Vietnamese-born health professionals : negotiating work and life in rural Australia

Introduction: Australia is a culturally diverse nation due to migrants from a wide variety of countries creating a multicultural society. The health professions are highly valued by the younger generation of overseas-born migrants who have acculturated into Australian society; many have chosen health care as their profession in Australia. However, most migrants settle in metropolitan areas and young health professionals may find working in rural or remote Australia culturally and professionally highly challenging. The present study of migrant health professionals examined the life experiences and acculturation strategies of Vietnamese-born health professionals working and living in rural Australia. Objectives: The two main study objectives were to: (1) examine aspects of the acculturation of overseas-born and Australian-trained health professionals in the Australian health discourse; and (2) identify key coping strategies used by them when in working in the rural context.

Methods: Six overseas-born, Australian-trained health professionals were invited to participate in this qualitative study using a snowball sampling technique. The participants were all born in Vietnam and had experienced working in rural Australia. They included three medical doctors, a dentist, a physiotherapist and a nurse. The interviews were recorded and four participants also provided additional written responses to some of the open-ended interview questions. The interview data were transcribed and later coded for thematic analysis. Topics and themes that emerged focused on the issues and strategies of acculturation to the rural health context.

Results: The study showed that the acculturation process was affected by the participants’ views about and attitudes towards working in an Australian rural context. The study identified these essential strategies used by the participants in adapting to a new workplace: collaborating, distancing, adjusting, repairing, and accommodating.

Conclusion: The study provides insights into the lives of these health professionals in a rural context, and particularly their experience of cultural shock and the coping strategies they may use. A need is identified for a larger study to inform recruitment and retention of these health professionals to rural Australia, and to assist universities to prepare such students and their clinical supervisors for rural placements.

Australian dental policy reform and the use of dental therapists and hygienists

Oral diseases including dental caries and periodontal disease are among the most prevalent and costly diseases in Australia today. Around 5.4% of Australia’s health dollar is spent on dental services totalling around $2.6 billion, 84% of which are delivered through the private sector (AIHW 2001). The other 16% is spent providing public sector services in varied and inadequate ways. While disease rates among school children have declined significantly in the past 20 years the gains made among children are not flowing on to adult dentitions and our aging population will place increasing demands on an inadequate system into the future (AHMAC 2001). Around 50% of adults do not received regular care and this has implications for widening health inequalities as the greatest burden falls on lower income groups (AIHW DSRU 2001). The National Competition Policy agenda has initiated, Australia-wide, reviews of dental legislation applying to delivery of services by dentists, dental specialists, dental therapists and hygienists and dental technicians and prosthetists. The review of the Victorian Dentists Act 1972, was completed first in 1999, followed by the other Australian states with Queensland, the ACT and the Northern Territory still developing legislation. One of the objectives of the new Victorian Act is to ‘…promote access to dental care’. This study has grown out of the need to know more about how dental therapists and hygienists might be utilised to achieve this and the legislative frameworks that could enable such roles. This study used qualitative methods to explore dental health policy making associated with strategies that may increase access to dental care using dental therapists and hygienists. The study used a multiple case study design to critically examine the dental policy development process around the Review of the Dentists Act 1972 in Victoria; to assess legislative and regulatory dental policy reforms in other states in Australia and to conduct a comparative analysis of dental health policy as it relates to dental auxiliary practice internationally. Data collection has involved (I) semi-structured interviews with key participants and stakeholders in the policy development processes in Victoria, interstate and overseas, and (ii) analysis of documentary data sources. The study has taken a grounded theory approach whereby theoretical issues that emerged from the Victorian case study were further developed and challenged in the subsequent interstate and international case studies. A component of this study has required the development of indicators in regulatory models for dental hygienists and therapists that will increase access to dental care for the community. These indicators have been used to analyse regulation reform and the likely impacts in each setting. Despite evidence of need, evidence of the effectiveness and efficiency of dental therapists and hygienists, and the National Competition Policy agenda of increasing efficiency, the legislation reviews have mostly produces only minor changes. Results show that almost all Australian states have regulated dental therapists and hygienists in more prescriptive ways than they do dentists. The study has found that dental policy making is still dominated by the views of private practice dentists under elitist models that largely protect dentist authority, autonomy and sovereignty. The influence of dentist professional dominance has meant that governments have been reluctant to make sweeping changes. The study has demonstrated alternative models of regulation for dental therapists and hygienists, which would allow wider utilisation of their skills, more effective use of public sector funding, increased access to services and a grater focus on preventive care. In the light of theses outcomes, there is a need to continue to advocate for changes that will increase the public health focus of oral health care.

