Towards an update on the antimicrobial use in Adult Care Units in Brazil: insights from multi-hospital prevalence study.

Introduction. Efforts to understand the burden of antibiotic use in low- and middle-income countries such as Brazil are essential for developing strategies that are effective and appropriate in the context of endemic multidrug-resistant organisms.Aim. This study aims to determine antimicrobial-prescribing practices among patients hospitalized in intensive care units (ICUs) for adults in Brazil.Methodology. A 1-day point prevalence multicentre survey was conducted in 58 adult ICUs across the five regions of Brazil. The institutions were categorized according to their type and size. Detailed antimicrobial prescription data were prospectively provided to all patients hospitalized on the day of data collection.Results. A total of 620 patients were included in the study, of whom 63.9% were receiving at least one antimicrobial. Of these, 34.6% were treated for an infection, but only 39.9% of the cases were based on microbiological criteria. Empirical treatment was applied to 72.3% of the patients. Significant differences in antibiotic usage were observed across the different hospitals included in the study. Overall, treatment was most commonly directed towards pneumonia (51.8%) and bloodstream infections (29.6%). Glycopeptides (19.4%) and carbapenems (18.5%) were the most prescribed in teaching hospitals, while in non-teaching hospitals, carbapenems (17.8%) and broad-spectrum cephalosporins (16.8%) were most frequently used.Conclusion. Our study reveals alarming data on antibiotic use in adult ICUs in Brazil, with high frequencies of severe healthcare-associated infections acquired in these units, where patients are frequently subjected to empirical treatment.

Habilidades de comunicação clínica: análise da autoavaliação dos residentes de medicina de família e comunidade / Clinical communication skills: analysis of the self-assessment of family medicine residents

Resumo Introdução: O conhecimento das habilidades de comunicação clínica é primordial para o adequado exercício da medicina de família e comunidade (MFC), visto que um dos princípios da especialidade advém da relação médico-pessoa. A comunicação assertiva é uma competência clínica básica que deve ser aprendida, sobretudo, durante a residência médica. Não se trata de uma característica inata, perpassa um processo de conhecer, aplicar e dominar, necessitando, portanto, de avaliações. Objetivo: Este estudo teve como objetivo avaliar a percepção dos médicos residentes de MFC em relação às suas habilidades de comunicação. Método: Trata-se de um estudo quantitativo, descritivo e transversal. O cenário de estudo foi o conjunto de programas de residência de MFC do município de João Pessoa, na Paraíba. A coleta de dados foi feita a partir de um questionário on-line, disponível para preenchimento de setembro a novembro de 2022. Utilizamos para a construção do questionário o instrumento A Consulta em 7 Passos. Desenvolvemos escores denominados índice de desempenho geral (IDg), índice de desempenho por passo da consulta (IDp) e índice de desempenho por item (IDitem). Na análise estatística, utilizamos o teste t para amostras independentes. Resultado: O IDg médio foi de 72,0%. Os residentes tiveram o maior índice de IDp no passo 5 da consulta (81,7%), seguido pelos passos 2 (77,6%), 3 (76,1%) e 6 (75,9%). Os menores desempenhos foram nos passos 4 (68,9%), 7 (63,7%) e 1 (63,3%). Não houve significância estatística quanto ao desempenho quando se compararam sexo, ano de residência e programa. Conclusão: Os residentes de MFC avaliam positivamente suas habilidades de comunicação. Entretanto, ainda há o que aprimorar, como fomentar momentos crítico-reflexivos sobre os fenômenos subjetivos que ocorrem na consulta. Destarte, a utilização do instrumento A Consulta em 7 Passos se revelou, no presente estudo, como uma ferramenta importante no processo de formação e avaliação da comunicação clínica durante a residência.

