Resumo Compreender os sentidos e significados atribuídos às vivências cotidianas de usuárias e profissionais da atenção primária à saúde (APS), em serviços públicos de assistência materna, é o objetivo deste artigo. Trata-se de estudo de abordagem qualitativa a partir do relato desses sujeitos sobre suas interações. Foram realizados grupos focais com 56 mulheres, de classes populares, de 17-35 anos, majoritariamente autoidentificadas como pretas ou pardas; e 115 profissionais da APS, em duas cidades de um estado do nordeste brasileiro. O tema “violência” emergiu espontaneamente em discussões sobre direitos na gestação, parto e puerpério. As mulheres relataram dificuldades no acesso e problemas na qualidade dos serviços ofertados. As relações hierárquicas e assimétricas entre profissionais e usuárias são atravessadas por uma violência simbólica, naturalizada, institucionalmente legitimada, que se reproduz em um jogo de (des)responsabilização dos profissionais. Como resposta, usuárias recorrem ao controle das emoções e à violência. A depender do contexto, a violência é mais ou menos explícita, atuando como um fio condutor, uma linguagem simbólica, presente na relação usuárias-profissionais de saúde. O cotidiano é marcado por práticas violentas que geram violência como resposta e revelam o não reconhecimento da mulher como sujeito integral e de direitos.

Abstract The aim of this article is to understand the senses and meanings attributed to the daily experiences of primary health care (PHC) users and practitioners in public maternal care services. This is a qualitative study based on these individuals' accounts of their interactions. Focus groups were held with 56 working class women, aged 17-35, mostly self-identified as black or brown, and 115 PHC practitioners, in two cities in a northeastern Brazilian state. The theme of "violence" emerged spontaneously in discussions about rights during pregnancy, childbirth and the puerperium. The women reported difficulties in access and problems with the quality of the services offered. The hierarchical and asymmetrical relations between practitioners and users are crossed by symbolic, naturalized and institutionally legitimized violence, which is reproduced in a game of (dis)accountability on the part of the practitioners. In response, users resort to controlling their emotions and resorting to violence. Depending on the context, violence is more or less explicit, acting as a common thread, a symbolic language, present in the relationship between users and health practitioners. Daily life is marked by violent practices that generate violence as a response and reveal the failure to recognize women as integral subjects with rights.

Abstract The aim of this article is to understand the senses and meanings attributed to the daily experiences of primary health care (PHC) users and practitioners in public maternal care services. This is a qualitative study based on these individuals' accounts of their interactions. Focus groups were held with 56 working class women, aged 17-35, mostly self-identified as black or brown, and 115 PHC practitioners, in two cities in a northeastern Brazilian state. The theme of "violence" emerged spontaneously in discussions about rights during pregnancy, childbirth and the puerperium. The women reported difficulties in access and problems with the quality of the services offered. The hierarchical and asymmetrical relations between practitioners and users are crossed by symbolic, naturalized and institutionally legitimized violence, which is reproduced in a game of (dis)accountability on the part of the practitioners. In response, users resort to controlling their emotions and resorting to violence. Depending on the context, violence is more or less explicit, acting as a common thread, a symbolic language, present in the relationship between users and health practitioners. Daily life is marked by violent practices that generate violence as a response and reveal the failure to recognize women as integral subjects with rights. (PHC individuals interactions 5 1735, 1735 17 35, 35 17-35 selfidentified self identified brown 11 state "violence pregnancy puerperium offered disaccountability dis accountability context explicit thread language 173 1 3 17-3 17-

Resumo Compreender os sentidos e significados atribuídos às vivências cotidianas de usuárias e profissionais da atenção primária à saúde (APS), em serviços públicos de assistência materna, é o objetivo deste artigo. Trata-se de estudo de abordagem qualitativa a partir do relato desses sujeitos sobre suas interações. Foram realizados grupos focais com 56 mulheres, de classes populares, de 17-35 anos, majoritariamente autoidentificadas como pretas ou pardas; e 115 profissionais da APS, em duas cidades de um estado do nordeste brasileiro. O tema “violência” emergiu espontaneamente em discussões sobre direitos na gestação, parto e puerpério. As mulheres relataram dificuldades no acesso e problemas na qualidade dos serviços ofertados. As relações hierárquicas e assimétricas entre profissionais e usuárias são atravessadas por uma violência simbólica, naturalizada, institucionalmente legitimada, que se reproduz em um jogo de (des)responsabilização dos profissionais. Como resposta, usuárias recorrem ao controle das emoções e à violência. A depender do contexto, a violência é mais ou menos explícita, atuando como um fio condutor, uma linguagem simbólica, presente na relação usuárias-profissionais de saúde. O cotidiano é marcado por práticas violentas que geram violência como resposta e revelam o não reconhecimento da mulher como sujeito integral e de direitos. APS , (APS) materna artigo Tratase Trata interações 5 populares 1735 17 35 17-3 anos pardas 11 brasileiro “violência gestação puerpério ofertados simbólica naturalizada legitimada desresponsabilização des responsabilização contexto explícita condutor usuáriasprofissionais (APS 173 1 3 17-

ABSTRACT Objective: To analyze characteristics of the home visit (HV) in Brazil, 2012 and 2017. Methods: Ecological study, with panel data whose units of analysis were the Primary Health Care teams in Brazil, participants of the 1st and 3rd cycles of the Program to Improve Access and Quality of Primary Care of the Unified Health System. Descriptive, inferential and spatial analyzes (alpha=5%) were performed. Results: There was an increase in the proportion of teams that carried out home visits at a frequency defined based on risk and vulnerability analysis and actively searched for people with respiratory symptoms and women with delayed and altered cytopathological examination. In the heat maps, the Northeast, Southeast and South regions had a higher concentration of teams that carried out the HV and carried out an active search. Conclusion: The maintenance and qualification of HVs must be a priority in Brazil, since there are few countries in the world with such capillarity of health services, reaching the homes of millions of people. Objective (HV Brazil 201 2017 Methods study st rd System Descriptive alpha=5% alpha5 alpha 5 (alpha=5% performed Results examination maps Northeast search Conclusion services 20 alpha=5 (alpha=5 2 alpha= (alpha= (alpha

