Facing the decline in vaccine coverage observed since 2016, the new Brazilian government committed to reversing this scenario. To achieve this, the Federal Government launched the National Vaccination Movement and the 'Health with Science' platform to combat vaccine misinformation, promoted Microplanning, providing tools for decision-making at the territorial level, allocated 30 million dollars to states and municipalities to implement innovative vaccination strategies, standardized the rules of the information systems for the registration of vaccine doses, and directed data to the National Health Data Network (RNDS). Reversing the declining trend of vaccination coverage in Brazil is challenging, but within just one year, it is possible to observe significant results from governmental actions. Out of the eight recommended vaccines by the age of one, seven showed an increase in vaccination coverage in 2023 compared to 2022: Most states showed improvements in vaccination coverage. Many challenges persist in advancing the vaccination agenda. However, there are reasons to celebrate the reversal of the declining trend in coverage of several vaccines in this first year of government and the increase in the number of municipalities that have fully achieved the vaccination coverage target. The National Vaccination Movement, with public opinion awareness, the resumption of regionalized communication campaigns, localized micro-planning actions including extramural vaccination strategies, and the integration of information systems, has been decisive in strengthening work in the territories and thus restoring a culture of immunization, a source of pride in the country and internationally recognized, throughout the 50 years of the National Immunization Program

Resumo O artigo versa sobre o mundo do trabalho da saúde, especialmente no SUS no contexto da pandemia no Brasil. O artigo utilizou dados das pesquisas “Condições de trabalho dos profissionais de saúde no contexto da COVID-19 no Brasil” e “Os trabalhadores invisíveis da saúde: condições de trabalho e saúde mental no contexto da COVID-19 no Brasil”. A análise dos dados comprova que a pandemia evidenciou problemas estruturais existentes no âmbito do Sistema Único de Saúde, envolvendo a gestão da FTS o que pode ser interpretado como mais um dos reflexos das desigualdades socioeconômicas já existentes no país. Destacam-se: a reduzida oferta de educação permanente, a regulação do cuidado híbrido, precarização, desproteção no ambiente de trabalho, frágil biossegurança levando a trágicas taxas de adoecimento e mortes de trabalhadores da saúde. Conclui mostrando a importância de formulação de políticas públicas no âmbito da gestão da educação e do trabalho no SUS que assegurem a discussão sobre cuidado híbrido como nova forma de atuar sem perder qualidade, a necessidade de se rever questões referentes a: educação permanente, proteção, valorização e redução das desigualdades apontadas entre os contingentes profissionais analisados nesse artigo.

Abstract This article addresses the world of healthcare work, especially in the Brazilian Unified Healthcare System (SUS) in the context of the COVID-19 pandemic in Brazil. This study used data from the following surveys: “Working conditions of health professionals in the context of COVID-19 in Brazil” and “The Invisible health workers: working conditions and mental health in the context of COVID-19 in Brazil”. Data analysis proves that the pandemic highlighted existing structural problems within SUS, involving the issue of healthcare workforce (HWF) management, which can be interpreted as another reflection of the socioeconomic inequalities that already exist in the country. This article highlights: the reduced provision of permanent education, the regulation of hybrid care, precariousness, a lack of protection in the work environment, as well as fragile biosecurity leading to tragic rates of illness and death of health workers. Our study concludes by showing the importance of formulating public policies in the scope of education and work management in SUS that ensure the discussion on hybrid care as a new way of acting without losing quality, together with the need to review issues related to permanent education, protection, valuation, and reduction of inequalities pointed out among the professional contingents analyzed in this article.

