de Melhoria do Acesso e Qualidade da Atenção Básica:: estratégicas utilizadas em dois estados nordestinos

OBJETIVO:&nbsp;Analisar a utilização das dimensões estratégicas propostas pelo Programa de Melhoria do Acesso e da Qualidade da Atenção Básica nos estados do Piauí e Ceará.&nbsp;METODOLOGIA:&nbsp;Trata-se de um estudo transversal utilizando dados provenientes da Avaliação Externa e apresentados diante do cruzamento de variáveis explicativas: estado, porte populacional, estrato de certificação e percentual de cobertura pela Estratégia Saúde da Família.&nbsp;RESULTADOS:&nbsp;Foi possível identificar diferenças significativas nos resultados das dimensões entre equipes de municípios de porte populacional diferente e constatar que mesmo sendo estados com similaridades, Piauí e Ceará apresentaram diferentes resultados na utilização das estratégicas propostas (Autoavaliação, monitoramento, educação permanente e apoio institucional).&nbsp;CONCLUSÕES:&nbsp;As estratégias de melhoria do acesso e qualidade, apesar de seu papel indutor de mudanças, ainda não protagonizaram as ações diante do programa nos estados investigados

Factors associated with self-rated health in older adults receiving oral prosthetic rehabilitation

Objectives: To assess factors associated with self-perception of health in older adults submitted to oral prosthetic rehabilitation in order to contribute to a more contextualized planning of public policies, actions and health services aimed at healthy aging. Design: Analytical cross-sectional study. Setting: Dental specialty centers. Participants: 244 people aged 60 years and older enrolled for oral prosthetic rehabilitation. Intervention: Interviews, oral examination and anthropometric measurements. Measurements: A questionnaire assessed demographic and economic data, general health and oral health and self-perception of oral health-related quality of life was measured by the Geriatric Oral Health Assessment Index (GOHAI). Performance in instrumental activities of daily living was assessed by the Lawton and Brody scale, mood was assessed by the Geriatric Depression Scale and nutritional status was assessed by the Mini Nutritional Assessment. Results: The multivariate analysis showed that factors such as hospitalization in the previous year, diabetes and risk of malnutrition determined the negative self-perception of general health and current health status compared with 12 months ago. Needing assistance to perform AIDL significantly influenced self-perception of general health while income and vision problems interfered with older adults’ perception of their current health status compared with 12 months ago. Conclusion: Older adults who needed oral prosthetic rehabilitation exhibited a predominantly negative self-perception of oral health.info:eu-repo/semantics/publishedVersio

Prevalence and health promotion actions related to hyposalivation and mouth discomfort in a nursing homesfor elders

Objectiveto verify the prevalence of hyposalivation inan institutionalized elder population and its relationship with oral discomfort. A cross-sectional study was conducted with older people living in a Nursing Homein Fortaleza-Brazil. Data collection occurred through the application of sociodemographic questionnaire; sialometry examination, test for evaluating the salivary flow speed; and by a subjective quantification of dry mouth intensity (Visual Analog Scale). Results: sixty-five older people aged between 61 and 91 years (mean74.5±8.0) were evaluated, 30(46.2%) were women and 35(53.8%) men. The majority had low monthly income (55;84.6%) and low schooling (44;67.7%). The mean salivary flow was 0.4 ±0.2, withvery low flow (0.1-0.3 ml/min) being more prevalent; females presented lower salivary flow (p=0.033) than males; there was an association between salivary flow and dry mouth sensation (p<0.001) and halitosis (p<0.001). The correlation between sialometry and VAS showed that the lower the salivary flow, the greater the perception of dry mouth sensation. Health promotion actions and treatment (proper hydration; tooth brushing; saliva stimulants) can be performed in order to minimize dry mouth/ hyposalivation impact on elders’ quality of life. Conclusion: Low salivary flow was prevalent in the study subjects. It interferes in oral discomfort and causes dry mouth sensation.info:eu-repo/semantics/publishedVersio

Infraestrutura e processo de trabalho na atenção primária à saúde: PMAQ no Ceará

OBJETIVO: Analisar a qualidade da infraestrutura e do processo de trabalho da Estratégia Saúde da Família nos municípios do Ceará entre 2012 e 2014. MÉTODOS: Estudo transversal, utilizando dados secundários da avaliação externa do 1º (2012) e 2º (2014) ciclo do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica no Ceará. Vinte indicadores compostos foram utilizados para averiguar a qualidade da infraestrutura e do processo de trabalho. RESULTADOS: Dados de 183 (99,4%) dos 184 municípios foram avaliados nos dois ciclos. Avaliaram-se 1.441 equipes para infraestrutura e 800 equipes para processo de trabalho. Dentre os 20 indicadores compostos avaliados, houve melhoria em 18, porém de forma não homogênea, variando de 0,0 a 413,5%. Observou-se que quanto menor o valor inicial do indicador, maior a variação na qualidade entre 2012 e 2014. Os indicadores da infraestrutura e do processo de trabalho foram influenciados pela região de saúde e porte populacional do município, sendo mais evidente a influência nas variáveis de processo de trabalho. CONCLUSÕES: Identificou-se que melhorias da qualidade referentes à infraestrutura e ao processo de trabalho ocorreram no período de implantação do programa no estado do Ceará de forma equitativa, sendo influenciadas pelo porte populacional e pela região, demonstrando a influência do contexto na implementação de políticas públicas dessa natureza.OBJECTIVE: To analyze the quality of the infrastructure and work process of the Family Health Strategy in the municipalities of Ceará between 2012 and 2014. METHODS: Cross-sectional study, using secondary data from the external evaluation of the 1st (2012) and 2nd (2014) cycle of the National Program for Improvement of Access and Quality of Primary Care in Ceará. A total of 20 composite indicators were used to verify the quality of infrastructure and work process. RESULTS: Data from 183 (99.4%) of the 184 municipalities of Ceará were collected in both cycles. A total of 1,441 teams were evaluated for the infrastructure and 800 for the work process. Among the 20 composite indicators evaluated, 18 presented an improvement, but in a non-homogeneous way, ranging between 0.0 and 413.5%. We observed that the lower the initial value of the indicator, the greater the variation in quality between 2012 and 2014. The indicators of infrastructure and work process were influenced by the regional health system and population size of the municipality, being more evident the influence on the variables of the work process. CONCLUSIONS: We identified that quality improvements related to infrastructure and work process occurred in the period of implementation of the program in the state of Ceará in an equitable manner, being influenced by population size and regional health system, showing the influence of the context in the implementation of public policies of this nature