ABSTRACT

BACKGROUND: In the Dominican Republic about 14.5% of children do not reach their full potential by age five, with children of low socioeconomic position most affected. The Nurturing Care Framework is an evidence-informed actionable framework to help children thrive, but we must first understand cultural contexts and childrearing practices that contribute to delay. This study applies the Nurturing Care Framework to explore the context of home-based care among young children in the Dominican Republic. METHODS: We conducted a sociodemographic survey and semi-structured qualitative interview with 25 mothers ages 19-42 (7 under the age of 18 at first birth) with low socioeconomic position and children under five that live in the capital city Santo Domingo. We asked in-depth questions about the Nurturing Care Framework's domains of responsive caregiving and opportunities for early learning. We used consensual coding and deductive thematic analysis to analyze transcriptions, examined convergence and divergence in themes between adolescent and adult mothers, and organized themes using concept mapping. RESULTS: A few mothers provide responsive caregiving to their child, but they are unaware of its benefit to their child's development. Adolescent mothers expressed lower confidence in their mothering skills. Across age groups, mothers did not see themselves as agents of change in their child's early learning process and allow several hours of videos each day. Mothers provide children opportunities for learning through social interaction, a possible strength among this population. With regards to security and safety, about half of mothers use corporal punishment, all but one of these is an adolescent mother. CONCLUSION: Findings highlight the need for parenting programs that build on strengths such as child-to-child social interaction and provide parents with opportunities to develop knowledge and skills to provide early learning opportunities. Interventions should target families with low socioeconomic position and adolescent mothers.

ABSTRACT

Paracoccidioidomycosis (PCM) is endemic in impoverished communities in Latin America. This study aimed to understand the impact of sociodemographic, economic, and climatic factors on the number of hospitalizations and deaths due to PCM in São Paulo (SP) state, Brazil. Data on 645 municipalities were collected from government databases between 2006 and 2020. The Spearman's correlations between sociodemographic variables (population density, Municipal Human Development Index, and number of public health facilities in the municipality) and PCM rates showed the strongest negative correlation coefficients among the other variables. Multiple regression models reinforced the influence of sociodemographic and climatic factors on PCM reports.

This study was designed to gain insight into how external factors influence the number of reports related to paracoccidioidomycosis in São Paulo state, Brazil, 2006­2020. We found interesting things when we looked at how hospitalizations and deaths were linked to sociodemographic variables.

ABSTRACT

OBJECTIVE: To analyze the retail food environment and identify the presence of food swamps around public and private higher education institutions (HEIs) in Belo Horizonte, Minas Gerais. METHODS: This is an ecological study with the analysis unit being a 500-meter buffer network around 81 in-person HEI units. The density and proximity between the HEIs and food purchasing establishments for immediate consumption were assessed according to the administrative category and per capita income of the census tract, as well as the presence of food swamps. RESULTS: In 98.76% of the buffers there was at least one establishment for immediate consumption. Snack bars, restaurants, and bars were the categories most available and closest to the HEIs. The density of establishments was higher around private HEIs and around HEIs located in higher income areas. It was found that 95.06% of HEIs were located in areas classified as food swamps. CONCLUSION: Thus, the HEIs evaluated were exposed to neighborhoods with an unhealthy food environment, which may predispose university students to food choices based on the consumption of ultra-processed foods and alcoholic beverages.

ABSTRACT

To describe the temporal evolution of the main causes of mortality in Minas Gerais (MG), Brazil, and to verify the association with socioeconomic indicators. This is a mixed ecological study in which age-standardized mortality rates were calculated per 100,000 inhabitants due to noncommunicable diseases (NCDs), communicable, neonatal and nutritional diseases (NNDs) and external causes (ECs) for 853 municipalities in MG, according to data from the Global Burden of Disease (GBD) study, in the three-year periods 2000 to 2002 (T1), 2009 to 2011 (T2) and 2016 to 2018 (T3). Between T1 and T3, mortality due to NCDs predominated; there was a 22.4% decrease in the rates for NCDs (553.6 to 429.9) and a 29% decrease in the rates for NCDs (83 to 58.9), and a 3.5% increase in EC (62.2 to 64.4). The correlation coefficients were positive (R > 0.70; p < 0.05) and higher mortality rates were found in areas with worse socioeconomic status.

Descrever a evolução temporal das principais causas de mortalidade em Minas Gerais (MG), Brasil, e verificar a associação com indicadores socioeconômicos. Estudo ecológico misto em que foram calculadas taxas de mortalidade padronizadas por idade, por 100 mil habitantes, por doenças crônicas não transmissíveis (DCNT), doenças transmissíveis, neonatais e nutricionais (TNN) e causas externas (CE), para 853 municípios de MG, segundo dados do estudo Carga Global de Doenças (GBD), nos triênios 2000 a 2002 (T1), 2009 a 2011 (T2) e 2016 a 2018 (T3). Entre T1 e T3 predominou a mortalidade por DCNT; houve decréscimo de 22,4% das taxas por DCNT (553,6 para 429,9) e de 29% da s taxas por TNN (83 para 58,9), e acréscimo de 3,5% por CE (62,2 para 64,4). Os coeficientes de correlação foram positivos (R > 0,70; p < 0,05) e foram encontrados taxas mais elevadas de mortalidade em áreas de pior status socioeconômico.

