Factors associated with concurrent alcohol, tobacco and illicit drug use: 2019 National School-Based Health Survey. / Fatores associados ao policonsumo de álcool, tabaco e drogas ilícitas: Pesquisa Nacional de Saúde do Escolar 2019.

The aim of this study was to analyze the factors associated with concurrent alcohol, tobacco and illicit drug use among Brazilian schoolchildren aged 13-17. We conducted a cross-sectional study using data from the 2019 National School-Based Health Survey. The outcome was use of the three substances during the last 30 days. Hierarchical multiple logistic regression was carried out with independent variables grouped into four blocks: sociodemographic characteristics; family context; behavioral aspects; and stressors. Variables with p<0.05 were retained in the final model. The prevalence of concurrent substance use was 3.3%. Being male, living in the Midwest, South and Southeast, skipping school without parent permission, parents not knowing what their children do in their free time, having parents who smoke, having experienced physical aggression from parents, feeling that life is not worth living, trying drinking and illicit drugs before the age of 13, and having friends who drink alcohol, smoke and use drugs in their presence remained associated with the outcome in the final model. The findings reveal high prevalence of concurrent alcohol, cigarette and illicit drug use among adolescents and that poly use is associated with sociodemographic, family, and behavioral factors and stressors.

Objetivou-se analisar os fatores associados ao policonsumo de álcool, tabaco e drogas ilícitas, entre adolescentes escolares brasileiros de 13 a 17 anos. Estudo transversal, com dados da Pesquisa Nacional de Saúde do Escolar (2019). A variável desfecho foi o relato de consumo das três substâncias nos últimos 30 dias. As variáveis independentes foram agrupadas em quatro blocos: características sociodemográficas; contexto familiar; situações estressoras; aspectos comportamentais. Foi realizada análise de regressão logística múltipla hierarquizada, permanecendo no modelo final as variáveis com p<0,05. A prevalência de policonsumo em adolescentes escolares foi 3,3%. No modelo final, sexo masculino, morar na região Centro-Oeste, Sul e Sudeste, faltar a escola sem permissão, pais não saberem o que fazem no tempo livre, ter pais fumantes, sofrer agressão física pelos pais, sentir que a vida não vale a pena ser vivida, experimentar bebida alcoólica e drogas ilícitas antes dos 13 anos, ter amigos que bebem bebida alcoólica, fumam e usam drogas na sua presença permaneceram associados ao desfecho. Os dados mostram alta prevalência de policonsumo de três substâncias entre adolescentes e sua associação a fatores sociodemográficos, familiares, comportamentais e a eventos estressantes.

Intervention for ineffective airway clearance in asthmatic children: a controlled and randomized clinical trial.

This study aimed to analyse the effectiveness of an intervention for the nursing diagnosis of ineffective airway clearance in asthmatic children. A blinded, randomized and controlled clinical trial was developed in a paediatric hospital located on northeast of Brazil with 42 asthmatic children aged ≤ 36 months. The children were randomly divided into two groups (intervention and control) by means of a simple drawing. The applied intervention included actions related to change of positioning and stimulation of cough. The main findings of this study show that before the intervention, no significant difference was observed in the health status of the children. After the intervention, the indicators of choking (16.83 vs. 26.17, P = 0.007) and adventitious breath sounds (16.4 vs. 26.6, P = 0.005) were higher, on average, in the intervention group. It was observed an improvement in obstructive symptoms in children who received the intervention proposed.

Stress and associated factors in public school teachers: a cross-sectional study.

Introduction: The search for improving productivity and performance at work has exposed workers to high levels of stress. Since the working conditions of basic education teachers interfere negatively with their health, it is important to study the entire context involving teachers, in order to encourage the promotion of workers' health actions. Objectives: To investigate stress levels and associated factors in public school teachers. Methods: The study was conducted through online questionnaires sent to public school teachers in the state of Piauí, in 2020, using the snowball method. Sociodemographic and economic characteristics and risk habits (smoking, alcoholism, and sedentary lifestyle) of the study sample were investigated, as well as clinical, anthropometric, and stress-related conditions. Results: A total of 126 teachers participated in the study, most of which were women (88.9%), had a family income from three to four minimum salaries (30.2%), and worked two shift or more (55.6%); furthermore, 10.3% reported having hypertension; 8.7%, musculoskeletal diseases; 3.2%, thyroid-related problems; and 2.4%, diabetes. A statistically significant difference in median stress levels was observed in women (p = 0.002) and in individuals with thyroid problems (p = 0.015). Conclusions: Teachers, especially women working in this job, suffer from expressive levels of stress, which can directly affect their quality of life, requiring the development of measures to prevent stress, in order to improve the health and the performance of these professionals.

Introdução: A busca por mais produtividade e desempenho no trabalho tem submetido trabalhadores a altos níveis de estresse. As condições de trabalho do professor de educação básica interferem de forma negativa sobre a sua saúde; assim, é importante que todo o contexto que envolve o professor seja estudado a fim de incentivar a promoção de ações de saúde do trabalhador. Objetivos: Verificar os níveis de estresse e fatores associados em professores de escolas públicas. Métodos: O estudo foi realizado através de questionários on-line enviados para professores de escolas públicas do Piauí, no ano de 2020, utilizando-se o método bola de neve. Foram investigadas as características sociodemográficas e econômicas, os hábitos de risco (tabagismo, alcoolismo e sedentarismo) e as condições clínicas, antropométricas e de estresse da amostra estudada. Resultados: Participaram deste estudo 126 professores, dos quais 88,9% eram mulheres, com renda familiar entre três e quatro salários-mínimos (30,2%), que trabalham em dois turnos ou mais (55,6%); 10,3% afirmaram possuir hipertensão, 8,7% disseram sofrer de doenças osteomusculares, 3,2% relataram problemas relacionados à tireoide e 2,4% são diabéticos. Foi encontrada uma diferença de medianas estatisticamente significante entre os níveis de estresse e o sexo feminino (p = 0,002) e problemas de tireoide (p = 0,015). Conclusões: Os professores, especialmente as mulheres, sofrem de níveis de estresse expressivos, o que pode afetar diretamente a qualidade de vida, sendo necessário que medidas preventivas de estresse sejam criadas a fim de melhorar a saúde e o rendimento desses profissionais.

