Adherence to secondary prevention measures after acute coronary syndrome in patients associated exclusively with the public and private healthcare systems in Brazil.

Adherence to secondary prevention measures after acute coronary syndrome (ACS) is essential to prevent disease recurrence. In Brazil, the Brazilian Unified Health System (SUS, in Portuguese), and the private healthcare system (PHCS) coexist. We aimed to evaluate the adherence to secondary prevention in patients with ACS who were assisted by either SUS or PHCS. In this longitudinal prospective study, patients with ACS were admitted to the four cardiological reference hospitals of Sergipe, three of which assisted PHCS users, and one, SUS users. We analyzed the two patient care models with multiple logistic regression models for adherence to physical activity, pharmacotherapy, and smoking cessation. We enrolled 581 volunteers in this study: 44.1 % from SUS and 55.9 % from PHCS. PHCS users showed greater adherence to pharmacotherapy at both 30 and 180 (p = 0.001) days after ACS with better results in all classes of medications (p < 0.05) than SUS users did. They also showed better adherence to physical activity (p = 0.047). There was no distinction between the groups regarding smoking cessation. The secondary prevention measures after ACS were more effective in PHCS users than in SUS users due to better adherence, especially to pharmacotherapy and regular physical activity.

Quality of Life among Patients with Acute Coronary Syndromes Receiving Care from Public and Private Health Care Systems in Brazil.

(1) Background: Quality of life (QOL) is used as a health indicator to assess the effectiveness and impact of therapies in certain groups of patients. This study aimed to analyze the QOL of patients with acute coronary syndrome (ACS) who received medical treatment by a public or private health care system. (2) Methods: This observational, prospective, longitudinal study was carried out in four referral hospitals providing cardiology services in Sergipe, Brazil. QoL was evaluated using the Medical Outcomes Study 36-Item Short-Form Health Survey. The volunteers were divided into two groups (public or private health care group) according to the type of health care provided. Multiple linear regression models were used to evaluate QoL at 180 days after ACS. (3) Results: A total of 581 patients were eligible, including 44.1% and 55.9% for public and private health care, respectively. At 180 days after ACS, the public health care group had lower QoL scores for all domains (functional capacity, physical aspects, pain, general health status, vitality, social condition, emotional profile, and health) (p < 0.05) than the private group. The highest QoL level was associated with male sex (p < 0.05) and adherence to physical activity (p ≤ 0.003) for all assessed domains. (4) Conclusions: This shows that social factors and health status disparities influence QoL after ACS in Sergipe.

Harvesting rainwater for food security: farmers' perceptions of the Boardwalk Cisterns Program in Alagoas, Brazil.

INTRODUCTION: Boardwalk Cisterns is a government program that aims to attend a population with precarious access to water in Brazil. Developed as part of the Zero Hunger strategy, it intends to increase food security and contribute to the realization of the human right to food. The objective of this study was to assess farmers' perceptions of the Boardwalk Cisterns program and its impact on the food security situation of beneficiary households. METHODS: Data were collected through a descriptive cross-sectional quali-quantitative survey. Questionnaires were applied to farming families selected from two municipalities in the state of Alagoas (Northeast Brazil), containing questions on sociodemographic characteristics, production methods, and food security status. The Free Evocation Technique for social representation, analyzed through the software Ensemble of Programs Permettant L'analyze des Évocations, was used to ascertain farmers' perceptions of the program. RESULTS: The study showed a positive perception of the interviewees in relation to the boardwalk cisterns. The program brought some improvement in the agricultural production conditions and, consequently, in the food security situation of the households. Corn, beans and cassava were the most common crops, with almost half of this production (48.3%) destined for consumption by the families themselves. Farmers also reported having more water, allowing them to plant more fruit trees, as well as medicinal and ornamental plants. Nevertheless, 79.1% of the households interviewed were still in a situation of food insecurity, of which 28.1% were classified as mild food insecurity, 26% as moderate food insecurity, and 25% as severe food insecurity. CONCLUSION: Farmers were correct in their perception that the Boardwalk Cisterns program improved their food security situation. The program resulted in greater access to water, and greater production and consumption of food. However, by itself, the Boardwalk Cisterns program was not enough to raise beneficiary families above their food-insecure status. The program alleviated the problem of food insecurity, but other complementary government interventions are needed to guarantee the food security of families living in extreme poverty.

Low adherence to traditional dietary pattern and food preferences of low-income preschool children with food neophobia.

OBJECTIVE: To associate dietary patterns and food neophobia in low-income preschoolers. DESIGN: This was a cross-sectional study using a semi-structured questionnaire for socio-demographic data, birth conditions and breast-feeding history. Food neophobia was assessed using an adapted version of the Child Food Neophobia Scale. Children's nutritional status was assessed using BMI-for-age and height-for-age Z-scores. Dietary patterns were estimated using a semi-quantitative FFQ through exploratory factor analysis. Multiple linear regression was used to test for an association between food neophobia and dietary pattern adherence. SETTING: Philanthropic childhood education schools in Aracaju, an urban community in northeastern Brazil, between July and December 2017. PARTICIPANTS: Two hundred fourteen children aged 3-6 years and their parents. RESULTS: The percentages of low/medium and high food neophobia among preschoolers were 85·9 % and 11·2 %, respectively. Children with high food neophobia more frequently consumed ultra-processed foods rich in sugars (snacks, filled and unfilled cookies and sweets), as well as protein-rich foods (white meat, cheese and yogurt). Three dietary patterns were identified (traditional, snacks and school snacks). Children with a high level of neophobia had lower adherence to traditional dietary patterns. CONCLUSIONS: A high level of food neophobia among socially vulnerable preschoolers is an eating behaviour related to unhealthy eating and is associated with the poorest diet in typical foods.

