FioSchisto's expert perspective on implementing WHO guidelines for schistosomiasis control and transmission elimination in Brazil.

The World Health Organization (WHO) recognizes schistosomiasis as one of the Neglected Tropical Diseases targeted for global elimination in the 2030 Agenda of the Sustainable Development Goals. In Brazil, schistosomiasis mansoni is considered a public health problem, particularly prevalent among vulnerable populations living in areas with poor environmental and sanitary conditions. In 2022, the WHO published a Guideline encompassing recommendations to assist national programs in endemic countries in achieving morbidity control, eliminating schistosomiasis as a public health problem, and advancing towards interrupting transmission. The perspectives presented here, collectively prepared by members of the Oswaldo Cruz Foundation's (Fiocruz) Schistosomiasis Translational Program (FioSchisto), along with invited experts, examine the feasibility of the WHO recommendations for the Brazilian settings, providing appropriate recommendations for public health policies applicable to the epidemiological reality of Brazil, and suggests future research to address relevant issues. In Brazil, the provision of safe water and sanitation should be the key action to achieve schistosomiasis elimination goals. The agencies involved in measures implementation should act together with the Primary Care teams for planning, executing, monitoring, and evaluating actions in priority municipalities based on their epidemiological indicators. Host snails control should prioritize judicious ecological interventions at breeding sites. The Information, Education, and Communication (IEC) strategy should be associated with water and sanitation and other control actions, actively involving school community. To identify infected carriers, FioSchisto recommends a two-stage approach of immunological and molecular tests to verify transmission interruption during the intervention and beyond. Praziquantel administration should be done under medical supervision at the Primary Care level. MDA should be considered in exceptional settings, as a measure of initial attack strategy in locations presenting high endemicity, always integrated with water and sanitation, IEC, and snail control. To assist decision-making, as well as the monitoring and evaluation of strategic actions, there is a need for an Information System. FioSchisto considers this systematization essential to make investments in strategic research to support the improvement of schistosomiasis control actions. Efforts toward schistosomiasis elimination in Brazil will succeed with a paradigm shift from the vertical prescriptive framework to a community-centered approach involving intersectoral and interdisciplinary collaboration.

[Schistosomiasis, soil-transmitted helminthiases and sanitation in Latin America and the Caribbean: a systematic reviewRelación entre la prevalencia de esquistosomiasis y geohelmintiasis y las condiciones sanitarias en América Latina y el Caribe: una revisión sistemática]. / Esquistossomose, geo-helmintíases e condições sanitárias na América Latina e Caribe: uma revisão sistemática.

Objective: To investigate the relationship between the prevalence of schistosomiasis and soil-transmitted helminthiasis with variables related to access to water, sanitation and solid waste in Latin American and Caribbean (LAC) countries. Method: A systematic review was performed in the LILACS, PubMed, Web of Science, and SciELO databases. Studies published between 1950 and August 2021, with an ecological design and a focus on population groups (states, municipalities and/or districts), having the prevalence of infection by Schistosoma mansoni, Ancylostoma sp., Necator americanus, Ascaris lumbricoides or Trichuris trichiura as primary variable and access to water, sewage and/or solid waste as explanatory variables were included. Open access articles with full text available in English, Spanish, or Portuguese were considered. The risk of bias and the quality of the studies were assessed according to the Joanna Briggs Institute manual. Results: Of 2 714 articles, nine were eligible, published between 1994 and 2021 and covering 22 LAC countries and 14 350 municipalities. All articles had moderate methodological quality. Environmental variables indicated an association between water supply and solid waste collection with schistosomiasis; water supply with ascariasis, trichuriasis and hookworm; and sewage with ascariasis and hookworm. Except for one article, which had regional coverage for LAC, all the others were developed in Brazil. Conclusion: There is a clear need to expand research on the association between household and collective health conditions and parasitic diseases for all endemic countries in LAC to support environmental strategies to control these diseases.