RESUMO Objetivo: Analisar características da visita domiciliar (VD) no Brasil em 2012 e 2017. Métodos: Estudo ecológico com dados em painel cujas unidades de análise foram as equipes de saúde da Atenção Primária à Saúde no Brasil, participantes do 1º e 3º ciclos do Programa de Melhoria do Acesso e Qualidade da Atenção Básica do Sistema Único de Saúde. Foram realizadas análises descritivas, inferenciais e espaciais (alpha=5%). Resultados: Houve aumento na proporção de equipes que realizavam visita domiciliar com periodicidade definida a partir da análise de risco e vulnerabilidade e na de busca ativa de pessoas com sintomáticos respiratórios e de mulheres com exame citopatológico atrasado e alterado. Nordeste, Sudeste e Sul foram as regiões com maior concentração de equipes que realizavam a VD e faziam busca ativa. Conclusão: A manutenção e qualificação das VD deve ser uma prioridade no Brasil, uma vez que poucos são os países no mundo com tamanha capilaridade dos serviços de saúde, alcançando os domicílios de milhões de pessoas. Objetivo (VD 201 2017 Métodos º descritivas alpha=5%. alpha5 alpha alpha=5% . 5 (alpha=5%) Resultados alterado Nordeste Conclusão 20 alpha=5 (alpha=5% 2 alpha= (alpha=5 (alpha= (alpha

ABSTRACT Objective: To analyze characteristics of the home visit (HV) in Brazil, 2012 and 2017. Methods: Ecological study, with panel data whose units of analysis were the Primary Health Care teams in Brazil, participants of the 1st and 3rd cycles of the Program to Improve Access and Quality of Primary Care of the Unified Health System. Descriptive, inferential and spatial analyzes (alpha=5%) were performed. Results: There was an increase in the proportion of teams that carried out home visits at a frequency defined based on risk and vulnerability analysis and actively searched for people with respiratory symptoms and women with delayed and altered cytopathological examination. In the heat maps, the Northeast, Southeast and South regions had a higher concentration of teams that carried out the HV and carried out an active search. Conclusion: The maintenance and qualification of HVs must be a priority in Brazil, since there are few countries in the world with such capillarity of health services, reaching the homes of millions of people.

RESUMO Objetivo: Analisar características da visita domiciliar (VD) no Brasil em 2012 e 2017. Métodos: Estudo ecológico com dados em painel cujas unidades de análise foram as equipes de saúde da Atenção Primária à Saúde no Brasil, participantes do 1º e 3º ciclos do Programa de Melhoria do Acesso e Qualidade da Atenção Básica do Sistema Único de Saúde. Foram realizadas análises descritivas, inferenciais e espaciais (alpha=5%). Resultados: Houve aumento na proporção de equipes que realizavam visita domiciliar com periodicidade definida a partir da análise de risco e vulnerabilidade e na de busca ativa de pessoas com sintomáticos respiratórios e de mulheres com exame citopatológico atrasado e alterado. Nordeste, Sudeste e Sul foram as regiões com maior concentração de equipes que realizavam a VD e faziam busca ativa. Conclusão: A manutenção e qualificação das VD deve ser uma prioridade no Brasil, uma vez que poucos são os países no mundo com tamanha capilaridade dos serviços de saúde, alcançando os domicílios de milhões de pessoas.

Resumo O aleitamento materno (AM) é um direito humano e deve ser iniciado desde o nascimento. A adequação das estratégias da Rede Cegonha (RC) pode contribuir na promoção do AM. O objetivo foi identificar os fatores associados ao AM na primeira e nas 24 horas de nascidos vivos a termo em maternidades vinculadas à RC. Estudo transversal com dados do segundo ciclo avaliativo 2016-2017 da RC, que abrangeu todo o Brasil. Foram obtidas razões de chance por meio de regressão logística binária segundo modelo hierarquizado, com intervalos de confiança a 95% e p-valor < 0,01. A prevalência de AM na primeira hora foi de 31%, e nas 24 horas, de 96,6%. Aumentaram as chances de AM na primeira hora: presença de acompanhante na internação, contato pele a pele, parto vaginal, assistência ao parto por enfermeira e acreditação da unidade na Iniciativa Hospital Amigo da Criança. Resultados semelhantes nas 24 horas, e associação com idade materna inferior a 20 anos. O AM na primeira hora foi menos satisfatório do que nas 24h, provavelmente pela elevada prevalência de cesariana, fator associado à menor chance de AM precoce. A capacitação dos profissionais sobre AM de forma contínua e a presença de enfermeiro obstetra no parto são recomendadas para ampliar o AM na primeira hora.

Abstract Breastfeeding (BF) is a human right, and it must start from birth. The adequacy of Rede Cegonha (RC) strategies can contribute to the promotion of BF. The objective was to identify factors associated with BF in the first and 24 hours of live births at full-term maternity hospitals linked to CR. Cross-sectional study with data from the second evaluation cycle 2016-2017 of the RC that covered all of Brazil. Odds ratios were obtained through binary logistic regression according to a hierarchical model, with 95% confidence intervals and p-value < 0.01. The prevalence of BF in the first hour was 31% and in the 24 hours 96.6%. The chances of BF in the first hour increased: presence of a companion during hospitalization, skin-to-skin contact, vaginal delivery, delivery assistance by a nurse and accreditation of the unit in the Baby-Friendly Hospital Initiative. Similar results at 24 hours, and association with maternal age below 20 years. BF in the first hour was less satisfactory than in the 24 hours, probably due to the high prevalence of cesarean sections, a factor associated with a lower chance of early BF. Continuous training of professionals about BF and the presence of an obstetric nurse during childbirth are recommended to expand BF in the first hour.