Abstract This article addresses the world of healthcare work, especially in the Brazilian Unified Healthcare System (SUS) in the context of the COVID-19 pandemic in Brazil. This study used data from the following surveys: “Working conditions of health professionals in the context of COVID-19 in Brazil” and “The Invisible health workers: working conditions and mental health in the context of COVID-19 in Brazil”. Data analysis proves that the pandemic highlighted existing structural problems within SUS, involving the issue of healthcare workforce (HWF) management, which can be interpreted as another reflection of the socioeconomic inequalities that already exist in the country. This article highlights: the reduced provision of permanent education, the regulation of hybrid care, precariousness, a lack of protection in the work environment, as well as fragile biosecurity leading to tragic rates of illness and death of health workers. Our study concludes by showing the importance of formulating public policies in the scope of education and work management in SUS that ensure the discussion on hybrid care as a new way of acting without losing quality, together with the need to review issues related to permanent education, protection, valuation, and reduction of inequalities pointed out among the professional contingents analyzed in this article. (SUS COVID19 COVID 19 COVID-1 Brazil surveys Working The workers . HWF (HWF country highlights precariousness environment quality valuation COVID1 1 COVID-

Resumo O artigo versa sobre o mundo do trabalho da saúde, especialmente no SUS no contexto da pandemia no Brasil. O artigo utilizou dados das pesquisas “Condições de trabalho dos profissionais de saúde no contexto da COVID-19 no Brasil” e “Os trabalhadores invisíveis da saúde: condições de trabalho e saúde mental no contexto da COVID-19 no Brasil”. A análise dos dados comprova que a pandemia evidenciou problemas estruturais existentes no âmbito do Sistema Único de Saúde, envolvendo a gestão da FTS o que pode ser interpretado como mais um dos reflexos das desigualdades socioeconômicas já existentes no país. Destacam-se: a reduzida oferta de educação permanente, a regulação do cuidado híbrido, precarização, desproteção no ambiente de trabalho, frágil biossegurança levando a trágicas taxas de adoecimento e mortes de trabalhadores da saúde. Conclui mostrando a importância de formulação de políticas públicas no âmbito da gestão da educação e do trabalho no SUS que assegurem a discussão sobre cuidado híbrido como nova forma de atuar sem perder qualidade, a necessidade de se rever questões referentes a: educação permanente, proteção, valorização e redução das desigualdades apontadas entre os contingentes profissionais analisados nesse artigo. Brasil Condições COVID19 COVID 19 COVID-1 Os . Saúde país Destacamse Destacam Destacam-se permanente precarização qualidade proteção COVID1 1 COVID-

Resumo Objetivo Analisar um instrumento para o monitoramento da atenção básica. Métodos Pesquisa quantitativa, descritiva e analítica, consistiu na aplicação do instrumento em 442 Unidades Básicas de Saúde - UBS do município de São Paulo, contando com a participação de gestores locais na sua elaboração; o instrumento foi composto por 47 quesitos que contemplaram indicadores de Estrutura, Processo e Resultado e foram organizados em seis blocos temáticos: I - recepção técnica acolhedora – RTA (acolhimento); II - trabalho da enfermagem; III - trabalho médico; IV - organização assistencial e integração da equipe; V - cobertura vacinal e de programas; VI- gestão e participação. Para análise estatística utilizou-se o programa SPSS 25.0. Resultados A média e a mediana de pontuação obtidas pelas 414 UBS avaliadas (total de 470 pontos possíveis) foram 356 e 380, respectivamente. Por meio de modelagem multivariada, nove quesitos de Estrutura e Processo se destacaram, quando analisados em relação aos quesitos de Resultado, apresentando associação estatística (p<0,05): RTA realizada em todos períodos da UBS; treinamento específico para atendimento na RTA; atuação clínica do enfermeiro; retaguarda médica sistematizada para RTA; equipe de saúde bucal completa; horário reservado para reunião da equipe; atendimento em grupo realizado sistematicamente; ações de promoção à saúde; acomodações físicas adequadas. Conclusão o instrumento apresentou capacidade para captar diferentes estágios da organização e de resultados das unidades participantes do estudo e, além de uma avaliação global, revelou questões críticas dos serviços relacionadas às mudanças pretendidas. Como ferramenta avaliativa para os serviços pode contribuir no monitoramento e no apoio à tomada de decisões tecno-gerenciais cotidianas.

