Predicting the prevalence of type 2 diabetes in Brazil: a modeling study.

Aims: We adopted a modeling approach to predict the likely future prevalence of type 2 diabetes, taking into account demographic changes and trends in obesity and smoking in Brazil. We then used the model to estimate the likely future impact of different policy scenarios, such as policies to reduce obesity. Methods: The IMPACT TYPE 2 DIABETES model uses a Markov approach to integrate population, obesity, and smoking trends to estimate future type 2 diabetes prevalence. We developed a model for the Brazilian population from 2006 to 2036. Data on the Brazilian population in relation to sex and age were collected from the Brazilian Institute of Geography and Statistics, and data on the prevalence of type 2 diabetes, obesity, and smoking were collected from the Surveillance of Risk and Protection Factors for Chronic Diseases by Telephone Survey (VIGITEL). Results: The observed prevalence of type 2 diabetes among Brazilians aged over 25 years was 10.8% (5.2-14.3%) in 2006, increasing to 13.7% (6.9-18.4%) in 2020. Between 2006 and 2020, the observed prevalence in men increased from 11.0 to 19.1% and women from 10.6 to 21.3%. The model forecasts a dramatic rise in prevalence by 2036 (27.0% overall, 17.1% in men and 35.9% in women). However, if obesity prevalence declines by 1% per year from 2020 to 2036 (Scenario 1), the prevalence of diabetes decreases from 26.3 to 23.7, which represents approximately a 10.0% drop in 16 years. If obesity declined by 5% per year in 16 years as an optimistic target (Scenario 2), the prevalence of diabetes decreased from 26.3 to 21.2, representing a 19.4% drop in diabetes prevalence. Conclusion: The model predicts an increase in the prevalence of type 2 diabetes in Brazil. Even with ambitious targets to reduce obesity prevalence, type 2 diabetes in Brazil will continue to have a large impact on Brazilian public health.

Cut-off points in the waist:height ratio for the prediction of insulin resistance, second stage of sexual maturation in Brazilian adolescents.

The objective of this study was verify the best waist:height ratio (WHtR) cut-off points for the prediction of insulin resistance (IR) according to stage of sexual maturation in Brazilian adolescents. Data were analysed from 37 759 adolescents between 12 and 17 years of age, of both sexes, participating in the ERICA study on cardiovascular risk factors in adolescents ('Estudo de Riscos Cardiovasculares em Adolescentes - ERICA'). The following variables were included sex, age and sexual maturity according to the Tanner stage, waist circumference, height, WHtR, fasting insulin and fasting blood sugar so as to obtain the homeostasis model assessment-estimated insulin resistance (HOMA-IR). We constructed an Receiver Operating characteristic (ROC) curve for each group in order to determine the best WHtR cut-off points for the sample stratified by sex and stratified by sex and sexual maturation stage. The female sex corresponded to 60% of the sample, with a mean age of 14·7 years (sd ± 0·08 years) and 13·1 % had IR. The prediction of IR through the WHtR indicator was better for boys, where all the areas under the ROC curve were superior to 0·70. When stratifying by sex alone, the best WHtR cut-off points found were equal to 0·45 for girls and 0·44 for boys. When stratifying by Tanner maturation stages, the cut-off points were reduced with advancing sexual maturation in the male group, while the opposite occurred in the female group. Among Brazilian adolescents, WHtR is a good predictor of IR evaluated by HOMA-IR, but different cut-off points should be adopted according to sex and sexual maturation stage.

Estudo da mortalidade infantil nos estados brasileiros utilizando aplicação de dados em painel / Study of child mortality in brazilian states using panel data application / Estudio de mortalidad infantil en estados brasileños mediante aplicación de datos de panel

Este trabalho tem como objetivo determinar uma relação linear entre a Taxa de Mortalidade Infantil (TMI) e um conjunto de variáveis socioeconômicas observadas por unidades federativas no período de 2005 à 2010 utilizando o modelo de dados em painel de efeitos fixo e aleatório. Metodologia: trata-se de um estudo descritivo com abordagem quantitativa, com utilização dos Sistema de Informação sobre Mortalidade (SIM) e o Sistema de Informações sobre Nascidos Vivos (SINASC) e em seguida utilizou-se o software R para realizar esta análise de dados com a função plm. Resultados: os estudos mostram que o modelo mais adequado é o de efeito fixo com transformação logarítmica nas variáveis independentes e na variável dependente que foram as seguintes: TMI, taxa de analfabetismo, PIB per capita, proporção pessoas com baixa renda, percentual da população servida por rede de abastecimento de água e a proporção da população servida por coleta de lixo. Conclusão: As variáveis independentes que causam impacto significativo na TMI são taxa de analfabetismo, PIB per capita e proporção de pessoas com baixa renda.

This work aims to determine a linear relationship between the Infant Mortality Rate (IMR) and a set of socioeconomic variables observed by federative units in the period from 2005 to 2010 using the fixed and random effects panel data model. Methodology: this is a descriptive study with a quantitative approach, using the Mortality Information System (SIM) and the Live Birth Information System (SINASC) and then using the R software to perform this data analysis with the plm function. Results: studies show that the most appropriate model is the fixed effect model with logarithmic transformation in the independent variables and the dependent variable, which were as follows: IMR, illiteracy rate, GDP per capita, proportion of people with low income, percentage of the population served by water supply network and the proportion of the population served by garbage collection. Conclusion: The independent variables that have a significant impact on IMR are the illiteracy rate, GDP per capita and the proportion of people with low income.

Este trabajo tiene como objetivo determinar una relación lineal entre la Tasa de Mortalidad Infantil (TMI) y un conjunto de variables socioeconómicas observadas por las unidades federativas en el período 2005 a 2010 utilizando el modelo de datos de panel de efectos fijos y aleatorios. Metodología: se trata de un estudio descriptivo con enfoque cuantitativo, utilizando el Sistema de Información de Mortalidad (SIM) y el Sistema de Información de Nacidos Vivos (SINASC) y luego utilizando el software R para realizar este análisis de datos con la función plm. Resultados: los estudios muestran que el modelo más adecuado es el modelo de efectos fijos con transformación logarítmica en las variables independientes y la variable dependiente, las cuales fueron las siguientes: TMI, tasa de analfabetismo, PIB per cápita, proporción de personas con bajos ingresos, porcentaje de la población atendida por red de suministro de agua y la proporción de la población atendida por recolección de basura. Conclusión: Las variables independientes que tienen un impacto significativo en la TMI son la tasa de analfabetismo, el PIB per cápita y la proporción de personas con bajos ingresos.