Abstract Breastfeeding (BF) is a human right, and it must start from birth. The adequacy of Rede Cegonha (RC) strategies can contribute to the promotion of BF. The objective was to identify factors associated with BF in the first and 24 hours of live births at full-term maternity hospitals linked to CR. Cross-sectional study with data from the second evaluation cycle 2016-2017 of the RC that covered all of Brazil. Odds ratios were obtained through binary logistic regression according to a hierarchical model, with 95% confidence intervals and p-value < 0.01. The prevalence of BF in the first hour was 31% and in the 24 hours 96.6%. The chances of BF in the first hour increased: presence of a companion during hospitalization, skin-to-skin contact, vaginal delivery, delivery assistance by a nurse and accreditation of the unit in the Baby-Friendly Hospital Initiative. Similar results at 24 hours, and association with maternal age below 20 years. BF in the first hour was less satisfactory than in the 24 hours, probably due to the high prevalence of cesarean sections, a factor associated with a lower chance of early BF. Continuous training of professionals about BF and the presence of an obstetric nurse during childbirth are recommended to expand BF in the first hour. (BF right birth (RC 2 fullterm full term CR Crosssectional Cross sectional 20162017 2016 2017 2016-201 Brazil model 95 pvalue p value 001 0 01 0.01 31 966 96 6 96.6% increased hospitalization skintoskin skin contact BabyFriendly Baby Friendly Initiative years sections 2016201 201 2016-20 9 00 0.0 3 96.6 201620 2016-2 0. 96. 20162 2016-

Resumo O aleitamento materno (AM) é um direito humano e deve ser iniciado desde o nascimento. A adequação das estratégias da Rede Cegonha (RC) pode contribuir na promoção do AM. O objetivo foi identificar os fatores associados ao AM na primeira e nas 24 horas de nascidos vivos a termo em maternidades vinculadas à RC. Estudo transversal com dados do segundo ciclo avaliativo 2016-2017 da RC, que abrangeu todo o Brasil. Foram obtidas razões de chance por meio de regressão logística binária segundo modelo hierarquizado, com intervalos de confiança a 95% e p-valor < 0,01. A prevalência de AM na primeira hora foi de 31%, e nas 24 horas, de 96,6%. Aumentaram as chances de AM na primeira hora: presença de acompanhante na internação, contato pele a pele, parto vaginal, assistência ao parto por enfermeira e acreditação da unidade na Iniciativa Hospital Amigo da Criança. Resultados semelhantes nas 24 horas, e associação com idade materna inferior a 20 anos. O AM na primeira hora foi menos satisfatório do que nas 24h, provavelmente pela elevada prevalência de cesariana, fator associado à menor chance de AM precoce. A capacitação dos profissionais sobre AM de forma contínua e a presença de enfermeiro obstetra no parto são recomendadas para ampliar o AM na primeira hora. (AM nascimento RC (RC 2 20162017 2016 2017 2016-201 Brasil hierarquizado 95 pvalor p valor 001 0 01 0,01 31 31% 966 96 6 96,6% internação vaginal Criança anos 24h h cesariana precoce 2016201 201 2016-20 9 00 0,0 3 96,6 201620 2016-2 0, 96, 20162 2016-

Abstract This article aims to evaluate the effect of the COVID-19 pandemic on malnutrition among children under two years of age enrolled in the Bolsa Família Program (BFP). Ecological study of interrupted time series (ITS), with low weight for age, stunting, and overweight as time-dependent variables of malnutrition, extracted monthly (Jan/2008 to June/2021) from the Food and Nutrition Surveillance System. The COVID-19 pandemic was the exposure, dichotomized into pre-pandemic and pandemic. In RStudio, the trend was obtained by Prais-Winsten regression, and the effect of the pandemic on the time-dependent variables was determined by SARIMA modeling, estimating the regression coefficients (RC) adjusted for trend and seasonality (α = 5%). The pandemic was associated with an increase in: i) low weight for age in the South (RC = 0.94; p < 0.001) and Southeast (RC = 1.97; p < 0.001); ii) height deficit in the Midwest (RC = 2.4; p = 0.01), South (RC = 2.15; p < 0.001) and Southeast (RC = 2.96; p < 0.001); and iii) and overweight in the North (RC = 1.51; p = 0.04), Midwest (RC = 2.29; p = 0.01), South (RC = 2.83; p < 0.001), and Southeast (RC = 0.72; p = 0.04). The pandemic increased underweight in the South and Southeast, and the double burden of malnutrition in the Midwest, South, and Southeast. In the Northeast and North, higher rates of malnutrition still persist.

Resumo O objetivo do artigo é avaliar o efeito da pandemia de COVID-19 sobre a má nutrição em crianças menores de dois anos inscritas no Programa Bolsa Família. Estudo ecológico de série temporal interrompida, tendo o baixo peso por idade, o déficit de estatura e o excesso de peso como variáveis tempo-dependentes de má nutrição, extraídas mensalmente (jan/2008 a junho/2021) do Sistema de Vigilância Alimentar e Nutricional. A pandemia de COVID-19 foi a exposição, dicotomizada em pré e pandemia. No programa RStudio, a tendência foi obtida pela regressão de Prais-Winsten, e o efeito da pandemia sobre as variáveis tempo-dependentes, pela modelagem SARIMA, calculando-se coeficientes de regressão (CR) ajustados para tendência prévia e sazonalidade (α = 5%). A pandemia se associou ao aumento do: i) baixo peso por idade no Sul (CR = 0,94; p < 0,001) e Sudeste (CR = 1,97; p < 0,001); ii) déficit de estatura no Centro-Oeste (CR = 2,4; p = 0,01), Sul (CR = 2,15; p < 0,001) e Sudeste (CR = 2,96; p < 0,001); e iii) excesso de peso no Norte (CR = 1,51; p=0,04), Centro-Oeste (CR = 2,29; p = 0,01), Sul (CR = 2,83; p < 0,001) e Sudeste (CR = 0,72; p = 0,04). A pandemia aumentou o baixo peso no Sul e Sudeste e a dupla carga de má nutrição no Centro-Oeste, no Sul e no Sudeste. No Nordeste e no Norte persistem taxas mais altas de má nutrição.

