RESUMEN

The aim of the present study was to investigate the prevalence of oral health-related shame and the associated factors among 8-to-10-year-old Brazilian schoolchildren. A cross-sectional study was conducted with 388 children randomly selected from public and private schools of Diamantina, southeastern Brazil. In order to identify the feeling of shame, self-reports were collected through a single question, "In the last month, did you feel ashamed because of your teeth or mouth? Two calibrated examiners performed the clinical examination for dental caries (DMFT/dmft index), traumatic dental injuries (O' Brien), and malocclusion (Dental Aesthetic Index). Sociodemographic indicators were obtained through a questionnaire answered by the children's caregivers. Descriptive analysis, chi-square test, and hierarchical Poisson regression models were performed (95%CI; p < 0.05). The prevalence of shame was 38.1% (n = 148). The adjusted regression analysis demonstrated a significant association between shame and untreated dental caries (PR: 1.34; 95%CI: 1.04-1.74; p = 0.02), age of 10 years (PR: 1.36; 95%CI: 1.05-1.76; p = 0.01), and with parents with less than eight years of schooling (PR: 1.30; 95%CI: 1.00-1.68; p = 0.04). Older children with untreated dental caries and whose parents had lower education level presented a higher prevalence of oral health-related shame.

Asunto(s)

RESUMEN

Studies evaluating the factors associated with under reporting and with the recognition and reporting of child physical abuse are scarce and highly necessary. This study aimed to assess the prevalence of recognition and reporting of child physical abuse (CPA) by Brazilian dentistsin primary care and associated factors. A cross-sectional study was carried out with a representative sample of dentistsfrom the Family Health Strategy in Belo Horizonte. A self-administered questionnaire validated to Brazilian Portuguesewas used for data collection. Statistical analysis included univariate and multiple analyses through Poisson regression. A total of 181dentists participated in the study. Among them, 73 (40.3%) had already recognized some cases of CPA, but only 11 (6.1%) ended up reporting. Dentists with six to 19 years of experience as a municipal worker presented 2.38 times [PR = 2.38 (95%CI: 1.29-4.41)] more probability to recognize cases of CPA than the ones with less than six years. Having a graduate degree with a major in childcare [PR = 4.50 (95%CI: 1.08-18.68)] was associated with a larger number of reports. The employment duration as municipal worker was positively associated with the recognition of CPA cases and the prevalence of reporting was low.

Asunto(s)

RESUMEN

Abstract Studies evaluating the factors associated with under reporting and with the recognition and reporting of child physical abuse are scarce and highly necessary. This study aimed to assess the prevalence of recognition and reporting of child physical abuse (CPA) by Brazilian dentistsin primary care and associated factors. A cross-sectional study was carried out with a representative sample of dentistsfrom the Family Health Strategy in Belo Horizonte. A self-administered questionnaire validated to Brazilian Portuguesewas used for data collection. Statistical analysis included univariate and multiple analyses through Poisson regression. A total of 181dentists participated in the study. Among them, 73 (40.3%) had already recognized some cases of CPA, but only 11 (6.1%) ended up reporting. Dentists with six to 19 years of experience as a municipal worker presented 2.38 times [PR = 2.38 (95%CI: 1.29-4.41)] more probability to recognize cases of CPA than the ones with less than six years. Having a graduate degree with a major in childcare [PR = 4.50 (95%CI: 1.08-18.68)] was associated with a larger number of reports. The employment duration as municipal worker was positively associated with the recognition of CPA cases and the prevalence of reporting was low.

Resumo Estudos que avaliem os fatores associados à subnotificação e às dificuldades dos dentistas para identificar e notificar abuso físico infantil são escassos e necessários. Este estudo teve como objetivo investigar a prevalência de identificação e de notificação de abuso físico infantil (AFI) e fatores associados por dentistas da atenção primária. Trata-se de um estudo transversal com amostra representativa dos dentistas da Estratégia Saúde da Família de Belo Horizonte. Para a coleta de dados foi utilizado um questionário autoaplicável, validado para uso no Brasil. A análise estatística incluiu análise univariada e múltipla pela regressão de Poisson. Um total de 181 profissionais participaram do estudo. Destes, 73 (40,3%) já identificaram algum caso de AFI, mas apenas 11 (6,1%) realizaram a notificação. Dentistas com seis a 19 anos de trabalho no município apresentaram probabilidade 2,38 vezes [RP = 2,38 (CI 95%: 1,29-4,41)] maior de identificar casos de AFI do que aqueles com menos de seis anos de atuação. Possuir pós-graduação com foco em crianças [PR = 4,50(CI 95%: 1,08-18,68)] esteve positivamente associado a um maior número de notificações. O tempo de trabalho no município esteve associado à identificação de casos de AFI. A prevalência de notificação encontrada foi baixa.