Abstract Introduction: Knowledge of clinical communication skills is essential for the proper practice of Family Medicine, since one of the principles of the specialty treats the doctor-person relationship as fundamental. Good communication is a basic clinical competence and must be learned, above all, during medical residency. Communication is not an innate characteristic, but a process of self-knowledge, therefore requiring self-assessments. Objective: This study aimed to evaluate the perception of Family Medicine residents doctors in relation to their communication skills. Method: This is a quantitative, descriptive and cross-sectional study. The study setting was the set of Family Medicine Residency Programs in the city of João Pessoa, Paraíba. Data collection was performed using an online questionnaire, available to be completed from September to November 2022. We used the instrument A consulta em 7 passos (7-step consultation) to construct the questionnaire. We developed scores called overall performance index (IDg), query step performance index (IDp) and item performance index (IDitem). In the statistical analysis, we used the t test for independent samples. Result: The average overall performance index (IDg) was 72.0%. Residents had the highest IDp rate in step 5 of the consultation (81.7%), followed by step 2 (77.6%), step 3 (76.1%) and step 6 (75.9% ). While residents had the lowest performances in descending order in steps 4 (68.9%), 7 (63.7%) and 1 (63.3%). There was no statistical significance between sexes, year of residency and residency program. Conclusion: MFC residents positively evaluate their communication skills. However, there is still room forto improvement in how to encourage critical-reflective moments about the subjective phenomena that occur in the consultation. Furthermore, the use of a consulta em 7 passos is an important tool in the training and evaluation process in residency.

Dermoscopy of very small basal cell carcinoma (≤3mm).

BACKGROUND: Basal cell carcinoma (BCC) dermoscopy is key to lower the biopsy threshold of suspicious lesions. There is a scarcity of published data on the dermoscopy of very small BCC (≤3mm) and its differences from larger BCCs. OBJECTIVE: To describe and compare dermoscopic features of BCCs measuring ≤3mm, with those from 3 to 10mm. METHODS: An analytical cross-sectional study, included biopsy-proven BCCs that had dermoscopic photographic images, between January 2017 and December 2022 in a Skin Cancer Center in Medellín, Colombia. Demographic, clinic-pathological and dermoscopic features were compared between very small BCCs (vsBCCs) and a reference group. RESULTS: A total of 326 BCCs in 196 patients were included, of whom 60% were male. The most common Fitzpatrick phototype was III. vsBCCs accounted for 25% of the lesions (81/326). Face and neck were the most frequent locations (53%), especially in very small tumors. The nodular type was more common in very small tumors than in larger lesions, the superficial type was less frequent, and aggressive types were equally prevalent in both groups. On dermoscopy, very small tumors were statistically more likely to present pigmented structures than reference lesions, especially blue-gray dots (67% vs. 54%), vessels were less frequent, particularly short-fine telangiectasias (SFT) (52% vs. 66%), as were other structures such as shiny white structures (SWS), ulceration, micro-erosions, and scales. STUDY LIMITATIONS: Latin-American sample, lacks information on dark phototypes CONCLUSIONS: Pigmented structures, especially blue-gray dots, were most common in vsBCCs when compared to larger lesions; SFT, SWS and other findings were less prevalent.

Physical Education for Health Among School-Aged Children and Adolescents: A Scoping Review of Reviews.

BACKGROUND: Physical education (PE) classes in schools are considered relevant to implement interventions, especially focused on physical activity. However, evidence overviews on how PE classes contribute to general health (physical, social, affective, and cognitive domains) are still needed. Thus, we summarized evidence synthesis (eg, systematic reviews) that addressed the contribution of PE classes to the health of school-aged children and adolescents. METHODS: We performed a scoping review with searches in 8 databases and institutional websites to find systematic reviews or meta-analyses that answered this review's research question. Data charting form included the identification of the study, health outcomes, and PE classes' strategies (policies and environment, curriculum, appropriate instructions, and evaluation). An interactive process was performed to build the evidence summary. RESULTS: An initial search yielded 2264 titles, and 49 systematic reviews (including 11 with meta-analysis) were included in this review. Most documents reported the main benefits of PE classes on physical domain outcomes (eg, physical activity, cardiorespiratory fitness, body mass index, and fundamental motor skills). However, evidence on the benefits of PE classes in affective (eg, enjoyment, motivation, and autonomy); social (eg, cooperation, problem-solving, and making friends); and cognitive (eg, memory, attention, concentration, and decision making) domains were found. Strategies on PE classes for health benefits were highlighted. CONCLUSIONS: These elements were detailed in the evidence summary, which may be considered to guide researchers, teachers, and practitioners to define research and practice priorities on PE class interventions for health in the school context.

