Prevalence of bullying and associated factors among Brazilian schoolchildren in 2015. / Prevalência de bullying e fatores associados em escolares brasileiros, 2015.

This study analyzed the prevalence of bullying and associated factors among Brazilian schoolchildren using data produced by the 2015 National School Health Survey (PeNSE, acronym in Portuguese) consisting of a national sample of 102,301 eighth grade students. The prevalence of bullying was calculated and bivariate analysis was performed using a 95% confidence level to determine the association between victimization and socio-demographic variables and other variables relating to family background, mental health, and risk behaviors. Multivariate analysis was then conducted using the biologically plausible variables of interest. For the final model, variables that obtained p-values of < 0.05 were maintained. The prevalence of bullying was found to be 7.4%. The results of the multivariate analysis showed that boys aged 13 years studying in public schools who worked and whose mother did not have any schooling were more likely to be bullied, as were schoolchildren who felt lonely, had no friends, suffered from insomnia, skipped lessons without parental permission, and who smoked. Victims of bullying were predominantly 13-year-olds from an unfavorable social and family background, painting a picture of vulnerability that calls for support from social protection networks, schools and families alike .

O estudo analisou a prevalência de sofrer bullying e fatores associados em escolares brasileiros. Trata-se de análise da Pesquisa Nacional de Saúde do Escolar (PeNSE) 2015 em amostra nacional com 102.301 alunos do 9º ano. Foi calculada a prevalência de sofrer bullying e foi feita inicialmente análise bivariada com estimativas de razões de chance (OR) e IC95% para estimar as associações entre vitimização e variáveis sociodemográficas, contexto familiar, violência familiar, saúde mental e comportamentos de risco. Posteriormente, procedeu-se ao modelo de regressão logística múltipla, inserindo as variáveis de interesse com (p < 0,20). No modelo final ajustado (ORa) permaneceram variáveis com p < 0,05. A prevalência de bullying foi de 7,4%. A análise multivariada mostrou que quem tem maior chance de sofrer bullying são os escolares do sexo masculino, com 13 anos, da escola pública, filhos de mães sem escolaridade, que trabalham, com relato de solidão, sem amigos, com insônia; que sofreram agressão física dos familiares, faltaram as aulas sem avisar aos pais, usaram tabaco. Predominaram vítimas de 13 anos, com contexto social e familiar desfavorável, mostrando cenário de vulnerabilidades, demandando apoio de redes de proteção social, escolar e famíliar.

Probability of premature death for chronic non-communicable diseases, Brazil and Regions, projections to 2025. / Probabilidade de morte prematura por doenças crônicas não transmissíveis, Brasil e regiões, projeções para 2025.

OBJECTIVE: Objective: To analyze the mortality trends for Chronic Noncommunicable Diseases (NCDs) in the period 2000-2013 and its probability of death until 2025. METHOD: time series analysis of mortality from cardiovascular diseases, cancer, diabetes and chronic respiratory disease, with correction for ill-defined causes and underreporting of deaths and calculation of probability of death. RESULTS: There was an average decline of 2.5% per year in all four major NCDs in Brazil. There was a decline in all regions and federal units. The reduced likelihood of death by 30% in 2000 to 26.1% in 2013 and expected decline to 20.5% in 2025. CONCLUSION: From the trend of reduction is expected to reach Brazil reducing overall goal 25% by 2025.

OBJETIVO: Analisar as tendências de mortalidade por doenças crônicas não transmissíveis (DCNT) no período de 2000 a 2013 e a probabilidade de morte até 2025. MÉTODO: Análise de série temporal de mortalidade das DCNT (doenças cardiovasculares, câncer, diabetes e doenças respiratórias crônicas), com correções para causas mal definidas e sub-registro de óbitos, e a probabilidade de morte por essas doenças. RESULTADOS: Houve declínio médio de 2,5% ao ano no conjunto das quatro principais DCNT no Brasil entre 2000 e 2013, em todas as regiões e unidades federativas. A probabilidade de morte foi reduzida de 30% em 2000 para 26,1% em 2013, e estima-se que caia para 20,5% em 2025. CONCLUSÕES: Dada a tendência de queda, prevê-se que o Brasil atinja a meta global de redução de 25% até 2025.

Prevalência de bullying e fatores associados em escolares brasileiros, 2015 / Prevalence of bullying and associated factors among Brazilian schoolchildren in 2015

Resumo O estudo analisou a prevalência de sofrer bullying e fatores associados em escolares brasileiros. Trata-se de análise da Pesquisa Nacional de Saúde do Escolar (PeNSE) 2015 em amostra nacional com 102.301 alunos do 9º ano. Foi calculada a prevalência de sofrer bullying e foi feita inicialmente análise bivariada com estimativas de razões de chance (OR) e IC95% para estimar as associações entre vitimização e variáveis sociodemográficas, contexto familiar, violência familiar, saúde mental e comportamentos de risco. Posteriormente, procedeu-se ao modelo de regressão logística múltipla, inserindo as variáveis de interesse com (p < 0,20). No modelo final ajustado (ORa) permaneceram variáveis com p < 0,05. A prevalência de bullying foi de 7,4%. A análise multivariada mostrou que quem tem maior chance de sofrer bullying são os escolares do sexo masculino, com 13 anos, da escola pública, filhos de mães sem escolaridade, que trabalham, com relato de solidão, sem amigos, com insônia; que sofreram agressão física dos familiares, faltaram as aulas sem avisar aos pais, usaram tabaco. Predominaram vítimas de 13 anos, com contexto social e familiar desfavorável, mostrando cenário de vulnerabilidades, demandando apoio de redes de proteção social, escolar e famíliar.

Abstract This study analyzed the prevalence of bullying and associated factors among Brazilian schoolchildren using data produced by the 2015 National School Health Survey (PeNSE, acronym in Portuguese) consisting of a national sample of 102,301 eighth grade students. The prevalence of bullying was calculated and bivariate analysis was performed using a 95% confidence level to determine the association between victimization and socio-demographic variables and other variables relating to family background, mental health, and risk behaviors. Multivariate analysis was then conducted using the biologically plausible variables of interest. For the final model, variables that obtained p-values of < 0.05 were maintained. The prevalence of bullying was found to be 7.4%. The results of the multivariate analysis showed that boys aged 13 years studying in public schools who worked and whose mother did not have any schooling were more likely to be bullied, as were schoolchildren who felt lonely, had no friends, suffered from insomnia, skipped lessons without parental permission, and who smoked. Victims of bullying were predominantly 13-year-olds from an unfavorable social and family background, painting a picture of vulnerability that calls for support from social protection networks, schools and families alike .

Probabilidade de morte prematura por doenças crônicas não transmissíveis, Brasil e regiões, projeções para 2025 / Probability of premature death for chronic non-communicable diseases, Brazil and Regions, projections to 2025

RESUMO: Objetivo: Analisar as tendências de mortalidade por doenças crônicas não transmissíveis (DCNT) no período de 2000 a 2013 e a probabilidade de morte até 2025. Método: Análise de série temporal de mortalidade das DCNT (doenças cardiovasculares, câncer, diabetes e doenças respiratórias crônicas), com correções para causas mal definidas e sub-registro de óbitos, e a probabilidade de morte por essas doenças. Resultados: Houve declínio médio de 2,5% ao ano no conjunto das quatro principais DCNT no Brasil entre 2000 e 2013, em todas as regiões e unidades federativas. A probabilidade de morte foi reduzida de 30% em 2000 para 26,1% em 2013, e estima-se que caia para 20,5% em 2025. Conclusões: Dada a tendência de queda, prevê-se que o Brasil atinja a meta global de redução de 25% até 2025.

