[Remote control or unlikely control? Behavioral economics and the promotion of healthy behaviors¿Control remoto o remota probabilidad de control? La economía comportamental y la promoción de determinados patrones de comportamiento]. / Controle remoto ou remoto controle? A economia comportamental e a promoção de comportamentos saudáveis.

Behavioral economics is a field of knowledge and practices that studies the effect of psychological, cognitive, emotional, and social factors relating to decision-making by individuals and institutions. It assumes that human choices are not the result of careful consideration of costs and benefits, and that some aspects (e.g., defaults, framings, and anchoring effects) may influence an individual's decision-making. Thus, the aim of this essay is to present some general aspects of behavioral economics and discuss its possible application in the promotion of healthy behaviors. One of the roles of health care professionals is to facilitate the adoption of healthy behaviors by the population. There is evidence of a positive influence of some behavioral economics concepts regarding the adoption of various health behaviors, such as food choices, physical activity, adherence to vaccination campaigns, and organ donation. Thus, it is believed that the appropriation of some of these concepts and insights may both promote healthier behaviors and support more effective actions to encourage these healthy behaviors.

La economía comportamental es un campo de conocimientos y prácticas que estudia el efecto de los factores psicológicos, cognoscitivos, emocionales y sociales sobre la toma de decisiones de las personas y las instituciones. Esa disciplina parte de la premisa de que las formas de elección humana no son el resultado de una cuidadosa ponderación de los costos y beneficios, y de que algunos aspectos (por ejemplo, la opción predeterminada, el efecto de enmarcación y el efecto de anclaje) pueden influir en la toma de decisiones por parte de las personas. Por ende, el objetivo de este texto es presentar los aspectos generales de la economía comportamental y algunas reflexiones sobre su posible aplicación en la promoción de patrones de comportamiento saludable. Una de las funciones de los profesionales de salud es facilitar la adopción de patrones de comportamiento saludable por parte de la población. En esa perspectiva, se ha comprobado que la aplicación de los conceptos de la economía comportamental puede tener un efecto positivo en la adopción de diversos patrones de comportamiento en materia de salud, por ejemplo, la selección de alimentos, la práctica de la actividad física, la adhesión a campañas de vacunación y la donación de órganos. De ese modo, se cree que la apropiación de algunos conceptos y percepciones de la economía comportamental permite, por un lado, promover los patrones de comportamiento saludable y, por otro, apoyar medidas más eficaces para incentivar esos tipos de comportamiento.

[Barriers perceived by health directors for evidenced-based decision-makingObstáculos percibidos por los directores de servicios de salud para la toma de decisiones basada en la evidencia]. / Barreiras percebidas por diretores de saúde para tomada de decisão baseada em evidências.

OBJECTIVE: To identify the barriers to evidence-based decision-making regarding chronic noncommunicable diseases perceived by health administrators from the state of Paraná, Brazil. METHODS: Telephone interviews were performed with 20 health region directors using a semi-structured script. The interviews were performed in 2015 and had a mean duration of 23 minutes. After transcription of the interview, the contents were analyzed for identification of subject categories. RESULTS: Two categories were identified: organizational and personal barriers. The most frequent organizational barriers were "poor planning or management" and "regional and cultural characteristics of the population." The most frequent personal barriers were "lack of incentive and difficulty to work with scientific evidence" and "lack of training and professional qualification." CONCLUSION: Support to health professionals should be enhanced through technical training courses linked to political and scientific efforts that address the health needs of the community.

OBJETIVO: Determinar los obstáculos para la toma de decisiones basada en la evidencia referentes a la prevención de enfermedades crónicas no transmisibles, según la percepción de los administradores de servicios de salud en el estado de Paraná. MÉTODOS: Se realizaron entrevistas telefónicas a 20 directores de unidades regionales de salud, por medio de una guía semiestructurada. Las entrevistas se efectuaron en el 2015 y duraron un promedio de 23 minutos. Después de la transcripción, se analizó su contenido para determinar los tipos de obstáculos existentes. RESULTADOS: Se detectaron dos tipos de obstáculos, a saber, organizacionales y personales. Los obstáculos organizacionales más frecuentes fueron la falta de planificación y de gestión y las características regionales y culturales de la población. Los obstáculos personales más frecuentes fueron la falta de incentivos, las dificultades para trabajar con pruebas científicas y la falta de capacitación y de idoneidad profesional. CONCLUSIÓN: Se sugiere reforzar el apoyo a los profesionales de salud por medio de cursos de capacitación técnica que abarquen esfuerzos políticos y científicos y atiendan las prioridades de salud de la comunidad.

Characteristics and counseling strategies for physical activity used by primary health care professionals. / Características e estratégias de aconselhamento para atividade física utilizadas por profissionais da atenção primária à saúde.

This study aim to describe the characteristics and strategies of counseling for physical activity used by Primary Health Care (PHC) professionals. A survey was carried out with 587 (85.4% women) health professionals who work in PHC in Florianopolis, in the state of Santa Catarina, southern Brazil. Counseling carried out in the last 12 months was considered. Operational aspects related to counseling practices and strategies used for counseling were evaluated. The frequency of physical activity guidance was 86.2% (95%CI = 83.2-88.8%). Counseling was characterized as a brief practice, carried out in individual consultations, aimed at adults and the older adults and people with morbidities. The most used strategy was to guide users to participate in physical activity groups at the Health Center (89.5%) and in relation to the 5As method, giving some "advice" was the most used strategy (99.0%) and the least used. used was to follow strategies (22.6%). Counseling for physical activity has been based on a brief practice, carried out in individual consultations and focused on people with morbidities and on adults and the elderly. The strategies used do not seem to cover the full care of the advised users.