Food and nutritional security of semi-arid farm families benefiting from rainwater collection equipment in Brazil.

The objective of this study was to identify and describe the experience of family farmers and their respective families after using the Boardwalk Cistern rainwater collection system and consequent impacts on nutrition profile and food security. This is a qualitative-quantitative study conducted in two municipalities in the semi-arid region of the state of Alagoas, northeastern Brazil. A structured questionnaire was applied to collect information on demographic and socioeconomic status and household access to food, based on the Brazilian Food Insecurity Scale of 29 family farmers' households. Food intake was assessed by food intake markers of the Ministry of Health, while nutritional status was determined by measuring the weight and height of all family members and waist circumference of adults. Nutrition diagnosis was performed using the cutoff points of body mass index for age. Three focus groups were conducted, and the information collected was analyzed through Content Analysis with the aim of knowing the participants' perception of the effects of the received water equipment. The study showed a high prevalence of excess weight (52.7%) and high risk for cardiovascular diseases (35.9%) marked by a high salt and sugar in the food intake. Food Insecurity Scale showed that food insecurity is a problem occurring in 75% of these families. However, focus groups showed that families have a positive perception of Boardwalk Cisterns for their food security. They believe that agricultural production has improved, thereby offering a wider range of foods and, consequently, improving food security. In conclusion, this study highlights the importance of water access programs for food production within public policies to guarantee FNS.

Spatial analysis of cerebral palsy in children and adolescents and its association with health vulnerability.

Cerebral Palsy (CP) is commonly associated with low socioeconomic status. Use of spatial statistics and a Geographic Information Systems (GIS) are scarce and may contribute to the understanding of CP in a social context. To that end a spatial analysis of CP in children and adolescents was performed to analyze the association of CP with levels of vulnerability in a city (Aracaju, Sergipe) in north-eastern Brazil. In addition, an ecological study was conducted with data obtained from a populationbased survey and secondary data. Exploratory spatial data analysis and linear regression were used. A total of 288 CP cases were identified, with a prevalence of 1.65/1,000 and differences among city neighbourhoods ranging from 0-4/1,000. The mean age of cases studied was 9 years 1 month, with a standard deviation of 5 years 2 months. Most study subjects with cerebral palsy (163) were male (56.4%). The distribution of CP in the study population was not homogeneous throughout the territory. Some areas had clusters, with more cases associated with areas of high vulnerability. Spatial data analysis using GIS was useful to gain an epidemiological understanding of CP distribution that can guide decisionmaking with respect to production, distribution, and regulation of health goods as well as services at the local level.

Consistência interna da Escala Brasileira de Insegurança Alimentar aplicada por entrevista telefônica e preenchida pelo entrevistado / Internal consistency of brazilian food insecurity scale carried out by a phone interview and completed by the interviewes

OBJECTIVE: To evaluate the internal consistency and predictive validity of the Brazilian Food Insecurity Scale applied by two unconventional methods, as well as its external validity expressed in relation to the per capita family income. METHODS: The Scale was sent to the household of 488 adolescents enrolled in fifth grade of public schools of Piracicaba, Sao Paulo, Brazil, composing the initial sample of the main study. However, since some scholars' responsible did not send the filled questionnaire back, it was necessary to conduct the interview over the phone. After applying the exclusion criteria, the final sample consisted in 350 scholars, where 310 questionnaires were self-administered and 40 were responded by phone. Cronbach's alpha was used toverify internal consistency and Pearson's Chi-squared was applied to verify predictivevalidity. RESULTS: Cronbach's alpha coefficients was 0.91 and 0.92 to self administered Scale and to the Scale conduct by phone, respectively. Education level and per capita household income were higher among households in which Scale was completed by phone. The proportion of scholars whose families were beneficiaries of Cash transfer programs, was higher among the group which the Scale was self-administered. CONCLUSION: The prevalence of food insecurity did not differ between both groups, but it is possible to assume that the self-administered group is more vulnerable, since lower income and higher participation in Cash transfer programs were observed. Both application methods showed good internal consistency and predictive validity. Therefore, both can be used in further studies

