Introduction: The elderly population faces a triple burden of disease, predominantly chronic non-communicable diseases that require continuous treatment. Polypharmacy, characterized by the simultaneous use of five or more drugs, is increasingly common in this age group. Objective: To estimate the occurrence of falls and their association with polypharmacy use in the elderly. Method: This is divided into two studies: 1) an integrative literature review and 2) a cross-sectional study with multiple analyses of the factors associated with the occurrence of falls in the elderly, carried out from September to November 2023, in a municipality in the northeast of Brazil. Results: Article 1 - Brazil contributed with three publications and China, Thailand, Spain, and Italy, each with one publication respectively, in which 468,880 people using polypharmacy participated. Polypharmacy was more frequent in elderly people being treated for chronic diseases, especially systemic arterial hypertension (SAH) and diabetes mellitus, which were described in 71.4% of the studies. The frequency of polymedication in elderly people being monitored in primary health care ranged from 18.8% to 100.0%. The most commonly used drugs were for the cardiovascular and metabolic systems. Article 2 - The study involved 100 elderly people aged between 60 and 93, 68% female. The prevalence of falls was 42% and the factors associated with falls were polypharmacy, poor handgrip strength, and age 75. 61% of participants had one or more chronic diseases. Conclusion: Elderly people in polypharmacy require greater attention and care to prevent adverse events such as falls. The research data revealed that the prevalence of falls in the elderly was positively associated with polypharmacy, poor handgrip strength, and being 75 years old.

The puerperal period, understood as the period immediately after childbirth and of varying duration, is considered a critical time of transition, as changes occur in the woman's social role and identity, which will influence her routine and interpersonal relationships. During this phase, these mothers often experience psychological distress and need a social support network. The aim of this study was to understand the social support network in the puerperium through a virtual group. This is a case study with a qualitative approach. Data was collected between November and December 2023, using a semi-structured interview script. Ten (10) women were interviewed at home or online, depending on the availability and preference of the participants.  The study followed Resolution 466/12 of the National Health Council and was approved by the Research Ethics Committee of the Onofre Lopes University Hospital of the Federal University of Rio Grande do Norte (UFRN). Data analysis used Bardin's content analysis, which resulted in 3 thematic categories: Puerperium: from romanticization to reality; Virtual mothers' group: experiences of mothers in the covid-19 pandemic; Virtual support network: welcome amid adversity. The participants were women aged between 28 and 41, married or in a stable union, the majority identified themselves as brown or black (seven) and three as white. They all had some kind of support network, including husbands/partners, nannies, mothers, family members or friends. For mothers, the postpartum period is generally idealized, but the experience of being a mother presents many difficulties, with feelings such as fear, anguish, anxiety and psychological stress, as well as fatigue, insomnia and social isolation, weakening the women, who need to reorient their life context in this new phase. After coping with the initial months of the puerperium, and having suffered direct and indirect repercussions on their health, the women sought various protective strategies, including participation in a virtual support group, learning to deal with their fears, giving new meaning to the situations they had experienced and regaining their self-esteem and being a woman, a professional, a friend and not just a mother.  In the midst of current changes, the use of information technology has made its contribution, as the virtual support network has been a refuge for talking, exchanging experiences, feeling welcomed and minimizing the wear and tear of this transitional phase experienced by so many women.

In the state of Rio Grande do Norte, the State Secretariat of Public Health of Rio Grande do Norte, in 2012, joined the Primary Care planning process in partnership with the Ministry of Health and the National Council of Health Secretaries in perspective of promoting moments of discussion and change in the operating modes of teams and services, in search of the correct operationalization of interconnected Care Networks, capable of meeting, with quality, the demand of each municipality in the State. The implantation of the project, with a priority network, has been developed in the 4th Health Region of the State since 2019, that of care for diseases and chronic conditions. Therefore, this work aims to analyze the structural and cyclical aspects pointed out by the actors participating in the activities of the pilot project to implement the care network for diseases and conditions chronicles in the 4th Health Region of Rio Grande do Norte. This is an exploratory, descriptive study, with a qualitative approach, which applied an electronic characterization questionnaire and a semi-structured interview, with open questions, via Google Meet. The data was analyzed according to the content analysis technique in the thematic modality, proposed by Laurence Bardin. From the results found, it was possible to understand the tutor's role in the Basic Laboratory Units, skills developed and the main difficulties seen in project implementation, including the work process, organizational factors related to local management, staff and population. The participants' speeches highlighted their satisfaction in working on the project, while revealing an overload of work to juggle the practice of tutoring and the demands related to services inherent to professional training. The results obtained in this study point to the need to strengthen the number of personnel, encourage professionals to remain on the team, avoiding turnover, raise awareness among the population on how to do health care and create spaces for dialogue between tutors and municipal management with a focus on effective communication. Such improvements are intended to strengthen the performance of the Health Regional at all levels of health care, improve professional care, as well as contribute to the use of information from the study to support SESAP/RN in decision-making

Thesis objective: To analyze the health-disease process of adults and elderly people from the perspective of nutrition based on the NOVA food classification methodology. This work is being developed in three articles. Article 1: This is a cross-sectional quantitative study that aims to: describe food consumption according to the NOVA classification of the Brazuca Natal Study population and investigate the association between food consumption and anthropometric nutritional status (ANS) in adults and elderly residents of Natal. The study population consists of a sample of 398 individuals with complete data on food consumption and ANS. Data collection took place in 2019-2020 through an interview based on the national health survey, using the Epicollect5 software (for socioeconomic and ANS variables) and Globodiet (for food consumption). We analyzed food consumption according to the NOVA classification into: unprocessed or minimally processed foods (UMP), culinary ingredients, processed foods (PF), and ultra-processed foods (UPF), as well as 34 subgroups. The energy consumption was 1936 kcal (95% CI: 1877.0-1994.0), mostly from UMP (55.70%) and UPF (19.20%). In the multivariate analysis, we found an association between body mass index and the subgroups: fruits, vegetables, vegetable oils, cheeses, and sweets. In the analysis with relative fat mass, we observed an association with UMP (OR: 1.76; 95% CI: 1.04-2.98), PF (OR: 0.51; 95% CI: 0.30-0.86), and UPF (OR: 0.38; 95% CI: 0.23-0.65). When the outcome was waist circumference, there was an association with UMP (OR: 1.90; 95% CI: 1.06-3.41) and UPF (OR: 0.47; 95% CI: 0.26-0.86). Our data reveal the predominance of UMP in the diet of the Brazuca Natal population. However, there is a significant proportion of UPF and PF. We also found that lower consumption of UMP and higher consumption of PF and UPF tend to be risk factors for overweight, metabolic complications, and mortality. Articles 2 and 3: These are being conducted in light of the 2020 guidelines of the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) which aim to investigate whether there is an association between the type of food processing according to NOVA and cognitive decline and dementia in adults and the elderly. The second article is a systematic review protocol that presents an initial literature review partially answering the guiding question. It was possible to perceive that the type of food processing impacts the risk and development of cognitive decline and all-cause dementias. In the third article, the systematic review included 4 studies. Three studies evaluated cognitive decline/performance as the primary outcome and one evaluated dementias. Only one study did not observe an association between UPF consumption and brain health. One study analyzed the association between UMP and all-cause dementia. We concluded that food processing impacts brain health in both adults and the elderly. Furthermore, we emphasize that other chronic conditions, such as diabetes mellitus and overweight, as well as socioeconomic variables, such as age and gender, can directly interfere in the food processing-brain health association.

Introduction: Introduction: The Oral Health Country/Area Profile Project (CAPP) represents the largest global repository of oral health data, compiling information collected from 205 countries, including all 193 members of the World Health Organization (WHO). This database serves as an indispensable source of information, providing a comprehensive view of the global oral health landscape. However, it is important to discuss whether the evidence provided truly reflects the oral health situation in these countries. Additionally, it is necessary to understand the oral health scenarios that result from robust analyses and to relate them to important determinants in their context, such as the predominant welfare regime in each country.

Objective: The purpose of this study is initially to conduct an analysis of the quality of evidence underlying the global oral health profile provided by CAPP, a crucial step for the selection of studies. Subsequently, it aims to discuss the global oral health landscape in alignment with reality and in relation to predictive variables. Method: For the initial assessment of the data, the "Appraisal Tool for Cross-Sectional Studies” (AXIS) was used, adapted to extract only the methods section. The results were subjected to Item Response Theory (IRT) to establish the weighting of each item, resulting in a score, which was then related to variables of interest such as age range, year of data collection, and region of the country. All retrieved articles were evaluated for evidence quality and subsequently included in the final sample for analysis of the DMF index. Results: A clear polarization in the quality of oral health data was evident. Variables such as age range, year of data collection, and WHO region demonstrated relevance in interpreting the results. Notably, the Americas and Western Pacific regions showed the highest quality scores. In relation to the AXIS tool, dimensions assessing study design adequacy, sample representativeness relative to the target population, and the project's ability to provide a representative selection proved to be more discriminative. Of the 1,222 documents retrieved, 72 were retained for analysis of the global oral health scenario, based on previously measured evidence quality. Analysis of the DMF index for children aged 10 to 14 years revealed higher averages in North America and Europe and lower averages in Sub-Saharan Africa and the Middle East/North Africa. Social-democratic countries exhibited better oral health outcomes, with a strong correlation between Human Development Index (HDI) and oral health expenditures. The analysis confirmed significant disparities between regions and economic systems in their impact on oral health. Conclusion: The study assessed the methodological robustness and reliability of research in the CAPP global oral health database, highlighting variations in data quality and specific regional challenges. The analysis of the DMF index also revealed distinct regional patterns, suggesting the influence of political and socioeconomic factors. Political models are crucial for understanding these discrepancies.

O objetivo deste estudo é analisar a adesão às dietas saudáveis e sustentáveis e os ambientes alimentares de adultos e idosos do município de Natal/RN. Trata-se de um estudo quantitativo, observacional, transversal, analítico. Os dados individuais foram obtidos do estudo de base populacional “Brazilian Usual Consumption Assessment” (Brazuca-Natal) de 2019-2020. Analisaram-se os dados considerando os pesos amostrais decorrentes de amostras complexas. Para cada estudo, foram desenvolvidas técnicas de análise múltipla que contemplaram seus objetivos. Os resultados foram discutidos em dois artigos científicos em fase de revisão para publicação em periódicos e dois artigos em fase de finalização. O artigo inicial é uma revisão sistemática que avalia os índices que mensuram a adesão às dietas sustentáveis baseados nas definições da comissão EAT-Lancet. Por meio dele identificamos a utilização de diferentes métricas, dificultando a comparação entre os índices e a tendência a negligenciar aspectos sociais.  Para os demais artigos, foram avaliados 411 adultos e idosos, por meio de entrevistas domiciliares contendo questões sociodemográficas, de estilo de vida, dados clínicos, antropométricos e dietéticos que tiveram o recordatório alimentar de 24h (R24h) orientado pelo software Globodiet®. A adesão às dietas sustentáveis foi mensurada pelo Planet Health Diet Index (PHDI), a insegurança alimentar, pela Escala Brasileira de Insegurança Alimentar (EBIA) e a saúde cardiovascular pelo Ideal Cardiovascular Health (ICH). Todos os estabelecimentos que comercializavam alimentos no município de Natal/RN foram identificados e, em seguida, foram classificados os ambientes alimentares em desertos e pântanos alimentares. O escore total médio de adesão ao PHDI foi de 29,4 de 150 pontos. Para os escores dos componentes, as maiores pontuações foram para frutas, leguminosas e vegetais e as menores para gordura animal e carne vermelha. A adesão à dieta sustentável está diretamente relacionada a ser do sexo masculino e não consumir álcool e inversamente relacionada a ter 1 a 9 anos de estudos e estar em insegurança alimentar. Os resultados mostraram baixa adesão a um padrão alimentar saudável e sustentável, distante das recomendações do EAT-Lancet. Os resultados entre a associação das dietas sustentáveis e o risco cardiometabólico ainda estão sendo realizados, assim como os da relação dos ambientes alimentares e a adesão a este tipo de dieta. 

Immersive technologies have been increasingly integrated into the educational context as they enable more interactive and revolutionary learning experiences. They are particularly important for promoting increased collaboration among users of virtual environments and enhancing creativity and motivation in their activities, especially when the target audience is teenagers. In this context, such technologies offer an opportunity to develop research that proposes effective, longitudinal, and self-sustainable strategies for health education initiatives. Therefore, the present study focuses on the development of a digital tool using gamification and Virtual Reality techniques aimed at teenagers, which can be applied in the school environment to prevent the adoption of risky behaviors by encouraging healthy food consumption, sleep habits, and regular physical activity. This research involves both development and application in the form of technological production. The study is organized into two sections: 1) Section I: Development of systematic reviews: a. Scientific evidence regarding the use of Extended Reality associated with food consumption, sleep quality, and physical activity in adolescents; b. Scientific evidence regarding the use of gamification strategies associated with food consumption, sleep quality, and physical activity in adolescents; b. 2) Scientific evidence regarding the use of Minecraft Education associated with food consumption, sleep quality, and physical activity in adolescents. Section II: Development of the digital tool using Virtual Reality technologies and gamification strategies based on the results of the systematic reviews presented in this thesis. For the systematic reviews, review protocols were registered in the International Prospective Register of Systematic Reviews (PROSPERO) database (CRD42022373833, CRD42022373876, and CRD42023467642) based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) guidelines. As a result, three protocol articles and two systematic reviews were developed. The tool was built in partnership with Universidad Católica San Antonio de Murcia in Murcia, Spain, with versions produced for both Brazil and Spain. This was based on the stages of constructing decision trees with experts from each country on the research topic. The objective of this instrument is to provide adolescents with the opportunity to make healthy choices in various environments. The tool development process is detailed in the sixth article included in this thesis, and currently, the testing process for the two versions is underway in their respective countries.

Objective: The study seeks to develop and validate an instrument for evaluating the quality of the Reception service with Risk Classification in obstetrics with evaluation dimensions for users, health professionals, and managers. Methods: This is a methodological study with a quantitative diagnostic approach that is divided into two stages: in the first, a study was developed in which an instrument was created and divided into 3 modules: with a dimension for the user (module 1), for health workers (module 2) and for the manager (module 3). This product was validated in terms of content by a committee of judges (experts) specialized in the area. The tool was created based on the theoretical framework proposed by Donabedian and the objectives proposed by the World Health Organization and the Ministry of Health through the Prenatal and Birth Humanization Program. The analysis of this stage was carried out using the committee's agreement index (CI), Content Validity Index (CVI), and Kappa index to evaluate and reach the ideal parameters of agreement and content validity between the judges. Results: The instrument was validated for content in stage 1 of the study, after evaluation by the Committee of Experts, considering values for CVI, CI, and Kappa equal to or greater than 0.8 for each item evaluated. Conclusion: It is expected that this study will be able to evaluate the quality of Reception services with Risk Classification from the perspective of managers, health professionals, and users of maternal and child services.

Multiprofessional Residency Programs in Mental Health (PRMSM) are strategic in training for psychosocial care in the Unified Health System. The training in Mental Health in Primary Care by the Multiprofessional Residency Programs in Mental Health in Brazil was analyzed. The study was carried out in four stages: theoretical study of the dismantling of the National Policy on Mental Health, Alcohol and other Drugs (2016 to 2022) and its interfaces with training by the PRMSM in Brazil; documentary study of seventeen Pedagogical Projects of the PRMSM in Brazil; exploratory study through interviews with seventeen PRMSM coordinators; evaluability study with 20 experts to validate the Criteria Matrix through the Delphi Consensus. The results of this thesis are divided into four articles. The results produce an analysis of mental health training in the context of the Brazilian psychiatric counter-reform, between 2016 and 2022, a period of serious setbacks in the National Mental Health Policy for Alcohol and Other Drugs. In relation to the theoretical support of the PRMSM, it indicates a greater occurrence of psychopathology, problematizing the risk of reproducing the medicalizing psychiatric paradigm and the need to strengthen Mental Health in Primary Care. It addresses the teaching-learning scenarios of PRMSM, tools and technologies in Mental Health in Primary Care and the formation of new subjectivities for practices in Mental Health in Primary Care by residences. And, the validation of the Criteria Matrix through the Delphi Consensus.The validation process took place in three rounds, validating 44 criteria divided into 3 dimensions and 6 subdimensions. The advances, trends and challenges of training for Mental Health in Primary Care by PRMSM are discussed. Advances consist of dialogue with the National Policy on Mental Health, Alcohol and Other Drugs in defense of the human rights of people with mental health problems and/or who make harmful use of alcohol and other drugs, in addition to innovation in educational processes based on learning through experience. Trends are directed towards the decolonial debate on madness and training for practices in Mental Health in Primary Care. Challenges are part of the disputes over models of mental health care and the capitalist-colonial subjectivity that impact the implementation of interprofessionality. Residencies raise new subjectivities for work in the territory in search of the implementation of the sociocultural dimension of the Brazilian Psychiatric Reform. However, for such implementation, investments and public policies are necessary to guarantee the return of professionals trained by the PRMSM to the Psychosocial Care Network.

The theme related to professional training in the health area has been highlighted with different approaches in the literature. Although general aspects are presented, it is important that practical experiences of experiences in institutional settings are presented since they are real portraits of what happens in the practice of the teaching-learning process of students and have repercussions at the macro level, in the professional profile model of graduates and the quality of the care services provided. The Federal University of Rio Grande do Norte presents in its curricular proposal for health courses, a curricular component integrated between the different courses in the area, with experience in the territory taking place in different services and professionals with the community. The component is called Health and Citizenship (SACI). In this sense, this thesis aims to present the contributions of SACI in the consolidation of the general principles to be incorporated into the National Curricular Guidelines (DCN) of undergraduate courses in the health area as specified in Resolution 569 of the National Health Council of 2017, dialoguing with the theories of Complex Thinking and Problem-Based Education. Thus, a case study with a qualitative approach is used, which unfolds through two methodological designs: documentary analysis of portfolios constructed by students who took the curricular component and application of questionnaires with online interviews with professors from different health courses at UFRN. The results showed that curricular components with didactic-pedagogical characteristics similar to those of SACI, based on theoretical references such as complexity and liberating learning, have the potential to promote critical and reflective training capable of meeting the numerous and varied demands of the Unified Health System. Furthermore, SACI proved to be a model of curricular component that is modeled in a manner consistent with the recommendations of the DCN. Despite these positive findings, there are difficulties to be overcome so that the implementation of the component achieves its educational objectives to the greatest potential. Despite the limitation of the results of this Thesis, a contribution is perceived in terms of promoting reflections on possibilities for remodeling curricular models with the insertion of curricular components that better bring students closer to the reality of the SUS and in the search for improvements that enable both educational institutions and health services to integrate so that they collaborate intersectorally in the training of professionals closer to what is recommended by the current health system.

Introduction: In Brazilian history, Public Policies were achieved through social movements in different forms of struggles and political confrontations. In the field of health, the protagonists of the Sanitary Reform yearned for a health care model that would meet needs, democratize health as a universal right and consider the principle of integrality in care. Thus, the Unified Health System (SUS) was established and, in this context, the National Policy on Integrative and Complementary Practices (PNPIC) was published as one of the many achievements of users and health professionals. The insertion of Integrative and Complementary Health Practices (PICS) was marked by interests, such as recovering the knowledge and identity of popular groups, some historically marginalized, and by the State's interest in a new culture of care based on health promotion. Objective: Given this context, the present study aims to characterize the profile of adult and elderly users and the PICS developed in the context of the SUS in the municipality of Natal, Rio Grande do Norte. Method: This is a study with a quantitative approach, of the exploratory-descriptive type, whose format is field with a survey design in the Primary Health Care Network of the municipality of Natal, limited to the Basic Health Unit, Health Strategy of Family and Mixed Unit. Results: 522 medical records of enrolled users were analyzed, the highest frequency being adult females (83.0%); elderly people of non-white race/color (82.6%) and with low education (67.8%); arterial hypertension (30.4%) and diabetes (17.4%) were more frequent in elderly people, as well as the presence of body pain (71.3%) and tooth/gum disease (42.6%). Auriculotherapy (58.2%) was the most used integrative practice in treatment procedures; 53.4% of the population received at least one service and 39.3% were attended in the North I health district. Conclusion: The study reaffirms the position of PICS in health care in the SUS, as well as showing its use for the health of the population, contributing to the PICS studies for health promotion, prevention and protection, as well as providing important information in the context of the integrative health of this public for health planning and management at municipal, state and national levels.

Introduction: The food thought of rights for health by the health proposal and the proposal of federal formulas through the constitution and nutritional measures are against the formulation of a management strategy of objectives: To analyze social health as benefits by formulas in the city of Natal/ RN assisted in the period from 2010 to 2020. Methods: This is a documentary study, with an exploratory descriptive approach with an analysis approach, in which the unit of analysis was the individual processes of requesting nutritional formula with the City of Natal as defendant . Results: For the sociodemographics related to the author, medical and legal profile of the sanitary characteristics of the city of Natal/RN, nutritional formulas between the years 2010, it can be seen that the highest percentage of males (52.0%) and aged under 18 (64.0%). Most of the origins came from the health districts Norte I (28.0%) and Norte II (22.0%). Most cases refer only to a disease or condition that requires the use of food formulas (54.0%). In most cases, the formulation of the nutritional formula came from the public sector (60.0%). The most requested type of food formula was modules and supplements for adults (32.0%). The majority of lawsuits originated from representation through a court decision (80.0%) and a court decision issued through a judgment (60.0%). The most common health problem was allergy to cow's milk protein (14.0%), followed by stroke (8.0%). As for the monthly cost to meet the demands of care, the total amount considering the fulfillment of all demands as guidelines for the processes in a single month was R$ 40,790.48. The amount required for the monthly cost of the formulas prescribed in the 2 follow-ups varied between R$ 3.36 and R$ 3366.00, with an average of R$ 815.00.

The pandemic of COVID-19 brought with it numerous challenges regarding the discovery of conditioning factors for the worsening of the disease and its forms of treatment, as well as the search for the rapid development of safe and effective immunizers to combat the virus, to contribute to the reduction of mortality cases in Brazil. The study aims to evaluate the vaccination coverage of COVID-19 and its association with the mortality indicator in the adolescent, adult and elderly population in the state of Rio Grande do Norte, Brazil. This is an ecological, quantitative study on the vaccinated population in the state of Rio Grande do Norte, through data made available by the health information systems e-SUS Epidemiological Surveillance (e-SUS-VE), in the period from January 2021 to March 2022. The data were analyzed using Microsoft Excel software, used for data grouping, as well as JoinPoint software used for statistical analysis. The vaccination coverage goal set by the PNI is at least 90% of the target population vaccinated. The results revealed that the statewide average vaccination coverage in the period studied was 81.8%. The following regions had outstanding vaccination coverage: Alto Oeste - VI and Seridó - IV, with 91% and 83%, respectively. The region with the highest rate of cases during the study period was the Seridó - IV region, with 23.9%, followed by the Alto Oeste health region VI, with 19.1%. As for the number of deaths, the Metropolitan VII and Vale do Açu VIII regions had the most expressive numbers, with 1.8% and 1.6%, respectively. The results found showed that the lower the vaccination coverage, the higher the incidence of deaths, except for the metropolitan region (Regional VII), which even presenting the third highest percentage of vaccination coverage among the eight regions, recorded the highest percentage of deaths. Therefore, considering most of the findings, it can be said that there is a relationship between vaccination coverage and the number of cases and deaths from COVID-19 among the health regions of the state of Rio Grande do Norte (RN). It is concluded that in the period analyzed Rio Grande do Norte had a coverage below the national average of 90%, however, a positive impact on the reduction of mortality in the same period studied can be seen.