Fatores que influenciam a mortalidade infantil / Factors influencing infant mortality / Factores que influyen en la mortalidad infantil

A taxa de mortalidade infantil é um indicador internacional que melhor representa os estágios de desenvolvimento econômico e social de um país ou região, uma vez que está diretamente ligada às características socioeconômicas e, consequentemente, sofre variações decorrentes de alterações neste padrão. Este artigo aponta os principais fatores que contribuíram no aumento da taxa de mortalidade infantil no Brasil no período de 2005 a 2019. Logo, configura-se como do tipo observacional, de caráter ecológico, com abordagem quantitativa, utilizando dados secundários sobre mortalidade infantil. A coleta dos dados foi realizada por intermédio do site do Departamento de Informática do Sistema Único de Saúde (DATASUS), utilizando a ferramenta denominada TABNET para subtrair as informações sobre Sistema de Informações sobre Mortalidade (SIM). Em seguida foram analisados no software estatístico RStudio e apresentados em tabelas e gráficos. Os principais motivos para óbitos foram: afecções originadas no período perinatal, malformações congênitas, deformidade e anomalias cromossômicas, doenças do aparelho respiratório e algumas doenças infecciosas e parasitárias, sendo assim, observou-se que o ambiente hospitalar com 90,93% atingiu os maiores casos de mortalidade, seguido do ambiente domiciliar com 5,53%. Em relação às regiões, o Sudeste obteve maior número de casos de mortalidade infantil, seguido da região Nordeste. Percebe-se que a redução da mortalidade infantil é de extrema importância, bem como a descrição dos fatores que contribuem para a sua redução.

The infant mortality rate is an international indicator that best represents the stages of economic and social development of a country or region, since it is directly linked to socioeconomic characteristics and, consequently, suffers variations arising from changes in this pattern. This article points out the main factors that contributed to the increase in the infant mortality rate in Brazil in the period from 2005 to 2019. Therefore, it is characterized as observational, ecological, with a quantitative approach, using secondary data on infant mortality. Data collection was carried out through the website of the Department of Informatics of the Unified Health System (DATASUS), using the tool called TABNET to subtract information on the Mortality Information System (SIM). They were then analyzed in the statistical software RStudio and presented in tables and graphs. The main reasons for death were: disorders originating in the perinatal period, congenital malformations, deformity and chromosomal abnormalities, respiratory system diseases and some infectious and parasitic diseases. Thus, it was observed that the hospital environment with 90.93% reached the highest mortality cases, followed by the home environment with 5.53%. In relation to the regions, the Southeast region had the highest number of infant mortality cases, followed by the Northeast region. It is perceived that the reduction of infant mortality is of extreme importance, as well as the description of the factors that contribute to its reduction.

La tasa de mortalidad infantil es un indicador internacional que mejor representa las etapas de desarrollo económico y social de un país o región, ya que está directamente vinculada a las características socioeconómicas y, en consecuencia, sufre variaciones derivadas de los cambios en este patrón. Este artículo señala los principales factores que contribuyeron al aumento de la tasa de mortalidad infantil en Brasil en el período de 2005 a 2019. Por lo tanto, se configura como de tipo observacional, de carácter ecológico, con abordaje cuantitativo, utilizando datos secundarios sobre mortalidad infantil. La recogida de datos se realizó a través de la página web del Departamento de Informática del Sistema Único de Salud (DATASUS), utilizando la herramienta denominada TABNET para sustraer la información sobre el Sistema de Información de Mortalidad (SIM). A continuación, se analizaron en el programa estadístico RStudio y se presentaron en tablas y gráficos. Las principales causas de muerte fueron: trastornos originados en el período perinatal, malformaciones congénitas, deformidades y anomalías cromosómicas, enfermedades del sistema respiratorio y algunas enfermedades infecciosas y parasitarias, por lo que se observó que el medio hospitalario con 90,93% alcanzó los mayores casos de mortalidad, seguido del medio domiciliario con 5,53%. En relación a las regiones, la región Sudeste presentó el mayor número de casos de mortalidad infantil, seguida de la región Nordeste. Se percibe que la reducción de la mortalidad infantil es de extrema importancia, así como la descripción de los factores que contribuyen a su reducción.

Fear of COVID-19, food insecurity and anxiety in women dwelling in João Pessoa, Paraíba: a cross-sectional study / Medo da COVID-19, insegurança alimentar e ansiedade em mulheres residentes em João Pessoa, Paraíba: um estudo transversal

ABSTRACT Objective: To describe the fear caused by the COVID-19 pandemic and to analyze the association of food insecurity and fear of COVID-19 as anxiety predictors in women who are Sistema Único de Saúde users. Method: A cross-sectional study was conducted in 2021 with 73 women out of 118 who were followed up in a cohort study in the municipality of João Pessoa, Paraíba, Brazil. The women were selected in health units before the pandemic and their telephone contact enabled remote data collection. Socioeconomic and demographic information, food insecurity, fear of COVID-19, and anxiety were assessed. The Brazilian Food Insecurity Scale, the State-Trait Anxiety Inventory, and the Fear of COVID-19 Scale were used. An association between variables was performed using the chi-square test and a logistic regression verified the independent effect of variables concerning anxiety. A 5% significance level was considered. Results: The median age of the women was 33 years and the median per capita family income was BRL 665.33. Most of them lived with a partner and declared themselves mostly black or brown. Lower income and greater severity of food insecurity were associated with greater fear of COVID-19, and this feeling increased the probability of women being in a high anxiety state (OR=3.167). Conclusion: The most vulnerable women, with lower income and greater food insecurity had more fear of COVID-19 which increased their anxiety. Even after the pandemic is over, the effects of these events can maintain a state of mental distress that must be considered and properly cared for.

RESUMO Objetivo: O estudo teve como objetivo descrever o medo causado pela pandemia da COVID-19 e analisar a associação da insegurança alimentar e do medo da COVID-19 como preditores da ansiedade em mulheres usuárias do Sistema Único de Saúde. Métodos: Trata-se de um estudo transversal realizado em 2021 com 73 mulheres de um total de 118 que foram acompanhadas em um estudo de coorte no município de João Pessoa, Paraíba, Brasil. As mulheres foram selecionadas em unidades de saúde antes da pandemia, e o contato telefônico possibilitou a coleta de dados de forma remota. Informações socioeconômicas e demográficas, sobre insegurança alimentar, medo da COVID-19 e ansiedade foram avaliadas. Utilizou-se a Escala Brasileira de Insegurança Alimentar, o Inventário de Ansiedade Traço-Estado e a Escala de Medo de COVID-19. A associação entre variáveis foi realizada com teste qui-quadrado, e a regressão logística verificou o efeito independente das variáveis com relação à ansiedade. Considerou-se significância de 5%. Resultados: A mediana da idade das mulheres foi de 33 anos, e a renda familiar per capita foi de R$ 665,33. As mulheres, em sua maioria, conviviam com companheiro e se autodeclararam pretas ou pardas. Menor renda e maior severidade da insegurança alimentar estiveram associadas a maior medo da COVID-19, e esse sentimento aumentou as chances de as mulheres estarem em estado de alta ansiedade (OR=3,167). Conclusão: As mulheres mais vulneráveis, com menor renda e maior insegurança alimentar tiveram mais medo da COVID-19, e isso colaborou para o aumento da ansiedade dessas mulheres. Mesmo com o fim da pandemia, os efeitos dessa fase podem manter um estado de sofrimento mental que precisa ser considerado e cuidado apropriadamente.