Abstract This article aims to evaluate the effect of the COVID-19 pandemic on malnutrition among children under two years of age enrolled in the Bolsa Família Program (BFP). Ecological study of interrupted time series (ITS), with low weight for age, stunting, and overweight as time-dependent variables of malnutrition, extracted monthly (Jan/2008 to June/2021) from the Food and Nutrition Surveillance System. The COVID-19 pandemic was the exposure, dichotomized into pre-pandemic and pandemic. In RStudio, the trend was obtained by Prais-Winsten regression, and the effect of the pandemic on the time-dependent variables was determined by SARIMA modeling, estimating the regression coefficients (RC) adjusted for trend and seasonality (α = 5%). The pandemic was associated with an increase in: i) low weight for age in the South (RC = 0.94; p < 0.001) and Southeast (RC = 1.97; p < 0.001); ii) height deficit in the Midwest (RC = 2.4; p = 0.01), South (RC = 2.15; p < 0.001) and Southeast (RC = 2.96; p < 0.001); and iii) and overweight in the North (RC = 1.51; p = 0.04), Midwest (RC = 2.29; p = 0.01), South (RC = 2.83; p < 0.001), and Southeast (RC = 0.72; p = 0.04). The pandemic increased underweight in the South and Southeast, and the double burden of malnutrition in the Midwest, South, and Southeast. In the Northeast and North, higher rates of malnutrition still persist. COVID19 COVID 19 COVID-1 BFP. BFP . (BFP) ITS, ITS , (ITS) stunting timedependent dependent Jan/2008 Jan2008 Jan 2008 (Jan/200 June/2021 June2021 June 2021 System exposure prepandemic pre RStudio PraisWinsten Prais Winsten modeling RC α 5%. 5 5% 5%) i 0.94 094 0 94 0.001 0001 001 1.97 197 1 97 ii 2.4 24 2 4 0.01, 0.01 01 0.01) 2.15 215 15 2.96 296 96 iii 1.51 151 51 0.04, 004 0.04 04 0.04) 2.29 229 29 2.83 283 83 0.001, 0.72 072 72 0.04. persist COVID1 COVID- (BFP (ITS Jan/200 Jan200 200 (Jan/20 June/202 June202 202 0.9 09 9 0.00 000 00 1.9 2. 0.0 2.1 21 2.9 1.5 2.2 22 2.8 28 8 0.7 07 7 Jan/20 Jan20 20 (Jan/2 June/20 June20 0. 1. Jan/2 Jan2 (Jan/ June/2 June2 Jan/ (Jan June/

Resumo O objetivo do artigo é avaliar o efeito da pandemia de COVID-19 sobre a má nutrição em crianças menores de dois anos inscritas no Programa Bolsa Família. Estudo ecológico de série temporal interrompida, tendo o baixo peso por idade, o déficit de estatura e o excesso de peso como variáveis tempo-dependentes de má nutrição, extraídas mensalmente (jan/2008 a junho/2021) do Sistema de Vigilância Alimentar e Nutricional. A pandemia de COVID-19 foi a exposição, dicotomizada em pré e pandemia. No programa RStudio, a tendência foi obtida pela regressão de Prais-Winsten, e o efeito da pandemia sobre as variáveis tempo-dependentes, pela modelagem SARIMA, calculando-se coeficientes de regressão (CR) ajustados para tendência prévia e sazonalidade (α = 5%). A pandemia se associou ao aumento do: i) baixo peso por idade no Sul (CR = 0,94; p < 0,001) e Sudeste (CR = 1,97; p < 0,001); ii) déficit de estatura no Centro-Oeste (CR = 2,4; p = 0,01), Sul (CR = 2,15; p < 0,001) e Sudeste (CR = 2,96; p < 0,001); e iii) excesso de peso no Norte (CR = 1,51; p=0,04), Centro-Oeste (CR = 2,29; p = 0,01), Sul (CR = 2,83; p < 0,001) e Sudeste (CR = 0,72; p = 0,04). A pandemia aumentou o baixo peso no Sul e Sudeste e a dupla carga de má nutrição no Centro-Oeste, no Sul e no Sudeste. No Nordeste e no Norte persistem taxas mais altas de má nutrição. COVID19 COVID 19 COVID-1 Família interrompida tempodependentes tempo dependentes jan/2008 jan2008 jan 2008 (jan/200 junho/2021 junho2021 junho 2021 Nutricional exposição RStudio PraisWinsten, PraisWinsten Prais Winsten, Winsten Prais-Winsten tempodependentes, dependentes, SARIMA calculandose calculando CR α 5%. 5 5% . 5%) i 0,94 094 0 94 0,001 0001 001 1,97 197 1 97 ii CentroOeste Centro Oeste 2,4 24 2 4 0,01, 0,01 , 01 0,01) 2,15 215 15 2,96 296 96 iii 1,51 151 51 p=0,04, p004 p=0,04 04 p=0,04) 2,29 229 29 2,83 283 83 0,72 072 72 0,04. 004 0,04 0,04) CentroOeste, Oeste, COVID1 COVID- jan/200 jan200 200 (jan/20 junho/202 junho202 202 0,9 09 9 0,00 000 00 1,9 2, 0,0 2,1 21 2,9 1,5 p00 p=0,0 2,2 22 2,8 28 8 0,7 07 7 jan/20 jan20 20 (jan/2 junho/20 junho20 0, 1, p0 p=0, jan/2 jan2 (jan/ junho/2 junho2 p=0 jan/ (jan junho/ p=

