Marcos Azeredo Furquim Werneck

Nem tudo é estágio: contribuições para o debate

This paper discusses supervised training as a fundamental opportunity for the consolidation of the teaching space and also as means of facing the challenges posed by the guidelines for dental courses. It is not a new proposal. It is in fact a fight for changes in dental practicing which began in the 70s with the movement for the integration between dental teaching and dental services. It approaches public health services spaces and the world of work as central for a new teaching strategy. That would generate the opportunity to graduate professionals with a more critical profile, also capable of understanding reality and intervening on it. The paper points the risks of understanding and misunderstanding - supervised training with practicing inside the dental school, under the label of curricular supervised training. In that perspective traditional practices, with emphasis on technical and biological aspects would not have the potential to achieve the changes proposed by the curricular guidelines. While highlighting the relevance of curricular supervised training in professional education, the paper sets a dialogue with ABENO, contesting some of its positions. In that sense, the paper shows the need for a deeper and more participative discussion, that joins as many dental schools as possible.

Gerenciamento de resíduos sólidos de odontologia em postos de saúde da rede municipal de Belo Horizonte, Brasil

OBJETIVO: Verificar a conformidade do processo de gerenciamento dos residuos solidos odontologicos pelas unidades basicas de saude da rede municipal de Belo Horizonte frente a legislacao vigente. METODO: Foram avaliadas 54 unidades basicas de saude das 105 unidades da rede municipal que prestavam atendimento odontologico. Em cada unidade, foram entrevistados o gerente, um atendente de consultorio dentario e um auxiliar de servicos gerais. Com base nos requisitos estabelecidos pelo Manual de Gerenciamento de Residuos de Servicos de Saude de Belo Horizonte, foram avaliados os seguinte aspectos: tecnicos e operacionais (classificacao e caracterizacao dos residuos, processos de minimizacao, segregacao, tratamento previo, acondicionamento, coleta e transporte internos e externos e abrigo externo); gerais e organizacionais (fiscalizacao, area construida, licenciamento ambiental, planta baixa com discriminacao das areas geradoras de residuos e presenca de responsavel tecnico); recursos humanos (registro e controle de vacinacao dos trabalhadores, programa de seguranca e medicina do trabalho, programa de prevencao de riscos ambientais, programa de controle medico e saude ocupacional, comissao de controle de infeccao hospitalar e treinamento em manejo de residuos de servicos de saude). RESULTADOS: Cada unidade basica de saude gerava uma media de 270 litros de residuos por dia. Nenhuma possuia um plano de gerenciamento de residuos de servicos de saude. Os unicos itens em conformidade com a legislacao em todas as unidades foram: as agulhas e o mercurio eram segregados; eram utilizados recipientes de papelao resistente com simbologia adequada para acondicionamento dos residuos perfurocortantes; e a coleta e transporte internos de residuos eram feitos diariamente. CONCLUSAO: Enquanto nao forem estabelecidos os riscos reais de cada classe de residuos, todas deveriam ser consideradas como potencialmente perigosas. Por outro lado, uma lei em vigor por si so nao garante que a saude da populacao esta protegida. Antes de impor exigencias legais, e preciso verificar ate que ponto os orgaos publicos estao preparados para cumpri-las. A realizacao de pesquisas sobre gerenciamento de residuos e importante para fundamentar a legislacao.

Relationship between Primary and Secondary Dental Care in Public Health Services in Brazil

This cross-sectional study evaluated the relationship between primary and secondary oral health care in Brazil. For this purpose, data from the National Program for Improving Access and Quality of Primary Care were used. Dentists from 12,403 oral health teams (OHTs) answered a structured questionnaire in 2012. The data were analyzed descriptively and by cluster analysis. Of the 12,387 (99.9%) OHTs that answered all the questions, 62.2% reported the existence of Dental Specialties Centers (DSCs) to which they could refer patients. The specialties with the highest frequencies were endodontics (68.4%), minor oral surgery (65.8%), periodontics (63.0%), radiology (46.8%), oral medicine (40.2%), orthodontics (20.5%) and implantology (6.2%). In all percentiles, the shortest wait time for secondary care was for radiology, followed by oral medicine and the other specialties. In the 50th percentile, the wait for endodontics, periodontics, minor oral surgery and orthodontics was 30 days, while for implantology, the wait was 60 days. Finally, in the 75th percentile, the wait for endodontics, orthodontics and implantology was 90 days or more. Two clusters, with different frequencies of OHT access to specialties, were identified. Cluster 1 (n = 7,913) included the OHTs with lower frequencies in all specialties except orthodontics and implantology compared with Cluster 2 (n = 4,474). Of the Brazilian regions, the South and Southeast regions had the highest frequencies for Cluster 2, with better rates for the relationship between primary and secondary care. This study suggests certain difficulties in the relationship between primary and secondary care in specific specialties in oral health, with a great number of OHTs with limited access to DSCs, in addition to different performance in terms of OHT access to DSCs across Brazilian regions.