Adolescence is characterized by the period between 10 to 19 years old. This is a phase for
interventions related to adopting a healthy lifestyle, as well as its importance and impact on
health throughout life. Studies show that increasingly, teenagers do not meet
recommendations for healthy eating, which is due, among other things, to the loss of interest
in this type of habit, often not stimulated. In addition, inadequate lifestyle habits, unbalanced
nutrition, and sedentary behavior become one of the main factors for chronic non-
communicable diseases, negatively affecting adulthood. Therefore, the present study aimed to
map national and international scientific production on healthy eating with adolescents,
mediated by Information and Communication Technologies (ICT). This is a scoping literature
review, structured in the methodology recommended by the Joanna Briggs Institute and
PRISMA-ScR. Thus, the following steps were adopted: formulation of research questions,
definition of inclusion and exclusion criteria, definition of the research strategy, selection of
studies/evidence sources, data extraction and coding, analysis, and interpretation of results.
The consulted databases were: Medline/Pubmed, Cumulative Index to Nursing and Allied
Health Literature (CINAHL), Scopus, Embase, and Latin American and Caribbean Health
Sciences Literature (LILACS). The entire study selection process also occurred in duplicate,
independently. The database search resulted in 12,990 works, after the application of initial
filters and removal of duplicates, resulting in 7,898 documents. In the end, the sample resulted
in 20 articles published in journals. It was possible to verify that most of the scientific
production occurred internationally, with emphasis on studies conducted in the United States
of America and Canada, with only one study conducted at the national level. In addition, the
review showed that ICT are tools that can assist in promoting healthy habits, especially in the
field of nutrition. Despite this, a critical view is necessary regarding the use of these
technologies, especially regarding the content addressed. Thus, from this study, it is intended
to contribute to the construction of knowledge regarding the use of ICT aimed at promoting
healthy eating with adolescents.

The emergence of vaccine production is justified by the number of deaths caused by the respiratory syndrome, and the need to control these cases and their severe forms. Concomitantly with the advancement of immunization of the population, it was observed that the social movement of vaccine hesitation characterized by refusal or delay in accepting vaccination has taken on worldwide proportions in recent years, based on questions referring mainly to the efficacy and safety of immunizers. In view of this, it is important to discuss individuality versus collectivity, and to understand the justifications that are associated with the COVID-19 vaccine hesitancy process. This study aims to analyze the vaccine hesitation process against COVID-19 in Brazil, from the perspective of those who hesitate. This is a descriptive exploratory study, with a qualitative characteristic, and a snowball-type non-probabilistic sample approach. The methodology uses chains of references to build its sample population research subjects will be individuals who may have hesitated to take any of the immunobiologicals against COVID-19 that are currently offered by the National Immunization Program, be over 18 years old, reside in the geographic territory of Rio Grande do Norte, and have accepted participate in the research by signing the Term of Free and Informed Consent – TCLE, the content analysis used the Collective Subject Discourse technique, described by LEFEVRE & LEFEVRE, based on the Theory of Social Representations. The preliminary results were organized in a systematic way, where the subjects participating in the research were socioeconomically characterized, we listed categories according to the meaning of the central ideas to understand the individual as a social being regarding the process of vaccine hesitation of COVID-19, being them: Experiences and experiences about the pandemic and the COVID-19 disease; Perceptions about the COVID-19 vaccine and vaccination; Justifications associated with vaccine hesitancy against COVID-19 and other related factors. Evidencing findings regarding these perspectives, the main notes found associated with the vaccine hesitation process are related to various reasons, namely: immunization imposition, distrust of the effects of immunobiologicals, misinformation, fear of reactions, conspiracy theories, political influence and the infodemic. Therefore, knowing that the choice to be vaccinated goes beyond an individual criterion, it becomes necessary for health policy makers to dialogue about strategies that reinforce the safety, need, efficacy and importance of the vaccine for everyone.

With the advance of the judicialization of health in Brazil, in the 2000s, the National Council of Justice (CNJ) began to prepare studies and propose concrete measures with the objective of better understanding this phenomenon, as well as rationalizing the judicial demands involving assistance to health in the country. In this context, the CNJ then determined the creation of the Judiciary Technical Support Centers (NATJUS), by state and federal courts, with a view to producing technical opinions to support judicial decisions in the health area. In Rio Grande do Norte, under the aegis of CNJ Recommendation nº 31, of March 30, 2010, a Technical Chamber was created in 2014 by the State Committee on Health Demands, which later became known as NATJUS. This study aims to analyze the influence of opinions on medicines, prepared by NATJUS of Rio Grande do Norte, on the outcomes of lawsuits filed against public entities, as well as, and especially, the acceptability of these opinions by magistrates. The period of analysis is the triennium 2017-2019, period after the publication of CNJ Resolution No. 238, of September 6, 2016, which determined the formation of these nuclei. This is an exploratory, retrospective and descriptive study, with a quantitative-qualitative approach, in which an analysis was carried out of 212 opinions requested by magistrates from NATJUS, made available in the JUDSAÚDE system, as well as the judicial processes in the context of which they were requested. . Thus, in addition to the description and general characterization of all opinions requested from NATJUS and made available in the referred system, it was observed that there was a higher percentage of requests for opinions by the federal judiciary (81.6%), as well as a high percentage of court decisions that considered these opinions (81.6%). There was a greater number of favorable opinions to the author's request (65.1%), as well as that, for the most part, the opinions were of medicines not available within the scope of the Unified Health System (SUS) (81.0% ), notably antineoplastic and immunomodulatory drugs (38.3%), according to the ATC classification. It was also observed that the percentage of cases in which opinions were requested from the NATJUS, in the period considered, was very low (9.6%), as well as that the impact of the performance of the NATJUS, in the sense of reducing the number of convictions against of the State of Rio Grande do Norte, in the medication processes, was very low (2.1%). It is expected, therefore, that with the implementation of the e-natjus system, by the CNJ, there will be a greater adherence of the Norte-riograndense judiciary to the use of this important tool, since the judicial decision in health needs a technical basis. Finally, in addition to health issues, the judge, in order to decide fairly, considering the entire social and economic context of public health policy, should not do without this aid.

In Brazil, despite healthcare being a constitutionally recognized fundamental right and having
the largest publicly funded healthcare system, there is chronic underfunding. As a result,
healthcare litigation is used to hold the government accountable for meeting healthcare needs.
Nutrition and diet play an essential role in health, supported by the National Food and
Nutrition Policy and the 1988 Federal Constitution. However, nutritional formulas used to
treat or prevent nutrition-related issues are often unattainable due to high costs and lack of
free access through the healthcare system. This study aims to assess legal actions for the
supply of demanded nutritional formulas against the state of Rio Grande do Norte between
2017 and 2021. The study is of an exploratory descriptive nature, using a database of
individual legal cases filed against the state during the mentioned period. A descriptive
analysis of the data was carried out using Microsoft Excel version 2306. A total of 132 active
cases were identified. The majority of claimants were female (52.3%), and the pediatric
population accounted for 40.9% of the cases. Diseases of the nervous system accounted for
40.2% of the total indications for nutritional formulas. Most claimants originated from the 7th
health region of RN - Natal and the metropolitan area (42.9%). The seizure of funds was part
of 54.5% of all cases, and nutritional formulas were prescribed by nutritionists in 66.7% of
cases compared to medical prescriptions. Regarding the costs incurred through legal demands,
the accumulated total during the evaluated period was R$ 3,828,262.00, with an annual
average of R$ 765,652.50 spent. Modified and pediatric formulas represented the majority of
costs in the evaluated period, accounting for 44.6% and 44.1%, respectively. The average
time between litigation and the date of the judicial decision was 28.8 days, and the total time
from litigation to receiving care was approximately 64.8 days. The research aimed to enhance
understanding of the legal action regarding nutritional formulas in the state of RN,
considering the lack of literature on the topic. Given the significance of the issue, it is
necessary to provide technical assistance to the legal system to ensure equitable, regulated,
and uninterrupted access that meets users' needs and promotes rational use, considering that
nutritional care is essential and a matter of bioethics.

Continuing Health Education presents itself as a powerful tool to promote transformations desired by managers and workers to improve services and the health system. This study's main objectives are to understand Permanent Health Education in the work process of Primary Health Care from the perspective of professionals who work in the current context of the Unified Health System and to develop a theoretical model on Permanent Health Education in the work process in Primary Health Care in the current context of the Unified Health System. The study participants were formed by health professionals from the Basic Health Units that are part of the Western Health District of the city of Natal, Rio Grande do Norte, Brazil. This is a research with a qualitative approach that has as its methodological reference the Grounded Theory, with a structuralist approach proposed by Strauss and Corbin. Grounded Theory was chosen because it is a methodological approach that is rigorous during data collection and analysis, considering that the research will study a professional training strategy inserted into the routine and work process of professionals in a procedural manner. Data collection took place between January and May 2023 through in-depth interviews, based on the following guiding question: Talk about continuing education in your work process in primary health care. Data collection followed theoretical sampling, being carried out from three sample groups, the first composed of 16 nurses, the second by five managers and the third by a nursing technician and four community health agents. Data analysis was carried out simultaneously with data collection, with constant raising of new questions and carrying out comparative analysis, following open, axial and selective coding. The Atlas ti software, version 8, was used as a technological tool, with the appropriate license acquired. With the coding of the interviews, 1391 citations, 824 codes, four memos, 27 groups of codes and 16 networks or analytical diagrams were obtained from the analysis. After data analysis, the theoretical model was validated by the following groups: two researchers selected for their expertise in investigations, discussions and practices in Continuing Health Education; three researchers with expertise in the GT method; five participants from the study sample groups. The results achieved were divided into categories according to paradigmatic circumstances, conditions, action/interaction and consequences. The following representative categories of the phenomenon studied were elucidated: Pointing out needs and paths for implementing EPS in PHC; Facing the adversities of working in health and the need for applied knowledge and adequate working conditions; Proposing strategies and relationships that enhance the materialization of EPS; Establishing the advances arising from EPS in the context of PHC; and Declaring the difficulties of not implementing EPS in the health work process. The results provided the construction of the theoretical model that represents the understanding of Continuing Health Education in the Primary Health Care Work Process from the perspective of professionals working in the current context of the Unified Health System.

The mission of the National Immunization Program is based on the control and eradication of vaccine-preventable diseases. Insufficient campaigns and declining vaccination coverage can increase the burden of endemic infectious diseases and the risk of resurgence of eliminated pathogens. In view of this, this study aims to assess vaccination coverage in Brazil, based on the time series from 2000 to 2022. This is a national population-based ecological study, using secondary data obtained from the Department of Informatics of the Unified Health System of the Ministry of Health, collected from February to May 2023. The dependent variables used were vaccination coverage and immunobiologicals, and the independent variables were Brazilian regions, states, years and underage age group. The data was analyzed using Excel 2016 for Windows, Joinpoint Regression Program and Power Business Intelligence. The results obtained in this study point to overall vaccination coverage of the Brazilian population above 80% in 2001, 2004, 2011, 2014 and 2015 and a considerable decline from 2016 onwards, with the lowest rates recorded in 2016 and 2021. In the temporal analysis, the states of the North, Northeast and Southeast had the lowest overall average vaccination coverage rates for the period. In addition, the linear regression showed four temporal variations with straight line segments to explain the autocorrelation, showing equivalent breakpoints in the 2013-2016, 2016-2019 and 2019-2022 periods, following a decreasing, increasing and decreasing order. The Northern region shows a negative variation with statistical significance in the 2019-2022 segment, confirming the downward trend. As for immunobiologicals in children under two years of age, the BCG vaccine leads the highest rates in the Brazilian states, reaching parameters above expectations (90%). In the state of Espírito Santo, the rates developed by the polio vaccine surpass BCG, and in all the country's states the target against polio (95%) is reached, except in Amapá. Another immunobiological that performs well is dose one of the triple viral vaccine, with the states of Amazonas, Amapá and Acre failing to reach the target (95%). In the regions of Brazil, high rates of vaccination coverage were identified in 2015 in the Northeast, especially in the states of Ceará and Pernambuco. The same behavior in 2015 can be seen in the North, with emphasis on the state of Rondônia, in the Midwest with the state of Minas Gerais and in the South with visibility in the state of Santa Catarina. In the Southeast of the country, high vaccination rates are not identified in a specific year, so it can be seen that the Federal District leads the rates in the period from 2004 to 2010, followed by a downward trend in subsequent years, and the state of Mato Grosso do Sul recorded high vaccination rates in 2014 and 2015. The importance of the strategy of systematic updating of health professionals, training in information systems, as well as the microplanning of high-quality vaccination activities of the routine program, intensification and campaigns is essential for all stages of vaccination to be carried out properly and safely, reaching as many people as possible.

Adolescence is a period marked by several neuroendocrine changes that influence brain development and behavior. Adolescents are more likely to adopt risky behaviors in their lifestyle, including sedentary behavior. In this sense, intervention studies have sought to develop efficient strategies to encourage adolescents to adopt a healthy lifestyle. However, although promising actions can be identified in the literature, the real mechanism that acts in the regulation of behavior in adolescents seems to be associated with the neurotrophin Brain-Derived Neurotrophic Factor (BDNF), and studying how risk behaviors influence its secretion are of great relevance to develop more effective interventions. Therefore, the objective of this thesis is to describe the theoretical foundation to the planning of a school-based multicomponent intervention with combined actions to promote physical activity, reduction of sedentary behavior and food and nutrition education, and the possible consequences for cognitive performance and adolescent health. The methodology of this thesis is described in the format of a collection of articles and was divided into four stages. The first stage describes a systematic review that was developed during the theoretical foundation studies for planning the intervention of the Attitude, Movement and Choices for a Healthy Life Program (AME Program), and it was possible to identify the need to implement a specific training stage for physical education teachers. In the second stage, was detailed the methodology of a systematic review that will be developed with the objective of investigating the association between sedentary behavior and BDNF in adolescents. The methodological protocol for the review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) under the identifier CRD42022369220 and follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The third stage presents this completed systematic review, with all search results and analysis of information extracted from the included articles. The fourth step is a study of rationale and theoretical foundation for the methods addressed in the sedentary behavior axis of the AME Program intervention, which was registered on the Brazilian Registry of Clinical Trials platform under the number RBR-86xv46. The results of this thesis are based on the production of studies and, considering that part is still in the writing phase, the appreciation and suggestions of the examining board will contribute to the methodological and scientific quality of the articles. It can be said that the AME Program is an integrated, sustainable and low-cost proposal, with great potential to produce benefits in lifestyle, cognitive performance and health of adolescents. Finally, the results of these studies will strengthen evidence-based practice in research aimed at promoting health in the school context.

Introduction: Syphilis has become a public health problem in several regions of the world. Objective: To analyze the temporal trend and spatial distribution of gestational and congenital syphilis in Brazil, from 2008 to 2018. Method: This is a study of different methods. 1) Time series study of the detection rate of gestational syphilis and correlation between socioeconomic and health service variables. Data were extracted from publicly accessible national databases. The Joinpoint Regression software and Pearson's correlation coefficient were used. 2) Ecological study of spatial analysis of the detection rate of gestational syphilis and spatial correlation between socioeconomic variables and health services. Extracted secondary data, aggregated in 482 Immediate Urban Articulation Regions. GeoDa software was used. 3) Ecological study of temporal trends and spatial distribution of the incidence rate of congenital syphilis and spatial correlation between socioeconomic variables and health services. Secondary data extracted. Joinpoint Regression and GeoDa software were used. 4) Protocol for a scoping review with the objective of proposing a protocol to identify and map the use of Spatial Analysis as a tool in research on syphilis in the health area. It was based on the Joanna Briggs Institute manual and guided by PRISMA-ScR. Results: In the first study, the South region showed the greatest trend; while the Midwest, smaller. Correlation detected with the Municipal Human Development Index, illiteracy rate, percentage of primary health care coverage and proportion of doctors, nurses and basic health units per inhabitant. In the second study, the detection rate of gestational syphilis was unevenly distributed and showed a spatial correlation with the Municipal Human Development Index, percentage of primary care coverage and proportion of physicians per population. In the third study, the incidence rate of congenital syphilis showed an upward trend and uneven distribution. It showed a spatial correlation with the percentage of individuals with inadequate water supply and sanitation and the percentage of live births with 1 to 3 prenatal consultations. The fourth study explained the research question, the databases for searches, inclusion and exclusion criteria, data extraction worksheet and the type of data analysis. Final considerations: Investments in health and social policies are necessary to mitigate social vulnerabilities and strengthen primary health care for syphilis control.

Introduction: The food environment is the physical, economic, political and sociocultural context in which each consumer engages with the food system to acquire, prepare and consume food. This environment involves the availability, accessibility, convenience, promotion, quality and sustainability of food. Compromising access to and availability of healthy foods in sufficient quantities characterizes food insecurity. Objective: To analyze the food environment and its relationship with the occurrence of food insecurity at home and socioeconomic conditions. Method: It is a study of different methods. 1) Systematic review on the relationship between food environments and food insecurity, based on a systematic literature search in the PubMed, Web of Science, Science Direct, EMBASE and LILACS databases in January 2023. 2) Ecological study with census tracts of the city of Natal-RN, based on the identification of food acquisition establishments, grouped in the categories of in-natura or minimally processed, ultra-processed or mixed. Food deserts were calculated by the density of healthy establishments divided by 10,000 inhabitants and classified as less than or equal to the 25th percentile. We used socioeconomic data from the 2010 Census. Multiple Poisson regression was used to observe the relationship between the existence of food deserts and swamps and social infrastructure. 3) This is a quantitative and cross-sectional study with individual demographic, socioeconomic and food insecurity data from the Brazuca Natal Study and the relationship with the census tracts classified into deserts and food swamps. Results: In the systematic review, 22 articles were included, 18 of which found an association between food environments and food (in)security, the majority being in developed countries, in the global North. In the ecological study, it was identified that 51.45% of the food acquisition establishments in the city were of the ultra-processed type. There was a higher density of food establishments in regions with better socioeconomic conditions. The census tracts classified as food deserts (25%) were associated with household conditions and worse infrastructure in the sector. While 75% were identified as a food swamp, associated with better infrastructure in the sector. In the cross-sectional study, food insecurity was found in 42.3% of respondents, associated with individual and sector demographic and socioeconomic variables. Deserts and food swamps did not show a spatial distribution pattern and were not associated with food insecurity. Conclusion: There are inequalities in the distribution of different food acquisition establishments in the city of Natal/RN, with a predominance of food swamps. Thus, actions are needed to improve the sectors' infrastructure, decentralize the supply of healthy foods and limit the sale of ultra-processed foods, with a view to ensuring healthy food choices. It is important that new studies assess the different dimensions of the food environment, to allow a better identification of factors associated with food insecurity in different socioeconomic contexts.

Introduction: Cardiovascular diseases (CVD) are the principal cause of morbidity and mortality in the world. Therefore, experts have studied strategies for preventing and treating cardiovascular events. One of this knowledge is vitamin E stands out for its antioxidant and anti-inflammatory properties, supported by findings that higher dietary intake of vitamin E and higher concentrations of serum α-tocopherol (α-TOH) are associated with a lower risk of cardiovascular events. Therefore, data on the nutritional status of vitamin E in the population and its relationship with cardiovascular risk factors are relevant strategies to support programs and public policies aimed at preventing and treating CVD. Objective: To evaluate the nutritional status of vitamin E and its association with cardiovascular risk factors in adults and older adults in the Brazuca Natal Study. Methods: This is a study of different methodological strategies. 1) The narrative review aimed to verify if surveys could demonstrate an association between serum vitamin E and the occurrence of CVD. Moreover, we would like to understand whether vitamin E deficiency (VED) should also be considered a public health problem. 2) Cross-sectional study, divided into two scientific articles. The first article evaluated the prevalence of VED and whether cardiovascular risk factors influenced serum α-TOH status in adults and older adults in the Brazuca Natal Study. We performed a multiple linear regression analysis between serum α-TOH (dependent variable) and cardiovascular risk factors. The second article aimed to evaluate vitamin E intake, and we would like to identify the principal food sources of this micronutrient intake. To this end, we analyzed socioeconomic and demographic conditions (sex, age, color/race, education, per capita income, and health district of residence), and vitamin E intake (dependent variable). Results: In the narrative review, we observed that VED could be a public health problem. The prevalence of VED varies from 0.6% to 55.5% in the world, with higher percentages in Asia and Europe, where the high mortality rates from CVD stand out. Population studies suggest the protective effects of vitamin E on CVD. However, intervention studies with α-TOH supplementation have not confirmed its cardioprotective action. In article 2 of the cross-sectional study, we observed that 24.8% of adults and older adults in Natal had VED, and 89% had low concentrations of circulating α-TOH (below 30 µmol/L). We found that females had higher mean serum α-TOH values. In addition, the cardiovascular risk factors that increased the individuals' serum α-TOH were a high visceral adiposity index and higher global risk score values. Article 3 demonstrated that 95.7% of individuals had a low intake of vitamin E, considering the Estimated Average Requirement (EAR) of 12 mg/day, with lower intake values among older adults, women, and those who have a per capita income of less than half minimum wage and with less education. Soybean oil, açaí pulp, and red meat provided the highest content of ingested vitamin E. Conclusion: the study demonstrated a high prevalence of VED and low consumption of vitamin E in the studied population. We verified an association between serum α-TOH and cardiovascular risk factors.

Brazil came to occupy second place in the absolute number of deaths from Covid-19 and, in March 2021, it was considered the global epicenter of the pandemic. The lack of adoption of alternatives for managing the health crisis that privileged the principles, methods and practices of epidemiological surveillance to combat it allowed this scenario. Added to this, scientific denialism on the part of the Brazilian federal government continued to be established in the country, with the perpetuation of discourses of contempt for universities and the rights of the most vulnerable populations. Thus, this thesis aims to analyze, in the light of Intervention Bioethics (BI), factors related to the Brazilian federal government's stance towards Covid-19. This is a Case Study with a qualitative approach. We opted for several sources of evidence, using the triangulation of data from documents relating to the period of the Covid-19 pandemic in Brazil and which were in accordance with the proposed objectives: (a) videos and texts of official statements by the federal government, carried out by the former President of the Republic, during the first year of the Covid-19 pandemic in Brazil, 2020; (b) the final report of the Covid-19 CPI, carried out in 2021 in Brazil; (c) journalistic/news articles that recount important events in Brazil at the time of the Covid-19 pandemic; and (d) publications by ANVISA about the health guidelines for containing Covid-19 in Brazil, that is, which ethical parameters should be followed, according to the regulations published by that body. The results were analyzed using Thematic Content Analysis and are arranged in three sections: (1) published article entitled “The Covid-19 CPI: a bioethical analysis of what was revealed in the management of the pandemic”. This article aims to discuss, based on the main findings of the Covid-19 CPI, the stance of the Brazilian federal government and its consequences in the management of the pandemic, in light of BI; (2) article accepted for publication entitled “Bioethics, Brazilian official pronouncements and the Covid-19 pandemic: irresponsibility and lack of protection”. This article analyzes the official statements of the Brazilian federal government, made by Bolsonaro in 2020, during the Covid-19 pandemic. For this critical analysis, the BI theoretical framework was used; (3) article under construction for subsequent submission entitled “Management of the Covid-19 Pandemic in perspective: bioethical inconsistencies between ANVISA and the Brazilian federal government”. This article presents data collected in ANVISA publications about health guidelines for combating the Covid-19 pandemic, and seeks to analyze, through BI, the bioethical inconsistencies between the measures proposed by the Agency and those adopted by the federal government. Based on the analysis carried out in this thesis, it is concluded that the bioethical precepts proposed by BI were not respected in confronting the Covid-19 pandemic in Brazil, highlighting the negligence, on the part of the Brazilian federal government, of ethical parameters such as solidarity, corporeality, responsibility, vulnerability, equity, justice and the 4 'feet' of BI that involve precaution, prudence, protection and prevention.

INTRODUCTION: Chikungunya Fever is a disease that, in its acute phase, causes polyarthralgia, myalgia and fever, and its symptoms can last for a period of up to three years after its initial presentation. After the great national outbreak experienced in the year 2015, in Rio Grande do Norte, Brazil, more than 16,800 cases have been registered, until the year 2019. OBJECTIVE: Analyze the cases of elderly people affected by Chikungunya Fever in Rio Grande do Norte, between 2016 and 2020. METHODS: This is a hybrid analytical epidemiological study, part cross-sectional, part ecological. The data on disease notification and deaths of the elderly due to Chikungunya Fever were obtained from the Information System for Notifiable Diseases and the Mortality Information System, respectively. The population was composed of elderly people, aged 60 years or older, residing in Rio Grande do Norte, in the period between 2016 and 2020. The data were analyzed according to the dependent variables, disease notification and deaths, through the Software SPSS, version 20. An evaluation of the Epidemiological Surveillance Systems was performed, regarding their quality and acceptability. The ecological part will be composed of a spatial analysis, according to the municipalities of residence, done through the TerraView software; and a linear regression analysis, done with the Joinpoint software, to evaluate any change in the trend line. RESULTS: There were 4,994 cases of elderly people affected by Chikungunya Fever, between the years 2016 and 2020, predominantly females (63.3%), with an average age of 70.5 years (±8.2 years), black and brown (62.1%), with 49.4% without having completed elementary school. In the period, 47 deaths (0.94%) with Chikungunya fever as the cause of death were registered in the Mortality Information System. The completion of all data evaluated by the municipalities was considered regular (67.34%). There were 117 cases (2.29%) with duplicate notification. Regarding the dissonance of data among the three spheres, a discrepancy was observed by the low notification of cases by the headquarters city of VI URSAP, compared to data at state and national levels; and by the high number of notifications by the headquarters of VIII URSAP, also compared to state and national levels.