National Vaccine Coverage Survey 2020: methods and operational aspects.

OBJECTIVE: The national vaccination coverage survey on full vaccination at 12 and 24 months of age was carried out to investigate drops in coverage as of 2016. METHODS: A sample of 37,836 live births from the 2017 or 2018 cohorts living in capital cities, the Federal District, and 12 inner cities with 100 thousand inhabitants were followed for the first 24 months through vaccine record cards. Census tracts stratified according to socioeconomic levels had the same number of children included in each stratum. Coverage for each vaccine, full vaccination at 12 and 24 months and number of doses administered, valid and timely, were calculated. Family, maternal and child factors associated with coverage were surveyed. The reasons for not vaccinating analyzed were: medical contraindications, access difficulties, problems with the program, and vaccine hesitancy. RESULTS: Preliminary results showed that less than 1% of children were not vaccinated, full coverage was less than 75% at all capitals and the Federal District, vaccines requiring more than one dose progressively lost coverage, and there were inequalities among socioeconomic strata, favorable to the highest level in some cities and to the lowest in others. CONCLUSION: There was an actual reduction in full vaccination in all capitals and the Federal District for children born in 2017 and 2018, showing a deteriorating implementation of the National Immunization Program from 2017 to 2019. The survey did not measure the impacts of the COVID-19 pandemic, which may have further reduced vaccination coverage.

Temporal trend of simultaneous risk factors for chronic non-communicable diseases: National School Health Survey 2009, 2012, 2015.

OBJECTIVE: To analyze the temporal trend of simultaneous occurrence of behavioral risk factors for chronic non-communicable diseases in Brazilian school adolescents. METHODS: Ecological time-series study that analyzed data from the three editions of the National Survey of School Health with students in the 9th year of public and private schools. Cluster analysis was performed to identify the simultaneity of the following factors: irregular consumption of fresh or minimally processed foods, regular consumption of processed and ultra-processed foods, insufficient level of physical activity during leisure time, consumption of alcoholic beverages, use of cigarettes and illicit drugs. The cluster trend was tested using simple linear regression. RESULTS: The sample was composed of 173,310 school adolescents. Sixty-four possible combinations were evaluated, resulting in the formation of six clusters. The grouping formed by all factors showed the highest ratios observed/expected prevalence in the last two years of the series. The highest ratios were observed for combinations in which alcohol and cigarettes were present. These substances integrated five of the six clusters. One of the groups (insufficient level of physical activity during leisure time + consumption of alcoholic beverages + use of cigarettes and illicit drugs) had an upward trend throughout the series. CONCLUSION: The trend analysis showed four out of six clusters remaining stable throughout the series, which shows that the factors are persistently present among school adolescents.

Relationship between sexual maturation and anthropometric and blood pressure indicators in teenagers. / Relação entre maturação sexual e indicadores antropométricos e pressóricos em adolescentes.

This study aimed to investigate the relationship between sexual maturation and anthropometric and blood pressure indicators in teenagers. This was a population-based cross-sectional study, conducted with 345 teenagers, aged 10 to 19 years, between 2018 and 2020. In this study, data referent to sociodemographic and anthropometric variables, blood pressure, and sexual maturation were collected. The data analysis was performed by applying the Principle Component Analysis (PCA), which generated three components and then tested the correlation between sexual maturation and the generated components. Most of the teenagers were female (53%), normotensive (66.1%), and with a normal weight (73%). A positive correlation was found between breast development and component 1 and component 2, as well as a negative correlation between the breasts and component 3. In the boys, the development of genitals and pubic hair was positively correlated with component 2 and inversely correlated with component 3. It could therefore be concluded that there is a relationship between sexual maturation and the anthropometric and blood pressure indicators, which proved to be representative variables for cardiovascular risk in teenagers, even if not in their entirety.

Objetivou-se investigar a relação entre a maturação sexual com indicadores antropométricos e pressóricos de adolescentes. Estudo transversal de base populacional, realizado entre 2018 e 2020, com 345 adolescentes de 10 a 19 anos. Coletou-se variáveis sociodemográficas e antropométricas, pressão arterial e maturação sexual. A análise dos dados foi feita por meio da Análise de Componentes Principais, que gerou três componentes e, posteriormente, testou-se a correlação entre a maturação sexual e os componentes gerados. A maioria dos adolescentes eram do sexo feminino (53%), normotensos (66,1%) e com peso normal (73%). Houve correlação positiva entre o desenvolvimento das mamas com o componente 1 e o componente 2, e correlação negativa entre mamas e o componente 3. Nos meninos, o desenvolvimento dos genitais e pelos pubianos estiveram positivamente correlacionados com o componente 2 e inversamente correlacionados com o componente 3. Conclui-se que existe relação entre a maturação sexual e os indicadores antropométricos e pressóricos, sendo variáveis representativas de risco cardiovascular em adolescentes, mesmo que não em sua totalidade.

