Advances and challenges in oral health after a decade of the “Smiling Brazil” Program

ABSTRACT OBJECTIVE To analyze oral health work changes in primary health care after Brazil’s National Oral Health Policy Guidelines were released. METHODS A literature review was conducted on Medline, LILACS, Embase, SciELO, Biblioteca Virtual em Saúde, and The Cochrane Library databases, from 2000 to 2013, on elements to analyze work changes. The descriptors used included: primary health care, family health care, work, health care policy, oral health care services, dentistry, oral health, and Brazil. Thirty-two studies were selected and analyzed, with a predominance of qualitative studies from the Northeast region with workers, especially dentists, focusing on completeness and quality of care. RESULTS Observed advances focused on educational and permanent education actions; on welcoming, bonding, and accountability. The main challenges were related to completeness; extension and improvement of care; integrated teamwork; working conditions; planning, monitoring, and evaluation of actions; stimulating people’s participation and social control; and intersectorial actions. CONCLUSIONS Despite the new regulatory environment, there are very few changes in oral health work. Professionals tend to reproduce the dominant biomedical model. Continuing efforts will be required in work management, training, and permanent education fields. Among the possibilities are the increased engagement of managers and professionals in a process to understand work dynamics and training in the perspective of building significant changes for local realities.

Expectations of elderly people on the nurse-client relationship and interaction in home care : "When I see the nurse's smiling face it feels likes sunshine on a rainy and gloomy day"

The purpose of the thesis was to explore expectations of elderly people on the nurse-client relationship and interaction in home care. The aim is to improve the quality of care to better meet the needs of the clients. A qualitative approach was adopted. Semi-structured theme interviews were used for data collection. The interviews were conducted during spring 2006. Six elderly clients of a private home care company in Southern Finland acted as informants. Content analysis was used as the method of data analysis. The findings suggest that clients expect nurses to provide professional care with loving-kindness. Trust and mutual, active interaction were expected from the nurse-client relationship. Clients considered it important that the nurse recognizes each client's individual needs. The nurse was expected to perform duties efficiently, but in a calm and unrushed manner. A mechanic performance of tasks was considered negative. Humanity was viewed as a crucial element in the nurse-client relationship. Clients expressed their need to be seen as human beings. Seeing beyond the illness was considered important. A smiling nurse was described to be able to alleviate pain and anxiety. Clients hoped to have a close relationship with the nurse. The development of a close relationship was considered to be more likely if the nurse is familiar and genuine. Clients wish the nurses to have a more attending presence. Clients suggested that the work areas of the nurses could be limited so that they would have more time to transfer from one place to another. Clients felt that they would benefit from this as well. The nurses were expected to be more considerate. Clients wished for more information regarding changes that affect their care. They wished to be informed about changes in schedules and plans. Clients hoped for continuity from the nurse-client relationship. Considering the expectations of clients promotes client satisfaction. Home care providers have an opportunity to reflect their own care behaviour on the findings. To better meet the needs of the clients, nurses could apply the concept of loving-kindness in their work, and strive for a more attending presence.

The Smiling Project: development of a new program for gait and balance training

Introduction: The SMILING project, a multicentric project fundedby the European Union, aims to develop a new gait and balance trainingprogram to prevent falls in older persons. The program includes the"SMILING shoe", an innovative device that generates mechanical perturbationwhile walking by changing the soles' inclination. Induced perturbationschallenge subjects' balance and force them to react to avoidfalls. By training specifically the complex motor reactions used to maintainbalance when walking on irregular ground, the program will improvesubjects' ability to react in situation of unsteadiness and reduce theirrisk of falling. Methods: The program will be evaluated in a multicentric,cross-over randomized controlled trial. Overall, 112 subjects (aged≥65 years, ≥1 falls, POMA score 22-26/28) will be enrolled. Subjectswill be randomised in 2 groups: group A begin the training with active"SMILING shoes", group B with inactive dummy shoes. After 4 weeksof training, group A and B will exchange the shoes. Supervised trainingsessions (30 minutes twice a week for 8 weeks) include walkingtasks of progressive difficulties.To avoid a learning effect, "SMILINGshoes" perturbations will be generated in a non-linear and chaotic way.Gait performance, fear of falling, and acceptability of the program willbe assessed. Conclusion: The SMILING program is an innovative interventionfor falls prevention in older persons based on gait and balancetraining using chaotic perturbations. Because of the easy use of the"SMILING shoes", this program could be used in various settings, suchas geriatric clinics or at home.

Embodied memory: unconscious smiling modulates emotional evaluation of episodic memories.

Since Damasio introduced the somatic markers hypothesis in Damasio (1994), it has spread through the psychological community, where it is now commonly acknowledged that somatic states are a factor in producing the qualitative dimension of our experiences. Present actions are emotionally guided by those somatic states that were previously activated in similar experiences. In this model, somatic markers serve as a kind of embodied memory. Here, we test whether the manipulation of somatic markers can modulate the emotional evaluation of negative memories. Because facial feedback has been shown to be a powerful means of modifying emotional judgements, we used it to manipulate somatic markers. Participants first read a sad story in order to induce a negative emotional memory and then were asked to rate their emotions and memory about the text. Twenty-four hours later, the same participants were asked to assume a predetermined facial feedback (smiling) while reactivating their memory of the sad story. The participants were once again asked to fill in emotional and memory questionnaires about the text. Our results showed that participants who had smiled during memory reactivation later rated the text less negatively than control participants. However, the contraction of the zygomaticus muscles during memory reactivation did not have any impact on episodic memory scores. This suggests that manipulating somatic states modified emotional memory without affecting episodic memory. Thus, modulating memories through bodily states might pave the way to studying memory as an embodied function and help shape new kinds of psychotherapeutic interventions.