The study aims to analyze the quality of Maternal and Child Health within the scope of
Primary Care in Rio Grande do Norte in the three cycles of the PMAQ-AB from the
perspective of users. This is an evaluative, cross-sectional, retrospective study using
secondary data from the 1º, 2º and 3º cycle of the PMAQ-AB. The sample consisted of 7,787
users, respectively, 1,085, 715 and 866 Basic Health Units participating in the external
evaluation of the Program, in the 3 cycles. The dependent variables for evaluation in the three
cycles were “satisfaction with care”, “material conditions”, “access to health services”,
“inputs” and “drugs”. For the last three variables, scores were created using the
interdependence technique (Exploratory Factor Analysis of the Principal Component Analysis
(PCA) type and Item Response Theory (IRT) type, obtained to reduce the number of variables
in each dimension and subdimension. Pearson's chi-square test and Kruskal-Wallis' H test
were used to compare quality scores, means of satisfaction with care and availability of
materials, among the three PMAQ cycles. In the organizational dimension, when analyzing
the quality of care, a significant difference (p>0.001) between the 3 cycles was identified in
the women's health subdimension, totaling 51% in the last cycle. Regarding satisfaction with
care, 90.2% recommended the Basic Health Unit to a friend or family member (p>0.001) and
only 13.2% (p>0.001) of the users would change their team or Basic Health Unit if had the
option. The structural dimension showed improvement in the three sub-dimensions 44%
(p>0.001), drugs 52.4% (p>0.001) and material 93.6% (p>0.001). There is an improvement in
Primary Care from the perspective of users in Rio Grande do Norte, especially in women's
health. It is also evident the importance of investing in quality improvement programs to
strengthen Primary Care.

Non-technical skills are social, personal, and cognitive skills that can influence safety and efficiency in performing tasks. Studies show that in intensive care units, most safety incidents have low performance in these skills as their root cause, and training programs are an alternative to solving this problem. This study aimed to analyze the effect of implementing non-technical skills programs in intensive care units based on Kirkpatrick's evaluation model for training programs, which includes reaction to training, learning, behaviors, and organizational results. For this, we perform a systematic review, registered on the PROSPERO platform under the code: CRD42021244769. We review original articles published in the following databases/portals: Pubmed/Medline, Scopus, Web of Science, Science Direct, CINHAL, EMBASE, and PsycINFO. We include randomized clinical trials, quasi-experimental studies with a control group, or studies with a before and after design. The risk of bias for the included studies was assessed using the Risk of Bias 2, Risk of Bias in Non-randomized Studies of Interventions, and NHI Assessment Tool for Before and After Studies tools. Two pairs of reviewers independently selected and evaluated the works, and in case of disagreement, we consulted the fifth reviewer. From a universe of 3976 documents identified in the databases/portals, 14 studies were included in the review. In the reaction dimension, the participants evaluated the training programs as useful, even though the teaching strategies implemented were different.  Only one study explored the effect of the training program on the learning dimension, however, the difference was not significant. We identified a positive relationship between the adoption of non-technical skills training programs and the improvement of teamwork behaviors, situational awareness, leadership, and communication. In the organizational results, there were no significant changes observed in patient safety culture, as well in the length of stay and mortality rates, and the improvement of process indicators was limited. The analysis of the risk of bias indicated a low methodological quality, mostly linked to the way of measuring the outcomes, predominantly self-reported. The adoption of non-technical skills training programs in intensive care units shows limited effects, but they can contribute to the existing professional training curriculum.

The right to food begins by guaranteeing all citizens daily access to food in sufficient quantity and quality. It is the right to food to have correct information about the content of food and preparations, healthy eating practices and lifestyle, which promote health and reduce risks for diseases and guarantee food security. Within the scope of Food and Nutrition Security (SAN) several aspects reflect the social reality; should be approached and analyzed simultaneously, establishing correlations. In this way, this research evaluated the occurrence of food insecurity and overweight, and the relationship with food purchase and consumption habits, among the adult and elderly population of the Brazuca Study - Natal/RN. This is a cross-sectional study, conducted with 411 adults and elderly people living at home. Household interviews were carried out using an electronic questionnaire (Epicollect5) to obtain demographic, socioeconomic, anthropometric (weight, height) and AI-related data. To measure the AI, the prevalence and confidence interval (95%) were calculated. The analysis of factors associated with food insecurity was performed using Poisson regression, with robust variance estimation, to obtain crude and adjusted prevalence ratios (PR) and their confidence intervals (95%). Variables with p<0.20 were included in the model and those with p<0.05 remained in the final model. In the BMI analysis, excess weight (overweight/obesity) was observed in 76.3% (CI: 70.3– 81.7%) of adults and 61.3% of the elderly (CI: 54.5 – 68.1%). AI was observed in 42.2% (CI: 37.6 – 47.3) of respondents. A total of 398 respondents were investigated, of which 80.2% (CI: 85.4 – 92.0) make their purchases in super/hypermarkets and 2.3% (CI: 2.0 – 5.8) in street markets. The habit of consuming powdered juice or soda, between 1 and 4 times a week, was indicated by 28.7% (CI: 24.5-33.3%) of the individuals surveyed. In this same weekly interval, 48.2% (CI: 43.5-53.0%) of the interviewees prefer cookies or sweet biscuits with or without filling. Super/hypermarkets are  requented by 37.4% of people considered in AI and 62.6% of those in SA. There was a significant association between the family income variable, between R$ 401 and R$ 998.00 RP = 3.56 (2.19- 5.78) and ≤ R$ 400.00 RP = 5.22 (3.30-5.78) 8,25) and the occurrence of AI. Per capita family income was the factor associated with the greatest effect on the prevalence of food insecurity. People with per capita family income between R$ 401.00 and R$ 998.00 have a prevalence of food insecurity 2.9 times higher than people with income equal to or greater than R$ 999.00. This effect is more pronounced in people earning up to R$ 400.00
per capita, in which the prevalence of food insecurity is 4.13 (p<0,001) times higher. A higher prevalence of food insecurity was also observed among people with inadequate access to treated water PR=1.46 (CI: 1,19-1,78).As for the adjusted analysis, a 37% higher prevalence of food insecurity was observed among individuals who reported consuming fruits from 1 to 4 times a week, and 42% higher among those who reported consuming
fruits never or almost never. The consumption of cookies or crackers, consuming 5 or more times was associated with a 30% higher prevalence of food insecurity. It is concluded that households in a situation of FI consume fruits less frequently, which can compromise the health and guarantee of SAN of the population studied. 

The pandemic generated by the new coronavirus (SARS-CoV-2), which started in December 2019, has been characterized by severe acute respiratory syndrome (SARS), among other relevant health problems. The objective of this research is to analyze the burden of the Covid-19 pandemic on the elderly population in Brazil, by estimating the COVID-19 mortality curve for the year 2020, observing the years of life lost and effects on life expectancy. This is an ecological study of multiple groups, whose unit of analysis will be composed of the municipalities in Brazil. The study population is people aged 60 years and over. Death data were extracted secondarily through the Mortality Information System (SIM). The results of the present study show that there are differences in mortality from Covid-19 between regions in Brazil. The most affected age group was 80 years and over. And the male sex having a higher occurrence of deaths. From the spatial statistics, the correlation between PMR by Covid-19 and the socioeconomic variables of the study was verified. With regard to years of life lost, the Southeast and Northeast regions stood out with the highest absolute number of potential years lost. The estimates produced by the multiple decrement tables represented gains in years in life expectancy for all regions when excluding Covid-19 deaths. For both sexes, the greatest gains occurred in the North and Midwest regions, reaching more than 2 years in gains considering the absence of these deaths. The northern region still had the highest probability of death when including only deaths from Covid-19 (_nq_x) and a significant reduction when these deaths were eliminated (_nq_x-^ix). This study may support strategic planning/actions aimed at fighting Covid-19.

The main objective of this study was to develop a theoretical model on frontline care work in the COVID-19 pandemic, considering the ways of coping and the repercussions on the health of the professionals involved. The main researcher acted as a professional nurse on the front line within a COVID-19 sector in the research institution, a situation that aroused the search for understanding the suffering, as well as the learning caused by this disease. This is a qualitative research that uses Grounded Theory as its methodological framework in the structuralist approach of Strauss and Corbin. The Onofre Lopes University Hospital of the Federal University of Rio Grande do Norte was the research scenario. A theoretical sampling of the population of professional nurses, physiotherapists, doctors and nursing technicians was carried out, divided into two sample groups: one with health professionals who worked on the front lines of the COVID-19 pandemic and the other with managers of the COVID sectors -19 of the institution where the study was conducted. Data collection was carried out through in-depth interviews, which were carried out in person and online, according to the availability and preference of the participants. A total of 24 interviews were carried out, with six managers, nine nurses, four physicians, one physiotherapist and four nursing technicians. Data analysis was performed through open, axial and selective coding, using the Atlas Ti 22.0 software. The results achieved made it possible to elucidate the central category of the phenomenon, Working on the front line of care in the COVID-19 pandemic, based on the support of 21 subcategories and five categories, according to the paradigmatic circumstances, the conditions: Working in care during the pandemic by high transmissibility agent; the action/interaction: Facing the adversities of working in care during the COVID-19 pandemic; and Engaging with people involved in the care of patients with COVID-19; and the consequences: Dealing with the impact of work on one's own health and Reaching teachings and overcoming the adversities of working in the pandemic. By highlighting the articulation between the categories, it was possible to represent them through a theoretical model of the studied phenomenon. Working on the front line of care during the COVID-19 pandemic represented a challenge for health professionals and managers in various aspects of professional activity and the personal dimension, which had to adapt to the pandemic situation, facing feelings such as fear, anguish , impotence and experiencing situations that impacted positively and negatively on patient care and on the way of relating. After facing the worst moments of the pandemic, and having suffered direct and indirect repercussions on their health, they adopted different protective strategies, learning to deal with the public health emergency, re-signifying the situations experienced and achieving professional learning that propelled new work perspectives . The theoretical model developed will be able to contribute to the planning and development of institutional strategies to face critical periods, characterized by an increase in the demand for health services, the presence of a highly transmissible etiological agent and, mainly, the impact on the health of health professionals, with suffering and illness in those involved in the assistance front line.

The Primary Care Access and Quality Improvement Program (PMAQ-AB) implemented in 3 evaluation cycles (2011/2019), represents a turning point in the performance evaluation of Primary Health Care (PHC) in Brazil. The Program has 3 components: Voluntary adhesion of municipal managers and Contracting of teams; the External Assessment (AE/PMAQ-AB) and Certification; and Recontractualization, in addition to a transversal development axis. This study aims to assess the quality of AE/PMAQ-AB in light of internationally recognized standards. This is a summative meta-assessment using the qualitative Case Study method, preceded by an Indicator Content Validation Study. The matrix of indicators was prepared based on the 4 principles/standards of the Joint Committee on Standards for Educational Evaluations (utility, feasibility, propriety and accuracy) and articulated at each stage of the evaluation (stakeholder engagement, program description, evaluation design , systematization and analysis of evidence, justification of conclusions and sharing of lessons learned). Validation used the intentional sample with 2 groups of judges (7 experts and 16 evaluators) in 2 rounds of the Delphi technique with each group and analysis through agreement indices. The Case Study, between July/2018 and December/2019, had 54 participants. Semi-structured interviews (01 with a coordinator from the Ministry of Health (MS) and 6 from the universities) and focus groups (01 with a technical team from the MS and 6 from the universities) were used, in addition to the analysis of 07 formal documents of the Program. Data were categorized by dimensions and standards and their respective criteria/indicators adapted to the context of AE/PMAQ-AB. Categorization was performed using the Atlas ti software. 8.4.24 and followed by Bardin's content analysis. The “Involvement of Stakeholders” presented an agreement in the instances of the Unified Health System, expansion of the adhesion of the municipalities in the cycles, credibility of the evaluator and conciliation by the federal government of the interests of certification of the municipalities and of research by the universities, as strengths; and as a deficiency, the absence of users in the decision-making processes of formulating and executing the program. The “Program Description” was positive in the consistency of the AE/PMAQ-AB with the National Primary Care Policy/2011. The “Evaluation Design” portrayed the Brazilian PHC and construction of comparable standards and certification criteria. The use of Information Technology, logistics and guidelines for training the interviewers gave the collection homogeneity, pointing to the usefulness and feasibility. The "Systematization and Analysis of Evidence" had as strengths the online validation systems, offer of micro data, availability of electronic reports to stakeholders, but there were weaknesses in the transmission of the methodology to municipal managers, incipient strategies of technical empowerment for interpretation and applicability of results impacting negatively on the dimension “Justification of Conclusions”. In the “Sharing Lessons Learned”, the utility of AE/PMAQ-AB prevailed for a culture of evaluation in management, services, and academia. The meta-assessment presents a systemic view of the AE/PMAQ-AB, helping managers and professionals in the PHC assessment process. It raises awareness of user engagement in policy and program evaluations, making them more plural, participatory and democratic.

The present study aimed to understand the factors associated with dental services utilization by adults in Brazil. This is a quantitative, observational, cross-sectional, analytical study. Individual data from the National Health Surveys developed in 2013 and 2019 are available on the Brazilian Institute of Geography and Statistics website. Data were analyzed by adjusting the sample weights resulting from complex samples. For each study, multivariate analysis techniques addressed the study's objectives. The results will be discussed in 3 scientific papers accepted for publication in journals. It was noticed that the population subgroups comprising Blacks and those residing in the North or Northeast, with lower social class and education, had a greater chance of having irregular follow-up and never having been to the dentist. In addition, this population stratum also had a greater chance of undergoing surgical or emergency dental procedures in the last dental appointment. The outcome never had a dental appointment was significantly associated with illiterate, males, without private dental insurance, self-rated oral health as bad or very bad, household not enrolled in primary care teams, household in a rural area, high household crowding, and low household income per capita. The highest prevalence of public dental service utilization on an individual level was observed among unable to read or write people, indigenous, black or brown, with per capita household income of up to U$124, living in the rural area, and who self-rated oral health as regular or very bad/bad. On the contextual level, highest public dental service utilization was observed among those living in federal units with increased oral health coverage in primary health care. In general, we observe inequalities in dental services utilization in Brazil. This scenario occurs when social characteristics and facilitating aspects determine who uses the services, to the detriment of the need to use them. Despite this, we observed an important effect resulting from the provision of dental services in primary care as a mitigating factor for such inequalities, demonstrating a positive effect of the strategies adopted in the National Oral Health Policy.

The gender is one of the factors associated with Food Insecurity (FI). Although people in gender minority groups are exposed to potential risk factors for FI, we do not have large-scale data on these groups. This is due to the way gender is classified in population surveys (i.e., male and female), leaving transgender populations “hidden” in a binary classification. In this thesis, we propose to explore the relationships between minority gender experiences and vulnerability to FI. In this way, we investigated the nexus between transgender experiences and the impact on dietary outcomes and verified the association of social, economic and prejudice factors with AI in a group of transgender people. We conclude that excluding gender diversity in research on food insecurity has possibly failed to reveal important demands for the transgender population. In this thesis, we present the relationships understood so far between AI in the transgender population, as well as possible challenges and alternative strategies for overcoming them. We hope that in doing so, we can guide food and nutrition policies and surveillance systems, as well as researchers around the world, to understand the hidden diversity in AI studies.

The disease caused by the new coronavirus (COVID-19) is currently the most serious public health problem in the world. Evaluating the temporal distribution and factors associated with mortality from COVID-19 in different publics can provide evidence about the temporal dynamics and the groups with the highest risk of death. Furthermore, with the measures adopted to face the pandemic, changes were observed in the professional practice of health professionals and teachers, and it is important to assess the impact on mental health. In this context, the aim of this study was to assess morbidity and mortality from COVID-19 in Brazil and the impact of the pandemic on the mental health of health professionals and teachers. To respond to this objective, four studies were developed. In the first, a cross-sectional study, 8,402 children and adolescents aged 0 to 19 years with SARS due to COVID-19 were included. The incidence and mortality rates were 13.74 and 1.35 per 100,000, respectively, with a mortality rate of 9.81%. In the multivariate analysis using Poisson Regression with robust variance, the factors associated with a higher risk of death were age group < 1 year, heart disease, immunosuppressive diseases, neurological diseases and Down syndrome. In the second article, a systematic review, it was identified that the instruments Mini Nutritional Assessment (MNA), MNA-short form, the Geriatric Nutrition Risk Index, the Nutritional Risk Screening 2002, the Malnutrition Universal Screening Tool, the modified Nutrition Risk in Critically Ill (NUTRIC) score and the Subjective Global Assessmen have high sensitivity for identifying nutritional risk in older adults with COVID-19. In the third article, a systematic review on the mental health of teachers in times of COVID-19, it was found that the prevalence of anxiety ranged from ten to 49.4%, for depression, from 15.9 to 28.9%, and, for stress, from 12.6 to 50.6%. Working in schools (compared to universities), being female and experiencing a return to face-to-face classes were factors related to a higher risk of emotional changes. In the fourth article, a systematic review with meta-analysis on anxiety in health professionals, a prevalence of 35% (95%CI: 29-40) was identified, being higher in women and nurses. Working on the front lines, being infected with the coronavirus and having chronic illnesses were also factors associated with a higher risk of anxiety. The results of this thesis show that despite being less prevalent than in the elderly, COVID-19 also affects a considerable number of children and adolescents in Brazil. For the older adults, it was found that nutritional screening instruments are useful for identifying nutritional risk. A high prevalence of alterations in the emotional state was registered in health professionals and teachers, with the need for collective health measures aimed at preventing these alterations in these professionals. There is a need to include this agenda in Health Surveillance, specifically Occupational Health.

Introduction: Access to medication is a global challenge, especially in developing countries, so data from population surveys are essential to measure related factors. In addition, the high prevalence of people with chronic diseases and, consequently, who use continuous medication implies the need to guarantee this access through efficient public policies. Objective: To analyze access to medicines in Brazil and associated factors, based on data from the 2019 National Health Survey (PNS). Methods: This is a cross-sectional population-based study that used data from the PNS 2019, enabling the writing of three studies: 1 – general assessment of access to medicines by the Brazilian population, based on Andersen's behavioral model; 2 – analysis of factors associated with access to medication for the treatment of arterial hypertension and diabetes; 3 – study of factors associated with the use of medication for the treatment of depression. In the three studies, descriptive analysis was performed, followed by multivariate analysis, considering the independent variables that presented a significance level greater than 95%. Results: In article 1, it was observed that the greatest chances of not having access to medication at the individual level were observed in people aged between 40 and 59 years, women, people with complete elementary school and high school, with lower family income people who performed consultations in public services, individuals with a worse self-rated health and those who sought the health service for disease prevention and health promotion. In article 2, data regarding access via the Popular Pharmacy Program of Brazil (PFPB) and public service were analyzed. There was a higher prevalence of access to medication for hypertension and oral medication for diabetes via PFPB, and the factors that most influenced this access were a higher age group, lower income, lower education, not having a health plan and reporting a self-assessment of health too bad. Access to insulin, in turn, was more prevalent via the public health service, and the factors that most influenced this access were black/brown race, lower income, not having a health plan and reporting a very poor self-rated health. In article 3, it was found that the factors associated with not using medication prescribed for depression in the last two weeks were marital status, self-rated health, prevalence of sleep problems, routine medical appointments, and time since diagnosis of the disease. Conclusions: Access to medication in the Brazilian population is related to socioeconomic and health perception factors. In general, the importance of the PFPB as a policy to expand access to essential medicines in Brazil is proven, considering the free use of antihypertensive and antidiabetic drugs, as well as the weaknesses of the public health system in Brazil in the supply of medicines. Furthermore, these findings can guide the updating or formulation of public policies on medicines and pharmaceutical assistance, promoting better mechanisms for the purchase of medicines by the user and, consequently, reducing health inequities.

Introduction:   COVID-19 is characterized  by a respiratory syndrome with variations  in the degree of severity. However, this disease has disproportionately affected institutionalized elderly people, leading to a high mortality in this population.  Objective:  To analyze the health conditions that make institutionalized elderly people more vulnerable to severe form and death by COVID-19. Methods:  Two analyses were performed: 1) descriptive study, cross-sectional approach, carried out in eight LSIEs of the Metropolitan region of Natal, Rio Grande do Norte, with a population of 267 elderly people, between February and December 2018, which used as an instrument to collect sociodemographic data, health and risk factors the Elderly Health Booklet, and pearson's chi-square and Chance Ratio tests were performed for the analysis of variables; 2) systematic review of the literature of observational epidemiological studies published between January 2020 and February 10, 2021, for which searches were performed in the databases Virtual Health Library (VHL), PubMed, Scopus and Web of Science, using mesh and DeCS descriptors, and evaluated the risk of  bias by instruments of the Joanna Briggs Institute. Results:  1) Of the 267 elderly people evaluated, the most prevalent risk conditions were cognitive impairment (57.5%), hypertension (55.6%) and diabetes (27.5%), with a higher frequency of low birth weight in elderly with cognitive impairment (24.6%), and overweight in those hypertensive (23.3%) diabetics (12.9%). Body mass index (BMI) was associated with the age group 80 years or more (p=0.013), hypertension (p<0.001) and diabetes (p=0.001). Hypertensive elderly people are more likely to have low weight when compared to non-hypertensive people (CR=3.6; IC95% 1.5-8.6). 2) A  total of  171 publications were identified, of which 9 met the eligibility criteria. The complementary search in the list of references of these studies resulted in two articles. With this, 11 articles were included in the review. Different risk factors were identified grouped into: sociodemographic factors - male gender, age over 80 years and institutionalization itself; clinical manifestations – presence of symptoms, loss of appetite, fever, diarrhea, altered mental status, lethargy, respiratory symptoms and shorthand; and  health conditions – cardiovascular diseases, diabetes, kidney disease, functional and cognitive decline, Parkinson's disease, frailty, depression and chronic obstructive pulmonary disease. Final considerations:  Institutionalized elderly people present health conditions that make them more vulnerable to progress to the severe form of COVID-19 if infected, which requires the adoption of protective measures for this population and the adoption of protocols for timely infected individuals and those at higher risk for severe form of the disease.

The object of study of this dissertation is the training of the sanitarist at the undergraduate level. It is delimited in the historical recovery of undergraduate courses in Collective Health and drawing training carried out for the new profession. The objective is to analyze the graduate training in Collective Health of existing courses in Brazil in the light of the Pedagogical Projects of the Courses. This is a qualitative and exploratory study with a documentary approach, using the content analysis method, in the thematic modality according to the technique of Minayo (2014) contemplating three phases. In phase 1), the selection of 22 pedagogical projects of the course of undergraduate courses in Collective Health and organization of textual corpus; 2) the data were organized into 4 corpus from 4 record units; 3) was performed the encoding, later processing the 4 corpus in the Iramuteq software for obtaining the Descending Hierarchical Classification, to analyze, interpret and present the results through dendrograms. The results demonstrate an openness course, with a concentration between 2008-2009, the last in 2019. The courses are organized in the Brazilian regions in greater number in the northern region with 27.3%. Most courses follow or fit the National Curriculum Guidelines of the Course of Graduation in Collective Health (DCNCsGSC) 2017 with a predominance of workload equal to or greater than 3,200 hours, duration from eight to nine semesters and an average of four years, with night shift in 45.5% of courses. The average offer is 1,864 vacancies/year with entry through of Enem/SISU, with 68% of courses in federal universities and 77.3% with nomenclature Bachelor's Degree in Collective Health. Of the 22 courses, 18 were evaluated by the MEC, being 67% with concept 5. Training allows a gradual construction of knowledge from curricular components between 45 to 60 hours arising from epidemiology, from human and social sciences, surveillance, health sciences, education, planning, management, health services, and policies. The courses are articulated with health services and systems SUS publics and with the community through practical classes, internships, research, and projects extension and technical visits, strengthening the students' practical contact with real situations of the health of the population, as well as mitigating that the graduates can enter professionally in these spaces. It is concluded that the courses are consolidated based on the regionalization of courses, the number of vacancies, unification of the nomenclature, and the predominance of the concept of excellence. The training follows the DCNCsGSC regulations of the bases of Collective Health, so that the articulation with the SUS has contributed to its strengthening and training of human resources in health.