Abstract Objective To analyze an instrument for monitoring primary care. Methods Qualitative, descriptive, and analytic research that consisted in the application of the instrument in 442 Basic Health Units - PCC from São Paulo city with the participation of local managers in its elaboration; the instrument is composed of 47 aspects that contemplated indicators of Structure, Process, and Result and we organized them in six thematic blocks: I - welcoming technical reception – WTR (reception); II - nursing work; III - medical work; IV - assistance organization and team integration; V - vaccination and program coverage; VI - management and participation. For the statistical analysis, we utilized the SPSS 25.0 program. Results The average and median scores obtained by the 414 evaluated Primary Care Centers (total of 470 possible points) were 356 and 380, respectively. Through the multivariate modeling, nine aspects of Structure and Processes stood out, when analyzed concerning the aspects of the Result, presenting statistical association (p<0.05): WTR carried out in every period of Primary Care Centers; specific training for the care in WTR; nurse clinical performance; systematized medical rearguard for WTR; complete oral health team; reserved time for team meeting; group appointment carried out systematically; health promotion actions; adequate physical accommodations. Conclusion The instrument presented the capacity to capture different stages of the organization and the results of the participant units of this study, and, besides a global evaluation, it revealed critical questions of the services related to the intended changes. As an evaluative tool for the services, it may contribute to the monitoring and the support to the everyday techno-management decision making.

Resumen Objetivo Analizar un instrumento para el monitoreo de la atención básica. Métodos Estudio cuantitativo, descriptivo y analítico, que consistió en la aplicación de un instrumento en 442 Unidades Básicas de Salud (UBS) del municipio de São Paulo y contó con la participación de administradores locales para su elaboración. El instrumento estuvo compuesto por 47 ítems que contemplaron indicadores de Estructura, Proceso y Resultado, y fueron organizados en seis bloques temáticos: I – recepción técnica acogedora RTA (acogida); II – trabajo de enfermería; III – trabajo médico; IV – organización asistencial e integración del equipo; V – cobertura de vacunación y programas; VI – gestión y participación. Para el análisis estadístico se utilizó el programa SPSS 25.0. Resultados El promedio de puntuación obtenido por las 414 UBS evaluadas fue 356 y la mediana de 380 (total de 470 puntos posibles). Por medio de la modelación multivariada, se destacaron nueve ítems de Estructura y Proceso, al ser analizados con relación a los ítems de Resultado, y presentaron asociación estadística (p<0,05): RTA realizada en todos los períodos de la UBS, capacitación específica para atención en la RTA, actuación clínica del enfermero, retaguardia médica sistematizada para RTA, equipo de salud bucal completa, horario reservado para reunión del equipo, asistencia en grupo realizada sistemáticamente, acciones de promoción de la salud, instalaciones físicas adecuadas. Conclusión El instrumento presentó capacidad para captar diferentes niveles de la organización y de resultados de las unidades participantes en el estudio y, además de una evaluación global, reveló cuestiones críticas de los servicios relacionadas con los cambios pretendidos. Como herramienta evaluadora de los servicios, puede contribuir para monitorear y respaldar la toma de decisiones tecno-administrativas cotidianas.

Abstract: This study analyzed the consequences of the disordered expansion of Dentistry courses on the distribution of professionals, the job market, and limitations of the National System of Higher Education Assessment (SINAES) developed as a guarantee of education quality. This observational, descriptive, and analytical study used secondary data from several official databases. The number of courses was obtained from the e-MEC registry. From the Higher Education Census, the study collected historical series of courses offered, number of candidates per open seat, number of individuals who initiated and completed the course, and information about professors in the public and private schools. The reports related to Dentistry courses from the National Health Council were also analyzed. The performance of undergraduate students was assessed from synthesis reports of Enade from 2004 to 2016. The number of dentists and their regional distribution was based on the Federal Dental Council, and Brazilian population and gross domestic product were collected from the Brazilian Institute of Geography and Statistics. Dentistry courses in Brazil grew exponentially from 1856 to 2020; among the 544 authorized courses, 82 currently have not yet started their activities. The fast expansion of courses in Brazil has worsened the regional asymmetries in the supply of dentist, and the SINAES has not been able to fully assure the quality of Dentistry courses. Brazilian dentistry, which has increased its scientific and technological development since the 19th century, with outstanding intellectual production, is at risk of a collapse due to a plethora of dentists.

