O SUS e a Política Nacional de Promoção da Saúde: perspectiva resultados, avanços e desafios em tempos de crise

Health Promoting Universities and the salutogenic theory: contemporary challenges in the Latin American reality

The objective is to reflect on the existing articulation between Aaron Antonovsky's salutogenic theory and Health Promoting Universities, highlighting the challenges for the operationalization of health promotion actions in the Latin American university scenario in the contemporary world. The visible adherence of the ideas of the salutogenic theory to the guiding components of the Health Promoting Universities movement was identified, which has contributed to successful experiences around the world. Practices in the light of salutogenic theory can be considered effective strategies for improving the quality of life in the university setting; however, it is necessary for those involved to detach themselves so that the logic of acting based on a pathogenic process is broken. Furthermore, regional challenges in the Latin American reality must be understood and overcome with the support of public policies.

Associations between bullying and risk for eating disorders in adolescents

OBJECTIVES

to analyze the associations between bullying participation profiles (victims, bullies, and bully-victims) and the risk for eating disorders in adolescents.

METHODS

a cross-sectional study was conducted with 491 students, aged 10 to 18 years. Data were collected through the application of the Peer Victimization and Aggression Scale and the Eating Attitudes Test, and were statistically analyzed using analysis of variance (ANOVA) and Spearman correlation.

RESULTS

the risk for eating disorders was higher for the victim profile, both for boys and girls. For both sexes, physical victimization, verbal victimization, and relational victimization were significantly associated with variables related to the risk for eating disorders. For boys, there were also significant associations related to aggression.

CONCLUSIONS

student victims, especially boys, are more vulnerable to the consequences of bullying in relation to the risk for eating disorders.

Burden of ischemic heart disease attributable to trans fatty acids, 1990-2019

BACKGROUND & AIM

The impact of cardiovascular disease attributable to trans fatty acids (TFAs) in the Brazilian population has not been systematically evaluated. This study aims to analyze the burden of ischemic heart disease (IHD) attributable to TFAs in Brazil between 1990 and 2019.

METHODS

Data from the Global Burden of Disease Study 2019 were used to investigate the attributable burden in Brazil and its 27 federative units, for both sexes-pooled adults aged ≥25 years. Mortality and disability-adjusted life years (DALYs) from IHD attributable to TFAs were expressed as crude and age-standardized rates and differences from 1990 to 2019 by percentage and annualized rate of change. Linear regression was used to investigate trends. National voluntary and regulatory policies for industrial TFAs (iTFAs) implemented until 2019, summary exposure value (SEV) and sociodemographic index (SDI) were examined.

RESULTS

Between 1990 and 2019, crude and age-standardized mortality rates from IHD attributable to TFAs decreased by -15.9% and -58.0%, respectively, in Brazil. A decrease in crude (-23.3%) and age-standardized (-56.4%) DALY rates of IHD attributable to TFAs was also noticed in the country. States of the South, Southeast, and the Federal District had the largest declines of IHD attributable to TFAs, while states of the Northeast and North had the smallest or even an increase. The policies already adopted had little effect on the IHD burden. A lower SEV and higher SDI value seemed to reduce the burden of IHD.

CONCLUSIONS

Although a downward trend in IHD attributable to TFAs and a reduction in exposure to TFAs were observed, this burden is still relevant in Brazil, reinforcing the importance of diet policies, such as banning iTFAs.

Development and Validation of a Transgender Health Care Humanization Scale

Purpose

Stigma and discrimination against transgender people can lead to their segregation. Fighting stigma and discrimination is a crucial strategy to expand access to health services. The goals of the present study were to develop and validate a transgender health care humanization scale (THcH scale) to evaluate the perception of humanization in health care for transgender individuals.

Methods

This cross-sectional study included 340 health care providers aged ≥18 years. Participants answered a structured questionnaire when attending HIV/AIDS scientific meetings or at their place of work. An exploratory factor analysis was conducted, using a polychoric matrix and robust diagonally weighted least squares extraction method. The number of retained factors was defined through the parallel analysis technique, with random permutation of the observed data and the use of Robust Promin rotation.

Results

The interpretability of correlation matrix items was suggested by the Bartlett's sphericity tests (1633.7, df=91; p<0.001) and Kaiser-Meyer-Olkin Test (0.875). The factor structure showed adequate adjustment indices (χ2=44,200, df=52; root mean square error of approximation p<0.05; comparative fit index=0.968; Tucker-Lewis index=0.945; goodness-of-fit index = 0.995). Only one factor was retained by parallel analysis, explained by 54.17% of the variance of the construct and confirmed by the following indices: unidimensional congruence=0.902, explained common variance=0.828, and mean of item residual absolute loadings=0.279. Good reliability was confirmed by Cronbach's alpha test (0.899).

