Association of knowledge, preventive counseling and personal health behaviors on physical activity and consumption of fruits or vegetables in community health workers.

BACKGROUND: There is evidence that if a health professional is active and has a healthy diet, he/she is more likely to advise patients about the benefits of physical activity and healthy eating The aims of this study were to: (1) describe the personal physical activity, consumption of fruits and vegetables behaviors and nutritional status of community health workers; (2) evaluate the association between knowledge, delivery of preventive counseling and personal behaviors among community health workers. METHODS: This was a cross-sectional study conducted in a nationally sample of health professionals working in primary health care settings in Brazil in 2011. This survey was part of the second phase of the Guide for Useful Interventions for Activity in Brazil and Latin America project, and data were collected through telephone interviews of 269 community health workers from the Unified Health Care system of Brazil. We applied questionnaires about personal reported behaviors, knowledge and preventive counseling in physical activity and consumption of fruits and vegetables. We calculated the prevalence and associations between the variables with logistic regression. RESULTS: The proportion of community health workers that practiced 150 minutes per week of physical activity in leisure time or transportation was high (64.9%). Half of community health workers were overweight and only 26.2% reported consuming five portions/day of fruits or vegetables. Most community health workers reported counseling about physical activity for more than six months (59.7%), and most were not knowledgeable of the fruits and vegetables and physical activity recommendations. Meeting the fruits and vegetables recommendations was associated with correct knowledge (OR = 4.5; CI95% 1.03;19.7), with reporting 150 minutes or more of physical activity per week (OR = 2.0; CI95% 1.03;3.7) and with reporting physical activity in leisure time (OR = 2.0; CI95% 1.05;3.6). Regular physical activity counseling was associated with reporting 10-149 minutes per week (OR = 3.8; CI95% 1.1;13.3) and with more than 150 minutes of physical activity per week (OR = 4.9; CI95% 1.5;16.5). CONCLUSION: Actions to promote physical activity and healthy eating and to improve knowledge among community health workers within the health care system of Brazil could have a potential positive influence on delivery of preventive counseling to patients on this topic.

Physical activity promotion by health practitioners: a distance-learning training component to improve knowledge and counseling.

Aim To report an evaluation of health professionals' participation in a distance-learning physical activity training course developed in a low socio-economic region of São Paulo city, Brazil. BACKGROUND: In countries with public universal health systems, physical activity promotion in primary health care settings can reap results, particularly given that such interventions have the potential to reach a large percentage of the population. However, few studies proposed physical activity training for health professionals in low- and middle-income countries. Brazil is a continental country and has the Unified Health System which incorporates family health teams in over 85% of Brazilian cities. METHODS: The physical activity training was part of the fifth module of an educational intervention throughout a distance-learning course focusing on health professionals at M'Boi Mirim district in São Paulo city. The training totaled 3 h and had five themes of physical activity: (1) concepts, definitions benefits; (2) evaluation; (3) recommendation; (4) interventions; (5) physical activity counseling. The opinion of health professionals was evaluated after training by two open questions. Findings Out of 106 professionals who took part of the course, only 22.6% (n=24) had accessed the fifth module. These professionals were predominantly female (79.2%), nurses (66.7%) and aged 30 years or older. Responses highlighted the course approach focused on physical activity for improving patient's quality of life and well-being, disease prevention and health improvements. Regarding the themes for improvement, the health professionals identified that there was a need to experience physical activity classes first-hand, and the need to link physical activity counseling to the local venues that provide structured physical activity programs. We recommend that further training courses can be conducted based on this model for health professionals to promote physical activity to the community in Brazil.

Multivariate hierarchical model for physical inactivity among public school children.

