Self-rated health among adolescents from vulnerable areas and their sociodemographic, lifestyle and contextual factors: A multilevel analysis.

PURPOSE: Understanding self-rated health in young people can help orient global health actions, especially in regions of social vulnerability. The present study analysed individual and contextual factors associated with self-rated health in a sample of Brazilian adolescents. DESIGN AND METHODS: Cross-sectional data from 1272 adolescents (aged 11-17; 48.5% of girls) in low human development index (HDI) neighbourhoods were analysed (HDI from 0.170 to 0.491). The outcome variable was self-rated health. Independent variables relating to individual factors (biological sex, age and economic class) and lifestyle (physical activity, alcohol, tobacco consumption and nutritional state) were measured using standardised instruments. The socio-environmental variables were measured using neighbourhood registered data where the adolescents studied. Multilevel regression was used to estimate the regression coefficients and their 95% confidence intervals (CI). RESULTS: Good self-rated health prevalence was of 72.2%. Being male (B: -0.165; CI: -0.250 to -0.081), age (B: -0.040; CI: -0.073 to -0.007), weekly duration of moderate to vigorous physical activity (B: 0.074; CI: 0.048-0.099), body mass index (B: -0.025; CI: -0.036 to -0.015), number of family healthcare teams in the neighbourhood (B: 0.019; CI: 0.006-0.033) and dengue incidence (B: -0.001; CI: -0.002; -0.000) were factors associated with self-rated health among students from vulnerable areas. CONCLUSIONS/PRACTICAL IMPLICATIONS: Approximately three in every 10 adolescents in areas of social vulnerability presented poor self-rated health. This fact was associated with biological sex and age (individual factors), physical activity levels and BMI (lifestyle) and the number of family healthcare teams in the neighbourhood (contextual).

National policies on physical activity from 64 countries with different economies: a scoping review with thematic analysis.

In 2018, the World Health Organization (WHO) launched a Global Action Plan on Physical Activity (PA), which included 20 policy actions for creating active societies, environments, people and systems. The objective of this scoping review was to summarize the themes/contents of national PA policies/plans conforming to the WHO's proposals and the country's economy. This review followed Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines for scoping reviews. A systematic search of electronic databases (Web of Science, Medline/PubMed, LILACS, PsycINFO, Scopus and SPORTDiscus) and 441 government documents/websites from 215 countries/territories was conducted (February 2021). Documents on national-level policies, published in English, Spanish and Portuguese since 2000, were eligible. The information on content and structure was systematically extracted and summarized into dimensions proposed by the WHO: active societies, environments, people and systems. The search identified 888 article references and 586 potentially relevant documents. After the screening, 84 policy documents from 64 countries were eligible. Most documents (n = 46) provided detailed PA policies/plans amid other health topics (e.g. non-communicable diseases, named 'general documents'), and 38 were PA-specific. The content analysis merged 54 visions, 65 missions, 108 principles, 119 objectives, 53 priorities, 105 targets, 126 indicators and 1780 actions/strategies from 38 PA-specific and 46 general documents. Among the PA-specific documents, the active system's dimension was the most contemplated in the principles (n = 43), priorities (n = 51) and action/strategies (n = 530) elements. At the same time, the objectives (n = 39), targets (n = 52) and indicators (n = 58) presented contents more frequently related to the active people dimension. For the general documents, all principles (n = 4), objectives (n = 14) and priorities (n = 7) were related to the dimension of active people, while target (n = 51), indicator (n = 53) and actions/strategies (n = 292) elements presented content related to all dimensions. The increase in countries with national PA policies/plans should be followed by improving the current ones because important dimensions seem to be not considered in these documents. This will facilitate a global PA agenda that considers the complexity and multidimensionality of PA promotion.

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.

Physical activity, sedentary behavior and sleep measured by smartwatch: a scoping review protocol / Atividade física, comportamento sedentário e sono medidos por smartwatch: protocolo de revisão de escopo