OBJETIVO: Avaliar a consistência interna da Escala Brasileira de Insegurança Alimentar aplicada por dois métodos não convencionais, assim como sua validade externa expressa na relação com rendimento familiar per capita. MÉTODOS: A escala foi enviada para os domicílios dos 488 adolescentes da amostra inicial, matriculados na 5ª série de escolas públicas de Piracicaba, São Paulo, Brasil. Como parte de seus responsáveis não devolveu o questionário preenchido, realizou-se contato telefônico para a execução da entrevista. Após a aplicação dos critérios de exclusão, a amostra final do estudo foi constituída por 350 escolares, sendo 310 com questionários autopreenchidos e 40 respondidos por telefone. Aplicou-se o teste de alpha de Cronbach e Chi-quadrado de Pearson. RESULTADOS: O coeficiente alpha de Cronbach para a escala autopreenchida foi de 0,91, enquanto que para a escala aplicada por entrevista telefônica foi de 0,92. Puderam ser observados maiores níveis de escolaridade e renda familiar dentre domicílios em que a escala foi preenchida por telefone. Já nos domicílios em que os próprios responsáveis a preencheram, foi observada maior proporção de escolares cuja família recebia benefícios de programas de transferência de renda. CONCLUSÃO: A prevalência de insegurança alimentar não foi diferente entre os dois grupos, embora o grupo que a autopreencheu apresente maior vulnerabilidade, já que revelam menor rendimento. e maior participação em programas sociais. Ambos os métodos de preenchimento mostraram boa consistência interna e boa validade preditiva, podendo ser utilizados em futuros estudos

Prevalência da inadequação no consumo de nutrientes entre gestantes atendidas em unidades básicas de saúde / Prevalence of inadequacy in nutrient consumption among pregnant women attended in basic health units / Prevalencia de la inadecuación del consumo de nutrientes por embarazadas asistidas en unidades básicas de salud

Objetivo: Avaliar a prevalência da inadequação no consumo de nutrientes entre gestantes atendidas em Unidades Básicas de Saúde de Picos-PI, Brasil. Métodos: Estudo transversal envolvendo 72 gestantes. Coletaram-se dados sociodemográficos e de estilo de vida, além de informações sobre ingestão dietética, a partir de 3 recordatórios alimentares de 24 horas. Calcularam-se prevalências de inadequação para carboidrato, cálcio, ferro, vitaminas A, C, E e ácido fólico, baseando-se em suas respectivas médias estimadas (EAR); avaliouse a adequação da ingestão energética habitual em relação ao gasto energético usual indiretamente pelo índice de massa corporal (IMC). Resultados: Verificou-se que 86,1% (n=62) das gestantes apresentavam renda per capita inferior a 1 salário mínimo, 4,2% (n=3) fumavam e 11,1% (n=8) faziam uso de bebida alcoólica durante a gestação. No que se refere ao consumo, os carboidratos e a vitamina C tiveram prevalência de inadequação menor que 2%, enquanto a vitamina A ficou entre 30% e 50%. Cálcio, ferro, ácido fólico e vitamina E tiveram prevalência de inadequação maior que 98%. Ao considerar que 38,9% (n=28) das gestantes estavam com excesso de peso e 4,2% (n=3), com baixo peso, presume-se elevada prevalência de consumo inadequado de energia. Conclusão: Houve elevada prevalência de inadequação no consumo dos micronutrientes cálcio, ferro, ácido fólico e vitamina E nas gestantes, além de inadequação de consumo energético ? situação preocupante, visto que pode desencadear consequências adversas para o binômio mãe-filho.

Objective: To assess the dietary intake of pregnant women attended in Basic Health Units of Picos-Piauí. Methods: Cross-sectional study involving 72 pregnant women. Sociodemographic and lifestyle data was collected, plus information on dietary intake from three 24-hour food recalls. The prevalence of inadequacy for carbohydrate, calcium, iron, A, C, E vitamins, and folate were calculated based on their respective estimated average requirements (EAR), while the adequacy of habitual energy intake relative to usual energy expenditure was estimated indirectly by body mass index (BMI). Results: It was found that 86.1% of the pregnant women had a per capita income lower than one minimum wage, 4.2% were smokers and 11.1% used alcohol during pregnancy. As regards consumption, carbohydrates and vitamin C had inadequacy prevalence lower than 2%, while vitamin A ranged from 30 to 50%. Calcium, iron, folate, and vitamin E had inadequacy prevalence higher than 98%. Considering that 38.9% of the pregnant women were overweight and 4.2%, underweight, it is assumed that the prevalence of energy intake inadequacy is high. Conclusion: There was a high inadequacy prevalence in the micronutrients calcium, iron, folate, and vitamin E intake in pregnant women, as well as high inadequacy of energy consumption ? a disturbing situation, since it can trigger adverse consequences for the mother-baby binomial.

Objetivo: Evaluar la prevalencia de la inadecuación del consumo de nutrientes por embarazadas asistidas en Unidades Básicas de Salud de Picos-PI, Brasil. Métodos: Estudio transversal com 72 embarazadas. Se recogieron datos sociodemográficos, Del estilo de vida e informaciones sobre ingesta dietética a partir de 3 recordatorios de 24 horas. Se calculó las prevalencias de inadecuación para carbohidrato, calcio, hierro, vitaminas A, C, E y ácido fólico basándose en sus respectivas medias estimadas (EAR); se evaluó la adecuación de ingesta energética habitual respecto al gasto energético usual de modo indirecto a través Del índice de masa corporal (IMC). Resultados: Se verificó que El 86,1% (n=62) de las embarazadas presentaban renta per capita menor que 1 sueldo mínimo, el 4,2% (n=3) fumaban y el 11,1% (n=8) tomaban bebida alcohólica en el embarazo. Respecto al consumo, los carbohidratos y la vitamina C tuvieron prevalência de inadecuación menor que el 2% mientras que la vitamina A se quedó entre el 30% y el 50%. Calcio, hierro, ácido fólico y vitamina E tuvieron prevalencia de inadecuación mayor que el 98%. Considerando que el 38,9% (n=28) de las embarazadas tenían exceso de peso y el 4,2% (n=3) bajo peso, presúmase de elevada prevalencia del consumo inadecuado de energía. Conclusión: Hubo elevada prevalencia de inadecuación del consumo de los micronutrientes calcio, hierro, ácido fólico y vitamina E en las embarazadas además de la inadecuación del consumo energético ? situación preocupante ya que puede desencadenar consecuencias adversas para el binomio madre-hijo.