Describir la evolución temporal de las principales causas de mortalidad en Minas Gerais (MG), Brasil, y verificar la asociación con indicadores socioeconómicos. Estudio ecológico mixto en el que se calcularon las tasas de mortalidad estandarizadas por edad, por 100.000 habitantes, por enfermedades crónicas no transmisibles (ENT), enfermedades transmisibles, neonatales y nutricionales (ENN) y causas externas (CE), para 853 municipios de MG, según datos del estudio Carga Global de Enfermedad (GBD), en los trienios 2000 a 2002 (T1), 2009 a 2011 (T2) y 2016 a 2018 (T3). Entre T1 y T3 predominó la mortalidad por ENT; Se observó una disminución del 22,4% en las tasas de ENT (553,6 a 429,9) y una disminución del 29% en las tasas de TNC (83 a 58,9), y un aumento del 3,5% en las de EC (62,2 a 64,4). Los coeficientes de correlación fueron positivos (R > 0,70; p < 0,05) y se encontraron tasas de mortalidad más altas en zonas de peor nivel socioeconómico.

ABSTRACT

The aim of this study was to identify dietary patterns (DP) and their association with socioeconomic, demographic, lifestyle, and overweight characteristics in adults from the Metropolitan Region of Recife (MRR) in 2015/16 and 2019. A cross-sectional study was conducted with individuals of both sexes, aged 20 to 59 years. DPs were identified using Principal Component Analysis (PCA). Binary logistic regression was used to estimate crude and adjusted odds ratios and 95% confidence intervals (95%CI). Three DPs were identified: Dual, Ultra-processed (UP), and Traditional. The Dual DP explained the highest variance in 2015/16 (15.4%), while in 2019, it was the UP DP (15.1%). In 2015/16, the Dual DP was related to the age groups of 20-29 years and 30-40 years, with no associations in 2019. The Traditional DP was associated with physical activity in 2015/16 and, in 2019, with living with ≥5 people in the household, lower education, and overweight. The dietary patterns in 2019 showed a stronger association with social determinants, indicating a greater influence of these factors on eating habits.

Objetivou-se identificar os padrões alimentares e sua associação com características socioeconômicas, demográficas, de estilo de vida e excesso de peso em adultos da Região Metropolitana do Recife, em 2015/16 e 2019. Estudo transversal com indivíduos de ambos os sexos, com idades entre 20 e 59 anos. Os padrões alimentares (PA) foram identificados por meio da análise de componentes principais (ACP). A regressão logística binária foi utilizada para estimar as razões de chances bruta e ajustada e intervalos de confiança 95% (IC95%). Foram identificados três PA: Duplo, Ultraprocessado (UP) e Tradicional. Observou-se que o PA Duplo explicou a maior variância em 2015/16 (15,4%), enquanto em 2019 foi o PA UP (15,1%). Em 2015/16, o PA Duplo associou-se à idade ≥41 anos, maior escolaridade e segurança alimentar (SA); já em 2019, associou-se a maior escolaridade, SA e excesso de peso. O PA UP relacionou-se às faixas etárias de 20-29 anos e 30-40 anos em 2015/16, sem associações em 2019. O PA Tradicional associou-se à prática de atividade física em 2015/16 e, em 2019, a residir com ≥5 pessoas no domicílio, menor escolaridade e excesso de peso. Os padrões alimentares em 2019 mostraram uma maior associação com os determinantes sociais, indicando maior influência desses fatores na alimentação.

El objetivo fue identificar patrones alimentarios y su asociación con características socioeconómicas, demográficas, de estilo de vida y de sobrepeso en adultos de la Región Metropolitana de Recife, en 2015/16 y 2019. Estudio transversal con individuos de ambos sexos, con edades entre 20 y 59 años. años. Los patrones dietéticos (PD) se identificaron mediante análisis de componentes principales (ACP). Se utilizó regresión logística binaria para estimar los odds ratios crudos y ajustados y los intervalos de confianza del 95% (IC95%). Se identificaron tres PDs: Doble, Ultraprocesado (UP) y Tradicional. Se observó que el Doble PD explicó la mayor variación en 2015/16 (15,4%), mientras que en 2019 fue el PD UP (15,1%). En 2015/16, el Doble PD se asoció con edad ≥41 años, educación superior y seguridad alimentaria (SA); en 2019, se asoció con estudios superiores, SA y sobrepeso. El PD UP se relacionó con los grupos etarios de 20-29 años y 30-40 años en 2015/16, sin asociaciones en 2019. El PD Tradicional se asoció con la práctica de actividad física en 2015/16 y, en 2019, con la vida con ≥5 personas en el hogar, menor nivel educativo y sobrepeso. Los patrones dietéticos en 2019 mostraron una mayor asociación con los determinantes sociales, lo que indica una mayor influencia de estos factores en la dieta.

ABSTRACT

This study aimed to examine the conceptions of disability among 30 professionals in training or practice, representing 14 distinct health professions, through individual interviews. A committee of experts developed thirty-four representative statements encompassing religious-moral, medical, social, and affirmative perspectives on disability. The participants provided justifications for their positions on each statement, unveiling a coexistence of understandings that encompassed both medical and social perspectives on disability. A recurring argument emphasized bodily impairments as the origin of social inequalities, advocating for health practices that aim to normalize individuals. Simultaneously, the need for societal transformation to dismantle barriers, foster inclusion, and ensure rights was also acknowledged. Some justifications critically addressed ideologies that individualize disability and social processes that contribute to inequality. Moral and/or religious interpretations were frequently used by the participants. However, the study highlighted the limited comprehension of disability as a complex and multidimensional phenomenon, indicating a pressing need for enhanced attention to professional training in this area.