The high rhythm of work added to the physical and psychological demands lead to a picture of stress in personal and work contexts. Stress is defined as a physiological, psychological and behavioral response of an individual in order to adapt to the demands of the environment and the internal ones, being seen as a stimulant and source of balance. In addition to this, other causes can be inserted, such as the professional's life habits, among them: cigarette, alcohol, lack of physical exercise, sleep deprivation, among others, which are harmful to health. This reality has been the most observed in the hospital scenario, possibly associated with problems related to the fatigue of compassion, where professionals end up discounting their special. The motivation for the study, it was understood why the high numbers of absenteeism in oncology, and if this occurs, the work process itself occurs, identifying them. Then the following research question was elaborated: analysis of published studies on absenteeism in oncology hospitals in the form of systematic review. This is a Systematic Literature Review (RSL). This type of study serves to guide the development of projects, indicating new directions for investigations and identifying which research methods were used in an area. A literature review was carried out to give robustness to the theme. This review was based on three pillars: 1) multidisciplinary work and; 2) absenteeism among professionals. Subsequently, the descriptors were elected and based on them, searches were carried out on the electronic databases PUBMED, LILACS and SCOPUS. After reading, those who did not answer the research question were excluded, thus obtaining a result from 11 studies. The main occupational diseases were listed by the authors of the selected studies. The main disorders were of psychic origin (depression and Burnout syndrome) and of musculoskeletal origin (RSI / WRMSD). It was discussed about each disorder presented by the authors in addition to contributions from other authors, in order to contextualize the research.

The COVID-19 pandemic has led several countries, including Brazil, to adopt measures to contain the transmission of the disease. It has been identified that the elderly are among the most vulnerable individuals to the most severe forms of the disease, being considered a risk group. Given this scenario, the present study is justified by Knowing the negative affectivity which mainly involves emotional states such as depression, anxiety and stress of elderly people monitored during the COVID-19 pandemic in the territory of the Family Health Units (USF) in the city of Natal. This is a cross-sectional and analytical study. Secondary data from the surveillance forms of the extension project “Prevention of COVID-19: telesurveillance of the elderly in primary health care” were used. Of the elderly people monitored by the Telesurveillance and Telemonitoring project, 251 elderly people agreed to answer the DASS-21 completely, 63.3% of the sample was female. For data collection, the reduced version of the Depression, Anxiety and Stress Scale (DASS-21) was used. Quantitative data were processed and analyzed using the statistical package Statistical Package for Social Sciences (SPSS for Windows) in its version 22.0. The research project is in line with Resolution nº 466/2012 of the National Health Council and has been submitted for evaluation to the Research Ethics Committee nº 4.431.316. Data collected by the researcher indicate that elderly people have significant levels of anxiety, depression and stress (p<0.05) during the COVID-19 pandemic period. The average age corresponds to 71.09 years (SD=7.91). Regarding frequency and percentage, 57.8% had levels of depression; 52.6% had levels of anxiety; and 52.6% had stress levels. Elderly people reported that they (69.8%) already felt anxious, depressive and stressful symptoms before the COVID-19 pandemic. Regarding the prevalence of symptoms, there was no significant difference (p>0.05) between genders. It was observed that the fear of becoming infected with the disease, as well as the measures taken to reduce its contagion (quarantine, isolation and social distancing) can negatively impact the psychological of elderly people, thus triggering mental disorders, such as: depression , anxiety and stress, in addition to the fear of dying, sadness and loneliness.

The objective was to analyze the stage of diagnosis and mortality from lung cancer and its relationship with socioeconomic factors and the provision of health services in Brazil. This is an ecological and cross-sectional study. Deaths (C33-34) were collected from the Mortality Information System for the period from 2011 to 2015. Individual data related to cancer diagnosis and socioeconomic conditions were obtained from the Integrator of Hospital Cancer Records for the period 2006 to 2015. The contextual variables were collected in the Atlas of Human Development in Brazil, in the National Register of Health Facilities and in the National Supplementary Health Agency. For analysis of mortality and late diagnosis of lung cancer, the Chi-Square test and the Poisson Regression with robust variance were applied to a 95% confidence level. The spatial dependence on mortality rates and the proportion of delayed diagnosis (PDD) were verified by the Moran Global index and the Local Spatial Association Indicator. Early diagnosis was analyzed using Pearson's chi-square test and multilevel Poisson regression. The average age-adjusted mortality rate between 2011 and 2015 was 12.8 deaths per 100,000 inhabitants. The high mortality rates from lung cancer were significantly associated with the density of general practitioners (PR = 1.68), establishments qualified in oncology (PR = 1.49) and inversely associated with % of poor (PR = 1.73) and, they presented spatial autocorrelation (Moran = 0.5; p = 0.01). The multivariate spatial model was constituted by the variables Establishments qualified in oncology, Income and Coverage of health plans and presented an explanatory power of 66% for lung cancer mortality. Between 2011 and 2015, the PDD was 85.49% for the population between 18 and 99 years old. PDD, combined for both sexes, showed low spatial autocorrelation, however significant (Moran = 0.37; p = 0.01) and correlation with Aging Rate (0.109; p = 0.010),% of Workers Exposed to carcinogenic agents (p = 0.019), Gini (p = 0.001) and Density of Primary Health Care Teams (p = 0.042). From 2006 to 2015, 87.71% of cases were diagnosed at an advanced stage. The age group of 50 to 59 years (PR = 1.04), male (PR = 1.02), non-white race / color (PR = 1.01), incomplete elementary education (PR = 1.05) and small cell tumors (PR = 1.08) are associated with advanced diagnosis. For the same period, the proportion of early lung cancer diagnosis was associated with an older age group (70 years or older - RP 1.30; CI 1.14-1.48), with higher education (RP 1.45 ; CI 1.24-1.69), female (PR 1.18; CI 1.10-1.26) and squamous cell tumor (PR 1.19; CI 1.10-1.29). Early diagnosis was not associated with contextual variables. There are inequalities in the distribution of lung cancer mortality rates related to the provision of health services and socioeconomic conditions. The absence of a direct relationship between the context and the stage of cancer in the diagnosis points to the greater influence that the individual and tumor characteristics have on the detection of cancer.

The Long-Stay Institution for the Elderly (ILPI) are a type of home assistance, collective and with longitudinal care, aimed at people aged 60 or over, with or without family support, where they must live in conditions of freedom , dignity and citizenship. However, in the history of the institutionalization of old age, these ILPI were also known as asylums that were sometimes configured as spaces for the exercise of Christian charity and for the protection of individual and family poverty, with rules to limit and homogenize the activities of sheltered elderly people. , depriving them of social and family life, which is observed in some ILPI even today. In this sense, questions arise about the care offered, whose reflection focuses on the process of asylum for institutionalized elderly people. The objective is to analyze the process of care provided to institutionalized elderly people, from the creation of ILPI to the present day. This research has a mixed approach, descriptive and exploratory and was carried out in public and philanthropic ILPI in Rio Grande do Norte, registered in the Unified Social Assistance System (SUAS) and recognized by the Health Surveillance. The fieldwork was carried out in the first half of 2019, using an instrument of direct observation, application of structured questionnaires and semi-structured interviews with actors involved in the foundation of the ILPI. The analysis of the data raised aspects that cross and condition the care offered to residents. Thus, the discussions are organized in three chapters, namely: 1- Profile of Long Term Care Institutions for the Elderly and residents' quality of life; 2- Institutionalization of the elderly: between curative and alienating care; and, 3- Live or coexist? Challenges and possibilities of care for the elderly in Long Term Care Institutions. Therefore, the reflection on the care offered at the ILPI shows a discontinuity in the dialogue between the social and health care networks, producing the need for transformation in the long-term care of the elderly. The networks need to come together for effective planning regarding public policies for the protection of the elderly, showing strategies that meet the needs of Brazilian society in aging, through services that support longitudinal care and promote the deinstitutionalization of elderly people in the ILPI who have the possibility of getting back together in their family and community.

The neonatal period requires qualified attention, given the newborn’s susceptibility to adversities. This study was intended to assess the accomplishment of the care actions recommended by the Brazilian Ministry of Health for the neonatal period and its associations with institutional characteristics and demographic partners. A longitudinal study was held in four public maternity hospitals in the city of Natal/RN, Brazil. The sample consisted of 415 mother/child binomials, being full-term newborns, weight ≥ 2.5 kg and Apgar ≥ 7.0. Data collection took place 48 hours after birth (in person), with seven days and 28 days of life (by telephone call). From the obtained data, five studies were developed, three cross-sectional, one longitudinal; and, in view of the current context of Covid-19, a reflective study. The studies addressed the following issues: (1) Care actions for the newborn and the continuity of care in the neonatal period; (2) Prevalence of the five neonatal screening tests; (3) Determinants of the supply of complement to breast milk in the first 48 hours of life; (4) Feeding practices in the neonatal period; (5) Challenges to maintain exclusive breastfeeding in view of the measures imposed to prevent transmissibility by the SARS-CoV-2 coronavirus. The statistical analysis included applications of Pearson’s chi-square and multiple Poisson regression, with a 95% confidence interval (95% CI). Of the 415 binomials initially assessed, there was a loss of 13.7% in the second period and 16.6% in the third period. The mothers, mostly, were in the age group of 20 to 29 years (46.5%), were married or lived in a stable relationship (79.0%) and had high school or higher education (65.3%). As for the newborn, most (52.5%) were male, with an average gestational age of 39.2 weeks and birth weight of 3.310g. The main results of the studies should be highlighted: (1) Of the 29 actions performed in the maternity ward and 11 in Primary Health Care, 22.5% were classified as satisfactory, 45% partial and 32.5% unsatisfactory. The adequacy of composite care indicators was associated with multiparous women undergoing vaginal delivery, and low complexity risk maternity hospitals. (2) The prevalence of the five tests (36.6%) was associated with mothers living in the state capital (PR = 1.36; 95% CI = 1.18-1.56) and with those who received guidance at the maternity hospitals (PR = 1.30; 95% CI = 1.08-1.67). (3) Half of the newborns received complementary breast milk, being 57.6% in the first hour of life and 92% with artificial formula, which was associated with maternal age ≤ 20 years (PR = 0.64; 95% CI = 0.47-0.86), primiparity (PR=1.37; 95% CI=1.11-1.60) and cesarean delivery (PR = 1.2; 95% CI = 1.00-1.45). (4) Regarding feeding practices, the prevalence of EBF was 48.7%, 91.6% and 83.3% at 48 hours, seven and 28 days, respectively. Early weaning was associated with the absence of paternal support (RR: 4.98; CI: 2.54-9.79) and the use of a pacifier (RR = 3.2, CI: 1.63-6.32) seven days, and only using a pacifier (RR = 2.48, CI: 1.53-4.02) at 28 days. (5) The mother/baby transmissibility by the new coronavirus is still a controversial issue that, given the uncertainties, may compromise team/family/mother/newborn interaction, as well as breastfeeding, in the first hours of life. The results underline the need to restructure care and readjust good practices that favor comprehensive and longitudinal care of the newborn.  

This thesis aims to evaluate main aspects of health staff professional training in Primary Health Care Multiprofessional Programs (PHCMP) in Brazil and their employability in Unified Health System (SUS) from graduates from 2015 to 2019. In order to achieve this objective, three studies were developed: a systematic review (SR), an evaluability study and a cross-sectional study. The SR sought to understand how professional training in PHCMP has been provided. The review was performed on Scielo, BVS and PubMed databases in 2019. Thirteen articles were included, from whom the following categories emerged: Mechanisms contribution to training through work; Definer strategies for professional training; Potentialities of PHCMP to health professional training and Experienced difficulties during professional training process. The evaluability study aimed to build and validate a matrix of evaluation criteria for PHCMP, covering the stages of elaboration of a theoretical logical model, proposal of a preliminary criteria matrix and validation by the Delphi consensus technique. The study was carried out in three rounds of validation, with the participation of 16 experts. A matrix composed by 44 criteria, organized in 11 sub-dimensions, which are grouped in the dimensions Personal motivation, Pedagogical approach and In-service education scenarios was obtained. The crosssectional study was performed on 365 graduates from PHCMP from 2015 to 2019, whose programs were affiliated to Higher Education Institutions, Government Schools and Public Health Schools in Brazil. Data collection occurred through online tool application composed by structured form approaching graduate main characteristics, professional training during undergraduate, employability with emphasis to SUS; beyond the previously validated criteria matrix. The cross-sectional study results were organized in three articles. The first one approached employability in SUS and its associated factors, finding a proportion of 47.9% of graduate working in SUS, being this outcome associated to graduate Nurses and Dentists (RP 1,87; IC95% 1,54 – 2,28) and to no insertion in stricto sensu post-graduate courses (RP 0,77; IC95% 0,61-0,97). Employability also revealed a great part of graduate precariously inserted to labor market. The preliminary results from the second article point out as main motivations to seek PHCMP those related to increasement of practical skills in real settings, beyond associations of Nursery or Dentistry and Pet-Saúde program participation to the outcome high affinity with working process in primary care. The third article results, which is in process of formulation, suggest professional training in PHCMP in line with contemporaneous demands of health professional training, with focus on integrality and prevention, although limitations are identified in practical scenarios and within individuals involved in professional training. The thesis in progress supports the potential of PHCMP in training differentiated professionals, at the same time that signals to necessity of qualification processes and the proposition of a valorization Health Residencies policy.

Introduction: The public health is constituted as a field of knowledge that aims to understand health and explain its social determinants, and the scope of practices aimed primarily at promoting it. Due to its characterization, public health is a field that has the potential to contribute to the reorientation of health practices of different health professions, such as speech-language-hering sciences. In Brazil, the speech-language-hearing therapists practice focused on school health, between the 1920s and 1940s, with practices based on health pedagogization and medicalization of education. Between 1950 and 1970, it directed it’s work to private offices and rehabilitation clinics. In the 1990s, with the recently created Unified Health System (SUS), public gaps were identified in the performance of the speech-language-hearing therapist, beginning studies to rethink their training in the health context. Purpose: To analyze public health training in speech-language-hearing undergraduate programs at public Higher Education Institutions (HEIs) in the Northeast. Methodology: For the production of the data, interviews were conducted with key informants, students and professors from seven public HEIs in the Northeast. The interviews were recorded, transcribed, categorized and analyzed through Content Thematic Analysis. In addition, a documentary analysis of the lattes curricula of the speech-language-hearing teachers responsible for the public health curricular components in the Brazilian public HEIs was identified using the “snowball” technique. This analysis allowed to characterize of the training, performance and publication of these teachers. The data produced were organized in IBM SPSS software version 20, generating descriptive statistics, and correspondence analysis was performed. Results: It was identified in the analysis of the students' interviews that they have training experiences in public health that favor learning in SUS, but that have weaknesses in interprofessionality and in the integration of content. In the interviews with teachers, it was observed that speech-language-hearing undergraduate programs have a heterogeneous approach to public health and a predominance of traditional methodology in curriculum, which favors a fragmentation of knowledge. In the analysis of the teacher education, performance and production characterization, it was possible to visualize the existence of teachers who did not have postgraduate training in public  health and who publish articles in the field of speech-language-hearing clinic. In addition, it is also possible to notice the existence of differences in the characterization of training and performance of teachers when analyzing this reality in the regions of the country, with the Northeast region having the most teachers with training, performance and publication in the area of public health. Final considerations: From the perspective of subjects involved with training, this work shows, in the context of the Northeast, the potentials and limits that speech-language-hearing undergraduate programs in public HEIs have for training in public health and SUS. Furthermore, the work expands the analysis to the national scope, through the identification of the characterization of performance, training and publication of teachers, aiming to stimulate reflection on how this profile can, in some way, influence the training in public health.

Introduction: Chronic spine problems are strongly present in society and have a relevant impact on public health due to their high prevalence and the rate of disability and absenteeism that they cause in the population. Much has been discussed about the possible causes of these problems, however little emphasis has been given to the social context and public policies involved in its genesis. In addition, further research is needed on the influence of lifestyle habits, such as the use of technologies and the management of these cases in primary health care. In addition to these aspects, these conditions can generate high waiting lines, increasing the waiting time for the treatment of these conditions. An organized PHC can reduce this high number of cases, in addition to contributing to infectious and contagious conditions, such as Covid-19. This thesis aims to analyze in a broader way the factors that may be associated with chronic spinal problems, as well as the impact of Primary Health Care on Covid-19 management and on the waiting time for the specialized physiotherapy service. Methodology: it is divided into four studies. 1) cross-sectional study, with multilevel analysis of factors associated with chronic back problems, based on the National Health Survey; 2) case-control study, with analysis of factors associated with chronic neck pain in young adults, based on primary data; 3) cross-sectional study, with multilevel analysis of factors associated with waiting time for specialized physiotherapy services, based on the National Program for Improving Access and Quality of Primary Care; and 4) time series with data on diagnosed cases of COVID-19 and their deaths as outcomes in the capitals of the Northeast region of Brazil. Results: a higher prevalence of chronic spine problems was found in females (PR = 1.23; 95% CI 1.15-1.30), aged over 49 years (PR = 1.75; 95% CI 1.1 -1.90), and in individuals who perform heavy activities at work (PR = 1.37; 95% CI 1.28-1.46). It was associated with worse self-assessment of health status (PR = 3.92; 95% CI 3.03-5.07), greater number of days with perception of depression (PR = 1.70; 95% CI 1.50-1, 94), and the presence of smoking habits (PR = 1.37; 95% CI 1.27-1.48). There was also an association for chronic spine problems in cities with a higher proportion of NASF per inhabitants (PR = 1.28; 95% CI 1.07-1.54). For chronic neck pain in young adults, a greater association was observed in individuals with greater sedentary behavior (OR = 2.41; 95% CI 1.01-5.88) and with vision problems (OR = 2.83; 95% CI 1 , 26-6.38). No association was found between chronic neck pain and postural habits and use of a cell phone. As for the waiting time for the specialized physiotherapy service, less referral time was found in the health teams that received support for the planning and organization of the work process (p <0.0001), in those that provide information about the health situation. health (p <0.0016), in teams that have a counter-reference (p <0.0001) and in teams that are supported by the NASF physiotherapist (p <0.0001. In the management of Covid, a greater coverage of PHC (p=0.01), in addition to a higher rate of social isolation (p=0.001) were shown to be mitigating factors for the dissemination of COVID-19 and its deaths. Conclusion: There is an association of chronic spinal problems with both biological and behavioral factors, and an importance of organization and greater coverage of PHC, both for a reduction in the time of referral to the specialized physiotherapy service, and in the management of Covid-19 , with a greater attenuation of cases and deaths in locations with greater coverage of PHC.

Hearing impairment compromises the child's language development and learning process. The Neonatal Hearing Screening programs aim to identify and treat children with disabilities early and must be integrated into the Care Network for People with Disabilities. This thesis aims to evaluate the Neonatal Hearing Screening programs and the Care Network for People with Hearing Impairment aimed at children born in the cities of Natal and Santa Cruz in the state of Rio Grande do Norte. This is a cross-sectional study, using secondary data. The target population are children born in three municipal public maternity hospitals studied in the period 2015 to 2019. Three studies were developed, of which the first two refer to the program in Santa Cruz. The first evaluated the quality indicators of the newborn hearing screening program and found that of the eight indicators, only three, retest and referral rates for auditory diagnosis and age at screening completion, are within the recommended range, the others are inferior or null. The second assessed access to child hearing health services and the factors that influence access to a newborn hearing screening program in the state of Rio Grande do Norte and found an evasion in access to the service and completion of the diagnosis and children are assisted at later ages. The mother's age and education and the distance between the municipality and the service did not influence access to and use of the service. The third study verified the quality indicators of the three neonatal hearing screening programs and analyzed access to the Hearing Health Care Network for children in the state of Rio Grande do Norte. Screening was not universal in maternity hospitals and access to the Network presents a high dropout rate, yet, therapeutic interventions were offered to children with hearing impairment. The results point to the need for improvements in screening programs both in maternity hospitals and in hearing health services, dropout is a problem and specialized assistance occurs late. The Network offered the treatment recommended by public policies for children with hearing impairment.

Even in an aging society, elderly people contribute to a restriction of individual experiences from the induction of universal old age, in which the extension of functional capacity and the need to justify its usefulness are premises of social approval. Objective: To develop a conceptual model based on Person-Centered Care and public policies for the protection of the elderly. Methods: This is an exploratory qualitative research with an analytical and documental approach, divided into five stages: (1) we carried out a documentary research on the factors involved in the process of formulating public policies for the protection of the elderly. We seek to understand the guidelines that establish its functioning and the power relations intrinsic to different sociopolitical and economic interests under the prerogative of biopolitics; (2) we conducted a Scoping Review, following the guidelines established by the Joanna Briggs Institute's (JBI) from the following research question: which initiatives are relevant to promote quality in Primary Health Care for the elderly in line with the dimension of quality PersonCentered Care; (3) documentary research to understand the power relations that determine the social construction of the elderly based on the National Health Promotion Policies; (4) qualitative research based on secondary data collected at the State Council for the Rights of the Elderly in the state of Rio Grande do Norte to understand the obstacles associated with the functioning of the rights councils for the elderly and (5) qualitative study considering the previous steps for the development of the conceptual model of care for the elderly with emphasis on the dimension of quality Person-Centered Care and Primary Health Care. Results and discussion: We found that the mechanisms of power implicit in the policies protect old age for better management and efficiency from the capitalist interests. The light of an uninterrupted youth ideal materialized by profit and productivity is denaturalized. Thus, the neoliberal ideology based on depoliticization and individualistic messages ignores the social aspects related to the elderly person's own trajectory to induce, according to a prescriptive and regulatory biomedical rationality, the utopia of achieving aging without old age and legitimizing the State's disaccountability as promoter of health and care for the elderly. Final considerations: In light of the above, we built a conceptual model for the care of the elderly, opposing the neoliberal precepts surrounding the commodification of health to the detriment of the sociopolitical role of the elderly and, therefore, the recognition of multidimensional aspects as essential social instruments of political emancipation and health promotion.

Introduction: Suicidal behavior is configured as a self-deliberate conduct with the purpose of causing harm or death, and can be understood as an interim between suicidal ideation, suicide attempts and that may culminate in the act of committing suicide. Farmers are at risk of suicidal ideation due to vulnerability and exposure to different factors associated with living conditions and work in the field. Objective: To analyze factors associated with ideation and suicide attempts in farmers. Method: This is a study of different methods. 1) a systematic review of observational studies on factors associated with suicidal behavior in farmers was developed, with searches in PubMed, LILACS, Web of Science, Scopus, PsycInfo and CINAHL databases; 2) cross-sectional study, carried out from August 2019 to March 2020, with 450 farmers in Rio Grande do Norte, where the prevalence of suicidal ideation was assessed through the Beck Suicidal Ideation Inventory, and sociodemographic variables were analyzed, of health, income, work; 3) case-control study, in order to assess suicidal behavior considering suicidal ideation and suicide attempt, in which the sample corresponded to four controls per case and, to compensate for possible losses, 15% was increased, with the final size defined in 62 cases and 288 controls. Results: 14 studies were included in the systematic review, and factors associated with suicidal behavior in farmers were identified in mental health (depression), seasonal impacts (drought) and occupational exposures (herbicides and insecticides). In the cross-sectional stage, the prevalence of suicidal ideation was 12.4% (95%CI 9.69-15.84). In the final multivariate model, the variables associated with the highest prevalence of IS were: female gender (PR=3.28), having a diagnosis of mental disorder in the family (PR=2.37), presence of common mental disorder (PR=2. 50), alcohol abuse (RP=2.22) and being salaried or temporary (R=1.91). In the case-control study, a positive and significant association was observed between suicidal behavior and having a diagnosis of mental disorder in the family (OR=2.30), having a common mental disorder (OR=3.16), having previously undergone health treatment mental (OR=3.08), perform salaried or temporary work (OR=2.69) and have been poisoned by pesticides (OR=3.34). Conclusion: suicidal ideation and suicide attempt in farmers are mainly associated with health aspects, especially mental health, work and the female gender, and signals the need to strengthen public policies for suicide prevention with targeting strategies effective for the rural worker.