Theory of planned behaviour and implementation intentions in dental attendance

The thesis used a model of health behaviour to examine the predictors of dental attendance. Older respondents who had strong intentions, low perceived vulnerability, stable plans to attend, and were influenced by significant others were more likely to have attended the dentist for preventive care in the last 12 months. The portfolio concludes that attachment theory is a useful conceptual framework for enhancing our understanding of the antecedents and consequences of childhood sexual abuse.

Exploring child dental service use among migrant families in metropolitan Melbourne, Australia

Abstract Background This study describes and explores factors related to dental service use among migrant children. Methods A cross-sectional analysis of baseline data from Teeth Tales, an exploratory trial implementing a community based child oral health promotion intervention. The sample size and target population was 600 families with 1-4 year old children from Iraqi, Lebanese and Pakistani backgrounds residing in metropolitan Melbourne. Participants were recruited into the study using purposive and snowball sampling techniques. Results Most (88%; 550/625) children had never visited the dentist (mean (SD) age 3.06 years (1.11)). In the fully adjusted model the variable most significantly associated with child dental visiting was parent reported 'no reason for child to visit the dentist' (OR = 0.07, p < 0.001). Of those children whose parents reported their child had no reason to visit the dentist, 22% (37/165) experienced dental caries with 8% (13/165) at the level of cavitation. Conclusions Dental service use by migrant preschool children was very low. The relationship between perceived dental need and dental service use is currently not aligned. One in 10 children of select migrant background had visited a dentist, which is in the context of 1 in 3 with dental caries. To improve utilization, health services should consider organizational cultural competence, outreach and increased engagement with the migrant community.

Saúde bucal no programa de saude da família: o caso do distrito sanitário norte em Natal - RN

The inclusion of the dentist in the Family Health Program (FHP) teams designates a reorganization of the mouth health care in your country and establishes a new scenario in Brazilian odontology, through of a new way to organize the basic health care, creating conditions to consolidate in mouth health practice actions, in the level of the basic attention, the validation of Unique Health System (UHS) constitutional principles. The purpose of this research is to verify if the actuation of mouth health teams (MHT) dentists, in Natal city north sanitary district, is tuned with FHP goals.The target research population was composed by all dentists working in Basic Health Units (BHU) of Natal north sanitary district. Fifth-eight questionnaires were applied and using open and closed questions we look for identify the functional characteristics of each BHU, the dentists professional attributions on each BHU, as well as the clinical procedures that they execute. This research also searched to identify the factors that facilitate and/or difficult the inclusion process and the dentists activities performance on these BHUs, as well as the necessary actions to north sanitary district MHTs to fulfill the objectives proposed by FHP. The results point that the inclusion of mouth health actions in north sanitary district FHPs brought the incorporation of new values to the used practices. Whoever, its necessary a more frequent evaluation of the carried actions, in a way they can be adapted to the real community necessities, and, is fundamental the data accompaniment, for that these serve of base for planning and redirecting activities, in a way that we do not have only a reproduction of traditional practices, fragmented and isolated, but a truly substitution of the traditional practices and a new way of promoting health

Associação entre as narrativas em saúde bucal e condições socioeconômico-culturais: a dentição como reflexo da desigualdade social

