Self-rated health among adolescents from vulnerable areas and their sociodemographic, lifestyle and contextual factors: A multilevel analysis.

PURPOSE: Understanding self-rated health in young people can help orient global health actions, especially in regions of social vulnerability. The present study analysed individual and contextual factors associated with self-rated health in a sample of Brazilian adolescents. DESIGN AND METHODS: Cross-sectional data from 1272 adolescents (aged 11-17; 48.5% of girls) in low human development index (HDI) neighbourhoods were analysed (HDI from 0.170 to 0.491). The outcome variable was self-rated health. Independent variables relating to individual factors (biological sex, age and economic class) and lifestyle (physical activity, alcohol, tobacco consumption and nutritional state) were measured using standardised instruments. The socio-environmental variables were measured using neighbourhood registered data where the adolescents studied. Multilevel regression was used to estimate the regression coefficients and their 95% confidence intervals (CI). RESULTS: Good self-rated health prevalence was of 72.2%. Being male (B: -0.165; CI: -0.250 to -0.081), age (B: -0.040; CI: -0.073 to -0.007), weekly duration of moderate to vigorous physical activity (B: 0.074; CI: 0.048-0.099), body mass index (B: -0.025; CI: -0.036 to -0.015), number of family healthcare teams in the neighbourhood (B: 0.019; CI: 0.006-0.033) and dengue incidence (B: -0.001; CI: -0.002; -0.000) were factors associated with self-rated health among students from vulnerable areas. CONCLUSIONS/PRACTICAL IMPLICATIONS: Approximately three in every 10 adolescents in areas of social vulnerability presented poor self-rated health. This fact was associated with biological sex and age (individual factors), physical activity levels and BMI (lifestyle) and the number of family healthcare teams in the neighbourhood (contextual).

Health outcomes in women attending with clinical guideline PROGYNE to a primary care center for cervical cancer prevention.

AIM: The objective of the current study was to analyze the health outcomes of women attending with a clinical guideline to consultations for cervical cancer (CC) prevention in a primary care center. METHODS: A cross-sectional design was used, and data were collected from March to July 2016 with a sample of 87 women in Fortaleza, Brazil. RESULTS: The following correlations were found: previous history of sexually transmitted infection (p = 0.025), women who used oral contraceptives (p = 0.035), and undergo the Papanicolaou test annually; having black skin color (p = 0.031) and attending to the first gynecological consultation; being single (p = 0.031), family history of cancer (p < 0.001), and undergoing the first Papanicolaou test within the first 3 years of sexual activity; age up to 30 years and positive colposcopy (p = 0.027); and being single and positive colposcopy (p = 0.021). CC was characterized by the presence of intraepithelial lesion detected on colposcopy (gold standard). Receiver operating characteristic curves were used to evaluate the diagnostic accuracy of visual inspection with Lugol's iodine, digital cervicography, and Papanicolaou test. The area under the curve values were as follows: digital cervicography: 0.558, p = 0.509; Lugol's iodine: 0.491, p = 0.919; and Papanicolaou test: 0.697, p = 0.024. CONCLUSION: Colposcopy in primary care provided a faster diagnosis of pre-cancerous lesions. Understanding the health outcomes of women who underwent consultations for CC prevention, as well as the screening and diagnosis methods used, is essential to the service and national health system of the less developed countries.

Factors Associated With Body Image Perception Among Brazilian Students From Low Human Development Index Areas.

This study aimed to evaluate sociodemographic, behavioral, and individual factors associated with body image perception in a sample of adolescents from schools in low Human Development Index areas in Brazil. This cross-sectional study included 609 boys and 573 girls (aged 11-17 years). Body image perception (nine-silhouettes scale) and sociodemographic, behavioral, and individual variables were included. Multinomial logistic regression analysis was used. Most boys (76.9%) and girls (77.5%) were dissatisfied with their body image. Body mass index status and healthy body image evaluation were significantly associated with body image dissatisfaction in both boys and girls ( p < .001), and daily fruit consumption was associated with body image dissatisfaction only in boys ( p = .035). Education and health care focused on body image can pay special attention to young people from vulnerable areas with unhealthy nutritional status and focus on strategies that enable improving the perception of a healthy body and a healthy diet.