The health impacts of physical activity (PA), sedentary behavior (SB), and sleep are well established; thereby, the identification of instruments to assess and monitor these behaviors at a populational lev-el is relevant. In this context, smartwatches, which are wristwatch-shaped devices equipped with sen-sors, have been identified as alternatives for objectively measuring PA, SB, and sleep. Therefore, this protocol aimed at describing the goals and methods of a scoping review to map the literature on the use of smartwatches to objectively measure PA, SB, and/or sleep across the lifespan (e.g., children, adolescents, adults, and elderly) and in different contexts. Studies will be included if they use smart-watches to objectively measure at least one of the behaviors (PA, SB, and sleep) in children, adoles-cents, adults, and older adults, published after 2013. No language filter will be applied. Searches will be carried out in six databases (Pubmed/Medline, Scopus, Web of Science, LILACS, IEEE Xplore Digital Library, Scielo, Health Technology Assessment Database, and Cochrane clinical trials) and two clinical trial repositories. The screening and data extraction will be performed independently by two authors who had previous experience in reviews and technologies. The synthesis of the results will follow the Joanna Briggs Institute framework for extracting the results in scoping reviews. The results can contribute to scientific progress by identifying gaps and research trends, guiding future studies, and informing companies, healthcare professionals, and the general public who use smart-watch as a measurement tool for physical activity, sedentary behavior, and sleep

Os impactos da atividade física (AF), comportamento sedentário (CS) e sono na saúde são bem estabelecidos, tornando-se relevante identificar instrumentos que permitam avaliar e monitorar esses comportamentos em nível populacional. Nesse contexto, os smartwatches, que são dispositivos em formato de relógio de pulso, com-postos por sensores, tem sido apontado como alternativa para mensurar objetivamente AF, CS e sono. Portanto, o objetivo deste protocolo foi descrever os objetivos e métodos de uma revisão de escopo para mapear a literatura científica sobre o uso de smartwatches para medir objetivamente AF, CS e/ou sono em diferentes populações e contextos. Os estudos serão incluídos se usarem smartwatches para medir objetivamente pelo menos um dos comportamentos (AF, CS e sono) em crianças, adolescentes, adultos e idosos, publicados após 2013. Nenhum filtro de idioma será aplicado. As buscas serão realizadas em sete bases de dados (Pubmed/Medline, Scopus, Web of Science, IEEE Xplore Digital Library, Scielo, LILACS, Health Technology Assessment Database e Cochrane Clinical Trials) e dois repositórios de ensaios clínicos. A triagem e extração dos dados serão realizadas de forma independente por dois autores com experiência prévia em revisões e tecnologias. A síntese dos resultados seguirá o framework do Joanna Briggs Institute para extração dos resultados nas revisões de escopo. Os resultados podem contribuir para o progresso científico, identificando lacunas e tendências de pesquisa, orientando futuros estudos, empresas que atuam neste mercado, profissionais de saúde e o público em geral que utilizam smartwatch como um instrumento de medição para atividade física, comportamento sedentário e sono

A systematic review of the clustering and correlates of physical activity and sedentary behavior among boys and girls.

Identifying the clustering and correlates of physical activity (PA) and sedentary behavior (SB) is very important for developing appropriate lifestyle interventions for children and adolescents. This systematic review (Prospero CRD42018094826) aimed to identify PA and SB cluster patterns and their correlates among boys and girls (0-19 years). The search was carried out in five electronic databases. Cluster characteristics were extracted in accordance with authors' descriptions by two independent reviewers and a third resolved any disagreements. Seventeen studies met the inclusion criteria and the population age ranged from six to 18 years old. Nine, twelve, and ten cluster types were identified for mixed-sex samples, boys, and girls, respectively. While girls were in clusters characterized by "Low PA Low SB" and "Low PA High SB", the majority of boys were in clusters defined by "High PA High SB" and "High PA Low SB". Few associations were found between sociodemographic variables and all cluster types. Boys and girls in "High PA High SB" clusters had higher BMI and obesity in most of the tested associations. In contrast, those in the "High PA Low SB" clusters presented lower BMI, waist circumference, and overweight and obesity. Different cluster patterns of PA and SB were observed in boys and girls. However, in both sexes, a better adiposity profile was found among children and adolescents in "High PA Low SB" clusters. Our results suggest that it is not enough to increase PA to manage the adiposity correlates, it is also necessary to reduce SB in this population.