Oral Health: Work Process and Interdisciplinarity

ABSTRACT Objective: To contribute to the debate about tools that favor the organization of the health work process and its interface with interdisciplinary practices. Material and Methods: We opted for a textual construction based on more specific publications on the field of oral health care. Results: The matrix support is configured as a method of inter-professional activity in co-management that aims to favor the qualification of the health care network. From this perspective, it is an interdisciplinary practice capable of integrating two or more areas of knowledge for a better performance of the actors involved in a given organizational and decision-making process, whether in the clinical or health management scope. Conclusion: Matrix support is an essential tool for the practice of managing health services and amplifying interdisciplinary actions.

Care actions for newborns and factors associated with longitudinality in the follow-up care in the neonatal period: Care actions for the newborn.

As newborns are highly vulnerable, they require essential care for adequate child development. This study aimed to assess the care provided to newborns during the first 28 days of life and identify factors associated with adequate care. This was a longitudinal study conducted with 415 mothers and full-term newborns from 4 public maternity hospitals in Natal, Brazil, in 2019. Assistance, socioeconomic, and demographic data were collected 3 times: 48 hours, 7 days, and 28 days after birth. Pearson's chi-square and Poisson regression tests were used with a confidence interval of 95%. Most mothers were between 20 and 29 years old (46.5%), had a high school or higher education (65.3%), a partner (79%), an income of ≤ 1 minimum wage (64, 6%), and were multiparous (62.9%). A total of 29 actions performed in maternity hospitals and 11 in primary healthcare were evaluated. Among the first, 8 (27.6%) were satisfactory; 11 (37.9%), partially satisfactory; and 10 (34.5%), unsatisfactory. In primary care, 2 actions (18.2%) were considered satisfactory; 3 (27.3%) partially satisfactory; and 6 (54.5%) unsatisfactory. In the multivariate analysis of the composite indicators related to adequacy of care, women undergoing vaginal delivery, those who are multiparous, and maternity hospitals at usual risk were associated with better adequacy of care indicators (P ≤ .05). Maternity hospitals accredited to the Baby-Friendly Hospital Initiative had lower chances of the adequacy of promotion to exclusive breastfeeding. The sample loss rate was 13.7% in the first week and 16.6% at the end of the study period. There was inadequacy in the performance of care actions for newborns regarding access and comprehensiveness of care. These weaknesses highlight the need for reassessing skills and coordinating actions in the child's healthcare network.

Tracking of Dietary Patterns in the Secondary Prevention of Cardiovascular Disease after a Nutritional Intervention Program-A Randomized Clinical Trial.

Individuals with a history of previous cardiovascular events have an increased risk of mortality and morbidity, so adherence to a healthy dietary pattern is essential. We aimed to evaluate and compare dietary patterns between the control and the experimental group from the BALANCE Program. A total of 2360 individuals aged 45 years or older with previous cardiovascular disease were included. The individuals were randomized into two groups: intervention (dietary prescription with nutritional recommendations, nutritional education program based on playful strategies, suggestions of typical and accessible Brazilian foods and intensive monitoring) and control (conventional nutritional counseling). The dietary patterns were identified using factor analysis with the principal component extraction method, and the t-Student tests and ANOVA test were performed to evaluate the associated factors. Four dietary patterns were identified for both groups: "Traditional", "Snack", "Western", "Cardioprotective". There was an increase in the variances of the "Cardioprotective" pattern in both groups. Regarding the "Western" pattern, there was a significant reduction in the variances of the experimental group (10.63% vs. 8.14%). Both groups had improvements in eating habits, especially in the first year of follow-up. The greater increase in adherence to the traditional and cardioprotective pattern in the experimental group justifies the initiative of the BALANCE program.

Association between Cardiovascular Risk in Adolescents and Daily Consumption of Soft Drinks: a Brazilian National Study

Abstract Background: Cardiovascular risk in adolescence is a public health problem that has grown along with the increase in soft drink consumption. Objective: To investigate the association between cardiovascular risk factors and daily consumption of soft drinks in Brazilian adolescents. Methods: We conducted a cross-sectional, national, school-based study of 36,956 Brazilian adolescents aged 12 to 17 years. Daily soft drink consumption was estimated using a 24-hour dietary recall. Cardiovascular risk was categorized as overweight, obesity, hypertension, hyperglycemia, and dyslipidemia. The survey command of Stata 14.0® was used to analyze data from a complex sample. The chi-square test was used to assess differences in soft drink consumption and other variables in the descriptive analysis. The odds ratio of cardiovascular risk factors and their respective 95% confidence intervals were estimated, considering sociodemographic and behavioral variables in the Mantel-Haenszel model. Statistical significance was set at p < 0.05. Results: Daily consumption of soft drinks was common among adolescents. A daily serving ≥ 450 mL was significantly associated with overweight and hypertension. Results associated with the consumption of regular soft drinks show the possibility of reverse causality. Consumption of diet soft drinks in adolescence should be considered a cardiovascular risk factor. Conclusion: Daily consumption of soft drinks can be understood as a relevant risk factor in the epidemiological scenario. Improper eating habits are multifactorial in nature and need to be better understood in the context of adolescent health and further explored in national surveys.

Effects of the economic recession on suicide mortality in Brazil: interrupted time series analysis.

OBJECTIVES: to analyze trends in suicide rates in Brazil in the period before and after the start of the economic recession. METHODS: interrupted time series research using national suicide data recorded in the period between 2012 and 2017 with socioeconomic subgroups analyses. Quasi-Poisson regression model was employed to analyze trends in seasonally adjusted data. RESULTS: there was an abrupt increase in the risk of suicide after economic recession in the population with less education (12.5%; RR = 1.125; 95%CI: 1.027; 1.232) and in the South Region (17.7%; 1.044; 1.328). After an abrupt reduction, there was a progressive increase in risk for the black and brown population and for those with higher education. In most other population strata, there was a progressive increase in the risk of suicide. CONCLUSIONS: the Brazilian economic recession caused different effects on suicide rates, considering social strata, which requires health strategies and policies that are sensitive to the most vulnerable populations.