Dermoscopy of very small basal cell carcinoma (≤3 mm)

Abstract Background Basal cell carcinoma (BCC) dermoscopy is key to lower the biopsy threshold of suspicious lesions. There is a scarcity of published data on the dermoscopy of very small BCC (≤3 mm) and its differences from larger BCCs. Objective To describe and compare dermoscopic features of BCCs measuring ≤3 mm, with those from 3 to 10 mm. Methods An analytical cross-sectional study, included biopsy-proven BCCs that had dermoscopic photographic images, between January 2017 and December 2022 in a Skin Cancer Center in Medellín, Colombia. Demographic, clinic-pathological and dermoscopic features were compared between very small BCCs (vsBCCs) and a reference group. Results A total of 326 BCCs in 196 patients were included, of whom 60% were male. The most common Fitzpatrick phototype was III. vsBCCs accounted for 25% of the lesions (81/326). Face and neck were the most frequent locations (53%), especially in very small tumors. The nodular type was more common in very small tumors than in larger lesions, the superficial type was less frequent, and aggressive types were equally prevalent in both groups. On dermoscopy, very small tumors were statistically more likely to present pigmented structures than reference lesions, especially blue-gray dots (67% vs. 54%), vessels were less frequent, particularly short-fine telangiectasias (SFT) (52% vs. 66%), as were other structures such as shiny white structures (SWS), ulceration, micro-erosions, and scales. Study limitations Latin-American sample, lacks information on dark phototypes Conclusions Pigmented structures, especially blue-gray dots, were most common in vsBCCs when compared to larger lesions; SFT, SWS and other findings were less prevalent.

Physical Activity Guidelines for the Brazilian Population: Recommendations Report.

BACKGROUND: This article presents the recommendations from the Physical Activity Guidelines for the Brazilian Population. METHODS: A steering committee composed of a chair, 6 experts in physical activity, and representatives from the Ministry of Health/Brazil, Pan American Health Organization, Brazilian Society of Physical Activity and Health designed the guidelines, which was implemented by 8 working groups, as follows: (1) understanding physical activity, (2) children up to 5 years old, (3) children and youth from 6 to 17 years old, (4) adults, (5) older adults (60 years and above), (6) physical education at school, (7) pregnant and postpartum women, and (8) people with disabilities. The methodological steps included evidence syntheses, hearings with key stakeholders, and public consultation. RESULTS: Across 8 chapters, the guidelines provide definitions of physical activity and sedentary behavior, informing target groups on types of physical activity, dosage (frequency, intensity, and duration), benefits, and supporting network for physical activity adoption. The guidelines are openly available in Portuguese, Spanish, English, and Braille and in audio versions, with a supplementary guide for health professionals and decision makers, and a report about the preparation and references. CONCLUSIONS: The Physical Activity Guidelines for the Brazilian Population provide evidence-based recommendations, being a public-directed resource to contribute to the physical activity promotion in Brazil.

Physical Activity Guidelines for the Brazilian Population: Development and Methods.

BACKGROUND: This article describes the process and methods used in the development of the first ever Physical Activity Guidelines for the Brazilian Population. METHODS: The steering committee established 8 working groups based on other guidelines and the Brazilian agenda for public health and physical activity (PA) promotion: (1) understanding PA; (2) children up to 5 years; (3) children and youth (6-17 y); (4) adults; (5) older adults (60 years and above); (6) physical education at school; (7) pregnant and postpartum women; and (8) people with disabilities. Working groups were formed to (1) synthesize the literature on each topic; (2) conduct workshops with stakeholders, health professionals, researchers, and the public; and (3) prepare a draft chapter for open online consultation. RESULTS: The document provides guidance for the population on the benefits of being active and recommendations regarding the amount (frequency, intensity, and duration) of PA recommended across all chapters. It also includes information on supporting networks for PA. CONCLUSIONS: The PA guidelines are widely accessible in Portuguese, including versions in English, Spanish, audiobook, and Braille, and will assist policy makers and professionals from several sectors to promote PA. The ultimate goal is to increase population levels of PA in Brazil.

Mapping recommended strategies to promote active and healthy lifestyles through physical education classes: a scoping review.