"For whom was it effective?" Moderators of the effect of a school-based intervention on potential physical activity determinants among Brazilian students.

Knowledge about the effects of school-based interventions on modifiable physical activity (PA) determinants (e.g., social support), and whether the intervention effect differs according to students' characteristics (e.g., age and gender) are relevant PA promotion topics. This study aims to answer these topics among Brazilian students. This cluster-randomized controlled trial was conducted with 548 students in the intervention group and 537 in the control group (51.5% of boys; aged 11-18years). The four-month intervention included strategies focused on training teachers, opportunities for PA in the school environment, and health education. Potential PA determinants (attitude, self-efficacy, support of friends, parents, and teachers, perceived neighborhood environment and PA facilities in school) and moderators (gender, age, socioeconomic status (SES), and PA level at baseline) were assessed using self-reported instrument. Height and weight were measured to estimate the students' body mass index (BMI) status. Generalized linear models were used. In general, there was a significant and positive intervention effect for attitude, support of friends and teachers for PA, as well as PA facilities in school; effect size was 0.29, 0.24, 0.34, and 0.29, respectively (P<0.05). Age (support of friends, parents and teachers, and PA facilities in school), SES (support of friends and PA facilities in school), and BMI status (support of friends) were moderators of the intervention effect on some outcomes. In conclusion, the intervention improved potential PA determinants, but some changes occurred differently according to students' characteristics. These findings should be considered in PA policies in the school context. TRIAL REGISTRATION: This study is registered at Clinicaltrials.govNCT02439827.

Rationale and methods of a cluster-randomized controlled trial to promote active and healthy lifestyles among Brazilian students: the "Fortaleça sua Saúde" program.

BACKGROUND: Interventions on adolescents' lifestyle are important, but the main mechanisms that explain the changes (mediating variables) on lifestyle are unclear. This paper presents the rationale and methods of an intervention program focused on promoting active and healthy lifestyles (especially physical activity [PA] practice and reducing screen time) among Brazilian students-the Fortaleça sua Saúde program (Portuguese for "strengthen your health"). METHODS/DESIGN: This is a school-based cluster-randomized controlled trial. Three intervention and three control (no intervention) full-time public schools were randomly selected in Fortaleza, northeastern Brazil. Students (n = 1,272) from classes in Grades 7-9 were eligible, and 1,085 (548 in the intervention and 537 in control schools) completed the baseline and follow-up measures. The program duration was approximately four months and took place in 2014. Intervention strategies focused on teacher training, activities on health in the curriculum, active opportunities in the school environment (the availability of equipment for PA), and health education (health materials for students and parents). Data collection was undertaken before and immediately after the intervention. The primary variables included the practice of PA (weekly PA volume, PA behavior change stage and preference for PA during leisure-time) and screen time (TV and computer/video games). Potential intrapersonal, interpersonal and environmental mediators of PA and screen time were evaluated by a standardized questionnaire. Other lifestyle components (e.g., eating habits, substance use), psychological (e.g., self-rated health, body satisfaction) and biological (general and abdominal obesity) aspects, as well as academic performance were also evaluated in the total sample. Depressive symptoms, eating disorders, sleep quality, objectively-measured PA, and sedentary time were evaluated in obese students. DISCUSSION: If effective, this program will contribute to the development of public policies for the promotion of active and healthy lifestyles in youth, especially those from low- and middle-income countries. The main intrapersonal, interpersonal and/or environmental mediators of PA and screen time may also be indicated. Finally, we anticipate that the proposed strategies may be adaptable to public schools and may even be extended to the entire school system. TRIAL REGISTRATION: ClinicalTrials.Gov: NCT02439827 . Registration date: May 3, 2015.