Methodology and indicators for NBCAL monitoring in stores and health services: a multicenter study (Multi-NBCAL). / Metodologia e indicadores para monitoramento da NBCAL em estabelecimentos comerciais e serviços de saúde: estudo multicêntrico (Multi-NBCAL).

The Brazilian Code of Marketing of Infant and Toddlers Food, Nipples, Pacifiers and Baby Bottles (NBCAL), in force in Brazil since 1988, is still systematically violated, exposing mothers and family members to illegal marketing of products that compete with breastfeeding. This study aimed to describe a multicenter study methodology and propose standardized indicators for NBCAL monitoring. This is a Multicenter Study for NBCAL Compliance Assessment (Multi-NBCAL) conducted in seven Brazilian cities: Rio de Janeiro, São Paulo, Ouro Preto (Minas Gerais State), Florianópolis (Santa Catarina State), Brasília (Federal District), João Pessoa (Paraíba State), and Belém (Pará State). Assessment tools were adapted from NetCode/WHO and IBFAN Brazil (International Baby Food Action Network) to conduct two evaluations: (1) evaluation of NBCAL compliance in stores, and NBCAL knowledge and practices of store managers; (2) evaluation of the interaction between the baby food industry and health professionals and post-partum mothers in maternity hospitals. Five indicators were developed to assess NBCAL compliance in stores; seven indicators to assess the knowledge and practices of store managers; five indicators to assess the provision of incentives to maternity hospitals, health professionals, and mothers by sectors; and five indicators to assess NBCAL knowledge and practices of health professionals. The NBCAL assessment methodology with the proposal of standardized indicators allows comparability of studies about this theme. Using these indicators in periodic national or regional investigation can help monitor the level of NBCAL implementation in Brazil.

A Norma Brasileira de Comercialização de Alimentos para Lactentes e Crianças de Primeira Infância, Bicos, Chupetas e Mamadeiras (NBCAL), vigente no Brasil desde 1988, ainda é sistematicamente infringida, expondo mães e familiares ao marketing ilegal de produtos que competem com o aleitamento materno. O objetivo foi descrever metodologia de estudo multicêntrico e propor indicadores padronizados para monitoramento da NBCAL. Estudo Multicêntrico para Monitoramento da NBCAL (Multi-NBCAL) conduzido em sete cidades brasileiras: Rio de Janeiro; São Paulo; Ouro Preto (Minas Gerais); Florianópolis (Santa Catarina); Brasília (Distrito Federal); João Pessoa (Paraíba) e Belém (Pará). Instrumentos de avaliação foram adaptados do NetCode/WHO e da IBFAN Brasil (Rede Internacional em Defesa do Direito de Amamentar) para condução de dois inquéritos: (1) avaliação do cumprimento da NBCAL em estabelecimentos comerciais e das práticas e conhecimento dos seus gerentes sobre a NBCAL; (2) avaliação em maternidades da interação da indústria de alimentos infantis com profissionais de saúde e mães. Foram elaborados cinco indicadores para avaliação do cumprimento da NBCAL em estabelecimentos comerciais; sete indicadores para avaliar conhecimentos e práticas dos seus responsáveis; cinco indicadores para avaliar a oferta de incentivos a maternidades, profissionais de saúde e mães pelas indústrias e cinco indicadores para avaliar conhecimento e práticas de profissionais de saúde quanto à NBCAL. A metodologia de avaliação da NBCAL, com a proposta de indicadores padronizados, permite a comparabilidade de estudos sobre o tema. A utilização desses indicadores em inquéritos periódicos, nacionais ou regionais, pode contribuir para monitorar o grau de implementação da NBCAL no Brasil.

La Norma Brasileña de Comercialización de Alimentos para Lactantes y Niños en la Primera Infancia, Tetillas, Chupetes y Biberones (NBCAL), vigente en Brasil desde 1988, todavía es sistemáticamente infringida, exponiendo a madres y familiares al marketing ilegal de productos que compiten con la lactancia materna. El objetivo fue describir la metodología de estudio multicéntrico y proponer indicadores estandarizados para el monitoreo de la NBCAL. Estudio Multicéntrico para Monitoreo de la NBCAL (Multi-NBCAL) llevado a cabo en siete (7) ciudades brasileñas: Río de Janeiro; São Paulo; Ouro Preto (Minas Gerais); Florianópolis (Santa Catarina); Brasilia (Distrito Federal); João Pessoa (Paraíba) y Belém (Pará). Se adaptaron instrumentos de evaluación del NetCode/OMS y de la IBFAN Brasil (Red Internacional de Acción por la Alimentación Infantil)para la realización de dos encuestas: (1) evaluación del cumplimiento de la NBCAL en establecimientos comerciales y de las prácticas y conocimiento de sus gerentes sobre la NBCAL; (2) evaluación en maternidades de la interacción de la industria de alimentos infantiles con profesionales de salud y madres. Se elaboraron cinco indicadores para la evaluación del cumplimiento de la NBCAL en establecimientos comerciales; siete indicadores para evaluar conocimientos y prácticas de sus responsables; cinco indicadores para evaluar la oferta de incentivos a maternidades, profesionales de salud y madres por las industrias y cinco indicadores para evaluar el conocimiento y prácticas de profesionales de salud, respecto a la NBCAL. La metodología de evaluación de la NBCAL, con la propuesta de indicadores estandarizados, permite la comparabilidad de estudios sobre el tema. La utilización de estos indicadores en encuestas periódicas, nacionales o regionales, puede contribuir a monitorear el grado de implementación de la NBCAL en Brasil.

Effects of the economic recession on suicide mortality in Brazil: interrupted time series analysis / Efectos de la recesión económica en la mortalidad por suicidio en Brasil: análisis de series de tiempo interrumpido / Efeitos da recessão econômica na mortalidade por suicídio no Brasil: análise com séries temporais interrompidas

ABSTRACT Objectives: to analyze trends in suicide rates in Brazil in the period before and after the start of the economic recession. Methods: interrupted time series research using national suicide data recorded in the period between 2012 and 2017 with socioeconomic subgroups analyses. Quasi-Poisson regression model was employed to analyze trends in seasonally adjusted data. Results: there was an abrupt increase in the risk of suicide after economic recession in the population with less education (12.5%; RR = 1.125; 95%CI: 1.027; 1.232) and in the South Region (17.7%; 1.044; 1.328). After an abrupt reduction, there was a progressive increase in risk for the black and brown population and for those with higher education. In most other population strata, there was a progressive increase in the risk of suicide. Conclusions: the Brazilian economic recession caused different effects on suicide rates, considering social strata, which requires health strategies and policies that are sensitive to the most vulnerable populations.