Conclusion

The THcH scale showed good psychometric properties. This self-report questionnaire, which can be completed in 5 min, may be useful in scientific research and could guide health care providers in expansion of a Health Humanization Policy and in deconstructing prejudice against transgender people in health care settings.

Programa Saúde na Escola: potencialidades e limites da articulação intersetorial para promoção da saúde infantil

RESUMO O estudo objetivou compreender as potencialidades e os limites da articulação intersetorial do Programa Saúde na Escola para a promoção da saúde infantil, sob a ótica dos profissionais da atenção primária. Pesquisa de abordagem qualitativa, descritiva-exploratória, realizada com 20 profissionais da área da saúde, residentes em quatro municípios da Região da Grande Florianópolis. A coleta de dados foi desenvolvida por meio de entrevistas, no período de novembro de 2020 a março de 2021. Os dados passaram por análise de conteúdo e discutidos à luz do referencial teórico da promoção da saúde. Destacaram-se, como potencialidades, o acompanhamento das condições de saúde dos escolares, a ampliação do acesso à informação, a parceria com outros setores e a criação de vínculos com a comunidade escolar. Os limites evidenciados foram a cobertura parcial da rede escolar, o desconhecimento sobre o programa, a sobrecarga de atividades, os impactos causados pela pandemia da Covid-19, a falta de recursos humanos e de infraestrutura. Conclui-se que há necessidade de fortalecimento do Programa Saúde na Escola enquanto política pública, com vistas à efetivação de ações articuladas entre saúde e educação para o alcance da melhoria da qualidade de vida dos escolares, com atuação sobre os seus determinantes sociais.

School Health Program: potential and limits of the intersectoral articulation to promote the health of children

ABSTRACT The study aimed to understand the potential and limits of the intersectoral articulation of the School Health Program for the promotion of children’s health from the perspective of primary care professionals. This research had a qualitative, descriptive-exploratory approach, carried out with 20 health professionals from different professional categories, in four municipalities in the Greater Florianópolis. Data collection was carried out through interviews from November 2020 to March 2021. The data underwent content analysis and discussed according to the theoretical framework of health promotion. It stood out as potential: monitoring the health conditions of schoolchildren, expanding access to health information, partnership with other sectors, and the creation of links with the school community. The limits highlighted were the partial coverage of the school network, the lack of knowledge about the program, the overload of activities, the lack of human resources and infrastructure, and the impacts caused by the COVID-19 pandemic. It is concluded that there is a need to strengthen the School Health Program as a public policy with the purpose of implementing articulated actions between health and education so that they can actually improve schoolchildren’s quality of life and act on their social determinants.

Factors related to the accumulation of healthy behavior among older adults attending primary Health Care

The adoption and maintenance of healthy behaviors contribute for its accumulation throughout life, which require more than information disclosure and recommendations. Biopsychosocial factors may work as barriers to adherence to healthier behaviors, and yet have been underexplored. The objective was to investigate the factors related to the accumulation of healthy behavior among older adults attending Primary Health Care. Cross-sectional analysis with 201 older adults from baseline of Longitudinal Investigation of Functioning Epidemiology (LIFE) was performed in a Southeastern Brazilian city. The Healthy Behavior Score (HBS), ranging from 0 to 8, was calculated by the sum of the following habits: Physical activity practice, healthy eating, water consumption, night sleep time, not smoking, not drinking alcohol, frequent social relations, and spirituality. A linear multivariate regression was performed to test the influence of biopsychosocial aspects on HBS, with 95% confidence interval. Higher number of healthy behaviors was related to high social support, better cognitive status, less depressive symptoms and lower functional performance. Additionally, age and resilience score were correlated to healthy behaviors, which were higher among women and those with sufficient income. Multivariate analysis revealed depressive symptoms, functional performance and education as independent predictors of HBS. Depressive symptoms, functional performance and education are predictors of accumulation of health behaviors, independently of health status, contextual and sociodemographic aspects. Higher social support partially contributed to the higher number of healthy behaviors, and should be considered in public health policies for healthy longevity.

National Health Survey 2019: medication obtainment through the Brazilian Popular Pharmacy Program by adults being treated for hypertension and diabetes

OBJECTIVE

To describe the proportion of adults with hypertension and diabetes who obtained medication through the Brazilian Popular Pharmacy Program (Programa Farmácia Popular).

METHOD

Population-based descriptive study, using data from the 2019 Brazilian National Health Survey. The proportion of individuals who obtained at least one type of medication for hypertension and diabetes in the Program was analysed according to socioeconomic and demographic characteristics, by regions and federative units.