ABSTRACT: Objective: Objective: To analyze the mortality trends for Chronic Noncommunicable Diseases (NCDs) in the period 2000-2013 and its probability of death until 2025. Method: time series analysis of mortality from cardiovascular diseases, cancer, diabetes and chronic respiratory disease, with correction for ill-defined causes and underreporting of deaths and calculation of probability of death. Results: There was an average decline of 2.5% per year in all four major NCDs in Brazil. There was a decline in all regions and federal units. The reduced likelihood of death by 30% in 2000 to 26.1% in 2013 and expected decline to 20.5% in 2025. Conclusion: From the trend of reduction is expected to reach Brazil reducing overall goal 25% by 2025.

Use of psychoactive substances among Brazilian adolescents and associated factors: National School-based Health Survey, 2015. / Uso de substâncias psicoativas em adolescentes brasileiros e fatores associados: Pesquisa Nacional de Saúde dos Escolares, 2015.

AIM: To analyze the consumption of tobacco, alcohol and illicit drugs among schoolchildren according to demographic factors, family context and mental health. METHODS: We used data from the National School-based Health Survey 2015 and included in the sample 102,301 schoolchildren in the 9th grade. We estimated the prevalence of tobacco and alcohol use in the last 30 days and drug experimentation according to demographic, mental health and family context variables. Then, a bivariate analysis was performed using Pearson's χ2 test and the unadjusted odds ratio (OR) was calculated. Finally, we conducted a multivariate analysis including independent variables with an unadjusted association (p < 0.20), for each outcome, estimating the adjusted OR with a 95% confidence interval. RESULTS: The prevalence of tobacco consumption was 5.6%; alcohol consumption, 23.8%; and drug experimentation, 9.0%. Multivariate analysis has indicated that living with parents, having meals with parents or guardian, and family supervision were associated with lower substance consumption; whereas missing classes without parental consent has increased the chances of substance use. Increased chance of substance use was also associated with white skin color, increasing age, to work, feeling lonely and having insomnia. Not having friends was associated with drug and tobacco use, but this was protective for alcohol consumption. CONCLUSIONS: Family supervision was protective for psychoactive substance use among Brazilian schoolchildren, whereas work, loneliness and insomnia have increased their chances of use.

OBJETIVO: Analisar o uso de substâncias psicoativas (tabaco, álcool e drogas ilícitas) em escolares em relação a fatores sociodemográficos, contexto familiar e saúde mental. MÉTODOS: Foram utilizados dados da amostra de 102.301 escolares do nono ano da Pesquisa Nacional de Saúde do Escolar de 2015. Realizou-se o cálculo da prevalência de uso de tabaco e de álcool nos últimos 30 dias e experimentação de drogas, segundo variáveis sociodemográficas, contexto familiar e saúde mental. Procedeu-se a análise univariada, por teste do χ2 de Pearson e cálculo das odds ratios (OR) não ajustadas. Por fim, realizou-se análise multivariada para cada desfecho com as variáveis que apresentaram associação com os desfechos (p < 0,20), calculando-se as OR ajustadas com intervalo de confiança de 95%. RESULTADOS: A prevalência de uso de tabaco foi de 5,6%; do uso de álcool, 23,8%; e da experimentação de drogas, 9,0%. A análise multivariada apontou que, no contexto familiar, morar com os pais, fazer refeição com pais ou responsável e a supervisão familiar foram associados a menor uso de substâncias; enquanto faltar às aulas sem consentimento dos pais aumentou a chance de uso. Maior chance do uso de substâncias esteve ainda associada a cor branca, aumento da idade, trabalhar, sentir-se solitário e ter insônia. Não ter amigos foi associado com uso de drogas e tabaco, porém foi protetor para o uso de álcool. CONCLUSÕES: A supervisão familiar foi protetora do uso de substâncias psicoativas em escolares brasileiros, enquanto trabalhar, sentir-se solitário e ter insônia aumentaram suas chances de uso.

Factors associated with the use of waterpipe and other tobacco products among students, Brazil, 2015. / Fatores associados ao uso de narguilé e outros produtos do tabaco entre escolares, Brasil, 2015.

OBJECTIVE: To identify the frequency and factors associated with the use of waterpipe and other tobacco products among Brazilian students. METHODS: This is a cross-sectional study based on data from the National Adolescent Student Health Survey. The sample consisted of 9th-grade students from elementary school. We conducted a descriptive analysis of the use of tobacco products in 2012 and 2015. To explore the relationship between the use of other tobacco products and factors such as sociodemographic characteristics, family, mental health, and life habits, we calculated the adjusted odds ratio. RESULTS: The use of other tobacco products increased from 4.8% (95%CI 4.6 - 5.0) in 2012 to 6.1% (95%CI 5.7 - 6.4) in 2015, with a higher proportion among boys. Waterpipe was the most commonly used product in 2015 (71.6%; 95%CI 68.8 - 74.2), especially among girls. Factors positively associated with the use of other tobacco products were: attending private school, living with father/mother, working, not having friends, suffering domestic violence, skipping classes, consuming cigarettes and alcohol, experimenting drug, having had sex, having smoker parents or guardians, and seeing people smoking. The protective factors were: female gender, increasing age, multiracial or indigenous people, having meals with a guardian, family supervision, and practicing physical activity. CONCLUSION: The use of other tobacco products was high and has been increasing in recent years, particularly waterpipe. It is important to raise awareness of the risks and monitor the use of these products, as well as improve public policies of tobacco control in the country.

OBJETIVO: Identificar a frequência e os fatores associados ao uso de narguilé e outros produtos do tabaco entre os escolares brasileiros. MÉTODOS: Estudo transversal com dados da Pesquisa Nacional de Saúde do Escolar. A amostra foi composta por alunos do 9º ano do Ensino Fundamental. Foi realizada análise descritiva do uso de produtos do tabaco em 2012 e 2015. Para explorar a relação de fatores como características sociodemográficas, familiares, saúde mental e hábitos de vida com o uso de outros produtos do tabaco, foram calculados odds ratio ajustados. RESULTADOS: O uso de outros produtos do tabaco aumentou de 4,8% (IC95% 4,6 - 5,0), em 2012, para 6,1% (IC95% 5,7 - 6,4), em 2015, com maior proporção em meninos. O narguilé foi o produto mais usado em 2015 (71,6%; IC95% 68,8 - 74,2), sendo mais frequente em meninas. Foram positivamente associados ao uso de outros produtos do tabaco: escola privada, morar com pai/mãe, trabalhar, não ter amigos, sofrer violência familiar, faltar às aulas, fazer uso de cigarros e álcool, ter experimentado drogas, já ter tido relação sexual, ter pais ou responsáveis fumantes e presenciar pessoas fumando. Os fatores de proteção foram: sexo feminino, incremento da idade, cor da pele parda ou indígena, fazer refeições com responsável, ter supervisão familiar e praticar atividade física. CONCLUSÃO: Conclui-se que o uso de outros produtos do tabaco foi elevado, com aumento nos últimos anos, destacando-se o narguilé. Torna-se importante a conscientização dos riscos e a vigilância do uso desses produtos, bem como o avanço das políticas públicas de controle do tabagismo no país.