Abstract The scope of this study was to analyze the factors associated with the use of dental services in Brazil. The review strategy included PubMed, SciELO, LILACS, BBO, EMBASE, Scopus, WOS and Google Scholar databases, in addition to repositories and databases of dissertations and theses. Studies were selected using the PEO (Population/Exposure/Outcomes) strategy. The outcome of this study was the use of dental services in the last year by the Brazilian population, treated as dichotomous variables for the following analyses: ≤ 1 year and > 1 year. Mantel-Haenszel random effect meta-analysis was performed, estimating Prevalence Ratios (PR) and 95% confidence intervals (95%CI). A total of 94 studies were selected. The majority (98%) had a cross-sectional design, with 63% derived from primary data. For the meta-analysis, 25 studies were included. The use of oral health services in the last year was associated with higher education (≥ 8 years of schooling) (PR = 0.49, (95%CI: 0.39-0.60)); higher family income (≥ 2 minimum wages) (RP = 0.79, (95%CI: 0.74-0.84)); and living in urban areas (RP = 0.79, (95%CI: 0.64-0.97)). The availability of dental services in the Unified Health System needs to be made readily accessible to people with lower income, less education and those living in rural areas. Brazil PubMed SciELO LILACS BBO EMBASE Scopus theses Population/Exposure/Outcomes PopulationExposureOutcomes Population Exposure Outcomes (Population/Exposure/Outcomes population analyses MantelHaenszel Mantel Haenszel metaanalysis meta analysis performed PR 95 95%CI. 95CI CI 95%CI . (95%CI) 9 98% 98 (98% crosssectional cross sectional design 63 data metaanalysis, analysis, ≥ ( schooling 049 0 49 0.49 (95%CI 0.390.60 039060 0.39 0.60 39 60 0.39-0.60)) wages RP 079 79 0.79 0.740.84 074084 0.74 0.84 74 84 0.74-0.84)) 0.640.97. 064097 0.64 0.97 64 97 0.64-0.97)) (98 6 04 4 0.4 390 0.390.6 03906 039 0.3 060 0.6 3 0.39-0.60) 07 7 0.7 740 0.740.8 07408 074 084 0.8 0.74-0.84) 640 0.640.97 06409 064 097 0.9 0.64-0.97) (9 0. 0.390. 0390 03 06 0.39-0.60 0.740. 0740 08 0.74-0.84 0.640.9 0640 09 0.64-0.97 0.390 0.39-0.6 0.740 0.74-0.8 0.640. 0.64-0.9 0.39-0. 0.74-0. 0.640 0.64-0. 0.39-0 0.74-0 0.64-0 0.39- 0.74- 0.64-

Resumo O objetivo foi analisar os fatores associados ao uso dos serviços odontológicos no Brasil. A estratégia de revisão incluiu as bases PubMed, SciELO, LILACS, BBO, EMBASE, Scopus, WOS e Google Scholar, além de repositórios e bancos de dissertações e teses. Os estudos foram selecionados usando a estratégia PEO (população/exposição/desfechos). O desfecho deste estudo foi o uso dos serviços odontológicos no último ano pela população brasileira, tratado como variáveis dicotômicas para as análises: ≤ 1 ano e > 1 ano. Foi realizada uma metanálise de efeito randômico de Mantel-Haenszel, estimando-se razões de prevalência (RP) e intervalos de confiança de 95% (IC95%). Foram selecionados 94 estudos. A maioria (98%) tinha delineamento transversal, sendo 63% oriundos de dados primários. Para a metanálise, 25 estudos foram incluídos. O uso dos serviços odontológicos no último ano esteve associado com maior escolaridade (≥ 8 anos de estudo) (RP = 0,49, (IC95%: 0,39-0,60)); maior renda familiar (≥ 2 salários-mínimos) (RP = 0,79, (IC95%: 0,74-0,84)); e residir na zona urbana (RP = 0,79, (IC95%: 0,64-0,97)). A oferta de serviços odontológicos no Sistema Único de Saúde precisa ser ampliada entre pessoas com menor renda, menor escolaridade e moradores da zona rural. Brasil PubMed SciELO LILACS BBO EMBASE Scopus Scholar teses população/exposição/desfechos. populaçãoexposiçãodesfechos população/exposição/desfechos . exposição desfechos (população/exposição/desfechos) brasileira análises MantelHaenszel, MantelHaenszel Mantel Haenszel, Haenszel Mantel-Haenszel estimandose estimando se RP 95 IC95%. IC95 IC IC95% (IC95%) 9 98% 98 (98% transversal 63 primários incluídos ≥ ( 049 0 49 0,49 (IC95% 0,390,60 039060 0,39 0,60 39 60 0,39-0,60)) saláriosmínimos salários mínimos salários-mínimos 079 79 0,79 0,740,84 074084 0,74 0,84 74 84 0,74-0,84)) 0,640,97. 064097 0,64 0,97 64 97 0,64-0,97)) rural (população/exposição/desfechos IC9 (98 6 04 4 0,4 (IC95 390 0,390,6 03906 039 0,3 060 0,6 3 0,39-0,60) 07 7 0,7 740 0,740,8 07408 074 084 0,8 0,74-0,84) 640 0,640,97 06409 064 097 0,9 0,64-0,97) (9 0, (IC9 0,390, 0390 03 06 0,39-0,60 0,740, 0740 08 0,74-0,84 0,640,9 0640 09 0,64-0,97 (IC 0,390 0,39-0,6 0,740 0,74-0,8 0,640, 0,64-0,9 0,39-0, 0,74-0, 0,640 0,64-0, 0,39-0 0,74-0 0,64-0 0,39- 0,74- 0,64-

Resumo O objetivo foi analisar os fatores associados ao uso dos serviços odontológicos no Brasil. A estratégia de revisão incluiu as bases PubMed, SciELO, LILACS, BBO, EMBASE, Scopus, WOS e Google Scholar, além de repositórios e bancos de dissertações e teses. Os estudos foram selecionados usando a estratégia PEO (população/exposição/desfechos). O desfecho deste estudo foi o uso dos serviços odontológicos no último ano pela população brasileira, tratado como variáveis dicotômicas para as análises: ≤ 1 ano e > 1 ano. Foi realizada uma metanálise de efeito randômico de Mantel-Haenszel, estimando-se razões de prevalência (RP) e intervalos de confiança de 95% (IC95%). Foram selecionados 94 estudos. A maioria (98%) tinha delineamento transversal, sendo 63% oriundos de dados primários. Para a metanálise, 25 estudos foram incluídos. O uso dos serviços odontológicos no último ano esteve associado com maior escolaridade (≥ 8 anos de estudo) (RP = 0,49, (IC95%: 0,39-0,60)); maior renda familiar (≥ 2 salários-mínimos) (RP = 0,79, (IC95%: 0,74-0,84)); e residir na zona urbana (RP = 0,79, (IC95%: 0,64-0,97)). A oferta de serviços odontológicos no Sistema Único de Saúde precisa ser ampliada entre pessoas com menor renda, menor escolaridade e moradores da zona rural.