With the objective of reducing risks in health services, the National Health Surveillance System implemented the Integrated Plan for Health Management of Patient Safety in Health Services (2015). This plan instituted the Self-Assessment of Patient Safety Practices so that each hospital service with an intensive care bed would report its compliance with legal provisions. Although the self-assessment or self-inspection of health services is a practice applied internationally and nationally, it is necessary to analyze the reliability of the information produced with this type of regulatory intervention. Thus, this project proposes to conduct a national primary study to analyze the reliability of the Self-Assessments of Patient Safety Practices in Brazil. This is a cross-sectional study to analyze the reliability in which they will be calculated: a) general agreement index; b) specific agreement index; c) point and interval estimation (95%) of Kappa; d) correlation coefficient for the difference indicator of percentage of adhesion. The sample will be random stratified composed of 66 health services in the country that participated in the Self-assessment in 2018. Upon official request from Anvisa, the Sanitary Surveillance teams of the respective municipalities / States where these services are located, will interview those in charge of the Safety Nuclei of the Patient following a questionnaire specifically designed for this purpose. This tool is based on the Self-Assessment Form to check the compliance of information provided by self-inspection. The results are expected to provide evidence on the validity and usefulness of this national intervention for patient safety and a better knowledge about the use of self-inspection as a method for monitoring and controlling risks in health services.

Introduction: Adolescence is an important phase of transition of human life. Lifestyle represents conscious actions that reflect personal attitudes and values, the individual's perception is associated with their quality of life. Its influence can provide the maintenance of well-being, favoring longevity or generating problems and health problems still in adolescence or adulthood. Objectives: To produce an indicator of health risk behavior and an inherent to the school structure, and tonalyze the influence of individual and contextual factors on the behavior of risk to the health of adolescents. Method: The data originated from PeNSE (2015), a sample of 102,072 questionnaires. The analysis focused on the association of the frequency of consumption of healthy and unhealthy foods, physical activity practice, alcohol and tobacco use in relation to the socioeconomic dimension of the school and the influence of the school environment. For the risk profile, a factor analysis was performed. The was fit using the polycoric matrix. Then, the variables related to the school were submitted to analysis from the item response theory (TRI) technique. To verify the factors associated with risk profiles, the final modeling for observing the effect on outcomes was obtained from Poisson's multilevel regression. Results: It was observed that the healthy eating behavior positively associated with females, Brancthe, aged 12-14 years whose mothers had at least complete elementary school, living in Capital, in the most developed regions, in socioeconomic situation in the upper or upper tercil. Regarding low healthy eating and physical activity, a positive association was observed with females, age group 15-18 years, whose mothers have not studied, live in less developed regions, and are in socioeconomic situations of poverty. The high use of smoking and alcohol consumption presented a positive association with males, aged between 15-18 years. In multilevel analysis, for the and high unhealthy eating score, being female (PR=1.10) is a risk factor, with an association of 10%. About contextual factors private schools (RP=1.12) and with a regular structure (RP=1.12) or good (RP=1.14), establish a risk association of 12-14% the structure of the school. The healthy eating score and low physical activity, convergence was not achieved. For high smoking use and alcohol consumption, being female (RP=0.87) is a 14% protection factor. Age between 15 and 18 years (PR=1.36) establishes a risk association at 36%. Attending private school assumes protection association in 12% (RP=0.88). Conclusion: The school becomes a privileged place for health promotion, because it is a social space where schoolchildren spend much of their time. However, it is necessary to promote actions in intersectoral partnerships, mobilize resources, integrated and coordinated efforts and actions, as well as to advance communication and health education, by appropriate means that new times require when considering, in particular, the connection with the interests and possibilities presented by youth.

The NASF were created with the objective of strengthening, integrating and expanding the activities developed by the Health Familly , being a specialized support of performance guided by Matrix Support. In the work routine, there are some obstacles for the NASF to be effective in the face of the health situations of the territories it supports. Thus, the objective of this study is to understand the work process of the NASF in a capital city in northeastern Brazil, based on the perception of its professionals. This is a case study with a qualitative approach, carried out with 11 professionals. For data collection, the semi-structured interview and empirical field observation were used. The data were processed through Content Analysis, categorizing the findings using the Thematic Analysis modality. All participants were publicly contested in the municipality, distributed in three NASF teams, the majority being female (n = 9), with an average age of 56 years. The professional categories that were interviewed include Physiotherapists, Physical Education Professionals, Nutritionists, Psychologists and Social Workers. From the analysis of the empirical material, five thematic categories emerged: The NASF work agent; labor relations and their implications for health practices; an incorporation of NASF's means of work; presentation of the work scenario of NASF professionals; and the paths taken, the future and uncertainties. According to the data obtained, there was no training in health that would instrumentalize professionals for SUS, the work with the supported teams develops in a distant way, with isolated actions, and the work relations with the management are marked by a lack of dialogue between peers and pressure for productivism. Regarding Matrix Support, professionals recognize their conceptual aspects, but there is still the reproduction of the logic of referral and a defense by activities of assistance nature. Work tools are also recognized, but underutilized in conducting cases. In the groups conducted by the NASF, although they did not present a defined methodology, efforts were noticed to incorporate practices based on Popular Education in Health. The work scenario has some limitations, such as the precariousness of the Health Care Networks and lack of inputs and materials for the development of activities. Even so, it is evident that the provision of NASF services has broadened the scope of the ESF's actions and the professionals note that it is not possible to discuss resolvability of the service without mentioning points that interfere with the work developed. Faced with the new PNAB, some professionals feel comfortable prioritizing individual care and others recognize the threat of losing the matrix function of the Centers. NASF still faces many difficulties in establishing itself as decisive and essential for PHC in Brazil. It is necessary to review the guiding documents of the work so that its performance is enhanced, redirecting the practices for the defense of Matrix Support as guiding this work, in order to strengthen the permanence of the NASF with the Family Health of Brazil.

Introduction: The National School Feeding Program (PNAE) is one of the oldest and most comprehensive programs related to Food and Nutrition Security (FNS) of schoolchildren. Through Law 11. 947/2009 30%, of foodstuffs must coming directly from family farming. Objective: To characterize the scenario of the acquisition of food from family farming under the PNAE in the municipalities of the state of Rio Grande do Norte accompanied by the Collaborating Center for School Food and Nutrition (CECANE / UFRN) in 2017 and 2018. Method: This is an evaluative research with ecological design, whose information was analyzed according to data from (CECANE) linked to the Federal University of Rio Grande do Norte (UFRN) from 2017 and 2018. The sample consisted of 31 municipalities where It was analyzed the percentage of food acquisition from family farming to PNAE in 2017 and 2018, as well as the possible difficulties in relation to this process, being variables related to the management model, bureaucratic demands, internal demands and forms of acquisition. Results: It was found that the municipalities that received monitoring and advice from CECANE in 2017 and 2018, more than 50% reported having purchased food from family farming in the previous year and said they are buying it in the current year. All municipalities reported using the centralized management model, 29% reported acquisition below 30%, 9.7% reported acquisition above 30% and 61.3% were unable to report the percentage in 2017 and 2018. Related to bureaucratic demands, It was observed that the intersectoral articulation and the public call notice were considered difficult in the process of buying and selling these foods. Concerning the internal demands the hygienic-sanitary conditions necessary for the farmer's regularization as fit to supply proved to be a point that may impact the percentage of purchase, and as regards the forms of acquisition, acquisition of organic foods and / or agroecological to be a major difficulty, listed by 80.6% of the municipalities.

Access to prenatal care is the main promoter of healthy birth and the main preventive measure of maternal mortality from preventable causes in primary care. Early entry to this service makes it possible to reach the appropriate number of consultations, as well as the performance of the recommended procedures and suitability definers. Race / skin color is an important predictor of the population's health status, as well as a marker of social inequalities. The objective was, then, to carry out a systematic review of the literature and meta-analysis of cross-sectional studies, to identify the prevalence of access to prenatal care in the first trimester of pregnancy according to race or ethnicity and its magnitude of association. The protocol for this review is registered on the PROSPERO platform under number CRD42020159968. Searches were conducted at PUBMED, LILACS, Web of Science, Scopus, CINAHL and in the gray literature (Google Scholar and Opengray), using the descriptors "pregnancy", "prenatal" and "Accessibility to health services". The quality of studies and the risk of bias were analyzed using the Joanna Briggs Critical Assessment Checklist for Cross-Sectional Analytical Studies. After the analysis steps, 17 studies were included in this review. The extracted data were tabulated and distributed qualitatively and quantitatively through meta-analysis. It was observed that, in most of the included studies, black women were those who had less access to prenatal services in the first trimester, with a prevalence of access ranging from 53% to 56.4%; white women between 74% and 76.5%; and those of other ethnicities from 64.2% to 68.8%. In the quantitative analysis of the data, it was found that black women, when compared to white women, had a 43% less chance (OR = 0.57 95% CI 0.51-0.64) of obtaining obstetric care in the first trimester, and of 22% less chances when compared with women of other ethnicities (OR = 0.78 CI 95% 0.65-0.95). Thus, it is concluded that black women, even when contrasted with white and other minorities of similar sociodemographic characteristics, still received a difficulty in accessing maternal health services, and it can be inferred that the issue of race / skin color is itself an important determinant in obtaining obstetric care, requiring the development of public policies aimed at this population and expanding their access to health services.

Introduction: Although it is a physiological event, institutionalized birth is a complex process that often results in unnecessary interventions and harm. To reduce maternal and neonatal morbidity and mortality, which is intrinsically related to quality of care, the World Health Organization (WHO) developed the Safe Birth Checklist. Studies demonstrate their potential effect on improving good practice, but new studies need to assess their impact on adverse events and health outcomes. Objectives: (1) to evaluate and compare adherence to Good Practice (GP) and incidence of Obstetric Adverse Events (AE) in maternity wards in Brazil and Mexico; (2) develop a platform for monitoring childbirth care indicators; (3) analyze the effect of the intervention with the checklist on the quality of care. Method: This is a multicenter research carried out in hospitals in Brazil and Mexico, part of the WHO Safe Childbirth Checklist Collaboration initiative. An uncontrolled quasi-experimental time series design was performed with retrospective analysis of birth records from 2015 to 2016 for 24 successive biweekly measurements and cross-sectional analysis before-after longitudinal measurements. 1,440 deliveries were reviewed in two hospitals in northeastern Brazil and 2,707 in five Mexican hospitals. Chi-square statistics and control graphs were performed to evaluate the performance of the transverse and longitudinal estimates, respectively. The software for collecting, monitoring and analyzing indicators was developed with Information Technology professionals to issue evaluation reports containing descriptive tables and longitudinal and cross-sectional graphs of estimates. Results: Before the implementation of the checklist, a low adherence to BP and a high incidence of AE was identified in institutions in both countries, especially in Brazilian hospitals (26.8% of BP and 16.0% of AE) and those specialized in pregnancy high risk (24.5% BP and 27.2% EA). After the implementation of the checklist in Brazilian services, even with a relatively low level of completion (20.7%), a significant increase (p <0.001) was found in the general compliance with 9 BP recommended by the checklist for the management of hypertensive disorders and of immediate care for mother and baby was 45.4% in the reference period and rose to 49.2% after the intervention (relative improvement of 7.0%; p <0.001). There was also a significant reduction in the rate of deliveries complicated by severe hypertensive disorders, hemorrhage and AS and in the incidence of uterine rupture, obstetric hemorrhage and severe hypertension. The development of the Plataforma QualiParto (in Portuguese) (qualiparto.ccs.ufrn.br) allowed participating services to use a system to monitor and evaluate outcome indicators and care processes of childbirth. Conclusions: The main results of this study (knowledge of the obstetrics GP and AE profile, intervention with checklist and development of technology for quality monitoring allowed the contextual identification and prioritization of interventions for quality improvement and benefited the care of mothers and newborns and the organizational management of services, making obstetric practices safer and more effective.

Dentofacial deformity (DDF) can be understood as a distortion in the process of skeletal and dental development, leading to a geometric discrepancy between maxilla and mandible, affecting the functions of the stomatognathic system and facial aesthetics, with psychological and social consequences. Its treatment is carried out in an interdisciplinary way, mainly involving surgery, and orthodontics. The aim of this study is to determine the accuracy of IOFTN in screening the need for surgical treatment in patients with DDF in the Brazilian population, validating it through an integrative review on its use, and verifying its validity by comparing its results with clinical indications between those who need and not undergo a surgical procedure to correct Dentofacial Deformity. In the integrative review we obtained 13 studies that used IOFTN in its methodology. All studies used secondary data, obtaining 90.7% of individuals classified in the categories “Great need for treatment” (class 4) and “very great need for treatment” (class 5). All patients in the study who had an indication for surgery were classified in classes 3, 4 and 5. 85.5% of them in classes 4 and 5. Among those who had no indication for surgery, 79.2% were class 1 and 2 (who do not need to perform a surgical procedure). The accuracy values were considered good, with an ideal cutoff point between classes 2 and 3, where the highest diagnostic precision (90.91%) was obtained, with 100% sensitivity and 79.17% specificity. From that point on, sensitivity tends to decrease and specificity increases. Therefore, classes 3, 4 and 5 are effective in determining the need for surgical treatment of DDF. With that, we can say that the IOFTN is an effective and reliable index to predict, in a clear and objective way, the need for orthognathic surgery. 

Introduction: The National School Feeding Programme (PNAE) is one of the oldest programmes in Brazil in the area of Food and Nutrition Security in Brazil (SAN) and with a significant number of students attended, which makes it important to evaluate the implementation and impacts of this programme. Objective: to evaluate the contributions of direct food purchases from family agriculture to the PNAE on SAN in Brazil. Method: This is an evaluative research, using secondary data, in which different methods are used: an integrative review of the literature; a spatial correlation analysis to know the spatial distribution of the purchase of food from family agriculture and analysis of purchase trends in the years studied; and a third descriptive analysis of the deficit of stature and the percentage of resources used in the purchase of food from family agriculture with analysis through the t-test for independent samples, and multivariate analysis performed through multiple linear regression with significance of 0.05%. Results: the main contributions of the purchase of food from family agriculture for school feeding on the FNS reported were the access to diversified, mostly in natura, minimally processed and organic food; the formation of local food production and distribution markets bringing the consumer and the small producer closer together; the access to food with better nutritional and hygienic sanitary quality; and the incentive to promote healthy eating habits. Regarding the panorama of the use of PNAE resources for the acquisition of food from family agriculture, the percentage of municipalities that comply with the legal requirement rose from 34.3% in 2013 to 43.7% in 2016, with the largest number of municipalities in the southern region of the country with 72.5%, while only 26.1% in the Midwest, 27.4% in the North and 31.6% in the Northeast. The South region stands out when compared to the others (p = < 0.001). The trend analysis of the union's annual budget resources showed an average growth of 30.8% (CI = 13.2-51.1). When assessing the difference in averages between the purchases and the deficit of stature in under five years there was a statistically significant difference in the deficit of stature in the municipalities that used < 30% and ≥30%, with a difference of 1.47%. As well, in the multiple analysis it was found that the variables with independent effect on the stature deficit in children under five years, besides the purchase of food from family agriculture, were the HDI, Gini Index, illiteracy rate and proportion of extremely poor children. The linear regression model showed that for each percentage point of increase in the use of resources for the purchase of food from family agriculture to the PNAE by the municipality there will be, on average, a decrease of 0.55% in stature deficit, independent of the other variables. Conclusion: from the results it can be concluded that the purchase of food from family agriculture for the PNAE in Brazil promoted the improvement of the SAN in its different dimensions and reduced the deficit of stature in children under five years. 

Quality of life (QOL) studies have been increasingly valued, given the growing aging population and increased survival of individuals with Chronic Noncommunicable Diseases (NCD). The identification of conditions that may be related to the QOL of people can help explain the heterogeneous distribution of adverse health issues. Besides, it provides decision-making support to those responsible for the management, and it can expand government actions to ensure better social, economic, and health conditions for the population. This study aimed to identify socioeconomic, demographic, lifestyle, health, and food security characteristics that may be associated with the QoL of adults and older adults in the city of Natal, Brazil. Cross-sectional research performed using data from the BRAZUCA Natal study. A group of 295 adults and older adults of both sexes aged over 20 years, residents in Natal-Brazil participated in home interviews, using a digital questionnaire (Epicollect5). The WHOQOL-bref questionnaire used to the measured quality of life and the food insecurity by the Brazilian Food Insecurity Scale (EBIA in Portuguese). Also, socioeconomic, demographic, lifestyle, and health data were collected. Data analysis was performed from the absolute and percentage frequencies, and Poisson multivariate regression was used to verify the association between quality of life domains (physical, psychological, social relations and environment) and two general questions “Perception of QOL” and “Satisfaction with health”  with the independent variables. Stratified analysis carried out to determine the association between the food security situation and QOL among people with food safety - SA (n = 152) and Food Insecurity - IA (n = 143). For the general population, being non-white people (PR = 1.56; 95% CI 1.10-2.19) and being mildly insecure (PR = 2.53; 95% CI 1.62-3.96) moderate (PR = 3.19; 95% CI 2.03-5.00) and severe (PR = 2.86; 95% CI 1.65-4.95) were associated with a higher probability of Perception of regular quality of life , bad or very bad. Satisfaction with regular, unsatisfactory, or very unsatisfactory health was associated with mild food insecurity (PR = 1.73; 95% CI 1.26-2.37), emotional disorders (1.88; 95% CI 1.43-2,49) and having hypertension (1.39; 95% CI 1.05-1.84). In the stratified analysis, being sedentary, sleeping less than 7 hours a day, having diabetes, hypertension, overweight and emotional disturbances were associated with a low perception of QOL (in different domains) in both groups (SA and AI). In group IA, in addition to the factors mentioned, being elderly, not having a partner, not having daily availability of water, and drinking untreated water was associated with a low perception of QOL, highlighting the social vulnerability of this group. In addition to conditions related to social and health inequities, QOL was shown to be associated with conditions related to physical and mental health, NCD, and their risk factors, regardless of being in a situation of AI. However, in the AI group, the condition was worsened due to the lack of adequate access to water, doubly violating the right to adequate food.

Breast and cervical cancers stand out among female cancer types with high incidence and mortality rates, which have considerable regional differences. The discussion on inequalities in the diagnosis and death due to breast and cervical cancer enables the understanding of the understanding of these diseases at the individual and population levels. The objective of this thesis was to analyze the staging and mortality from breast and cervical cancer and its connection with socioeconomic context and the distribution of health services in Brazil. Five observational studies were developed, one of the classic ecological type, two cross-sectional studies and two of the ecological type of spatial analysis. The mortality data were collected from the Mortality Information System (SIM). Individual data related to the diagnosis of cancer were obtained from the Integrator of Hospital Cancer Registries (RHC). The contextual socioeconomic variables were collected in the Atlas of Human Development in Brazil and the data on offer of health services from the National Registry of Health Institutions (NRHI), the Outpatient Health Information System (SIA-SUS) and the Agency National Supplementary Health (ANS). The mortality analysis was performed using the Poisson regression with robust variance. For the analysis of advanced staging, the Multilevel Poisson Regression model was chosen, with a random intercept. In the spatial analysis, the Moran Global Index and the Local Spatial Association Indicator (LISA) and the models with global spatial effects were used. The main results were: (1) The average age-standardized mortality rates for cervical and breast cancers were, respectively, 5.95 (±3.97) and 10.65 (±3.12) per 100,000 women. The high mortality rate from breast cancer was associated with a higher density of general practitioners and a greater offer of health services in oncology. The high mortality rate due to cervical cancer was associated with higher rates of local social inequality and lower levels of human development in the regions evaluated. (2) The proportion of late breast cancer diagnosis in Brazil was of 40.0%. Advanced staging was associated with individual and contextual factors related to public access to health services and the low density of mammography equipment. (3) In 32.4% of cervical cancer cases, staging was absent, significantly associated with individual and contextual factors in the provision of health services. The proportion of advanced staging was 48.4%, with association with individual and contextual factors of public access to health services and the low proportion of cytopathological exams. (4) Advanced staging of breast cancer presented positive spatial correlation with the Gini Index and a negative one with the density of gynecologists. Mortality rates presented a positive spatial correlation with the HDI and the density of gynecologists. (5) Advanced staging of cervical cancer presented a positive spatial correlation with the Gini Index and a negative correlation with the proportion of beneficiaries of private health plans. Mortality rates presented a positive spatial correlation with the Gini Index and a negative one with the density of gynecologists. The study highlights the social inequalities involved in advanced staging and mortality from breast and cervical cancer in Brazil. The importance of structuring equality in the access to health services and technologies in the Brazilian territory is highlighted. In addition, the reorientation of public health policies would make it possible to optimize the control, prevention and timely treatment of breast and cervical cancer.

Introduction: Wins instrumentalist musicians belong to a specific group of individuals who use the vocal tract intensely in the exercise of their professional activities, which can lead to the development of work-related voice disorders. These disturbances can be triggered or aggravated by individual, organizational and environmental factors of the work. Objective: This study aims to verify the perception of vocal tract discomfort associated with the working characteristics of instrumental musicians in the city of Natal-RN and to identify the presence of vocal and laryngeal symptoms and associated factors in these professionals. Methodology: The sample consisted of 117 professional and training musicians, who answered a questionnaire of socioeconomic characterization, demographic and health conditions and habits, as well as filling the Vocal Tract Discomfort Scale (EDTV). A Systematic Review was also performed on the electronic databases Science Direct, Scopus, Web of Science, PubMed and LILACS, gray literature as well as manual search, without limitation of date and language, as directed by PRISMA. A title and summary analysis was carried out, followed by the analysis of the full text, risk assessment of bias (Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies) and synthesis of the results. The research was conducted independently by two researchers. Results: The most frequent DTV symptoms reported by the musicians were dryness (53%), irritated throat (35.9%) and sensitive throat (30.8%). Similarly, these symptoms presented higher averages in EDTV before and after the practice of the instrument, the dryness symptom being more frequent the more intense. Musicians who report muscle pain, gastroesophageal reflux, and respiratory allergies have a greater number of DTV symptoms. According to the six studies selected for systematic review, the main vocal symptoms in musicians of blowing are: dysphonia, altered vocal quality, hoarseness and voice failures - laryngeal symptoms - dryness, sore throat, throat irritation, throat clearing, discomfort and tension. The associated factors identified to these symptoms were the shorter time of profession, intense use of the instrument and individual vocal issues. However, the methodological discrepancies between the studies, especially in relation to the heterogeneity and size of the sample and the instruments used, signalize great variability and compromise the reliability of the results. Conclusion: The symptoms of vocal tract discomfort are present in high frequency in wind instrumentalists musicians, being more frequent in musicians with less instrument study time. In addition, the various vocal and laryngeal symptoms found in wind instrumentalists musicians in the selected studies were associated with individual factors (prior vocal alteration, inadequate vocal habits) and organizational factors of the work (time of profession, intense use, type and instrument technique). We also reinforce the need for health education actions for these professionals taking into account physiological aspects as well as working conditions.