RESULTS

The proportion of individuals who obtained medication for hypertension was 45.1% (95%CI 43.7;46.5), and, for diabetes, 51.5% (95%CI 49.5;53.6). Respectively for both conditions, medication obtainment was higher in the South region (54.3%; 95%CI 51.3;57.2 and 59.1%; 95%CI 54.6;63.7) and lower in the higher strata level of education (30.9%; 95%CI 27.7;34.2 and 40.7%; 95%CI 35.1;46.3) and income (24.0%; 95%CI 19.7;28.2 and 28.9%; 95%CI 22.1;35.7).

CONCLUSION

Regional and socioeconomic inequalities were identified in obtaining medication for hypertension and diabetes through the Program.

Alcohol Consumption and Smoking During Covid-19 Pandemic: Association with Sociodemographic, Behavioral, and Mental Health Characteristics

The Covid-19 pandemic is related to increased alcohol consumption and smoking. These behaviors may be related to several sociodemographic, behavioral and mental health factors. Thus, the aim of this study was to assess the association between alcohol consumption and cigarette smoking with sociodemographic, behavioral and mental health characteristics. This study used data from two population-based studies conducted in two cities from Southern Brazil amid the Covid-19 pandemic. Individuals aged 18 years or older were included and selected using a multistage sampling procedure. Alcohol consumption and smoking and changes in such consumption during the Covid-19 pandemic were evaluated. Sociodemographic, behavioral, pandemic-related, and mental health variables were also included. A hierarchical model was used to conduct the adjusted analyses, and Poisson regression with robust adjustment was used for variance. A total of 2170 individuals were studied. The prevalence of alcohol consumption and smoking were 9.3% and 14.2%, respectively. The rates of increase in alcohol consumption and smoking during the Covid-pandemic were about 20% and 30%, respectively. They were higher among those with depressive symptoms, feeling of sadness and self-reported stress. Those with poor diet quality had higher prevalence of alcohol consumption (PR: 1.82) and were 1.58 times more likely to smoke. The findings may help stakeholders in health and political systems to better understand the consequences of the Covid-19 pandemic and develop strategies to mitigate these consequences in Brazil and elsewhere.

Developing a protocol based on the Brazilian Dietary Guidelines for individual dietary advice in the primary healthcare: theoretical and methodological bases

To describe the methodology of development of a protocol for application of the Brazilian Dietary Guidelines by primary healthcare professionals in individual dietary advice. A five-step approach was followed: (1) format definition; (2) definition of the instrument for assessment of individuals’ food consumption; (3) Dietary Guidelines’ content extraction; (4) protocol content development; (5) content and face validity. An example from Brazil was displayed with the development of a protocol to guide healthcare professional decision-making when providing nutrition advice based on the Brazilian Dietary Guidelines. The instrument of the Brazilian Nutrition Surveillance System (SISVAN) was chosen to the food consumption assessment, which contains questions about the consumption of seven healthy or unhealthy food groups and one question about eating modes. The Guidelines’ content extraction process led to the identification of recommendations related to the food consumption markers assessed by the SISVAN questionnaire. Then, a protocol was developed in a flowchart format, in which the professional’s conduct is guided by the answer given to each question of the SISVAN instrument. For each ‘non-compliant’ answer (unhealthy eating practice), the professional is instructed how to provide recommendations and identify obstacles. Lastly, experts and healthcare professionals highlighted pertinence, clarity and usability of the protocol. This study provides the blueprint for the phase-wise development of protocols of application of the Dietary Guidelines and may contribute to promote healthier eating and ending malnutrition in all its forms.

Burden of non-communicable diseases attributable to dietary risks in Brazil, 1990-2019: an analysis of the Global Burden of Disease Study 2019

INTRODUCTION

An unhealthy diet is a modifiable risk factor for non-communicable diseases (NCDs), one of the most important public health problems in Brazil. This study aimed to analyze the burden of NCDs attributable to dietary risks in Brazil between 1990-2019.

METHODS

Secondary data from the Global Burden of Disease Study were used to estimate the burden attributable to fifteen dietary risks in Brazil. The main sources of data for Brazil were national surveys and international databases. A comparative risk assessment was used to obtain the population attributable fraction. We described the intake of each dietary risk and the distribution of number and rates of deaths and Disability-adjusted life years (DALYs) attributable to diet by sex, age, state, and year from 1990-2019.

RESULTS

Cardiovascular diseases, diabetes mellitus, and neoplasms were the main NCDs attributable to an unhealthy diet. Age-standardized mortality and DALYs rates attributable to unhealthy diet decreased between 1990-2019 (-51.5% and -48.8, respectively). Diet high in red meat and sodium, and low in whole grains were the three main risk factors contributing to the burden of NCDs both in 1990 and 2019. The burden of NCDs was higher among males in the middle-aged population (around 50 years), as well as in the states of Maranhão, Rio de Janeiro, and Alagoas.