O artigo investigou concepções de deficiência de 30 profissionais em formação ou em exercício, de 14 profissões da saúde, por meio de entrevistas individuais. Foram elaboradas, por um comitê de especialistas, 34 afirmativas representativas de perspectivas religiosa/moral, médica, social e afirmativa da deficiência. Os entrevistados justificaram seu posicionamento diante de cada afirmativa, revelando a coexistência de compreensões referentes tanto às perspectivas médicas quanto sociais da deficiência. Foi frequente o argumento de que impedimentos corporais são determinantes de desigualdades sociais e que práticas de saúde devem buscar a normalização do indivíduo, e também apontada a necessidade de mudança social para remoção de barreiras, inclusão e garantia de direitos. Emergiram, em poucas justificativas, críticas a ideologias individualizantes e processos sociais produtores de desigualdade. Foram frequentes as interpretações morais e/ou religiosas. A compreensão da deficiência como fenômeno complexo e multidimensional permanece limitada, revelando a necessidade de atenção à formação profissional.

Este artículo investigó las concepciones sobre discapacidad de 30 profesionales en formación o en ejercicio, de 14 profesiones de la salud, a través de entrevistas individuales. Un comité de expertos preparó 34 declaraciones que representaban perspectivas religiosas/morales, médicas, sociales y afirmativas de la discapacidad. Los entrevistados justificaron su posición en relación a cada afirmación, revelando la coexistencia de interpretaciones que se refieren tanto a la perspectiva médica como a la social de la discapacidad. Hubo a menudo un argumento de que las deficiencias corporales son determinantes de las desigualdades sociales y que las prácticas de salud deberían buscar normalizar al individuo, y también se destacó la necesidad de un cambio social para eliminar barreras, incluir y garantizar derechos. En algunas justificaciones surgieron críticas a ideologías individualizadoras y procesos sociales que producen desigualdad. Las interpretaciones morales y/o religiosas fueron frecuentes. La comprensión de la discapacidad como fenómeno complejo y multidimensional sigue siendo limitada, lo que revela la necesidad de prestar atención a la formación profesional.

ABSTRACT

The study objective was to evaluate the temporal trend of nutritional status assessment coverage among Quilombola children in the Food and Nutrition Surveillance System (SISVAN). An ecological time-series study was conducted on the coverage of SISVAN data among Quilombola children under five years of age in Brazilian municipalities between 2008 and 2019. Prais-Winsten regression was performed to analyze the trend and the average annual percentage change (APC) of coverage, in accordance with demographic, socioeconomic and healthcare variables. The results revealed that national coverage varied from 0.1% in 2008 to 2.8% in 2013, decreasing to 0.3% in 2019. The national APC coverage was 11% from 2008 to 2019, corresponding to a stationary trend (p=0.68). All states showed an increase in coverage from 2008 to 2013, followed by a decrease through to 2019. The States of Mato Grosso do Sul and Sergipe showed an increasing trend, while Acre had a decreasing trend. The other states revealed a stationary trend. No temporal variation was observed in coverage according to the variables of interest. The conclusion drawn was that low SISVAN coverage was found among Quilombola children, with a steady temporal trend in most Brazilian states.

O objetivo é avaliar a tendência temporal da cobertura de avaliação do estado nutricional entre crianças quilombolas no Sistema de Vigilância Alimentar e Nutricional (SISVAN). Estudo ecológico de série temporal sobre a cobertura do SISVAN entre crianças quilombolas menores de cinco anos de idade nos municípios brasileiros entre 2008 e 2019. Realizou-se regressão de Prais-Winsten para analisar a tendência e a variação percentual anual (VPA) média da cobertura, segundo variáveis demográficas, socioeconômicas e assistência à saúde. A cobertura nacional variou de 0,1% em 2008 para 2,8% em 2013, decrescendo para 0,3% em 2019. A VPA da cobertura nacional foi de 11% entre 2008 e 2019, correspondente a tendência estacionária (p=0,68). Todas os estados apresentaram aumento na cobertura de 2008 para 2013, seguida de uma redução até 2019. Os estados do Mato Grosso do Sul e Sergipe apresentaram tendência crescente, enquanto o Acre demonstrou tendência decrescente. Os demais estados demonstraram tendência estacionária. Nenhuma variação temporal foi observada na cobertura segundo as variáveis de interesse. Baixas coberturas do SISVAN foram encontradas entre crianças quilombolas, com tendência temporal estacionária na maioria dos estados brasileiros.

El objetivo es evaluar la tendencia temporal en la cobertura de la evaluación del estado nutricional de los niños quilombolas en el Sistema de Vigilancia Alimentaria y Nutricional (SISVAN). Estudio ecológico de series temporales sobre la cobertura del SISVAN en niños quilombolas menores de cinco años en municipios brasileños entre 2008 y 2019. Se realizó una regresión de Prais-Winsten para analizar la tendencia y la variación porcentual anual promedio (VPA) de la cobertura, según variables demográficas, socioeconómicas y atención de salud. La cobertura nacional varió de 0,1% en 2008 a 2,8% en 2013, disminuyendo a 0,3% en 2019. El VPA de la cobertura nacional fue de 11% entre 2008 y 2019, correspondiente a una tendencia estacionaria (p=0,68). Todos los estados mostraron un aumento en la cobertura entre 2008 y 2013, seguido de una reducción hasta 2019. Los estados de Mato Grosso do Sul y Sergipe mostraron una tendencia creciente, mientras que Acre mostró una tendencia decreciente. Los estados restantes mostraron una tendencia estacionaria. No se observó variación temporal en la cobertura según las variables de interés. Se encontró baja cobertura del SISVAN entre los niños quilombolas, con una tendencia temporal estacionaria en la mayoría de los estados brasileños.