O estudo buscou descrever as características e estratégias de aconselhamento para atividade física utilizadas por profissionais da atenção primária à saúde (APS). Foi realizada uma pesquisa com 587 profissionais de saúde (85,4% mulheres) que atuam na APS de Florianópolis, no estado de Santa Catarina, Sul do Brasil. Foram considerados os aconselhamentos efetuados nos últimos 12 meses, avaliando-se aspectos operacionais relacionados às práticas e estratégias utilizadas. A frequência de orientação de atividade física foi de 86,2% (IC95% = 83,2-88,8%). O aconselhamento se caracterizou como uma prática breve, realizada em consultas individuais, voltadas para adultos e idosos e pessoas com morbidades. A estratégia mais utilizada foi orientar usuários a participarem de grupos de atividade física no Centro de Saúde (89,5%), e em relação ao método 5As, dar algum "conselho" foi a estratégia mais utilizada (99,0%), e a menos utilizada foi seguir estratégias (22,6%). Aconselhamento para atividade física tem sido baseado em uma prática breve, realizada em consultas individuais e focada em pessoas com morbidades e em adultos e idosos. As estratégias utilizadas parecem não abranger o cuidado integral dos usuários aconselhados.

Federal government budgetary and financial resources for body practices and physical activities in the Unified Health System: analysis of the 2019-2022 governmental cycle. / Recursos da União para as práticas corporais e atividades físicas no SUS: análise do ciclo governamental 2019-2022.

Through quantitative exploratory research, the present study analyzed the amount foreseen in the Federal Budget and the amounts paid (nominal and deflated) for programs and actions to promote body practices and physical activities (Health Academy Program and the Federal Incentive for Physical Activity in Primary Health Care) from 2019 to 2022. The values of investment in body practices and physical activities in SUS per capita, according to the population covered by Primary Health Care (PHC) and per participant in public programs, were also calculated. The following was found: (1) that the resources that were actually paid were 3.31% to 15.06% lower than those approved in the budget (nominal) and (2) the low annual (maximum) values found, regardless of whether nominal or deflated - per capita (R$ 0.21 to 0.30) per population covered by PHC (R$ 0.25 to 0.40) and per participant (R$ 10.61 to 14.61). It was concluded that the low investment in the promotion of body practices and physical activities decreases access and does not contribute to the full functioning of SUS by preventing or hindering the expansion of possibilities of comprehensive health care.

Por meio de pesquisa quantitativa de caráter exploratório, o presente estudo teve o objetivo de analisar o orçamento e o financiamento federal de programas e ações de promoção das práticas corporais e atividades físicas no Sistema Único de Saúde (SUS) de 2019 a 2022 (Programa Academia da Saúde e o Incentivo Federal de Custeio da Atividade Física na Atenção Primária). Foram analisados e calculados os valores per capita, pela população coberta pela atenção primária e por participante de programas públicos. Os recursos efetivamente pagos foram de 3,31% a 15,06% menores dos que os aprovados no orçamento (nominal), e também foram identificados os baixos valores (máximos) anuais, independentemente se nominal ou deflacionado per capita (R$ 0,21 a 0,30) por população coberta pela atenção primária (R$ 0,25 a 0,40) e por participante (R$ 10,61 a 14,61). Concluiu-se que o baixo investimento na promoção das práticas corporais e atividades físicas diminui o acesso e não contribui para o pleno funcionamento do SUS ao impedir ou dificultar a ampliação de possibilidades do cuidado integral em saúde.

Association between physical activity domains and depressive symptoms among Brazilian adults: does every move count? / Associação entre domínios da atividade física e sintomas depressivos em adultos brasileiros: todo movimento conta?

This study aimed to investigate the practice of physical activities in the four domains (leisure time, transportation, household, and work) and the prevalence of depressive symptoms in Brazilian adults, in general and stratified by sex, schooling level, and having or not a self-reported diagnosis of depression. This is a cross-sectional study with data from 88,531 individuals aged 18 years or older, who responded to the Brazilian National Health Survey in 2019. The depressive symptoms were evaluated by the Patient Health Questionnaire-9 (PHQ-9). Those who practice physical activities at least once a week in a given domain were considered physically active. Additionally, the calculation of physical activities duration was conducted and later divided into quartiles for each domain. For the association analyses, the crude odds ratio (crudeOR) and adjusted odds ratio (adjustedOR) were calculated for the total and stratified analyses. Individuals who are physically active during leisure time showed a lower chance of presenting depressive symptoms, in total (adjustedOR = 0.74; 95%CI: 0.64-0.86) and in all stratifications, except for individuals with self-reported depression. The associations of leisure-time physical activity were most frequent in those who practice from 121 to 360 minutes/week. The individuals who were active in the transportation, household, and work domains had a higher chance of presenting depressive symptoms in some groups, with more consistent results for household physical activities. The results showed that the relationship between physical activities and depression among Brazilians varies according to domain and duration, and that the concept that "every move counts" seemed to be correct only for the leisure-time domain.

O objetivo desta pesquisa foi investigar a relação da prática de atividade física nos quatro domínios (tempo livre, deslocamento, doméstico e trabalho) e a prevalência de sintomas depressivos em adultos brasileiros, de maneira geral e estratificando-se por sexo, escolaridade e ter ou não diagnóstico referido de depressão. Estudo transversal, com dados de 88.531 indivíduos de 18 anos ou mais, respondentes da Pesquisa Nacional de Saúde de 2019. Os sintomas depressivos foram avaliados pelo Patient Health Questionnaire-9 (Questionário de Saúde do Paciente-9, PHQ-9). Foram considerados fisicamente ativos aqueles que referiram realizar atividade física pelo menos uma vez por semana no respectivo domínio. Adicionalmente, foi realizado o cálculo de tempo de prática semanal, sendo posteriormente divididos em quartis em cada domínio. Para as análises de associação, foram calculados o odds ratio bruto (ORbruto) e ajustado (ORajustado), no total e nas análises estratificadas. Os fisicamente ativos no tempo livre tiveram menor chance de apresentar sintomas depressivos, no total (ORajustado = 0,74; IC95%: 0,64-0,86) e em todas as estratificações, menos naqueles com depressão autorreferida. As associações na atividade física no tempo livre foram mais frequentes naqueles que praticavam entre 121 e 360 minutos semanais. Os indivíduos ativos nos domínios de deslocamento, doméstico e trabalho tiveram maior chance de apresentar sintomas depressivos em alguns grupos, com resultados mais consistentes para a atividade física doméstica. Os resultados evidenciaram que a relação da atividade física com a depressão em brasileiros varia conforme o domínio e a duração da atividade física, e que a ideia de que "todo movimento conta" parece adequada apenas para o domínio de tempo livre.