Uso de substâncias psicoativas em adolescentes brasileiros e fatores associados: Pesquisa Nacional de Saúde dos Escolares, 2015 / Use of psychoactive substances among Brazilian adolescents and associated factors: National School-based Health Survey, 2015

RESUMO: Objetivo: Analisar o uso de substâncias psicoativas (tabaco, álcool e drogas ilícitas) em escolares em relação a fatores sociodemográficos, contexto familiar e saúde mental. Métodos: Foram utilizados dados da amostra de 102.301 escolares do nono ano da Pesquisa Nacional de Saúde do Escolar de 2015. Realizou-se o cálculo da prevalência de uso de tabaco e de álcool nos últimos 30 dias e experimentação de drogas, segundo variáveis sociodemográficas, contexto familiar e saúde mental. Procedeu-se a análise univariada, por teste do χ2 de Pearson e cálculo das odds ratios (OR) não ajustadas. Por fim, realizou-se análise multivariada para cada desfecho com as variáveis que apresentaram associação com os desfechos (p < 0,20), calculando-se as OR ajustadas com intervalo de confiança de 95%. Resultados: A prevalência de uso de tabaco foi de 5,6%; do uso de álcool, 23,8%; e da experimentação de drogas, 9,0%. A análise multivariada apontou que, no contexto familiar, morar com os pais, fazer refeição com pais ou responsável e a supervisão familiar foram associados a menor uso de substâncias; enquanto faltar às aulas sem consentimento dos pais aumentou a chance de uso. Maior chance do uso de substâncias esteve ainda associada a cor branca, aumento da idade, trabalhar, sentir-se solitário e ter insônia. Não ter amigos foi associado com uso de drogas e tabaco, porém foi protetor para o uso de álcool. Conclusões: A supervisão familiar foi protetora do uso de substâncias psicoativas em escolares brasileiros, enquanto trabalhar, sentir-se solitário e ter insônia aumentaram suas chances de uso.

ABSTRACT: Aim: To analyze the consumption of tobacco, alcohol and illicit drugs among schoolchildren according to demographic factors, family context and mental health. Methods: We used data from the National School-based Health Survey 2015 and included in the sample 102,301 schoolchildren in the 9th grade. We estimated the prevalence of tobacco and alcohol use in the last 30 days and drug experimentation according to demographic, mental health and family context variables. Then, a bivariate analysis was performed using Pearson's χ2 test and the unadjusted odds ratio (OR) was calculated. Finally, we conducted a multivariate analysis including independent variables with an unadjusted association (p < 0.20), for each outcome, estimating the adjusted OR with a 95% confidence interval. Results: The prevalence of tobacco consumption was 5.6%; alcohol consumption, 23.8%; and drug experimentation, 9.0%. Multivariate analysis has indicated that living with parents, having meals with parents or guardian, and family supervision were associated with lower substance consumption; whereas missing classes without parental consent has increased the chances of substance use. Increased chance of substance use was also associated with white skin color, increasing age, to work, feeling lonely and having insomnia. Not having friends was associated with drug and tobacco use, but this was protective for alcohol consumption. Conclusions: Family supervision was protective for psychoactive substance use among Brazilian schoolchildren, whereas work, loneliness and insomnia have increased their chances of use.

Fatores associados ao uso de narguilé e outros produtos do tabaco entre escolares, Brasil, 2015 / Factors associated with the use of waterpipe and other tobacco products among students, Brazil, 2015

RESUMO: Objetivo: Identificar a frequência e os fatores associados ao uso de narguilé e outros produtos do tabaco entre os escolares brasileiros. Métodos: Estudo transversal com dados da Pesquisa Nacional de Saúde do Escolar. A amostra foi composta por alunos do 9º ano do Ensino Fundamental. Foi realizada análise descritiva do uso de produtos do tabaco em 2012 e 2015. Para explorar a relação de fatores como características sociodemográficas, familiares, saúde mental e hábitos de vida com o uso de outros produtos do tabaco, foram calculados odds ratio ajustados. Resultados: O uso de outros produtos do tabaco aumentou de 4,8% (IC95% 4,6 - 5,0), em 2012, para 6,1% (IC95% 5,7 - 6,4), em 2015, com maior proporção em meninos. O narguilé foi o produto mais usado em 2015 (71,6%; IC95% 68,8 - 74,2), sendo mais frequente em meninas. Foram positivamente associados ao uso de outros produtos do tabaco: escola privada, morar com pai/mãe, trabalhar, não ter amigos, sofrer violência familiar, faltar às aulas, fazer uso de cigarros e álcool, ter experimentado drogas, já ter tido relação sexual, ter pais ou responsáveis fumantes e presenciar pessoas fumando. Os fatores de proteção foram: sexo feminino, incremento da idade, cor da pele parda ou indígena, fazer refeições com responsável, ter supervisão familiar e praticar atividade física. Conclusão: Conclui-se que o uso de outros produtos do tabaco foi elevado, com aumento nos últimos anos, destacando-se o narguilé. Torna-se importante a conscientização dos riscos e a vigilância do uso desses produtos, bem como o avanço das políticas públicas de controle do tabagismo no país.

ABSTRACT: Objective: To identify the frequency and factors associated with the use of waterpipe and other tobacco products among Brazilian students. Methods: This is a cross-sectional study based on data from the National Adolescent Student Health Survey. The sample consisted of 9th-grade students from elementary school. We conducted a descriptive analysis of the use of tobacco products in 2012 and 2015. To explore the relationship between the use of other tobacco products and factors such as sociodemographic characteristics, family, mental health, and life habits, we calculated the adjusted odds ratio. Results: The use of other tobacco products increased from 4.8% (95%CI 4.6 - 5.0) in 2012 to 6.1% (95%CI 5.7 - 6.4) in 2015, with a higher proportion among boys. Waterpipe was the most commonly used product in 2015 (71.6%; 95%CI 68.8 - 74.2), especially among girls. Factors positively associated with the use of other tobacco products were: attending private school, living with father/mother, working, not having friends, suffering domestic violence, skipping classes, consuming cigarettes and alcohol, experimenting drug, having had sex, having smoker parents or guardians, and seeing people smoking. The protective factors were: female gender, increasing age, multiracial or indigenous people, having meals with a guardian, family supervision, and practicing physical activity. Conclusion: The use of other tobacco products was high and has been increasing in recent years, particularly waterpipe. It is important to raise awareness of the risks and monitor the use of these products, as well as improve public policies of tobacco control in the country.

The practice of bullying among Brazilian schoolchildren and associated factors, National School Health Survey 2015. / A prática de bullying entre escolares brasileiros e fatores associados, Pesquisa Nacional de Saúde do Escolar 2015.