OBJECTIVE: To identify biological and sociodemographic factors associated with physical inactivity in public school children. METHODS: Parents of 2,519 children (49.3% of whom were girls), aged 7 to 10 years (mean = 7.6+/-0.9 years), from eight public schools in São Paulo, Brazil, completed a self-administered questionnaire. We used multiple correspondence analysis to identify groups of responses related to levels of physical activity and inactivity and to obtain an optimal scale. The cluster analysis identified groups of active and inactive children. The analysis of the receiver operator characteristic (ROC) curve, for the study of diagnostic properties of a simplified scale for physical inactivity derived from the optimal scale, revealed that a cutoff point of 3 had the best sensitivity and specificity, being therefore used as the outcome variable in the regression model. A multivariate hierarchical model was built, including distal and proximal categorical variables, with a p < 0.05. RESULTS: Physical inactivity was positively associated with biological factors such as being overweight, being older than 7.5 years, being a female, and having a good appetite, and with socioeconomic factors such as having garbage collected less than twice a week and having mothers who work outside the home. CONCLUSION: The results are consistent with published data about determinant factors of physical activity and inactivity among children, showing that questionnaires answered by parents and submitted to a sophisticated statistical analysis can be used in population-based studies involving children younger than 10 years old.

Prevalence of health promotion programs in primary health care units in Brazil.

OBJECTIVE: Assessment of prevalence of health promotion programs in primary health care units within Brazil's health system. METHODS: We conducted a cross-sectional descriptive study based on telephone interviews with managers of primary care units. Of a total 42,486 primary health care units listed in the Brazilian Unified Health System directory, 1,600 were randomly selected. Care units from all five Brazilian macroregions were selected proportionally to the number of units in each region. We examined whether any of the following five different types of health promotion programs was available: physical activity; smoking cessation; cessation of alcohol and illicit drug use; healthy eating; and healthy environment. Information was collected on the kinds of activities offered and the status of implementation of the Family Health Strategy at the units. RESULTS: Most units (62.0%) reported having in place three health promotion programs or more and only 3.0% reported having none. Healthy environment (77.0%) and healthy eating (72.0%) programs were the most widely available; smoking and alcohol use cessation were reported in 54.0% and 42.0% of the units. Physical activity programs were offered in less than 40.0% of the units and their availability varied greatly nationwide, from 51.0% in the Southeast to as low as 21.0% in the North. The Family Health Strategy was implemented in most units (61.0%); however, they did not offer more health promotion programs than others did. CONCLUSIONS: Our study showed that most primary care units have in place health promotion programs. Public policies are needed to strengthen primary care services and improve training of health providers to meet the goals of the agenda for health promotion in Brazil.

Prevalence of anemia among preschoolers and response to iron supplementation.

OBJECTIVES: To assess the prevalence of anemia among children attending public preschools in Ilhabela, state of São Paulo, Brazil, and their response to a treatment regimen. METHODS: Between 2007 and 2008, the weight, height, and hemoglobin levels of 667 children were measured in the school setting. Anemic children were prescribed a 12-week course of ferrous sulfate, and follow-up assessment visits were scheduled for halfway through this course and the end of treatment. RESULTS: The prevalence of anemia was 25.6% (N = 170). The lowest hemoglobin level measured was 9.5 g/dL. Anemia was most prevalent (36%) in children between the ages of 60 and 65 months. Median hemoglobin levels rose to 11.8 g/dL from 10.5 g/dL after treatment; 76% of children recovered from anemia. CONCLUSION: Screening for anemia in the school setting and prompt therapy, including mid-treatment follow-up, proved to be an effective strategy for facing this major public health issue.