RESUMEN Objetivos: analizar tendencias de tasas de suicidio en Brasil, antes y después del inicio de la recesión económica. Métodos: estudio de series de tiempo interrumpido utilizando datos nacionales de suicidio registrados entre 2012 y 2017 con análisis por subgrupos socioeconómicos. Modelo de regresión quasi-Poisson empleado para analizar tendencias de datos ajustados estacionalmente. Resultados: observado aumento abrupto en el riesgo de suicidio pos recesión económica en la población con menor escolaridad (12,5%; RR = 1,125; IC95%:1,027; 1,232) y en la Región Sur (17,7%; 1,044; 1,328). Pos reducción abrupta, ocurrió aumento progresivo en el riesgo para la población de negros y pardos y de mayor escolaridad. En la mayoría de los demás estratos poblacionales, verificado aumento progresivo en el riesgo de suicidio. Conclusiones: la recesión económica brasileña produzco efectos diferentes en las tasas de suicidio, considerando los estratos sociales, lo que demanda estrategias de salud y políticas sensibles a poblaciones más vulnerables.

RESUMO Objetivos: analisar as tendências nas taxas de suicídio no Brasil, no período antes e depois do início da recessão econômica. Métodos: estudo de séries temporais interrompidas utilizando dados nacionais de suicídio registrados no período entre 2012 e 2017 com análises por subgrupos socioeconômicos. Modelo de regressão quasi-Poisson foi empregado para analisar as tendências dos dados ajustados sazonalmente. Resultados: observou-se aumento abrupto no risco de suicídio após recessão econômica na população com menor escolaridade (12,5%; RR = 1,125; IC95%:1,027; 1,232) e na Região Sul (17,7%; 1,044; 1,328). Após redução abrupta, ocorreu aumento progressivo no risco para a população de pretos e pardos e na de maior escolaridade. Na maioria dos demais estratos populacionais, verificou-se aumento progressivo no risco de suicídio. Conclusões: a recessão econômica brasileira produziu efeitos diferentes nas taxas de suicídio, considerando os estratos sociais, o que demanda estratégias de saúde e políticas sensíveis às populações mais vulneráveis.

Differences in quality of life and food insecurity between men and women living with HIV/AIDS in the state of Paraíba, Brazil. / Diferenças na qualidade de vida e insegurança alimentar entre homens e mulheres vivendo com HIV/Aids no estado da Paraíba, Brasil.

A prevalence study was conducted to compare quality of life and food insecurity in men and women living with HIV/AIDS. The sample comprised 481 HIV-infected individuals undergoing antiretroviral therapy at a referral hospital in the State of Paraíba, Brazil. Food insecurity and quality of life were assessed using the Brazilian Household Food Insecurity Scale and WHOQOL-HIV Bref, respectively. The results were presented as absolute and relative frequencies and gender differences were tested using the chi-squared test adopting a significance level of 0.05. The findings showed that 40.1% of the sample were women. A higher percentage of women than men had a low income and low education level (65.8% and 72.5%, respectively). Prevalence of food security was lower in women than in men (29.0% compared to 42.7%), and a higher percentage of women than men reported below average quality of life (54.9% compared to 44.4%). The findings reveal that, besides the usual difficulties faced by HIV-infected patients, this group showed a significant level of gender inequality. The management of HIV patient care should consider these important findings, promoting access to care and support services and gender equality so that women can live fairer and more equal lives.

Estudo de prevalência realizado com pessoas vivendo com HIV/Aids, em terapia antirretroviral, com o objetivo de comparar a qualidade de vida e a insegurança alimentar entre homens e mulheres. Foram incluídos aleatoriamente quatrocentos e oitenta e um indivíduos que buscaram atendimento hospitalar. A insegurança alimentar foi avaliada pela Escala Brasileira de Insegurança Alimentar e a qualidade de vida pelo instrumento WHOQOL-HIV-Bref. Os resultados foram apresentados em frequência absoluta e relativa e as diferenças entre os sexos foram testadas com o teste qui-quadrado, considerando significância de 5%. Do total da amostra, 40,1% eram do sexo feminino e essas apresentaram piores condições de renda (65,8%), baixa escolaridade (72,5%), menor prevalência de segurança alimentar (29,02%) e qualidade de vida abaixo da média (54,9%), comparadas com os homens (44,4%). Os resultados do estudo mostram que além das dificuldades enfrentadas pelos portadores do vírus HIV, este grupo apresenta uma importante desigualdade de gênero e a gestão do cuidado voltado a estas pessoas deve considerar este importante achado, promovendo o acesso a políticas sociais e promovendo a isonomia entre os gêneros, em prol de uma vida feminina mais justa e igualitária.

Coronary heart disease and stroke mortality trends in Brazil 2000-2018.

OBJECTIVE: To analyse the mortality rate trend due to coronary heart disease (CHD) and stroke in the adult population in Brazil. METHODS: From 2000 to 2018, a time trend study with joinpoint regression was conducted among Brazilian men and women aged 35 years and over. Age-adjusted and age, sex specific CHD and stroke trend rate mortality were measured. RESULTS: Crude mortality rates from CHD decreased in both sexes and in all age groups, except for males over 85 years old with an increase of 1.78%. The most accentuated declining occurred for age range 35 to 44 years for both men (52.1%) and women (53.2%) due to stroke and in men (33%) due to CHD, and among women (32%) aged 65 to 74 years due to CHD. Age-adjusted mortality rates for CHD and stroke decreased in both sexes, in the period from 2000 to 2018. The average annual rate for CHD went from 97.09 during 2000-2008 to 78.75 during 2016-2018, whereas the highest percentage of change was observed during 2008 to 2013 (APC -2.5%; 95% CI). The average annual rate for stroke decreased from 104.96 to 69.93, between 2000-2008 and 2016-2018, and the highest percentage of change occurred during the periods from 2008 to 2013 and 2016 to 2018 (APC 4.7%; 95% CI). CONCLUSION: The downward trend CHD and stroke mortality rates is continuing. Policy intervention directed to strengthen care provision and improve population diets and lifestyles might explain the continued progress, but there is no room for complacency.

[Factors associated with the incidence and mortality from COVID-19 in the autonomous communities of Spain]. / Factores asociados a la incidencia y la mortalidad por COVID-19 en las comunidades autónomas.

OBJECTIVE: Analyze the evolution of the epidemic of COVID-19 after the alarm state and identify factors associated with the differences between the autonomous communities. METHOD: Ecological study that used epidemiological, demographic, environmental and variables on the structure of health services as explanatory variables. The analysis period was from March 15th (the start of the alarm state) until April 22nd, 2020. Incidence and mortality rates were the main response variables. The magnitude of the associations has been estimated using the Spearman correlation coefficient and multiple regression analysis. RESULTS: Incidence and mortality rates at the time of decree of alarm status are associated with current incidence, mortality and hospital demand rates. Higher mean temperatures are significantly associated with a lower current incidence of COVID-19 in the autonomous communities. Likewise, a higher proportion of older people in nursing homes is significantly associated with a higher current mortality in the autonomous communities. CONCLUSION: It is possible to predict the evolution of the epidemic through the analysis of incidence and mortality. Lower temperatures and the proportion of older people in residences are factors associated with a worse prognosis. These parameters must be considered in decisions about the timing and intensity of the implementation of containment measures. In this sense, strengthening epidemiological surveillance is essential to improve predictions.