[Instruments of health literacy used in nursing studies with hypertensive elderly]. / Instrumentos de letramento em saúde utilizados nas pesquisas de enfermagem com idosos hipertensos.

This study aimed to analyze nursing research regarding the instruments used to evaluate health literacy in elderly hypertensive patients. This is an integrative literature review done in the databases LILACS, PubMed, CINAHL, Scopus, and Cochrane, in June 2013. The articles, electronically available, were selected for full-text review by nurses, who assessed health literacy of elderly with hypertension. Eight studies were selected for analysis and four different instruments were used in the research. The instruments were developed according to a methodology and they were all designed to evaluate the abilities of elderly regarding reading, numeracy, pronunciation and recognition of some health-related words. The nursing research analyzed in this study revealed the gaps in care related to measures aimed to increase patient's involvement in decision-making. Also, the instruments used for measuring health literacy showed limitations, and there is no gold standard test.

Quality of life and associated factors for community health workers in the context of the COVID-19 pandemic in northeastern Brazil.

In this study, we evaluated the quality of life (QoL) and associated factors of community health workers (CHWs) in different urban settings as a contributor to the preparedness of Brazilian primary care for future sanitary emergencies. The sample included 1935 CHWs from 4 state capitals and 4 inland municipalities in northeastern Brazil. Information was collected on QoL (WHOQOL-BREF), work routines, sociodemographics, direct and indirect exposure to violence, general self-efficacy, social support (MSPSS), mental health (SRQ-20) and coronavirus anxiety. The data were subjected to multiple linear regression analysis (α = 5%). In the state capitals, the factors associated with loss of QoL were poor mental health, lack of training, uncertainty about occupational biosafety, and lack of adaptation of services to tend to patients diagnosed with COVID-19. Among the inland municipalities, the main factors were coronavirus anxiety, poor mental health, lack of adaptation of services, lack of training, and lack of personal protective equipment (PPE). A high MSPSS (family and friends) score and self-efficacy had positive impacts on QoL in both urban settings. Our results highlight the need for investment in permanent education, PPE, social support, and mental health care for CHWs.

[Translation and validation of the Partner Communication Scale - Brazilian version with female teenagers]. / Tradução e validação da escala Partner Communication Scale - versão brasileira com adolescentes do sexo feminino.

This study aimed to describe the process of adaptation and validation of the Partner Communication Scale with female adolescents in Fortaleza, CE, Brazil. This methodological research, with a quantitative approach, was conducted with 313 adolescent, aged 14-18 years who had already lost their virginity. The transcultural adaptation process was performed by using translation, back translation, evaluation of the translations by a committee of judges, and testing of the final-draft version. The scale was administered with a sociodemographic questionnaire including sexual and reproductive variables, from November 2010 to January 2011. The reliability was assessed by the Cronbach's alpha (0.86), which demonstrated that it can be successfully applied in the setting of primary health care, during nurse consultations. Moreover, the scale allows for the identification of factors that hinder or facilitate communication, especially concerning sexually transmitted diseases. The scale is an adequate way to verify communication between sexual partners in adolescence.

[Vulnerability of adolescent students to STD / HIV in Imperatriz - Maranhao]. / Vulnerabilidade de adolescentes escolares as DST/HIV, em Imperatriz-Maranhão.

The aim of this study was to investigate the vulnerability of adolescent students related to sexually transmitted diseases (STD) and the human immunodeficiency virus (HIV), identifying the main risk behaviors and prevention. This quantitative, cross-sectional study was performed in three public schools in Imperatriz--Maranhão, with 295 adolescents, using a structured questionnaire. The results show that: most young people (86.3%) who used a condom the last time they had intercourse, usually keep this practice, 82.8% of adolescents who understand the concept of HIV protect themselves against these infections and believe the main form of contamination is through sex, infected blood or through the placental barrier. We conclude that most teenager participants showed coherent knowledge about sexual practices and risk behaviors that make them vulnerable to STD/HIK presenting a positive aspect for the prevention of these diseases.