BACKGROUND: Understanding which strategies have been recommended for the promotion of active and healthy lifestyles through physical education (PE) classes can guide PE policies and practice. Therefore, we summarized worldwide recommendations regarding strategies for PE classes that have aimed to promote active and healthy lifestyles among school-aged children and adolescents. METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines were utilized. A literature search was carried out in June 2020 in eight peer-reviewed literature databases, in addition to searches in institutional and personal libraries. The eligibility criteria included any online document that included recommendations targeting any dimension of PE classes (e.g., policy and environment, curriculum, appropriate instruction, student assessment, and strategies that interact with PE) published since 2000. RESULTS: In total, 2,408 potentially eligible documents were screened. Of these, 63 were included in the final analysis. The recommended strategies were as follows: six referred to policy and environment (valuing PE, higher frequency and duration of classes, inclusive PE classes, mandatory daily classes, evaluation of PE classes, and qualified teachers), five to curriculum (structure, type of content, cross-cutting themes, and components that improve PE classes), four to appropriate instruction (promotion of physical activities, inclusion of social issues, employment of the use of innovative technologies, and organization of the teaching-learning process), and three to student assessment (understanding human movement concepts, evaluation of contents, and assessment methods to develop an active and healthy lifestyle). CONCLUSION: Twenty-one strategies recommended for PE classes linked to five dimensions aimed at different target populations were identified. Over half were linked to the dimensions of policy and environment and appropriate instruction. PE is recommended to be mandatory and valued at all educational levels, with weekly frequency that contributes to an active and healthy lifestyle. This review shows that guaranteeing different experiences beyond sports, improving social inclusion, using innovative technologies, and providing adequate materials and spaces to be important challenges and ways to guide policies, programs, and new research in this field of knowledge. Open Science Framework Registration: https://osf.io/harwq/.

Socioeconomic and Gender Inequalities in Leisure-Time Physical Activity and Access to Public Policies in Brazil From 2013 to 2019.

BACKGROUND: This study aims to describe changes in gender and wealth inequalities in leisure-time physical activity (PA) of Brazilians during a 6-year interval. It also aims to evaluate inequalities regarding PA public programs awareness, participation, and access to public spaces for PA. METHODS: Data from 2 population-based surveys conducted in 2013 and 2019 were used. Leisure-time PA prevalence was assessed considering those reporting ≥150 minutes per week. The authors evaluated gender inequalities calculating differences and ratios, and wealth inequalities using the slope index of inequality and the concentration index- assessing changes over time. RESULTS: National levels of leisure-time PA increased from 2013 to 2019, and an increase in inequalities was observed; women and the poorest groups still presented lower prevalence. A decline in socioeconomic inequalities was observed from 2013 to 2019 regarding the availability of public spaces and awareness about public programs. However, outcomes remained more common among the richest group. Inequalities did not vary for participation in public programs. CONCLUSION: Although leisure-time PA increased from 2013 to 2019 at a national level, there were no improvements in gender inequalities, and wealth inequalities worsened over time. Indicators of public strategies for PA increased for the population, but inequalities remain.

Recrutamento e retenção de médicos para a Atenção Básica: permanentes desafios para o Brasil / Recruitment and retention of physicians for Primary Health Care: permanent challenges for Brazil

O objetivo deste estudo é analisar as evidências científicas e documentais sobre as estratégias relacionadas ao recrutamento e à retenção de médicos para Atenção Básica (AB) e implementadas pelo Programa Mais Médicos. Trata-se de uma revisão integrativa que incluiu documentos oficiais sobre o PMM e artigos sobre recrutamento e retenção de médicos na AB. As estratégias encontradas na literatura foram formação médica, incentivos aos médicos, características intrínsecas ao médico e à localidade, investimento em infraestrutura e recrutamento de médicos intercambistas. O PMM contemplou todas essas categorias, porém não contemplou todas as subcategorias encontradas na literatura, como presença de equipe interprofissional. Portanto, as medidas implementadas a partir do Programa encontram-se em consonância com as estratégias mais apontadas na literatura atual sobre recrutamento e retenção de médicos na AB.

The aim of this study is to analyze the scientific and documentary evidence on the strategies related to the recruitment and retention of doctors for Primary Care (AB) and those implemented by the Mais Médicos Program. It is an integrative review that included official documents on the PMM and articles on recruiting and retaining doctors in AB. The strategies found in the literature were medical training, incentives for doctors, characteristics intrinsic to the doctor and the location, investment in infrastructure and recruitment of exchange students. The PMM covered all of these categories, but did not include all the subcategories found in the literature, such as the presence of an interprofessional team. Therefore, the measures implemented from the Program are in line with the most pointed strategies in the current literature on the recruitment and retention of doctors in AB.