Objetivo: Investigar la relación entre la prevalencia de esquistosomiasis y geohelmintiasis y las variables de acceso al agua, el saneamiento y el manejo de residuos sólidos en los países de América Latina y el Caribe. Métodos: Se realizó una revisión sistemática en las bases de datos LILACS, PubMed, Web of Science y SciELO. Todos los artículos fueron de calidad metodológica moderada. Se incluyeron estudios publicados entre 1950 y agosto del 2021, con diseño ecológico y atención en agregados demográficos (estados, municipios o distritos), que tuvieran como resultado principal la prevalencia de infección por Schistosoma mansoni, Ancylostoma spp., Necator americanus, Ascaris lumbricoides o Trichuris trichiura y como variable explicativa el acceso al agua, el saneamiento y el manejo de residuos sólidos. Se analizaron artículos de texto completo y acceso libre en español, inglés o portugués. El riesgo de sesgo y la calidad de los estudios se evaluaron según las normas del manual del Instituto Joanna Briggs. Resultados: De los 2 714 artículos, hubo 9 que cumplieron con los requisitos establecidos; estos se publicaron entre 1994 y el 2021 y abarcaron 22 países y 14 350 municipios de América Latina y el Caribe. Las variables ambientales indicaron una relación del abastecimiento de agua y la recolección de residuos sólidos con la esquistosomiasis; del abastecimiento de agua con la ascariasis, la tricuriasis y la anquilostomiasis; y del saneamiento con la ascariasis y la anquilostomiasis. Con excepción de un artículo que abarcó la Región de América Latina y el Caribe, todos los demás se realizaron en Brasil. Conclusiones: Es evidente la necesidad de ampliar las investigaciones sobre la relación entre las condiciones sanitarias domésticas y colectivas y las enfermedades parasitarias en todos los países de América Latina y el Caribe donde son endémicas, con el fin de formular estrategias centradas en el medio ambiente para controlar esas enfermedades.

Esquistossomose, geo-helmintíases e condições sanitárias na América Latina e Caribe: uma revisão sistemática

[RESUMO]. Objetivo. Investigar a relação entre prevalência de esquistossomose e geo-helmintíases e variáveis de acesso a água, esgotamento sanitário e resíduos sólidos em países da América Latina e Caribe (ALC). Métodos. Realizou-se uma revisão sistemática nas bases de dados LILACS, PubMed, Web of Science e SciELO. Foram incluídos estudos publicados entre 1950 e agosto de 2021, com desenho ecológico e foco em agregados populacionais (estados, municípios e/ou distritos), tendo como desfecho primário a prevalên- cia da infecção por Schistosoma mansoni, Ancylostoma sp., Necator americanus, Ascaris lumbricoides ou Trichuris trichiura e como variável explicativa o acesso a água, esgotamento sanitário e/ou resíduos sólidos. Foram considerados artigos com disponibilidade de texto completo e acesso livre nos idiomas inglês, espa- nhol ou português. O risco de viés e a qualidade dos estudos foram avaliados conforme o manual do Instituto Joanna Briggs. Resultados. De 2 714 artigos, nove foram elegíveis, publicados entre 1994 e 2021 e cobrindo 22 países da ALC e 14 350 municípios. A qualidade metodológica de todos os artigos foi moderada. As variáveis ambien- tais apontaram associação de abastecimento de água e coleta de resíduos sólidos com esquistossomose; abastecimento de água com ascaridíase, tricuríase e ancilostomíase; e de esgotamento sanitário com asca- ridíase e ancilostomíase. Exceto por um artigo com abrangência regional para ALC, todos os demais foram desenvolvidos no Brasil. Conclusão. Evidencia-se a necessidade de ampliar a pesquisa sobre a associação entre condições sanitárias domiciliares e coletivas e doenças parasitárias para todos os países endêmicos da ALC para embasar estratégias ambientais para controle dessas doenças.

[ABSTRACT]. Objective. To investigate the relationship between the prevalence of schistosomiasis and soil-transmitted helminthiasis with variables related to access to water, sanitation and solid waste in Latin American and Caribbean (LAC) countries. Method. A systematic review was performed in the LILACS, PubMed, Web of Science, and SciELO databases. Studies published between 1950 and August 2021, with an ecological design and a focus on population groups (states, municipalities and/or districts), having the prevalence of infection by Schistosoma mansoni, Ancylostoma sp., Necator americanus, Ascaris lumbricoides or Trichuris trichiura as primary variable and access to water, sewage and/or solid waste as explanatory variables were included. Open access articles with full text available in English, Spanish, or Portuguese were considered. The risk of bias and the quality of the studies were assessed according to the Joanna Briggs Institute manual. Results. Of 2 714 articles, nine were eligible, published between 1994 and 2021 and covering 22 LAC coun- tries and 14 350 municipalities. All articles had moderate methodological quality. Environmental variables indicated an association between water supply and solid waste collection with schistosomiasis; water supply with ascariasis, trichuriasis and hookworm; and sewage with ascariasis and hookworm. Except for one article, which had regional coverage for LAC, all the others were developed in Brazil. Conclusion. There is a clear need to expand research on the association between household and collective health conditions and parasitic diseases for all endemic countries in LAC to support environmental strategies to control these diseases.

