Georgia Costa de Araújo Souza

O SUS nos seus 20 anos: reflexões num contexto de mudanças

A partir de uma breve retrospectiva sobre o direito a saude conquistado pelo cidadao brasileiro, este artigo tem como objetivo discorrer sobre o Sistema Unico de Saude (SUS) ao longo da sua trajetoria de 20 anos, destacando em forma de analise critica os avancos conquistados na saude e os desafios a serem superados. Sao discutidas as tematicas do direito a saude como responsabilidade do Estado a partir da Conferencia de Alma-Ata, da Constituicao Federal e das Leis Orgânicas da Saude; as diretrizes do SUS envolvendo as competencias da Uniao, do Estado e do Municipio. Discute ainda a importância da Estrategia Saude da Familia na consolidacao da Atencao Basica no Brasil, as dificuldades do processo de regionalizacao e o papel da gestao e da participacao social como bases para a construcao do SUS que queremos.

Social determinants of dental treatment needs in Brazilian adults

BackgroundThe chronic cumulative nature of caries makes treatment needs a severe problem in adults. Despite the fact that oral diseases occur in social contexts, there are few studies using multilevel analyses focusing on treatment needs. Thus, considering the importance of context in explaining oral health related inequalities, this study aims to evaluate the social determinants of dental treatment needs in 35–44 year old Brazilian adults, assessing whether inequalities in needs are expressed at individual and contextual levels.MethodsThe dependent variables were based on the prevalence of normative dental treatment needs in adults: (a) restorative treatment; (b) tooth extraction and (c) prosthetic treatment. The independent variables at first level were household income, formal education level, sex and race. At second level, income, sanitation, infrastructure and house conditions. The city-level variables were the Human Development Index (HDI) and indicators related to health services. Exploratory analysis was performed evaluating the effect of each level through calculating Prevalence Ratios (PR). In addition, a three-level multilevel modelling was constructed for all outcomes to verify the effect of individual characteristics and also the influence of context.ResultsIn relation to the need for restorative treatment, the main factors implicated were related to individual socioeconomic position, however the city-level contextual effect should also be considered. Regarding need for tooth extraction, the contextual effect does not seem to be important and, in relation to the needs for prosthetic treatment, the final model showed effect of individual-level and city-level. Variables related to health services did not show significant effects.ConclusionsDental treatment needs related to primary care (restoration and tooth extraction) and secondary care (prosthesis) were strongly associated with individual socioeconomic position, mainly income and education, in Brazilian adults. In addition to this individual effect, a city-level contextual effect, represented by HDI, was also observed for need for restorations and prosthesis, but not for tooth extractions. These findings have important implications for the health policy especially for financing and planning, since the distribution of oral health resources must consider the inequalities in availability and affordability of dental care for all.

Teaching-learning process in times of the Unified Health System (SUS): training of faculty and dental surgeons in Brazil

With the aim of contributing to the current curricular transformation of Brazilian Dentistry courses, this study describes the training of dental surgeons considering the needs of the public Unified Health System (SUS – Sistema Unico de Saude). We focus on the health care model currently in force and emphasize the idea that so as to attain the principles of this model, a shift in the training of instructors who lecture in Dentistry should occur. Some aspects of the training of such instructors, together with the implementation of the National Curricular Guidelines in Dentistry courses, are discussed, and the professional profiles of graduates from Brazilian dental schools are analyzed. We conclude our work by considering some elements that should be observed in order to improve the training process so that it will lead to the training of dental surgeons able to act within a new perspective, that of health promotion