Can physical education state policies impact on youth's health behaviors? A natural experiment study / Instrução normativa da educação física impacta nos comportamentos de saúde? Um experimento natural

Since 2011 an educational policy promulgated that public schools from Pernambuco have had to offer physical education (PE) class in the same shift where students are enrolled. This study examined the impact of the implementation of an educational policy on PE offering and students' participa-tion, and whether health related behaviors could be moderated by PE participation. It was a natural experiment study performed with data obtained from two cross-sectional studies (2007 and 2012) of a sample (n = 715) of high-school students from Caruaru. PE offering was assessed by asking students if they had PE class and adaptedquestionnairewas used to assess health-related informa-tion. It was observed that before policy implementation, most of the students (♂: 72.4%; ♀: 69.0%) was not engaged in any PE class during the week. After policy implementation the proportion of students who had at least one PE class/week increased (♂: 68.7%; ♀: 68.9%). Having ≥1 PE classes was not associated with the amount of physical activity either before (♂: OR = 1.47 (95%CI: 0.78 ­ 2.76)); ♀: OR = 1.02 (95%CI: 0.61­ 1.72) or after (♂: OR = 0.90 (95%CI: 0.51 ­ 1.58); ♀: OR = 1.06 (95%CI: 0.63 ­ 1.80)) policy implementation. Fruit consumption was the only health-related behavior associated to PE class (♂: OR = 1.55 (95%CI: 1.01 ­ 2.70); ♀: OR = 1.48 (95%CI: 1.02 ­ 2.10)). PE offering and participation of students improved and it seems that implementation of new policies for PE might impact on students' behaviors, although, regarding to some limitations, not sufficiently to impact on overall students' health behaviors

Desde 2011 uma instrução normativa estipulou que escolas públicas de Pernambuco ofertassem aulas de educação física (EF) no turno em que estudantes estão matriculados. Este estudo examinou o impacto dessa normativa na oferta de aulas de EF, na participação e sua associação com comportamentos de saúde dos estudantes. Tratou-se de um experimento natural realizado com dados de dois estudos transversais (2007 e 2012) de uma amostra (n = 715) de estudantes do ensino médio de Caruaru. A oferta de EF foi avaliada perguntando aos estudantes se eles tinham aula de EF, e um questionário adaptado foi utilizado para avaliar comportamentos de saúde. Verificou-se que antes da implementação da normativa a maioria dos estudantes não tinha aulas de EF (♂: 72,4%; ♀: 69,0%). Depois da implementação, a proporção de estudantes que tiveram uma aula de EF/semana aumentou (♂: 68,7%; ♀: 68,9%). Ter ≥1 aula de EF não foi associado o nível de atividade física em adolescentes antes (♂: RO= 1,47 (95%IC: 0,78­2,76); ♀: RO = 1,02 (95%IC: 0,61 ­ 1,72)) ou depois (♂: RO = 0,90 (95%IC: 0,51 ­ 1,58); ♀: RO = 1,06 (95%IC: 0,63 ­ 1,80)) da implementação. Consumo de frutas foi o único comportamento de saúde associado com as aulas de EF (♂: RO = 1,55 (95%IC: 1,01 ­ 2,70); ♀: RO = 1,48 (95%IC: 1,02 ­ 2,10). Após implementação da norma-tiva houve melhorias na oferta de aulas de EF e participação dos estudantes. Parece que isto pode impactar comportamentos de saúde em adolescentes, porém, devido limitações, é insuficiente para impactar os compor-tamentos de saúde no geral

Educação física escolar: Guia de Atividade Física para a População Brasileira / Physical Education: Physical Activity Guidelines for the Brazilian Population

As aulas de educação física (EF) escolar representam um momento propício para conhecer e viven-ciar a pluralidade do movimento humano, favorecendo a promoção de uma vida ativa e saudável. A importância da EF escolar foi reconhecida pelo Guia de Atividade Física para a População Brasileira (Guia), que dedicou um capítulo para orientar a comunidade escolar sobre os benefícios à saúde e as estratégias de sucesso adotadas nas aulas de EF escolar. O objetivo deste estudo é apresentar o processo de elaboração das recomendações brasileiras de EF escolar para a população brasileira, mais especificamente os estudantes, professores, pais e responsáveis, e gestores. Esse capítulo do Guia foi desenvolvido por dez pesquisadores brasileiros, incluindo um representante do Ministério da Saúde. Três sínteses de evidências, escutas ao público-alvo e consulta pública foram realizadas para a construção das recomendações. Dados de 49 revisões sistemáticas sobre os benefícios da EF escolar à saúde e de 22 intervenções nas aulas de EF escolar com estudantes brasileiros foram sumarizados. Ainda, foram sintetizados 63 documentos nacionais e internacionais com estratégias recomendadas para a EF escolar, com foco nas dimensões: política e ambiente; currículo; instrução apropriada; avaliação; e estratégias que interagem com a EF escolar. Os grupos focais e a consulta pública fun-damentaram a elaboração e o aprimoramento da versão final das recomendações. Espera-se que estas recomendações alicercem a criação de políticas públicas, melhorem a conscientização sobre a importância da prática de atividade física na EF escolar e enfatizem a necessidade de realizar estudos futuros nesta área de conhecimento