Assessment of the usability of a nutritional epidemiology computerized system / Avaliacao da usabilidade de um sistema computadorizado de epidemiologia nutricional

INTRODUCTION: Epidemiological research has been adhering to new technologies, such as computer systems, and using the Internet as a tool. Usability is a characteristic of a specific product concerning the facility to use it, its speed and the facility to learn how to use it. It should also not present errors, or these must be easy to solve, in case they occur, thus providing high satisfaction to users. OBJECTIVE: To evaluate the usability of the "System of health and nutrition monitoring - nutrition of school children" (NUTRISIM). METHODS: A sample of 17 Information Technology professionals evaluated the system and answered the "Questionnaire for System Usability", which determines the level of usability of systems by the Fuzzy Logic. The questionnaire contains 30 questions, which are divided into six metrics. The usability of the system determines six usability criteria in a large Fuzzy scale. RESULTS: With the exception of the metric "error control", all metrics were analyzed as "very good". The metrics "error control", "efficiency" and "satisfaction" presented medium amplitude, which is a better result in relation to the metrics "easy to learn", "easy to remember" and "effectiveness", which was assessed as "high". CONCLUSION: The study showed that the system is easy to be learned and used, but the answers are scattered. The instrument proved to be a useful tool to monitor and evaluate health and dietary intake in epidemiologic studies. .

INTRODUÇÃO: As pesquisas epidemiológicas vêm aderindo a novas tecnologias, tais como sistemas computadorizados, e utilizando a Internet como ferramenta. A usabilidade é uma característica de um determinado produto relativo à facilidade de uso, à rapidez para aprender a usá-lo, ao fato de não gerar erros ou à facilidade de resolução dos mesmos, caso ocorram, oferecendo um alto grau de satisfação para seus usuários. OBJETIVO: Avaliar a usabilidade do "Sistema de monitoramento da saúde e alimentação - nutrição do escolar" (NUTRISIM). METÓDOS: A avaliação do sistema foi realizada pela Lógica Fuzzy, através do "Questionário para Usabilidade de Sistemas", composto por 30 questões que se dividiam em seis métricas, respondido por 17 profissionais de Tecnologia da Informação. A avaliação da usabilidade do sistema consiste em determinar, para cada um dos seis critérios de usabilidade, um conceito na escala Fuzzy. RESULTADOS: Todas as métricas obtiveram avaliação "muito boa" com exceção da relacionada com o "controle de erros". As amplitudes referentes às métricas "controle de erros", "eficiência" e "satisfação" foram consideradas com designação "média", melhor resultado do que para as métricas "facilidade de aprender", "facilidade de relembrar" e "eficácia", que apresentaram classificação "alta". CONCLUSÃO: Pode-se perceber que o sistema é fácil de aprender e de usar, porém apresenta dispersão entre as respostas. O instrumento mostrou ser uma ferramenta útil para a avaliação e monitoramento da saúde e do consumo alimentar em pesquisas epidemiológicas de pequeno a grande porte. .

Assessment of the usability of a nutritional epidemiology computerized system.

INTRODUCTION: Epidemiological research has been adhering to new technologies, such as computer systems, and using the Internet as a tool. Usability is a characteristic of a specific product concerning the facility to use it, its speed and the facility to learn how to use it. It should also not present errors, or these must be easy to solve, in case they occur, thus providing high satisfaction to users. OBJECTIVE: To evaluate the usability of the "System of health and nutrition monitoring - nutrition of school children" (NUTRISIM). METHODS: A sample of 17 Information Technology professionals evaluated the system and answered the "Questionnaire for System Usability", which determines the level of usability of systems by the Fuzzy Logic. The questionnaire contains 30 questions, which are divided into six metrics. The usability of the system determines six usability criteria in a large Fuzzy scale. RESULTS: With the exception of the metric "error control", all metrics were analyzed as "very good". The metrics "error control", "efficiency" and "satisfaction" presented medium amplitude, which is a better result in relation to the metrics "easy to learn", "easy to remember" and "effectiveness", which was assessed as "high". CONCLUSION: The study showed that the system is easy to be learned and used, but the answers are scattered. The instrument proved to be a useful tool to monitor and evaluate health and dietary intake in epidemiologic studies.