[RESUMEN]. Objetivo. Investigar la relación entre la prevalencia de esquistosomiasis y geohelmintiasis y las variables de acceso al agua, el saneamiento y el manejo de residuos sólidos en los países de América Latina y el Caribe. Métodos. Se realizó una revisión sistemática en las bases de datos LILACS, PubMed, Web of Science y SciELO. Todos los artículos fueron de calidad metodológica moderada. Se incluyeron estudios publicados entre 1950 y agosto del 2021, con diseño ecológico y atención en agregados demográficos (estados, municipios o distritos), que tuvieran como resultado principal la prevalencia de infección por Schistosoma mansoni, Ancylostoma spp., Necator americanus, Ascaris lumbricoides o Trichuris trichiura y como variable explicativa el acceso al agua, el saneamiento y el manejo de residuos sólidos. Se analizaron artículos de texto completo y acceso libre en español, inglés o portugués. El riesgo de sesgo y la calidad de los estudios se evaluaron según las normas del manual del Instituto Joanna Briggs. Resultados. De los 2 714 artículos, hubo 9 que cumplieron con los requisitos establecidos; estos se publi- caron entre 1994 y el 2021 y abarcaron 22 países y 14 350 municipios de América Latina y el Caribe. Las variables ambientales indicaron una relación del abastecimiento de agua y la recolección de residuos sólidos con la esquistosomiasis; del abastecimiento de agua con la ascariasis, la tricuriasis y la anquilostomiasis; y del saneamiento con la ascariasis y la anquilostomiasis. Con excepción de un artículo que abarcó la Región de América Latina y el Caribe, todos los demás se realizaron en Brasil. Conclusiones. Es evidente la necesidad de ampliar las investigaciones sobre la relación entre las condicio- nes sanitarias domésticas y colectivas y las enfermedades parasitarias en todos los países de América Latina y el Caribe donde son endémicas, con el fin de formular estrategias centradas en el medio ambiente para controlar esas enfermedades.

Effect of environmental factors in reducing the prevalence of schistosomiasis in schoolchildren: An analysis of three extensive national prevalence surveys in Brazil (1950-2018).

BACKGROUND: Over seven decades, Brazil has made admirable progress in controlling schistosomiasis, and a frequent question about the explanation for this reduction refers to the effect of improving environmental factors in the country. This article seeks to identify factors related to the change in the epidemiological situation of schistosomiasis mansoni infection by analyzing three national prevalence surveys conducted since 1950. METHODOLOGY/PRINCIPAL FINDINGS: This is an ecological study analyzing an unbalanced panel of data based on national surveys and considering the municipality as the unit of analysis. The sample consisted of 1,721 Brazilian municipalities, in which a total of 1,182,339 schoolchildren aged 7-14 were examined during the three periods corresponding to each survey (1947-1953, 1975-1979, and 2010-2015). The percentage of municipalities with zero cases of schistosomiasis was: 45.4%, 54.2% and 73.7%, respectively for those periods. A zero-inflated Poisson regression model, with fixed and random effects, was fitted to assess the association between candidate factors and disease prevalence using a significance level of 5%. There was a significant decrease in disease prevalence between the first and last periods analyzed (RR 0.214, CI 0.184-0.249), with a protective association with access to sanitation (RR 0.996, CI 0.994-0.998), urbanization (RR 0.991, CI 0.989-0.993), and living in own households (RR 0.986, CI 0.983-0.989); and an inverse association with piped water supply (RR 1.010, CI 1.008-1.011). CONCLUSION: The findings of this study indicate a decrease in the prevalence of schistosomiasis over seven decades in schoolchildren from the analyzed Brazilian municipalities, associated with environmental factors and social conditions. The increased access to piped water in the municipalities apparently triggers other ways of contact with unsafe water bodies, generating new transmission routes and suggesting the need for a systemic approach concerning contact with water.