This study explored associations between bullying and sociodemographic, mental health and risk behavior variables in school age children. This cross-sectional survey analyzed data from the National School Health Survey (PeNSE 2015). A multiple logistic regression analysis checked for factors associated with bullying. Nineteen point eight percent (95%CI 10.5 - 20.0) of the students claimed they practiced bullying. The practice of bullying was more common among students enrolled in private schools, those living with their parents, and those whose mothers have more years of schooling and are gainfully employed (28.1% CI 27.3-28.8). In terms of mental health characteristics, bullying was more common among those feeling alone, suffering from insomnia and with no friends. Looking at family characteristics, those reporting they are physically punished by family members (33.09% CI 33.1-34.6) and miss school without telling their family (28.4% 95% CI 27.9-29.0) are more likely to practice bullying. Bullying was more frequent among those reporting tobacco, alcohol and drug use, and among students claiming to have had sexual relations. The data shows that bullying is significant and interferes in school children's health and the teaching-learning process. This must be addressed looking at youth as protagonists and in an inter-sectoral context.

A prática de bullying entre escolares brasileiros e fatores associados, Pesquisa Nacional de Saúde do Escolar 2015 / The practice of bullying among Brazilian schoolchildren and associated factors, National School Health Survey 2015

Resumo O estudo objetivou verificar associações entre a prática de bullying com variáveis sociodemográficas, de saúde mental e de comportamentos de risco em escolares. O inquérito, de corte transversal, analisa dados da Pesquisa Nacional de Saúde do Escolar (PeNSE 2015). Foi realizada análise de regressão logística múltipla para verificar fatores associados à prática de bullying. O autorrelato de praticar bullying foi referido por 19,8% (IC95% 19,5-20,0) dos estudantes. A prática foi mais frequente entre os que estudam na escola privada, cujas mães têm maior escolaridade, moram com os pais, os quais trabalham. Entre as características da saúde mental foi mais frequente a prática de bullying entre os que relatam solidão, insônia e não ter amigos. Dentre as características da família, os que relatam apanhar de familiares e os que faltam as aulas sem comunicar a família praticam mais bullying. A prática de bullying foi mais frequente em quem relata uso de tabaco, álcool, experimentar drogas e em escolares que relatam ter tido relação sexual. Neste cenário, os dados indicam que a prática do bullying é aspecto relevante que interfere no processo ensino-aprendizagem e na saúde dos escolares. Tornando-se necessário enfrentar no contexto da intersetorialidade e do protagonismo juvenil.

Abstract This study explored associations between bullying and sociodemographic, mental health and risk behavior variables in school age children. This cross-sectional survey analyzed data from the National School Health Survey (PeNSE 2015). A multiple logistic regression analysis checked for factors associated with bullying. Nineteen point eight percent (95%CI 10.5 - 20.0) of the students claimed they practiced bullying. The practice of bullying was more common among students enrolled in private schools, those living with their parents, and those whose mothers have more years of schooling and are gainfully employed (28.1% CI 27.3-28.8). In terms of mental health characteristics, bullying was more common among those feeling alone, suffering from insomnia and with no friends. Looking at family characteristics, those reporting they are physically punished by family members (33.09% CI 33.1-34.6) and miss school without telling their family (28.4% 95% CI 27.9-29.0) are more likely to practice bullying. Bullying was more frequent among those reporting tobacco, alcohol and drug use, and among students claiming to have had sexual relations. The data shows that bullying is significant and interferes in school children's health and the teaching-learning process. This must be addressed looking at youth as protagonists and in an inter-sectoral context.

Assessment in the primary care of the State of São Paulo, Brazil: incipient actions in sexual and reproductive health.

OBJECTIVE: The objective of this study is to assess performance in sexual and reproductive health of primary health care services of the Brazilian Unified Health System, in the State of São Paulo, Brazil. METHODS: An evaluative framework was built for sexual and reproductive health with the categorization of 99 indicators in three domains: sexual and reproductive health promotion (25), sexually transmitted infections/AIDS prevention and care (43), and reproductive health care (31). This framework was applied to assess the services responses to the questionnaire of Quality Evaluation of Primary Health Care in the Municipalities of São Paulo State (QualiAB), in 2010. Percentages were calculated for positive responses to indicators and performance in the sexual and reproductive health dimension, according to domains, and their contribution to the overall score in sexual and reproductive health (Friedman), relative participation (Dunn), and correlation (Spearman) was verified. RESULTS: Overall, 2,735 services participated in the study. They were located in 586 municipalities (distributed throughout the 17 regional health departments of São Paulo), of which 70.6% had fewer than 100,000 inhabitants. The overall average performance of these services for sexual and reproductive health is 56.8%. The actions are characterized by: prenatal with adequate beginning and exams, better organization for immediate rather than for late postnatal care, and selective reproductive planning for some contraceptives; prevention based on specific protection, limitations in the prevention of congenital syphilis, in the treatment of sexually transmitted infections, and in the screening of cervical and breast cancer; specific educational activities, with a restricted vulnerability approach, focus on sexuality over reproduction. The domain of reproductive health has greater participation in the overall score, followed by prevention/care and promotion. The three domains are correlated; the domain of prevention/care has the highest correlation with the other ones. CONCLUSIONS: The implementation of sexual and reproductive health in primary health care in the services studied is incipient. The revision of the purpose of the work, the dissemination of technologies, and the investing in permanent education are needed. The evaluative framework built can be used by the sexual and reproductive health program services and management in primary health care, thereby contributing to their actions. OBJETIVO: Avaliar o desempenho em saúde sexual e reprodutiva de serviços de atenção primária à saúde do Sistema Único de Saúde, no estado de São Paulo. MÉTODOS: Construiu-se quadro avaliativo para a saúde sexual e reprodutiva com a categorização de 99 indicadores em três domínios: promoção à saúde sexual e reprodutiva (25), prevenção e assistência às doenças sexualmente transmissíveis/aids (43), e atenção à saúde reprodutiva (31). Esse quadro foi aplicado para avaliar as respostas dos serviços ao questionário Avaliação da Qualidade da Atenção Básica em Municípios de São Paulo (QualiAB), em 2010. Calcularam-se as porcentagens de respostas positivas aos indicadores e o desempenho na dimensão saúde sexual e reprodutiva, segundo os domínios; e verificou-se sua contribuição para o escore geral em saúde sexual e reprodutiva (Friedman), participação relativa (Dunn) e correlação (Spearman). RESULTADOS: Participaram 2.735 serviços, localizados em 586 municípios (distribuídos nos 17 departamentos regionais de saúde paulistas), dos quais 70,6% municípios com menos de 100.000 habitantes. A média geral do desempenho desses serviços para saúde sexual e reprodutiva é 56,8%. As ações são caracterizadas por: pré-natal com início e exames adequados, melhor organização para puerpério imediato do que tardio, e planejamento reprodutivo seletivo para alguns contraceptivos; prevenção baseada em proteção específica, limites na prevenção da sífilis congênita, no tratamento de doenças sexualmente transmissíveis, no rastreamento do câncer cervical e mamário; atividades educativas pontuais, com restrita abordagem das vulnerabilidades, predomínio do enfoque da sexualidade centrado na reprodução. O domínio saúde reprodutiva tem maior participação no escore geral, seguido de prevenção/assistência e promoção. Os três domínios estão correlacionados; o domínio prevenção/assistência apresenta as maiores correlações com os demais. CONCLUSÕES: A implementação da saúde sexual e reprodutiva na atenção primária à saúde nos serviços estudados é incipiente. É necessário rever finalidades do trabalho, disseminar tecnologias e investir em educação permanente. O quadro avaliativo construído pode ser utilizado pelos serviços e pela gestão do programa de saúde sexual e reprodutiva na atenção primária à saúde e contribuir para suas ações.