Temporal trend of COVID-19 incidence and mortality rates and their relationship with socioeconomic indicators in the state of Piauí, Brazil: an ecological study, 2020-2021. / Tendência temporal das taxas de incidência e de mortalidade por COVID-19 e sua relação com indicadores socioeconômicos no Piauí: estudo ecológico, 2020-2021.

OBJECTIVE: To analyze the temporal trend of COVID-19 incidence and mortality rates and their relationship with socioeconomic indicators. METHODS: This was an ecological time series study of COVID-19 cases/deaths in municipalities in Piauí, Brazil, between March, 2020 and May, 2021. Prais-Winsten linear regression model and Spearman's correlation test were used. RESULTS: There were 271,228 cases and 5,888 deaths in the period. There was a rising trend in COVID-19 incidence rate, while the mortality trend was stable. The spatio-temporal analyses showed higher incidence/mortality in the second and fifth quarters of the period. There was no statistically significant correlation between COVID-19 and the Social Vulnerability Index (IVS). Significant correlations between the Municipal Human Development Index (IDHM) and COVID-19 incidence (p-value < 0.001) and mortality rates (p-value < 0.001) were found. CONCLUSION: There was a rising trend in COVID-19 incidence and stability in COVID-19 mortality. Correlation between the MHDI and these two indicators was moderate and weak, respectively, demanding public service management decisions aimed at improving the population's quality of life.

Prevalence and factors associated with overweight in adults in Brazilian capitals and the Federal District, 2019. / Prevalência e fatores associados ao excesso de peso em adultos nas capitais e no Distrito Federal, Brasil, 2019.

OBJECTIVE: Se To analyze the prevalence and factors associated with overweight in Brazilian capitals and the Federal District, Brazil, 2019. METHODS: Se Cross-sectional study, with data from the Surveillance of risk and protective factors for chronic diseases by telephone survey, 2019. Prevalence was calculated overweight and association with sociodemographic and behavioral characteristics and health status, stratified according to sex. RESULTS: Se The prevalence of overweight was 55.9% (95%CI 54.9;56.9), associated in men with age of 35-44 years (PR=1.87 - 95%CI 1.65;2.12), alcohol consumption (PR=1.09 - 95%CI 1.03;1.15), and hypertension (PR=1.24 - 95%CI 1.17;1.31); and in women, associated to age 45-54 years (PR=2.03 - 95%CI 1.77;2.32), habit of watching television for 3h/day (PR=1.09 - 95%CI 1.04;1.15), and poor/very poor health status (PR=1.31 - 95%CI 1.20;1.43). CONCLUSION: Se Overweight was observed in more than half of the sample, associated with hypertension, diabetes mellitus and alcohol consumption, in both sexes.

Construction and validation of educational material on promoting breastfeeding in schools.

OBJECTIVE: to build and validate an educational technology on the promotion of breastfeeding for schoolchildren. METHODS: a methodological study was developed through a bibliographic survey, situational diagnosis, creation of illustrations, layout, design and texts, validation of the material with the help of expert judges and target audience. RESULTS: the content judges enabled the validation of the material with an overall Content Validity Index of 90%, the judges of the design Suitability Assessment of Materials of 90.4% and the target audience with a 95.6% agreement. The readability percentage proved to be excellent, with an overall score of 100%. CONCLUSION: the educational technology proved to be a valid and reliable instrument to promote a breastfeeding culture among schoolchildren.

Access to the Unified Health System in the perspective of male homosexuals.

OBJECTIVES: To analyze the perception of male homosexuals regarding the access to the Unified Health System. METHODS: A qualitative study with male homosexuals in a city in the Northeast Brazil. Eight subjects participated, a socioeconomic questionnaire was used for data collection and a focal group was carried out, in which the narratives were recorded and later transcribed. For the analysis of the speeches, the analysis of thematic content was used. RESULTS: The analysis revealed five thematic categories that express the limitations on humanization and reception, as well as in the quality of health care offered to subjects, disregarding the psychosocial and lifestyle-related demands. FINAL CONSIDERATIONS: It was emphasized that the focus group technique contributed to the approach of the research with the perception of male homosexuals marked by prejudice and discrimination, reflecting the subjects' dissatisfaction with the care received in the health services.

Health literacy of adults with and without arterial hypertension.

OBJECTIVE: Assess the level of health literacy of adults, with and without hypertension, treated in three basic health units (UBS) in Picos, Piauí. METHODS: Cross-sectional study conducted with 357 adults. Data were collected using a questionnaire with sociodemographic variables, and literacy was assessed by the Test of Functional Literacy in Adults. Descriptive analysis was performed followed by the association between literacy and exposure variables with Pearson's chi-squared (X2) test and Mann-Whitney U test. RESULTS: Inadequate or marginal health literacy was found in three units investigated (71.5%; 77.8% and 85.2%);. Age and the years of schooling were factors associated with inadequate literacy in adults with hypertension (p<0.0001). CONCLUSION: Inadequate literacy was found in more than 70% of the hypertensive patients investigated. This finding reinforces the need to improve the self-care skills of hypertensive patients, especially the older ones and those with few years of schooling.