Exploring professionalization among Brazilian oral health technicians

Professional dental auxiliaries emerged in the early 20th century in the United States of America and quickly spread to Europe and other regions of the world. In Brazil, however, oral health technicians (OHTs), who occupy a similar role as dental hygienists, had a long journey before the occupation achieved legal recognition: Brazilian Law 11.889, which regulates this occupation in the country, was only enacted in 2008. The aim of this paper is to review the literature on the professionalization of OHTs, highlighting the triggering, limiting and conflicting aspects that exerted an influence on the historical progress of these professionals in Brazil. We have tested Abbott’s and Larson’s theory on professionalization, against the history of OHTs. A number of different dental corporative interests exerted an influence over professionalization, especially in discussions regarding the permissible activities of these professionals in the oral cavity of patients. With primary health care advances in Brazil, the importance of these professionals has once again come to the forefront. This seems to be a key point in the consolidation of OHTs in the area of human resources for health in Brazil.

Describing the primary care actions of oral health teams in Brazil.

Objective: To describe the primary care actions performed by oral health teams (OHTs) that participated in a large national survey led by the Ministry of Health in 2012. Methods: A total of 12,403 dentists from OHTs completed a set of survey questions (response rate = 85.01%) on the organization of care, basic dental procedures and oral health surveillance actions of OHTs. Descriptive and hierarchical cluster analyses were developed. Results: The majority of OHTs (85.2%) reported that they performed “patient welcoming”. The delivery of services was based on a patient’s identified disease risk (83.1%), and continuity of care was ensured by 85.9% of OHTs. Individual preventive, restorative and surgical procedures were performed by the majority of the teams; however, screening for oral cancer and construction of dental prostheses/dentures occurred less frequently. Cluster 1 was composed of OHTs with the lowest proportion of oral healthcare actions related to oral cancer and dental prostheses/dentures, and the Southeastern and Southern regions had higher proportions of OHTs from cluster 2. Conclusions: OHTs adhere to some of the principles of primary care organizations; however, the teams perform fewer actions related to oral cancer treatment and rehabilitation with complete dentures. The geographical distribution of the clusters was unequal in Brazil.

Atribuições dos Técnicos em Saúde Bucal na Estratégia Saúde da Família em Minas Gerais, Brasil

The scope of this article is to analyze the self-reporting of duties performed by the Oral Health Technicians in the State of Minas Gerais. A cross-sectional descriptive study was conducted through telephone interviews, with a representative sample of 231 workers. The descriptive analysis involved the calculation of proportions. It was found that 71.6% (95% CI, 64.4 to 77.5) performed coronal polishing, 63.2% (95% CI, 56.1 to 69.7) carried out scaling of dental calculus and 14.7% (95% CI, 10.3 to 15.4) inserted restorative materials. Regarding preventive/collective actions, 100% (95% CI, 97.6 to 100.0) participated in educational activities, 99% (95% CI, 96.1 to 99.8) demonstrated oral hygiene techniques, 96.6% (95% CI, 92.7 to 98.4) administrated topical fluoride, 77.9% (95% CI, 71.5 to 83.3) made home visits, and 96.6 % (95% CI, 92.7 to 98.4) performed collective actions, especially in schools. Oral Health Technicians have spent their more time on preventive/collective activities than on individual clinical care.

Análise da atenção secundária em saúde bucal no estado de Minas Gerais, Brasil

The scope of this study was to describe and analyze specialized outpatient procedures in periodontics, endodontics and oral surgery performed in the State of Minas Gerais in 2010. Secondary data for the procedures performed in healthcare facilities and registered in the Information System of the Unified Health System were used. Descriptive and bivariate analysis was performed, considering p <0.05. 707,559 procedures were performed in 2,547 health units distributed in 693 (81%) counties in the State. Of these procedures, 55% are in the area of surgery, 28% in periodontics and 17% in endodontics. The units are predominantly public under municipal administration, 52.5% of which have an oral health team (OHT) and 96.9% have no qualification as Dental Specialty Centers (DSCs). DSCs are more efficient than the other units (p <0.001), but there is a significant percentage that fails to comply with the goals of the Ministry of Health. Municipalities that have DSCs have higher population, more OHTs, lower potential coverage and better HDI. A significant number of specialized procedures are performed in the State of Minas Gerais, especially in primary care settings. DSC establishments are more efficient than non-DSC, considering the average number of procedures. The minimum production goals are met by a minority of DSCs.