CONCLUSIONS

The present study found a suboptimum diet among the Brazilian population. The major contributors to this burden were diet high in red meat and sodium and low in whole grains. This study supports priorities in public policies on food and nutrition to reduce the burden of NCDs.

Associação entre avaliação positiva da atenção primária à saúde e características sociodemográficas e comorbidades no Brasil

RESUMO Objetivo: Descrever a avaliação positiva da atenção primária à saúde (APS) no Brasil na ótica dos usuários e sua associação com as características sociodemográficas e comorbidades. Métodos: Análise da Pesquisa Nacional de Saúde 2019, com amostra de 9.562 adultos que responderam ao primary care assessment tool (PCATool). Foi testada a associação entre avaliação positiva da APS (escore geral ≥6,6) e características individuais, sendo utilizadas as razões de prevalência (RP) calculadas por meio de regressão de Poisson. Resultados: Menos de 40% dos brasileiros avaliaram a APS com escore alto. No que se refere à associação das variáveis sociodemográficas com a avaliação elevada da APS, ajustada por sexo e idade, encontrou-se que a melhor avaliação da APS ocorreu entre mulheres [RPaj 1,10 (intervalo de confiança de 95% — IC95% 1,00–1,21)]; idosos (60 anos ou mais) [RPaj 1,27 (IC95% 1,09–1,48)]; pessoas com renda per capita de um a três salários mínimos (SM) [RPaj 1,14 (IC95% 1,03–1,27)] e ≥5 SM [RPaj 1,75 (IC95% 1,39–2,21)] quando comparadas com renda até um SM; e moradores das regiões Sul, Sudeste e Centro-Oeste em relação à Região Norte. Considerando as variáveis de comorbidades, avaliaram bem a APS indivíduos com hipertensão [RPaj 1,29 (IC95% 1,17–1,43)]; diabetes [RPaj 1,21 (IC95% 1,08–1,36)]; doença cardíaca [RPaj 1,23 (IC95% 1,07–1,41)]; distúrbio osteomuscular [RPaj 1,36 (IC95% 1,10–1,69)]; doença do pulmão [RPaj 1,48 (IC95% 1,13–1,95)] e obesidade [RPaj 1,15 (IC95% 1,03–1,28)] em comparação com pessoas eutróficas. Conclusão: Usuários que avaliaram bem a APS são mulheres, idosos, com prevalências elevadas de doenças crônicas não transmissíveis. A avaliação positiva da APS, em geral, resulta da maior utilização dos serviços de saúde.

Association between positive assessment of Primary Health Care, sociodemographic characteristics and comorbidities in Brazil

ABSTRACT Objective: To describe positive evaluations of Primary Health Care (PHC) in Brazil from the perspective of users and their association with sociodemographic characteristics and comorbidities. Methods: Analysis of the 2019 National Health Survey, in which 9,562 adults responded to the Primary Care Assessment Tool (PCATool). The association between positive PHC assessment (overall score ≥6.6) and individual characteristics was tested using Prevalence Ratios (PR) calculated by Poisson Regression. Results: Less than 40% of Brazilians rated PHC with a high score. Regarding the association of sociodemographic variables with high PHC assessment, adjusted for sex and age, the best PHC assessments were made by women [PRaj 1.10 (95%CI 1.00–1.21)]; elderly (60 years and over) [PRaj 1.27 (95%CI 1.09–1.48); people with a per capita income of 1 to 3 minimum wages (MW) PRaj 1.14 (95%CI 1.03–1.27) and ≥5 MW PRaj 1.75 (95%CI 1.39–2.21) when comparing with income up to 1 MW; residents of the South, Southeast and Midwest regions, compared to the North Region. Considering comorbidities, individuals with hypertension PRaj1,29 (95%CI 1.17–1.43); diabetes PRaj 1.21 (95%CI 1.08–1.36); heart disease PRaj 1.23 (95%CI 1.07–1.41); musculoskeletal disorders PRaj 1.36 (95%CI 1.10–1.69); lung disease PRaj 1.48 (95%CI 1.13–1.95) and obesity PRaj 1.15 (95%CI 1.03–1.28) rated PHC better when compared to normal weight people. Conclusion: Users who evaluate PHC well are usually women, elderly, with high prevalence of chronic non-communicable diseases. A positive evaluation of PHC, in general, results from greater use of health services.