Fatores associados ao policonsumo de álcool, tabaco e drogas ilícitas: Pesquisa Nacional de Saúde do Escolar 2019 / Factors associated with concurrent alcohol, tobacco and illicit drug use: 2019 National School-Based Health Survey

Resumo Objetivou-se analisar os fatores associados ao policonsumo de álcool, tabaco e drogas ilícitas, entre adolescentes escolares brasileiros de 13 a 17 anos. Estudo transversal, com dados da Pesquisa Nacional de Saúde do Escolar (2019). A variável desfecho foi o relato de consumo das três substâncias nos últimos 30 dias. As variáveis independentes foram agrupadas em quatro blocos: características sociodemográficas; contexto familiar; situações estressoras; aspectos comportamentais. Foi realizada análise de regressão logística múltipla hierarquizada, permanecendo no modelo final as variáveis com p<0,05. A prevalência de policonsumo em adolescentes escolares foi 3,3%. No modelo final, sexo masculino, morar na região Centro-Oeste, Sul e Sudeste, faltar a escola sem permissão, pais não saberem o que fazem no tempo livre, ter pais fumantes, sofrer agressão física pelos pais, sentir que a vida não vale a pena ser vivida, experimentar bebida alcoólica e drogas ilícitas antes dos 13 anos, ter amigos que bebem bebida alcoólica, fumam e usam drogas na sua presença permaneceram associados ao desfecho. Os dados mostram alta prevalência de policonsumo de três substâncias entre adolescentes e sua associação a fatores sociodemográficos, familiares, comportamentais e a eventos estressantes.

Abstract The aim of this study was to analyze the factors associated with concurrent alcohol, tobacco and illicit drug use among Brazilian schoolchildren aged 13-17. We conducted a cross-sectional study using data from the 2019 National School-Based Health Survey. The outcome was use of the three substances during the last 30 days. Hierarchical multiple logistic regression was carried out with independent variables grouped into four blocks: sociodemographic characteristics; family context; behavioral aspects; and stressors. Variables with p<0.05 were retained in the final model. The prevalence of concurrent substance use was 3.3%. Being male, living in the Midwest, South and Southeast, skipping school without parent permission, parents not knowing what their children do in their free time, having parents who smoke, having experienced physical aggression from parents, feeling that life is not worth living, trying drinking and illicit drugs before the age of 13, and having friends who drink alcohol, smoke and use drugs in their presence remained associated with the outcome in the final model. The findings reveal high prevalence of concurrent alcohol, cigarette and illicit drug use among adolescents and that poly use is associated with sociodemographic, family, and behavioral factors and stressors.

Protocolo de intervenções nutricionais para o manejo da obesidade infantil na Atenção Primária à Saúde / Protocol to implement nutritional interventions for the management of childhood obesity in Primary Health Care

Objetivo: Construir e validar um protocolo de intervenções nutricionais para o manejo da obesidade infantil no âmbito da Atenção Primária à Saúde. Métodos: Trata-se de um estudo metodológico, organizado em três fases: elaboração de uma revisão sistemática do tipo overview, com uso das recomendações PRISMA, construção do protocolo clínico e validação do conteúdo com uso dos instrumentos AGREE II e AGREE-REX. Resultados: Foram incluídos 17 estudos para a construção do protocolo, indicando efetividade em intervenções com desfechos na redução significativa do IMC, mudança no comportamento e hábitos alimentares, aumento no nível de conhecimento sobre alimentação saudável. A avaliação do protocolo clínico obteve uma pontuação >70% e, conforme o parâmetro utilizado (≥50% qualidade alta), foi considerado adequado para implementação no campo da saúde da criança, mais especificamente no manejo da obesidade infantil. Conclusão: Um protocolo assistencial para o manejo da obesidade infantil no âmbito da Atenção Primária à Saúde representa de forma positiva uma estratégia sustentável e flexível com atuação de diversos atores sociais como profissionais da saúde e familiares, dentre outros, contribuindo para a redução de riscos de comorbidades associadas à obesidade e custos de saúde, bem como para promover comportamentos mais saudáveis na população pediátrica. Descritores: Atenção Primária à Saúde; Obesidade Infantil; Manejo da Obesidade; Protocolos Clínicos.

Objective: To create and validate a protocol to implement nutritional interventions for the management of childhood obesity in the Primary Health Care scope.Methods: This is a methodological study organized into three phases: elaboration of a systematic review of the "overview" type using the PRISMA recommendations; preparation of the clinical protocol; and content validation using the AGREE II and AGREE-REX instruments.Results: A total of 17 studies were included to create the protocol, indicating effectiveness in interventions with outcomes in a significant BMI reduction, change in eating behaviors and habits, and increase in the knowledge level about healthy eating. The clinical protocol assessment obtained a score >70% and, according to the parameter used (≥50% high quality), it was considered adequate for implementation in the children's health field, more specifically in the management of childhood obesity.Conclusion: A care protocol for the management of childhood obesity in the Primary Health Care scope positively represents a sustainable and flexible strategy with performance of several social actors such as health professionals and family members, among others, contributing to reducing risks of comorbidities associated with obesity and health costs, as well as to promoting healthier behaviors in the pediatric population. Descriptors: Primary Health Care; Pediatric Obesity; Obesity Management; Clinical Protocols.