Sewerage as a protective factor for prevalence of hookworm infection in schoolchildren in Brazil: A multilevel ecological analysis of national prevalence surveys (1950-2018).

INTRODUCTION: The prevalence of hookworm infection in Brazil has decreased considerably in recent decades. However, there is no definitive consensus as to which changes have contributed to this reduction. A hypothesis is that improvements in environmental factors have contributed to lowering the parasite load and the level of host-parasite contact. METHODS: This is an ecological study using unbalanced panel data from two Brazilian surveys (1947-1953 and 2010-2015), with municipalities as the analysis unit. The sample comprised 1428 municipalities, in which a total of 745,983 schoolchildren aged 7 to 14 were examined. Zero-inflated Poisson regression models, with fixed and random effects were estimated to evaluate the association of potential explanatory variables with the prevalence of hookworm infection at a significance level of 5 %. RESULTS: We identified a significant decrease in the prevalence between the first and last analyzed periods (RR 0.096; CI 0.086-0.107); The following variables were found to have a protective effect: access to sanitary sewage systems (RR 0.984, CI 0.982-0.986), urbanization (RR 0.995, CI 0.993-0.997), and gross domestic product (RR 0.929, CI 0.912-0.945). CONCLUSION: The findings of this study show a decrease in the prevalence of hookworm infections over six decades in schoolchildren in the Brazilian municipalities. Environmental, demographic, and economic factors were associated with this trend. A historical analysis indicates that interventions aimed at improving sanitation contributed to reducing the disease prevalence.

Esquistossomose, geo-helmintíases e condições sanitárias na América Latina e Caribe: uma revisão sistemática / Schistosomiasis, soil-transmitted helminthiases and sanitation in Latin America and the Caribbean: a systematic review / Relación entre la prevalencia de esquistosomiasis y geohelmintiasis y las condiciones sanitarias en América Latina y el Caribe: una revisión sistemática

RESUMO Objetivo. Investigar a relação entre prevalência de esquistossomose e geo-helmintíases e variáveis de acesso a água, esgotamento sanitário e resíduos sólidos em países da América Latina e Caribe (ALC). Métodos. Realizou-se uma revisão sistemática nas bases de dados LILACS, PubMed, Web of Science e SciELO. Foram incluídos estudos publicados entre 1950 e agosto de 2021, com desenho ecológico e foco em agregados populacionais (estados, municípios e/ou distritos), tendo como desfecho primário a prevalência da infecção por Schistosoma mansoni, Ancylostoma sp., Necator americanus, Ascaris lumbricoides ou Trichuris trichiura e como variável explicativa o acesso a água, esgotamento sanitário e/ou resíduos sólidos. Foram considerados artigos com disponibilidade de texto completo e acesso livre nos idiomas inglês, espanhol ou português. O risco de viés e a qualidade dos estudos foram avaliados conforme o manual do Instituto Joanna Briggs. Resultados. De 2 714 artigos, nove foram elegíveis, publicados entre 1994 e 2021 e cobrindo 22 países da ALC e 14 350 municípios. A qualidade metodológica de todos os artigos foi moderada. As variáveis ambientais apontaram associação de abastecimento de água e coleta de resíduos sólidos com esquistossomose; abastecimento de água com ascaridíase, tricuríase e ancilostomíase; e de esgotamento sanitário com ascaridíase e ancilostomíase. Exceto por um artigo com abrangência regional para ALC, todos os demais foram desenvolvidos no Brasil. Conclusão. Evidencia-se a necessidade de ampliar a pesquisa sobre a associação entre condições sanitárias domiciliares e coletivas e doenças parasitárias para todos os países endêmicos da ALC para embasar estratégias ambientais para controle dessas doenças.