RESUMO Objetivos Os objetivos deste estudo foram avaliar a prevalência e a gravidade da fluorose dentária e avaliar o impacto da fluorose dentária na qualidade de vida relacionada à saúde bucal (QVRSB) de crianças residentes em duas cidades peruanas com diferentes níveis de flúor de água. Métodos Uma amostra de 292 crianças entre 11 e 14 anos de idade e ambos os sexos foram selecionada nas escolas públicas e privadas de ensino fundamental nas duas cidades. O exame oral clínico foi realizado utilizando-se o índice de Dean para avaliar a prevalência e a gravidade da fluorose dentária e o Questionário de Percepção Infantil 11-14 (CPQ 11-14) para avaliar a associação entre fluorose dentária e QVRSB. Resultados A prevalência de fluorose dentária foi de 75% e o escore moderado foi o mais frequente (36%). As duas cidades têm baixo nível socioeconômico e predominam as crianças de escolas públicas (74%). Não houve impacto da fluorose na QVRSB. É possível que os adolescentes que vivem em um contexto social em que a aparência dentária seja muito semelhante entre as pessoas tenham um senso de identidade diferente de outras sociedades, o que pode influenciar em sua percepção de QVRSB. Conclusão Embora a prevalência de fluorose dentária tenha sido muito alta, não teve impacto na QVRSB.

ABSTRACT Objectives The aims of this study were to evaluate the prevalence and severity of dental fluorosis and to assess the impact of dental fluorosis on oral health related quality of life (OHRQoL) of children living in two Peruvian towns with different water fluoride levels. Methods A sample of 292 children between 11 and 14 years of age and both genders were selected among public and private primary schools in the 2 towns. Clinical oral examination was carried out using Dean’s index to assess the prevalence and severity of dental fluorosis and the Child Perceptions Questionnaire 11-14 (CPQ 11-14) was used to evaluate the association between dental fluorosis and OHRQoL. Results Dental fluorosis prevalence was 75% and the moderate score was the most frequent (36%). The two towns have a low socioeconomic level and children from public schools predominate (74%). There was no impact of fluorosis on OHRQoL. It is possible that adolescents living in a context with very similar dental appearance of their peers build a sense of identity different than other populations, which can influence in their OHRQoL perception. Conclusions Even though dental fluorosis prevalence was very high it did not have impact on OHRQoL.

ABSTRACT Objective: To investigate the possible relationship between early admission to the school of children in early childhood and oral health conditions (OH) and nutritional status (NS). Material and Methods: Cross-sectional study conducted with 140 children aged 3-4 years, selected for convenience, in 4 public schools in the city of São Paulo, Brazil, during 2016, divided into children with early (IE) and late (IL) admission at school. Comparisons between groups were performed for the presence of overweight / obesity (OW / OB), caries lesions (CL), malocclusion (MO) and dental biofilm (DB), in addition to socioeconomic and dietary data. Multiple regression analysis was applied to determine the association between age of admission at school and OH and NS. Results: Children with IE had CL = 28.1%; DB = 46.9%; MO = 54.7% and OW / OB = 25.9%. Children with IE had IL = 29.8%; DB = 35.1%; MO = 61.4% and OW / OB = 30.8%. No significant association was found between age of admission at school and CL: 1.40 (0.53-3.73) 0.490; DB: 0.51 (0.22-1.16) 0.112; MO: 1.77 (0.77-4.05) 0.173 and OW / OB: 1.27 (0.55-2.92) 0.568, [OR (95% CI) p]. Conclusion: The age of admission at school of children in early childhood did not show a significant association with OH and NS.

Abstract Telehealth has been applied in the Unified Health System (SUS) as a tool for qualifying professionals and improving the healthcare provided to the population served by the system. The aim of the present study was to evaluate the impact of teleconsultations on the qualifications of the clinical approach of the oral health teams involved in primary health care (PHC) in the state of Rio Grande do Sul under the Telehealth Brazil Networks Programme. The sample population of the study was composed of 285 dentists and 132 oral health assistants belonging to the Family Health Teams. A chi-square test was used to investigate possible associations between the absolute number of teleconsultations performed and several independent variables, namely, gender, age, dental specialty, time since graduation, time working in the Family Health Strategy (FHS), employment status, type of training institution, familiarity with information technology, and work satisfaction at the health facility. The level of significance was p < 0.05. Use of the oral health teleconsultation service led to a reduction of more than 45% in the number of referrals to other levels of care. However, no significant association was found between the number of teleconsultations and the independent variables analysed. The use of teleconsultations proved to be a powerful tool for professional training, for increasing the effectiveness of PHC, and for improving the oral healthcare provided.