Desigualdades de cor/raça na disponibilidade de instalações para a prática de atividades físicas e esportes nas escolas públicas de educação básica do Brasil / Color/race inequalities in the availability of facilities for physical activities and sports in public elementary schools in Brazil / Desigualdades de color/raza en la disponibilidad de instalaciones para la práctica de actividades físicas y deportivas en escuelas públicas de educación básica en Brasil

RESUMO O objetivo deste estudo ecológico foi estimar desigualdades nas instalações para atividades físicas e esportes (AF) nas escolas públicas de Educação Básica brasileiras (n=70.276), conforme a proporção de matrículas de estudantes autodeclarados negros. Os resultados mostraram que escolas urbanas e rurais com maior proporção de matrículas de estudantes negros (≥60%) apresentaram menos pátio descoberto, quadra coberta e descoberta, parque infantil, estúdio de dança e materiais para a prática desportiva e recreação. Essas desigualdades são traços do racismo, que é estruturante na sociedade brasileira e é institucionalizado na oferta de condições desfavoráveis ao engajamento em AF nas escolas públicas que atendem um maior número de alunos pretos e pardos.

ABSTRACT The aim of this study was to estimate inequality in physical activity and sports facilities at Brazilian public elementary schools, according to percent of self-reported black students. Our results showed that schools from urban or rural areas with a higher percentage of enrollments of self-reported black students (≥60%) presented fewer outdoor courtyards, sport court indoor and outdoor, playgrounds, dance studios, and materials for sports and recreation. These inequalities are a feature of racism, which is structural in Brazilian society and institutionalized in unfavorable conditions for engaging in physical activity and sports at public elementary schools where there is a higher number of black students.

RESUMEN Este estudio ecológico tuvo como objetivo estimar las desigualdades en las instalaciones para actividades físicas y deportivas (AF) en las escuelas públicas brasileñas de Educación Básica (n=70.276), según la proporción de matrículas de alumnos que se declararon negros. Los resultados mostraron que las escuelas urbanas y rurales con mayor proporción de matrículas de estudiantes negros (≥60%) tenían menos patio al aire libre, canchas interiores y exteriores, parques infantiles, estudios de danza y materiales para deportes y recreación. Esas desigualdades son rasgos del racismo, que es estructural en la sociedad brasileña y está institucionalizado al ofrecer condiciones desfavorables para la práctica de AF en las escuelas públicas que atienden a un mayor número de alumnos negros y pardos.

School Nursing Guide for student health promotion: construction and validity / Guía de Enfermería Escolar para la promoción de la salud de jóvenes estudiantes: construcción y validación / Guia de Enfermagem Escolar para promoção da saúde de jovens estudantes: construção e validação

ABSTRACT Objectives: to describe the process of construction and validity of a School Nursing Guide for student health promotion. Methods: a methodological study, carried out from February to December 2021, composed of Convergent Care Research based on Pender's Health Promotion Model. Based on the literature and dialogue with 11 nurses in the seven online focus groups, actions were constructed. Subsequently, 24 judges assessed content and appearance. Results: the guide proposes strategies for developing school nursing practices focusing on health promotion. The Appearance Validity Index ranged from 0.63 to 1.0, and the total was 0.84. The Content Validity Index ranged from 0.95 to 1.0, and the total was 0.997. Conclusions: the guide incorporated the needs of young people recognized by professionals, and the assessment phase confirms its validity, and can be used in the context of practice with young people.

RESUMEN Objetivos: describir el proceso de construcción y validación de la Guía Escolar de Enfermería para la promoción de la salud de los jóvenes estudiantes. Métodos: estudio metodológico, realizado de febrero a diciembre de 2021, compuesto por Investigación de Atención Convergente basada en el Modelo de Promoción de la Salud de Pender. Con base en la literatura y el diálogo con 11 enfermeras en los siete grupos focales en línea, se construyeron acciones. Posteriormente, 24 jueces evaluaron el contenido y la apariencia. Resultados: la guía propone estrategias para el desarrollo de prácticas escolares de enfermería con foco en la promoción de la salud. El índice de validez de apariencia osciló entre 0,63 y 1,0 y el total fue de 0,84. El índice de validez de contenido osciló entre 0,95 y 1,0 y el total fue de 0,997. Conclusiones: la guía incorporó las necesidades de los jóvenes reconocidas por los profesionales, y la fase de evaluación confirma su validación, pudiendo ser utilizada en el contexto de la práctica con jóvenes.

