Mapeamento da imunização contra o vírus da hepatite b e a estigmatização de doenças virais no contexto odontológico.
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Data
2020-10-30
Autores
Wakayama, Bruno [UNESP]
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Universidade Estadual Paulista (Unesp)
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Introdução: A AIDS e a Hepatite B são doenças virais de grande impacto epidemiológico e social, que repercutem de maneira negativa em todas as conjunturas, instâncias e práxis da saúde pública mundial. Na perspectiva odontológica, a alta infectividade, a patogenicidade e a estigmatização do vírus da imunodeficiência humana (HIV) e da hepatite B (VHB), além de deixarem os profissionais mais expostos às suas vulnerabilidades laborais, podem fomentar práticas e presunções discriminatórias. Objetivo: A presente tese foi dividida em dois capítulos, com objetivos diferentes. Capítulo 1 - mapear o perfil de imunização dos cirurgiões-dentistas da rede pública de saúde por meio do teste imunocromatográfico Anti-HBsAg e identificar seus fatores associativos. Capítulo 2 - comparar o conhecimento, a presença e a manifestação de atos discriminatórios e estigmatizantes de cirurgiões-dentistas, auxiliares e acadêmicos de Odontologia a respeito das representações sociais do HIV/AIDS e da hepatite B. Metodologia: Tratam-se de dois estudos epidemiológicos transversais quantitativos. Para a condução metodológica do primeiro capítulo, fizeram parte do universo amostral cirurgiões-dentistas da Atenção Primária à Saúde (APS) de 40 municípios pertencentes ao Departamento Regional de Saúde – II (DRS-II), do estado de São Paulo. A coleta dos dados foi feita em três etapas: aplicação do inquérito semiestruturado; investigação do protocolo vacinal contra o VHB; e análise da imunização pelo teste rápido imunocromatográfico Ant-HbsAg. Para o processamento estatístico, foi utilizada a análise bivariada em subsequência à análise de regressão logística binomial. No segundo capítulo, fizeram parte do universo amostral cirurgiões-dentistas e auxiliares em saúde bucal da APS dos 40 municípios da DRS-II e acadêmicos de Odontologia de uma universidade pública. Para a condução do estudo foi construído um instrumento de pesquisa que tinha como objetivo identificar de maneira ampla e objetiva as atitudes e os comportamentos potencialmente profusos de ações discriminantes. Para análise dos dados utilizou-se o Teste Z de proporção para comparação entre os grupos. Resultados: No capítulo 1, do total da amostra (219), 74,9% afirmou ter tomado as três doses da vacina e 35,6% não estava imune contra o VHB. Foram verificadas associações entre a variável dependente e o tempo de trabalho no serviço público; o conhecimento da temática em estudo; o desconhecimento do número de doses da vacina que foram administradas; e ter tomado menos de três doses da vacina. No capítulo 2, participaram da pesquisa 550 sujeitos. Foram verificadas associações significativas no conhecimento dos participantes do estudo sobre o HIV/AIDS e hepatite B, com maior representatividade de cirurgiões-dentistas. Dentre as doenças infecciosas analisadas, foi observado, de modo geral, um maior receio perante o HIV/AIDS. Por outro lado, quando inqueridos sobre o risco de infectividade, houve maior representatividade da hepatite B. Além disso, 30,7% e 42,2% dos indivíduos aceitariam ser atendidos por um profissional com HIV/AIDS e hepatite B, respectivamente, com maiores proporções de recusas pelos auxiliares e acadêmicos. Sobre a existência de distinções nas condutas clínicas de atendimento ao paciente com AIDS e hepatite B, o grupo de auxiliares teve as maiores proporções. Conclusão: No primeiro capítulo, parte dos cirurgiões-dentistas da APS não eram imunes contra o VHB. Já sobre os fatores de risco analisados, foi verificado que o conhecimento, o tempo de trabalho e a completude do esquema vacinal foram influentes para a não imunização. No segundo capítulo, foi possível concluir que o conhecimento sobre a temática ainda é obstáculo a ser enfrentada pelos auxiliares e acadêmicos. Em relação à presença e à manifestação de atitudes discriminatórias e estigmatizantes, foi constatado que elas existem de maneira velada e oculta pelos grupos dos acadêmicos e auxiliares, principalmente em relação ao HIV/AIDS.