Physical Education (PE) classes represent an appropriate time to know and experience the plurality of the human movement, favoring the promotion of a healthy and active life. The importance of PE was recognized by the Physical Activity Guide for the Brazilian Population, which dedicated a chapter to guide the school community on the health benefits and successful strategies adopted in PE classes. This study aimed to show the process of elaborating Brazilian recommendations for PE for the Brazilian population, more specifically students, teachers, parents and guardians, and managers. This chapter of the Guide was developed by ten Brazilian researchers, including a spokeswoman of the Ministry of Health. Three syntheses of evidence, focus groups/interviews and public consultation were carried out to construct the recommendations. Data from 49 systematic reviews on the health benefits of PE and 22 interventions in PE classes with Brazilian students were summarized. Also, 63 documents were synthesized with strategies recommended for PE classes, focusing on the dimensions: politics and environment; curriculum; appropriate instruction; evaluation; and strategies that interact with PE. The focus groups and the public consultation were the basis for the elaboration and improvement of the final version of the recommendations. It is expected that these recommendations can assist the creation of public policies, the improvement of practice PE and the need to conduct future studies in this area of knowledge

A estratégia LET US Play aumenta a atividade física de crianças nas aulas de educação física escolar / The LET US Play strategy increases children`s physical activity in physical education classes

O estudo objetivou comparar duas estratégias (Tradicional x LET US Play) com o intuito de aumen-tar o número de passos (NP) durante as aulas de educação física escolar de crianças. Trata-se de um ensaio clínico randomizado cruzado (cross over), realizado em uma escola municipal de Cuiabá, Mato Grosso. Foram aplicadas 10 aulas à 25 crianças (11 meninos e 14 meninas) do 4º ano do Ensino Fun-damental. Dividida em dois momentos de 15 minutos (monitorados), com um espaço de 10 minutos entre eles para hidratação (não monitorados), a aula consistia na aplicação das atividades (estafeta, base quatro, futsal, queimada e empresta bandeira) usando a estratégia Tradicional ou LET US Play, de forma alternada e aleatória. Ao final de cada atividade, o NP foi medido por meio da pulseira inteligente Xiaomi Mi band 2. Utilizou ANOVA One Waypara analisar o NP entre as estratégias, estratificada por sexo, com grau de significância de 5%. Observou-se que, o NP dados pelas crianças na intervenção LET US Play foi superior ao Tradicional em todas as atividades (estafeta, base quatro, futsal, queimada, empresta bandeira), tanto em meninos quanto em meninas, independentemente da ordem de aplicação (p < 0,01). Conclui-se que o LET US Play aumentou o NP das crianças durante as aulas de educação física e pode ser uma estratégia interessante para maximizar a atividade física nesse público

This study aimed to compare two strategies (Traditional x LET US Play) focused on increasing the number of steps (NS) during physical education classes for children. This is a randomized crossover clinical trial, carried out in a municipal elementary school from Cuiabá-MT. Ten classes were given to 25 children (11 boys and 14 girls) from the 4th grade. Divided into two moments of 15 minutes each (monitored), with a 10 minutes break between for hydration (not monitored). The class sessions consisted of activities (relay races, base four, futsal, dodgeball and borrow flag) using Traditional or LET US Play strategies, selected randomly and alternately. At the end of each activity the NS was measured through the Xiaomi Mi band 2 smart bracelet. The NP between the strategies and interactions with sex were assessed using one-way analysis of variance (ANOVA) with a statistical significance set at p < 0.05. It was observed that the NS given by the children in the LET US Play intervention was higher than the Traditional in all activities (relay races, kickball, indoor soccer, dodgeball, lend flag) in boys and girls regardless of the delivered order (p < 0,01). It was concluded that LET US Play increased children's NS during physical education classes and can be an interesting strategy to maximize physical activity among this population