Family influence on the consumption of sugary drinks by children under two years old.

OBJECTIVE: To evaluate the influence of family habits and household characteristics on the consumption of sugary drinks by Brazilian children under two years old. METHODS: This was a cross-sectional study that used secondary data generated by the National Health Survey (PNS) in 2013. We studied 4,839 pairs of children under two years old and adults living in the same house. We estimated the prevalence of the indicator of sugary drinks consumption for the total sample of children and according to family and household variables. We applied multiple logistic regression analysis to evaluate the influence of family habits and household characteristics on the consumption of sugary drinks by the children. RESULTS: The consumption of sugary drinks was identified in 32% of the studied children (95%CI 30.6-33.3) and was independently associated with the following family and household characteristics: regular consumption of sugary drinks by the adult living in the house (OR = 1.78; 95%CI 1.51-2.10), watching TV for more than three hours per day (OR = 1.22; 95%CI 1.03-1.45), older age (OR = 3.10; 95%CI 1.54-6.26), greater education level (OR = 0.70; 95%CI 0.53-0.91), house located in the Northeast region (OR = 0.65; 95%CI 1.54-6.26), and number of family members (OR = 1.05; 95%CI 1.00-1.09). CONCLUSIONS: Our findings indicate the high prevalence of sugary drinks consumption by Brazilian children under two years old and show that sociodemographic characteristics and family habits affect this feeding practice not recommended in childhood.

OBJETIVO: Avaliar a influência de hábitos familiares e características do domicílio sobre o consumo de bebidas açucaradas em crianças brasileiras menores de dois anos. MÉTODOS: Estudo transversal que utilizou dados secundários gerados pela Pesquisa Nacional de Saúde (PNS), em 2013. Foram estudados 4.839 pares de crianças menores de dois anos e adultos residentes no mesmo domicílio. Foram estimadas as prevalências do indicador consumo de bebidas açucaradas para a amostra total de crianças e segundo categorias de variáveis familiares e do domicílio. Aplicou-se análise de regressão logística múltipla para avaliar a influência de hábitos familiares e características do domicílio sobre o consumo de bebidas açucaradas pelas crianças. RESULTADOS: O consumo de bebidas açucaradas foi identificado em 32% das crianças estudadas (IC95% 30,6-33,3) e esteve independentemente associado com as seguintes caraterísticas familiares e domiciliares: consumo regular de bebidas açucaradas pelo adulto residente no domicílio (OR = 1,78; IC95% 1,51-2,10), hábito de assistir TV por mais de 3 horas diárias (OR = 1,22; IC95% 1,03-1,45), maior idade (OR = 3,10; IC95% 1,54-6,26), maior escolaridade (OR = 0,70; IC95% 0,53-0,91), domicílio localizado na região Nordeste (OR = 0,65; IC95% 1,54-6,26) e número de componentes da família (OR = 1,05; IC95% 1,00-1,09). CONCLUSÕES: Os achados apontam a alta prevalência de consumo de bebidas açucaradas em crianças brasileiras menores de dois anos e que características sociodemográficas e hábitos familiares influenciam essa prática alimentar não recomendada na infância.

Assessment in the primary care of the State of São Paulo, Brazil: incipient actions in sexual and reproductive health / Avaliação na atenção primária paulista: ações incipientes em saúde sexual e reprodutiva

ABSTRACT OBJECTIVE The objective of this study is to assess performance in sexual and reproductive health of primary health care services of the Brazilian Unified Health System, in the State of São Paulo, Brazil. METHODS An evaluative framework was built for sexual and reproductive health with the categorization of 99 indicators in three domains: sexual and reproductive health promotion (25), sexually transmitted infections/AIDS prevention and care (43), and reproductive health care (31). This framework was applied to assess the services responses to the questionnaire of Quality Evaluation of Primary Health Care in the Municipalities of São Paulo State (QualiAB), in 2010. Percentages were calculated for positive responses to indicators and performance in the sexual and reproductive health dimension, according to domains, and their contribution to the overall score in sexual and reproductive health (Friedman), relative participation (Dunn), and correlation (Spearman) was verified. RESULTS Overall, 2,735 services participated in the study. They were located in 586 municipalities (distributed throughout the 17 regional health departments of São Paulo), of which 70.6% had fewer than 100,000 inhabitants. The overall average performance of these services for sexual and reproductive health is 56.8%. The actions are characterized by: prenatal with adequate beginning and exams, better organization for immediate rather than for late postnatal care, and selective reproductive planning for some contraceptives; prevention based on specific protection, limitations in the prevention of congenital syphilis, in the treatment of sexually transmitted infections, and in the screening of cervical and breast cancer; specific educational activities, with a restricted vulnerability approach, focus on sexuality over reproduction. The domain of reproductive health has greater participation in the overall score, followed by prevention/care and promotion. The three domains are correlated; the domain of prevention/care has the highest correlation with the other ones. CONCLUSIONS The implementation of sexual and reproductive health in primary health care in the services studied is incipient. The revision of the purpose of the work, the dissemination of technologies, and the investing in permanent education are needed. The evaluative framework built can be used by the sexual and reproductive health program services and management in primary health care, thereby contributing to their actions.

RESUMO OBJETIVO Avaliar o desempenho em saúde sexual e reprodutiva de serviços de atenção primária à saúde do Sistema Único de Saúde, no estado de São Paulo. MÉTODOS Construiu-se quadro avaliativo para a saúde sexual e reprodutiva com a categorização de 99 indicadores em três domínios: promoção à saúde sexual e reprodutiva (25), prevenção e assistência às doenças sexualmente transmissíveis/aids (43), e atenção à saúde reprodutiva (31). Esse quadro foi aplicado para avaliar as respostas dos serviços ao questionário Avaliação da Qualidade da Atenção Básica em Municípios de São Paulo (QualiAB), em 2010. Calcularam-se as porcentagens de respostas positivas aos indicadores e o desempenho na dimensão saúde sexual e reprodutiva, segundo os domínios; e verificou-se sua contribuição para o escore geral em saúde sexual e reprodutiva (Friedman), participação relativa (Dunn) e correlação (Spearman). RESULTADOS Participaram 2.735 serviços, localizados em 586 municípios (distribuídos nos 17 departamentos regionais de saúde paulistas), dos quais 70,6% municípios com menos de 100.000 habitantes. A média geral do desempenho desses serviços para saúde sexual e reprodutiva é 56,8%. As ações são caracterizadas por: pré-natal com início e exames adequados, melhor organização para puerpério imediato do que tardio, e planejamento reprodutivo seletivo para alguns contraceptivos; prevenção baseada em proteção específica, limites na prevenção da sífilis congênita, no tratamento de doenças sexualmente transmissíveis, no rastreamento do câncer cervical e mamário; atividades educativas pontuais, com restrita abordagem das vulnerabilidades, predomínio do enfoque da sexualidade centrado na reprodução. O domínio saúde reprodutiva tem maior participação no escore geral, seguido de prevenção/assistência e promoção. Os três domínios estão correlacionados; o domínio prevenção/assistência apresenta as maiores correlações com os demais. CONCLUSÕES A implementação da saúde sexual e reprodutiva na atenção primária à saúde nos serviços estudados é incipiente. É necessário rever finalidades do trabalho, disseminar tecnologias e investir em educação permanente. O quadro avaliativo construído pode ser utilizado pelos serviços e pela gestão do programa de saúde sexual e reprodutiva na atenção primária à saúde e contribuir para suas ações.