Abstract The scope of this study was to analyze the factors associated with the use of dental services in Brazil. The review strategy included PubMed, SciELO, LILACS, BBO, EMBASE, Scopus, WOS and Google Scholar databases, in addition to repositories and databases of dissertations and theses. Studies were selected using the PEO (Population/Exposure/Outcomes) strategy. The outcome of this study was the use of dental services in the last year by the Brazilian population, treated as dichotomous variables for the following analyses: ≤ 1 year and > 1 year. Mantel-Haenszel random effect meta-analysis was performed, estimating Prevalence Ratios (PR) and 95% confidence intervals (95%CI). A total of 94 studies were selected. The majority (98%) had a cross-sectional design, with 63% derived from primary data. For the meta-analysis, 25 studies were included. The use of oral health services in the last year was associated with higher education (≥ 8 years of schooling) (PR = 0.49, (95%CI: 0.39-0.60)); higher family income (≥ 2 minimum wages) (RP = 0.79, (95%CI: 0.74-0.84)); and living in urban areas (RP = 0.79, (95%CI: 0.64-0.97)). The availability of dental services in the Unified Health System needs to be made readily accessible to people with lower income, less education and those living in rural areas.

Resumo Objetivou-se analisar a tendência dos indicadores do Programa Nacional de Imunizações (PNI) em menores de um ano e classificar os municípios quanto ao risco de transmissão de doenças imunopreveníveis (RTDIp) no Maranhão de 2010 a 2021. Estudo ecológico de série temporal, baseado em dados secundários de cobertura vacinal (CV), homogeneidade de cobertura vacinal (HCV), proporção de abandono (PA) e RTDIp, com abrangência estadual, para vacinas do calendário nacional infantil. Regressão de Prais-Winstein estimou tendência (α = 5%) e variação percentual anual (VPA) dos indicadores. Houve CV flutuantes e discrepantes entre as vacinas, com tendência decrescente (p < 0,01), exceto contra hepatite B (p = 0,709) e rotavírus (p = 0,143). As quedas mais acentuadas foram para as vacinas contra febre amarela e BCG. Todas as taxas de HCV estavam abaixo do esperado, com a diminuição a partir de 2014 e VPA de 5,75% a 14,02%. Houve tendência crescente da PA para pentavalente e poliomielite. No período de 2015 e 2021 houve incremento de 52,54% na proporção dos municípios maranhenses com RTDIp muito alto (p = 0,025) e alto (p = 0,028). Ao longo de 12 anos, houve piora dos indicadores do PNI em menores de um ano, reafirmando a suscetibilidade para o surgimento de doenças imunopreveníveis.

Abstract We aimed to analyze the trend of indicators of the National Immunization Program (acronym in Portuguese. PNI) in children under one-year-old and classify municipalities regarding the risk of transmission of vaccine-preventable diseases (RTVPD) in Maranhão from 2010 to 2021. This ecological time series study was based on secondary data on vaccination coverage (VC). vaccination coverage homogeneity (VCH). proportion of abandonment (PA). and RTVPD. with state coverage for vaccines in the national children’s calendar. Prais-Winsten regression estimated trends (α=5%) and the indicators’ annual percentage change (APC). We identified fluctuating and discrepant VC between vaccines. with a decreasing trend (p < 0.01). except those against Hepatitis B (p = 0.709) and oral human rotavirus (p = 0.143). The sharpest falls were for Yellow Fever (APC = 12.24%) and BCG (APC = 12.25%) vaccines. All VCH rates were lower than expected. with a drop from 2014 and APC between 5.75% (Pneumococcal 10; p = 0.033) and 14.02% (Poliomyelitis; p < 0.01). We observed an increasing trend in PA for Pentavalent (APC = 4.91%; p < 0.01) and Poliomyelitis (APC = 3.55%; p < 0.01). We identified an increase of 52.54% in the proportion of municipalities in Maranhão from 2015 to 2021. with extremely high (p = 0.025) and high (p = 0.028) RTVPD. The PNI indicators deteriorated. reaffirming the susceptibility to the emergence of vaccine-preventable diseases.

Abstract We aimed to analyze the trend of indicators of the National Immunization Program (acronym in Portuguese. PNI) in children under one-year-old and classify municipalities regarding the risk of transmission of vaccine-preventable diseases (RTVPD) in Maranhão from 2010 to 2021. This ecological time series study was based on secondary data on vaccination coverage (VC). vaccination coverage homogeneity (VCH). proportion of abandonment (PA). and RTVPD. with state coverage for vaccines in the national children’s calendar. Prais-Winsten regression estimated trends (α=5%) and the indicators’ annual percentage change (APC). We identified fluctuating and discrepant VC between vaccines. with a decreasing trend (p < 0.01). except those against Hepatitis B (p = 0.709) and oral human rotavirus (p = 0.143). The sharpest falls were for Yellow Fever (APC = 12.24%) and BCG (APC = 12.25%) vaccines. All VCH rates were lower than expected. with a drop from 2014 and APC between 5.75% (Pneumococcal 10; p = 0.033) and 14.02% (Poliomyelitis; p < 0.01). We observed an increasing trend in PA for Pentavalent (APC = 4.91%; p < 0.01) and Poliomyelitis (APC = 3.55%; p < 0.01). We identified an increase of 52.54% in the proportion of municipalities in Maranhão from 2015 to 2021. with extremely high (p = 0.025) and high (p = 0.028) RTVPD. The PNI indicators deteriorated. reaffirming the susceptibility to the emergence of vaccine-preventable diseases. acronym Portuguese oneyearold one year old vaccinepreventable vaccine preventable RTVPD (RTVPD 201 2021 VC. . (VC) VCH. (VCH) PA. (PA) childrens s calendar PraisWinsten Prais Winsten α=5% α5 α 5 (α=5% APC. (APC) 0.01. 001 0.01 0 01 0.709 0709 709 0.143. 0143 0.143 143 0.143) 12.24% 1224 12 24 12.25% 1225 25 expected 575 75 5.75 Pneumococcal 10 0.033 0033 033 1402 14 02 14.02 (Poliomyelitis 4.91% 491 4 91 3.55% 355 3 55 5254 52 54 52.54 0.025 0025 025 0.028 0028 028 deteriorated 20 202 (VC (VCH (PA α=5 (α=5 00 0.0 0.70 070 70 014 0.14 12.24 122 1 2 12.25 57 7 5.7 0.03 003 03 140 14.0 4.91 49 9 3.55 35 525 52.5 0.02 002 α= (α= 0. 0.7 07 0.1 12.2 5. 14. 4.9 3.5 52. (α 12. 4. 3.