A Critical Review on New Approaches for Chronic Disease Prevention in Brazil and Canada: From Wholistic Dietary Guidelines to Physical Activity Security

In light of new evidence on the prevention of chronic diseases and the elevated rates of overweight and obesity in Brazil and Canada, this critical review aims to interpret and synthesize current aspects regarding dietary and physical activity initiatives in both countries and make future recommendations. The pioneering work presented in the last Brazilian dietary guidelines has been called a model that can be applied globally, given its conceptualization of healthy eating that translates easily to practical guidance. The new Canadian Food Guide has incorporated similar aspects, also putting the country as a leader in dietary guidance. With these new recommendations, citizens in both Brazil and Canada have access to impactful evidence-informed nutritional guidelines. Both documents propose eating patterns that focus not only on health benefits, such as chronic disease prevention, but also incorporate well-being concerning cultural, economic, sociodemographic, biological, and ecological dimensions. A similar approach is required for physical activity to allow individuals to have attainable health and life goals and thereby fully enjoy their lives, regardless of geographical location, health status, and socioeconomic condition, a concept recently described as physical activity security. The wholistic dietary guidelines from both countries represent a change in paradigm in public health. Likewise, national evidence-based policies are warranted to reduce disparities in physical activity, allowing healthier and more active lifestyles for everyone.

Development and validation of an instrument to evaluate interventions in relation to Health Promotion principles

OBJECTIVE

To develop and validate of an instrument to evaluate interventions in relation to Health Promotion principles in Brazil.

METHODS

A cross-sectional study of the development and validation of an instrument was carried out, based on the assessment of the first version by 20 health workers, the final version by 19, analysis of reliability by 31, and content evaluation of the first version by ten experts and of the final version by 12 experts. The content validity index, Cronbach's alpha (α) and intraclass correlation coefficient were used.

RESULTS

The indicators achieved 89.9% adequacy, 82.5% clarity, internal consistency was α = 0.80, and the test-retest correlation was 0.93.

CONCLUSION

The instrument showed acceptable validity and reliability and can be used for the evaluation of Health Promotion interventions.

COVID-19 and health promotion in Brazil: community health workers between vulnerability and resistance

Health promotion in Brazil relies on community health workers (CHWs), frontline providers linking the health system with vulnerable groups. Brazilian CHWs are overwhelmingly women from poor backgrounds, with precarious and sometimes hazardous working conditions, as well as fragmented and unsystematic training. This paper evaluates how the COVID-19 pandemic exacerbated pre-existing vulnerabilities of CHWs (pertaining to low salary, precarious and hazardous working conditions and inadequate training) and created new ones, with a profound impact on their ability to carry out health promotion activities. Drawing on testimonials of dozens of CHWs and online discussions promoted by their unions, the paper reveals that during the pandemic CHWs were asked to continue their work without adequate training and protective equipment, thus exposing themselves to the risk of infection. It further shows how the pandemic rendered dangerous the close interaction with patients that is at the heart of their health promotion role. Nonetheless, CHWs sought to adapt their work. In the absence of leadership and coordination on the part of the federal government, CHWs mobilized different forms of resistance at the national and individual levels. Despite this, COVID-19 contributed to a trajectory of erosion of health promotion in Brazil. Findings from this case signal the difficulties for health promotion in low- and middle-income countries relying on CHWs to bridge the health system and vulnerable users.

Evaluation of community physical activity programs in Brazil: a scoping review

Community physical activity programs were created to encourage and increase the practice of physical activity in the Brazilian population and promote healthy life habits. The Brazilian Ministry of Health invested in the evaluation of these programs and consolidated partnerships that favor the development of relevant evidence on the topic. The current study aimed to identify and summarize the scientific highlights on the approaches and results of evaluations performed in the Health Academy Program and City Academy Program. This is a scoping review based on the methodology of the Joanna Briggs Institute. We used the MEDLINE via PubMed, LILACS, Scopus, and Cochrane databases, the website of the Health Academy Program, the Catalogue of Theses and Dissertations of the Brazilian Graduate Studies Coordinating Board, and the Brazilian Digital Library of Theses and Dissertations. The sample included quantitative or qualitative primary studies with no limit on year of publication. Twenty-four studies published from 2009 to 2020 were selected and subdivided according to the approaches to evaluation: evaluability, sustainability, process (supply and structure), outcome (impact and satisfaction), and degree of inference (adequacy, plausibility, and probability). The results of the evaluations showed that the programs offer various activities, positively impact users' health indicators, and contribute to the increase in leisure-time physical activity. The evaluation of these programs is essential for the administration, health services, and healthcare workers, since it allows verifying the implementation of the proposed activities, coverage, access, impact, and interference by the political context in their continuity.