PMAQ - CEO External Evaluation: Revealing Indicators for Planning Services

Objective: To analyze the indicators of planning and management actions for the work process organization in Centers of Dental Specialties (CEO) presented in the external evaluation tool to the Improving Access and Quality of CEO - AIQP-CEO Program and to provide a follow-up and monitoring tool of goals. Material and Methods: Cross-sectional study with the use of secondary data from the external evaluation of 930 CEOs in Brazil. A descriptive analyses of indicators identified in the “Planning and managing actions for work process organization in CEO” sub-dimension was performed. It provides two monitoring tools: monthly production for each specialty, and monthly minimal and mandatory performance of CEO goals. Results: It was shown that 85.4% of CEO teams have made the monitoring of the goals established to each offered specialty, and 73.1% have performed self-assessment in the last six months, in which most of the teams (647 - 69.6%) have used the Self-Assessment to the Improving Access and Quality Program - SAIQP. It was demonstrated that of the 680 teams that performed self-assessment, 612 (65.8%) consider the results in the teamwork organization. Conclusion: The PMAQ CEO external evaluation brought important information to the qualification process of health services. Concerning the planning, the majority of teams performed the follow-up of goals and self-assessment, and they used the self-assessment results in the teamwork organization. According to results, some tools should be used to support CEO teams in the follow-up of the monthly production by specialty and in the monitoring of goals.

Adaptação da versão saúde bucal do instrumento de diagnóstico do estágio de desenvolvimento da rede de atenção à saúde

A implantacao de redes de atencao a saude bucal e um processo recente e necessita de ser avaliado. Este estudo objetivou descrever as etapas de adaptacao da versao saude bucal de um instrumento para avaliar o estagio de desenvolvimento da rede de atencao a saude no Sistema Unico de Saude do Brasil. O instrumento original, denominado Instrumento de Diagnostico do Estagio de Desenvolvimento da Rede de Atencao a Saude, foi desenvolvido por Mendes (2011). Foi realizada a avaliacao formal dos significados geral e referencial do instrumento original, chegando-se a versao adaptada. Para isso, o instrumento foi analisado por um comite de especialistas da area em questao. A compreensao da versao adaptada foi avaliada em um pre-teste aplicado para 20 coordenadores municipais de saude bucal de Minas Gerais. Constatou-se uma boa equivalencia conceitual, funcional, de itens, semântica e operacional entre os instrumentos. A versao saude bucal foi bem compreendida, apresentando-se adequada para ser testada quanto as suas propriedades psicometricas. Essa etapa se encontra em fase de conclusao.The implementation of oral healthcare networks is a recent process that requires evaluation. The current study aimed to describe the stages in the adaptation of the oral healthcare version of an instrument to evaluate the stage of development in the healthcare network under the Unified National Health System (SUS). The original instrument, called Instrument for the Diagnosis of Developmental Stages in the Healthcare Network, was developed by Mendes (2011). A formal evaluation was made of the general and referential meanings from the original instrument, producing the adapted version. The instrument was analyzed by a committee of oral health experts. Comprehension of the adapted version was evaluated using a pretest applied to 20 municipal oral health coordinators in Minas Gerais State. The results showed good conceptual, functional, item, semantic, and operational equivalence between the instruments. The oral health version was well understood and proved adequate for testing its psychometric properties. The latter stage is under completion.

Análisis de medidas de adaptación de una herramienta de diagnóstico de salud bucal para evaluar una etapa de desarrollo en la atención de la salud

A implantacao de redes de atencao a saude bucal e um processo recente e necessita de ser avaliado. Este estudo objetivou descrever as etapas de adaptacao da versao saude bucal de um instrumento para avaliar o estagio de desenvolvimento da rede de atencao a saude no Sistema Unico de Saude do Brasil. O instrumento original, denominado Instrumento de Diagnostico do Estagio de Desenvolvimento da Rede de Atencao a Saude, foi desenvolvido por Mendes (2011). Foi realizada a avaliacao formal dos significados geral e referencial do instrumento original, chegando-se a versao adaptada. Para isso, o instrumento foi analisado por um comite de especialistas da area em questao. A compreensao da versao adaptada foi avaliada em um pre-teste aplicado para 20 coordenadores municipais de saude bucal de Minas Gerais. Constatou-se uma boa equivalencia conceitual, funcional, de itens, semântica e operacional entre os instrumentos. A versao saude bucal foi bem compreendida, apresentando-se adequada para ser testada quanto as suas propriedades psicometricas. Essa etapa se encontra em fase de conclusao.The implementation of oral healthcare networks is a recent process that requires evaluation. The current study aimed to describe the stages in the adaptation of the oral healthcare version of an instrument to evaluate the stage of development in the healthcare network under the Unified National Health System (SUS). The original instrument, called Instrument for the Diagnosis of Developmental Stages in the Healthcare Network, was developed by Mendes (2011). A formal evaluation was made of the general and referential meanings from the original instrument, producing the adapted version. The instrument was analyzed by a committee of oral health experts. Comprehension of the adapted version was evaluated using a pretest applied to 20 municipal oral health coordinators in Minas Gerais State. The results showed good conceptual, functional, item, semantic, and operational equivalence between the instruments. The oral health version was well understood and proved adequate for testing its psychometric properties. The latter stage is under completion.