ABSTRACT

The study aimed to describe health and living conditions and analyze factors associated with the quality of the diet of women and children under 5 years of age in 9 rural quilombola communities, certified and without land title in the state of Goiás. Cross-sectional study, in which were constructed the indicators of consumption of ultra-processed foods, diet diversity and diet quality. The association of socioeconomic factors with indicators of dietary diversity and quality was assessed using Pearson's chi-square test, Fischer's exact test and logistic regression analysis. 203 women and 73 children aged 0 to 59 months participated in the study. In women, greater dietary diversity associated with higher income, non-participation in an income transfer program and higher education; in children, fewer people living in the household, B/C socioeconomic classification and diverse maternal diet. Low diet quality in children associated with less diversity in the maternal diet; in women, the income variable was associated with lower diet quality in the chi-square analysis, but the multiple analysis showed an opposite result for this variable. There is an urgency to implement effective actions to guarantee the right to health and adequate and healthy food for this population.

O estudo objetivou descrever condições de saúde e vida e analisar fatores associados à qualidade da dieta de mulheres e crianças menores de 5 anos em 9 comunidades quilombolas rurais, certificadas e não tituladas do estado de Goiás. Estudo de delineamento transversal, no qual foram construídos indicadores de consumo de alimentos ultraprocessados, diversidade e qualidade da dieta. Foi avaliada a associação de fatores socioeconômicos com os indicadores de diversidade e qualidade da dieta, usando teste de qui-quadrado de Pearson, teste exato de Fischer e análise de regressão logística. Participaram do estudo 203 mulheres e 73 crianças de 0 a 59 meses. Nas mulheres, maior diversidade da dieta associou-se à maior renda, não participação em programa de transferência de renda e maior escolaridade; nas crianças, à menor quantidade de moradores no domicílio, classificação socioeconômica B/C e dieta diversa materna. A baixa qualidade da dieta em crianças associou-se à menor diversidade da dieta materna; em mulheres, a variável renda esteve associada à menor qualidade da dieta na análise de qui-quadrado, mas a análise múltipla mostrou um resultado oposto para esta variável. Há urgência em implementar ações efetivas para garantia do direito à saúde e alimentação adequada e saudável para essa população.

El estudio tuvo como objetivo describir las condiciones de vida y salud y analizar factores asociados a la calidad de la dieta de mujeres y niños menores de 5 años en 9 comunidades rurales quilombolas, certificadas y no certificadas en el estado de Goiás. Estudio transversal, en cuyos indicadores se construyeron consumo de alimentos ultraprocesados, diversidad y calidad de la dieta. La asociación de factores socioeconómicos con indicadores de diversidad y calidad de la dieta se evaluó mediante la prueba de chi-cuadrado de Pearson, la prueba exacta de Fischer y el análisis de regresión logística. Participaron en el estudio 203 mujeres y 73 niños de 0 a 59 meses. En las mujeres, una mayor diversidad dietética se asoció con mayores ingresos, no participación en un programa de transferencia de ingresos y educación superior; en los niños, el menor número de residentes en el hogar, la clasificación socioeconómica B/C y la dieta materna diversa. La baja calidad de la dieta en los niños se asoció con una menor diversidad en la dieta materna; en las mujeres, la variable ingreso se asoció con una menor calidad de la dieta en el análisis chi-cuadrado, pero el análisis múltiple mostró un resultado opuesto para esta variable. Es urgente implementar acciones efectivas para garantizar el derecho a la salud y a una alimentación adecuada y saludable para esta población.

ABSTRACT

The scope of this study was to verify differences in the characteristics of predominantly ultra-processed foods or culinary dishes on sale from the largest food delivery app in Brazil in neighborhoods with differing socioeconomic categories in the city of São Paulo. Twenty neighborhoods were selected, categorized according to quartiles of the Municipal Human Development Index. Data on food on sale, classified as culinary preparations or ultra-processed foods, were collected from the centroid of the neighborhoods. A sample of 350 promotions was analyzed, and their characteristics were compared according to the degree of processing categories and vulnerability of the neighborhood. A higher prevalence of promotions for ultra-processed foods was observed in three out of four socioeconomic categories. Places that offered culinary preparations were closer than places that offered ultra-processed foods. The average price and discount were higher for ultra-processed foods. Given the wide availability of ultra-processed foods, it seems necessary to promote the consumption of culinary preparations and highlight them in digital food environments in order to discourage the choice of ultra-processed foods.

O objetivo deste estudo foi verificar diferenças em características das promoções de alimentos predominantemente ultraprocessados ou predominantemente preparações culinárias no maior aplicativo de delivery de comidas do Brasil em bairros com distintas categorias socioeconômicas na cidade de São Paulo. Foram sorteados 20 bairros categorizados segundo quartos do Índice de Desenvolvimento Humano Municipal. Do centroide dos bairros, foram coletados dados de promoções de alimentos, classificadas como preparações culinárias ou alimentos ultraprocessados; 350 promoções compuseram a amostra e suas características foram comparadas segundo as categorias de grau de processamento e de vulnerabilidade do bairro. Observou-se maior prevalência de promoções de ultraprocessados em três de quatro categorias socioeconômicas. Locais que ofereciam preparações culinárias estavam mais próximos que os locais que ofereciam ultraprocessados. O preço e o desconto médios foram maiores para alimentos ultraprocessados. Diante da ampla oferta de alimentos ultraprocessados, parece necessário um maior incentivo ao consumo e destaque a preparações culinárias nos ambientes alimentares digitais, a fim desestimular a escolha por alimentos ultraprocessados.