This anthropological study investigates the lived-experience of oral diseases in the context of poverty in Northeast Brazil. During six months in 2004???, ethnographic interviews, narratives and participant-observation with 31 residents of the low-income community, Dendê, located in Fortaleza, Ceará were conducted and analyzed utilizing a hermeneutic-dialetic method. It is revealed that precarious life conditions make prioritizing caretaking a difficult task. Despite suffering tooth pain, seeking a dentist's care is perceived as "a luxury" not a citzens' right. Difficulties in accessing services and poor quality restorations, favor tooth extractions as the most effective intervention. The deterioration of one's oral health is lamented by community members who seek help from popular clinics, politicians and traditional healers. The experience of dental disease differs according to social class, leaves oral scars of inequity, harms self-esteem and inhibits social inclusion. In this context, "treating" the Teeth of Inequity demands that we deepen our comprehension of the social determinants of health, reduce injustice in the access to quality care, remove demoralizing stigmas and empower the community to confront structural forces which affect its life

Acesso aos serviços odontológicos e incidência de cárie em adolescentes e fatores de risco em município do Nordeste Brasileiro, 2006

The aims of this study were to analyze the access of dental services by child population, to determine the prevalence of dental caries, gingivitis and malocclusion in resident children from the municipal district of Sobral Ceará and to evaluate the incidence of the dental decay in adolescents associated with the factors related to socioeconomic condition, access to health services and self-perception. This study had as main factor the multidisciplinary represented by the participation of health professional (doctors, dentists, nurses) in the development of the survey's initial reference; student from Human Sciences area to apply the structured questionnaire in domiciliary visits; statistics professionals in the orientation of the analysis to be held and family health team (community health agents, dentists and dental clinic assistants) in the scheduling of domiciliary visits and the accomplishment of oral exam. The sample was determined from the domicile record that included children born between 1990 and 1994 to develop the research Children health conditions in the municipal district of Sobral Ceará . The first sample comprised 3425 parents of children from 5 to 9 years old, living in the urban area at the municipal district of Sobral Ceará, aiming at identifying the most important factors associated to the access to dental service. From this sample, 1021 children were selected in a systematic way, for the accomplishment to the epidemiological study of decay, gingivitis and malocclusion. In the study's third phase, in order to arrange the group to be followed, 688 adolescents were examined and interviewed, by means of the active search from the 1021 individuals that had been previously examined. It was observed that 50.9% of the children had access to dental service at least once in a lifetime. Of this total, 65.3% accomplished it during the last year, and 85.4% of these did in public services, what allows to identify the importance of this sector in the access to dental services. It was observed that the factors that most affected the access to dental 129 services were related to socioeconomic condition, such as the access to health plan, the possession of toothbrush, garbage collecting, mother s schooling, sewerage treatment and malnutrition. In relation to oral diseases, an increase in the DMF-T index according the age was observed, from 0.10 in five years old to 1.66 in the nine years old, while with the dmf-t index, the inverse happened, since the index decreased from 3.59 in five years old to 2.69 in nine years old. In relation to gingivitis, an average 32.7% of the children presented gum bleeding. In what concerns malocclusion, it was observed that 60.3% of the children didn't present any problem, 30.17% had light malocclusion and 9.5% severe malocclusion. The average incidence of dental caries was 1.86 teeth per youngster. Among the studied variables, tooth pain in the last six months, mother's income and school snack, adjusted by the perception about the need of treatment, the mother's schooling and the dentist's appointment at least once in a lifetime, were the variables that presented positive relationship with the high incidence of dental caries on this population by logistic regression. Variables of socioeconomic nature, related to the access to health services and behavior and biological variables presented a relationship with the high caries incidence. The study point out to the need of developing health actions in a humanized way, by an oral health team effectively bound to the population's interest, with the great objective to provide, with the public health services managers, adequate conditions to improve oral health

Conhecimento dos adolescentes sobre métodos contraceptivos: pesquisa-ação em uma unidade do programa saúde da família de Natal