RESUMO Objetivos: descrever o processo de construção e validação do Guia de Enfermagem Escolar para promoção da saúde de jovens estudantes. Métodos: estudo metodológico, realizado de fevereiro a dezembro de 2021, composto por Pesquisa Convergente-Assistencial fundamentada no Modelo de Promoção da Saúde de Pender. A partir da literatura e diálogo com 11 enfermeiros nos sete grupos focais online, foram construídas ações. Posteriormente, 24 juízes avaliaram o conteúdo e a aparência. Resultados: o guia propõe estratégias para o desenvolvimento das práticas de enfermagem escolar enfocando a promoção da saúde. O Índice de Validade de Aparência variou de 0,63 a 1,0, e o total foi de 0,84. O Índice de Validade de Conteúdo variou de 0,95 a 1,0, e o total foi de 0,997. Conclusões: o guia incorporou as necessidades dos jovens reconhecidas pelos profissionais, e a fase de avaliação confirma sua validação, podendo ser utilizado no contexto da prática com jovens.

School Nursing Guide for student health promotion: construction and validity.

OBJECTIVES: to describe the process of construction and validity of a School Nursing Guide for student health promotion. METHODS: a methodological study, carried out from February to December 2021, composed of Convergent Care Research based on Pender's Health Promotion Model. Based on the literature and dialogue with 11 nurses in the seven online focus groups, actions were constructed. Subsequently, 24 judges assessed content and appearance. RESULTS: the guide proposes strategies for developing school nursing practices focusing on health promotion. The Appearance Validity Index ranged from 0.63 to 1.0, and the total was 0.84. The Content Validity Index ranged from 0.95 to 1.0, and the total was 0.997. CONCLUSIONS: the guide incorporated the needs of young people recognized by professionals, and the assessment phase confirms its validity, and can be used in the context of practice with young people.

Is oral microbiota associated with overweight and obesity in children and adolescents? A systematic review.

This article aims to verify the relationship between the composition and diversity of oral microbiota with overweight and obese children and adolescents. This systematic review was registered in PROSPERO, followed PRISMA 2020, and included an electronic search until March 2022, in PubMed/MEDLINE, Web of Science, Scopus, and The Cochrane Library databases. Studies were eligible if they compared the oral microbiota according to nutrition status among children and adolescents. Independent peers using JBI Critical Appraisal Checklists assessed the quality of studies. Eleven studies were eligible to be included in this review, with a total of 1,695 children and adolescents, 224 were obese, 190 were overweight, 1,154 were eutrophics and 127 were underweight. The most frequent phyla in overweight and obese children and adolescents, in comparison to their counterparts were Firmicutes, Bacteroidetes, Proteobacteria, Actinobacteria and Fusobacteria. It was identified that nine of the eleven articles selected showed an association between oral microbiota and overweight and obesity in children and adolescents. We observed that there is an important association between oral bacterial composition diversity and overweight and obesity. This finding indicates the relevance of the evaluation and surveillance in oral health to control cases of overweight and obesity in children and adolescents.

Is Participation in Physical Education Classes Related to Physical Activity and Sedentary Behavior? A Systematic Review.

BACKGROUND: The aim of this systematic review was to summarize the results and assess the methodological quality of studies that analyzed the relation between physical education participation, physical activity, and sedentary behavior in schoolchildren. METHODS: Searches were conducted for original cross-sectional and longitudinal observational studies published in Portuguese, English, and Spanish between January 2007 and August 2020, on the PubMed, Web of Science, Scientific Electronic Library Online, Education Resources Information Center, and Scopus databases. RESULTS: A total of 60 articles (68 independent samples) were included in the revision (58 cross-sectional and 2 longitudinal observational studies). With regard to methodological quality, 27%, 52%, and 21% of the studies were classified as high, moderate, and low methodological quality, respectively. Physical activity was analyzed in 93% of the studies (n = 56) and sedentary behavior in 33% (n = 20). The higher frequency of physical education participation was associated with higher physical activity levels (56 of 68 results - 54/65 cross-sectional and 2/3 longitudinal studies) and less sedentary behavior (14 of 24 results), even after stratifying analyses by type and methodological quality. CONCLUSION: Physical education class participation may contribute to students being physically more active and less likely to engage in sedentary behavior.

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/.