El objetivo de este estudio fue verificar diferencias en las características de las promociones de alimentos predominantemente ultraprocesados o preparaciones predominantemente culinarias en la mayor aplicación de entrega de alimentos de Brasil en barrios con diferentes categorías socioeconómicas de la ciudad de São Paulo. Se seleccionaron 20 barrios según cuartos del Índice de Desarrollo Humano Municipal. Desde el centroide de los barrios se recogieron datos sobre promociones de alimentos, clasificadas como preparaciones culinarias o alimentos ultraprocesados. Unas 350 promociones conformaron la muestra y se compararon sus características según las categorías de nivel de tramitación y vulnerabilidad barrial. Se observó una mayor prevalencia de promociones de alimentos ultraprocesados en tres de cuatro categorías socioeconómicas. Los lugares que ofrecían preparaciones culinarias estaban más cerca que los lugares que ofrecían alimentos ultraprocesados. El precio y el descuento promedios fueron mayores para los alimentos ultraprocesados. Dada la amplia gama de alimentos ultraprocesados, parece necesario incentivar un mayor consumo y resaltar las preparaciones culinarias en los entornos alimentarios digitales, con el fin de desalentar la elección de alimentos ultraprocesados.

ABSTRACT

Farmers' markets are important spaces for the commercialization of fruits and vegetables, which access by the urban population is considered one of the key aspects of healthy cities. This study adopts an ecological approach with geographic-spatial emphasis to describe accessibility to farmers' markets in Porto Alegre-RS, by four different modes of transport (walking, bicycle, bus, and car) and their associations with income and race/skin color. The distribution of markets across the city is more balanced than other food establishments, although physical accessibility is highly uneven across modes of transport: the ability to reach a market on foot in 10 minutes or less is restricted to no more than 25% of the population, while almost 90% can do it by driving a car. The study found a direct and positive association between levels of accessibility to farmers' markets and income: wealthier areas can reach fairs in less time using any mode of transport than poorer ones (p<0.001). Regions with a majority of white inhabitants have better accessibility to the fairs on foot, by bicycle, and by bus (p<0.01) than regions with a majority of Black, Indigenous, or yellow populations.

ABSTRACT

This study aims to estimate the prevalence of special diets and analyze the sociodemographic profile, nutritional status, and eating habits of the Brazilian population that uses special diets. This cross-sectional study was conducted with data from the second 2017/2018 National Food Survey (n=45,689 individuals aged at least 10 years). We questioned the use of hypertension, diabetes, cholesterol, heart disease, and weight-loss diets. Dieting prevalence was estimated by sociodemographic characteristics and nutritional status, and logistic regression models were employed to assess factors associated with dieting. All analyses considered sample design and expansion factors. The prevalence of special diets was 14.3%. Weight-loss (5.2%) and hypertension (4.6%) diets were the most prevalent. Women, older adults, individuals with higher incomes, and obese individuals were more likely to follow any type of special diet than their peers.

O objetivo do presente estudo foi estimar a prevalência do uso de dietas especiais e analisar o perfil sociodemográfico, o estado nutricional e uso de sal, açúcar e adoçantes em brasileiros que realizam dietas especiais. Trata-se de um estudo transversal utilizando dados do segundo Inquérito Nacional de Alimentação 2017/2018 (n=45.689 indivíduos com pelo menos 10 anos de idade). Foi questionado o uso de dietas para hipertensão, diabetes, colesterol, doença do coração e para emagrecer. Foi estimada a prevalência do uso de dietas de acordo com características sociodemográficas e estado nutricional, e modelos de regressão logística foram utilizados para avaliar os fatores associados à realização de dietas. Todas as análises consideraram o desenho da amostra e os fatores de expansão. A prevalência do uso de dietas especiais foi de 14,3%, sendo as dietas para emagrecer (5,2%) e pressão alta (4,6%) as mais prevalentes. As mulheres, idosos, indivíduos de maior renda e com obesidade tiveram maiores chances de realizarem qualquer tipo de dieta especial quando comparados aos seus pares.

El objetivo del presente estudio fue estimar la prevalencia del uso de dietas especiales y analizar el perfil sociodemográfico, el estado nutricional y el uso de sal, azúcar y edulcorantes en brasileños que siguen dietas especiales. Se trata de un estudio transversal que utiliza datos de la segunda Encuesta Nacional de Alimentación 2017/2018 (n=45.689 personas de al menos 10 años). Se cuestionó el uso de dietas para la hipertensión, la diabetes, el colesterol, las enfermedades cardíacas y la pérdida de peso. Se estimó la prevalencia del uso de dieta según características sociodemográficas y estado nutricional, y se utilizaron modelos de regresión logística para evaluar factores asociados al uso de dieta. Todos los análisis consideraron el diseño muestral y los factores de expansión. La prevalencia del uso de dietas especiales fue del 14,3%, siendo las dietas para adelgazar (5,2%) y la hipertensión arterial (4,6%) las más prevalentes. Las mujeres, las personas mayores, las personas con mayores ingresos y las personas con obesidad tenían más probabilidades de seguir cualquier tipo de dieta especial en comparación con sus pares.

ABSTRACT

The scope of this study was to identify and analyze the social representations of Primary Health Care users of the SUS in the Federal District (FD) with respect to COVID-19 in the context of the Pandemic. It involved a qualitative study based on Social Representation Theory (SRT) that analyzed 1,713 interviews with Iramuteq software users. The Descending Hierarchical Classification (DHC) procedure distributed 85.79% of the word sets associated with COVID-19 into five lexical groupings. The main representations of the COVID-19 pandemic for PHC users in the FD are fear and death. The lack of coordination of the health system, which required governance by the State, made it difficult for people to receive care in a timely manner. Historically excluded social segments, particularly the black, mixed-race and economically vulnerable population, experienced the most severe impact, including loss of life. Overcoming the conflict between an austere and minimally effective State prevailing at the time of the pandemic, and the need to build a solidarity-based health system in a society with major socio-economic disparities, was crucial in ensuring that health in the post-COVID-19 era, as a human right and value, remained at the center of the debate on the Bioethics of Intervention.