Este estudio tuvo como objetivo investigar la práctica de actividad física en cuatro dominios (ocio, desplazamiento, actividad doméstica y trabajo) y la prevalencia de síntomas depresivos en adultos brasileños, en general y estratificada por sexo, escolaridad y diagnóstico de depresión autoinformado. Se trata de un estudio transversal con datos de 88.531 individuos de 18 años o más, que respondieron la Encuesta Nacional de Salud en el 2019. Los síntomas depresivos se evaluaron mediante el Cuestionario sobre la Salud del Paciente-9 (PHQ-9). Aquellos que realizan actividad física al menos una vez por semana en un dominio determinado se consideraron físicamente activos. Además, se calculó el tiempo de actividad física y luego se dividió en cuartiles para cada dominio. Para los análisis de asociación, se calcularon el odds ratio crudo (ORcrudo) y el odds ratio ajustado (ORajustado) para los análisis total y estratificado. Los individuos que son físicamente activos en durante el ocio presentaron menos probabilidades de tener síntomas depresivos, en el total (ORajustado = 0,74; IC95%: 0,64-0,86) y en todas las estratificaciones, excepto los individuos con depresión autoinformada. Las asociaciones de actividad física en el tiempo libre fueron más frecuentes en quienes practicaban de 121 a 360 minutos/semana. Los individuos que eran activos en los dominios desplazamiento, actividad doméstica y trabajo tuvieron más probabilidades de presentar síntomas depresivos en algunos grupos, con resultados más consistentes para las actividades domésticas. Los resultados mostraron que la relación entre actividad física y depresión entre los brasileños varía según el dominio y la duración, y el concepto de que "cada movimiento cuenta" parece ser correcto solo para el dominio del ocio.

The inverse equity hypothesis in the implementation of NASF-AB in municipalities of Southern Brazil. / A hipótese da equidade inversa na implementação do NASF-AB em municípios do Sul do Brasil.

The present study aimed to analyze the evolution of the implementation of Family Health and Primary Health Care Expanded Support Centers (NASF-AB, in Portuguese) in the municipalities of Southern Brazil, from 2008 to 2019, in light of the inverse equity hypothesis. This was an ecological study, considering 1,188 municipalities of Southern Brazil. The analyses were separated by state, with municipalities divided into quartiles of Municipal Human Development Index - Income (MHDI-Income). Our study calculated the cumulative percentage of the implementation of NASF-AB within the given period and the inequality between Q1 (richest) and Q4 (poorest), assessed by the absolute and relative inequality measures. In Paraná, Q1 presented a higher coverage of NASF-AB than did Q4, and, although the inequality had decreased at the end of the period, it was still quite distinct, according to the "top inequality" pattern. In Santa Catarina, the predictions of the hypothesis were confirmed, with inequalities found in the beginning of the period and a near 90% decline once NASF-AB had been implemented in the municipalities of Q1, characterizing the "bottom inequality" pattern. In Rio Grande do Sul, the hypothesis was refuted observing that since 2014 there was a greater implementation in Q4 as compared to Q1 was observed.

O objetivo foi verificar a evolução da implementação do Núcleo Ampliado de Saúde da Família e Atenção Básica (NASF-AB) nos municípios da região Sul do Brasil, de 2008 a 2019, sob à luz da hipótese da equidade inversa. Estudo ecológico considerando 1.188 municípios do Sul do Brasil. As análises foram separadas por estado, com os municípios divididos em quartis de Índice de Desenvolvimento Humano Municipal - Renda. Foi calculado o percentual acumulativo de implementação do NASF-AB no período e a desigualdade entre Q1 (mais rico) e Q4 (mais pobre) verificada por medidas de desigualdade absoluta e relativa. No Paraná o Q1 apresentou maior cobertura do NASF-AB do que o Q4 e, apesar da desigualdade ter reduzido ao final do período, ainda estava bem demarcada, seguindo padrão "top inequality". Em Santa Catarina ocorreu o que prevê a hipótese, com aumento das desigualdades no início e posterior redução quando já existia NASF-AB em cerca de 90% dos municípios do Q1, caracterizando "botton inequality". No Rio Grande do Sul a hipótese foi refutada ao observar, a partir de 2014, maior implementação no Q4 em relação ao Q1.

Screen time and low back pain in children and adolescents: a systematic review of Brazilian studies.

OBJECTIVE: To identify and summarize the possible associations between screen time and low back pain in children and adolescents. DATA SOURCE: Systematic searches were performed in five electronic databases (Lilacs, Scielo, Scopus, PubMed and Web of Science) on 01/25/2021, complemented by manual searches in reference lists and on Google Scholar, looking for original scientific articles that included Brazilian observational studies; whose samples had children and/or adolescents aged between 6 and 19 years, without specific clinical conditions, and that presented analyses of associations between indicators of screen time and nonspecific low back pain, based on regression models. DATA SYNTHESIS: Nine cross-sectional studies whose samples had adolescents were included. Of the 18 analyses identified, nine reported risk relationships between the variables of interest. More specifically, risk associations were found in two studies that evaluated adolescents exposed to at least three hours using cell phone or tablet, and watching television per day. Also, instruments, cut-off points adopted, and screen equipment evaluated were diverse. CONCLUSIONS: Even though most of the risk associations were borderline from the statistical point of view, we found a higher frequency of risk associations between screen time and non-specific low back pain in adolescents exposed to screen time for at least three hours a day. In addition, further longitudinal studies with samples composed of children should be conducted across the country.