Prevalence of health promotion programs in primary health care units in Brazil / Prevalência de programas de promoção da saúde em unidades básicas de saúde no Brasil

OBJECTIVE Assessment of prevalence of health promotion programs in primary health care units within Brazil’s health system. METHODS We conducted a cross-sectional descriptive study based on telephone interviews with managers of primary care units. Of a total 42,486 primary health care units listed in the Brazilian Unified Health System directory, 1,600 were randomly selected. Care units from all five Brazilian macroregions were selected proportionally to the number of units in each region. We examined whether any of the following five different types of health promotion programs was available: physical activity; smoking cessation; cessation of alcohol and illicit drug use; healthy eating; and healthy environment. Information was collected on the kinds of activities offered and the status of implementation of the Family Health Strategy at the units. RESULTS Most units (62.0%) reported having in place three health promotion programs or more and only 3.0% reported having none. Healthy environment (77.0%) and healthy eating (72.0%) programs were the most widely available; smoking and alcohol use cessation were reported in 54.0% and 42.0% of the units. Physical activity programs were offered in less than 40.0% of the units and their availability varied greatly nationwide, from 51.0% in the Southeast to as low as 21.0% in the North. The Family Health Strategy was implemented in most units (61.0%); however, they did not offer more health promotion programs than others did. CONCLUSIONS Our study showed that most primary care units have in place health promotion programs. Public policies are needed to strengthen primary care services and improve training of health providers to meet the goals of the agenda for health promotion in Brazil. .

OBJETIVO Estimar a prevalência de programas de promoção da saúde nas unidades básicas de saúde no Brasil. MÉTODOS Estudo transversal descritivo realizado por meio de entrevistas telefônicas com coordenadores de unidades básicas de saúde. Do total de 42.486 unidades básicas de saúde cadastradas pelo Ministério da Saúde, 1.600 foram aleatoriamente selecionadas. As unidades foram amostradas nas cinco regiões do País de acordo com a proporção de unidades em cada região. Foi analisada a presença ou não de cinco programas de promoção da saúde: promoção de atividade física, cessação de tabagismo, cessação de uso de álcool e drogas ilícitas, alimentação saudável e ambiente saudável. Foram coletados dados sobre o tipo de ações desenvolvidas nos programas e a presença ou não da Estratégia de Saúde da Família na unidade. RESULTADOS A maioria das unidades básicas de saúde (62,0%) referiu ter pelo menos três programas de promoção da saúde e apenas 3,0% não tinha nenhum. A promoção do ambiente saudável e da alimentação saudável foram os programas mais prevalentes (77,0% e 72,0%, respectivamente), enquanto o controle do tabaco e do álcool foram referidos em 54,0% e 42,0% das unidades de saúde, respectivamente. A promoção de atividade física foi referida em menos de 40,0% das unidades e teve grande variação regional, com prevalência de 51,0% nas unidades do Sudeste e apenas 21,0% nas do Norte. A maioria das unidades de saúde (61,0%) oferecia Estratégia de Saúde da Família, porém não foi verificada maior prevalência de programas de promoção da saúde nessas unidades em relação ...

Prevalência de anemia em pré-escolares e resposta ao tratamento com suplementação de ferro / Prevalence of anemia among preschoolers and response to iron supplementation

OBJETIVOS: Avaliar a prevalência de anemia entre os pré-escolares da rede pública de Ilhabela (SP) e a resposta ao tratamento instituído. MÉTODOS: Estudo com 667 pré-escolares, entre 2007 e 2008. As crianças foram avaliadas na escola quanto ao peso, estatura e concentração de hemoglobina. As anêmicas foram tratadas com sulfato ferroso por 12 semanas, com uma consulta intermediária e outra ao final. RESULTADOS: A prevalência de anemia foi de 25,6 por cento (170 crianças). A concentração de hemoglobina mais baixa foi de 9,5 g/dL. A maior prevalência de anemia (36 por cento) ocorreu em crianças de 60 a 65 meses de idade. A mediana da concentração de hemoglobina evoluiu de 10,5 g/dL para 11,8 g/dL ao final do tratamento, recuperando 76 por cento das crianças. CONCLUSÃO: A identificação de crianças anêmicas nas escolas, o pronto tratamento da anemia e o acompanhamento durante o tratamento mostrou ser estratégia eficaz no combate a esse importante problema de saúde pública.