Intervenção educativa para professores de creches sobre primeiros socorros: estudo quase-experimental / Educational intervention on first aid for kindergarten teachers: quasi-experimental study

Objetivo: Testar uma intervenção educativa para professores de creche sobre primeiros socorros, quanto aos desfechos de conhecimento e habilidade. Métodos: Estudo quase-experimental do tipo antes e depois, realizado em dez creches municipais públicas no Piauí, no período de setembro a outubro de 2019. A amostra foi composta de 36 professores e a coleta de dados foi realizada em três etapas: pré-teste acerca do conhecimento e habilidades em primeiros socorros; aplicação de atividade educativa teórico-prática; e pós-teste. Os dados foram analisados a partir do teste de Wilcoxon. Resultados:97,2% são do sexo feminino, a média de idade é de 41,47 (± 9,48) anos, 86,1% são apenas graduados e 13,9% têm pós-graduação. Ademais, 97,2% não realizaram curso de primeiros socorros e 58,3% já haviam presenciado alguma necessidade desse tipo de atendimento. Os participantes apresentaram aumento do conhecimento após a intervenção nos seguintes itens: acionamento de socorro (p=0,000); detecção e conduta na parada cardiorrespiratória (p=0,000; p=0,002); e conduta em hemorragias (p=0,001). A habilidade técnica dos profissionais apresentou aumento em todos os passos do atendimento em vítimas de parada cardiorrespiratória com p<0,05 na totalidade de itens avaliados. Conclusão: Após a intervenção, observou-se aumento do conhecimento e habilidade dos professores sobre situações de primeiros socorros. Descritores: Primeiros Socorros; Educação em Saúde; Professores Escolares; Capacitação de Professores.

Objective: To test an educational intervention for kindergarten teachers on first aid, regarding the outcomes of knowledge and skill. Methods:Quasi-experimental study of the before and after type, carried out in ten public municipal kindergarten centers in Piauí, during September to October 2019. The sample consisted of 36 teachers and data collection was carried out in three stages: pre-test on knowledge and skills in first aid; application of theoretical-practical educational activity; and post-test. Data were analyzed using the Wilcoxon test. Results:97.2% were female, the average age was 41.47 (± 9.48) years, 86.1% were only graduates and 13.9% had graduate degrees. 97.2% did not take a first aid course and 58.3% had already witnessed some need for this type of care. Participants showed an increase in knowledge after the intervention in the following items: emergency response (p=0.000); detection and management of cardiorespiratory arrest (p=0.000; p=0.002); and management of bleeding (p=0.001). The technical ability of professionals showed an increase in all stages of care in victims of cardiorespiratory arrest with p<0.05 in all items evaluated. Conclusion:After the intervention, there was an increase in teachers' knowledge and skill about first aid situations. Descriptors: First aid; Health education; School teachers; Teacher training.

Intervenções não farmacológicas no manejo da obesidade infantil: uma overview / Non-pharmacological interventions in the management of childhood obesity: an Overview / Intervenciones no farmacológicas en el tratamiento de la obesidad infantil: una visión general

Objetivo: Analisar na literatura científica a efetividade das intervenções não farmacológicas para o manejo da obesidade infantil. Método: Trata-se de uma revisão sistemática do tipo overview. As bases científicas para coleta de dados foram: Cinahl, Cochrane, Lilacs, Medline, Scopus, Scielo e Science direct, e todo o processo de seleção foi feito por pares e avaliado pelo teste Kappa. A análise dos estudos utilizou os instrumentos: AMSTAR para avaliação da qualidade metodológica, Robis 2.0 para avaliação do risco de viés, e o Sistema Grade para classificar nível de evidência. Resultado: 17 estudos foram considerados elegíveis, e avaliação das evidências demonstrou que as intervenções não farmacológicas são efetivas para o manejo da obesidade infantil, sendo classificadas pelo Sistema Grade com alto e moderado nível de evidência. Essas intervenções são caracterizadas como: comportamentais, educacional, familiar, nutricional e tecnológica e são capazes de promover mudanças no Índice de Massa Corporal e estilo de vida. Conclusão: As intervenções não farmacológicas são capazes de promover mudanças positivas quanto ao comportamento alimentar e manejo da obesidade, entretanto os resultados não são imediatos.

Objective: To analyze the effectiveness of non-pharmacological interventions for the management of childhood obesity in the scientific literature. Method: This is a systematic review of the overview type. The scientific databases for data collection were: Cinahl, Cochrane, Lilacs, Medline, Scopus, Scielo and Science direct, and the entire selection process was done by pairs and evaluated by Kappa test. The analysis of the studies used the instruments: AMSTAR to assess methodological quality, Robis 2.0 to assess risk of bias, and the Grade System to rank level of evidence. Results: 17 studies were considered eligible, and evaluation of the evidence showed that non- pharmacological interventions are effective for the management of childhood obesity, being classified by the Grade System with high and moderate level of evidence. These interventions are characterized as: behavioral, educational, family, nutritional, and technological, and are able to promote changes in Body Mass Index and lifestyle. Conclusion: Non-pharmacological interventions are able to promote positive changes in eating behavior and obesity management, but the results are not immediate.

Objetivo: Analizar la efectividad de las intervenciones no farmacológicas para el manejo de la obesidad infantil en la literatura científica. Método: Se trata de una revisión sistemática de tipo panorámica. Las bases de datos científicas para la recogida de datos fueron: Cinahl, Cochrane, Lilacs, Medline, Scopus, Scielo y Science direct, y todo el proceso de selección se realizó por parejas y se evaluó mediante el test de Kappa. En el análisis de los estudios se utilizaron los instrumentos AMSTAR para evaluar la calidad metodológica, Robis 2.0 para evaluar el riesgo de sesgo y el Grade System para clasificar el nivel de evidencia. Resultados: Se consideraron elegibles 17 estudios, y la evaluación de la evidencia mostró que las intervenciones no farmacológicas son efectivas para el manejo de la obesidad infantil, siendo clasificadas por el Sistema Grade con nivel de evidencia alto y moderado. Estas intervenciones se caracterizan por ser: conductuales, educativas, familiares, nutricionales y tecnológicas, y son capaces de promover cambios en el Índice de Masa Corporal y en el estilo de vida. Conclusiones: Las intervenciones no farmacológicas son capaces de promover cambios positivos en la conducta alimentaria y en el manejo de la obesidad, pero los resultados no son inmediatos.