Desenvolvimento de um Recordatório de 24 horas estruturado e computadorizado para acompanhamento do consumo alimentar de escolares / Development of a structured and automated 24-hour Recall to evaluate dietary intake of schoolchildren

The 24-hour Dietary Recall is considered an efficient method to collect diet data and is also widely used in population food intake monitoring. However, it requires highly qualified interviewers, which hinders its use for large samples. The objective of this study was to develop a structured and automated 24-hour Dietary Recall (R24ec) to evaluate schoolchildren and adolescent food intake, with both online and offline modes. The foods chosen for the R24ec were pre-defined from a secondary database that represents the age range of the interviewee. Using a computer, the respondents described all foods and beverages they consumed the day before the interview. The R24ec includes six pre-defined meals, incorporated in questions that contextualize the daily routines and time of consumption on the day before the interview. It also contains a list of food divided into food groups and subgroups. During the interview, non-listed items were recorded in the blanks provided for this purpose. The R24ec also includes a food photographic atlas containing different types of food; it was used as a visual aid so that the interviewees could select portion sizes. The structured 24-hour Dietary Recall was successfully developed. It is posted at the University of Sao Paulo website: www.fsp.usp.br/nutrisim.

El uso del Recordatorio de 24 horas es un buen método para recolectar datos sobre dieta y se aplica al acompañamiento alimentario de la población. Este método, sin embargo, requiere encuestadores altamente entrenados, lo que dificulta su uso en investigaciones a gran escala. El objetivo de este estudio fue elaborar un Recordatorio de 24 horas estructurado, automatizado y computarizado (R24ec) para evaluación del consumo alimentario de niños y adolescentes; el Recordatorio puede ser completado de manera online y offline Los alimentos presentes en el R24ec fueron pre-definidos a partir de una base de datos secundaria, representativa de las edades estudiadas. Los entrevistados deben describir todos los alimentos y bebidas consumidos el día anterior a la entrevista, a través del uso de una PC. El R24ec contiene seis comidas pre-definidas, incluye preguntas que contextualizan las rutinas y los lugares visitados el día anterior. Contiene, además, una lista de alimentos dividida en grupos y subgrupos alimentares. Pueden adicionarse nuevos ítems, usando el menú ?ítems no encontrados?. Se desarrolló, además, un atlas fotográfico que ilustra diferentes tipos de alimentos y que ayuda visualmente a los entrevistados a seleccionar los tamaños de las porciones ingeridas. El Recordatorio de 24 horas estructurado fue desarrollado con éxito y el mismo está hospedado en el sitio web www.fsp.usp.br/ nutrisim de la Universidade de São Paulo.

O Recordatório de 24 horas é considerado um ótimo método para coletar dados dietéticos e é muito utilizado no acompanhamento alimentar da população. Porém requer entrevistadores altamente treinados, o que dificulta o seu uso em pesquisas com grandes amostras. O objetivo deste estudo foi desenvolver um Recordatório de 24 horas estruturado e computadorizado (R24ec) de autopreenchimento para avaliação do consumo alimentar de crianças e adolescentes nos modos on-line e off-line. Os alimentos escolhidos para o R24ec foram pré-definidos a partir de um banco de dados secundário representativo para esta faixa etária. Os entrevistados devem descrever todos os alimentos e bebidas consumidos no dia anterior à entrevista através de um computador. O R24ec foi desenvolvido contendo seis refeições pré-definidas, embutidas em questões que contextualizam as rotinas e locais do dia anterior. Contém ainda uma lista de alimentos dividida em grupos alimentares e subgrupos. Durante a entrevista, itens não listados podem ser adicionados em um grupo de ?itens não encontrados?. Desenvolveu-se ainda um atlas fotográfico contendo diferentes tipos de alimentos, que serve como auxílio visual, nele os entrevistados podem selecionar tamanhos de porções. O Recordatório de 24 horas estruturado foi desenvolvido com sucesso e está hospedado no site www.fsp.usp.br/nutrisim da Universidade de São Paulo.

Estimativa de valores corrigidos e o efeito da correção pelo erro de medida em dados dietéticos obtidos por Questionário de Frequência Alimentar para Adolescentes (QFAA) / Estimate of corrected values and the effect of correction for measurement error in dietary data obtained by the Food Frequency Questionnaire for Adolescents (AFFQ)

O objetivo do estudo foi estimar valores corrigidos para os dados dietéticos obtidos por QFAA na amostra principal de uma coorte de adolescentes e ilustrar o efeito desta abordagem nas informações de consumo alimentar. Os adolescentes foram avaliados em dois momentos, com intervalo médio de 12 meses. Em 2004, participaram 393 escolares, sendo reavaliado, em 2005, um total de 289 adolescentes. Dados dietéticos obtidos por Questionário de Frequência Alimentar para Adolescentes (QFAA) foram corrigidos utilizando-se os coeficientes de regressão estimados a partir da média de dois Recordatórios de 24 horas (R24h) da subamostra. Os valores corrigidos se aproximaram dos obtidos por R24h na subamostra. Em 2004 e 2005 observou-se diferença significativa entre as médias de consumo do QFAA antes e após a calibração para todos os nutrientes. Com o uso dos dados corrigidos aumentou a proporção de escolares que apresentaram consumo de fibras abaixo do recomendado. Portanto, conclui-se que dados calibrados podem ser utilizados para a obtenção de associações corrigidas devido ao deslocamento dos indivíduos dentro de categorias pré-determinadas.