The study analyzes the performance of the Public Prosecutor's Office in the defense of health for the strengthening of NASF's through the Health Defense Offices of Natal and the assistance of the Operational Support Center to the Health Protection Justice Prosecutors (CAOP) in order to identify as this work contributes to the strengthening of the Expanded Nuclei of Family Health and Basic Care (NASF-AB). It is a qualitative research of descriptive exploratory type that used as a collection instrument semi-structured interviews applied to key informants, having as subjects of the research the professionals who are part of the team of the Office of Justice of Defense of Health of Natal, including the promoters and their holders; professional member of the team of the Operational Support Center of the Justice Ministry of Health Defense; the professionals that integrate the Family Health Strategy teams of the municipality of Natal with the support of NASF-AB; and professionals who are part of the teams of the Expanded Nuclei of Family Health and Basic Care in Natal; with a total of 23 participants. In addition to the semi-structured interviews, a documentary analysis was carried out at the Office of Justice of Defense of Health of Natal, including Civil Inquiries, Recommendations and complaints received, all referring to NASF-AB in Natal; and also the analysis of the queries answered (doubts of the prosecution) and the reports of visits, all carried out by the CAOP Saúde team; and also of the strategic project of the Public Prosecution Service that included NASF-AB as one of its axes. Regarding the results, it can be seen that the performance of the Office of Justice of the Health of Natal is aimed at expanding the number of NASF-AB teams and structuring the working conditions of the teams already implemented, it is a focused work however, NASF-AB professionals revealed a dissatisfaction about the direction of this action due to the few advances made. And as for CAOP Saúde, this directs its action focused on the NASF from a Strategic Project, but focuses only on the municipalities of the interior of the state, not being requested to support the prosecution of Natal on this issue, failing to contribute with a more specialized look at this problem.

The advances of health policies from the Federal Constitution of 1988 are unquestionable. However, deficiencies in the physical structure, financing and management have meant that the Unified Health System was not able to meet the health needs of the population in its fullness. Changes in the epidemiological profile of the population and technological advances have caused the population to turn to the judiciary to satisfy their health demands. This practice has become increasingly recurrent and has become what is now called the Judicialization of Health, a multifaceted phenomenon with controversial views among the authors. Among the demands in the field of health, the processes that call for drugs stand out, and in this segment one of the biggest financial impacts is linked to antineoplastic drugs, since cancer is a group of chronic non-communicable diseases, which occupies a leading role among the largest causes of death in the world, and whose technological contribution to its treatment is constantly being renewed. This is a descriptive study of lawsuits claiming antineoplastic drugs that have the state of Rio Grande do Norte as sole defendant or in solidarity with other entities, between the five-year period from 2013 to 2017, analyzed by indicators withdrawn of the manual "Evaluation indicators and monitoring of drug lawsuits". A total of 145 procedures were collected, which were analyzed according to the socio-demographic characteristics of the author; Procedural characteristics of lawsuits; Medical-sanitary characteristics of actions and Political-administrative characteristics of actions. The findings so far show that the global expenditure of the defined temporal scope was R $ 17,745,602.70, with a greater number of cases coming from the capital of the State and of the Municipality of Mossoró, composed mostly by female individuals 60 and 69, represented by public defenders. 68% of the individuals had access to the medication, which had a purchase made mostly by the author of the action (62%).

Infant mortality is the term used to designate all deaths that occur in children under 1 year old of age. It is the most effective indicator in the evaluation of the health situation of the population. Over the last twenty-five years, it has been possible to observe a reduction in infant mortality in Brazil. It has been shown that the country has achieved four of all objectives of the Millennium Development Goals before 2015. In 2006, the Pact for Life was released highlighting infant mortality in one of its indicators, being divided into three pacts: reduction of neonatal mortality, infant mortality due to diarrhea and reduction of infant mortality due to pneumonia. This study aims to evaluate whether the goals of the Pact for Life established by Ordinance N º 399 has been reached in relation to neonatal mortality rate for diarrheal diseases and pneumonia before and after its release in 1996 decades to 2005 and 2007 to 2016. It appears as an epidemiological ecological study of time series and spatial correlation, conducted through the Mortality Information System, considering the years 1996 to 2016, excluding 2006 due the fact it is the year of implementation of the Pacto Pela Vida. For the development and analysis of the data the 161 Intermediate Regions of Urban Articulation were considered. The coefficient of infant mortality in the years studied was determined as a dependent variable and secondary dependent variables: coefficient of neonatal mortality, coefficient of infant mortality due to diarrhea and coefficient of infant mortality due to pneumonia.  As independent variables were selected: Human Development Index, Gini Index, percentage of poor, Bolsa Famíliacoverage, Primary Care coverage, nurses rate of family health strategies per thousand inhabitants, physicians rate of health strategies family per thousand inhabitants and coverage of childcare consultations. The descriptive data were analyzed in the software Statistical Package for the Social Sciences, then the mortality data were specialized in TerraViewto determine the spatial autocorrelation and bivariate analysis was used GeoDa software, and correlated the coefficient of infant mortality with the independent variables of the study. It was found that neonatal mortality only reached the target goal of 5% decrease in 2007 and 2016, while mortality from diarrhea and pneumonia did not reach the goal proposed by the indicator in any year (decrease of 50% and 20% % respectively). In addition, infant mortality decreased in the two decades analyzed, with a mean coefficient of 22.67 in the first decade and 14.30 in the second decade. When spatially evaluated, high coefficients of infant mortality were found with positive association when compared to neighboring regions. In addition, the spatial distribution presented statistical significance in all the independent variables of the study. Based on the results, it was possible to identify that the goals of the Pact for Life were not met, making it necessary to review health actions, suggesting that there is a fragility even if there are public health policies for children that aim at reducing those diseases that must corroborate with the improvement of child health indicators.

The fast transition in the demographic and epidemiological profile has recorded the increasein longevity, chronic illness and the prococity of disability, making the health system lessprepared to meet the growinf demando f people with non communicable chronic diseases,especially those with two or more, known as multimorbidity. This study aims to estimate theprevalence of multimorbidity in the brazilian population (≥18 years old) and to know itsassociated factors considering he data from the National Health Survey (PNS), 2013. Inprinciple, a systematic literature review was conducted based on the PRISMA protocol, inorder to identify the impacto f multimorbidity on workers' health. After the review, a crosssectional study was developed based on the data from the PNS, 2013, with 60,202 people over18 years old. Survey questions were used to answer wheter the individual had alread receivedthe   diagnosis   of   some   of   the   chronic   diseases   included   in   the   study.   We   analyze   theprevalences of multimorbidity in relation to socioeconomic characteristics, lifestyle and work;bivariate analysis with obtaining the prevalence ration (RP),  confidence intervals at a leve of95% (CI 95%); and multivariate model through Poisson regression, with Wald test robustestimation, for significant variables in the analysis.. The prevalence of multimorbidity was19.98 (95%CI: 19.29% - 20.70%) and was associated with the female gender. To the agerange of 60+, to live with the spouse, to ingest alcoholic beverage moderately, to be formersmoker, to be illiterate, to live the urban área, have health insurance, perform night work andhave already suffered some work accident. A low prevalence of multimorbidity was estimatedin the economically active brazilian population and was associated with labor, socioeconomicand lifestyle characteristics.   

This study aimed to elaborate and validate an instrument to evaluate the quality of care for childhood cancer. This is a cross-sectional quantitative diagnostic study, developed in 2018 and 2019 in the city of Natal/RN, in two stages comprised in the elaboration of the instrument and the validation of the instrument content by experts. The sample was selected by intentionality, following the inclusion criteria, so that the invitation to the judges was through an electronic form, obeying all ethical aspects for the research. The elaboration phase of the instrument was understood through the meeting with the experts, which directed the literature review that culminated in the elaboration of the first version of the instrument. Starting the second stage of the study, the instrument was subjected to expert evaluation, according to the Delphi technique, and should be evaluated by them, judging each item using the established Likert scale, until agreement was measured using the of the Content Validity Index by Item (IVC-I) and the Content Validity Index (IVC) of the instrument, adopting as a minimum reference value 0.78, and an acceptable agreement rate of 80%. Given the meeting of experts, it was possible to determine that the instrument would be organized by four domains: prior to diagnosis; for the diagnosis; treatment; after treatment. Thus, the evaluation criteria were defined, which were translated in the first version of the instrument with ninety-five items. After the first round of evaluation by the experts, of the 17 invited judges, 12 proceeded with the evaluation. It was observed that only 14 items presented CVI-I lower than recommended, CVI corresponded to 0.89, however CVI based on the criteria of the assessment used was equivalent to 0.75 which indicated the need for adjustments. Thus, 50 items were revised, 14 were deleted, 3 were added and 13 were kept according to the original wording. Therefore, the second version of the instrument was elaborated and submitted again to the judges, presenting IVC-I for all items with values above 0,78, in addition to IVC equivalent to 0.98, and according to the evaluation criteria. obtained an IVC of 0,99, compared to the participation of only ten judges. Thus, in view of obtaining agreement between the judges, the instrument was validated according to its content, tense in its final version the existence of eighty-four items. For this instrument the score was proposed based on the percentage of positive responses by domain, and overall, according to three evaluation categories: presence of weaknesses to obtain quality; presence of improvement opportunities to achieve quality; presence of strongholds to obtain quality. The use of such an instrument will contribute to the assessment of the quality of care attention for children and juvenile cancer, thus allowing the diagnosis of this, in order to guide the interventions to optimize the results obtained, consequently directing the organization and formatting of the care attention pursuing the destination of higher quality care attettion for children and young adults.

The present work deals with a qualitative research, using as methodological instruments: indepth interview and documentary research, focusing on the thematic content analysis based on Bardin. The objective was to understand the articulation of Primary Care in the Health Care Network for end-of-life care, through the analysis of how actions are developed and articulated health care services to assist people in end of life in the understanding of professionals and health managers. The study was developed in the state of Rio Grande do Norte and had as collaborators the managers and health workers who work in cities with more than 100,000 inhabitants: Natal, Mossoró, Parnamirim and São Gonçalo do Amarante. The collaborators were the Health Secretaries of the cities, the heads of the Primary Care Departments, as well as primary health care doctors, nurses and nursing technicians. The sample size of doctors, nurses and nursing technicians was defined by theoretical saturation. . The narratives were analyzed and categorized following the steps proposed by Bardin: Pre-analysis, Material Exploration, Coding and category selection. The thematic categories were related to the objectives of the work and later grouped into sections for discussion of the results. The complexity of living with the phenomenon of death, described by the research participants, points to an ambivalence: Death that is seen naturally, while there is great difficulty in dealing with it. The structure of the health system and lack of training were pointed out as elements that hinder end-of-life care, in addition to the absence of specific guidelines and provisions that offer subsidies, and the doctrinal principles of SUS were pointed as guidelines. It is considered that this study is an invitation to rethink practices, but also to problematize the very structure of the system. It is an appeal that adds to the struggle for the right to comprehensive care, which considers not only health-related needs but also those related to death.

Cochlear Implant (CI) is an electronic device capable of partially replacing a sensory organ in individuals with severe to profound hearing loss. Brazil currently has 26 referral centers that assist the deaf population at all ages, both in the private network and in the Unified Health Service. The objective of this study is to know the sociodemographic profile and the etiology of deaf children submitted to cochlear implantation by the Unified Health System in Rio Grande do Norte. This is a cross-sectional study, based on information from medical records of children using cochlear implants throughout the state, at the cochlear implant referral service, Otomed Clinic. The study population consisted of children from 0 to 12 years old, of both sexes, users of cochlear implants, who underwent surgery and activation between January 2008 and December 2017, residents of the state of Rio Grande do Norte. For the analysis of qualitative variables, it was used the description of absolute and relative frequencies and for the quantitative variables were extracted the measures of central tendency and dispersion. The qualitative analysis also considered the descriptions of the cases with the dissertation of the particular findings of the relevant cases. The partial results show that the service has been working positively regarding the equitable access of low-income families and early diagnosis, however, it was also observed the negative aspects such as the lack of etiological diagnosis of deafness, the cochlear implant after the critical period for oral language development and the failure of medical records.

The aim of this study was to analyze an association of socioeconomic factors with the quality and practices of municipal management in primary health care in Brazil, from a perspective of Planning, Self-Assessment and Institutional Support (AI). An ecological cross-sectional study with aggregation at the municipal level, conducted in 5324 Brazilian municipalities participating in the third cycle external evaluation phase, and statistical data on the final EAB certification of the Access and Quality Improvement Program - PMAQ-AB (2015- 2018). The dependent variables to the management were the activities of Planning, Self-Assessment and Institutional Support by EAB, after grouping by municipality and organization by participation were classified as: 1- “No team perform (2) - what is the quality of AB, how was the EAB grouped into: 1-Good Teams ”; 2- “Bad Teams”, and the answers were categorized as: 1- “No good (bad) teams”; 2- “Partially good (bad)”; 3- "All teams are good (bad)". The contextual independent variables were: Municipal Human Development Index - MHDI; Gini Index; Proportion of 15-24 year olds who do not study, do not exercise and are vulnerable in the vulnerable population in this range; Proportion of extreme poverty; adopted the categorization from the median.  In order to evaluate the associated factors, Pearson's chi-square test (Qui²)  was used. As the main results were observed on the Planning, Self-Assessment and Institutional Support activity, there is a significant association (p <0.001) for the population size, small size municipalities (up to 20,000hab), the best percentages and greater homogeneity within the population. of the territory; In general, the municipalities of the interior perform more as activities than the Brazilian capitals. In regional terms (p <0.001), the municipalities in which all teams develop better management are concentrated in the Northeast (Planning-89.9%; Self-assessment-72.9%; AI-85.1%) and less in the Northeast. North region (Planning-80.4%, Self-Assessment-48.3%; AI-69.1%). When it comes to socioeconomic aspects, or the percentage of management activities is detected in all as EAB in smaller municipalities (Gini up to 0.4900), (Planning-85.3%; Self-assessment- 76.3%; AI-80, 9%); low HDI (up to 0.6630) (Planning-89.1%; AI-83.6%), highest extremely weak proportion (> 6.880) (Planning-89.2%; AI-83.3%). The best teams (good teams) are concentrated in inland municipalities (24.1%), small, up to 20,000hab (29.1%); in the Northeast (26.3%) and lower in the North (10.6%), with lower inequality (Gini up to 0.4900) (28.6%) and highest mean extreme poverty (24.6%). the teams are in municipalities with the best HDI (33.8%); The results show the advancement in shared management, especially in the interior and small municipalities, induced by the equity policies, and expansion of the ESF, strengthening the National Policy of Primary Care, despite the challenges to be overcome, to achieve a management that impacts the work process of the Primary Care Teams and the reduction of regional inequalities.

The objective of this study was to identify the prevalence of multimorbidity in the elderly in Brazil and its factors associated with socioeconomic and lifestyle variables. This is a cross-sectional, population-based study. The database was used for the National Health Survey. The elderly were considered multimorbital when they had a diagnosis of two or more chronic diseases. In the analysis of the data, the chi-square test was used and then the prevalence ratios were estimated by means of Poisson multiple regression, both with 95% confidence level. A total of 11,697 elderly people with a mean age of 70.1 years participated in the study. The prevalence of multimorbidity was 53.1%. As a result of the multivariate analysis, the elderly (p<0.001), the older (p=0.002), those who are not single, more strongly associated with widowers (p=0.001) and those with health insurance in the (p<0.001) are associated with multimorbidity. Compared with the elderly with two chronic diseases, women are associated with three (p=0.003) and four or more chronic diseases (p<0,001). In addition, hypertension and high cholesterol (31.3%), hypertension and stroke (30.9%) and hypertension and diabetes (23.3%) were found to be the most prevalent conditions for those with multimorbidity. There was association of the first condition with the female sex (p<0.001), younger elderly people (p<0.001) and the fact of not smoking (p = 0.005). On the other hand, the second condition was associated with female gender (p = 0.001) and low level of education (p<0,001). The third group was associated with low educational level (p=0.020), those who did not exercise (p<0.001) and did not smoke (p<0.001). It is concluded that multimorbidity in Brazilian elderly is a very common condition and that it has been influenced by socioeconomic factors and little related to lifestyle. However, for the main multimorbities, in addition to socioeconomic conditions, lifestyle also influenced their prevalence.

Malnutrition in elderly people is related to the fragility, multimorbidity and mortality. In order to identify the risk of deficits early, anthropometric methods based on weight, height, perimeters and skinfolds can be used, which allow for the evaluation of anthropometric indicators. When it is not possible to measure weight and height, estimative equations can be used from these measures. The objective of this study was to evaluate the anthropometric nutritional status, to develop and validate equations for estimating weight and height in elderly living in nursing homes. The study was conducted with elderly people living of nursing homes in Brazil. Anthropometric data (weight, height, body perimeters and skinfolds) were collected for each participant. For analyze the anthropometric nutritional status Principal Component Analysis stratified by sex was performed and the factorial scores of the chosen model were evaluated in relation to the age group, type of nursing home, racial/ethnic identity, schooling, burden of disease and functional capacity. Methods of weight and height estimation were elaborated by linear multiple regression. The regression models developed considered statistical reliability criteria, such as the coefficient of determination (R²), the standard error of the estimate and the Akaike Information Criterion (AIC). The prediction equations were validated by concordance tests such as the Intraclass Correlation Coefficient (ICC) and its respective confidence interval (95% CI). For all analyzes, p values <0.05 were considered statistically significant. Regarding the analysis of main components, the extracted components were denominated "Anthropometric Nutritional State (ANS)" and "Stature (S)". It was verified that the elderly people living in non-profit nursing home (male ANS = -0.855, female ANS = -0.952, male S = -0.919, female S = -0.711), non-white color (male ANS = -0.866, female ANS = -0,816, male S = -0,783; female S = -0,700), low level of schooling (male ANS = -0.973, female ANS = -0.931, male E = -0.846, female E = -0.692), and with a restriction of mobility (male ANS = -0,855; female ANS = -1,076) were the ones that presented the lowest score in the evaluation by the joint indicators. In relation to the development of weight equations, we developed models of predictive equations broken down by the perimeter of the arm, another model adjusted to the statistical criteria, and a third model of equations with measures that are easy to obtain in bedridden or wheelchair-bound elderly. The most appropriate model is calf circumference, knee height, waist circumference, subscapular skinfold, age and sex (ICC = 0.876). Regarding the development of equations of height estimation, models were developed with measurements of knee height, hemi-span, demi-span or ulna length. The most adjusted model uses knee height, age and sex (ICC = 0.863). The components "Nutritional Status" and "Stature" were extracted, which had relation with, especially, the restriction of mobility. The development of weight and height estimation methods followed statistical criteria and the convenience of collecting the component variables of the models.

Sexual violence has a major impact on individuals, families and society in general. In addition to being a violation of human rights, it causes profound damage to physical, sexual, reproductive, emotional, mental and social well-being. However, due to their nature, their occurrence and impacts are often veiled, resulting in a significant underestimation of the actual level of damage caused. This type of injury has been registered in all countries, but the issue is still little investigated in developing countries. In this perspective, this paper aimed to know, from a conceptual and epidemiological point of view, the situation of sexual violence in Brazil, analyze its evolution over the years and its association with contextual characteristics and social inequities. To do so, this study was developed from six different designs in order to contemplate as much as possible the strands that involve such a complex phenomenon. In the first study a conceptual essay on sexual violence was carried out. In the other studies, an epidemiological approach was adopted using ecological designs with different statistical models. As for the units of analysis, individual data were used, from the municipalities and Brazilian federal units. The results analyzed in all the studies were the occurrence of sexual violence, in different calculations, with data collected by the Violence and Accident Surveillance System (VIVA) and / or National System of Public Security and Criminal Justice Statistics (SINESPJC). The independent variables used were individual characteristics collected by VIVA; contextual characteristics related to education, economic, social and employment conditions extracted from the Brazilian Census; and contextual variables related to health services, social services and public safety, obtained respectively from the National Registry of Health Establishments (CNES), the Public Health Information System (SIOPS), the Census of the Single Social Assistance System SUAS) and the Brazilian Yearbooks of Public Security. Descriptive analyzes, mean comparisons, multilevel Poisson analysis, multiple linear regression analysis for panel data, inequality analysis and multiple linear regression were performed. The results point to an unequal gender structure in Brazilian society, with a male hegemonic pattern that establishes behaviors and social positions, which has favored sexual violence. As for the associated factors, both individual and contextual characteristics are related to sexual violence, observing a strong contextual effect, at the level of federative units. The records of sexual violence were more prevalent in Brazilian municipalities and federative units with better socioeconomic conditions. These records varied over the years 2010 to 2014 between the Brazilian federal units, with an overall increase over the years. In the same period there was an improvement in the indicators of economic and social conditions in the Brazilian states and municipalities, with the highest records of sexual violence associated with the best living conditions in all years. There was an increase in the inequality of the rate of notifications of sexual violence as a function of household income and HDI. There was a reversal in the reports of sexual violence structured by social inequality in Brazil. There was an increase in the reporting rate of sexual violence, which was accompanied by a simultaneous increase in reporting inequality. Rates of records of sexual violence vary according to the registration system. In general, the police system recorded more sexual violence than the health services system. There is considerable underreporting of sexual violence in the VIVA system, especially in the southern region of the country and in small towns. However, in some federative units, the VIVA registry is more efficient in capturing sexual violence than the police system. Contextual factors are also associated with sub-registration of sexual violence in different information systems on the subject. It is concluded that more incisive gender equality policies backed by the reduction of structural violence are still necessary in Brazil to confront sexual violence. In addition, guarantees of basic rights, such as education and income, are also needed, both to reduce the statistics of the problem and to improve the registration of this grievance in the national information systems. More equitable income distribution and increased social development are also relevant factors in combating sexual violence in the country. Finally, it is understood that for the construction of more assertive health policies in the fight against sexual violence, it is necessary to compile information from different sources, considering that there is currently a considerable underreporting of the VIVA system, the main governmental tool of situational analysis of violence in the country.

The underreporting of deaths due to falls in the elderly has been commonly observed. In this regard, the probabilistic relationship of records has been increasingly used in the identification of subregistrations and for the improvement of information quality. The objective of this study was to evaluate the accuracy of the probabilistic relationship in the identification of deaths by falls individuals aged 60 and over in the State of Rio Grande do Norte, in the years 2010 and 2015. This is a Diagnostic study based on in the probabilistic relationship (linkage) of death records by falls reported to the Mortality Information System (SIM) and hospitalizations with falls information in the Hospital Intervention System (SIH) using RecLink software. In 2010 and 2015, a total of 23631 deaths were reported to the elderly, and 106 (0.45%) of them were caused by falls. In the same period, the SIH reported 3107 hospitalization procedures for the elderly with primary or secondary diagnosis of falls, of which, 163 died, a difference of 57 deaths. The method presented sensitivity of 99.9% in 2010, specificity of 74.7%, positive predictive value of 65.4%, negative predictive value of 99.9% and accuracy of 82.8%, in 2015 these values were, respectively, 99.8%, 83.8%, 62.6%, 99.9% and 87.2%. After linkage the specific mortality coefficient for fall was adjusted in 2010 from 15.9 to 65.2 / 1000.000hab, and in 2015 from 14.7 to 64.3, an increase of 308% and 333% respectively. These results suggest that the probabilistic relationship of registers is a valuable tool in the identification of under-registration in the systems. It is observed the need to qualify the morbidity and mortality data by falling in the elderly in the NB, so that the epidemiological picture can be closer to reality and that this data can serve as a basis for the design of strategies for health promotion and prevention of this aggravation.

Since changes in the oral cavity that cause aging lead to physiological changes that predispose the elderly to develop periodontal diseases, which is the most common condition, causing changes in periodontal tissues that most often culminate without edentulism. Before that, this research aimed to investigate a periodontal condition in institutionalized and non-institutionalized elderly from philanthropic and private institutions. This research is characterized by being a qualified prospective cohort for 128 elderly, 94 non-institutionalized and 34 institutionalized elderly. Most of the elderly were diagnosed with periodontics in stages I/II and grade A. The periodontal condition of the elderly is applied by individuals suffering from institutional damage or not seen by those suffering gingival bleeding, dental calculus, shallow and deep periodontal pocket. As latent variables created from the periodontal condition were Periodontal disease, Periodontal disease sequel and Deep periodontal pocket. There was a significant relationship (p <0.05) between functional capacity and periodontal impact factors and Deep periodontal pocket. The worsening of the Deep periodontal pocket factor was associated with variables institutionalization, diabetes and cognitive ability. It was concluded that in relation to periodontal diagnosis, the majority of the elderly have a higher prevalence of periodontics in recent groups and granules, as well as the elderly who were not institutionalized, non-diabetic and oriented are related to the worst Deep periodontal pocket. 