O estudo teve como objetivos identificar e analisar as representações sociais dos usuários da atenção primária do SUS do Distrito Federal acerca da COVID-19 no contexto da pandemia. Estudo qualitativo fundamentado na teoria das representações sociais (TRS) que analisou 1.713 entrevistas com usuários no software Iramuteq. O procedimento de classificação hierárquica descendente (CHD) distribuiu 85,79% dos conjuntos de palavras associadas à COVID-19 em cinco classes lexicais. São as principais representações da pandemia de COVID-19 dos usuários da APS do DF: medo e morte. A falta de coordenação do sistema de saúde, que requeria governança pelo Estado, dificultou que a assistência às pessoas chegasse a tempo oportuno. Os segmentos sociais historicamente excluídos, particularmente a população preta e parda, e economicamente vulnerável, vivenciaram de forma mais contundente diversas perdas, inclusive de vidas. A superação do conflito entre um Estado austero e mínimo, como a que prevaleceu no momento da pandemia, e a premência de construção de um sistema de saúde solidarista, em uma sociedade com grandes diferenças socioeconômicas, mantém no centro do debate da bioética de Intervenção a necessidade se avançar na garantia da saúde no pós-COVID-19.

El estudio tuvo como objetivo identificar y analizar las representaciones sociales de los usuarios de la Atención Básica del SUS en el Distrito Federal respecto a COVID-19 en el contexto de la Pandemia. Este estudio cualitativo basado en la Teoría de las Representaciones Sociales (TRS) analizó 1713 entrevistas a usuarios del software Iramuteq. El procedimiento de Clasificación Jerárquica Descendente (CJD) distribuyó el 85,79% de los conjuntos de palabras asociadas a COVID-19 en cinco clases léxicas. Las principales representaciones de la pandemia de COVID-19 entre los usuarios de la APS en el DF son el miedo y la muerte. La falta de coordinación del sistema de salud, que requería gobernanza por parte del Estado, dificultó que la asistencia llegara a las personas de manera oportuna. Los segmentos sociales históricamente excluidos, particularmente la población negra y morena y la población económicamente vulnerable, han experimentado varias pérdidas de manera más severa, incluidas las de vidas. La superación del conflicto entre un Estado austero y minimalista, como el que imperaba en tiempos de la pandemia, y la urgencia de construir un sistema de salud solidario, en una sociedad con grandes diferencias socioeconómicas, mantiene en el centro del debate de la Bioética de Intervención la necesidad de avanzar en la garantía de la salud en el período post-COVID-19.

ABSTRACT

Studies on environmental perception can contribute to managing solid waste on beaches, as they elucidate the nuances of the interaction between humans and the environment, highlighting the necessary transformations aligned with user preferences. The objective was to determine the socioeconomic profile of users and identify these actors environmental perceptions of solid waste of bathers on the beaches of Rio Negro and identify their environmental perception about the incorrect disposal of solid waste in these environments. Interviews were conducted on Ponta Negra, Lua, Tupé and Paricatuba beaches. Women predominated on Ponta Negra and Lua beaches, and men on Paricatuba and Tupé. On the Tupé and Lua beaches, people between 31 and 40 years old stood out. The majority (70%) responded that they completed high school and received up to two minimum wages. Users frequent Ponta Negra beach during the high-water season and the naturally formed beaches in the low waters of the Rio Negro. Most seek out beaches as leisure and consider cleanliness an essential factor. More than 80% stated that they do not leave trash on the beach, in practice, this information was not observed. Plastic was the main item reported. We evidenced that users have little awareness regarding environmental education on Amazon beaches and that educational actions must be carried out.

ABSTRACT

Breastfeeding experiences differ between primiparous and multiparous women. This study aims to investigate how parity influences breastfeeding duration among Brazilian women and to examine the relationship between the number of siblings and the duration of breastfeeding for each child. Data from the Pró-Saúde Study (1999-2012) were used to analyze breastfeeding duration. Differences between parity groups were tested using the chi-square test, while Kruskal-Wallis test and analysis of variance assessed variations in breastfeeding duration, with comparisons visualized using Kaplan-Meier plots. Characteristics such as maternal age and mode of delivery are relevant, especially among primiparous mothers, while maternal education and household income have a positive impact on breastfeeding duration. The use of the Cox model to analyze breastfeeding duration highlights the need for further investigation into the factors influencing this practice, especially considering the decrease in breastfeeding duration among children born in the 1990s and 2000s. These results point to the complex interaction of social, economic, and behavioral factors that should be considered in public policies aimed at maternal and child health.