Family influence on the consumption of sugary drinks by children under two years old / Influência familiar no consumo de bebidas açucaradas em crianças menores de dois anos

ABSTRACT OBJECTIVE To evaluate the influence of family habits and household characteristics on the consumption of sugary drinks by Brazilian children under two years old. METHODS This was a cross-sectional study that used secondary data generated by the National Health Survey (PNS) in 2013. We studied 4,839 pairs of children under two years old and adults living in the same house. We estimated the prevalence of the indicator of sugary drinks consumption for the total sample of children and according to family and household variables. We applied multiple logistic regression analysis to evaluate the influence of family habits and household characteristics on the consumption of sugary drinks by the children. RESULTS The consumption of sugary drinks was identified in 32% of the studied children (95%CI 30.6-33.3) and was independently associated with the following family and household characteristics: regular consumption of sugary drinks by the adult living in the house (OR = 1.78; 95%CI 1.51-2.10), watching TV for more than three hours per day (OR = 1.22; 95%CI 1.03-1.45), older age (OR = 3.10; 95%CI 1.54-6.26), greater education level (OR = 0.70; 95%CI 0.53-0.91), house located in the Northeast region (OR = 0.65; 95%CI 1.54-6.26), and number of family members (OR = 1.05; 95%CI 1.00-1.09). CONCLUSIONS Our findings indicate the high prevalence of sugary drinks consumption by Brazilian children under two years old and show that sociodemographic characteristics and family habits affect this feeding practice not recommended in childhood.

RESUMO OBJETIVO Avaliar a influência de hábitos familiares e características do domicílio sobre o consumo de bebidas açucaradas em crianças brasileiras menores de dois anos. MÉTODOS Estudo transversal que utilizou dados secundários gerados pela Pesquisa Nacional de Saúde (PNS), em 2013. Foram estudados 4.839 pares de crianças menores de dois anos e adultos residentes no mesmo domicílio. Foram estimadas as prevalências do indicador consumo de bebidas açucaradas para a amostra total de crianças e segundo categorias de variáveis familiares e do domicílio. Aplicou-se análise de regressão logística múltipla para avaliar a influência de hábitos familiares e características do domicílio sobre o consumo de bebidas açucaradas pelas crianças. RESULTADOS O consumo de bebidas açucaradas foi identificado em 32% das crianças estudadas (IC95% 30,6–33,3) e esteve independentemente associado com as seguintes caraterísticas familiares e domiciliares: consumo regular de bebidas açucaradas pelo adulto residente no domicílio (OR = 1,78; IC95% 1,51–2,10), hábito de assistir TV por mais de 3 horas diárias (OR = 1,22; IC95% 1,03–1,45), maior idade (OR = 3,10; IC95% 1,54–6,26), maior escolaridade (OR = 0,70; IC95% 0,53–0,91), domicílio localizado na região Nordeste (OR = 0,65; IC95% 1,54–6,26) e número de componentes da família (OR = 1,05; IC95% 1,00–1,09). CONCLUSÕES Os achados apontam a alta prevalência de consumo de bebidas açucaradas em crianças brasileiras menores de dois anos e que características sociodemográficas e hábitos familiares influenciam essa prática alimentar não recomendada na infância.

Bullying e fatores associados em adolescentes da Região Sudeste segundo a Pesquisa Nacional de Saúde do Escolar / Bullying and associated factors in adolescents in the Southeast region according to the National School-based Health Survey

RESUMO: Objetivo: Estimar a prevalência de bullying, sob a perspectiva da vítima, em escolares da Região Sudeste e analisar sua associação com variáveis individuais e de contexto familiar. Métodos: Analisadas informações de 19.660 adolescentes da Pesquisa Nacional de Saúde do Escolar (PeNSE), calculando-se associação entre bullying e variáveis sociodemográficas, comportamentos de risco, saúde mental e contexto familiar. Foram realizadas análises multivariadas e efetuado cálculo odds ratio (OR), com respectivos valores de intervalo de confiança (IC95%). Resultados: A prevalência de bullying foi de 7,8% (IC95% 6,5 - 9,2). Após o ajuste, foi constatada a sua associação com: os escolares menores de 13 anos (OR = 2,40; 1,4 - 3,93) (p < 0,001); a proteção para estudantes de 14, 15 e 16 anos (p < 0,0001); o sexo masculino (OR = 1,47 IC95% 1,35 - 1,59); a cor preta (OR = 1,24 IC95% 1,11 - 1,40); a cor amarela (OR = 1,38 IC95% 1,14 - 1,6); os alunos de escola privada (OR = 1,11 IC95% 1,01 - 1,23) e os alunos que trabalham (OR = 1,30 IC95% 1,16 - 1,45). Maior escolaridade das mães mostrou-se fator protetor em todas as faixas. Foram considerados de risco: sentir-se sozinho (OR = 2,68 IC95% 2,45 - 2,94), ter insônia (OR = 1,95 IC95% 1,76 - 2,17), não ter amigos (OR = 1,47 IC95% 1,24 - 1,75), sofrer agressão física dos familiares (OR = 1,83 IC95% 1,66 - 2,03), faltar às aulas sem avisar aos pais (OR = 1,23 IC95% 1,12 - 1,34), além de supervisão familiar (OR = 1,14 IC95% 1,05 - 1,23). Como fator de proteção, ter bebido nos últimos 30 dias (OR = 0,88 IC95% 0,8 - 0,97). Conclusão: O bullying amplia as vulnerabilidades entre escolares, o que sugere necessidade de uma abordagem intersetorial na busca de medidas para sua prevenção.