Smiling in a job interview: When less is more

Two studies examined the effect of applicants' smiling on hireability. In a pre-test study, participants were asked to rate the expected behavior for four types of applicants. Newspaper reporter applicants were expected to be more serious than applicants for other jobs. In Study 1, participants were randomly assigned to be an applicant or interviewer for a newspaper reporting job. Smiling was negatively related to hiring, and smiling mediated the relation between applicants' motivation to make a good impression and hiring. Hiring was maximized when applicants smiled less in the middle of the interview relative to the start and end. In Study 2, participants watched Study 1 clips and were randomly assigned to believe the applicants were applying to one of four jobs. Participants rated more suitability when applicants smiled less, especially for jobs associated with a serious demeanor. This research shows that job type is an important moderator of the impact of smiling on hiring.

Esthetic influence of negative space in the buccal corridor during smiling

The purpose of this study was to measure and verify the esthetic influence of the bilateral spaces between maxillary teeth and lip corners, called negative space (NS), during smile. The sample was comprised of 60 smile photographs obtained from 60 individuals (30 men and 30 women) aged 18 to 25 years old. Two orthodontists and two lay people evaluated these pictures regarding esthetics by a visual analogue scale. In each picture, the right and left NS were measured in millimeters and in proportion to the smile width (SW). Data were analyzed for statistical significance (P = .05). The mean NS of the sample was 6.68 ± 1.99 mm, and the NS proportion in relation to the SW was 9.6 ± 2.56%, for both sides of the arch. No significant asymmetries were observed between the right and left sides. The NS was significantly larger in men than in women when measured in millimeters (P = .028) (7.08 ± 2.24 mm in men vs 6.28 ± 1.62 mm in women), but the NS proportion to the SW was similar (9.94 ± 2.24% in men vs 9.26 ± 1.61% in women). When the 12 individuals with the smallest NS in proportion to SW were compared with the 12 individuals with the largest NS in proportion to SW, there was no statistical difference regarding the esthetic evaluation (P = .11). It was concluded that the NS did not influence the esthetic evaluation of smile photographs in the sample in this study, for both orthodontists and lay people. © 2006 by The EH Angle Education and Research Foundation, Inc.

The ability of orthodontists and laypeople in the perception of gradual reduction of dentogingival exposure while smiling

OBJETIVO: avaliar a diferença na percepção de ortodontistas e leigos quanto à redução da exposição dentogengival no sorriso. MÉTODOS: no total, 60 avaliadores de ambos os sexos (30 leigos e 30 ortodontistas) avaliaram fotografias do sorriso espontâneo de dois indivíduos, um do sexo masculino e um do feminino. A partir das imagens originais, a altura do sorriso foi modificada usando-se um programa de manipulação de imagens. Os examinadores emitiram notas de 0 a 10, conforme o nível de agradabilidade. A reprodutibilidade do método foi examinada através do teste de Wilcoxon, enquanto os testes de Friedman e Wilcoxon (P<0,05) foram utilizados para observar as diferenças intra e interexaminadores, respectivamente. RESULTADOS: os resultados demonstraram não haver diferença entre os grupos de avaliadores com relação à estética quando a altura de ambos os sorrisos foi modificada. Entretanto, o sorriso do indivíduo do sexo masculino teve menor aceitabilidade do que o sorriso feminino. Uma suave redução na exposição dentogengival no sorriso (2mm) não foi percebida por leigos ou ortodontistas (p>0,05). CONCLUSÃO: o sorriso do indivíduo do sexo feminino recebeu notas mais altas do que o do masculino; entretanto, amostras envolvendo um maior número de indivíduos em cada grupo são necessárias para confirmar se a observação estaria relacionada ao sexo do indivíduo examinado.

The ontogenesis of smiling and its association with mothers` affective behaviors: A longitudinal study

Two babies were observed from their third week to their sixth month of life. Our goals in the study were: to investigate developmental changes in smiling patterns; to analyze the smiling patterns observed in the presence of mother`s affective behaviors, and to verify whether the babies can answer contingently, with smiles, to mothers` affective behaviors. The babies and their mothers were videotaped at home. It was verified a positive linear trajectory tendency for the babies` smiles. The babies revealed a particular tendency to display one or two kinds of smiles. Babies answered contingently with smiles to their mothers` affective behaviors. Correlations between the most frequent types of babies` smiles and his/her mothers` smiles were verified (r = 37, p < .0017 - baby1, and r = .62, p < .0017 - baby2). Different types of smiles were exhibited by the babies as contingent answers to mothers` behaviors. The results show an association between babies` smiles and their mothers` affective behaviors. (C) 2009 Elsevier Inc. All rights reserved.

Be Careful Where You Smile : Culture Shapes Judgments of Intelligence and Honesty of Smiling Individuals

We thank all the supporting team-members involved in the translation procedures and data collections. Research was supported by the Polish NCN Grant 2011/03/N/HS6/05112 (K.K.) and Chinese NNSF Grant 31200788 (C.X).