Communication skills used as an important tool for patient-centered health systems and services. An effective professional-patient relationship should consider the patient's needs, placing them as an active subject in the decision-making process of their healthcare. Improved care can be stimulated through assessment and training in communication skills that enable behavioral changes in clinical practice. This study aims to develop technologies to improve communication skills of primary health care professionals. It is structured in a two-phase methodological model. Phase 1 includes the Systematic Review study and the process of cross-cultural adaptation and validation, and phase 2, the construction of the training protocol. The implementation of the Systematic Review was designed to provide scientific information on effective communication skills training to improve the self-efficacy of health professionals. We included 5 clinical studies investigating the effectiveness of communication skills training by searching 8 databases, extracting information on time, content and assessment methods employed. The quality of the studies was assessed by Risk of Bias by RevMan software. The review pointed out that the programs include content related to the basic concepts of communication, contextualized to the context in which professionals are inserted, and patient-centered. They use student-centered learning strategies such as videos and role play, pointing to improved communication skills after the intervention. the process of cross-cultural adaptation and validation of the Self-Efficacy Questionnaire (SE-12) was performed using standard methodology, through the following steps: conceptual and item equivalence, semantic equivalence (translations, retranslations, formal appraisal, discussion and synthesis, and pretest), operational and idiomatic equivalence, and measurement equivalence through Cronbach's Alpha (α) internal consistency analysis and exploratory factor analysis. A viable instrument was produced for the Brazilian context, which after some adjustments was considered valid, presenting high internal consistency (α = 0.946), and factor analysis indicating a single dominant factor in SE-12, with high correlation between items. Phase 2 is the construction of a communication skills training program for health professionals, consisting of 2 content modules, which should address basic concepts and specific themes of communication through active learning methodologies. The program should be implemented through 3 meetings in each module, with follow-up at 12 months. The evaluation of the participants should take place in six moments, through the Self-efficacy Questionnaire (SEbr-12) and the Jefferson Empathy Scale. The systematization of scientific evidence, the construction of an accurate and useful measure to assess the self-efficacy of communication of health professionals, and the proposal of a communication skills intervention program can instrument the improvement processes that focus on focused care. to the patient.

The objective of this study was to analyze the inequalities in spatial distribution of mortality among young people aged 15 to 29 years due to violent causes in Brazil. This is an ecological study in the 482 in the Immediate Regions of Urban Articulation (RIAU) of Brazil. The spatial distribution of violent deaths, intensity and significance were assessed using the Global and Local Moran index, their correlation with socioeconomic variables, and the Years of Life Lost (YLL) indicator for the period from 2001 to 2015 for five years. There were 425,180 deaths of young people due to violence in Brazil. Deaths were obtained in a secondary way from the Mortality Information System and the socioeconomic indicators of UNDP. The RIAUs that presented the highest Standardized Mortality Rates from 2001 to 2005 were: Foz do Iguaçu (48.45 deaths/ 100 thousand young people), Recife (42.26 deaths/ 100 thousand young people) and Vitória (37.18 deaths / 100 thousand young people); from 2006 to 2010: Foz do Iguaçu (48.12 deaths/ 100 thousand young people), Maceió (43.95 deaths/ 100 thousand young people) and Porto Seguro (40.40 deaths/ 100 thousand young people). From 2011 to 2015: São Miguel dos Campos - AL (53.29 deaths/ 100 thousand young people), Porto Seguro - BA (48.74 deaths/ 100 thousand young people) and Maceió - AL (45.13 deaths/ 100 thousand young people). The Moran Global test pointed to a pattern of spatial dependence in the distribution of rates for the North, Northeast and Southeast regions. These deaths resulted in a loss of YLL of 6,435,042.5 years in the first period, 6,494,960 years in the second and 7,216,005 in the third. The mean age of death is at 22 years of age, resulting in a mean PWL / death of 47 years. The ratio of YLL to sex ratio was 15.09 from 2001 to 2005 and from 15.22 from 2011 to 2015. Male overmortality is observed for all quinquennia, as well as for the black population, compared to the white population. The bivariate analysis showed that, among the 9 selected socioeconomic indicators, all correlated significantly with the RIAU Standardized Mortality Rate (p<0.05). It is concluded that violence mortality is unevenly distributed in the immediate regions, forming clusters in the north, northeast and southeast of the country. Although with a weak correlation with the socioeconomic factors, there was an unequal distribution in the territory, as well as differentials of YLL by sex and race / color.

Objective: To evaluate the Residual Monomer Release (RMR), Flexural Strength (FS), 

elastic modulus (EM) and cytotoxicity of GDMA-P-based experimental adhesives (EA). Methodology: EA 

were divided into 9 groups according to the following parameters: a) monomeric %mass 

of GDMA-P/HEMA/UDMA (10/30/30, 20/30/20 and 30/30/10); mol% of photoinitiators 

CQ/BAPO/EDMAB/DH (1.0/0.0/1.0/0.2, 0.0/1.0/0.0/0.2; 0.5/0.5/1.0/0.2). For cytotoxicity, NIH-3T3 

cells and the MTT Assay and Alamar Blue (n = 8) assays were used. For FS and EM, the method described 

in ISO 4049 (n = 7) was followed. To assess RMR, 54 third molars were used to obtain a flat area of dentin 

(n = 6), which received the adhesive systems and the MRL was read in a high performance liquid chromatography 

apparatus after 24 hours. Statistical analysis was performed with two-way ANOVA and Tukey post-hoc test 

(p<0.05). Results: for Alamar Blue, there was no difference among the 10%, 20% and 30% concentrations. 

Among the photoinitiators, CQ and BAPO alone presented better values for 30% and CQ + BAPO for the 20% 

concentration. For MTT Assay, there was no difference among photoinitiators and % of GDMA-P. For RMR, for 

the same photoinitiators and different concentrations of GDMA-P, the 10% concentration released more HEMA. 

For the different concentrations of GDMA-P and the same photoinitiators, the groups containing CQ released more 

HEMA. For UDMA, among the groups of photoinitiators, only CQ presented differences, being the percentage of 

10% of GDMA-P that most released UDMA monomers. For the three concentrations of GDMA-P, CQ released more 

UDMA monomers. For the release of GDMA-P, among the same photoinitiators, the concentration of 10% provided 

greater release of monomers to the groups containing CQ. Among the same concentrations and different 

photoinitiators, CQ provided greater release of GDMA-P to 10% and 30%. For the 20% concentration, BAPO 

allowed the highest release. For FS, 10% of GDMA-P presented differences between the photoinitiators, being the 

BAPO group the highest FS. The BAPO + CQ mixture allowed a higher FS value for the 20% and 30% 

concentrations. For EM, 30% GDMA-P was the only one to present significant difference, being the BAPO + CQ 

group the highest value. Conclusions: 20% and 30% concentrations of GDMA-P associated with the BAPO + CQ 

photoinitiator group may provide better results for the properties tested.

Aim: To identify the prevalence of the use of antipsychotics in elderly in Nursing Homes in the city of Natal-RN. Methodology: A cross-sectional study based on data from the project "Human Aging and Health: the reality of the institutionalized elderly in the city of Natal / RN", which occurred between October to December 2013 in 10 Nursing Homes of the city of Natal. The sample consisted of 320 residents of Nursing Homes who were 60 years or older who consented to participate in the study. For the identification of factors associated with antipsychotic prescription, bivariate analysis was used using the chi-square test and Poisson regression in which the dependent variable was the number of prescribed antipsychotics. Independent variables included age, gender, type of Nursing Homes (for-profit and non-profit), mental disorder, depressive symptoms, polypharmacy, cognitive impairment, functional capacity and morbidities. A multivariate analysis was performed from the Poisson Regression model with robust variance. Results: The prevalence of antipsychotic use among the elderly was 50% (n = 160). In the for-profit institutions, 65.5% (n = 76) of the elderly used at least 1 antipsychotic, whereas in non-profit Nursing Homes, the prevalence was 40.9% (n = 83). Multiple analysis showed that the age of 60 to 79 years (PR = 1.39), had moderate to severe cognitive impairment (PR = 1.78), had a mental disorder (PR = 2.07), had polypharmacy PR = 1.30), being in For-Profit Institutions (PR = 1.51), presented statistical association (p <0.05), to the greater use of antipsychotics in the elderly in the Natal’s Nursing Homes. Conclusion: A high prevalence of antipsychotic use was observed in Nursing Homes in the city of Natal and due to the possible negative outcomes that this may generate, other measures that result in decrease of the prescription of these medications should be evaluated.

Introduction: Hearing is fundamental for the development of language and learning, social interaction, acquisition of knowledge and makes it possible for the individual to transmit thoughts and feelings. Early prevention, identification and intervention of auditory changes are essential because of their relevance to language and learning aspects and to reduce costs with the consequences of hearing impairment. Objective: to analyze the prevalence of hearing impairment in schoolchildren in the city of Natal / RN and its associated factors. Methodology: This is a cross-sectional study that analyzed 238 primary school children and adolescents, enrolled in public schools in the city of Natal-RN, evaluated by meatoscopy, audiometric screening with a Telehealth Audiometer and self-rated hearing loss and earache evaluation. The bivariate analysis was used to identify factors associated with hearing loss using the Chi-square, Fisher's Exact and Prevalence Ratio tests, considering a significance of 5%. Data were analyzed in SPSS 23. Results: the prevalence of hearing loss was 16% (11.7% -21.4%); 20% reported ear pain and 26.1% presented altered meatoscopy. About 90% of the participants belonged to the economic class C-D-E; the mean age of participants was 10.76 years. The prevalence of hearing loss was higher among schoolchildren who reported hearing difficulties and earache, among children aged 6 to 12 years and type of airway infections (p <0.05). Airway infection (PR = 3.37 CI 95% 1.48-7.68) was found as a risk factor associated with hearing loss. Conclusions: the prevalence of hearing loss in schoolchildren in the city of Natal is above that reported in other studies conducted in Brazil for this age group, which shows the need for fonoaudiologic care, in order to systematize actions of hearing health promotion for this population in the city of Natal-RN.

Chronic diseases represent a problem of great magnitude and are the main cause of death today. It is pertinent to highlight that Systemic Arterial Hypertension and Diabetes Mellitus are among the main causes of morbidity and mortality due to these diseases. The objective of this study is to evaluate the indicators of morbidity and mortality in the Northeast of Brazil from Chronic Non-communicable Diseases - specifically Systemic Hypertension and Diabetes Mellitus, considering actions recommended by the Ministry of Health based on the External Evaluation of Program for Improving Access and Quality of Primary Care. This is a retrospective study, whose data were obtained in secondary banks, on actions developed by the Primary Care teams for chronic diseases and obtained in the Portal of the Department of Basic Attention of the Ministry of Health regarding the External Evaluation in cycles 1 and 2 of that program. The data for calculations referring to mortality and morbidity rates were obtained from the Health Information Systems on Mortality and Hospitals, respectively, through the Information System of the Unified Health System. The results showed that 5,549 teams of Basic Care, of the Northeast Region, participated in the improvement program in cycle 1 and, in cycle 2, this number was 10,678. The nurse was the professional who most answered the interview. Most of the teams said to program actions for hypertension, being 90% in cycle 1 and 96.6% in cycle 2. For diabetes were 90.1% and 96.1%. It is expressive the number of teams that referred to request specific tests, to have registered users and to schedule the actions from the stratification of cases for Hypertension and diabetes. The correlation between the morbimortality rates for both diseases presented a heterogeneous distribution and the concentration of these rates even in places with high coverage of Primary Care. The spatial analysis presented a poor autocorrelation for the rates but presented statistical significance (p<0.05) in the majority. On the spatial correlation with the coverage of Basic Attention in some analyzed places, it was possible to observe a significance of  95%. The study concludes that a significant number of Primary Care teams participated in the Basic Attention Improvement program in the Northeast Region. These presented positive answers for most of the questions about the management of hypertension and diabetes. Despite a high coverage of Basic Care and a poor correlation presented, morbidity and mortality indicators were unevenly distributed in the territory of the delimited Region, which reveals a need for state analysis.

Introduction: Temporomandibular dysfunction (TMD) is a condition that affects the chewing muscles, temporomandibular joint (TMJ), and associated structures. Such condition has high prevalence and implies in the biopsychosocial behavior of the individual, reflecting in damages the quality of life. Of multifactorial character, numerous options of therapy are available for the TMD, but without clear evidence of isolated effectiveness. Objective: The present study aims to evaluate the effectiveness of conservative therapies isolated for TMD, as well as their interference on quality of life, pain and anxiety in patients with dysfunction. Methods: A double-blind randomized clinical trial with TMD patients diagnosed by the Diagnostic Criteria for Temporomandibular Dysfunction (RDC / TMD) was performed. 85 patients were randomly assigned to four different groups: counseling (CA), manual therapy (TM), occlusal plaque (PO) and plaque associated with counseling (PO + AC) and evaluated without therapy and at 1 month and 3 months after therapy. The statistical test Slip Plot ANOVA with a confidence level of 95% was used. Results: all therapies were effective over time for the variables: pain (p = 0.000), oral health impact on quality of life (p = 0.000), general quality of life (p = 0.029) and physical p = 0.000), psychological (p = 0.006) and social p = 0.017) and anxiety through BAI, HADS and IDATE trait (p = 0.000, p = 0.000 and p = 0.002, respectively). Conclusions: conservative therapies (counseling, physical therapy, and plaque in association with counseling) were effective in improving pain symptomatology, anxiety and quality of life over time, but no therapy was superior to another.

Introduction: breast cancer is the type of neoplasia that has the highest incidence and the highest mortality rate in the female population worldwide. Affecting both developing and developed countries. Purpose: To evaluate the spatial distribution of mortality from breast cancer in the Intermediate Regions of Urban Articulation of Brazil from 1998 to 2015. Methodology: This is an ecological study carried out in Brazil through the 161 Regions of Urban Articulation that analyzed the deaths of women caused by breast cancer between the age of 50-69 years and its association with the ratio of screening mammography exams, population coverage estimated by the Primary Care teams, coverage of women with private health plans and the index of municipal human development (IDHM). It was calculated in terraView the global and Local Moran index for the mortality standardized rate (TMP) for breast cancer. In Geoda, the bivariate analyzes were performed between the mortality rate and the socioeconomic and service indicators; The local bivariate Index of Moran and representations by means of the Dispersion Diagram of Moran Bivariate and Lisa Cluster Map were calculated. Results: Breast cancer mortality rates in the period 1998-2006 ranged from 0.23 to 7.67 deaths per 100,000 inhabitants. (Moran index: 0.733, p-value: 0.01) with higher rates found in the South and Southeast regions; in the 2007/2015 period ranged from 0.23 to 8.73 / 100,000 inhabitants. (Moran index: 0.594, p-value: 0.01), the high rates were observed in the South, Southeast, Midwest and Northeast regions. In the bivariate analyzes, positive correlations were obtained between TMP for breast cancer and the ratio of mammographic examinations (I = 0.352), private health plan (I = 0.436) and IDHM (I = 0.733) and a negative correlation with the primary care (I = -0.116). Conclusions: Mortality from breast cancer has increased in the country over the years and the services and socio-economic indicators do not seem to contribute to a reduction of mortality, requiring reassessment and reformulation strategies that contribute to the reduction in mortality from breast cancer.

Aim: To analyze the behavior of peri-implant tissues during rehabilitation with   provisional crowns in superior esthetic region. Methods: This longitudinal observational study evaluated the periodontal condition of 16 patients rehabilitated with implant-supported provisional crowns in esthetic area using the parameters of Visible Plaque Index (VPI), Bleeding on probing (BoP) and Gingival Thickness (GT) of the adjacent teeth and the prosthetic space (PS) in T0 (before implant placement surgery), T1 (installation of provisional crown), and T2 (during soft tissue conditioning). The parameters: Probing Depth (PD), Transparency in Probe (TP), Height/Width of the interdental papilla (HP/WP), Height/Width of the provisional crown (HC / WC), and keratinized mucosa (KM) were performed on T1 and T2. The parameters of the implant-supported prosthesis were compared to the same aspects of adjacent teeth. Friedman and Wilcoxon tests were applied to analyze data from the follow-ups. The comparison between the rehabilitated region and the adjacent teeth were achieved using Wilcoxon test for paired sample. Both analyses showed significance level of 5%.  Results: The mean time of soft tissue conditioning was 40 days (mean of 2.6 sessions). There was an increase on the VPI between T0 (31.1%) and T2 (40.5%), but without statistically significant difference (p> 0.05). Regarding the BoP, it was not observed statistically significant differences over time (T0 - 21%, T2 = 20.8%). For GT, there was statistically significant difference between follow up periods (T0 - 1.66mm, T1 - 1.22mm, T2 - 1.16mm). The PD increased from T1 (1.76 mm) to T2 (1.86 mm) without statistically significant difference. The same was observed with an HC / WC (from 1.06 to 1.19) and HP / WP (0.62 to 0.84). The Wilcoxon test showed a not significant result between T1 and T2 for HP / WP (p <0.05) and HC / WC (p <0.05). When comparing the implant and the adjacent teeth area, the parameters that showed statistically difference (p<0,05) of means were: HP/WP in T1, with a lower mean (0,62) than the adjacent teeth (0.79); and GT at T0, when the implant area had a higher mean (1,66) than the adjacent teeth (1,18). Conclusion: For this study, the provisional implant-supported crown promoted alterations on the adjacent peri-implant soft tissue on GT, HP/WP, and HC/WC.

The judicialization of health is a phenomenon that began in Brazil after the Federal Constitution of 1988. This type of lawsuit has been growing in quantity every year, which directly affects health financing. The objective of this article is to characterize the legal claims for drugs in the State of Rio Grande do Norte in relation to the financial aspect in the years 2016 and 2017. This is a descriptive exploratory study, in which 370 individual 2016 and 2017, requesting medicines, moved in the State of Rio Grande do Norte. The amounts spent on the judicialization of medicines in these years were R$ 10.687.951,09. 572 drugs were required, 61.36% of which were outside the official list of drugs and the most demanded type of drug were antineoplastic agents and immunomodulators (24.13%). The purchase was made by the patient in 75.81% of the cases from the release of a court order. Thus, the judicialization of medicines in a small state causes iniquities in the access of users of the Brazilian health system to medicines and in the financing of Pharmaceutical Assistance.

The present study aimed to evaluate the best osteosynthesis arrangement in patients that underwent orthognathic surgery with mandibular advancement and mandibular angle clockwise and counter-clockwise rotation through a finite element analysis. A virtual model of a mandible was obtained via CT scan and then subjected to different kinds of surgical planning in the Dolphin® software. A total of 6 surgical plans were made and 6mm and 12mm advances were associated with linear, clockwise and counter-clockwise rotation of the mandibular angle. The virtually operated mandibles were then transformed in a solid framework in the NX 10® software. In this stage, the mandibular solids were meshed with the solids of the osteosynthesis plates and screws in a one or two plate fashion using 4 or 8 mini screws respectively. After the 12 solids were built, the Nastran software® was utilized to evaluate the superficial tensions after loading in the incisors region.

The Brazilian health regions correspond to 437 clusters of Brazilian municipalities and 1 that corresponds to the federal district, totaling 438 clusters. The distribution and composition of these regions is the responsibility of the states in partnership with the regional inter-agency commissions, with a great diversity in this distribution due to the peculiar dimensions and multiculturality of the Brazilian territory. This study aims to evaluate the regionalization of health in Brazil, the performance of the regions and associated factors, in light of the information provided by the health indicators, focusing on the hospital network. This is an ecological, multi-group, quantitative approach that incorporates descriptive and analytical statistical analysis using SPSS v. 24. Pearson's association and linear regression analyzes were performed, with the dependent variable being the proportion of hospitalizations within the health region and independent socioeconomic, structural, and health care variables. The period of analysis is from 2012 to 2016 and includes data from the Ministry of Health (DATASUS) linked to data from the Annual Report on Social Information and Atlas of Human Development in Brazil. The socioeconomic profile of the health regions presents better indexes in the South and Southeast regions of the country, with better HDI indicators, higher life expectancy, higher per capita income, lower percentage of those vulnerable to poverty and inadequate sanitary conditions. The health structure of the regions reveals that coverage and resources invested in primary health care are better in the Northeast, while the percentage of municipalities' own resources is higher in the Southeast. The number of beneficiaries of health insurance is higher in the Southeast. While the Central-West region has the highest number of hospitals per 100,000 inhabitants, the Southeast region has the largest number of beds and the Northeast region has the most basic care units. The Southeast region is the one that most invests in beds in detriment of the primary care units. The participation of SUS beds is greater in the Northeast and North regions. The South and Southeast regions have more doctors, nurses and intensive care beds. The health regions present in the South and Southeast of the country still stand out by interning patients within their regions of residence, maintaining the best indicators for the hospitalizations of urgency, medium and high complexity in their own health regions. However, the North region is the highlight for the number of hospitalizations in the own network, while the South region is the one that resorts the most to the private sector. The Central-West region is the one that presented the best indicators for medical consultation and outpatient production per inhabitant. The analysis of association with the hospitalization variable in the same region showed a significant correlation with the mean number of beds in SUS, life expectancy at birth and ambulatory procedures.

Objective: To evaluate the microtensile bond strength of repairs performed on bulk fill and conventional composite resins subjected to aging, after different adhesion protocols.Materials and methods: 42 specimens (8x8x4 mm³) of each of the following materials were prepared in shade A1: a microhybrid composite (Filtek Z250 XT-3M ESPE, St. Paul, MN, USA) and a regular consistency bulk fill (Filtek Bulk Fill - 3M ESPE, St. Paul, MN, USA). These specimens were aged by storage in artificial saliva at 37 ° C for 30 days. After, they received a mechanical surface treatment by means of abrasion with a diamond bur 4138F, followed by the division in six groups, according to the adhesion protocol employed: FSA - etching with 37% phosphoric acid + silane + conventional adhesive (Single Bond 2 - 3M ESPE, St. Paul, MN, USA); SA - silane + conventional adhesive; FA - etching with 37% phosphoric acid + conventional adhesive; A - conventional adhesive; FU - 37% phosphoric acid + universal adhesive (Universal Bond Single - 3M ESPE, St. Paul, MN, USA); U - universal adhesive. All specimens were repaired with Z250 XT composite, in shade A3, to differentiate them from the base materials. The repaired resin blocks were cut into sticks (8x1x1 mm³) and submitted to microtensile test. Fractured specimens were evaluated by macrophotography to determine the type of fracture (adhesive or cohesive). In order to analyze the differences among the adhesion protocols and among the composite types, two-way ANOVA statistical test was used, with a significance level of 5%. Results: No statistically significant differences were found in bond strength values among the adhesion protocols (p=0.38) and among the composite resins repaired (p=0.13), as well as no interaction between these variables (p=0.16). Conclusion: For the aging pattern adopted in this study, repair bond strength of bulk fill composites was similar to that found in conventional microhybrid composites, with no distinction between several adhesion protocols.

The objective of this study was to analyze the temporal distribution of infant deaths, bio sociodemographic factors related to infant mortality, the main causes, type of avoidance of death and factors related to the quality of maternal and child health care in Primary Health Care in Natal / RN, between 2003 and 2016, before and after the Pact for the Reduction of Infant Mortality in the Northeast and Legal Amazon (PRMI) (2003-2009 and 2010-2016 respectively). Ecological study, of a time series, carried out with data from the Mortality Information System. Infant mortality rates (IMR), neonatal (TMN) and post-neonatal (MTP), and IMR due to death and type of avoidance of death were calculated for each year evaluated. The join point method was used to calculate the Annual Percentage Change (APC). The bio sociodemographic variables were analyzed: sex, race, type of gestation, type of delivery, gestational age, and birth weight, comparing the periods of 2003-2009 and 2010-2016. To assess the association of these variables and the occurrence of infant death in the neonatal and post-neonatal period, the prevalence ratio (PR) and the 95% confidence interval were calculated. To evaluate the quality of care in Primary Care (AB), data from the Program for Improving Access and Quality of Primary Care (PMAQ-AB) 2014 were used. IMR significantly reduced -12.74% (95% CI -23.9 (-7.01% / year) and in endocrine and nutritional diseases (16.21% / year), between 2007 and 2011. From the causes of death, there was a significant reduction only in deaths due to respiratory diseases. The probability of avoidable death was higher in neonatal mortality for both 2003-2009 and 2010-2016 periods. From the bio sociodemographic variables analyzed, the type of gestation, gestational age at birth and birth weight were associated with neonatal mortality, with a higher probability of dying in the neonatal period; of twin gestation; premature and that presented very low birth weight in the two periods analyzed. Regarding maternal and child care, there was a significant increase in the number of pregnant women who performed more than 7 prenatal consultations (4.1% / year between 2003 and 2009) and the number of neonatal ICU beds (8.5% / year between 2005-2016). Of the total number of infant deaths, 1836 (71.7%) occurred due to preventable causes, the highest proportion being reduced by adequate attention to women during pregnancy (38%), which showed a tendency to increase between 2010 and 2016 (APC 6.59%). Regarding the quality of prenatal care, some indicators were found that may have a negative impact on the infant mortality rate: referral consultation (7.4%); existence of a system that alerts to the probable date of birth (10.2%); (34.7%) and early capture of pregnant women and complications during pregnancy (45.3%). It is concluded that PRMI's objective of reducing the IMR by 5% per year in 2009 and 2010 in Natal / RN was reached, but there was an upward trend in the succeeding years, which showed that efforts, were insufficient to keep infant mortality in decline. There is still a high occurrence of deaths due to preventable causes and failures in Primary Care assistance observed due to the low supply of some agreed maternal and child health indicators.