[Urban geographic space and fruit and vegetable consumption: 2013 National Health Survey]. / Espaço geográfico urbano e consumo de frutas e hortaliças: Pesquisa Nacional de Saúde 2013.

The aim of the study was to analyze the association between the urban geographic space and the regular consumption of fruit and vegetables in Brazil. It involved a population-based and cross-sectional study using data from the 2013 National Health Survey, considering 60,202 adults ≥18 years old. The dependent variables were regular fruit consumption (RFC) and regular vegetable consumption (RVC). The independent variable was the urban geographic space divided into three categories: capital, metropolitan region (MR) and interior. The Odds Ratio was calculated, adjusted by sociodemographic variables. Among women, the RFC was lower in MR (OR= 0.83; 95%CI: 0.73-0.94) and in the interior (OR= 0.68; 95%CI: 0.61-0.76), the same in men (RM: OR= 0.84; 95%CI: 0.75-0.93; Interior: OR= 0.78; 95%CI: 0.71-0.85). In most subcategories, the same was observed in the interior and the capital. There was no association with RVC and the urban geographic space in general, and when stratified in the subgroups even contradictory results were observed, because in some subgroups the RVC was higher in the capitals and lower elsewhere. Local aspects of production and distribution of these food products are considered when planning public policies that seek to promote consumption in the population.

O objetivo do estudo foi analisar a associação entre o espaço geográfico urbano e o consumo regular de frutas e hortaliças no Brasil. Estudo de base populacional, transversal, com dados da Pesquisa Nacional de Saúde (2013), considerando 60.202 adultos ≥18 anos. As variáveis dependentes foram o consumo regular de frutas (CRF) e o consumo regular de hortaliças (CRH). O espaço geográfico urbano foi a variável independente, dividida em: capital, região metropolitana (RM) e interior. Foi calculado o Odds Ratio ajustado pelas variáveis sociodemográficas. Entre as mulheres o CRF foi menor na RM (OR= 0,83; IC95%: 0,73-0,94) e no interior (OR= 0,68; IC95%: 0,61-0,76), o mesmo aconteceu entre os homens (RM: OR= 0,84; IC95%: 0,75-0,93; Interior: OR= 0,78; IC95%: 0,71-0,85). Na maioria das subcategorias o mesmo foi observado na comparação interior x capital. Não houve associação do CRH com o espaço geográfico urbano de maneira geral, e quando estratificado nos subgrupos foram observados resultados contraditórios, pois em alguns subgrupos o CRH foi maior nas capitais e em outros menor. Aspectos locais de produção e distribuição desses alimentos devem ser considerados no planejamento de políticas públicas que busquem a promoção de seu consumo.

[Incidence of increase and decrease in Body Mass Index in middle-aged men and women: four-year follow-up]. / Incidência de aumento e redução do Índice de Massa Corporal na meia-idade: seguimento de quatro anos.

The scope of this study was to analyze the incidence of increase and decrease in Body Mass Index (BMI) among middle-aged men and women according to sociodemographic characteristics and classification of nutritional status. It involved a population-based cohort of 689 adults aged 40 to 64 years followed up for four years. The proportion of reduction and increase in BMI (≥1 kg/m²) was verified according to sociodemographic variables and classification of nutritional status in the baseline by means of crude and adjusted Poisson regression. There was a higher incidence of reduced BMI among men in the 55-64 age group (RR: 1.78; 95%CI: 1.06-3.00), in those without a partner (RR: 1.85; 95%CI: 1.09-3.14), in those classified as overweight (RR: 2.06; 95%CI: 1.13-3.74) and in those classified as obese (RR: 2.33; 95%CI: 1.24-4.35), and among women in the 55-64 age group (RR: 1.43; 95%CI: 1.02-2.00) and in those classified as obese (RR: 2.10; 95%CI%: 1.30-3.38). The incidence of increased BMI was lower in the 55 to 64 age group among men (RR: 0.62; 95%CI: 0.41-0.95) and women (RR: 0.68; 95%CI: 0.49-0.95). These data are important for understanding the factors related to the variation of BMI and the elaboration of public policies aimed at the health care of middle-aged adults.

Objetivou-se analisar a incidência de aumento e de redução do Índice de Massa Corporal (IMC) entre homens e mulheres de meia-idade segundo características sociodemográficas e classificação do estado nutricional. Trata-se de uma coorte de base populacional com 689 adultos com idade entre 40 e 64 anos seguidos por quatro anos. Verificou-se a proporção de redução e de aumento do IMC (≥1 kg/m²) segundo variáveis sociodemográficas e classificação do estado nutricional na linha de base mediante regressão de Poisson bruta e ajustada. A maior incidência de redução do IMC foi observada entre os homens na faixa etária de 55 a 64 anos (RR: 1,78; IC95%: 1,06-3,00), naqueles sem companheira (RR: 1,85; IC95%: 1,09-3,14), nos classificados com sobrepeso (RR: 2,06; IC95%: 1,13-3,74) e obesidade (RR: 2,33; IC95%: 1,24-4,35), e entre as mulheres na faixa etária de 55 a 64 anos (RR: 1,43; IC95%: 1,02-2,00) e nas classificadas com obesidade (RR: 2,10; IC95%: 1,30-3,38). A incidência de aumento do IMC foi menor na faixa etária de 55 a 64 anos entre os homens (RR: 0,62; IC95%: 0,41-0,95) e mulheres (RR: 0,68; IC95%: 0,49-0,95). Estes dados são importantes para compreensão dos fatores relacionados à variação do IMC e elaboração de políticas públicas que visem o cuidado à saúde na meia-idade.