Abstract To assess the impact of oral conditions on the oral health-related quality of life (OHRQoL) of pediatric liver transplant candidates. This cross-sectional study included 60 children aged 13 to 48 months who were liver transplant candidates that attended the AC Camargo Cancer Center, São Paulo, Brazil. On the day of oral examinations, the children’s mothers were invited to answer two questionnaires; one related to children’s OHRQoL using the B-ECOHIS and another related to socioeconomic/demographic characteristics. Thereafter, a single, adequately trained dentist carried out children’s oral examinations for gingival inflammation (Silness-Löe index), dental plaque (Green-Vermillion Simplified index), dental caries (dmft index), developmental defects of enamel (DDE index), tooth discoloration, oral mucosal/lip alterations. The data collected also included socioeconomic/demographic characteristics and liver disease. The adjusted Poisson regression model was used to associate children’s socioeconomic/demographic characteristics and clinical conditions to the outcome. The adjusted regression model showed that children with untreated caries lesions (RR = 3.35, p < 0.0001) and tooth discoloration (RR = 1.74, p = 0.04) had poorer total B-ECOHIS scores. Dental discoloration and untreated caries lesions had a negative impact on the OHRQoL in pediatric liver transplant candidates.

RESUMO Introdução A Rede Universitária de Telemedicina (Rute) é uma iniciativa que visa, no Brasil, promover a integração em telemedicina e telessaúde de hospitais universitários, hospitais certificados de ensino, faculdades de Medicina e profissionais da área da saúde por meio de infraestrutura de tecnologia da informação e comunicação e dos grupos de interesse especial (SIGs). Nesses grupos, que são criados e coordenados por instituições integrantes da Rute, profissionais de saúde e pesquisadores planejam uma agenda de videoconferências e/ou webconferências para debater temas específicos. Este artigo apresenta resultados da classificação dos SIGs da Rute em grupos homogêneos com base em sua produção em comunicação, cooperação e coordenação (3C). Métodos Foi realizado um inquérito com coordenadores dos SIGs entre abril e maio de 2016. A classificação dos SIGs em grupos homogêneos considerou as atividades desenvolvidas na rede entre 2007 e o momento da aplicação do inquérito. O estudo é retrospectivo, baseado em dados históricos das unidades, instituições e SIGs. Os coordenadores de 71 SIGs Rute foram convidados a responder. Desses, 45 SIGs ativos responderam ao inquérito de avaliação por completo e foram considerados nas análises. Resultados Quase um terço dos coordenadores respondentes (35%) declarou que seus SIGs atuam no eixo ensino, 21% atuam nos eixos de assistência e pesquisa, desenvolvimento e inovação, enquanto 12% atuam em gestão e 11% em avaliação. Foi feita a classificação dos SIGs em três grupos homogêneos – colaboração emergente, colaboração em desenvolvimento e colaboração plena – e identificado que, fora das sessões, 71% dos 45 SIGs (11 do grupo colaboração emergente e 20 do grupo em desenvolvimento) usam correio eletrônico como principal ferramenta de comunicação. Quatro SIGs do grupo colaboração plena indicaram: uso de serviço de mensagens instantâneas (1 SIG), site próprio (1 SIG) e redes sociais (2 SIGs). Conclusão Os resultados deste estudo podem não aferir com precisão a real produção e colaboração que os SIGs desenvolvem. Sugere-se, portanto, apreciar esta análise como um ponto de partida ou um referencial para a comunidade Rute. Porém, os resultados indicam que o desenvolvimento da colaboração na Rute e nos SIGs verificado nas análises é significativo, apontando uma evolução positiva para a Rute quanto ao interesse, participação e divulgação de ações em telemedicina e telessaúde no País.