Body dissatisfaction, drug use, and associated factors among adolescents in three Brazilian cities. / Insatisfação com a imagem corporal, uso de drogas e fatores associados entre adolescentes em três cidades brasileiras.

OBJECTIVE: analyze the association between drug use and body dissatisfaction among adolescents in three Brazilian cities. METHOD: cross-sectional study, using a nested randomized controlled trial to evaluate the drug use prevention program #TamoJunto2.0 of the Ministry of Health in Brazilian schools. The sample consisted of 5,213 students from 73 schools in three Brazilian cities. The outcome body satisfaction was analyzed using the Stunkard scale and the explanatory variables were drug use and sociodemographic data. RESULTS: the adolescents were between 12 and 14 years old; about 69.9% of them reported body dissatisfaction, and 35.67% used alcohol in the previous year. Dissatisfaction due to overweight was higher among girls (41.5%) and dissatisfaction due to underweight was higher among boys (33.1%). Adolescents who used marijuana were 39% (OR=1.39) more likely to feel dissatisfied due to underweight and being a girl increased the chances of feeling dissatisfied due to overweight by 24% (OR=1.24). CONCLUSION: the levels of body dissatisfaction deserve attention in hebiatric nursing care and reinforce the importance of educational strategies addressing body image and drug use, relating them to the various subjective attributes that can affect the health of adolescents, whether in the community or at school.(1) High prevalence of body dissatisfaction related to overweight. (2) Girls presented 24% more chances of feeling body dissatisfaction due to overweight. (3) Marijuana use in adolescence can increase by 39% body dissatisfaction due to underweight. (4) Last year, about 35.7% of adolescents had already consumed alcohol. (5) Health promotion and stimulation of positive perceptions of self-image.

[Health promotion in the religious scenario: opportunities for nursing care]. / Promoção da saúde no cenário religioso: possibilidades para o cuidado de enfermagem.

This was a qualitative study of the documentary type carried out in the first half of 2008, and it aimed to describe the practices of health promotion developed in the religious scenario in a city in the countryside of Ceará, Brazil. Information were collected through audio-taped interviews with the priest in charge of the parish and the three coordinators of projects linked to the Catholic Church, selected by the identification of projects with the priest. The results show that promotion and health education are present in the activities developed by volunteers in the religious scenario. The church seeks to change attitudes and to promote the adoption of healthy behavior by individuals, through individual and collective actions. There is an urgent need to insert healthcare professionals in this scenario, strengthening it as a social support, gradually reducing the assistential activities and intensifying those aimed at health promotion with the support of nursing, in order to improve healthcare in this scenario.

Epidemiology of gestational syphilis in a Brazilian state: analysis in the light of the social-ecological theory.

OBJECTIVE: To analyze, in the light of the social-ecological theory, the temporal progression of gestational syphilis and its relationship with the implementation of the rede cegonha in Ceará. METHOD: This is a retrospective documental study, based on the information system of notifiable diseases about gestational syphilis in the perspective of the social-ecological theory. The sample consisted of all notifications from the state of Ceará in the period from 2007 to 2017. Data collection was carried out in October 2019. RESULTS: A total of 229,558 cases of gestational syphilis was reported in Brazil; of these, 7,040 were from the state of Ceará (3.1%), with a growing increase in cases over the years. Regarding the distribution of syphilis cases between the period before and after the implementation of the rede cegonha, there was an association with education (p < 0.0001), clinical classification (p < 0.0001), and gestational age (p = 0.0005). CONCLUSION: Despite the implementation of public policies and improvement of the epidemiological surveillance system, there is still a long way to go to control syphilis during pregnancy.

Family Health Postgraduate Program in the Brazilian northeast: repercussions in the professional exercise of postgraduates. / Programa de Pós-Graduação em Saúde da Família no nordeste brasileiro: repercussões no exercício profissional dos egressos.