[Occupational factors and physical activity among public school teachers: a prospective cohort study]. / Fatores ocupacionais e atividade física em professores da educação básica da rede pública: uma coorte prospectiva.

The association between self-reported changes in working conditions and the incidence of recommended levels of leisure-time physical activity (LTPA) among middle and high school teachers of the public school network was analyzed. It is a prospective cohort in which 298 teachers from the public middle and high school network in Londrina, State of Paraná, were monitored for 24 months. The incidence of recommended LTPA levels (≥150 minutes/week) was the study outcome. The analysis included adjusted Poisson regression models, using those who had the worst working conditions in the baseline, and remained unchanged in the follow-up, as a reference group. The incidence of recommended levels of LTPA was 23.2%, being higher among those who maintained a good balance between their personal and professional lives (RR=3.50; 95%CI=1.26-9.72), frequently became exhausted at work (RR=2.47; 95%CI=1.10-5.56), infrequently became exhausted at work (RR=2.42; 95%CI=1.09-5.36), rarely became exhausted at work (RR=2.78; 95%CI=1.30-5.95), rarely began to work too hard (RR=2.69; 95%CI=1.24-5.87) and those who rarely needed to work too much (RR=3.25; 95%CI=1.46-7.26). These results indicate the importance of improving working conditions in the promotion of AFTL.

Analisou-se a associação entre mudanças autorreferidas nas condições de trabalho e a incidência de níveis recomendados de atividade física no tempo livre (AFTL) em professores da educação básica da rede pública. Trata-se de uma coorte prospectiva em que 298 professores da educação básica da rede pública de Londrina, Paraná, foram seguidos por 24 meses. A incidência de níveis recomendados de AFTL (≥150 minutos/semana) foi o desfecho do estudo. A análise incluiu modelos de regressão de Poisson ajustados, sempre tendo como grupo referência aqueles que tinham a pior condição de trabalho na linha de base e assim permaneceram no seguimento. A incidência de níveis recomendados de AFTL foi de 23,2%, sendo maior naqueles que se mantiveram com bom equilíbrio entre vida pessoal e profissional (RR=3,50; IC95%=1,26-9,72), passaram a ficar frequentemente desgastados no trabalho (RR=2,47; IC95%=1,10-5,56), passaram a ficar raramente desgastados no trabalho (RR=2,42; IC95%=1,09-5,36), mantiveram-se raramente desgastados no trabalho (RR=2,78; IC95%=1,30-5,95), passaram a raramente trabalhar demais (RR=2,69; IC95%=1,24-5,87) e mantiveram-se raramente trabalhando demais (RR=3,25; IC=1,46-7,26). Estes resultados indicam a importância da melhoria das condições de trabalho na promoção da AFTL.

[Body practices and physical activities in the tripartite management of the SUS: organizational structure, financing and supply]. / As práticas corporais e atividades físicas na gestão tripartite do SUS: estrutura organizacional, financiamento e oferta.

The scope of this study was to analyze the organizational structure, financing and supply of programs and actions of bodily practices and physical activities (PCAF) considering the tripartite management of the Unified Health System (SUS). Focusing on the years2018 to 2020, information was requested from the Ministry of Health (MS), the 26 state health secretariats, the Federal District (SES) and the 26 municipal health secretariats in the capitals (SMS). 40 responses were received (rate of 74%). Based on the relevance of the Expanded Center for Family Health and Primary Care (Nasf AB) in the provision of PCAF, research was also carried out in information systems. It was observed that only the MS, two SES' and four SMS' had a specific PCAF management structure; the possibility of financing was identified by the MS, in six SES' and eight SMS'. With respect to the programs, they seem to be limited to the Health Academy. In relation to the offer of PCAF, it was observed that from 2015 to 2020 the percentage of participation of Nasf AB was always higher than 70%, reaching 82.3%. Thus, the panorama revealed in the MS, SES and SMS capitals sets up a timid arrangement of essential elements of organizational structure, funding, programs, and actions for the PCAF to advance as a public health policy.

Objetivou-se analisar a estrutura organizacional, o financiamento e a oferta de programas e ações de práticas corporais e atividades físicas (PCAF) considerando a gestão tripartite do Sistema Único de Saúde (SUS). Com recorte nos anos de 2018 a 2020, foram solicitadas informações do Ministério da Saúde (MS), das 26 secretarias estaduais de saúde e do Distrito Federal (SES) e das 26 secretarias de saúde municipais das capitais (SMS). Foram recebidas 40 respostas (taxa de 74%). De forma complementar, a partir da relevância do Núcleo Ampliado de Saúde da Família e Atenção Básica (Nasf AB) na oferta das PCAF, foi realizada pesquisa em sistema de informações. Apenas o MS, duas SES e quatro SMS apresentavam estrutura específica de gestão das PCAF; a possibilidade de financiamento foi apontada pelo MS, em seis SES e oito SMS. Em relação aos programas, parecem limitar-se ao Academia da Saúde. Já em relação à oferta de PCAF, observou-se que, de 2015 a 2020, o percentual de participação do Nasf AB foi sempre maior do que 70%, chegando a 82,3%. Assim, o panorama constituído no MS, nas SES e SMS das capitais configura uma tímida disposição de elementos essenciais, como estrutura organizacional, financiamento, programas e ações para que as PCAF possam avançar enquanto política pública de saúde.

Sedentary behavior and health-related quality of life in adolescents.