Avaliação de programa de atividade física para escolares: desenvolvimento e validação de instrumento / Evaluation of physical activity program for students: development and validation of an instrument

Este estudo objetiva desenvolver e validar um instrumento para avaliar dimensões do planejamento e processo de implementação de um programa de intervenção voltado à promoção de atividade física em escolares. Foi conduzido um estudo metodológico realizado durante os meses de julho a dezembro de 2016, vinculado ao programa de intervenção intitulado de "Movimente". O estudo envolveu as fases teórica (construção do instrumento), empírica e analítica (validação de conteúdo por especialistas, com atribuição de pontuação para os itens e de semântica, por membros da comunidade escolar e alunos do 7º ao 9º ano). O instrumento é dividido em duas dimensões: planejamento e processo. Resultados mostram que a dimensão de planejamento foi composta por indicadores acerca da importância da discussão sobre temas de saúde no contexto escolar, interesse em participar do programa e de suas respectivas ações. A dimensão de processo englobou indicadores sobre conhecimento e avaliação do programa e de suas respectivas ações, bem como sobre o interesse em manter o mesmo. Todas as questões foram consideradas válidas (índices de validade acima de 0,90) e compreensíveis (escores acima de 0,82). Conclui-se que o instrumento apresentou qualidade satisfatória no que diz respeito a validade de conteúdo e semântica, sendo considerado apropriado para avaliação do Programa Movimente e programas e ou projetos similares

This study aims to develop and validate an instrument that evaluates dimensions of planning and im-plementation of an intervention program focused on physical activity promotion in schoolers. It was conducted a methodological study carried out during the months of July to December of 2016, part of the Movimente Program. The study included theoretical (instrument development), empirical and analytical phases (content validadion by specialists, with scores atribution to each item, and by par-ticipants with characteristics similar to those of the target population, including school community, and students from 7th to 9th grade school). The instrument is composed by two dimensions: planning and process. Results show that planning was composed by indicators related to the importance of discussing health topics on the school context; interest in take part of the Program and its respective actions. Dimension included indicatos related to awaraness and evaluation program, and interest on program maintenance. All questions were considered valid (validation scores greater then 0.90) and with a good semantic (scores greated than 0.82). In conclusion, the instrument showed a reasonable quality regarding semantic and content validity, being considered apropriate for evaluation of Movi-mente Program and similar programs of physical activitiy programs in schoolers

Participação nas aulas de Educação Física em Pernambuco: uma análise de tendência temporal / Participation in Physical Education classes in Pernambuco: a temporal trend analysis

O objetivo do estudo foi analisar a tendência temporal e fatores associados à participação nas aulas de educação física de estudantes de Pernambuco. Estudo de tendência temporal composto por três levantamentos de abrangência estadual. Foram entrevistados 4.207 estudantes em 2006, 6.264 em 2011 e 6.002 em 2016, por meio do questionário "Global School-based Student Health Survey" (GSHS). O desfecho foi a participação nas aulas de Educação Física e as exposições foram as informações sociodemográficas. A análise bivariada foi realizada mediante teste Qui-quadrado e as análises multivariadas por regressão logística binária. Observou-se um aumento na prevalência de participação nas aulas de Educação Física (2006: 35%, 2011: 74% e 2016: 81,2%) destacando o aumento significativo no sexo masculino Δ% (2006-2016) = 123,5%. Ser do sexo masculino, estudar no período integral e ser filho de mães que estudaram, independente do tempo de estudo foi associado a maior participação nas aulas de educação física, assim como residir nas regiões do Agreste, Sertão e Sertão do São Francisco. Apesar do aumento na participação nas aulas de Educação Física em Pernambuco, a garantia deste componente curricular deve ser fortalecida, levando em consideração os grupos de risco para que aumente a participação nas aulas desses grupos

The aim of the study was to analyze the temporal trend and factors associated with participation in physical education classes in Pernambuco. The temporal trend study was composed of three surveys. A total of 4,207 students were interviewed in 2006, 6,264 in 2011 and 6,002 in 2016, using the "Global School-based Stu-dent Health Survey" (GSHS) questionnaire. The outcome was participation in Physical Education classes and the independent variables were sociodemographic information. The bivariate analysis was performed using the chi-square test and the multivariate analysis using binary logistic regression. There was an increase in the prevalence of participation in Physical Education classes (2006: 35%, 2011: 74% and 2016: 81.2%), highlighting the significant increase in males Δ% (2006-2016) = 123.5%. Male, studying full-time and being the son of mothers who studied was associated with greater participation in physical education classes, as well as living in the regions of Agreste, Sertão and Sertão do São Francisco. Despite the increase in par-ticipation in Physical Education classes in Pernambuco, the guarantee of this curricular component must be strengthened, considering risk groups in order to increase participation in classes for these groups

Implementation of a school-based physical activity intervention for Brazilian adolescents: a mixed-methods evaluation.