ABSTRACT

OBJECTIVE: To investigate the sociodemographic, maternal, and gestational factors associated with the dietary total antioxidant capacity in pregnant Brazilian women. METHODS: A cross-sectional study with 2,232 pregnant women aged 18 years old or older, in the first, second, and third trimesters of pregnancy, from eleven cities in the five Brazilian regions. A semi-structured questionnaire was applied to assess socioeconomic, demographic, and health data, and a 24-hour dietary recall (R24h) was used to assess food consumption and analyze the dietary total antioxidant capacity (DTAC), estimated using the ferric reducing antioxidant power (FRAP) method. RESULTS: The median of DTAC was 5.32 mmol/day. Aracaju, Sergipe (SE) had the highest median of DTAC (6.44 mmol/day) and Palmas, Tocantins (TO) had the lowest (4.71 mmol/day). Pregnant women aged 20 to 34 years (OR 1.86; 95%CI 1.26-2.76), 35 years old or older (OR 3.68; 95%CI 2.21-6.14) and who were in the second trimester of pregnancy (OR 1.50; 95%CI 1.11-2.01) were more likely to be above the median DTAC. While pregnant women with higher education had a 67% lower chance of being above the median DTAC (OR 0.67; 95%CI 0.48-0.92). CONCLUSION: The study demonstrated that there are differences in antioxidant consumption in different cities in Brazil and that associated factors such as age, education, and gestational trimester can impact the intake of foods rich in antioxidants. The profile found draws attention to the importance of an adequate diet rich in antioxidants during prenatal care.

ABSTRACT

OBJECTIVE: To analyze the prevalence of bullying practices and associated factors among Brazilian adolescents, according to the National Survey of School Health 2019. METHODS: This is a cross-sectional study with cluster sampling. The outcome variable, bullying practice, was assessed by the question: "In the last 30 days, have you mocked, ridiculed, teased, intimidated, or bullied any of your schoolmates to the point that they felt hurt, upset, offended, or humiliated?" (yes/no). Associations with sociodemographic characteristics, family environment, mental health, and risk behaviors were analyzed using Poisson regression with robust variance. RESULTS: 12.1% (95%CI 11.7-12.6) of adolescents reported bullying others. Positive associations were found among boys (PR 1.66; 95%CI 1.55-1.77); self-declared Black (PR 1.23; 95%CI 1.11-1.36) and brown (PR 1.1; 95%CI 1.02-1.18) adolescents; private school students (PR 1.29; 95%CI 1.21-1.37); those who felt lonely (PR 1.17; 95%CI 1.09-1.26); thought life was not worth living (PR 1.28; 95%CI 1.19-1.39); were physically assaulted by a family member (PR 1.67; 95%CI 1.55-1.79); skipped classes (PR 1.23; 95%CI 1.15-1.31); used tobacco (PR 1.34; 95%CI 1.22-1.47), alcohol (PR 1.38; 95%CI 1.28-1.50), and drugs (PR 1.17; 95%CI 1.04-1.31) regularly; and had sexual relations (PR 1.26; 95%CI 1.18-1.35). Ages 16 and 17 (PR 0.82; 95%CI 0.76-0.89) and family supervision were protective factors (PR 0.70; 95%CI 0.66-0.75). CONCLUSION: Bullying was more likely among boys, younger adolescents, those with family and mental health issues, and those engaged in risk behaviors. The importance of practices, such as family supervision in preventing bullying, is highlighted.

ABSTRACT

This study aimed to describe the prevalence of depressive symptoms and associated factors among older adults. A cross-sectional population-based study using data from the 2019 Brazilian National Health Survey was carried out. The prevalence of depressive symptoms was determined using the 9-item Patient Health Questionnaire (PHQ-9), and associations were tested according to sociodemographic, health and behavioral variables. Crude and adjusted prevalence ratios (PR) with 95% confidence intervals (95%CI) were calculated using Poisson's regression. The overall prevalence of depressive symptoms was 10.7% (95%CI: 9.9; 11.5). Higher PHQ-9 scores were associated with female gender (PR = 2.11, 95%CI: 1.82; 2.44), lack of participation in religious activities (PR = 1.20, 95%CI: 1.07; 1.35), nonsmoking status (PR = 1.55, 95%CI: 1.32; 1.83), poor or very poor self-perceived health (PR = 7.55, 95%CI: 5.82; 9.80), and multimorbidity (PR = 2.26, 95%CI: 1.85; 2.75). Higher education (PR = 0.55, 95%CI: 0.42; 0.73), income (PR = 0.68, 95%CI: 0.54; 0.85), and physical activity (PR = 0.72, 95%CI: 0.57; 0.90) were found to be negatively associated with the outcome. The most prevalent depressive symptoms were: sleeping problems (24.8%, 95%CI: 23.8; 25.8), not feeling rested or willing/feeling without energy (14.5%, 95%CI: 13.7; 15.4), and being depressed/down/without perspective (10.5%, 95%CI: 9.7; 11.2). These findings highlight the importance of prioritizing the identification and treatment of depressive symptoms in older Brazilian populations, particularly given that one in ten older Brazilians experience depressive symptoms.

ABSTRACT

Within-country differences in the prevalence of tobacco consumption may be expected in Mozambique, as determinants of tobacco use vary considerably countrywide. We compared the daily use of smoked and smokeless tobacco in 2005 and 2014/2015 across Mozambican regions. Two surveys were conducted in Mozambique, in 2005 and 2014/2015, with representative samples of the adult population, following the World Health Organization's STEPwise Approach to NCD Risk Factor Surveillance. Prevalence estimates were computed for daily use of different types of tobacco, stratified by regions. Data from the 2014/2015 survey were compared to those from the 2005 survey, after direct age-standardization. During the 10-year period, a significant reduction was observed in the prevalence of daily tobacco smoking among women in the Northern and men in the Southern provinces, due to the decrease in the consumption of hand-rolled cigarettes among Northern women (from 9.6% to 2.3%), and manufactured cigarettes among Southern men (from 23.7% to 11.8%). In Center and Northern regions, nonsignificant increases were observed in the consumption of manufactured cigarettes among men. The consumption of smokeless tobacco among Southern women decreased (from 3.1% to 1%). There was a decrease in the daily consumption of hand-rolled cigarettes among women in the North and of manufactured cigarettes among men in the South, as well as a potential trend towards residual smokeless tobacco consumption. However, the results suggest increases in the daily consumption of manufactured cigarettes among men in the Center and Northern regions.