Health education and the municipal health network: practices of nutritionists

Health education must be seen as an instrument used to promote quality of life. The objective of this study was to evaluate health education practices of nutritionists in a municipal health network. This is a qualitative study using Grounded Theory. Interviews and observation of educational activities were carried out. The use of materials was evaluated, together with attempts to engage the service users. Five analysis categories were applied. The intention of raising awareness and changing habits highlights the preference of professionals toward actions that are articulated and consistent with reality. Productivity valorization, insufficient training, and lack of physical structure were mentioned as restrictions. Most respondents did not evaluate results; they believe in sharing knowledge as a process that transforms reality; and defend the multidisciplinary approach and care by putting the concepts of integrality and equity into practice. The nutritionists' concepts of health education guide their professional performance, as they reflect the perspectives of the educational practices adopted.

The vulnerabilities of the Brazilian health workforce during health emergencies: Analysing personal feelings, access to resources and work dynamics during the COVID-19 pandemic

Public health emergencies are a test of resilience for health systems, which depend on health workforces that are well managed and cared for. The COVID‐19 pandemic exposed the weakness of many health systems in preparing their health workforces. The crisis also exacerbated the unequal conditions between different professions, an issue that is still understudied in the workforce literature. This paper analyzes the consequences of the COVID‐19 pandemic for different health professionals, considering the ways in which Brazil's the health system does or does not protect them. We also analyse the role of pre‐existing inequalities between different professions and social groups within the workforce in shaping their different experiences of the pandemic. We present data comparing the perceptions of different health professionals facing the pandemic in Brazil: physicians, nurses, and community health workers. Data were collected in an online survey in Brazil with 1630 health care workers between June 15th and July 1st. Findings suggest that none of the professions felt well prepared to work under emergencies. However, differences relating to professional background were exacerbated during the pandemic, creating unequal conditions for different health workers. These inequalities may pose new challenges for the post‐pandemic scenario.

Tendency of use and sources for obtaining oral antidiabetic drugs for treatment of diabetes in Brazil from 2012 to 2018: analysis of the Vigitel survey

OBJECTIVE

To estimate the prevalence of use of oral medications for the treatment of diabetes, as well as the distribution of sources for obtaining according to sociodemographic variables, in the Brazilian states' capitals and in the Federal District, and their evolution from 2012 to 2018.

METHODS

Cross-sectional and population-based study with individuals aged ≥ 20 years who reported a medical diagnosis of diabetes, interviewed through Vigitel from 2012 to 2018. We estimated the prevalence of use and the distribution of sources for obtaining according to sociodemographic variables (95%CI). We checked differences among proportions using the Pearson's χ2 test (Rao-Scott), with a significance level of 5%.

RESULTS

There was an increase in the prevalence of use of oral medications for the treatment of diabetes from 77.4 to 85.2% between 2012 and 2018, and a decrease in obtaining in the Health Unit Pharmacies of the Unified Health System (SUS), while there was an increase in obtaining in Popular Pharmacies.

CONCLUSIONS

In Brazil, SUS remained the main source for obtaining oral antidiabetic drugs, financing more than 70% of them in the country, considering the Health Unit Pharmacies and Popular Pharmacies, thereby showing the importance of public Pharmaceutical Policies in guaranteeing the access to medications by the Brazilian population, as well as in reducing inequities in the country. Nevertheless, the migration of obtaining by users from SUS Health Units to Popular Pharmacies suggests the weakening the responsibility of Primary Health Care in the provision oral antidiabetic drugs, thereby undermining the bond and the longitudinal care.

Desafios para a Atenção Primária à Saúde no Brasil: uma análise do trabalho das agentes comunitárias de saúde durante a pandemia de Covid-19

Resumo As fragilidades da Atenção Primária à Saúde podem ser reconhecidas por meio da análise do trabalho das agentes comunitárias de saúde. Uma vez que a situação enfrentada por essas profissionais representa desafios estruturais do sistema de saúde, este artigo tem como objetivo analisar a situação das profissionais em questão no enfrentamento à pandemia de Covid-19 no Brasil. Analisamos seus desafios com base nos dados coletados em um inquérito online e em netnografia. Para a realização da análise dos dados, optamos pela análise de conteúdo, inspirada na grounded-theory. Observamos três dimensões que representam como as agentes comunitárias de saúde experienciam a pandemia: mudanças nas práticas de trabalho, bem como nas interações entre trabalhadores e usuários e a expectativa do futuro no trabalho pós-pandemia. As análises mostram que para resguardar essas profissionais e garantir o funcionamento da Atenção Primária à Saúde é necessário contar com novas estratégias para viabilizar as dinâmicas locais de trabalho.