The effectiveness of physical activity interventions can be improved through examining the aspects related to their implementation. However, little such evidence has been collected, particularly in low- and middle-income countries. This study aimed to evaluate the implementation of a school-based physical activity intervention with qualitative and quantitative data from different actors (students, teachers and parents) involved in developing the program. The program was conducted in 2017 with three main components: (i) teacher training, (ii) environmental changes and (iii) educational actions. Mixed-method evaluation was performed by an independent evaluation team using a validated indicator matrix for the implementation process, including the self-reported information of students, teachers and parents, as well as interviews with teachers. In the 3 eligible schools, 350 adolescents (51% girls) answered the implementation questionnaire, as did 45 parents (84% mothers), and 47 teachers (70% female). In the qualitative analysis, 18 teachers participated. Categorical analysis found that the intervention was considered feasible by teachers. In general, teachers had a more positive perception of the implementation than did students. The lack of engagement from the school community and parents and the busy schedule of teachers were indicated to be the main difficulties. In conclusion, despite the teachers' motivation, some barriers prevented the successful implementation of the program.

Changes in Health-Related Quality of Life and Physical Activity Among Older Adults in the First-Wave COVID-19 Outbreak: A Longitudinal Analysis.

The current study aimed to follow the effects of social/physical distancing strategies on health-related daily physical activity and quality of life among older adults during the COVID-19 pandemic. Seventy-two older adults who were enrolled in a University-Community program in March 2020 (age = 66.8 ± 4.82 years, ♀59) answered five phone-based surveys up to 120 days after the COVID-19 outbreak (from April to August 2020). The Short Form 6D and international physical activity (short version) questionnaires were applied. A significant reduction was observed in daily physical activity levels, metabolic equivalent of task, and health-related quality of life scores as well as an increase in sitting time during the week and on weekend days (all p < .01). The authors noted differences in lifestyle conditions at the beginning of the social/physical distancing in the community assessed (p < .01). Health vulnerabilities among older adults have been emphasized during the COVID-19 outbreak, impacting daily physical activity and health-related quality of life.

Vulnerabilidade à inatividade física: validação de conteúdo dos marcadores para adultos / Vulnerabilidad a la inactividad física: validación de contenido de los marcadores para adultos / Vulnerability to physical inactivity: content validation of markers for adults

Resumo Objetivo Objetivou-se validar o conteúdo dos marcadores de vulnerabilidade à inatividade física em adultos. Métodos Estudo metodológico, fundamentado na Psicometria, que visa à elaboração das definições constitutivas e operacionais dos marcadores de vulnerabilidade à inatividade física em adultos e sua validação de conteúdo por especialistas. Os dados foram analisados mediante cálculo do Índice de Validade de Conteúdo (IVC) e Teste Binomial. Resultados Participaram da validação 13 juízes, profissionais da área da saúde, pesquisadores com publicações sobre o tema, provenientes de sete Estados brasileiros (Ceará, Pernambuco, Piauí, Bahia, Amazonas, Santa Catarina e Rio de Janeiro). Foram validados 40 marcadores, com 40 definições constitutivas e 133 definições operacionais. Esses foram agrupados em duas dimensões inter-relacionadas (Sujeito e Social) e 12 subdimensões (Situação Física, Situação Psicoemocional, Comportamento, Letramento Funcional, Relações Interpessoais, Perfil Socidemográfico, Ambiente, Políticas, Contexto Institucional, Cultura, Direitos Fundamentais). Todos apresentaram IVC excelentes (≥ 0,78). Conclusão Os marcadores propostos apresentaram parâmetros adequados de validade e podem ser usados para operacionalizar a mensuração do fenômeno vulnerabilidade à inatividade física na construção de instrumentos e estratégias para o cuidado de pacientes e enfrentamento da inatividade física.