Resumo Objetivou-se analisar a tendência dos indicadores do Programa Nacional de Imunizações (PNI) em menores de um ano e classificar os municípios quanto ao risco de transmissão de doenças imunopreveníveis (RTDIp) no Maranhão de 2010 a 2021. Estudo ecológico de série temporal, baseado em dados secundários de cobertura vacinal (CV), homogeneidade de cobertura vacinal (HCV), proporção de abandono (PA) e RTDIp, com abrangência estadual, para vacinas do calendário nacional infantil. Regressão de Prais-Winstein estimou tendência (α = 5%) e variação percentual anual (VPA) dos indicadores. Houve CV flutuantes e discrepantes entre as vacinas, com tendência decrescente (p < 0,01), exceto contra hepatite B (p = 0,709) e rotavírus (p = 0,143). As quedas mais acentuadas foram para as vacinas contra febre amarela e BCG. Todas as taxas de HCV estavam abaixo do esperado, com a diminuição a partir de 2014 e VPA de 5,75% a 14,02%. Houve tendência crescente da PA para pentavalente e poliomielite. No período de 2015 e 2021 houve incremento de 52,54% na proporção dos municípios maranhenses com RTDIp muito alto (p = 0,025) e alto (p = 0,028). Ao longo de 12 anos, houve piora dos indicadores do PNI em menores de um ano, reafirmando a suscetibilidade para o surgimento de doenças imunopreveníveis. Objetivouse Objetivou se (PNI (RTDIp 201 temporal CV, , (CV) HCV, (HCV) (PA estadual infantil PraisWinstein Prais Winstein α 5% 5 (VPA p 0,01, 001 0,01 0 01 0,01) 0,709 0709 709 0,143. 0143 0,143 . 143 0,143) BCG esperado 575 75 5,75 1402 14 02 14,02% poliomielite 202 5254 52 54 52,54 0,025 0025 025 0,028. 0028 0,028 028 0,028) 1 anos 20 (CV (HCV 00 0,0 0,70 070 70 014 0,14 57 7 5,7 140 14,02 525 52,5 0,02 002 2 0, 0,7 07 0,1 5, 14,0 52, 14,

ABSTRACT OBJECTIVE This study aimed to investigate the effect of mouthwash use on the development of oral cancer. METHODS Observational studies with adult/older adult populations that have examined the association between mouthwash use and oral cancer were included. Electronic search was performed in July 2022, with no time or language restrictions. PubMed/Medline, Embase, and Web of Science databases were used, and the search was extended to theses and dissertations libraries, Google Scholar, reference lists, and other sources. Methodological quality was assessed using the Newcastle-Ottawa Scale and quantitative data synthesis was performed by random effects meta-analysis, with different subgroup analyses and meta-regression. This revision was registered in Prospero (CRD42020143307). RESULTS Of the 4,094 studies identified in the search, 15 case-control studies were included in the review, totaling 6,515 cases and 17,037 controls. The meta-analysis included 17 measures of effect from 15 case-control studies. The pooled OR was 1.00 (95%CI: 0.79–1.26, n = 17 studies), but it was 2.58 (95%CI: 1.38–4.82, n = 2 studies) among those who had used mouthwashes three times or more times a day, and 1.30 (95%CI: 1.10–1.54, n = 4 studies) among those who had used mouthwashes for more than 40 years. CONCLUSIONS We found evidence that a high frequency of mouthwash use may be associated with an increased risk of oral cancer. However, despite the biological plausibility for this association, we suggest caution upon interpretation of our findings due to the few number of studies that have investigated the mouthwash use frequency, which should be considered. Therefore, we recommend that future studies assess, in detail, the frequency, duration, and content of mouthwashes to increase the strength of evidence for a possible dose-response effect of mouthwashes on oral cancer risk. adultolder older 2022 restrictions PubMedMedline PubMed Medline PubMed/Medline Embase libraries Scholar lists sources NewcastleOttawa Newcastle Ottawa metaanalysis, metaanalysis meta analysis, analysis metaregression. metaregression regression. regression meta-regression CRD42020143307. CRD42020143307 CRD . (CRD42020143307) 4094 094 4,09 1 casecontrol case control review 6515 6 515 6,51 17037 037 17,03 controls 100 00 1.0 95%CI 95CI CI 95 (95%CI 079126 0 79 26 0.79–1.26 studies, , 258 58 2.5 138482 38 82 1.38–4.82 day 130 30 1.3 110154 10 54 1.10–1.54 years However considered Therefore assess detail duration doseresponse dose response 202 CRD4202014330 (CRD42020143307 409 09 4,0 651 51 6,5 1703 03 17,0 1. 9 07912 7 0.79–1.2 25 5 2. 13848 3 8 1.38–4.8 13 11015 1.10–1.5 20 CRD420201433 (CRD4202014330 4, 65 6, 170 17, 0791 0.79–1. 1384 1.38–4. 1101 1.10–1. CRD42020143 (CRD420201433 079 0.79–1 138 1.38–4 110 1.10–1 CRD4202014 (CRD42020143 07 0.79– 1.38– 11 1.10– CRD420201 (CRD4202014 0.79 1.38 1.10 CRD42020 (CRD420201 0.7 1.1 CRD4202 (CRD42020 0. CRD420 (CRD4202 CRD42 (CRD420 CRD4 (CRD42 (CRD4 (CRD

ABSTRACT OBJECTIVE This study aimed to investigate the effect of mouthwash use on the development of oral cancer. METHODS Observational studies with adult/older adult populations that have examined the association between mouthwash use and oral cancer were included. Electronic search was performed in July 2022, with no time or language restrictions. PubMed/Medline, Embase, and Web of Science databases were used, and the search was extended to theses and dissertations libraries, Google Scholar, reference lists, and other sources. Methodological quality was assessed using the Newcastle-Ottawa Scale and quantitative data synthesis was performed by random effects meta-analysis, with different subgroup analyses and meta-regression. This revision was registered in Prospero (CRD42020143307). RESULTS Of the 4,094 studies identified in the search, 15 case-control studies were included in the review, totaling 6,515 cases and 17,037 controls. The meta-analysis included 17 measures of effect from 15 case-control studies. The pooled OR was 1.00 (95%CI: 0.79–1.26, n = 17 studies), but it was 2.58 (95%CI: 1.38–4.82, n = 2 studies) among those who had used mouthwashes three times or more times a day, and 1.30 (95%CI: 1.10–1.54, n = 4 studies) among those who had used mouthwashes for more than 40 years. CONCLUSIONS We found evidence that a high frequency of mouthwash use may be associated with an increased risk of oral cancer. However, despite the biological plausibility for this association, we suggest caution upon interpretation of our findings due to the few number of studies that have investigated the mouthwash use frequency, which should be considered. Therefore, we recommend that future studies assess, in detail, the frequency, duration, and content of mouthwashes to increase the strength of evidence for a possible dose-response effect of mouthwashes on oral cancer risk.

