Redução da desigualdade de acesso às ações de promoção da saúde na Atenção Primária brasileira: Programa Academia da Saúde / Reducing unequal access to health promotion actions in Primary Care in Brazil: Health Academy Program

Introdução: A situação de saúde marcada pela elevada prevalência de doenças crônicas não transmissíveis revela a necessidade de reestruturar a atenção à saúde. Nesse sentido, serviços como o Programa Academia da Saúde (PAS) foram implantados na Atenção Primária à Saúde (APS) brasileira. Objetivo: Analisar, sob a perspectiva dos usuários, o PAS como oportunidade de redução das desigualdades de acesso às ações de promoção da saúde na APS. Método: Trata-se de estudo qualitativo realizado na primeira unidade do PAS implantada em Belo Horizonte-MG, com ingressantes no serviço entre 2007 a 2011. A coleta de dados foi realizada mediante entrevista semiestruturada. Realizaram-se descrição dos dados sociodemográficos e análise de conteúdo do tipo temática. Resultado: Ingressaram no PAS, entre 2007 e 2011, 1.059 usuários, a maioria mulheres, adultos de meia idade, com baixa renda e elevadas prevalências de doenças crônicas não transmissíveis. Na perspectiva dos usuários, o PAS possibilitou o acesso às ações de promoção da saúde na APS, oportunizando a construção de escolhas mais saudáveis e mudanças nos modos de viver, sobretudo relacionados à atividade física e alimentação adequada e saudável, promovendo o empoderamento dos usuários. No entanto, foram identificadas limitações na integração do PAS com a Unidade Básica de Saúde adstrita. Conclusão: O PAS tem potencial para favorecer o acesso às ações de promoção da saúde na APS, embora ainda seja necessária maior integração com os demais pontos de atenção à saúde visando fortalecer o cuidado integral em rede e as ações de promoção da saúde. (AU)

Introduction: The health situation outlined by a high prevalence of chronic non-communicable diseases reveals the need for restructuring health care. In this sense, services such as the Health Academy Program (herein PAS) were implemented in Brazilian Primary Health Care (PHC). Objective: To analyze, from the perspective of users, PAS as an opportunity to reduce unequal access to health promotion actions in PHC. Method: This is a qualitative study carried out at the first PAS unit implemented in Belo Horizonte-MG, with participants who started using the service between 2007 and 2011. Data collection was carried out through semi-structured interviews. Sociodemographic data were described, and a thematic content analysis was carried out. Results: From 2007-2011, 1,059 users started attending PAS, most of them women, middle-aged adults with low income and high prevalence of chronic non-communicable diseases. From the users' perspective, PAS allowed accessing health promotion actions in PHC, making it possible to develop healthier choices and changes in the way of life, mainly those related to physical activity and healthy eating, empowering users. However, limitations were identified in the integration between PAS and the assigned Basic Health Unit. Conclusion: PAS has the potential to foster access to health promotion actions in PHC, although greater integration with other health care points is still needed in order to strengthen integral care networking and health promotion actions. (AU)

Ultraprocessed food consumption and risk of overweight and obesity: the University of Navarra Follow-Up (SUN) cohort study.

BACKGROUND: Ultraprocessed food consumption has increased in the past decade. Evidence suggests a positive association between ultraprocessed food consumption and the incidence of overweight and obesity. However, few prospective studies to our knowledge have investigated this potential relation in adults. OBJECTIVE: We evaluated the association between ultraprocessed food consumption and the risk of overweight and obesity in a prospective Spanish cohort, the SUN (University of Navarra Follow-Up) study. DESIGN: We included 8451 middle-aged Spanish university graduates who were initially not overweight or obese and followed up for a median of 8.9 y. The consumption of ultraprocessed foods (defined as food and drink products ready to eat, drink, or heat and made predominantly or entirely from processed items extracted or refined from whole foods or synthesized in the laboratory) was assessed with the use of a validated semiquantitative 136-item food-frequency questionnaire. Cox proportional hazards models were used to estimate adjusted HRs and 95% CIs for incident overweight and obesity. RESULTS: A total of 1939 incident cases of overweight and obesity were identified during follow-up. After adjustment for potential confounders, participants in the highest quartile of ultraprocessed food consumption were at a higher risk of developing overweight or obesity (adjusted HR: 1.26; 95% CI: 1.10, 1.45; P-trend = 0.001) than those in the lowest quartile of consumption. CONCLUSIONS: Ultraprocessed food consumption was associated with a higher risk of overweight and obesity in a prospective cohort of Spanish middle-aged adult university graduates. Further longitudinal studies are needed to confirm our results. This trial was registered at clinicaltrials.gov as NCT02669602.