Introduction: AIDS and hepatitis B are viral diseases of great epidemiological and social impact. They negatively affect all conjunctures, instances, and praxis of global public health. From the dental perspective, the high infectivity, pathogenicity, and stigmatization of the human immunodeficiency virus (HIV) and hepatitis B virus (HBV) expose professionals to their work vulnerability and may foster discriminatory practices and presumptions. Objective: the main objective was addressed in two chapters, with different purposes. In chapter 1, we aimed to map the immunization profile of dental surgeons in the public health system and to identify its associative factors. To this end, we employed the anti-HBsAg immunochromatographic test. In chapter 2, we aimed to compare the knowledge, presence, and manifestation of discriminatory and stigmatizing acts of dental surgeons, dental assistants, and dental students concerning the social representations of HIV/AIDS and hepatitis B. Methodology: Two quantitative cross-sectional epidemiological studies were conducted. In the first chapter, the sample comprised dental surgeons working at the Primary Health Care (PHC) of 40 municipalities belonging to the Regional Health Department II (DRS-II) of the state of São Paulo. Data collection was performed in three stages: a semi-structured interview; an investigation into the vaccine protocol against HBV; and an immunization analysis through the anti-HBsAg immunochromatographic rapid test. A binomial logistic regression analysis and a bivariate analysis provided the statistical data. In the second chapter, the sample comprised dental surgeons and dental assistants working at the PHC of 40 municipalities belonging to the DRS-II and dental students of a pubic university. We built a research instrument to broadly and objectively identify the potentially profuse attitudes and behaviors of discriminating actions. For data analysis, we performed the proportion Z-test to compare groups. Results: In chapter 1, 74.9% of the sample (219) claimed to have taken the three doses of the vaccine, while 35.6% were not immune against HBV. We verified associations between the dependent variable and the working time in the public service, the knowledge about the subject under study, the unawareness of the number of vaccine doses taken, and the fact of having taken less than three doses. In chapter 2, 550 subjects participated in the study. We found significant associations regarding participants' knowledge of HIV/AIDS and hepatitis B, with a greater representation of dental surgeons. Among the diseases investigated, HIV/AIDS raised the greatest concern. On the other hand, concerning the risk of infectivity, hepatitis B had a greater representativeness. In general, 30.7% and 42.2% of participants would accept receiving care from professionals with HIV/AIDS and hepatitis B, respectively; assistants and students had a higher proportion of refusal of care. Dental assistants had greater representativeness regarding distinctions in the clinical conduct of care for patients with AIDS or hepatitis B. Conclusion: In the first chapter, some of the dental surgeons were not immune to HBV. Regarding the risk factors, we verified that the knowledge, the working time, and the completeness of the vaccination schedule affected non-immunization. In the second chapter, we concluded that knowledge about the subject is still an impediment to be faced by dental assistants and students. Regarding the presence and manifestation of discriminatory and stigmatizing behaviors, we verified that they are veiled and hidden by groups of dental students and assistants, especially concerning HIV/AIDS.
Introduction: AIDS and hepatitis B are viral diseases of great epidemiological and social impact. They negatively affect all conjunctures, instances, and praxis of global public health. From the dental perspective, the high infectivity, pathogenicity, and stigmatization of the human immunodeficiency virus (HIV) and hepatitis B virus (HBV) expose professionals to their work vulnerability and may foster discriminatory practices and presumptions. Objective: the main objective was addressed in two chapters, with different purposes. In chapter 1, we aimed to map the immunization profile of dental surgeons in the public health system and to identify its associative factors. To this end, we employed the anti-HBsAg immunochromatographic test. In chapter 2, we aimed to compare the knowledge, presence, and manifestation of discriminatory and stigmatizing acts of dental surgeons, dental assistants, and dental students concerning the social representations of HIV/AIDS and hepatitis B. Methodology: Two quantitative cross-sectional epidemiological studies were conducted. In the first chapter, the sample comprised dental surgeons working at the Primary Health Care (PHC) of 40 municipalities belonging to the Regional Health Department II (DRS-II) of the state of São Paulo. Data collection was performed in three stages: a semi-structured interview; an investigation into the vaccine protocol against HBV; and an immunization analysis through the anti-HBsAg immunochromatographic rapid test. A binomial logistic regression analysis and a bivariate analysis provided the statistical data. In the second chapter, the sample comprised dental surgeons and dental assistants working at the PHC of 40 municipalities belonging to the DRS-II and dental students of a pubic university. We built a research instrument to broadly and objectively identify the potentially profuse attitudes and behaviors of discriminating actions. For data analysis, we performed the proportion Z-test to compare groups. Results: In chapter 1, 74.9% of the sample (219) claimed to have taken the three doses of the vaccine, while 35.6% were not immune against HBV. We verified associations between the dependent variable and the working time in the public service, the knowledge about the subject under study, the unawareness of the number of vaccine doses taken, and the fact of having taken less than three doses. In chapter 2, 550 subjects participated in the study. We found significant associations regarding participants' knowledge of HIV/AIDS and hepatitis B, with a greater representation of dental surgeons. Among the diseases investigated, HIV/AIDS raised the greatest concern. On the other hand, concerning the risk of infectivity, hepatitis B had a greater representativeness. In general, 30.7% and 42.2% of participants would accept receiving care from professionals with HIV/AIDS and hepatitis B, respectively; assistants and students had a higher proportion of refusal of care. Dental assistants had greater representativeness regarding distinctions in the clinical conduct of care for patients with AIDS or hepatitis B. Conclusion: In the first chapter, some of the dental surgeons were not immune to HBV. Regarding the risk factors, we verified that the knowledge, the working time, and the completeness of the vaccination schedule affected non-immunization. In the second chapter, we concluded that knowledge about the subject is still an impediment to be faced by dental assistants and students. Regarding the presence and manifestation of discriminatory and stigmatizing behaviors, we verified that they are veiled and hidden by groups of dental students and assistants, especially concerning HIV/AIDS.
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Palavras-chave
Hepatite B, Vacina contra Hepatite B, HIV, Estigma Social, Odontologia, Hepatitis B