Effects of a teacher training intervention on teachers' and students' motivation to physical education class / Efeitos de uma intervenção de formação de professores na motivação de professores e alunos para a aula de educação física

ABSTRACT The present study evaluated the effects of a teacher training intervention, based on Self-Determination Theory, on teachers' and students' motivation in physical education class. This is a pre-post quasi-experimental study with 4 physical education teachers and 611 students from four public schools. A handbook was developed and teacher training sessions were conducted. Statistical analysis consisted of paired t-tests and general linear model repeated measures to assess teachers' self-determined motivation and linear mixed effect regression to evaluate students' motivation. A significant increase in teachers' and students' motivation score was observed after the intervention. Among teacher, we verified an increase in self-determined motivation. Among students there were significant interaction time by group in Extrinsic Motivation Identified Regulation (F=5.6), Extrinsic Motivation External Regulation (F=7.41), Amotivation (F=5.32) and Self-determined Motivation (F=4.87). Also, Intrinsic Motivation significantly declined with age for boys (β= -0.151) and girls (β= -0.121) as well as Extrinsic Motivation Introjected Regulation for girls β= (-0.141). Training sessions can support teachers in planning lessons resulting in increasing teacher and students' motivation in physical education classes. However, this strategy was not enough to improve intrinsic motivation during the investigated period.

RESUMO O presente estudo avaliou os efeitos de uma intervenção com professores, baseada na Teoria da Autodeterminação, sobre a motivação de professores e alunos para a aula de educação física (EF). É um estudo quase-experimental do tipo antes e depois com 4 professores de EF e 611 alunos. Foi elaborado um manual e realizadas sessões de formação de professores. Análise estatística incluiu testes t pareados e medidas repetidas através do modelo linear geral e da regressão linear de efeito misto. Um aumento significante no escore de motivação de professores e alunos foi observado após a intervenção. Entre os professores verificou-se um aumento na motivação auto-determinada. Entre os alunos houve interação significante entre tempo por grupo (Motivação Extrínseca Regulação Identificada (F=5,6), Motivação Extrínseca Regulação Externa (F=7,41), Amotivação (F=5,32) e Motivação Autodeterminada (F=4,87). Além disso, a Motivação Intrínseca diminuiu significantemente com a idade para rapazes (β= -0.151) e moças (β= -0.121), bem como a Motivação Externa Regulação Introjetada para moças (β= -0.141). Sessões de formação podem apoiar os professores no planejamento resultando no aumento da motivação dos professores e alunos nas aulas de EF. No entanto, esta estratégia não foi suficiente para melhorar a motivação intrínseca no período investigado.

Physical activity and sedentary time of youth in structured settings: a systematic review and meta-analysis.

BACKGROUND: Structured settings, such as school, childcare, afterschool programs, summer camps, and physical activity/sport programs are crucial to promoting physical activity (PA) opportunities and reducing sedentary (ST) for children and adolescents. However, little is known about how much PA and ST children and adolescents accumulate in structured settings. The aim of this study is to conduct a systematic review and meta-analysis of the absolute amount of time youth spend physically active and sedentary in different structured settings (Prospero number: 42018111804). METHODS: Observational and experimental/quasi-experimental studies (baseline data only) with full-text available, written in English and published in a peer-reviewed journal, reporting the total amount of objectively measured PA (light, moderate, vigorous, and/or total physical activity) and/or time spent ST during structured settings among youth (3 to 18 years) were eligible. Adjusted meta-analysis was conducted to estimate the pooled mean of time spent in PA and ST, by settings and sex. RESULTS: A total of 187 studies (childcare n=60; school n=91; afterschool programs n=14; summer camp n=4; and Physical activity/ sport programs n=18) from 30 countries (47.9% United States), representing 74,870 youth (mean age 8.6 years old) were included. Overall, there was a high variation between studies in outcomes and settings. The meta-analyses revealed, on average, youth spend 221.8 minutes (36.7 min/hour) in ST and 32.1 minutes (5.1 min/hour) in MVPA during childcare hours, and 223.9 minutes (36.7min/hour) in ST and 27.8 min (4.4 min/hour) in MVPA at school. Relatively, youth are engaged in more MVPA in afterschool programs (11.7 min/hour), PA/ sport programs (20.9 min/hour), and summer camps (6.4 min/hour), when compared to childcare and school. CONCLUSION: Total PA accumulated during childcare and MVPA accumulated during schools hours were close to recommendations, despite high proportion of ST. Afterschool programs, summer camp and PA/ sport programs are important settings that can contribute to daily PA and reduced ST. Ensuring all youth have access to these structured settings may be an important step forward for public health.