Brazilian postgraduate education has grown in recent years, but there is a knowledge gap regarding whether the course's planned educational objective is being achieved. We aimed to evaluate the contribution of the Postgraduate Program in Family Health for the postgraduates' professional practice. This is a cross-sectional study conducted with 225 postgraduates from October 2019 to July 2020. Data were collected by an online questionnaire containing different sociodemographic and educational variables and competencies developed in the master's degree program and identifying the domains of Health Promotion Competencies. Most of the participants were female (78.2%), nurses (58.2%), public servants (64%), and SUS workers (93.3%). Two hundred and twenty-two (98.7%) postgraduates' final paper theme built on a practice-related issue. A high mean score was observed for all competencies analyzed. The mean scores for domains in Health Promotion competencies were high. We can conclude that the postgraduate program has contributed satisfactorily to the formation of critical, active masters, with competencies developed and being realized in professional practice.

A pós-graduação no Brasil tem crescido nos últimos anos, porém há uma lacuna do conhecimento em saber se o objetivo formativo planejado do curso está sendo alcançado. Com isso, objetivou-se avaliar a contribuição do Programa de Pós-graduação em Saúde da Família, no exercício profissional de seus egressos. Trata-se de estudo transversal, realizado nos meses de outubro de 2019 a julho de 2020, com 225 egressos. A coleta de dados se deu por meio de questionário on-line contendo distintas variáveis sociodemográficas e de formação, além de competências desenvolvidas no mestrado e identificação dos domínios das Competências de Promoção da Saúde. A maioria dos participantes era do sexo feminino (78,2%), enfermeiros (58,2), concursados (64%) e trabalhadores do SUS (93,3). Notou-se que 222 (98,7%) egressos tiveram a temática do trabalho de conclusão oriunda de uma questão relacionada à prática. Observou-se média elevada nos escores para todas as competências avaliadas. Foram elevados os escores médios dos domínios de Competências de Promoção da Saúde. Conclui-se que o programa de pós-graduação tem contribuído de forma satisfatória na formação de mestres críticos, atuantes, com competências desenvolvidas e sendo realizadas na prática profissional.

[Scales to preventive behavior measures in adolescent girls in the face of STD/HIV: an integrative review]. / Escalas para medida de comportamento preventivo em meninas adolescentes frente às DST/HIV: revisão integrativa.

Since the dawn of the AIDS epidemic in the international epidemiological scenario, prevention of transmission of HIV among women and adolescents has been one of the biggest challenges in controlling the disease. Through integrative review, this study aims to describe the studies that used validated scales in order to access behaviors of female adolescents facing the prevention of sexually transmitted diseases. Two databases were used for the selection of articles: PubMed, a digital file produced by the National Library of Medicine and the Cumulative Index to Nursing and Allied Health Literature (CINAHL); the sample consisted of seven items. The scales indicate that health professionals must recognize the interactions among peers, partners and parents to assess the vulnerability of adolescents and encourage the use of reliable tools for nursing practice in the prevention of these diseases.

[Perception of risk of school adolescents in relation to alcohol consumption and sexual behavior]. / Percepção de risco de adolescentes escolares na relação consumo de álcool e comportamento sexual.

Alcohol use has been a major precipitating cause of situations of vulnerability in adolescence. The study aims to analyze the risk perception about the relationship of adolescent alcohol use and sexual behavior. The subjects were ten adolescents between 14 and 19, students from a public school in Fortaleza, Ceará, Brazil. Exploratory and descriptive qualitative approach based on the technique of focus group and systematized by means of five workshops. Teenagers recognize the risk between alcohol consumption and sexual behavior and emphasize that drinking facilitates the relations between sexual peers and indicate the influence of media in this process. The perception of adolescents and their relation to alcohol abuse and its consequences is particularly relevant to the implementation of public policies for preventing and fighting alcohol consumption at this stage of growth and development.

[Health education based on culture circles]. / Educação em saúde a partir de círculos de cultura.