ABSTRACT: Objective: To estimate the prevalence of bullying from the perspective of victims in students from the Southeast region of Brazil and analyze its association with individual variables and family context. Methods: Information on 19,660 adolescents from the National School-based Health Survey was analyzed, calculating the association between bullying and sociodemographic variables, risk behaviors, mental health, and family background. Multivariate analysis and the calculation of odds ratio and confidence intervals were performed. Results: The prevalence of bullying was 7.8% (95%CI 6.5 - 9.2). After adjustment, the following associations were observed: students with less than 13 years of age (OR = 2.40; 1.4 - 3.93); protection for those aged 14, 15, and 16 years; male gender (OR = 1.47; 95%CI 1.35 - 1.59); black color (OR = 1.24; 95%CI 1.11 - 1.40); yellow color (OR = 1.38 95%CI 1.14 - 1.6); private school students (OR = 1.11; 95%CI 1.01 - 1.23); and students who work (OR = 1.30; 95%CI 1.16 - 1.45). Higher education of the mothers was a protective factor in all groups. Risk factors considered were feeling lonely (OR = 2.68; 95%CI 2.45 - 2.94), having insomnia (OR = 1.95; 95%CI 1.76 - 2.17), having no friends (OR = 1.47; 95%CI 1.24 - 1.75), suffering physical abuse from family members (OR = 1.83; 95%CI 1.66 - 2.03), missing classes without their parents’ knowledge (OR = 1.23; 95%CI 1.12 - 1.34), as well as family supervision (OR = 1.14; 95%CI 1.05 - 1.23). To have drunk in the last 30 days (OR = 0.88 95%CI 0.8 - 0.97) was a protective factor. Conclusion: Bullying increases vulnerabilities among students, which suggests the need for an intersectoral approach in order to find measures to prevent them.

Associations between the practice of bullying and individual and contextual variables from the aggressors' perspective / Associações entre a prática de bullying e variáveis individuais e de contexto na perspectiva dos agressores

ABSTRACT OBJECTIVES: To estimate the prevalence of bullying among Brazilian students from the aggressor's perspective and to analyze its association with individual and contextual variables. METHODS: This was a cross-sectional population-based study carried out with data from the National Survey on Student Health. A total of 109,104 students attending eight grade in public and private schools were included. Data were collected through a self-applied questionnaire. A model of association between bullying and variables in the following domains was tested: sociodemographics, risk behaviors, mental health, and family context. Univariate and multivariate analyses were also performed. RESULTS: The prevalence of aggressors in bullying situations was 20.8%. The following variables remained associated in the final multivariate model: male gender (OR: 1.87; 95% CI: 1.79-1.94), lower participation of 16-year-old students (OR: 0.66; 95% CI: 0.53-0.82), and students from private schools (OR: 1.33; 95% CI: 1.27-1.39). Most aggressors reported feeling lonely (OR: 1.22; 95% CI: 1.16-1.28), insomnia episodes (OR: 1.21; 95% CI: 1.14-1.29), and a high prevalence of physical violence in the family (OR: 1.97 95% CI: 1.87-2.08). Aggressors missed classes more frequently (OR: 1.45; 95% CI: 1.40-1.51), and they regularly consumed more tobacco (OR: 1.21; 95% CI: 1.12-1.31), alcohol (OR: 1.85; 95% CI: 1.77-1.92), and illegal drugs (OR: 1.91; 95% CI: 1.79-2.04); they also demonstrated increased sexual intercourse (OR: 1.49 95% CI: 1.43-1.55) and regular exercise (OR: 1.20; 95% CI: 1.16-1.25). CONCLUSIONS: The data indicate that bullying is an important aspect that affects the learning-teaching process and the students' health.

RESUMO OBJETIVOS: Estimar a prevalência de bullying, sob a perspectiva do agressor, em escolares brasileiros e analisar sua associação com variáveis individuais e de contexto. MÉTODOS: Estudo transversal, de base populacional, com dados da Pesquisa Nacional de Saúde do Escolar. Participaram 109.104 estudantes do 9° ano do ensino fundamental de escolas públicas e privadas. A coleta de dados ocorreu por meio de um questionário autoaplicável. Foi testado modelo de associação entre o bullying e variáveis nos seguintes domínios: sociodemográfico, comportamentos de risco, saúde mental e contexto familiar, bem como foram feitas análises uni e multivariada. RESULTADOS: A prevalência de agressores em situações de bullying foi de 20,8%. No modelo final multivariado permaneceram as seguintes variáveis associadas: sexo masculino (OR: 1,87; IC 95%: 1,79-1,94), menor participação de escolares de 16 anos (OR: 0,66; IC 95%: 0,53-0,82), estudantes de escola privada (OR 1,33 IC95% 1,27-1,39). A maioria dos agressores relatou se sentir solitário (OR: 1,22; IC 95%: 1,16-1,28), com episódios de insônia (OR: 1,21; IC 95%: 1,14-1,29) e alta prevalência de sofrer violência física familiar (OR: 1,97 IC 95%: 1,87-2,08). Os agressores faltam mais às aulas (OR: 1,45; IC 95%: 1,40-1,51), consomem regularmente mais tabaco (OR: 1,21; IC 95%: 1,12-1,31), álcool (OR: 1,85; IC 95%: 1,77-1,92) e drogas ilícitas (OR: 1,91; IC 95%: 1,79-2,04), tem relação sexual (OR: 1,49 IC 95% 1,43-1,55) e praticam atividade física regular (OR: 1,20 IC 95% 1,16-1,25). CONCLUSÕES: Os dados indicam que a prática do bullying é aspecto relevante que interfere no processo ensino-aprendizagem e na saúde dos escolares.

Bullying and associated factors in adolescents in the Southeast region according to the National School-based Health Survey. / Bullying e fatores associados em adolescentes da Região Sudeste segundo a Pesquisa Nacional de Saúde do Escolar.

OBJECTIVE:: To estimate the prevalence of bullying from the perspective of victims in students from the Southeast region of Brazil and analyze its association with individual variables and family context. METHODS:: Information on 19,660 adolescents from the National School-based Health Survey was analyzed, calculating the association between bullying and sociodemographic variables, risk behaviors, mental health, and family background. Multivariate analysis and the calculation of odds ratio and confidence intervals were performed. RESULTS:: The prevalence of bullying was 7.8% (95%CI 6.5 - 9.2). After adjustment, the following associations were observed: students with less than 13 years of age (OR = 2.40; 1.4 - 3.93); protection for those aged 14, 15, and 16 years; male gender (OR = 1.47; 95%CI 1.35 - 1.59); black color (OR = 1.24; 95%CI 1.11 - 1.40); yellow color (OR = 1.38 95%CI 1.14 - 1.6); private school students (OR = 1.11; 95%CI 1.01 - 1.23); and students who work (OR = 1.30; 95%CI 1.16 - 1.45). Higher education of the mothers was a protective factor in all groups. Risk factors considered were feeling lonely (OR = 2.68; 95%CI 2.45 - 2.94), having insomnia (OR = 1.95; 95%CI 1.76 - 2.17), having no friends (OR = 1.47; 95%CI 1.24 - 1.75), suffering physical abuse from family members (OR = 1.83; 95%CI 1.66 - 2.03), missing classes without their parents' knowledge (OR = 1.23; 95%CI 1.12 - 1.34), as well as family supervision (OR = 1.14; 95%CI 1.05 - 1.23). To have drunk in the last 30 days (OR = 0.88 95%CI 0.8 - 0.97) was a protective factor. CONCLUSION:: Bullying increases vulnerabilities among students, which suggests the need for an intersectoral approach in order to find measures to prevent them.