ABSTRACT Objective. To investigate the relationship between the prevalence of schistosomiasis and soil-transmitted helminthiasis with variables related to access to water, sanitation and solid waste in Latin American and Caribbean (LAC) countries. Method. A systematic review was performed in the LILACS, PubMed, Web of Science, and SciELO databases. Studies published between 1950 and August 2021, with an ecological design and a focus on population groups (states, municipalities and/or districts), having the prevalence of infection by Schistosoma mansoni, Ancylostoma sp., Necator americanus, Ascaris lumbricoides or Trichuris trichiura as primary variable and access to water, sewage and/or solid waste as explanatory variables were included. Open access articles with full text available in English, Spanish, or Portuguese were considered. The risk of bias and the quality of the studies were assessed according to the Joanna Briggs Institute manual. Results. Of 2 714 articles, nine were eligible, published between 1994 and 2021 and covering 22 LAC countries and 14 350 municipalities. All articles had moderate methodological quality. Environmental variables indicated an association between water supply and solid waste collection with schistosomiasis; water supply with ascariasis, trichuriasis and hookworm; and sewage with ascariasis and hookworm. Except for one article, which had regional coverage for LAC, all the others were developed in Brazil. Conclusion. There is a clear need to expand research on the association between household and collective health conditions and parasitic diseases for all endemic countries in LAC to support environmental strategies to control these diseases.

RESUMEN Objetivo. Investigar la relación entre la prevalencia de esquistosomiasis y geohelmintiasis y las variables de acceso al agua, el saneamiento y el manejo de residuos sólidos en los países de América Latina y el Caribe. Métodos. Se realizó una revisión sistemática en las bases de datos LILACS, PubMed, Web of Science y SciELO. Todos los artículos fueron de calidad metodológica moderada. Se incluyeron estudios publicados entre 1950 y agosto del 2021, con diseño ecológico y atención en agregados demográficos (estados, municipios o distritos), que tuvieran como resultado principal la prevalencia de infección por Schistosoma mansoni, Ancylostoma spp., Necator americanus, Ascaris lumbricoides o Trichuris trichiura y como variable explicativa el acceso al agua, el saneamiento y el manejo de residuos sólidos. Se analizaron artículos de texto completo y acceso libre en español, inglés o portugués. El riesgo de sesgo y la calidad de los estudios se evaluaron según las normas del manual del Instituto Joanna Briggs. Resultados. De los 2 714 artículos, hubo 9 que cumplieron con los requisitos establecidos; estos se publicaron entre 1994 y el 2021 y abarcaron 22 países y 14 350 municipios de América Latina y el Caribe. Las variables ambientales indicaron una relación del abastecimiento de agua y la recolección de residuos sólidos con la esquistosomiasis; del abastecimiento de agua con la ascariasis, la tricuriasis y la anquilostomiasis; y del saneamiento con la ascariasis y la anquilostomiasis. Con excepción de un artículo que abarcó la Región de América Latina y el Caribe, todos los demás se realizaron en Brasil. Conclusiones. Es evidente la necesidad de ampliar las investigaciones sobre la relación entre las condiciones sanitarias domésticas y colectivas y las enfermedades parasitarias en todos los países de América Latina y el Caribe donde son endémicas, con el fin de formular estrategias centradas en el medio ambiente para controlar esas enfermedades.

[The Bolsa Família Program and educational indicators of children, adolescents, and schools in Brazil: a systematic review]. / Programa Bolsa Família e indicadores educacionais em crianças, adolescentes e escolas no Brasil: revisão sistemática.

The "Bolsa Família" Program (BFP) is an income transfer program based on meeting certain conditions, being Brazil's main strategy for combating extreme poverty, hunger and social inequality. To satisfy the educational criteria, the offspring of the beneficiary families must attend school and score minimum school attendance rates. The aim of this study was to conduct a systematic review to assess the outcomes (effects and impact) of the BFP on educational indicators among the beneficiary families. A search was conducted in the Medline, Lilacs, EBSCO, Econstor, Science Direct and Web of Knowledge databases and the methodological quality of the articles included was evaluated using the Downs & Black checklist. Of the 2,391 studies identified, only 12 were selected. There was evidence that BFP had positive outcomes on educational indicators for the female gender and for the Northern region of Brazil. The results showed that BFP has no impact on academic proficiency and performance, but has a significant impact on school attendance and dropout rates.

O Programa Bolsa Família (PBF) é de transferência condicionada de renda, sendo a principal estratégia do Brasil para o combate à pobreza extrema, à fome e à desigualdade social. As condicionalidades na educação propiciam as condições de escolarização para os beneficiários. O objetivo do estudo foi realizar uma revisão sistemática para avaliar os desfechos (efeitos e impactos) do Programa Bolsa Família em indicadores educacionais entre os beneficiários. Foram consultadas as bases Medline, Lilacs, EBSCO, Econstor, Science Direct e Web of Knowledge. A qualidade metodológica dos artigos incluídos foi avaliada por meio de escores da escala de Downs & Black. Foram identificados 2.391 estudos e selecionados 12. Houve evidências de que o PBF tem desfechos positivos em indicadores educacionais para o sexo feminino e para a Região Norte. Como resultados, demostrou-se que o PBF não tem repercussão na proficiência e no desempenho escolar, mas impacta significativamente nas taxas de abandono e na frequência escolar.