The role of speech-language therapists in primary healthcare from the perspective of professionals in family health support centers

PURPOSE

To analyze the perception of professionals constituting Family Health Support Centers (FHSC) of a capital in the South Region of Brazil regarding the role of speech-language therapy professionals in primary care (PC).

METHOD

This is a qualitative, observational cross-sectional study. All professionals constituting the FHSC who voluntarily agreed to collaborate with the research participated in this study. A semi-structured questionnaire was applied containing information about the professional profile and activities developed in PC.

RESULTS

Health professionals perform actions that would allow for the joint participation of speech-language therapy professionals, since this category is not contemplated in the staff members that constitute the municipality team analyzed. According to the questionnaire, referrals to speech-language therapy professionals are mainly related children issues with speech and language. Little knowledge on the contribution of speech-language sciences regarding interdisciplinary actions was found.

CONCLUSION

The participants of this study demonstrated a reductionist perception regarding speech-language sciences in PC. In addition, the actions performed by the professionals of this study are directed towards what the speech-language professional could contribute instead. Further studies could demonstrate the benefits that speech-language professionals can provide to the activities performed.

Parents' perceptions and related factors of the oral health status of Brazilian children enrolled in public preschools

PURPOSE

This study aimed to evaluate parents' perceptions of the oral health status of children enrolled in public preschools and associated factors.

METHODS

This was a cross-sectional study with data collected via self-administered questionnaire. A total of 474 questionnaires were distributed in public preschools in the city of Canoas, Rio Grande do Sul, the southernmost state of Brazil. Poisson regression models were used in the multivariate analysis (p < 0.05).

RESULTS

The study included 171 (36%) valid questionnaires. The prevalence of parents who perceived the oral health status of their children as negative was 29.8% (n = 51). Mother being unemployed (vs employed) increased by 16% the likelihood of parents perceiving the oral health status of their children as negative (prevalence ratio [PR] 1.16; 95% confidence interval [CI] 1.02-1.31. Parents having (vs having not) observed difficulties in the child's ability to eat increased by 27% the likelihood of perceiving the child's oral health status as negative (PR 1.27; 95% CI 1.08-1.48), while child's tooth brushing 1-2 (vs 3 or more) times a day and family income up to 2 (vs 3 or more) minimum wages increased it by 14% (PR 1.14; 95% CI 1.03-1.27 for both). Current or past use (vs no use) of pacifiers increased by 12% the likelihood of parents' negative perceptions (PR 1.12; 95% CI 1.00-1.25).

CONCLUSION

We can conclude that unemployed mothers, low-income families, parents having observed child's feeding difficulties, child's tooth brushing 1-2 times a day, and current or past use of pacifiers contributed significantly to parents' negative perception of the child's oral health status. These factors are essential for the planning, implementation, monitoring, and evaluation of actions aimed at controlling the oral health of children enrolled in public preschools.

Knowledge and health promotion practice of Family Health Strategy nurses

OBJECTIVES

to analyze the knowledge and health promotion practice carried out by Family Health Strategy nurses.

METHODS

a descriptive study and qualitative approach. The study was conducted with 18 Family Health Strategy nurses from the city of São Carlos. Data were collected through semi-structured interviews and analyzed through thematic analysis. The study was approved by the Research Ethics Committee.

RESULTS

the data revealed that nurses had difficulties to conceptualize health promotion, and it is common to describe the definition of disease prevention. Nurses also reported developing group activities for health promotion; however, individual actions and consultations were still predominant. Final Considerations: it is necessary to develop sustainable strategies for collective health-promoting activities, in addition to strengthening multidisciplinary work and Continuing Education actions.

Promoção da saúde de crianças e adolescentes em uma Organização da Sociedade Civil: refletindo sobre os valores e a formação profissional

Resumo A concepção de infância modificou-se de acordo com as estruturas econômicas e de poder da sociedade, assim como os valores que influenciam o cuidado das crianças e dos adolescentes. Com o neoliberalismo, os direitos constitucionais reduziram-se, os valores defendidos na Constituição desvalorizaram-se, e as Organizações da Sociedade Civil tornaram-se as responsáveis pela atenção a essa população. Este trabalho tem como objetivo analisar como os valores e a formação profissional influenciam na promoção da saúde no atendimento a crianças e adolescentes em uma Organização da Sociedade Civil de Florianópolis, Santa Catarina. A pesquisa, realizada em 2018, utilizou abordagem qualitativa com entrevistas semiestruturadas e análise temática. Os resultados foram organizados em duas categorias: Formação profissional: ultrapassando o tecnicismo em busca da promoção à saúde; e Educação moral, valores e cidadania: a promoção da saúde na contramão dos valores neoliberais. É fundamental a discussão sobre a formação profissional em busca de um cuidado mais humanizado na universidade de modo a promover indivíduos críticos e com capacidade de refletir, transformar e recriar o seu trabalho. Além disso, a educação moral e a promoção da saúde buscam elementos para transformação do status quo que vai além das práticas médicas e engloba a promoção da cultura da paz e de direitos humanos e à emancipação do ser humano.