Asunto(s)

RESUMEN

Os abusos infantis constituem um sério problema de saúde pública. Os dentistas se encontram em posição estratégica para identificar e notificar abuso infantil. Entretanto, estudos apontam para alta prevalência de comportamento de não-notificação por esses profissionais. Além disso, os dentistas são frequentemente associados a dificuldades para identificar e notificar casos de abuso infantil entre seus pacientes. A literatura carece de estudos que trabalhem esses fatores em profundidade. Diante do exposto, alguns questionamentos são apresentados: Por que os dentistas estão frequentemente associados à alta prevalência de comportamento de não-notificação? Como eles percebem o abuso infantil no contexto e cotidiano de trabalho na atenção primária à saúde? Quais são as concepções de abuso infantil construídas pelos dentistas? Como os fatores associados à identificação e notificação de abuso infantil influenciam na abordagem dos casos pelos dentistas? Esses questionamentos embasaram a construção deste estudo. O objetivo deste estudo foi desenvolver um modelo teórico substantivo que permitisse compreender como esses fatores se relacionam com a identificação e notificação de abuso infantil pelos dentistas da Estratégia Saúde da Família (ESF) de Belo Horizonte em seu cotidiano de trabalho. Foi realizado um estudo qualitativo, seguindo o referencial metodológico da Grounded Theory, sob a luz teórica do Interacionismo Simbólico. A amostra foi intencional e caracterizada pela amostragem teórica. A coleta de dados foi realizada por meio de entrevistas individuais semiestruturadas em profundidade e o critério para finalização da coleta foi a saturação. Foram entrevistados 10 dentistas vinculados à ESF. O estudo resultou na construção de uma teoria a respeito da Abordagem de Abuso Infantil por Dentistas da ESF, que é constituída por 3 categorias. A primeira categoria, denominada Concepção de Abuso, apresenta o conjunto de significados e conceitos que definem o que é o abuso infantil para os profissionais. A segunda, denominada Concepção de Notificação e Sistema de Proteção à Crianças e Adolescentes, apresenta conceitos e significados atribuídos à notificação de abuso infantil e seus processos. A terceira categoria, chamada Condutas, apresenta os elementos que envolvem as atitudes e as condutas tomadas pelos dentistas frente a casos suspeitos ou confirmados de abuso infantil. A concepção dos dentistas sobre o tema é importante e influencia fortemente na abordagem de abuso infantil. Além disso, a abordagem de abuso infantil é influenciada e envolve desde questões individuais dos profissionais, até questões sociais, culturais e de organização do sistema de saúde. Este estudo apresenta contribuições relevantes para os dentistas e para a ESF. Seus resultados podem ser utilizados para embasar a construção e o desenvolvimento de estudos de intervenção no tema.

Child abuse is a serious public health problem. Dentists are in a strategic position to identify and report child abuse. However, studies point to a high prevalence of nonnotification behavior by these professionals. In addition, dentists are often associated with difficulties in identifying and reporting cases of child abuse among their patients. The literature lacks studies that work on these factors in depth. Given the above, some questions are raised: Why are dentists frequently associated with high prevalence of non-notification behavior? How do they perceive child abuse in the context and daily work of primary health care? What are the conceptions of child abuse built by dentists? How do the factors associated with the identification and reporting of child abuse influence dentists' approach of cases? These questions supported the construction of this study. The aim of this study was to develop a substantive theoretical model that would allow understanding how these factors are related to the identification and reporting of child abuse by dentists of the Family Health Strategy (FHS) in Belo Horizonte in their daily work. A qualitative study was carried out, following the Grounded Theory methodological framework, in the theoretical light of Symbolic Interactionism. The sample selection was intentional and characterized by theoretical sampling. Data collection was performed through semi-structured individual interviews and the criterion for finalizing the collection was saturation. We interviewed 10 dentists linked to the FHS. The study resulted in the construction of a theory about the Child Abuse Approach by FHS Dentists, which consists of 3 categories. The first category called Conception of Abuse, presents the set of meanings and concepts that define what child abuse is for professionals. The second, called Conception on the Notification and Protection System for Children and Adolescents, presents concepts and meanings attributed to the notification of child abuse and its processes. The third category, called Conducts, presents the elements that involve the attitudes and behaviors taken by dentists in the face of suspected or confirmed cases of child abuse. Dentists' views on the topic are important and strongly influence their approach to child abuse. The concepts presented are flawed because there is mainly a lack of technical training on the subject. In addition, the child abuse approach is influenced and involves from individual issues of professionals, to social, cultural and organizational issues in the health system. This study presents important contributions for dentists and the FHS. Its results can be used to support the construction and development of intervention studies on the topic.

Asunto(s)