OBJECTIVES: To assess the prevalence of anemia among children attending public preschools in Ilhabela, state of São Paulo, Brazil, and their response to a treatment regimen. METHODS: Between 2007 and 2008, the weight, height, and hemoglobin levels of 667 children were measured in the school setting. Anemic children were prescribed a 12-week course of ferrous sulfate, and follow-up assessment visits were scheduled for halfway through this course and the end of treatment. RESULTS: The prevalence of anemia was 25.6 percent (N = 170). The lowest hemoglobin level measured was 9.5 g/dL. Anemia was most prevalent (36 percent) in children between the ages of 60 and 65 months. Median hemoglobin levels rose to 11.8 g/dL from 10.5 g/dL after treatment; 76 percent of children recovered from anemia. CONCLUSION: Screening for anemia in the school setting and prompt therapy, including mid-treatment follow-up, proved to be an effective strategy for facing this major public health issue.

Multivariate hierarchical model for physical inactivity among public school children

OBJETIVO: Identificar fatores biológicos e sociodemográficos atribuíveis à inatividade física em crianças de escolas públicas. MÉTODOS: Foram estudadas, através de questionário auto-relatado pelos pais, 2.519 crianças (49,3 por cento meninas), de 7 a 10 anos (média = 7,6±0,9 anos), de oito escolas públicas da cidade de São Paulo. Aplicamos a análise de correspondência múltipla para identificar grupos de respostas relacionadas com padrões de atividade e inatividade física e a geração de uma escala ótima. A análise de agrupamento identificou os grupos de crianças ativas e inativas. A análise de curva ROC (receiver operator characteristic), para o estudo das propriedades diagnósticas de uma escala simplificada de inatividade física derivada da escala ótima, mostrou o ponto de corte = 3 como o de melhor sensibilidade e especificidade, sendo utilizado como a variável de resposta no modelo de regressão. Um modelo hierárquico multivariado foi construído, assumindo variáveis categóricas como distais e proximais, adotando-se p < 0,05. RESULTADOS: A inatividade física foi positivamente associada aos fatores determinantes biológicos como sobrepeso, idade maior do que 7,5 anos, sexo feminino e bom apetite, e aos determinantes socioeconômicos como freqüência de coleta de lixo menor do que duas vezes por semana e mães que trabalham fora de casa. CONCLUSÃO: Os resultados são coerentes com os dados publicados sobre fatores determinantes de atividade e inatividade física na infância, indicando que questionários respondidos pelos pais, submetidos a uma análise estatística sofisticada, podem ser viáveis em estudos populacionais envolvendo crianças menores de 10 anos.

OBJECTIVE: To identify biological and sociodemographic factors associated with physical inactivity in public school children. METHODS: Parents of 2,519 children (49.3 percent of whom were girls), aged 7 to 10 years (mean = 7.6±0.9 years), from eight public schools in São Paulo, Brazil, completed a self-administered questionnaire. We used multiple correspondence analysis to identify groups of responses related to levels of physical activity and inactivity and to obtain an optimal scale. The cluster analysis identified groups of active and inactive children. The analysis of the receiver operator characteristic (ROC) curve, for the study of diagnostic properties of a simplified scale for physical inactivity derived from the optimal scale, revealed that a cutoff point of 3 had the best sensitivity and specificity, being therefore used as outcome variable in the regression model. A multivariate hierarchical model was built, including distal and proximal categorical variables, with a p < 0.05. RESULTS: Physical inactivity was positively associated with biological factors such as being overweight, being older than 7.5 years, being a female, and having a good appetite, and with socioeconomic factors such as having garbage collected less than twice a week and having mothers who work outside the home. CONCLUSION: The results are consistent with published data about determinant factors of physical activity and inactivity among children, showing that questionnaires answered by parents and submitted to a sophisticated statistical analysis can be used in population-based studies involving children younger than 10 years old.