ABSTRACT

Dating violence during adolescence is a global public health issue due to its widespread occurrence and negative health consequences. Unfortunately, research addressing this topic in Latin American countries remains limited. Seeking to bridge this gap, the present study estimated the prevalence of both dating violence victimization and perpetration among high schoolers considering sociodemographic factors, exposure to other forms of violence, and school-related characteristics. A total of 539 students participated in the study selected by means of probabilistic sampling from private and public schools in Rio de Janeiro, Brazil. Dating violence was identified using the Conflict in Adolescent Dating Relationships Inventory. Victimization prevalence ranged from 16.7% (sexual) to 94.6% (emotional), whereas perpetration prevalence varied between 9.9% (sexual) and 94.6% (emotional). Boys were more physically victimized (37.2% vs. 24.5%) and perpetrated more sexual abuse (13.7% vs. 6.9%) than girls. Adolescents reporting child abuse, living in violent areas, and those who consumed alcoholic beverages more frequently had greater dating violence prevalence overall. However, some differences between male and female vulnerability characteristics merit debate. These heterogeneous profiles of victimization/perpetration between boys and girls indicate the need for specific dating violence prevention interventions.

ABSTRACT

This study aimed to evaluate the association between household food insecurity and child development at age 18 months in the municipality of Pelotas, Rio Grande do Sul State, Brazil. This longitudinal study was carried out with a population-based sample of 465 mothers and infants from Pelotas. Infants' cognitive, motor, socioemotional, and language developments were assessed by the Bayley Scales of Infant and Toddler Development, third edition. The Brazilian Food Insecurity Scale was used to define food safety/insecurity, which classifies households into four categories: food security or mild, moderate, or severe food insecurity. The results of the adjusted analysis showed that food insecurity only affected motor and socioemotional developments at age 18 months. Each increase in food insecurity score decreased that of motor development by 2.30 points on average (95%CI: -4.31; -0.48) at age 18 months. Similarly, each increase in food insecurity score decreased that of socioemotional development by 4.05 points on average (95%CI: -7.34; -0.76). Results show that food insecurity was associated with lower motor and socioemotional developments at age 18 months and stress the importance of the right to adequate food and to environments that provide stimulating experiences for child development.

O objetivo deste estudo foi avaliar a associação entre a insegurança alimentar domiciliar e o desenvolvimento infantil aos 18 meses na cidade de Pelotas, Rio Grande do Sul, Brasil. Realizou-se estudo longitudinal com uma amostra de base populacional de 465 mães e lactentes. Os desenvolvimentos cognitivo, motor, socioemocional e de linguagem dos lactentes foram avaliados através da terceira edição da Escala Bayley do Desenvolvimento do Bebê e da Criança Pequena. A insegurança alimentar foi mensurada por meio da Escala Brasileira de Insegurança Alimentar que classifica os domicílios em segurança alimentar ou insegurança alimentar leve, moderada ou grave. Os resultados mostraram que, após análise ajustada, apenas os desenvolvimentos motor e socioemocional sofreram efeito da insegurança alimentar aos 18 meses. A cada aumento do nível de insegurança alimentar, o escore de desenvolvimento motor diminuiu, em média, 2,30 pontos (IC95%: -4,31; -0,48) aos 18 meses de idade. Similarmente, a cada aumento do nível de insegurança alimentar, o escore de desenvolvimento socioemocional decresceu, em média, 4,05 pontos (IC95%: -7,34; -0,76). Os resultados evidenciam, portanto, que a insegurança alimentar foi associada a menores desenvolvimentos motor e socioemocional aos 18 meses do lactente, enfatizando a importância do direito à alimentação adequada e da existência de ambientes que forneçam experiências estimulantes para o desenvolvimento infantil.

El objetivo de este estudio fue evaluar la asociación entre la inseguridad alimentaria en el hogar y el desarrollo infantil a los 18 meses en la ciudad de Pelotas, Rio Grande do Sul, Brasil. Este es un estudio longitudinal con una muestra poblacional de 465 madres y lactantes de la ciudad de Pelotas. Los desarrollos cognitivo, motor, socioemocional y del lenguaje de los lactantes se evaluaron mediante la tercera edición de la Escala Bayley de Desarrollo de Bebés y Niños. La inseguridad alimentaria se midió utilizando la Escala Brasileña de Inseguridad Alimentaria, que clasifica a los hogares en seguridad alimentaria o inseguridad alimentaria (leve, moderada o grave). Los resultados mostraron que, después de un análisis ajustado, solo los desarrollos motor y socioemocional sufrieron el efecto de la inseguridad alimentaria a los 18 meses. Cada aumento en el nivel de inseguridad alimentaria llevó a una disminución en la puntuación de desarrollo motor en un promedio de 2,30 puntos (IC95%: -4,31; -0,48) a los 18 meses de edad. Del mismo modo, cada aumento en el nivel de inseguridad alimentaria llevó a una disminución en la puntuación de desarrollo socioemocional en un promedio de 4,05 puntos (IC95%: -7,34; -0,76). Los resultados muestran que la inseguridad alimentaria se asoció con menores desarrollos motor y socioemocional a los 18 meses del lactante, lo que indica la importancia del derecho a una alimentación adecuada y la existencia de entornos que brinden experiencias estimulantes para el desarrollo infantil.