OBJECTIVES: This research was realized in vitro assay to evaluate the traction resistance of prefabricated surgical hook, threaded prefabricated hooks, hooks made of stainless-steel wire and surgical hook made of brass wire comparing different ways of fixing them and different commercial brands. MATERIAL AND METHODS: The sample consisted of 340 segments of orthodontic wire associated to surgical hooks divided into 34 groups. One of them was the control group with 10 hooks made of brass wire fixated with silver weld and the others 33 experimental groups were composed of 10 surgical hooks in each group. In 25 groups, the hooks were prefabricated, fixed to the orthodontic wires by means of manual pressure made with appropriate pliers associated to different quantities of electric welding points. In one group, the pressure was performed with heavy-cut pliers and in another group the base of the hook was distempered and then the pressure was made with appropriate orthodontic pliers. The brands compared were Morelli, TP orthodontics, American Orthodontics and MAO MidAtlantic Ortho and the types of fixation were manual pressure made with appropriate pliers and manual pressure associated with 2,3,4 and 5 point of electric solder. In 5 groups, the hooks were made of stainless-steel wire, one group being fixed with silver solder or with 1, 2, 3, and 4 electric soldering points respectively. The last group consisted of 10 threaded surgical hooks. Topography of the sample was evaluated by scanning electron microscopy before and after the experiment. The Kruskal-Wallis and Mann-Whitney analyzes were used to compare the groups at a significance level of 0.05 to identify the differences between the measures of each group. RESULTS: The control group was better than all the other groups (p <0.0001 / Kruskal-Wallis). The group of steel hooks was independent of the control group (p <0.0001 / Kruskal-Wallis). American Orthodontics hooks were also found in relation to the other brands, regardless of the form of fixation (p <0.05 / Mann-Whitney). The rosquetics were those that improved with the difference between them (p <0.05 / Mann-Whitney). CONCLUSIONS: There was no increase in the resistance of the pressable hooks when different solder exposure points were saved. The best mark was an American Orthodontics. Welding wire hooks with soldering points have the same efficacy to welding with silver soldering, and can replace them. The threaded hooks are successful results with the clips.

Suicide is an intentional and deliberate act of putting an end to one's life. There are several factors related to this

type of self-inflicted death, which may be related to the biological, psychological and social. In this scenario, the 

gender relations are predicted as predictors of suicide, and all individual and non-individual factors that are based 

on social relations.  Thus, the objective of this study was to analyze the psychosocial context of women who 

committed suicide in the city of Caicó / RN. It is a qualitative research that uses the psychosocial autopsy method 

as a means to approach this phenomenon in a socially wide way and to seek singularities of the human dimensions. 

First-degree relatives of women who committed suicide between the years 2011 and 2016 were interviewed. 

The analysis of the collected material will be carried out through the thematic content analysis, using a theoretical 

reference on gender relations and suicide. Finally, it is expected that this study may reveal particularities about the 

suicide of women from the interior of Rio Grande do Norte, and may even subsidize preventive measures for suicide.

OBJECTIVE: To analyze the standardized mortality rate for suicide in the elderly in the Brazilian states and the differences between the genders. METHODS: An ecological study was carried out to analyze suicide deaths in the elderly in the Brazilian states, based on data from the Mortality Information System (SIM) in the period from 2011 to 2015. Deaths from suicides (self-induced injuries: X60 -X84), according to the age group of 60 years and over, and the gender of the individual, categorized from the International Statistical Classification of Diseases and Related Health Problems - 10th Revision. Information on deaths was collected from the Mortality Information System (SIM) of the Department of Informatics of the National Health System (Datasus). Population data by State and Federal District, by sex and by age group, were obtained from the Demographic Censuses and Intercensity Projections, on the website of the Brazilian Institute of Geography and Statistics (IBGE). RESULTS: 8,483 deaths from suicide among the elderly in Brazil were recorded between 2011 and 2015. The proportion of deaths was 80% (6,799) for males, and 20% (1,683) for females. The spatial distribution of the standardized Mortality Rate (TMP) for suicide according to sex in Brazil indicated an average rate of 0.84 deaths (105 inhabitants) for both sexes, 1.32 deaths (105 inhabitants) for males and 0.33 deaths (105 inhabitants) to the female. The highest TMP per suicide expressed per 100,000 inhabitants went to Rio Grande do Sul (both sexes with 1.99, male with 3.30 and female with 0.76), Santa Catarina (both sexes with 1.78, male with 2.80 and female with 0.74) and Piauí (both sexes with 1.52, male with 2.42 and female with 0.64). The TMP ratio between the male and female sexes in Brazil was 4.15 / 105 inhabitants. The states with the highest ratios were: Acre (10.20 / 105 inhabitants), Amapá (8.62 / 105 inhabitants), Bahia (5.39 / 105 inhabitants), Maranhão (5.25 / 105 inhabitants), Paraná (4.90 / 105 inhabitants), Mato Grosso 4.87 / 105 inhabitants) and Paraíba (4.84 / 105 inhabitants). CONCLUSIONS: Mortality due to suicide among the elderly presents a tendency to increase and its greatest distribution is between the states of the Northeast, Center-West and South of Brazil. There are differences between the proportion of deaths by suicide considering the male and female sexes among the elderly population, being the highest rates found in the male population

INTRODUCTION AND BACKGROUND: Although there are several forms of treatment for Dentin Hypersensitivity (DH), the main challenge is to find a substance or form of treatment that effectively eliminates pain and does not recur in the short or long term. OBJECTIVE: This randomized controlled clinical trial evaluated the efficacy of 4% sodium fluoride solution for the treatment of DH, comparing it to low power laser therapy with visible infrared LASER emitter, and the active AsGaAl medium. METHODOLOGY: The sample was composed of 92 dental elements selected after being submitted to two stimuli, a tactile one, and a second thermal-evaporative stimulus. The sensitivity was measured through a visual numerical scale. The teeth were alternately divided into two groups (Group 1 and Group 2) to receive the treatment according to the group for which it was selected. For Group 1, 4% sodium fluoride solution was applied in three sessions, with intervals of 1 week between them. The dental elements of Group 2 received low-power laser irradiation of AsGaAl diode in a punctual way, in the cervical region of the vestibular face in three sessions with intervals of 1 week between them. At each application of the 4% sodium fluoride solution or the low-power LASER, patient responses to tactile and thermal-evaporative stimuli were recorded on the visual numerical scale. At the end of the treatment and with one, three and six months, new evaluations were carried out to verify the effectiveness of the substances in the long term. Statistical analysis of the data was done using non-parametric Wilcoxon and Mann-Whitney tests, complemented with a descriptive analysis composed of tables and graphs. PARTIAL RESULTS: The results showed that after six months of treatment, there was a reduction in pain sensitivity in relation to both stimuli, both in dental elements treated with fluoride solution and those treated with LASER. The average pain of the dental elements treated with the 4% sodium fluoride solution increased from 5.93 to 1.73 in response to the evaporative stimulus and from 3.63 to 0.804 to the tactile stimulus. For dental elements treated with LASER, the average pain increased from 6.020 to 1.854 with the evaporative stimulus and from 3.50 to 0.937 with the tactile stimulus. All of these pain reductions were statistically significant (p <0.00). However, when comparing the two therapies, there were no statistically significant differences between them (P> 0.05). CONCLUSION: Both therapies were effective in reducing DH after six months of control. There is no statistically significant difference between the two therapies proposed in this study.

INTRODUÇÃO E JUSTIFICATIVA: Embora existam diversas formas de tratamento para a HSDC, o principal desafio é encontrar uma substância ou forma de tratamento que efetivamente elimine a dor e não tenha recidiva em curto e longo prazo. OBJETIVO: Este ensaio clínico controlado randomizado avaliou a eficácia do uso da solução de fluoreto de sódio a 4% para o tratamento da Hipersensibilidade Dentinária Cervical (HSDC) comparando- a laserterapia de baixa potência com emissor invisível de LASER infravermelho, e o meio ativo AsGaAl. METODOLOGIA: A amostra foi composta por 92 elementos dentários selecionados após serem submetidos a dois estímulos, um táctil, e um segundo estímulo, térmico-evaporativo,  A sensibilidade foi mensurada através de uma escala visual numérica. Os dentes foram distribuídos aleatoriamente e alternadamente em dois grupos (Grupo 1 e Grupo 2) para receber o tratamento de acordo com o grupo para o qual foi selecionado. Para o Grupo 1 foi realizado aplicação de solução de fluoreto de sódio a 4%, em três sessões, com intervalos de 1 semana entre elas, Os elementos dentários do grupo 2 receberam irradiação do LASER de baixa potência de diodo AsGaAl de forma pontual, na região cervical da face vestibular em três sessões com intervalos de 1 semana entre as mesmas. A cada aplicação da solução de fluoreto de sódio a 4% ou do LASER de baixa potência, foram registradas as respostas dos pacientes aos estímulos tácteis e térmicos-evaporativo, na escala visual numérica. Ao término do tratamento e com um, três e seis meses foram realizadas novas avaliações para a verificação da efetividade das substâncias em longo prazo. A análise estatística dos dados foi feita através dos testes não paramétricos Wilcoxon, Friedman e Mann-Whitney, complementada com uma análise descritiva composta de tabelas e gráficos. RESULTADOS PARCIAIS: Os resultados demostraram que após seis meses de encerrado o tratamento, houve redução da sensibilidade dolorosa frente aos dois estímulos, tanto nos elementos dentários tratados com a solução de fluoreto quanto aqueles tratados com o LASER.  A média de dor do elementos dentários tratados com  a solução de fluoreto de sódio a 4% passou de 5,93 para 1,73 em resposta ao estímulo evaporativo e de 3,63 para 0,804 ao estimulo táctil. Para os elementos dentários tratados com  LASER a media da dor passou de 6,020 para 1,854 ao estímulo evaporativo e de 3,50 para 0,937 ao estímulo táctil. Todas essas reduções da dor foram estatisticamente significativas (p <,0,00).  No entanto quando comparadas as duas terapias, não se observaram diferenças estatisticamente significantes entre as mesmas (P>0,05). CONCLUSÃO: As duas terapias foram eficazes na redução da HSDC após seis meses de controle. Não há diferença estaticamente significativa entre as duas terapias propostas nesse estudo.  

The current society is in constant process of aging, thus triggering a significant increase in the number of elderly people. In this sense, the present study aimed to analyze the prevalence and associated factors to multimorbidities and negative self-evaluation of health in elderlies in a municipality in the interior of the Brazilian Northeast. This is a transversal study with a quantitative, descriptive and inferential approach. The target group was 181 elderly people from the city of Pau dos Ferros, registered in the Family Health Strategies (ESF) of the municipality and that were randomly selected and proportional to the number of elderly registered in each ESF team in the municipality. Of the 181 elderly people, belonging to the first stage of the research, there was a loss of 33 elderly (18.2%). The interviewer in charge was a resident of each elderly woman, drawn with the Free and Informed Consent Form (TCLE) for the application of a questionnaire from the "Health, well-being and aging" survey (SABE). Data collection was performed from January to September, 2018. The Statistical Package for the Social Science (SPSS) was used to analyze the data, whose description was based on absolute and percentage frequency values. The inferential analysis was based on the Chi-square test for a significance level of 5% and, later, a logistic regression analysis, whose odds ratio was converted to the prevalence ratio. In the sample, female superiority was found (64.2%). It was observed that the age group between 70 and 79 years presented a frequency of 40.5% of the elderly, influencing the characterization of a municipality with an already marked aging process. Regarding the dependent variables, one has to consider two forms of conceptualization for the multimorbidities. The first one is the one that considers the presence of two chronic diseases, and the second one is based on three chronic diseases. For the first condition, a prevalence of 66.2% (95% CI 58.6 - 73.8%) was found, with a significant association with hypertension, polypharmacy, difficulty in accessing health services, and self-evaluation of memory. For multimorbidity characterized by three or more pathologies, a percentage of 40.5% (95% CI 32.6 - 48.4%) was obtained, with significant associations for polypharmacy, memory self-evaluation and hypertension. In addition, dependent self - rated health had a negative self - assessment prevalence of 73% (CI 95% 66 - 80%) with associations with the following variables: multimorbidities with 3 more pathologies, polypharmacy, oral health and number of caregivers. It is evident, therefore, how much the disease health process is influenced by the most varied factors, whether biological or not, evidencing the need for a strategy that discusses the social determinants as an important aspect to be taken into account in the care. Not unlike the other studies, SABE Pau dos Ferros has produced results that will support the execution of a strategic planning aimed at the elderly public.

The elderly population grows rapidly and reveals a variability of characteristics that results
in different levels of health. In order to make public policies adequate to the new demands, it
is essential to comprehend the real health pattern and the mortality statistics are an important
instrument to produce objective bases for this. In this sense, this ecological study proposes to
analyze the mortality profile of the elderly in the northeastern municipalities from 2001 to
2015, as well as to identify the contextual socioeconomic factors related. The elderly
population was analyzed from the perspective of their heterogeneity, dividing it into three
groups: 60 to 69 years old (younger or sexagenarians), 70 to 79 years (septuagenarians) and
80 years old or older (longevity). Based on data from the Mortality Information System (SIM)
and the Brazilian Institute of Geography and Statistics (IGBE), the causes of death, according
to ICD-10 chapters, were measured using Proportional Mortality (MP) for the descriptive
analysis of the Northeast region as a whole and through the Age - specific Mortality
Coefficient (CMId) for the delineation of the mortality profiles in municipalities level. Data
from IBGE, United Nations Program (PNUD) and the Institute of Applied Economic
Research (IPEA) were summarized by Principal Component Analysis for the Brazil and then
in the Northeastern municipalities specifically. The clusters of municipalities with similar
mortality profiles were defined by means of K-means Clustering Analysis and compared with
each other and with the socioeconomic indices by Student's T test, Mann-Whitiney, ANOVA
or Kruskal-Wallis, according to the number of groups and the distribution of the data, at a 5%
significance level. In addition, the results were analyzed spatially. In the studied period,
2,461,383 deaths were recorded in the elderly in Northeast. 44.2% of the deaths corresponded
to the octogenarians, 31.4% to the septuagenarians and 24.4% to the sexagenarians. Most of
the deaths occurred in the hospital (55.5%), among males (50.8%), brown race (49.0%),
married (37.1%) and without any study (34.5%). Regarding the causes of death,
cardiovascular diseases have the highest number of deaths (35.8%), followed by ill-defined
causes (15.4%) and neoplasms (13.1%). The clustering analysis formed five clusters for the
sexagenarians group (High burden of neoplasms, High burden of ill-defined causes, Low
coverage, Intermediate profile and High mortality and good registration), three for the
septuagenarians (Highest quality of information, Low coverage and Ill-defined causes and
low coverage profile) and two clusters for octogenarian’s individuals (Cardiovascular
diseases and ill-defined causes and low coverage and ill-defined causes). The indices of
Deprivation and Rurality were constructed for the Brazilian municipalities and, in the
application of the analysis specifically in Northeast, the first one was divided in two
components (Favorable socioeconomic context and Low education and dependence of the
State) and the second was adapted as Urbanization and its reflexes. The last one was the most
important factor for the discrimination of the northeastern municipalities. The bivariate
analysis showed that satisfactory levels of contextual socioeconomic determinants are related
to mortality patterns that are closer to the modern characteristics of epidemiological
transition, as well as a higher quality of the SIM, and this influence is greater in the younger
individuals. The municipalities identified in the clusters with the most unfavorable health
profiles should be prioritized in health planning, considering the socioeconomic context for
reducing health inequities.

As the fourth decade of HIV/AIDS epidemic in Brazil approaches, the epidemic context in the country has extremely complex new characteristics. In 2016, what we find in Brazil is a picture of resurgence of the epidemic with a new profile centered in MSM, chemical dependents, young gays and sex workers; reduction on international investments; and the upsurge of conservative sectors against public policies, restraining the epidemic approach based on human rights. At the same time, the United Nations affirm that it is possible to eradicate the epidemic of HIV/AIDS until 2030. The general purpose of this research is to understand and to assess experiences of people who live the epidemic of HIV/AIDS in the present context of adoption of therapeutic strategies in order to achieve national and international goals of eradication of the epidemic until 2030. Two central research strategies have been adopted: interviews focused on life stories and ocumentary research. The later assessed documents produced by the UN System that address the global policy of confrontation of the epidemic in the period from 2000 to 2016, in a total of 27 documents.The researcher has also explored official documents about the Brazilian Policy of Control and Eradication of the epidemic, from 1999 to 2016, and the Epidemiologic Bulletins of HIV/AIDS, from 2001 to 2016, in a total of 24 documents. Five health professionals and four users have been interviewed. The interpretive exercise of the interviews, with emphasis on life stories, was referenced in Sociology of Emergencies, Translation Work and in the Ecology of Knowledge, inspired by Boaventura de Souza Santos, who sought on local speech what, from the experience and expectation of the subjects who experience the care to the people living with HIV routinely, affirmed or denied knowledge and practices, new and old, and identified possibilities of future that are being built in the present through care practices concerned with the future of individuals and collectivities. The Translation work between narratives of subjects that produce local knowledge and practices and the official narrative that produces global knowledge from the argumentative work of the researcher was based on the analysis of the empirical material produced on the research and from the theoretical framework that has been adopted. From this work of translation between global, national and local knowledge and practices, prevention emerged as the most neglected stage of HIV/aids care and, thus, the most prone to setbacks, at the same time that we notice a pluralism of practical knowledge associated to it. Setting the epistemological path oriented by the ecology of knowledge, we identified the insufficiency of the image associated to combination prevention proposed by the Health Ministry in the representation of practices announced by different actors as being the ones with the capability of conciliation, provoking the need for its expansion. For this reason, based on the results of the study, we propose an alternative representation of the combination prevention mandala that embodies other aspects of the care applicable to the combination prevention. The interpretive exercise of approximation between different knowledge highlighted the need to put people, community and specially the right to prevention in the center of the responses to the confrontation of the epidemic of HIV/aids, if we want to understand the reinvention of the present more than projecting a future.

The present study aimed to investigate the elderly hospitalizations by cause group and by sensitive conditions to basic health (HSCBH), identifying their relationship with contextual factors in the Northeast of Brazil. A cross-sectional ecological study was performed using secondary data from the Hospital Information System of Brazil (SIH-SUS) to describe hospitalization rates by cause group and by HSCBH of the elderly between 2010 and 2015. The dependent variables were the elderly hospitalizations by cause group and by HSCBH. Therefore, the non-hierarchical cluster analysis (K-means) was performed by grouping of municipalities based on the cause group chapters in general admissions and those sensitive to basic care, with 3 Clusters. For the general hospitalization rate, Cluster 1 was characterized by the prevalence of low hospitalization rates, Cluster 2 with a high prevalence of hospitalization rates and Cluster 3 with predominance of intermediate hospitalization rates. In the HSCBH rates, Cluster 1 was classified as intermediate rates, 2 as low rates and 3 high rates. For the association with the dependent variables, were selected 11 independent socioeconomic contextual variables. The variables selected were summarized through the Factor Analysis starting Principal Components Analysis (PCA). Thus, we obtained component 1 that was called "urbanization and its reflexes", the second component being nominated as "favorable socioeconomic context" and the third component titled "little education and dependence of the state". In addition to these variables, we used the GINI Index, HDI, Firjan Index, the average coverage of basic care in municipalities between 2010 and 2015, and the rate of the physician visits among the elderly in basic care during the same period. The total hospitalization rate in the period was 1,212.60, with the greatest number being to circulatory system diseases, followed by respiratory system diseases and infectious/parasitic diseases. The clusters of hospitalization rates differed significantly between contextual factors, so that the municipalities with the highest hospitalization rates presented the highest values for the favorable socioeconomic context, the highest values being related to the few schooling and state dependence of municipalities with lower hospitalization rates. In relation to HSCBH, the total hospitalization rate was 527,524 (43.5% of all hospitalizations), with a higher number of heart failure diseases, followed by cerebrovascular and infectious gastroenteritis. In the association between the rates with the contextual factors, there was a significant difference between all the clusters and the factors. The cluster with the highest admission rates was the one that presented the highest averages for the “favorable socioeconomic contexto” and for “little education and dependence of the state”. The cluster with the lowest hospitalization rates had the highest averages for the "urbanization and its reflexes” factor. In the analysis of the coverage and the rate of physician visits among elderly people in basic care, it was observed that the clusters did not differ significantly, although in the cluster with the highest hospitalization rates, there were the highest number of physician visits among the elderly. About this context, was concluded that in this elderly population there is a predominance of hospitalizations due to diseases of the circulatory system. In the HSCBH, the largest number of hospitalizations is due to heart failure. Regarding the contextual factors, we can conclude that these fators interfere in a significant way in the hospitalizations of the elderly population, being relevant the point of these factors in the construction of the health public policies, taking into account the vulnerabilities of this population and contributing to the improvement of the elderly health  and the reduction of hospitalizations in this population.

One of the great challenges of clinical research is the development of new biomaterials that aid in tissue regeneration and accelerate the healing process. Experimental studies demonstrate the effect of platelet rich fibrin (PRF) on tissue regeneration techniques, optimizing the repair process; and can be used in injectable form (i-PRF). The objective of this research was to determine the cellular, morphology and protein characterizations  involved in the repair process and to evaluate its interaction with a bioceramic material from an in vitro model. Blood samples were collected from 15 human volunteers for comparison of the cellular constituents between i-PRF and peripheral blood. Samples of i-PRF and blood clots were cultured in vitro for 10 days. The supernatant of the samples was collected at intervals 1h, 8h, 24h, 3 days and 10 days for quantification of PDGF-AB and VEGF growth factors by ELISA immunoassay. Samples were histologically treated for morphological characterization and submitted to the immunohistochemical methodology for the labeling of IL-10, Osteocalcin  and TGF-β proteins. The gene expression of collagen transcription factor type 1 was investigated. Samples of i-PRF mixed with granular bioactive ceramics (HA / β-TCP) were prepared to evaluate the interaction between these compounds through SEM. A higher concentration of leukocytes (8,124 ± 1,419) and platelets (3.96x105 ± 0.72) in i-PRF compared to peripheral blood (p <0.001) was observed, with a higher proportion of lymphocytes (60%) in i- PRF. Higher levels of VEGF were released from the blood clot (1933± 704) compared to i-PRF (852 ± 376; p <0.001); no differences were observed between PDGF-AB levels (p>0.05). Immunohistochemical assay demonstrated staining  for TGF-β, IL-10 and Osteocalcin in the i-PRF group. RT-PCR analysis showed increased gene expression of collagen type 1 in the i-PRF group (p>0.05) . Microscopically, the formation of large platelets and fibrin clusters and a fibrin network in a three-dimensional spatial and homogeneous distribution were observed. SEM images showed good integration between the ceramic granules and the fibrin mesh formed by i-PRF. In describing and analyzing the morphological and biological properties of i-PRF in vitro, we can better understand its clinical effects and develop guidelines for future therapeutic applications.