It is a descriptive study with a qualitative approach, and an action-research type, which aimed to analyze the changes of knowledge about contraceptive methods invested to a teenager group attended in Igapó Family Healthcare Unit, in the city of Natal/RN, after consent and institutional assent of Ethics Committee of Rio Grande do Norte Federal University (Protocol No. 131/07). It were researched 16 teenagers of both sexes, with age ranging from 11 to 16 years. We used two structured questionnaires, one in the initial diagnosis and another during the seven meetings of the focus group, in addition to the field notes and the meetings discussions transcriptions. The data-collection was performed in the period of two months by a team composed by a nurse the research coordinator, a dentist, a nursing assistant, a community-based healthcare worker and a nursing academic. The quantitative and qualitative data were organized, tagged and categorized into spreadsheet in Microsoft Excel, being held a thematic analysis of speeches performed by the study participants. The results were presented as tables, graphics, photos, drawings and word clippings. The educational strategy developed in focus group allowed adolescents to discuss, exchange ideas and opinions on several contraceptive methods, providing expansion in knowledge of all contraceptives discussed, especially those natural and surgical, which were less mentioned at the beginning of the study. Among the advantages of the contraceptive methods listed by teenagers, was highlighted avoiding pregnancy and STDs in use of the barrier method of condom. As for the disadvantages more frequently noted by the survey with the misuse of barrier methods, was highlighted get pregnant, acquire STD's and do not prevent STD's in hormonal, natural and surgical methods. Adolescents showed consistency between the advantages and disadvantages and types of contraceptive methods, showing a widening in knowledge among them. It may be said that, in general, those surveyed had a good understanding about the use of the various contraceptive methods. Thus, the study participants had positively evaluated all the criteria used to qualify the meetings in the focus group. The action strategy of the focus group should be encouraged by professionals who work with teenagers, since they prefer to live in groups, one characteristic of adolescence.

Tuberculose: conhecimentos, representações sociais e experiências da doença na visão do portador

Tuberculosis is considered one of the most ancient human diseases, cases were registered 3900 years before Christ, and it is currently regarded as a serious public health problem in the world due to several factors such as income mismanagement, precarious standard of life and some sort of prejudice comprised by the word tuberculosis. Taking this into consideration, it was developed a descriptive and exploratory study aiming at analyzing the social representations of tuberculosis made by its patient from the Unidades de Saúde da Família (Family Health Units a public health program) in Campina Grande City PB, in relation to the decentralization of the policies that administrate the disease. It was interviewed 34 tuberculosis patient that were being treated from 2007 to 2008. The age group of the interviewees varied from 10 to 60 years old, but most of them were between 36 and 60 years old (58,8%, n=20), some were young adult and adult (21 35 years old), with 11 (32,3%) respondents, and, less frequent, children and teenagers (11 20 years old), with 03 (8,8%) participants. Data was collected through semi-structured interview. The questions that guided the research were elaborated based on the operational recommendations of DOTS strategy; that is: access to laboratory examinations; medication guarantee; directly observed treatment. Besides that, the experiences of the patient were considered in their relation with the family and the different social groups. The analysis of the discursive material was submitted to the Analyse Lexicale par Context d un Ensemble de Segments de Texte software - ALCESTE 4.7. Data interpretation showed five categories for the social representations of the tuberculosis patient that participated in DOTS strategy: 1) the accessibility of the health assistance service; 2) the patient perspective of the disease; 3) the change in the operation of the productive life; 4) the signals and symptoms of the tuberculosis disease; 5) the rearrangement and mechanisms used to face the disease. The Central Nucleus reveals that tuberculosis is a transmissible disease that can be prevented by people through educational practices, health promotion, active search for symptomatic respiratory and control of the carriers communication; these mechanisms should be incorporated to the routine of all participants of the family health groups. The Intermediate Elements, based on quotidian life, as well as the individual experiences of the tuberculosis patient, reveals prejudiced attitude and beliefs that lead to isolation and restriction of interpersonal relationship. Peripheral Elements were constituted by themes that showed the patient feelings of indignation because of the social barriers they had to face in the Family Health Units during the treatment. These elements demonstrate a negative perspective of the representation concerning the accessibility, i.e. inadequate structure of the health service; long distance to the Health Centre, this factormakes it difficult for the patient to continue the treatment; scheduling delay; and limited service regarding other requests (doctor, dentist etc). One expects to contribute for the construction of a new perspective of the health question between the different agents who make the assistencial institutions and formation of professionals, either in central or local scope