The scope of this study was to estimate calibrated values for dietary data obtained by the Food Frequency Questionnaire for Adolescents (FFQA) and illustrate the effect of this approach on food consumption data. The adolescents were assessed on two occasions, with an average interval of twelve months. In 2004, 393 adolescents participated, and 289 were then reassessed in 2005. Dietary data obtained by the FFQA were calibrated using the regression coefficients estimated from the average of two 24-hour recalls (24HR) of the subsample. The calibrated values were similar to the the 24HR reference measurement in the subsample. In 2004 and 2005 a significant difference was observed between the average consumption levels of the FFQA before and after calibration for all nutrients. With the use of calibrated data the proportion of schoolchildren who had fiber intake below the recommended level increased. Therefore, it is seen that calibrated data can be used to obtain adjusted associations due to reclassification of subjects within the predetermined categories.

[Estimate of corrected values and the effect of correction for measurement error in dietary data obtained by the Food Frequency Questionnaire for Adolescents (AFFQ)]. / Estimativa de valores corrigidos e o efeito da correção pelo erro de medida em dados dietéticos obtidos por Questionário de Frequência Alimentar para Adolescentes (QFAA).

The scope of this study was to estimate calibrated values for dietary data obtained by the Food Frequency Questionnaire for Adolescents (FFQA) and illustrate the effect of this approach on food consumption data. The adolescents were assessed on two occasions, with an average interval of twelve months. In 2004, 393 adolescents participated, and 289 were then reassessed in 2005. Dietary data obtained by the FFQA were calibrated using the regression coefficients estimated from the average of two 24-hour recalls (24HR) of the subsample. The calibrated values were similar to the the 24HR reference measurement in the subsample. In 2004 and 2005 a significant difference was observed between the average consumption levels of the FFQA before and after calibration for all nutrients. With the use of calibrated data the proportion of schoolchildren who had fiber intake below the recommended level increased. Therefore, it is seen that calibrated data can be used to obtain adjusted associations due to reclassification of subjects within the predetermined categories.

Reprodutibilidade de questionário informatizado de atividade física em adolescentes / Reliability of computerized questionnaire of physical activity in adolescents

O questionário tem sido um instrumento amplamente utilizado para avaliar atividade física habitual de adolescentes. O objetivo do presente estudo foi mensurar a reprodutibilidade de uma versão atualizada e informatizada do Questionário de Avaliação da Atividade Física para Adolescentes (QAFA) de Florindo et al. (2006). Participaram do estudo 135 alunos (61 meninos e 74 meninas) do 5º ao 8º ano escolar, entre 10 e 14 anos de idade (média= 11,57; DP=1,15 anos), matriculados em uma escola pública do município de Guarulhos. Foram utilizadas replicas da aplicação do questionário, com intervalo de duas semanas, para verificar a reprodutibilidade. Para a análise descritiva da amostra utilizou-se medidas de tendência central e dispersão. O teste de Kolmogorov Smirnov foi utilizado para testar a normalidade e o teste de Mann Whitney para comparação entre os gêneros. Para reprodutibilidade utilizou-se o coeficiente de correlação de Spearman, índice Kappa e a técnica de Bland-Altman. Os resultados revelaram coeficientes de correlação (ajustados) de 0,64 e 0,63 (p<0,05) para os meninos no que se refere aos escores de atividade física semanal e anual, respectivamente. Entre as meninas os coeficientes de correlação (ajustados) foram de 0,58 e 0,41 (p<0,05) para os escores de atividade física semanal e anual, respectivamente. De acordo com a técnica de Bland-Altman observou-se concordância satisfatória entre as replicas de aplicação do questionário. Conclui-se que o questionário informatizado pode ser recomendado para avaliar a atividade física habitual em estudos epidemiológicos com adolescentes por gerar dados reprodutíveis e apresentar vantagens referentes à informatização.

The questionnaire has been an important tool widely used to evaluate the frequency of the physical activity in adolescents. The aim of this study was to measure a reliability of an updated and computerized version of "Questionário de avaliação da atividade física de adolescentes of Florindo et al. (2006)". This study was applied by 135 students, (61 boys and 74 girls) from 5th to 8th grade, among 10 to 14 years old (average = 11,57; DP= 1,15 years old) all subscribed in a public school from Guarulhos. There were used copies from the questionnaire appliance, in between 2 weeks to measure the reliability. For descriptive analysis they have used measures of central tendency and dispersion. The Kolmogorov Smirnov test was used to verify the normality and Mann Whitney test to compare between genders. To reproducibility was used a Spearman's correlation coefficient, Index kappa and technique of Bland-Altman. The results have shown correlation coefficient (adjusted) from 0,64 and 0,63 (p<0,05) for boys referring to scores in weekly physical activities and annual, respectively. Among girls the correlation coefficient (adjusted) were from 0,58 and 0,41 (p<0,05) referring to scores in weekly physical activities and annual, respectively. According to the technique of Bland-Altman we could observe satisfactory concordance between the copies from the questionnaire appliance. We concluded the computerized questionnaire can be recommended to evaluate the frequency of the physical activity in adolescents in epidemiological studies due to the advantages of computerization and generation of reproductive data.

[Calibration study of the Food Frequency Questionnaire for Adolescents (AFFQ)]. / Estudo de calibração do Questionário de Frequência Alimentar para Adolescentes (QFAA).