Intervenções não farmacológicas no manejo da obesidade infantil: uma overview / Non-pharmacological interventions in the management of childhood obesity: an overview / Intervenciones no farmacológicas en el tratamiento de la obesidad infantil: una visión general

Objetivo: Analisar na literatura científica a efetividade das intervenções não farmacológicas para o manejo da obesidade infantil. Método: Trata-se de uma revisão sistemática do tipo overview. As bases científicas para coleta de dados foram: Cinahl, Cochrane, Lilacs, Medline, Scopus, Scielo e Science direct, e todo o processo de seleção foi feito por pares e avaliado pelo teste Kappa. A análise dos estudos utilizou os instrumentos: AMSTAR para avaliação da qualidade metodológica, Robis 2.0 para avaliação do risco de viés, e o Sistema Grade para classificar nível de evidência. Resultado: 17 estudos foram considerados elegíveis, e avaliação das evidências demonstrou que as intervenções não farmacológicas são efetivas para o manejo da obesidade infantil, sendo classificadas pelo Sistema Grade com alto e moderado nível de evidência. Essas intervenções são caracterizadas como: comportamentais, educacional, familiar, nutricional e tecnológica e são capazes de promover mudanças no Índice de Massa Corporal e estilo de vida. Conclusão: As intervenções não farmacológicas são capazes de promover mudanças positivas quanto ao comportamento alimentar e manejo da obesidade, entretanto os resultados não são imediatos.

Objective: To analyze the effectiveness of non-pharmacological interventions for the management of childhood obesity in the scientific literature. Method: This is a systematic review of the overview type. The scientific databases for data collection were: Cinahl, Cochrane, Lilacs, Medline, Scopus, Scielo and Science direct, and the entire selection process was done by pairs and evaluated by Kappa test. The analysis of the studies used the instruments: AMSTAR to assess methodological quality, Robis 2.0 to assess risk of bias, and the Grade System to rank level of evidence. Results: 17 studies were considered eligible, and evaluation of the evidence showed that non- pharmacological interventions are effective for the management of childhood obesity, being classified by the Grade System with high and moderate level of evidence. These interventions are characterized as: behavioral, educational, family, nutritional, and technological, and are able to promote changes in Body Mass Index and lifestyle. Conclusion: Non-pharmacological interventions are able to promote positive changes in eating behavior and obesity management, but the results are not immediate.

Objetivo: Analizar la efectividad de las intervenciones no farmacológicas para el manejo de la obesidad infantil en la literatura científica. Método: Se trata de una revisión sistemática de tipo panorámica. Las bases de datos científicas para la recogida de datos fueron: Cinahl, Cochrane, Lilacs, Medline, Scopus, Scielo y Science direct, y todo el proceso de selección se realizó por parejas y se evaluó mediante el test de Kappa. En el análisis de los estudios se utilizaron los instrumentos AMSTAR para evaluar la calidad metodológica, Robis 2.0 para evaluar el riesgo de sesgo y el Grade System para clasificar el nivel de evidencia. Resultados: Se consideraron elegibles 17 estudios, y la evaluación de la evidencia mostró que las intervenciones no farmacológicas son efectivas para el manejo de la obesidad infantil, siendo clasificadas por el Sistema Grade con nivel de evidencia alto y moderado. Estas intervenciones se caracterizan por ser: conductuales, educativas, familiares, nutricionales y tecnológicas, y son capaces de promover cambios en el Índice de Masa Corporal y en el estilo de vida. Conclusiones: Las intervenciones no farmacológicas son capaces de promover cambios positivos en la conducta alimentaria y en el manejo de la obesidad, pero los resultados no son inmediatos.

Child development as an intermediate element of food and nutrition in public policies / Desenvolvimento infantil como elemento intermediário nas políticas públicas de alimentação e nutrição

Abstract Objectives: to carry out a reflection in relation between food and nutrition along with child development. Methods: a bibliographic survey of Brazilian public policies on food and nutrition, followed by a descriptive-reflexive analysis about its nuances facing child development. Results: food and nutritional policies, although they do not bring the theme as the central axis of their actions, contemplating as an intermediate element dealing with the promotion of adequate and healthy food for the Brazilian population and the control and prevention of nutritional deficiencies, through food and nutritional education actions, national supplementation programs, addressed to the maternal and child population and the mandatory fortification of food. Conclusions: despite the emphasis on food and nutritional programs, it is imperative to draw attention to the necessary integration along with other areas related to child development promoting them entirety.

Resumo Objetivos: realizar uma reflexão acerca da relação da alimentação e nutrição com o desenvolvimento infantil. Métodos: levantamento bibliográfico das políticas públicas de alimentação e nutrição Brasileiras, seguido da análise descritiva-reflexiva acerca de suas nuances frente ao desenvolvimento infantil. Resultados: as políticas de alimentação e nutrição, apesar de não trazerem o tema como eixo central de suas ações, o contemplam como um elemento intermediário ao tratar da promoção da alimentação adequada e saudável para a população brasileira e do controle e prevenção de carências nutricionais, por meio de ações de educação alimentar e nutricional, de programas nacionais de suplementação, dirigidas ao público materno-infantil e da fortificação mandatória de alimentos. Conclusões: apesar do destaque a programas de alimentação e nutrição, imperativo chamar atenção para a sua necessária integração com as demais áreas ligadas ao desenvolvimento infantil para que o mesmo seja promovido em sua totalidade.