Metodologia e indicadores para monitoramento da NBCAL em estabelecimentos comerciais e serviços de saúde: estudo multicêntrico (Multi-NBCAL) / Metodología e indicadores para el monitoreo de la NBCAL en establecimientos comerciales y servicios de salud: estudio multicéntrico (Multi-NBCAL) / Methodology and indicators for NBCAL monitoring in stores and health services: a multicenter study (Multi-NBCAL)

A Norma Brasileira de Comercialização de Alimentos para Lactentes e Crianças de Primeira Infância, Bicos, Chupetas e Mamadeiras (NBCAL), vigente no Brasil desde 1988, ainda é sistematicamente infringida, expondo mães e familiares ao marketing ilegal de produtos que competem com o aleitamento materno. O objetivo foi descrever metodologia de estudo multicêntrico e propor indicadores padronizados para monitoramento da NBCAL. Estudo Multicêntrico para Monitoramento da NBCAL (Multi-NBCAL) conduzido em sete cidades brasileiras: Rio de Janeiro; São Paulo; Ouro Preto (Minas Gerais); Florianópolis (Santa Catarina); Brasília (Distrito Federal); João Pessoa (Paraíba) e Belém (Pará). Instrumentos de avaliação foram adaptados do NetCode/WHO e da IBFAN Brasil (Rede Internacional em Defesa do Direito de Amamentar) para condução de dois inquéritos: (1) avaliação do cumprimento da NBCAL em estabelecimentos comerciais e das práticas e conhecimento dos seus gerentes sobre a NBCAL; (2) avaliação em maternidades da interação da indústria de alimentos infantis com profissionais de saúde e mães. Foram elaborados cinco indicadores para avaliação do cumprimento da NBCAL em estabelecimentos comerciais; sete indicadores para avaliar conhecimentos e práticas dos seus responsáveis; cinco indicadores para avaliar a oferta de incentivos a maternidades, profissionais de saúde e mães pelas indústrias e cinco indicadores para avaliar conhecimento e práticas de profissionais de saúde quanto à NBCAL. A metodologia de avaliação da NBCAL, com a proposta de indicadores padronizados, permite a comparabilidade de estudos sobre o tema. A utilização desses indicadores em inquéritos periódicos, nacionais ou regionais, pode contribuir para monitorar o grau de implementação da NBCAL no Brasil.

La Norma Brasileña de Comercialización de Alimentos para Lactantes y Niños en la Primera Infancia, Tetillas, Chupetes y Biberones (NBCAL), vigente en Brasil desde 1988, todavía es sistemáticamente infringida, exponiendo a madres y familiares al marketing ilegal de productos que compiten con la lactancia materna. El objetivo fue describir la metodología de estudio multicéntrico y proponer indicadores estandarizados para el monitoreo de la NBCAL. Estudio Multicéntrico para Monitoreo de la NBCAL (Multi-NBCAL) llevado a cabo en siete (7) ciudades brasileñas: Río de Janeiro; São Paulo; Ouro Preto (Minas Gerais); Florianópolis (Santa Catarina); Brasilia (Distrito Federal); João Pessoa (Paraíba) y Belém (Pará). Se adaptaron instrumentos de evaluación del NetCode/OMS y de la IBFAN Brasil (Red Internacional de Acción por la Alimentación Infantil)para la realización de dos encuestas: (1) evaluación del cumplimiento de la NBCAL en establecimientos comerciales y de las prácticas y conocimiento de sus gerentes sobre la NBCAL; (2) evaluación en maternidades de la interacción de la industria de alimentos infantiles con profesionales de salud y madres. Se elaboraron cinco indicadores para la evaluación del cumplimiento de la NBCAL en establecimientos comerciales; siete indicadores para evaluar conocimientos y prácticas de sus responsables; cinco indicadores para evaluar la oferta de incentivos a maternidades, profesionales de salud y madres por las industrias y cinco indicadores para evaluar el conocimiento y prácticas de profesionales de salud, respecto a la NBCAL. La metodología de evaluación de la NBCAL, con la propuesta de indicadores estandarizados, permite la comparabilidad de estudios sobre el tema. La utilización de estos indicadores en encuestas periódicas, nacionales o regionales, puede contribuir a monitorear el grado de implementación de la NBCAL en Brasil.

The Brazilian Code of Marketing of Infant and Toddlers Food, Nipples, Pacifiers and Baby Bottles (NBCAL), in force in Brazil since 1988, is still systematically violated, exposing mothers and family members to illegal marketing of products that compete with breastfeeding. This study aimed to describe a multicenter study methodology and propose standardized indicators for NBCAL monitoring. This is a Multicenter Study for NBCAL Compliance Assessment (Multi-NBCAL) conducted in seven Brazilian cities: Rio de Janeiro, São Paulo, Ouro Preto (Minas Gerais State), Florianópolis (Santa Catarina State), Brasília (Federal District), João Pessoa (Paraíba State), and Belém (Pará State). Assessment tools were adapted from NetCode/WHO and IBFAN Brazil (International Baby Food Action Network) to conduct two evaluations: (1) evaluation of NBCAL compliance in stores, and NBCAL knowledge and practices of store managers; (2) evaluation of the interaction between the baby food industry and health professionals and post-partum mothers in maternity hospitals. Five indicators were developed to assess NBCAL compliance in stores; seven indicators to assess the knowledge and practices of store managers; five indicators to assess the provision of incentives to maternity hospitals, health professionals, and mothers by sectors; and five indicators to assess NBCAL knowledge and practices of health professionals. The NBCAL assessment methodology with the proposal of standardized indicators allows comparability of studies about this theme. Using these indicators in periodic national or regional investigation can help monitor the level of NBCAL implementation in Brazil.

Social determinants of health and COVID-19 infection in Brazil: an analysis of the pandemic.