Trânsito de saberes e campo representacional na visão dos profissionais da saúde da família e do programa de educação pelo trabalho e para a saúde

The Family Health Strategy (ESF) is emerging as a possible restructuring of services and new practices of intervention in health care; it requires skilled professionals to work with that framework. Within this purpose, we established the Education Programme for Work and Health (PET-Saúde), in order to integrate teaching and service activities, focusing on primary care. On this basis, the aim of this work is to apprehend the social representation of nurse, doctor and dentist (Project PET-Natal Health RN preceptors) on the ESF, while practice field of them. It is a descriptive and exploratory study, with a qualitative approach, carried out in 07 Family Health Units (USF) included in the PET-Saúde Natal (RN). The population was composed of 35 professional components of the primary care team with bachelor's degree of the USF linked to this project. The sample was composed of 05 nurses, 05 physicians and 05 dentists, for a total of 15 subjects. Data were collected through three instruments: the drawing-themed story, a semi-structured individual interviews and field diary. The data relating to the identification of the subjects were entered and tabulated by the Microsoft Excel software 2007 version. The drawing analysis and interpretation is given by the significance attributed to the resource chart from title and keywords assigned by the subjects, considering the ESF as an inductive term. The stories and interviews were transcribed and typed and then subjected to read/listen the material and a lexical analysis through Alceste. After this process, the discursive material was analyzed and discussed by theoretical and methodological feature of the Social Representations theory. The majority of health professionals were female, aged between 46 and 52 years old, married, income less than six minimum wage, time since graduation ranged from 22 to 29 years and working time in the ESF range from 02 to 11 years. From the classification system ALCESTE were selected categories identified by: Category 1 - ESF: relations and territory; Category 2 - Training and bond profile; Category 3 - Working process in the ESF; Category 4 - Articulation between teaching and service; Category 5 - Health care and disease prevention. The representational field construction, while a process, followed the logic of structural cores in existing categories. In this sense, it is clear that the ESF is an environment rich in diversity, experience and relationships with potential such as the relationship "very subject-subject" and the link established between professional-community, but also has some weaknesses such as poor working conditions, lack of popular participation and management support, thus difficulties in the achievement of teamwork. Being essential to that end, the teaching-service aimed at the formation of a new health professional able to work in the ESF. In this research, the training of the representational field encountered a diversity of structural cores, or thoughts on training, about the ESF because of the greater emphasis on the here and now of the interaction between health professionals, the ESF, the community, PET Health-UFRN and students, emphasizing that such proposals are still considered as concepts in the context of recent health and that, therefore, are not fully realized in the social imaginary

Controle profissional de biofilme dentário como estratégia para manutenção da saúde periodontal de pacientes com aparelho ortodôntico fixo: análise comparativa entre diferentes períodos

The presence of fixed orthodontics appliances interfere on sanitation, allowing periodontal diseases to appear, despite the fact patients keep on visiting the dentist every month. This research aims to determine a protocol for the mechanical control of the dental biofilm performed by the professional. A protocol that was able to maintain the periodontal health of the patients under orthodontic treatment with fixed appliances, and in order to do so, it used a non-controlled, randomized and blind clinical essay. The sample involved 40 adolescents who were under the installation of fixed orthodontics appliances and it was divided in three groups, as follows: monthly controlled group (group 1) composed of 11 patients, the quarterly controlled group (group 2) with 16 patients and the semestrial controlled group (group 3) with 13 patients. For data collection, an interview and clinical exams with probing depth measurement, quantity of keratinized mucosa, Gingival Index and the Plaque Index were used. On the initial exam all patients received brushing guidelines as well as the professional control of dental biofilm, with periodontal scaler, Robinson s brush and prophylactic paste. However, Group 1 returned every month for control procedures; Group 2 every three months and Group 3 after six months. The intervention had a six-month duration (for all the three groups), when all the exams were repeated by another examiner who did not know which group each patient was inserted in. Finally, the research concluded that despite the fact there is no statistically significant difference among the three groups, clinically the patients from the monthly group presented a better response to professional control, with less accumulation of dental biofilm and less rate of gingival inflammation. Thus, the mechanical control of the dental biofilm performed by the professional could not avoid gingival increase, characterized by the raise of probing depth measurement, neither the quantity of keratinized mucosa