Tendência temporal das taxas de incidência e de mortalidade por COVID-19 e sua relação com indicadores socioeconômicos no Piauí: estudo ecológico, 2020-2021 / Tendencia temporal de las tasas de incidencia y mortalidad por COVID-19 y su relación con indicadores socioeconómicos en el estado de Piauí, Brasil: estudio ecológico, 2020-2021 / Temporal trend of COVID-19 incidence and mortality rates and their relationship with socioeconomic indicators in the state of Piauí, Brazil: an ecological study, 2020-2021

Objetivo: Analisar a tendência temporal das taxas de incidência e de mortalidade por COVID-19 e sua relação com indicadores socioeconômicos. Métodos: Estudo ecológico de série temporal sobre casos/óbitos por COVID-19 em municípios do Piauí, Brasil, de março de 2020 a maio de 2021. Foram utilizados o modelo de regressão linear de Prais-Winsten e o teste de correlação de Spearman. Resultados: Houve 271.228 casos e 5.888 óbitos, com tendência crescente na incidência e estável na mortalidade por COVID-19. Análises espaço-temporais demonstraram maior incidência/mortalidade no segundo e no quinto trimestres do período. Não houve correlação estatisticamente significativa entre COVID-19 e índice de vulnerabilidade social (IVS). Foram observadas correlações significativas do índice de desenvolvimento humano municipal (IDHM) com taxas de incidência (p-valor < 0,001) e de mortalidade (p-valor < 0,001) pela doença. Conclusão: Houve tendência crescente na taxa de incidência e estabilidade na mortalidade por COVID-19, e respectivamente correlação moderada e fraca desses indicadores com o IDHM, demandando decisões de gestão voltadas à melhoria na qualidade de vida da população.

Objetivo: Analizar la tendencia temporal de las tasas de incidencia y mortalidad por COVID-19 y su relación con indicadores socioeconómicos. Métodos: Estudio de serie temporal ecológica de casos/muertes por COVID-19 en municipios de Piauí, Brasil, entre marzo de 2020 y mayo de 2021. Se utilizaron el modelo de regresión lineal de Prais-Winsten y la prueba de correlación de Spearman. Resultados: Hubo 271.228 casos y 5.888 defunciones en período. Hubo una tendencia creciente en la tasa de incidencia y estabilidad en la mortalidad por COVID-19. Los análisis espacio-temporales mostraron mayor incidencia/mortalidad en segundo/quinto trimestre del período. No hubo una correlación estadísticamente significativa entre COVID-19 y el índice de vulnerabilidad social (IVS). Se observaron correlaciones significativas entre índice de desarrollo humano municipal (IDHM) e incidencia (p-valor < 0,001) y mortalidad (p-valor < 0,001) por COVID-19. Conclusión: Hubo una tendencia creciente en la incidencia de COVID-19 y estabilidad en mortalidad por la enfermedad. Hubo correlación moderada y débil de estos indicadores con IDHM, exigiendo decisiones encaminadas a mejorar la calidad de vida de la población en los ámbitos de gestión.

Objective: To analyze the temporal trend of COVID-19 incidence and mortality rates and their relationship with socioeconomic indicators. Methods: This was an ecological time series study of COVID-19 cases/deaths in municipalities in Piauí, Brazil, between March, 2020 and May, 2021. Prais-Winsten linear regression model and Spearman's correlation test were used. Results: There were 271,228 cases and 5,888 deaths in the period. There was a rising trend in COVID-19 incidence rate, while the mortality trend was stable. The spatio-temporal analyses showed higher incidence/mortality in the second and fifth quarters of the period. There was no statistically significant correlation between COVID-19 and the Social Vulnerability Index (IVS). Significant correlations between the Municipal Human Development Index (IDHM) and COVID-19 incidence (p-value < 0.001) and mortality rates (p-value < 0.001) were found. Conclusion: There was a rising trend in COVID-19 incidence and stability in COVID-19 mortality. Correlation between the MHDI and these two indicators was moderate and weak, respectively, demanding public service management decisions aimed at improving the population's quality of life.

Temporal trend of simultaneous risk factors for chronic non-communicable diseases: National School Health Survey 2009, 2012, 2015 / Tendência temporal dos fatores de risco simultâneos para doenças crônicas não transmissíveis: Pesquisa Nacional de Saúde do Escolar 2009, 2012, 2015

ABSTRACT: Objective: To analyze the temporal trend of simultaneous occurrence of behavioral risk factors for chronic non-communicable diseases in Brazilian school adolescents. Methods: Ecological time-series study that analyzed data from the three editions of the National Survey of School Health with students in the 9th year of public and private schools. Cluster analysis was performed to identify the simultaneity of the following factors: irregular consumption of fresh or minimally processed foods, regular consumption of processed and ultra-processed foods, insufficient level of physical activity during leisure time, consumption of alcoholic beverages, use of cigarettes and illicit drugs. The cluster trend was tested using simple linear regression. Results: The sample was composed of 173,310 school adolescents. Sixty-four possible combinations were evaluated, resulting in the formation of six clusters. The grouping formed by all factors showed the highest ratios observed/expected prevalence in the last two years of the series. The highest ratios were observed for combinations in which alcohol and cigarettes were present. These substances integrated five of the six clusters. One of the groups (insufficient level of physical activity during leisure time + consumption of alcoholic beverages + use of cigarettes and illicit drugs) had an upward trend throughout the series. Conclusion: The trend analysis showed four out of six clusters remaining stable throughout the series, which shows that the factors are persistently present among school adolescents.