OBJECTIVE: To analyze the influence of socioeconomic, demographic, epidemiological factors, and the health system structure in the evolution of the COVID-19 pandemic in Brazil. METHODS: Ecological study with variables extracted from databases, having the incidence and mortality by COVID-19 until August 23, 2020, in Brazilian states, as response variables. The magnitude of the associations was estimated using Spearman's correlation coefficient and multiple regression analysis. RESULTS: In the Brazilian states, 59.8% of variation in the incidence of COVID-19 was justified by income inequality, significant home densification, and higher mortality. In the case of mortality, those same variables explained 57.9% of the country's variations in federal units. CONCLUSION: Our results indicate that socioeconomic factors influenced the evolution and impact of COVID-19 in Brazil. Thus, we suggest comprehensive actions to ensure economic conditions and strengthening of health networks for populations with socioeconomic vulnerability.

[Infant mortality in the Brazilian countryside: a proposal to overcome epidemiological and demographic invisibility]. / Mortalidade infantil no contexto da ruralidade brasileira: uma proposta para a superação da invisibilidade epidemiológica e demográfica.

The study aimed to compare two concepts of rurality, one proposed by the Brazilian Institute of Geography and Statistics (IBGE) and the other by the World Bank, to determine which is better fitted to the territory's reality, besides analyzing the infant mortality profile of rural municipalities (counties) in the state of Paraíba, Brazil, according to the best criterion for rurality. This was an observational epidemiological study conducted in the state of Paraíba. The method for analyzing rural/urban typologies was based on data mining, using the Apriori algorithm of association. Infant mortality was analyzed with descriptive statistics. The data were obtained from the Mortality Information System of the Brazilian Ministry of Health, from 2007 to 2016, and municipal indicators were from IBGE. The World Bank definition of rurality showed kappa = 0.337, compared to the IBGE definition, with kappa = 0.616. Among the 223 municipalities that were analyzed, the World Bank classified 130 (65.66%) correctly, and the IBGE 183 (82.06%). The predominant epidemiological profile of infant mortality in rural municipalities in Paraiba state was male gender (57.4%), brown skin color (61.1%), age from 0 to 7 days (52.4%), low birthweight (44%), and gestational age less than 37 weeks (43.2%). Underlying cause of death was classified as avoidable death via interventions by the Brazilian Unified National Health System (65.2%). The urban/rural typology adopted by the IBGE was better than the World Bank at classifying the municipalities in Paraiba state. This classification allowed studying the infant mortality profile in rural municipalities, which was similar to the overall profile, except for maternal schooling.

O estudo teve como objetivo comparar duas propostas de ruralidade, do Instituto Brasileiro de Geografia e Estatística (IBGE) e do Banco Mundial, respondendo qual delas melhor adéqua-se à realidade no território e conhecer o perfil da mortalidade infantil nos municípios rurais da Paraíba, Brasil, segundo o critério de ruralidade melhor avaliado. Trata-se de um estudo epidemiológico observacional, realizado no Estado da Paraíba. O método de análise das tipologias rural/urbano baseou-se na mineração de dados, com base no algoritmo de associação Apriori. Para a análise do óbito infantil, utilizou-se a estatística descritiva. Considerou-se os dados do Sistema de Informações sobre Mortalidade do Ministério da Saúde do Brasil, no período de 2007 a 2016, e indicadores municipais do IBGE. A tipologia de ruralidade do Banco Mundial apresentou kappa = 0,337 e a do IBGE kappa = 0,616. Entre os 223 municípios analisados, a tipologia do Banco Mundial classificou corretamente 130 (65,66%) e a do IBGE 183 (82,06%). O perfil epidemiológico predominante nos municípios rurais paraibanos foi sexo masculino (57,4%), cor parda (61,1%), idade entre 0 e 7 dias (52,4%), com baixo peso ao nascer (44%) e idade gestacional menor que 37 semanas (43,2%). A causa básica da morte foi classificada como morte evitável por intervenções do Sistema Único de Saúde (65,2%). A tipologia urbano/rural apresentada pelo IBGE classificou melhor os municípios paraibanos que a do Banco Mundial. Essa classificação possibilitou o estudo do perfil do óbito infantil nos municípios rurais, por meio do qual verificou-se, exceto pela escolaridade da mãe, similaridade com o perfil geral.

El objetivo del estudio fue comparar dos propuestas de ruralidad, la del Instituto Brasileño de Geografía y Estadística (IBGE) y la del Banco Mundial, respondiendo cuál de ellas se adecua mejor a la realidad en el territorio, así como conocer el perfil de mortalidad infantil en municipios rurales de Paraíba, Brasil, según el criterio mejor evaluado de ruralidad. Se trata de un estudio epidemiológico observacional, realizado en el estado de Paraíba. El método de análisis de las tipologías rural/urbana se basó en la mineración de datos, a partir del algoritmo de asociación Apriori. Para el análisis del óbito infantil, se utilizó la estadística descriptiva. Se consideraron los datos del Sistema de Informaciones de Mortalidad del Ministerio de Salud de Brasil, durante el período de 2007 a 2016, así como indicadores municipales del IBGE. La tipología de ruralidad del Banco Mundial presentó kappa = 0,337 y la del IBGE kappa = 0,616. Entre los 223 municipios analizados, la tipología del Banco Mundial clasificó correctamente 130 (65,66%) y la del IBGE 183 (82,06%). El perfil epidemiológico predominante en los municipios rurales paraibanos fue: sexo masculino (57,4%), color pardo (61,1%), edad entre 0 y 7 días (52,4%), con bajo peso al nacer (44%), edad gestacional menor de 37 semanas (43,2%). La causa básica de la muerte fue clasificada como muerte evitable por intervenciones del Sistema Único de Salud (65,2%). La tipología urbano/rural, presentada por el IBGE, clasificó mejor los municipios paraibanos que la del Banco Mundial. Esta clasificación posibilitó el estudio del perfil del óbito infantil en los municipios rurales, a través del cual se verificó, excepto por la escolaridad de la madre, similitud con el perfil general.

[Relationship between the supply of syphilis diagnosis and treatment in primary care and incidence of gestational and congenital syphilis]. / Relação entre oferta de diagnóstico e tratamento da sífilis na atenção básica sobre a incidência de sífilis gestacional e congênita.

Brazil has reported an increase in the incidence of both gestational and congenital syphilis, posing a serious public health problem in the country. The study aimed to analyze the relationship between the supply of syphilis diagnosis and treatment in primary care and the incidence rates of gestational and congenital syphilis. An ecological study analyzed these incidence rates and the coverage of diagnostic and therapeutic measures in primary care. The study sample consisted of municipalities (counties) with population over 20,000, with coverage by primary care over 50%, and where the majority of the teams were assessed in the second cycle of the National Program for Improvement of Access and Quality of Basic Care. Analysis of the effectiveness of detection and treatment measures was based on the development of the Index of Variation in Vertical Syphilis Transmission. The administration of penicillin and application of the rapid test in these municipalities showed median rates of 41.9% and 67.14%, respectively, with regional differences. Median incidence of gestational syphilis was 6.24 (IQR: 2.63-10.99) in municipalities with a higher supply of the rapid test and 3.82 (IQR: 0.00-8.21) in those with a lower supply, indicating an increase in detection capacity. Municipalities with a reduction in vertical transmission showed higher median rates of teams with supply of rapid testing and (83.33%; IQR: 50.00-100.00) and administration of penicillin (50.00%; IQR: 11.10-87.50), demonstrating a relationship between these measures and the reduction in congenital syphilis. The findings indicate the need to expand these services and to reinforce the importance of reducing vertical transmission.