O programa Saúde da Família pelo olhar do Cirurgião-Dentista

This study tried to know the social representation of dentists surgeons about the Family Health Program (FHP). Where used as methodological instruments a semi-structured interview and direct observation of work process in tive towns that are part of the metropolis region ofNatal city. During the interview some aspects where broached, such as the reasons of dentists surgeons join the FHP, what are the implications ofthe introduction of this program in the everyday practice, what kind of activities are they practicing and what are those professional missing the most in the FHP. In the direct observation where take in account some aspects related to the physic structure of health units, its service organization and demand, relationship amongst dentist and other member of the team, and about patient receptiveness, when they arrives at health unit. This study also identifY the researches subject showing their age, sex, for how they are graduates, what are them specialty and for how long they work for the FHP. The data had been analyzed through the analysis of content of Bardin5. The dentists depict the FHP for the change in assistance model through the preventive proposal of social work that makes possible to work with an ample concept of health. However what makes the FHP more attractive to dentists is the salary questiono The creation of bonds whit the community and the work whit groups and in team had been the main occurred changes in the daily one of the pratices ones of these professionals. The principal activities executed for these professionals inside of the new strategy of assistance in oral health are the carried trough preventive activities achieved in health units and social area. To them, the absence of institutional support and the employment of only one dentist for each team it is one the main point of strangling. There is no doubt that FHP is new strategy and that it is need a better integration amongst the professional, the institution

Caracterização do processo de trabalho do cirurgiãodentista na estratégia de saúde da família do município de Parnamirim-RN

Family Health Strategy (FHS), founded in 1994 has appeared to play a strategic role in the SUS construction and consolidation. It has reaffirmed its Principles and Guidelines and has elected family as core of attention. The principle that has guided the work concerns the quality of the relationship between professional and family. Thus, the FHS has the family as a subject of health-disease process, and relations with its own characteristics and can be partners in building their health and improvement of quality of life of its members and the entire community. This study aims to characterize the surgeon-dentist (SD) working process in the family health strategy, from the knowledge of the SD integration with other team members; organization of services; development of shares, changes perceived by SDs, as well as knowing the surgeon-dentist profile who is part of this strategy. The collecting tool used was a semi-structured questionnaire, in which participated 30 professionals. As for profile, most professionals were women, completed the graduation in public university and did not have any training to work by joining the FHS. Almost all have other public or private working ties. They often carry out activities with students, and occasionally do home visits. In relation to team work, in activities such as home visits, school health, community activities, among others, they sometimes seek the cooperation of other members. The way of accessing for users in the most part has occurred through the schedule. The most frequently activities made to the Centro Especialidades Odontológicas (CEO), are in Endodontics and Prosthesis. The majority of them participate in team meetings, but they do not have frequency set to happen. As for the planning and programming of activities to be conducted, most said that individually develops them. Concerning the performance of their duties, most reported being satisfied, but that improvements could happen. Besides, they reported improvements in dental care following the inclusion of SD in the FHS in various aspects, such as access, organization, humanization, care and oral disease prevention. The professionals had poor integration with other team members, in addition to have a profile to more individualistic work, a fact seized by way of development and planning of actions. They work the actions in individual and curative way, in detriment promotion and collective ones. They work humanization, definition of territory and adscript population. Thus, it is concluded that the working process developed by SDs, includes the part which is advocated by FHS. This points out to a greater undertaking of this process aiming to detect the weakness met in order to reach the potential that the FHS represents in organization of basic attention