Associations between the practice of bullying and individual and contextual variables from the aggressors' perspective.

OBJECTIVES: To estimate the prevalence of bullying among Brazilian students from the aggressor's perspective and to analyze its association with individual and contextual variables. METHODS: This was a cross-sectional population-based study carried out with data from the National Survey on Student Health. A total of 109,104 students attending eight grade in public and private schools were included. Data were collected through a self-applied questionnaire. A model of association between bullying and variables in the following domains was tested: sociodemographics, risk behaviors, mental health, and family context. Univariate and multivariate analyses were also performed. RESULTS: The prevalence of aggressors in bullying situations was 20.8%. The following variables remained associated in the final multivariate model: male gender (OR: 1.87; 95% CI: 1.79-1.94), lower participation of 16-year-old students (OR: 0.66; 95% CI: 0.53-0.82), and students from private schools (OR: 1.33; 95% CI: 1.27-1.39). Most aggressors reported feeling lonely (OR: 1.22; 95% CI: 1.16-1.28), insomnia episodes (OR: 1.21; 95% CI: 1.14-1.29), and a high prevalence of physical violence in the family (OR: 1.97 95% CI: 1.87-2.08). Aggressors missed classes more frequently (OR: 1.45; 95% CI: 1.40-1.51), and they regularly consumed more tobacco (OR: 1.21; 95% CI: 1.12-1.31), alcohol (OR: 1.85; 95% CI: 1.77-1.92), and illegal drugs (OR: 1.91; 95% CI: 1.79-2.04); they also demonstrated increased sexual intercourse (OR: 1.49 95% CI: 1.43-1.55) and regular exercise (OR: 1.20; 95% CI: 1.16-1.25). CONCLUSIONS: The data indicate that bullying is an important aspect that affects the learning-teaching process and the students' health.

Bullying and associated factors among Brazilian adolescents: analysis of the National Adolescent School-based Health Survey (PeNSE 2012) / Bullying e fatores associados em adolescentes brasileiros: análise da Pesquisa Nacional de Saúde do Escolar (PeNSE 2012)

OBJECTIVE: To estimate the prevalence of bullying from the victim's perspective in Brazilian school children and to analyze its association with individual and family context variables. METHODS: An analysis of the data on 109,104 adolescents, obtained by the National Adolescent School-based Health Survey, held in schools in 2012, was carried out. An association model between bullying and explanatory variables was tested in different contexts: sociodemographic, risk behaviors, mental health and family context. Univariate and multivariate analyzes were performed, calculating the Odds Ratio and confidence intervals. RESULTS: The prevalence of bullying found in this study was of 7.2% (95%CI 6.6 - 7.8). A higher chance of bullying was found among male students (OR = 1.58; 95%CI 1.51 - 1.66), with an inverse relation between age and bullying, with the magnitude of risk among adolescents younger than 13 years of age being higher when compared to those with 16 years of age or more. Of individual risk behaviors, only being a smoker remained in the final model (OR = 1.11; 95%CI 1.01 - 1.23). Mental health variables associated with bullying were: feeling lonely (OR = 2.66; 95%CI 2.52 - 2.81), insomnia (OR = 1.92; 95%CI 1.80 - 2.05), not having friends (OR = 1.71; 95%CI 1.54 - 1.89), and, in the family context, those who skip class without telling their parents (OR = 1.13; 95%CI 1,07 - 1,19) and those who suffer physical abuse by family members (OR = 2.03; 95%CI 1.91 - 2.146). CONCLUSION: Bullying was associated to male students, younger, of black color, smokers, with mental health vulnerabilities and victims of domestic violence. This suggests the need for a holistic approach from education and health professionals, parents and the community in seeking measures for the prevention of bullying. .

OBJETIVO: Estimar a prevalência de bullying, sob a perspectiva da vítima, em escolares brasileiros e analisar sua associação com variáveis individuais e de contexto familiar. MÉTODOS: Foram analisadas informações de 109.104 adolescentes obtidas da Pesquisa Nacional de Saúde do Escolar (PeNSE), 2012. Foi testado modelo de associação entre o bullying e variáveis explicativas nos seguintes domínios: sociodemográfico, comportamentos de risco, saúde mental e contexto familiar. Foram feitas analises uni e multivariada, calculando-se os odds ratio e respectivos intervalos de confiança. RESULTADOS: A prevalência de bullying foi de 7,2% (IC95% 6,6 - 7,8). Maior chance de bullying foi encontrada entre escolares do sexo masculino (OR = 1,58; IC95% 1,51 - 1,66), com uma relação inversa entre idade e bullying, sendo maior a magnitude do risco entre menores de 13 anos quando comparados aos de 16 ou mais anos. Dos comportamentos de risco individuais, apenas ser fumante se manteve no modelo final (OR = 1,11; IC95% 1,01 - 1,23). As variáveis de saúde mental associadas foram: sentir-se solitário (OR = 2,66; IC95% 2,52 - 2,81), ter insônia (OR = 1,92; IC95% 1,80 - 2,05), não ter amigos (OR = 1,71; IC95% 1,54 - 1,89) e, no contexto familiar os que faltam às aulas sem avisar os pais (OR = 1,13; IC95% 1,07 - 1,19) e relataram sofrer agressão física dos familiares (OR = 2,03; IC95% 1,91 - 2,16). CONCLUSÃO: O bullying mostrou-se associado aos escolares do sexo masculino, mais jovens, de cor preta, fumantes, além daqueles que apresentam vulnerabilidades no campo da saúde mental e de violência doméstica, o que sugere necessidade de uma abordagem holística de profissionais da educação, saúde, pais e comunidade na busca de medidas para sua prevenção. .

Validation of the pediatric surgical risk assessment scoring system.

BACKGROUND: Within the adult population, there exist numerous validated risk stratification tools aimed at predicting postoperative outcomes using preoperative and intraoperative parameters. However, similar tools for the pediatric population are scarce. We previously developed and reported on a scoring system to predict postoperative complications in children undergoing surgery at Boston Children's Hospital. The objective of this study was to validate our scoring system to determine its effectiveness in identifying children at risk for major complications or death within 30 days following surgery. STUDY DESIGN: A computer program randomly selected 2015 out of 11,734 patients who underwent surgery at our institution in 2009. The severity of the complications was graded based on the Clavien classification system, with major complications being a grade III or higher. The Preoperative Complication Score (PCS) and the Overall Complication Score (OCS) were calculated for all patients, and Receiver Operating Characteristic (ROC) curves were generated for each scoring system. RESULTS: The overall incidence of major complications was 3.9% (79 patients). Proportionally, cardiac surgery had the highest percentage of major complications (20% of the performed surgeries). Both PCS and OCS demonstrated excellent correlation with postoperative outcomes with c-statistic values of 0.740 (CI 0.682-0.800, p < 0.001) and 0.767 (CI 0.712-0.822, p < 0.001) respectively. CONCLUSIONS: We determined that both the PCS and OCS are effective in identifying children at risk for major complications and death following surgery. Further studies will be needed to determine if these scoring systems are applicable to children undergoing surgery at other institutions and if the use of the scoring systems would result in improved clinical outcomes and reduced costs.