Health-related quality of life (HRQoL) represents the perception of each person about different aspects of their lives in the health context (physical, psychological, social environment and interpersonal relationships). Among adolescents, HRQoL can change considering habits adopted in this phase of life. This study analyzed the association between time used on different sedentary behaviors (SB) and HRQoL in adolescents. This is a cross-sectional epidemiological study with adolescents between 10 - 15 years of age. The SB was measured using a questionnaire (n = 1,455 adolescents) and accelerometer (n = 844 adolescents), and HRQoL using KIDSCREEN - 27. Time on videogames/cell phones/tablets was inversely associated with overall HRQoL (ß = -0.021; 95%CI: -0.026; -0.006), psychological well-being (ß = -0.030; 95%CI: -0.050; -0.010), peer social support (ß = -0.041; 95%CI: -0.066; -0.016) and school environment (ß = -0.033; 95%CI: -0.056; -0.010) scores. Screen time was inversely associated with the school environment score (ß = -0.011; 95%CI: -0.020; -0.003). Computer time was positively associated with the psychological well-being (ß = 0.025; 95%CI: 0.006; 0.043) and peer social support scores (ß = 0.029; 95%CI: 0.004; 0.053). It concluded that adolescents with more screen time had lower HRQoL. However, theses associations varied with the type and method of SB measurement and the HRQoL dimension.

Stages of change for leisure time physical activity in Brazilian adults: longitudinal study. / Estágios de mudança de comportamento para atividade física no lazer em adultos brasileiros: estudo longitudinal.

The objective of this study was to analyze the maintenance of and movement between stages of change for leisure time physical activity (LTPA) after four years and the association with sociodemographic characteristics. A cross-sectional population-based study was conducted with 1,180 individuals aged 40 years or over in 2011. In 2015, 885 participants were reinterviewed. The dependent variables were the maintenance of and movement between stages of change for LTPA behavior. The data was analyzed using adjusted Poisson regression. We found that around 40% of the study participants were still at the same stage they were at in the first assessment, while 31.6% had relapsed and 27% had advanced at least one stage. The stages that showed the highest frequencies were remained in precontemplation and maintenance. The risk of remaining at the precontemplation stage was higher among men (RR=1.59; 95%CI:1.21-2.11), respondents aged ≥60 years (RR=1.35; 95%CI:1.03-1.78), those with a lower level of education (RR=1.24; 95%CI:1.04-2.33), and those from economic classes C and D/E (RR=1.71; 95%CI:1.17-2.49 and RR=1.88; 95%CI:1.12-3.18, respectively). The frequency of individuals who remained at the maintenance stage was significantly lower in economic classes D/E than in classes A/B (RR=0.35; 95%CI:0.14-0.87).

Objetivou-se analisar a manutenção e a alteração dos estágios de mudança de comportamento para atividade física no lazer (AFL) após quatro anos e sua associação com características sociodemográficas. No ano de 2011, realizou-se um estudo transversal de base populacional com 1.180 indivíduos de 40 anos e mais. Em 2015 foram reentrevistados 885 indivíduos. As variáveis dependentes foram a manutenção e a alteração dos estágios de mudança de comportamento para AFL. Para análise dos dados foi usada a regressão de Poisson ajustada. Após quatro anos, verificou-se que cerca de 40% dos sujeitos permaneceram no mesmo estágio que se encontravam na primeira avaliação, enquanto 31,6% regrediram e 27% avançaram pelo menos um estágio. As maiores frequências foram de indivíduos que permaneceram nos estágios de pré-contemplação e manutenção. Entre os que se mantiveram em pré-contemplação, observou-se maior risco nos homens (RR=1,59; IC95%:1,21-2,11), naqueles com idade ≥60 anos (RR=1,35; IC95%:1,03-1,78), com menor escolaridade (RR=1,24; IC95%:1,04-2,33) e das classes C (RR=1,71;IC95%: 1,17-2,49) e D/E (RR=1,88; IC95%:1,12-3,18). A frequência dos indivíduos das classes D/E que permaneceram no estágio de manutenção foi significativamente menor que os das classes A/B (RR=0,35; IC95%:0,14-0,87).

Development and validation of an instrument to evaluate interventions in relation to Health Promotion principles. / Desenvolvimento e validação de um instrumento para avaliar intervenções em relação aos princípios da Promoção da Saúde.

OBJECTIVE: To develop and validate of an instrument to evaluate interventions in relation to Health Promotion principles in Brazil. METHODS: A cross-sectional study of the development and validation of an instrument was carried out, based on the assessment of the first version by 20 health workers, the final version by 19, analysis of reliability by 31, and content evaluation of the first version by ten experts and of the final version by 12 experts. The content validity index, Cronbach's alpha (α) and intraclass correlation coefficient were used. RESULTS: The indicators achieved 89.9% adequacy, 82.5% clarity, internal consistency was α = 0.80, and the test-retest correlation was 0.93. CONCLUSION: The instrument showed acceptable validity and reliability and can be used for the evaluation of Health Promotion interventions.

[Co-occurrence of risk factors to health among university students of a Brazilian tertiary education institution]. / Coocorrência de fatores de risco à saúde em universitários de uma instituição de ensino superior brasileira.

The co-occurrence of risk factors can lead to chronic noncommunicable diseases and even loss of life. The objectives of this study were to describe the prevalence and analyze sociodemographic characteristics linked to university life associated with the co-occurrence of risk factors among undergraduates. The study consisted of three cross-sectional surveys in 2010, 2012 and 2014 of undergraduates in Bahia, Brazil. The outcome of this study was the co-occurrence of two or more risk factors (lower levels of leisure-time physical activities, overweight/obesity, irregular consumption of fruits/vegetables and self-assessed lack of stress). The association among the variables was conducted by establishing the Prevalence Ratios. A total of 878, 879 and 877 undergraduates participated in the study in the years 2010, 2012 and 2014, respectively. In all three surveys, the prevalence of two or more risk factors was greater than 70%. The co-occurrence of two or more risk factors was associated with women, mature students, undergraduates from the health area and students with more years at university. The conclusion drawn was that the prevalence of two or more risk factors was high and that women were the group that presented higher prevalence of co-occurrence of risk factors in all surveys.