Programa Bolsa Família e indicadores educacionais em crianças, adolescentes e escolas no Brasil: revisão sistemática / The Bolsa Família Program and educational indicators of children, adolescents, and schools in Brazil: a systematic review

Resumo O Programa Bolsa Família (PBF) é de transferência condicionada de renda, sendo a principal estratégia do Brasil para o combate à pobreza extrema, à fome e à desigualdade social. As condicionalidades na educação propiciam as condições de escolarização para os beneficiários. O objetivo do estudo foi realizar uma revisão sistemática para avaliar os desfechos (efeitos e impactos) do Programa Bolsa Família em indicadores educacionais entre os beneficiários. Foram consultadas as bases Medline, Lilacs, EBSCO, Econstor, Science Direct e Web of Knowledge. A qualidade metodológica dos artigos incluídos foi avaliada por meio de escores da escala de Downs & Black. Foram identificados 2.391 estudos e selecionados 12. Houve evidências de que o PBF tem desfechos positivos em indicadores educacionais para o sexo feminino e para a Região Norte. Como resultados, demostrou-se que o PBF não tem repercussão na proficiência e no desempenho escolar, mas impacta significativamente nas taxas de abandono e na frequência escolar.

Abstract The "Bolsa Família" Program (BFP) is an income transfer program based on meeting certain conditions, being Brazil's main strategy for combating extreme poverty, hunger and social inequality. To satisfy the educational criteria, the offspring of the beneficiary families must attend school and score minimum school attendance rates. The aim of this study was to conduct a systematic review to assess the outcomes (effects and impact) of the BFP on educational indicators among the beneficiary families. A search was conducted in the Medline, Lilacs, EBSCO, Econstor, Science Direct and Web of Knowledge databases and the methodological quality of the articles included was evaluated using the Downs & Black checklist. Of the 2,391 studies identified, only 12 were selected. There was evidence that BFP had positive outcomes on educational indicators for the female gender and for the Northern region of Brazil. The results showed that BFP has no impact on academic proficiency and performance, but has a significant impact on school attendance and dropout rates.

Fatores de risco associados ao desenvolvimento de bulimia e anorexia nervosa em estudantes universitários: uma revisão integrativa / Risk factors associated with the development of bulimia and anorexia nervosa in college students: an integrative review

[{"text": "Os transtornos de comportamento alimentar são denominados distúrbios psiquiátricos de etiologia multifatorial, caracterizados por consumo, padrões e atitudes alimentares extremamente distorcidas e preocupação exagerada com o peso e forma corporal, sendo os mais conhecidos a Bulimia e Anorexia Nervosa. O objetivo do estudo foi realizar uma revisão integrativa sobre os fatores de risco associados ao desenvolvimento destes transtornos em estudantes universitários. As bases de dados utilizadas para pesquisa foram Latin American and Caribbean Health Science Literature Database e Scientific Eletronic Library Online. Os critérios de inclusão para a escolha dos artigos foram população de jovens universitários; estudos experimentais ou não; estudos em português, inglês e espanhol, publicados no período de 2005 a 2015. Foram selecionados 41 artigos que estavam relacionados ao tema e utilizados 11 que estavam de acordo com os critérios de inclusão. Os resultados da revisão revelaram como fatores de risco para desenvolvimento dos transtornos a insatisfação e distorção da imagem corporal, sexo feminino, estudante do curso de nutrição e educação física, ambiente universitário estressante, sobrepeso e obesidade, idade, cultura familiar, contato com experiências alimentares inadequadas, supervalorização do peso e práticas incorretas de controle do peso. Conclui-se que esses fatores de risco refletem diretamente no aparecimento dos sintomas da doença e dessa forma, torna-se indispensável realização de estratégias a fim de identificar precocemente os sinais e sintomas das doenças evitando o desenvolvimento da bulimia e anorexia nervosa nesses estudantes, assim como medidas educativas junto a toda população.", "_i": "pt"}]