RESUMO: Objetivo: Analisar a tendência temporal da ocorrência simultânea de fatores de risco comportamentais para doenças crônicas não transmissíveis em adolescentes escolares brasileiros. Métodos: Estudo ecológico de série temporal, que analisou os dados das três edições da Pesquisa Nacional de Saúde do Escolar dos alunos do 9º ano de escolas públicas e privadas. Realizou-se a análise de cluster para a identificação da simultaneidade dos seguintes fatores: consumo irregular de alimentos in natura ou minimamente processados, consumo regular de alimentos processados e ultraprocessados, nível insuficiente de atividade física no lazer, consumo de bebidas alcoólicas, uso de cigarro e de drogas ilícitas. A tendência dos clusters foi testada utilizando-se regressão linear simples. Resultados: A amostra constituiu-se de 173.310 escolares. Sessenta e quatro possíveis combinações foram avaliadas, havendo a formação de seis clusters. O agrupamento formado por todos os fatores apresentou as maiores razões entre prevalências observadas e esperadas para os dois últimos anos da série. As maiores razões foram verificadas para as combinações em que estavam presentes o álcool e o cigarro. Além disso, essas substâncias integraram cinco dos seis clusters. Um dos agrupamentos (nível insuficiente de atividade física no lazer + consumo de bebidas alcóolicas + uso de cigarro e drogas ilícitas) apresentou tendência crescente durante toda a série. Conclusão: A análise de tendência constatou que quatro de seis clusters mantiveram-se estáveis durante toda a série, demonstrando que os fatores continuam presentes de forma persistente entre os adolescentes escolares.

Sintomatologia de ansiedade em profissionais do serviço de atendimento móvel de urgência / Sintomatología de la ansiedad en los profesionales del servicio de atención móvil de urgencias / Anxiety symptomatology in professionals of the mobile emergency care service

Objetivo: Rastrear sintomas de ansiedade em profissionais do Serviço de Atendimento Móvel de Urgência (SAMU). Método: Estudo exploratório, descritivo e transversal, de abordagem quantitativa, realizado em SAMU localizado no interior do Piauí, entre abril e junho de 2021, através de questionário on-line. O instrumento classificou os participantes em: ansiedade mínima; ansiedade leve; ansiedade moderada; e ansiedade grave. Para análise estatística utilizou-se o teste de razão de verossimilhança, pois, a razão esperada foi menor que 5 nas variáveis analisadas, sendo considerado o nível de significância de 5% (p<0,05). Resultados: Participaram do estudo 14 profissionais assistenciais. Entre os sintomas indagados, houve prevalência de: "incapacidade de relaxar" (35,7%), "medo que o pior aconteça" (35,6%), "palpitação ou aceleração do coração" (28,6%) e "sensação de calor" (28,5%). Conclusão: A maioria dos emergencistas foi classificada com ansiedade mínima, contudo, a baixa adesão de participantes dificultou uma análise mais consistente da sintomatologia de ansiedade nesses profissionais.(AU)

Objective: To screen anxiety symptoms in Mobile Emergency Care Service (SAMU) professionals. Method: Exploratory, descriptive and cross-sectional study, with quantitative approach, conducted in SAMU located in the interior of Piauí, between April and June 2021, through an online questionnaire. The instrument classified participants into: minimal anxiety; mild anxiety; moderate anxiety; and severe anxiety. For statistical analysis we used the likelihood ratio test, because the expected ratio was less than 5 in the variables analyzed, being considered the significance level of 5% (p<0.05). Results: Fourteen caregivers participated in the study. Among the symptoms inquired, there was a prevalence of: "inability to relax" (35.7%), "fear that the worst will happen" (35.6%), "palpitation or acceleration of the heart" (28.6%) and "feeling hot" (28.5%). Conclusion: Most emergency responders were classified with minimal anxiety, however, the low adherence of participants hindered a more consistent analysis of anxiety symptomatology in these professionals (AU)

Objetivo: Identificar los síntomas de ansiedad entre los profesionales del Servicio de Atención Móvil de Urgencias (SAMU). Método: Estudio exploratorio, descriptivo y transversal, con enfoque cuantitativo, realizado en un SAMU ubicado en el interior de Piauí, entre abril y junio de 2021, a través de un cuestionario online. El instrumento clasificó a los participantes en: ansiedad mínima, ansiedad leve, ansiedad moderada y ansiedad grave. Para el análisis estadístico se utilizó la prueba de la razón de verosimilitud, ya que la razón esperada era inferior a 5 en las variables analizadas, considerándose el nivel de significación del 5% (p<0,05). Resultados: Catorce cuidadores participaron en el estudio. Entre los síntomas indagados, hubo una prevalencia de: "incapacidad para relajarse" (35,7%), "miedo a que ocurra lo peor" (35,6%), "palpitaciones o aceleración del corazón" (28,6%) y "sensación de calor" (28,5%). Conclusión: La mayoría de los socorristas fueron clasificados con ansiedad mínima, sin embargo, la baja adherencia de los participantes impidió un análisis más consistente de la sintomatología de ansiedad en estos profesionales (AU)