A coocorrência de fatores de risco pode desencadear doenças crônicas não transmissíveis e no extremo, a mortalidade. Os objetivos deste estudo foram descrever as prevalências e analisar as características sociodemográficas e de vínculo com a universidade associadas à coocorrência de fatores de risco em universitários. O estudo, composto por três inquéritos transversais, foi realizado com universitários da Bahia, Brasil, nos anos de 2010, 2012 e 2014. O desfecho foi a coocorrência de dois ou mais fatores de risco (menores níveis de atividades físicas no tempo livre, excesso de peso, consumo irregular de frutas/hortaliças e auto avaliação negativa do estresse). A associação com as variáveis foi realizada pelas Razões de Prevalências. Participaram do estudo 878, 879 e 877 universitários nos anos 2010, 2012 e 2014, respectivamente. Nos três inquéritos, a prevalência de dois ou mais fatores de risco foram superiores a 70%. Tiveram maiores prevalências de coocorrência de dois ou mais fatores de risco as mulheres, universitários com idade avançada, da área de saúde e com mais tempo de universidade. Conclui-se que a prevalência de coocorrência de dois ou mais fatores de risco foi elevada e que as mulheres representaram o grupo que se destacou com maiores prevalências desse desfecho em todos os inquéritos.

Educational interventions for physical activity among Brazilian adults: systematic review.

OBJECTIVE: To summarize the main evidence from educational interventions designed to increase levels of physical activity (PA) among Brazilian adults. METHODS: Systematic review of intervention studies carried out in Brazil that implemented educational components aimed at promoting increased levels of PA among adult populations (18 to 65 years old). In October 2020, systematic searches were conducted in six databases, and in the reference lists of the assessed studies. RESULTS: Of the initial 2,511 studies, nine were included in the synthesis. Samples with specific characteristics (such as social vulnerability, physical inactivity, and overweight or obesity) were observed, with a greater number of women. Five interventions (55.6%) occurred in primary healthcare settings (PHC) of the Brazilian Unified Health System (SUS). Only four studies (44.4%) described the pedagogical frameworks structuring the educational approaches, among which counseling was the most used strategy, such as those carried out through face-to-face meetings, home visits, lectures, and phone calls (n = 8; 88.9%). Positive results were observed in three different indicators: increase in weekly PA volume (n = 4); increase in leisure-time PA rate (n = 1); and increase in the proportion of women classified as "very active/active" (n = 1). Given the sampling specificities, the domain "participant selection" showed a high number of interventions with high risk of bias. CONCLUSIONS: Educational approaches engendered some positive effects on different PA indicators, notably counseling as the main strategy used and approaches involving other health themes, such as nutrition and stress. However, considering the several determinants of PA in Brazil, future interventions should be conducted in different locations of Brazil in order to evaluate, in a broader way, their implementation processes and articulation with the many professionals working in PHC.

Analysis of the degree of implementation of Health Academy Program in a Brazilian midsize town.

In 2011, the Brazilian Minister for Health created the Health Academy Program (Programa Academia da Saúde) as a strategy to promote health and healthy lifestyles. However, the official standards do not seem to be clear enough to support the implementation program in the towns. The aim of this study was to analyse the degree of Health Academy Program implementation in a Brazilian midsize town Vitória de Santo Antão, Pernambuco State, in 2018. This is an evaluative study that carry out a normative approach, considering the dimensions of structure and process related to work process. The research is divided into: (1) elaboration of the theoretical model of evaluation, through the validation of the logical model; (2) verification of the level of implementation, through an interview with workers and managers. The cut-off scores for classification of implementation levels were: (1) incipient: > 0 < 33.3%; (2) intermediate: > 33.3 < 66.6%; (3) advanced: > 66.6%. The level of implementation was considered intermediate (37.54%). The score of the structure was higher (54.76%) than the process (26.06%). The low level of Health Academy Program implementation, especially related to the multi-professional articulation and the difficult connection with other sectors or social actors, shows the necessity of reorganization of the actions.

Health risk behaviors in elderly Brazilian widowers. / Comportamientos de riesgo para la salud en hombres mayores brasileños viudos.

The objective of this study was to compare the prevalence of health risk behaviors among elderly widowers with that of elderly partnered males, as well as single or divorced/separated men. Additionally, we set out to examine the prevalence of risk behaviors in elderly widowered men according to age, education level, and race/skin color. A cross-sectional study was conducted with elderly men (≥ 60 years) who were interviewed through the Surveillance System of Risk and Protective Factors for Chronic Diseases by Telephone Survey (Vigitel) in 2016 (n=5,384) and 2017 (n=5,801). The Vigitel survey includes representative samples of adults residing in the capitals of Brazilian states and the Federal District, and of those surveyed, 886 were widowers. Identified risk behaviors included physical inactivity during leisure time, irregular consumption of fruits, vegetables and legumes, smoking and alcohol abuse. The prevalence of smoking was lower among partnered elderly men [PR=0.68, CI95% (0.52-0.90)] than among widowers. There were no differences in the prevalence of other risk behaviors between widowers and other groups. When only widowers were taken into account, there was significant association of risk behaviors with age and educational level, but not with race/skin color.