[Physicians' job satisfaction with the More Doctors Program in the State of Paraíba, Brazil: assessment with structural equation modeling]. / Satisfação dos médicos do Programa Mais Médicos na Paraíba, Brasil: avaliação por modelagem de equações estruturais.

This study aimed to build a job quality assessment model for the More Doctors Program (PMM, in Portuguese) based on participating physicians' job satisfaction, using structural equation modeling. The assessment drew on a database with answers to a questionnaire developed by a group of the program's supervisors in the State of Paraíba, Brazil, and applied to physicians between December 2015 and September 2016. Exploratory factor analysis was performed to extract significant attributes and form final dimensions, and later confirmatory factor analysis was used to assess the relationship between variables. The initially proposed satisfaction model underwent some changes based on the analyses, and the final model consisted of 49 variables grouped in 6 dimensions: medications, structure, characteristics of the program, support, printed materials, and equipment. Medications and structure were the constructs with the greatest effect on physician satisfaction (0.53 and 0.39), followed by program characteristics and support (both with 0.29). The instrument proposed in this article should allow a comprehensive view of aspects involved in physicians' job satisfaction, providing a point of departure for future analyses and validations on job quality in primary care.

O objetivo deste trabalho foi construir um modelo de avaliação da qualidade do trabalho no Programa Mais Médicos (PMM), baseado na satisfação do médico participante, utilizando a abordagem da modelagem de equações estruturais. Para isso, foi usado o banco de dados de respostas de um questionário desenvolvido por um grupo de supervisores do programa no Estado da Paraíba, Brasil, e aplicado aos médicos do estado entre dezembro de 2015 e setembro de 2016. Foi realizada análise fatorial exploratória para extrair os atributos significativos e formar as dimensões finais e, após, a análise fatorial confirmatória para avaliar a relação entre as variáveis. O modelo de satisfação proposto inicialmente sofreu algumas modificações com base nas análises, e o modelo final foi composto por 49 variáveis indicadoras agrupadas em seis dimensões: medicamentos, estrutura, aspectos do PMM, apoio, impressos e equipamentos. Medicamentos e estrutura foram os construtos com maior efeito direto na satisfação do médico (0,53 e 0,39), seguidos pelos aspectos do PMM e apoio (ambos com 0,29). Acredita-se que o instrumento proposto neste artigo possibilita uma visão ampla sobre os aspectos envolvidos na satisfação do trabalho do médico, sintetizando um ponto de partida para análises e validações posteriores sobre a qualidade do trabalho na atenção básica.

El objetivo de este trabajo fue construir un modelo de evaluación de la calidad del trabajo en el Programa Más Médicos (PMM), basado en la satisfacción del médico participante, utilizando el abordaje del modelado de ecuaciones estructurales. Con este fin, se utilizó el banco de datos de respuestas de un cuestionario desarrollado por un grupo de supervisores del programa en el Estado de Paraíba, Brasil, y aplicado a los médicos del estado entre diciembre de 2015 y setiembre de 2016. Se realizó un análisis factorial exploratorio para extraer los atributos significativos y formar las dimensiones finales y, posteriormente, el análisis factorial confirmatorio para evaluar la relación entre las variables. El modelo de satisfacción propuesto inicialmente sufrió algunas modificaciones a partir de los análisis y el modelo final estuvo compuesto por 49 variables indicadoras agrupadas en 6 dimensiones: medicamentos, estructura, aspectos del PMM, apoyo, impresos y equipamientos. Medicamentos y estructura fueron los constructos con mayor efecto directo en la satisfacción del médico (0,53 y 0,39), seguidos por los aspectos del PMM y apoyo (ambos con 0,29). Se cree que el instrumento propuesto en este artículo posibilita una visión amplia sobre los aspectos implicados en la satisfacción del trabajo del médico, sintetizando un punto de partida para el análisis y validaciones posteriores sobre la calidad del trabajo en la atención básica.