Centros de especialidades odontológicas: avaliação da atenção de média complexidade na rede pública da Grande Natal

The Specialized Dental Care Centers (CEO) were developed to provide specialized dental care to the population, given the accumulated needs of health since the past. They must operate as units of reference for the Oral Health Team of the Primary Care, complementing the dental procedures performed at this level of attention. This study aims to assess the performance of CEOs of the Grande Natal Health Region as a strategy of Secondary Care consolidation in oral health through users, dentists and managers. For this to try to identify factors about access, hosting and satisfaction with the service, the actions developed in these centers, integration between the CEOs and the Basic Health Units (UBS), considering the reference and counter reference. Data were collected through semi-structured interview, conducted in four CEOs, among 253 users, 31 dentists and 4 managers. It was submitted to descriptive statistical analysis and to content analysis by software ALCESTE 4.5. The results revealed that the specialties of prosthesis, endodontics and surgery were the most sought by 38.2%, 23.7% and 21.7% of respondents, respectively. It was noticed that among users aged 18 to 30 years-old the greatest demand is for the specialty of endodontics (44.4%) and over 50 years for prosthesis (76.4%). There is a weakness in the reference and counter reference between UBS and CEO, because part of users goes directly to the centers without going before to the Primary Care and the majority does not want to return to the dentist of Health Unit. Satisfaction with care was reported by 90.9% of users, because they resolved the problems needed and were welcomed by the team. But the delay in care was the main factor for not satisfaction. For most dentists, some users could solve their problems completely in Primary Care, which shows the existence of unnecessary referrals to the CEOs, however they consider the existence of limiting factors in UBS that compromise the service. Most dentists revealed that some users do not get to CEOs with the basic dental treatment done, and some of them do not counter reference users. It can be concluded that the studied CEOs are being resolutive for those who access them, offering necessary care for the population, and if they don t account with this service, will encounter obstacles to resolution of problems, ranging seek care service in particular, in another public sector, or even giving up treatment. However, it is perceived the need of professionals training to understand the importance of the reference and counter reference, to that they can better serve and guide users. It is also important that cities offer better conditions to UBS and CEOs, so they can work together, with complementary actions of oral health, seeking full care, aiming for better resolution to the users' health problems

A educação permanente em saúde na ótica dos cirurgiões dentistas

This study aimed to examine the perception of dentist-surgeon about the Permanent Education in Health (PEH). It is characterized as a qualitative research with focus in the field of public health policies. It refers specifically to the development of Permanent Education policy in Health in the state of Rio Grande do Norte. They were participants of this research 42 dentist surgeons and 83.3% females and 16.7% males, participants in Specialization courses approved and agreed by the Permanent Education Center in Health (PEC-RN) in the period 2005 to 2007. These professionals are part of the Family Health Strategy (FHS), and 11.9% work in management at the central level and 88.1% are directly related to oral health care in the Basic Health Units of the Family, 30 cities in the state. Data collection was through a questionnaire, with questions that guided the research development and achieve the objectives proposed. The socio-demographic data were analyzed using the descriptive statistics and subjective content was subjected to content analysis by Bardin. The emerging categories from the textual material generated by respondents were: program content, methodological approach and concepts of Permanent Education in Health. The subjects surveyed reported that the program content is more comprehensive and directs to the reflection of everyday practices, with regard to the methodological approach, concern that occurs through discussion and reflection with dynamic, participative, varied and constructive activities, questioning and putting as the main focus. As for understanding of the concepts of the PEH, there was a consensus that define as education stable strategies which contributing to transform and improve the health workers to have the upgrade, improvement of practices, being based on everyday experience and taking into account the accumulation and renewal of these experiences. Therefore, results presented showed that there is a clear understanding of the subjects on the proposals and guidelines of the PEH. It was concluded that lack continuous access to the policies proposed by Ministry of Health involving health workers, managers, communities, through social control and the teaching-service integration and that they are worked within the health system and can classify all these segments of society favor the existence of a more participatory, effective, fair and better quality health service