ABSTRACT Introduction The Telemedicine University Network (RUTE) in Brazil is an initiative that promotes collaboration between university hospitals, teaching hospitals, health professionals, and students using information and communication technology infrastructure to support special interest groups (SIGs) in health care. Health professionals in RUTE-member institutions plan a program of video conferences and/or web conferences to discuss specific themes. This article presents the results of an analysis of the collaboration between the Special Interest Groups (SIGs) of the Telemedicine University Network (RUTE) considering the SIGs production in communication, cooperation and coordination (3C). Methods A survey was applied to SIG coordinators between April and May 2016. The classification of SIGs into homogeneous groups considered the activities developed in the network between 2007 and the time of the survey application. The study is retrospectively based on historical data from units, institutions and SIGs. The coordinators of 71 RUTE SIGs were invited to respond. Of those, forty-five active SIGs responded to the evaluation survey in its entirety and were considered in the analyses. Results Almost one third of the respondent coordinators (35%) stated that their SIG works in the education axis, 21% work in the care and research, development and innovation axes, while 12% work in management and 11% in evaluation. The SIGs were grouped into three homogeneous categories: emergent collaboration, collaborative development, and full collaboration, and it was identified that 71% of the 45 SIGs (11 in the emerging and 20 developing groups) use email as the main extra-session communication tool. Four SIGs from the full collaboration group reported: use of instant messaging service (1 SIG), own website (1 SIG) and social networks (2 SIGs). Conclusion The results of this study suggests may not accurately gauge the actual production and collaboration that SIGs develop and this analysis can be considered as a starting point or as a reference for the RUTE community. However, the results suggest significant growth in collaboration between RUTE-member SIGs, indicating a positive trend for the RUTE regarding the interest, participation and dissemination of actions in telemedicine and telehealth in the country.

Resumo Introdução O OSCE é um método de avaliação de competências clínicas que tem obtido popularidade internacional na educação em Medicina e Odontologia. Objetivo O objetivo do presente estudo foi descrever as etapas de desenvolvimento do OSCE para o curso de graduação em Odontologia e relatar a percepção dos estudantes sobre este método de avaliação, em relação ao grau de dificuldade, tempo para realização de cada etapa, importância de cada estação, número de estações, organização do exame, bem como o tempo total para a realização do OSCE. Material e método Esta pesquisa foi um estudo observacional e transversal, composto pela realização do OSCE e posterior aplicação de um questionário avaliativo aos alunos que cursavam o quarto semestre do curso de Odontologia. Esses alunos possuíam conhecimentos básicos em um nível intermediário de competências, compatíveis com sua etapa de ensino. Resultado No que diz respeito ao número de estações, 43 (97,7%) dos estudantes responderam que era apropriado, o processo da OSCE como um todo estava muito bem organizado (n = 25; 56,8%), organizado (n = 17; 38,6%) ou não muito organizado (n = 1; 2,27%) e sobre o tempo total do processo do OSCE, 29 (65,9%) relataram que era apropriado; 10 (2,27%) disseram que foi curto; 4 (9,09%), que foi longo. Conclusão A percepção do aluno foi positiva, especialmente em relação à organização e ao tempo atribuído a cada estação. Além disso, os alunos consideraram que os tópicos e questões aplicados em cada estação eram relevantes.

Abstract Introduction The OSCE is a method of clinical competencies evaluation that has gained international popularity in medical and dental education. Objective The purpose of the present study was to describe the stages of development of the OSCE for the undergraduate course in Dentistry and to report the students' perception about this method of evaluation, regarding the degree of difficulty, time for each stage, importance of each station, number of stations, organization of the exam, as well as the total time for the OSCE. Material and method This research was an observational and cross-sectional study, composed of the carry out of an OSCE and later application of an evaluative questionnaire to the students who were in the fourth semester of the Dentistry course. These students had basic knowledge and an intermediate level of competences, compatible with their stage of education. Result As regards the number of stations, 43(97.7%) of the students responded that this was appropriate, OSCE process as a whole was very well organized (n=25; 56.8%), organized (n=17; 38.6%) or not very organized (n=1; 2.27%) and about the total time of the OSCE process, 29(65.9%) reported that it was appropriate; 10 (2.27%) said that it was short; 4 (9.09%), that it was long. Conclusion The student’s perception was positive especially regarding to organization and the time attributed to each station. Furthermore, the students considered that the topics and questions applied in each station were relevant.