In order to establish calibration factors of the Adolescent Food Frequency Questionnaire (AFFQ), 74 boys and girls from Piracicaba (SP, Brazil) with ages ranging from 10 to 14 took part in the study. Dietary intake (assessed by the food frequency questionnaire and 24-hour recall) was assessed and adjusted for energy intake. Descriptive statistics, variance analysis using one classification factor, Pearson's correlation coefficients and linear regression were performed. The average of two 24-hour recalls was used as a reference for calibration of data. Calibration coefficients (λ) ranged from -0.07 (iron) to 0.40 (vitamin C) revealing substantial error in the dietary method tested, albeit similar to those observed in the literature. As these coefficients were low, they indicate the need for reformulating the instrument regarding some nutrients, though application was not considered advisable for correcting information on iron and retinol. The methodology used to calibrate dietary data can consider measurement error in the assessment when its assumptions are respected, since violations of these assumptions may lead to other errors that are difficult to predict.

Estudo de calibração do Questionário de Frequência Alimentar para Adolescentes (QFAA) / Calibration study of the Food Frequency Questionnaire for Adolescents (AFFQ)

Para determinar fatores de calibração do Questionário de Frequência Alimentar para Adolescentes (QFAA), participaram do estudo 74 adolescentes de Piracicaba (SP), com idades entre 10 e 14 anos. Dados de consumo alimentar foram levantados por meio de um QFAA e dois recordatórios de 24 horas ajustados pela energia. Foram realizadas análises descritivas, análise de variância com um fator de classificação, coeficientes de correlação de Pearson e regressão linear. A média dos dois recordatórios foi utilizada como referência para calibrar os dados. Os coeficientes de calibração variaram de -0,07 (ferro) a 0,40 (vitamina C), mostrando substancial erro no método de inquérito dietético testado, mas sendo semelhantes aos observados na literatura. Devido ao fato de se apresentarem baixos, indicam a necessidade de reformulação do instrumento para alguns nutrientes, sendo desaconselhada sua aplicação para corrigir informações de ferro e retinol. A metodologia utilizada é capaz de considerar nas análises os erros de mensuração quando suas pressuposições são respeitadas, uma vez que violações desses pressupostos podem levar ao surgimento de outros erros de difícil predição.

In order to establish calibration factors of the Adolescent Food Frequency Questionnaire (AFFQ), 74 boys and girls from Piracicaba (SP, Brazil) with ages ranging from 10 to 14 took part in the study. Dietary intake (assessed by the food frequency questionnaire and 24-hour recall) was assessed and adjusted for energy intake. Descriptive statistics, variance analysis using one classification factor, Pearson's correlation coefficients and linear regression were performed. The average of two 24-hour recalls was used as a reference for calibration of data. Calibration coefficients (λ) ranged from -0.07 (iron) to 0.40 (vitamin C) revealing substantial error in the dietary method tested, albeit similar to those observed in the literature. As these coefficients were low, they indicate the need for reformulating the instrument regarding some nutrients, though application was not considered advisable for correcting information on iron and retinol. The methodology used to calibrate dietary data can consider measurement error in the assessment when its assumptions are respected, since violations of these assumptions may lead to other errors that are difficult to predict.

Padrões alimentares, participação em programas sociais e demais fatores associados à insegurança alimentar e nutricional em adolescentes de escolas públicas no município de Piracicaba, São Paulo / Food patterns, participation in social programs and other factors related to food insecurity among adolescents enrolled in public schools of Piracicaba

Objetivo. Verificar a existência de associações entre a insegurança alimentar e nutricional e padrões alimentares, a participação em programas sociais, dentre outros fatores em adolescentes de escolas públicas de Piracicaba (SP). Métodos. Este estudo foi conduzido em amostra probabilística de 488 escolares da 5ª série do ensino fundamental da rede pública de Piracicaba. Foram coletadas informações demográficas, antropométricas, bioquímicas e de pressão arterial, sobre a adesão à alimentação escolar, e de consumo alimentar a partir de Questionário de Frequência Alimentar Simplificado para Adolescentes (QFASA). Também foram obtidas informações sobre as situações de insegurança alimentar e nutricional (IAN), participação em programas de transferência de renda e informações socioeconômicas. Foram realizadas análises descritivas, testes de Qui-quadrado de Pearson, t de Student e U de Mann Whitney. Padrões alimentares foram definidos a partir de Análise de Componentes Principais. A análise de regressão logística avaliou a influência de múltiplas variáveis na presença de IAN (variável dependente dicotômica). O estudo foi aprovado pelo Comitê de Ética da Faculdade de Saúde Pública. Resultados. De 308 escolares da amostra final, 54,5 por cento eram meninas. Mais de 40 por cento dos lares de escolares entrevistados apresentaram algum nível de IAN. Observaram-se elevadas proporções de adesão a alimentação escolar (70 por cento) e de excesso de peso (39 por cento). O principal padrão alimentar observado contou com maior participação de doces, massas, carnes, salgados, pães, frutas e hortaliças.

Validation of a food frequency questionnaire to assess the consumption of carotenoids, fruits and vegetables among adolescents: the method of triads.