ABSTRACT Objective: To analyze the impact of the COVID-19 pandemic on dentists’ income and to identify associated factors in one of the poorest Brazilian states. Material and Methods: A cross-sectional study including dentists who volunteered to answer an electronic questionnaire in Maranhão. Hierarchical multinomial logistic regression analyses were performed, estimating crude and adjusted odds ratios (OR) and respective 95% confidence intervals (95%CI) (alpha=5%). Results: The COVID-19 pandemic impacted the professionals´ income negatively [55.44% (50.26-60.52%)] and also positively [6.9% (4.55-9.94%)]. The negative impact on income was greater among male dentists (OR=2.54; 95%CI: 1.16-5.53), over 30 years of age (OR=3.03; 95%CI: 1.34-6.87), with family income below two minimum wages (OR=4.63; 95%CI: 1.50-14.30), who worked in the continent instead of in the capital island (OR=2.21; 95%CI: 1.14-4.29) and in the private sector (OR=31.43; 95%CI: 11.59-85.22). Moreover, those who had been tested for COVID-19, with a negative result, had a 21.3-fold greater chance of having an increased household income when compared to those who had not been tested. Conclusion: The COVID-19 pandemic negatively impacted the dentists’ income in Maranhão, especially the older, males, with lower incomes, and who worked in the private sector, living far from the capital. The SUS played an important role in the social protection of dentists during the COVID-19 pandemic, mitigating the economic impacts on the public sector working class. Objective COVID19 COVID 19 COVID-1 states Methods crosssectional cross sectional Maranhão performed OR (OR 95 95%CI 95CI CI (95%CI alpha=5%. alpha5 alpha alpha=5% . 5 (alpha=5%) Results professionals 55.44% 5544 55 44 [55.44 50.2660.52% 50266052 50.26 60.52% 50 26 60 52 (50.26-60.52%) 6.9% 69 6 9 [6.9 4.559.94%. 455994 4.55 9.94% 4 94 (4.55-9.94%)] OR=2.54 OR254 2 54 (OR=2.54 1.165.53, 116553 1.16 5.53 , 1 16 53 1.16-5.53) 3 OR=3.03 OR303 03 (OR=3.03 1.346.87, 134687 1.34 6.87 34 87 1.34-6.87) OR=4.63 OR463 63 (OR=4.63 1.5014.30, 1501430 1.50 14.30 14 1.50-14.30) OR=2.21 OR221 21 (OR=2.21 1.144.29 114429 1.14 4.29 29 1.14-4.29 OR=31.43 OR3143 31 43 (OR=31.43 11.5985.22. 11598522 11.59 85.22 11 59 85 22 11.59-85.22) Moreover COVID19, 19, result 21.3fold 213fold fold 21.3 Conclusion older males incomes class COVID1 COVID- alpha=5 (alpha=5% 55.44 554 [55.4 2660 50.2660.52 5026605 5026 50.2 6052 60.52 (50.26-60.52% 6.9 [6. 559 4.559.94% 45599 455 4.5 994 9.94 (4.55-9.94%) OR=2.5 OR25 (OR=2.5 165 1.165.53 11655 116 1.1 553 5.5 1.16-5.53 OR=3.0 OR30 0 (OR=3.0 346 1.346.87 13468 134 1.3 687 6.8 8 1.34-6.87 OR=4.6 OR46 (OR=4.6 5014 1.5014.30 150143 150 1.5 1430 14.3 1.50-14.30 OR=2.2 OR22 (OR=2.2 144 1.144.2 11442 114 429 4.2 1.14-4.2 OR=31.4 OR314 (OR=31.4 5985 11.5985.22 1159852 1159 11.5 8522 85.2 11.59-85.22 3fold 213 21. alpha= (alpha=5 55.4 [55. 266 50.2660.5 502660 502 50. 605 60.5 (50.26-60.52 6. [6 4.559.94 4559 45 4. 99 9.9 (4.55-9.94% OR=2. OR2 (OR=2. 1.165.5 1165 1. 5. 1.16-5.5 OR=3. OR3 (OR=3. 1.346.8 1346 13 68 1.34-6.8 OR=4. OR4 (OR=4. 501 1.5014.3 15014 15 143 14. 1.50-14.3 1.144. 1144 42 1.14-4. OR=31. OR31 (OR=31. 598 11.5985.2 115985 115 11. 852 85. 11.59-85.2 (alpha= 55. [55 50.2660. 50266 60. (50.26-60.5 [ 4.559.9 9. (4.55-9.94 OR=2 (OR=2 1.165. 1.16-5. OR=3 (OR=3 1.346. 1.34-6. OR=4 (OR=4 1.5014. 1501 1.50-14. 1.144 1.14-4 OR=31 (OR=31 11.5985. 11598 11.59-85. (alpha [5 50.2660 (50.26-60. 4.559. (4.55-9.9 OR= (OR= 1.165 1.16-5 1.346 1.34-6 1.5014 1.50-14 1.14- 11.5985 11.59-85 50.266 (50.26-60 4.559 (4.55-9. 1.16- 1.34- 1.501 1.50-1 11.598 11.59-8 (50.26-6 (4.55-9 1.50- 11.59- (50.26- (4.55- (50.26 (4.55 (50.2 (4.5 (50. (4. (50 (4 (5 (