Se buscó comparar la prevalencia de comportamientos de riesgo para la salud en hombres mayores viudos con las de hombres mayores con pareja, solteros y divorciados/separados, así como la prevalencia de comportamientos de riesgo en hombres mayores viudos según rango de edad, escolaridad y raza/color. Se realizó un estudio transversal con hombres mayores (≥ 60 años) entrevistados por el Sistema de Vigilancia de Factores de Riesgo y Protección para Enfermedades Crónicas por Encuesta Telefónica (Vigitel) en 2016 (n=5.384) y 2017 (n=5.801) que incluye muestras representativas de adultos de las capitales de los estados brasileños y del Distrito Federal. De ellos, 886 eran viudos. Los comportamientos de riesgo fueron: inactividad física en el tiempo libre, consumo irregular de frutas, verduras y legumbres, tabaquismo y consumo abusivo de alcohol. La prevalencia de tabaquismo fue menor entre los hombres mayores con pareja [RP = 0,68; IC95% (0,52-0,90)] que entre los viudos. En los demás comportamientos de riesgo no se observaron diferencias en la prevalencia de los viudos en relación a los demás grupos. Cuando se analizaron solamente los viudos, se observaron importantes asociaciones de los comportamientos de riesgo con las variables grupo de edad y escolaridad, pero no con raza/color.

[The urgency of Public Health in Physical Education training: lessons from COVID-19]. / A urgência da Saúde Coletiva na formação em Educação Física: lições com o COVID-19.

The COVID-19 pandemic has generated several controversies in the health area, particularly regarding social isolation measures, widely perceived as being one of the most effective strategies to reduce the spread of the virus. The Physical Education (PE) area became involved in these discussions, through contradictory positions of professionals, scientific societies and class entities regarding the reopening of fitness centers during the pandemic. We understand that some of these discussions revealed important weaknesses in relation to the approach to basic health knowledge, such as those related to epidemiology and public health measures. We seek in this essay, without the intention of exhausting the subject or performing an academic prescription, to support our position regarding the urgency of the approach of PE training within the field of Public Health, as well as presenting some proposals for this approach to effectively occur. We advocate training that favors a broader view of health, that enables professionals in the field to understand the potential relationship between PE and health, but at the same time recognize that physical activity is not a panacea and that human health has many others determinants and conditions.

Promotion of physical activity and public policies to tackle inequalities: considerarions based on the Inverse Care Law and Inverse Equity Hypothesis. / Promoção de atividade física e as políticas públicas no combate às desigualdades: reflexões a partir da Lei dos Cuidados Inversos e Hipótese da Equidade Inversa.

This Essay reflects on some current approaches to the promotion of physical activity, proposing greater visibility for leisure-time physical activities and inequalities in access to them. The current scenario of increasing inequalities and the importance of confronting them, highlighting the pertinence of public policies, is presented and discussed in light of two theories, the Inverse Equity Hypothesis and the Inverse Care Law. The Inverse Equity Hypothesis seeks to understand how inequalities tend to be established in health indicators, based on an expected increase in inequalities when health innovations initially reach the more socially and economically privileged groups. Meanwhile, the Inverse Care Law emphasizes that the availability of adequate healthcare tends to vary inversely to the population's need. By relating the theories and the promotion of leisure-time physical activity, the essay defends the expansion of public policies aimed at not further increasing inequalities. Public policies and their association with Brazilian Unified National Health System (SUS) and its principles should be the priority. The essay thus defends approaches to promote socially contextualized leisure-time physical activities, capable of prioritizing the groups that need them the most.

O presente Ensaio apresenta uma reflexão com base em algumas formas vigentes de promoção de atividade física, propondo visibilidade a atividades de lazer e suas desigualdades. O cenário atual de (aumento das) desigualdades e a importância do seu enfrentamento, destacando a pertinência das políticas públicas, são apresentados e discutidos à luz de duas teorias: a Hipótese da Equidade Inversa e a Lei dos Cuidados Inversos. A Hipótese da Equidade Inversa busca compreender como as desigualdades tendem a se estabelecer em indicadores de saúde, partindo de aumento esperado dessas desigualdades quando surgem inovações em saúde que atingem inicialmente os mais privilegiados social e economicamente. Já a Lei dos Cuidados Inversos destaca que a disponibilidade de uma atenção adequada em saúde tende a variar inversamente à necessidade da população. Nesse sentido, ao relacionar as teorias e a promoção de atividade física de lazer, o presente ensaio defende a ampliação das políticas públicas, buscando evitar o aumento das desigualdades. São as políticas públicas e a vinculação com o Sistema Único de Saúde (SUS) e com seus princípios que precisam ser compreendidas como prioridade. É nessa perspectiva que acreditamos em um avanço de ações de promoção das atividades físicas de lazer contextualizadas socialmente que sejam capazes de priorizar aqueles que mais necessitam.

Este Ensayo propone una reflexión sobre algunas formas vigentes de promoción de la actividad física, centrándose en las actividades físicas de ocio y sus desigualdades. El escenario actual de (aumento de las) desigualdades y la importancia de su enfrentamiento, destacando la pertinencia de las políticas públicas, se presenta y discute a la luz de dos teorías: la Hipótesis de la Equidad Inversa y la Ley de Cuidados Inversos. La Hipótesis de la Equidad inversa busca comprender cómo las desigualdades tienden a establecerse en indicadores de salud, partiendo de un aumento esperado de las desigualdades, cuando surgen innovaciones en salud que alcanzan inicialmente a los más privilegiados social y económicamente. Ya la Ley de los Cuidados Inversos destaca que la disponibilidad de una atención adecuada en salud tiende a variar inversamente, en función de las necesidades de la población. En este sentido, al relacionar las teorías y la promoción de la actividad física de ocio, este ensayo defiende la ampliación de las políticas públicas, con el fin de no ampliar las desigualdades. Son las políticas públicas, su vinculación con el Sistema Único de la Salud (SUS) y con sus principios los que necesitan ser comprendidos como prioridad. Desde esta perspectiva pensamos que se debe avanzar en la promoción de acciones de actividades físicas durante el ocio, contextualizadas socialmente, y que sean capaces de priorizar a quienes más lo necesitan.