O Brasil tem registrado aumento nas incidências de sífilis gestacional e congênita, revelando-se como um importante problema de saúde pública no país. O trabalho teve como objetivo analisar a relação entre as ofertas de diagnóstico e tratamento da sífilis na atenção básica e as incidências de sífilis gestacional e congênita. Foi realizado estudo ecológico analisando as incidências desses agravos e a cobertura de ações diagnósticas e terapêuticas na atenção básica. A amostra do estudo foi composta por municípios com população acima de 20.000 habitantes, com cobertura da atenção básica superior a 50% e nos quais a maioria das equipes foi avaliada no segundo ciclo do Programa de Melhoria do Acesso e da Qualidade na Atenção Básica. Para analisar a efetividade das ações de detecção e tratamento foi desenvolvido o Índice de Variação da Transmissão Vertical de Sífilis. A administração da penicilina e a realização de teste rápido nesses municípios obtiveram medianas iguais a 41,9% e 67,14%, respectivamente, com diferenças regionais. A mediana da incidência de sífilis gestacional foi 6,24 (IIQ: 2,63-10,99) em municípios com maior oferta de teste rápido, e de 3,82 (IIQ: 0,00-8,21) naqueles com oferta inferior, apontando aumento na capacidade de detecção. Municípios com redução da transmissão vertical apresentavam maiores medianas dos percentuais de equipes com oferta dos testes rápidos (83,33%; IIQ: 50,00-100,00) e realização de penicilina (50,00%; IIQ: 11,10-87,50), demonstrando relação entre estas ações e a redução de sífilis congênita. Os achados indicam a necessidade de ampliação dessas ofertas e reforça a importância na redução da transmissão vertical.

Brasil ha registrado un aumento en las incidencias de sífilis gestacional y congénita, revelándose como un importante problema de salud pública en Brasil. El estudio tuvo como objetivo analizar la relación entre las ofertas de diagnóstico y el tratamiento de la sífilis en la atención básica, así como las incidencias de sífilis gestacional y congénita. Se realizó un estudio ecológico, analizando las incidencias de esos problemas de salud y la cobertura de las acciones diagnósticas y terapéuticas en la atención básica. La muestra del estudio estuvo compuesta por municipios con una población por encima de los 20.000 habitantes, con una cobertura de atención básica superior a un 50%, y en los que la mayoría de los equipos se evaluó en el segundo ciclo del Programa Nacional de Mejora de Acceso y Calidad de la Atención Básica Para analizar la efectividad de las acciones de detección y tratamiento se desarrolló el Índice de Variación de la Transmisión Vertical de Sífilis. La administración de la penicilina y la realización del test rápido en estos municipios obtuvieron medias iguales a 41,9% y 67,14%, respectivamente, con diferencias regionales. La media de la incidencia de sífilis gestacional fue 6,24 (IIQ: 2,63-10,99) en municipios con mayor oferta de test rápido y de 3,82 (IIQ: 0,00-8,21) en aquellos con oferta inferior, apuntando un aumento en la capacidad de detección. Los municipios con una reducción de la transmisión vertical presentaban mayores medias de los porcentajes de equipos con oferta de tests rápidos (83,33%; IIQ: 50,00-100,00) y administración de penicilina (50,00%; IIQ: 11,10-87,50), demostrando la relación entre estas acciones y la reducción de sífilis congénita. Los resultados indican la necesidad de que exista una ampliación de esta oferta de servicios y refuerza la importancia en la reducción de la transmisión vertical.

Análise de uma estratégia educativa virtual voltada para o apoio ao aleitamento materno exclusivo / Analysis of a virtual educational strategy for the support of exclusive breastfeeding

Introdução: O aleitamento materno exclusivo é o período em que a criança recebe apenas o leite materno, sem a oferta de demais líquidos ou alimentos. Os benefícios à saúde da criança incluem sobretudo a redução do quadro de diarreias e doenças respiratórias, e isso tem sido um dos principais fatores para a redução histórica da mortalidade infantil. Diante disso, a Organização Mundial da Saúde recomenda essa prática até o sexto mês de vida da criança. A utilização da internet pode ser um recurso promissor para o alcance desse cenário. Objetivo: Este trabalho analisou uma estratégia educativa virtual voltada ao apoio a amamentação materna exclusiva. Métodos: Trata-se de um estudo qualitativo, em que foram analisadas as publicações de mulheres de uma comunidade privada da rede social online Facebook, gerenciada por profissionais de saúde. Resultados: O compartilhamento das experiências no grupo evidenciou o aleitamento como uma fase permeada por múltiplas dificuldades físicas, emocionais e sociais. Foram identificadas a sobrecarga de trabalho e a culpabilização das mulheres. As comunicações do espaço virtual, pautadas numa metodologia participativa, fortaleceram o diálogo com as participantes e entre elas. Conclusão: A moderação baseada nas demandas apresentadas pelo grupo possibilitou um apoio oportuno e articulado com as necessidades vivenciadas, promovendo o empoderamento das mulheres no processo de amamentar. Essa iniciativa mostrouse viável, prática, de baixo custo e com grande potencial de incrementar a duração da amamentação exclusiva entre as participantes. (AU)

Introduction: Exclusive breastfeeding is the period when the child receives only breast milk, without offering other liquids or food. The benefits to the child's health include, mainly, reduction of diarrhea and respiratory diseases and this has been one of the main factors for the historical reduction of infant mortality. Therefore, the World Health Organization recommends this practice until sixth months of life. The use of the internet can be a promising resource in order to achieve this scenario. Objective: This paper analyzed a virtual educational strategy that focused on the support of exclusive breastfeeding. Methods: It is a qualitative study, in which the publications of women from a private community of the online social network Facebook, managed by health professionals, were analyzed. Results: The sharing of experiences in the group showed breastfeeding as a phase permeated by multiple physical, emotional and social difficulties. Work overload and blaming women were identified. The communications of the virtual space based on a participatory methodology, strengthened the dialogue with the participants and between them. Conclusion: Moderation based on the demands presented by the group enabled timely support connected with the needs experienced, promoting the empowerment of women in the breastfeeding process. This initiative proved to be feasible, practical, of low cost and with great potential to increase the duration of exclusive breastfeeding among the participants. (AU)