The aim of this study was to validate the intake of carotenoids, fruits and vegetables estimated by the Food Frequency Questionnaire for Adolescents (FFQA) using the method of triads. Blood samples were collected from 80 elementary school adolescents to assess serum levels of ß-carotene. Partial correlation coefficients (r) were calculated between an estimated intake of carotenoids, fruits and vegetables and the serum levels of ß-carotene. Validity coefficients were calculated using the method of triads. With the exception of carotenoids, partial r from the food frequency questionnaire (FFQ) were greater than those of the 24-hour recall (24hR). The fruit/vegetable group showed the highest partial r for the FFQ (r = 0.235) and the 24hR (r = 0.137). The highest validity coefficient was obtained for the vegetable group, as assessed by the FFQ (r = 0.873). On average, the validity coefficient values for the FFQ were greater than those obtained for the 24hR or the ß-carotene serum levels. The FFQA is an accurate tool for estimating the intake of carotenoids, fruits and vegetables in this population group.

Validation of a food frequency questionnaire to assess the consumption of carotenoids, fruits and vegetables among adolescents: the method of triads / Validação de um questionário de frequência alimentar para avaliar o consumo de carotenóides, frutas e hortaliças: o método das tríades

The aim of this study was to validate the intake of carotenoids, fruits and vegetables estimated by the Food Frequency Questionnaire for Adolescents (FFQA) using the method of triads. Blood samples were collected from 80 elementary school adolescents to assess serum levels of β-carotene. Partial correlation coefficients (r) were calculated between an estimated intake of carotenoids, fruits and vegetables and the serum levels of β-carotene. Validity coefficients were calculated using the method of triads. With the exception of carotenoids, partial r from the food frequency questionnaire (FFQ) were greater than those of the 24-hour recall (24hR). The fruit/vegetable group showed the highest partial r for the FFQ (r = 0.235) and the 24hR (r = 0.137). The highest validity coefficient was obtained for the vegetable group, as assessed by the FFQ (r = 0.873). On average, the validity coefficient values for the FFQ were greater than those obtained for the 24hR or the β-carotene serum levels. The FFQA is an accurate tool for estimating the intake of carotenoids, fruits and vegetables in this population group.

O objetivo do estudo foi validar a ingestão de carotenóides, frutas e hortaliças estimada pelo Questionário de Frequência Alimentar para Adolescentes (QFAA) utilizando o método das tríades. Foram coletadas amostras sanguíneas de 80 adolescentes de uma escola de Ensino Fundamental para análise do b-caroteno plasmático. Coeficientes de correlação (r) parciais foram obtidos entre a ingestão de carotenóides, frutas e hortaliças e o b-caroteno plasmático. Os coeficientes de validade foram estimados a partir do método das tríades. O QFA apresentou valores de r parcial superiores ao recordatório alimentar de 24 horas (R24h), exceto para carotenóides. O grupo das frutas/hortaliças apresentou os maiores valores de r parciais tanto para o questionário de frequência alimentar (QFA) (r = 0,235) quanto para R24h (r = 0,137). O maior coeficiente de validade foi o do grupo de hortaliças avaliado pelo QFA (r = 0,873). Os valores de coeficiente de validade observados para o QFA foram em média superiores aos obtidos para R24h e b-caroteno plasmático. O QFAA é um instrumento com boa acurácia para estimar o consumo de carotenóides, frutas e hortaliças nesse grupo populacional.

Validity and reliability of self-reported weight and height measures for the diagnoses of adolescent's nutritional status

OBJETIVO: Avaliar a validade do peso, estatura e Índice de Massa Corporal (IMC) referidos e sua confiabilidade para o diagnóstico do estado nutricional de adolescentes de Piracicaba. MÉTODOS: Participaram do estudo 360 adolescentes de ambos os sexos, de escolas públicas de Piracicaba, com idade entre 10 e 15 anos. Os adolescentes auto-relataram seu peso e estatura, sendo esses valores obtidos por medidas diretas, logo em seguida, pelos entrevistadores. A validade do IMC referido foi calculada segundo índices de sensibilidade, especificidade e valor preditivo positivo (VPP). Avaliou-se a concordância entre as categorias de IMC obtido por meio das medidas referidas e aferidas a partir do coeficiente kappa ponderado, coeficiente de correlação de Lin. e gráficos de Bland e Altman e Lin. RESULTADOS: Verificou-se que tanto os meninos quanto as meninas subestimaram o peso (-1,0 meninas e meninos) e a estatura (meninas -1,2 e meninos -0,8) (p < 0,001). Os valores de IMC aferidos e referidos apresentaram uma concordância moderada. A sensibilidade do IMC referido para classificar os indivíduos obesos foi maior para os meninos (87,5 por cento), enquanto a especificidade foi maior para as meninas (92,7 por cento). O VPP foi elevado somente para a classificação da eutrofia. CONCLUSÕES: As medidas referidas de peso e estatura de adolescentes não representam medidas válidas e, portanto, não devem ser usadas em substituição aos valores mensurados. Além disso, verificou-se que 10 por cento dos meninos obesos e 40 por cento das meninas obesas poderiam permanecer não identificados utilizando-se as medidas auto-referidas, confirmando a baixa validade das medidas auto-referidas.