Prevalence and co-occurrence of modifiable risk factors in adults and older people

OBJECTIVE

To estimate the co-occurrence of the major risk factors for chronic diseases in adults (18-59 years old) and older people (≥ 60 years old) living in Brazilian state capitals and the Federal District.

METHODS

Cross-sectional study with population-based data from 35,448 adults and 18,726 older people collected in the Sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (System of Surveillance of Risk and Protective Factors for Chronic Diseases by Telephone Survey – Vigitel) in 2015. The prevalence of each of the five risk factors (smoking, overweight, physical inactivity, alcohol and unhealthy diet) was estimated, as well as their co-occurrence for the different possible combinations, according to socioeconomic and health self-assessment variables. The independent associations were verified via multinomial logistic regression to obtain the estimates of the odds ratio (OR) and corresponding 95% confidence intervals.

RESULTS

At least two risk factors were present in 38.5% of the adults and 37.0% of the older participants. The male adults and older participants who did not have private health insurance and classified their health as average or poor/very poor were more likely to have two or more concurrent risk behaviors. The greater chance of co-occurrence of smoking and alcohol abuse in adults (adjusted OR = 3.52) and older people (adjusted OR = 2.94) stands out.

CONCLUSIONS

The subgroups with increased risk of developing multiple unhealthy behaviors and the most prevalent behaviors were identified. These findings are expected to contribute to the better targeting of health promotion and preventive care. It is worth noting that, for the adoption of healthy lifestyle habits, macro-social and inter-sectoral policies are more effective.

Fiscal austerity measures hamper noncommunicable disease control goals in Brazil

Given the Constitutional Amendment 95 and the economic crisis, we discussed the possible effects of austerity measures on the achievement of the goals established for the control of chronic noncommunicable diseases (NCDs) in the country. The trends of NCDs and risk factors were analyzed, according to data from epidemiological surveys and mortality data from the Global Burden of Disease study. The resultsindicate a trend of stability in mortality rates by NCD in 2015 and 2016. Brazilians with low schooling, in general, have a higher prevalence of risk factors and a lower prevalence of protective factors. In the 2015-2017 period, previously favorable trends reversed for indicators such as fruit and vegetable consumption and physical activity, tobacco trends stabilized, and alcohol intake increased. In conclusion, should these trends be maintained, it is unlikely that Brazil will achieve the goals previously agreed upon with the World Health Organization and the United Nations to curb NCDs and their risk factors.

Pub Talk: participation, education and men’s health promotion

ABSTRACT Objective: To evaluate the execution process of dialogical actions of a socio-educational group called “Pub Talk”, created by professionals of the Paraisópolis II Basic Health Unit, recognizing challenges related to men’s health. Method: Comprehensive evaluative research, which parameters were conceptual aspects of the Nola Pender’s model. Interviews were conducted with the professionals and the focus group with men participating in the Group, analyzing three components of this model: individual experiences and characteristics; feelings and knowledge about the behavior one wants to achieve; desirable health promotion behavior. Results: The group is a self-care guiding intervention; values scientific and popular knowledge, with protagonism of those involved; covers the prevention of disease and changes of habits; has different perceptions regarding the structural and technical aspects of the meetings. Conclusion: Dialogic actions contributed to the promotion of the health of the participants by favoring the (re)cognition of determinants of their health and living conditions.

Promoção da saúde na Atenção Primária à Saúde: sistematização de desafios e estratégias intersetoriais

RESUMO Foi realizada revisão da literatura com o intuito de sistematizar o conhecimento produzido no campo da promoção da saúde com ênfase nos desafios e estratégias para implementação da intersetorialidade. As bases de dados consultadas foram Lilacs, SciELO, Web of Science e Science Direct; e identificadas publicações referentes ao período compreendido entre 2006 e 2017. O corpus contou com 28 artigos, sendo analisados os aspectos relacionados com os resultados dos estudos. Verificou-se que eles têm destacado a discussão de fragilidades contextuais relacionadas com aspectos gerenciais e operacionais das intervenções para promoção da saúde, assim como com estratégias adotadas para fomentar a implementação e gestão de ações intersetoriais. Conclui-se que são necessários investimentos em estudos de caso que permitam analisar intervenções concretas direcionadas à promoção da saúde, agregar novas explicações e estabelecer coerência com a complexidade dos distintos contextos no âmbito da Atenção Primária à Saúde.