This study aims at systematizing with the participants of Culture Circles a proposal of reconstruction of actions of health education that show the necessary competences to the nurses of Family Health Program for a practice in education on critical and reflexive health. It is constituted of a research action, where the researcher based in "Paulo Freire Method" is encouraging debates in eight Culture Circles having the participation of ten nurses. The Circles give them the training of a political conscience , essential to the process of " empowerment " of the health professional in practicing his socio-politics competence. The proposal of achieving the Culture Circles establish a link of complicity between health professionals and communitarian groups with the actions of health promotion.

[Environmental education and nursing: a necessary integration]. / Educação ambiental e enfermagem: uma integração necessária.

Environmental issue should be discussed in educational actions, because this debate leads people to reflect on what is ecologically healthy. It was aimed to reflect on Health promotion, Environmental education and Nursing. This is a reflexive study on environmental health in three groups: Promotion of environmental and human health; Educational actions in Environmental health; and Nursing and Health education. It was verified that environmental education is a theme that includes human well-being, being necessary actions of health promotion that qualify individual and community to practice their empowerment and autonomy.

Use of webQDA software on qualitative nursing research: an experience report.

OBJECTIVES: to report the user experience of the webQDA software in the support of qualitative data analysis about health literacy of older adults. METHODS: quasi-experimental research developed from January 2014 to January 2015, with 118 older adults, all of whom were interviewed to assess the level of health literacy. Interviews were carried out before and after four educational interventions, according to Freire's method named Culture Circle. The interviews were transcribed and entered in the software, which highlighted the analytical categories. RESULTS: the systems of sources, interpretative encoding and questioning of the data available in the software allowed the construction of three categories for the literacy levels and four categories for their dimensions. FINAL CONSIDERATIONS: We concluded that the webQDA software enables the structured encoding of qualitative materials, ensuring faster and effective management of data with systematization and analytical transparency.

Health literacy for caregivers of elders with alzheimer's disease.

OBJECTIVE: To identify the level of health literacy in informal caregivers of elders with Alzheimer's disease. METHODS: Descriptive study with a quantitative and qualitative approach, with health literacy as a theoretical framework. Research carried out with 42 informal caregivers of elders with Alzheimer's from a geriatrics outpatient clinic, using a questionnaire with sociodemographic data and the Health Literacy instrument. RESULTS: The functional and conceptual levels were more prevalent, with regards to elders with Alzheimer's, than the empowering level. Caregivers searched, evaluated, and used health information and expressed abilities to use and judge the information received. FINAL CONSIDERATIONS: The predominance of categories in the cognitive level of learning indicates the need to strengthen the empowering level of these caregivers. Health literacy made it possible to reveal the demands of informal caregivers of elders with Alzheimer's, evaluating their individual ability to offer this type of assistance. It is also a tool capable of reaching better health results.

Infrastructure and work process in primary health care: PMAQ in Ceará.

OBJECTIVE To analyze the quality of the infrastructure and work process of the Family Health Strategy in the municipalities of Ceará between 2012 and 2014. METHODS Cross-sectional study, using secondary data from the external evaluation of the 1st (2012) and 2nd (2014) cycle of the National Program for Improvement of Access and Quality of Primary Care in Ceará. A total of 20 composite indicators were used to verify the quality of infrastructure and work process. RESULTS Data from 183 (99.4%) of the 184 municipalities of Ceará were collected in both cycles. A total of 1,441 teams were evaluated for the infrastructure and 800 for the work process. Among the 20 composite indicators evaluated, 18 presented an improvement, but in a non-homogeneous way, ranging between 0.0 and 413.5%. We observed that the lower the initial value of the indicator, the greater the variation in quality between 2012 and 2014. The indicators of infrastructure and work process were influenced by the regional health system and population size of the municipality, being more evident the influence on the variables of the work process. CONCLUSIONS We identified that quality improvements related to infrastructure and work process occurred in the period of implementation of the program in the state of Ceará in an equitable manner, being influenced by population size and regional health system, showing the influence of the context in the implementation of public policies of this nature.