Resumen Objetivo Validar el contenido de los marcadores de vulnerabilidad a la inactividad física en adultos. Métodos Estudio metodológico, fundamentado en la psicometría, que busca elaborar las definiciones constitutivas y operativas de los marcadores de vulnerabilidad a la inactividad física en adultos y su validación de contenido por especialistas. Los datos fueron analizados mediante cálculo del Índice de Validez de Contenido (IVC) y prueba binominal. Resultados Participaron de la validación 13 jueces, profesionales del área de la salud, investigadores con publicaciones sobre el tema, provenientes de siete estados brasileños (Ceará, Pernambuco, Piauí, Bahia, Amazonas, Santa Catarina y Rio de Janeiro). Fueron validados 40 marcadores, con 40 definiciones constitutivas y 133 definiciones operativas. Fueron agrupados en dos dimensiones interrelacionadas (Sujeto y Social) y 12 subdimensiones (Situación física, Situación psicosocial, Comportamiento, Alfabetización funcional, Relaciones interpersonales, Perfil sociodemográfico, Ambiente, Políticas, Contexto institucional, Cultura, Derechos fundamentales). Todos presentaron IVC excelente (≥ 0,78). Conclusión Los marcadores propuestos presentan parámetros adecuados de validez y pueden ser usados para operacionalizar la medición del fenómeno vulnerabilidad a la inactividad física en la elaboración de instrumentos y estrategias para el cuidado de pacientes y afrontamiento de la inactividad física.

Abstract Objective To validate the content of markers of vulnerability to physical inactivity in adults. Methods This is a methodological study, based on psychometrics, which aims to develop constitutive and operational definitions of markers of vulnerability to physical inactivity in adults and content validation by experts. Data were analyzed by calculating Content Validity Index (CVI) and binomial test. Results Thirteen judges, health professionals, researchers with publications on the subject, from seven Brazilian states (Ceará, Pernambuco, Piauí, Bahia, Amazonas, Santa Catarina and Rio de Janeiro), participated in the validation. A total of 40 markers were validated, with 40 constitutive definitions and 133 operational definitions. These were grouped into two interrelated dimensions (subject and social) and 12 subdimensions (physical situation, psycho-emotional situation, behavior, functional literacy, interpersonal relationships, sociodemographic profile, environment, policies, institutional context, culture, fundamental rights). All had excellent CVI (≥ 0.78). Conclusion The proposed markers presented adequate parameters of validity and can be used to operationalize the measurement of vulnerability to physical inactivity phenomenon in the construction of instruments and strategies for patient care and coping with physical inactivity.

Imagem corporal de meninas e prevenção das infecções sexualmente transmissíveis / Female body image and prevention of sexually transmitted infections

RESUMO Objetivo identificar a associação entre a percepção da imagem corporal e a adoção de medidas preventivas de infecções sexualmente transmissíveis por adolescentes do sexo feminino. Métodos pesquisa descritiva, com método misto quantitativo-qualitativo sequencial, em três escolas de tempo integral, localizadas em bairros de vulnerabilidade social. Resultados participaram 147 adolescentes do sexo feminino, idade média de 14 anos. Predominou insatisfação da imagem corporal pelas Escala de Silhuetas e Escala de Avaliação de Insatisfação entre Adolescentes. Observou-se o desconhecimento do preservativo feminino e do manuseio correto do preservativo masculino para prevenção de infecções sexualmente transmissíveis. Conclusão não houve relação significativa entre as variáveis: percepção da imagem corporal, conhecimento de medidas preventivas e comportamento sexual, entretanto, evidenciou-se tendência das adolescentes insatisfeitas com a própria percepção da imagem corporal em se exporem ao comportamento sexual com mais de um parceiro ao mesmo tempo. Ademais, a insatisfação da imagem corporal das adolescentes influenciou o conhecimento acerca do preservativo feminino e do HIV. Contribuições para a prática as ações de promoção e educação em saúde de adolescentes meninas devem considerar fatores que elevem a percepção da imagem corporal positiva, a partir de estratégias que reforcem a autoestima e os comportamentos sexuais seguros.

ABSTRACT Objective to identify the association between the perception of body image and the adoption of preventive measures for sexually transmitted infections by female adolescents. Methods descriptive research, with a sequential quantitative-qualitative mixed method, in three full-time schools located in socially vulnerable neighborhoods. Results 147 female adolescents participated, with a mean age of 14. Body image dissatisfaction by the Silhouettes Scale and the Adolescent Dissatisfaction Rating Scale predominated. There was a lack of knowledge about the female condom and the correct handling of the male condom to prevent sexually transmitted infections. Conclusion there was no significant association among the variables: body image perception, knowledge of preventive measures, and sexual behavior; however, it was evidenced a tendency of the adolescents dissatisfied with their body image perception to expose themselves to sexual conduct with more than one partner at the same time. Furthermore, the adolescents' body image dissatisfaction influenced their knowledge about the female condom, and HIV. Contributions to practice the actions of health promotion and education for adolescent girls should consider factors that raise the perception of positive body image, from strategies that reinforce self-esteem and safe sexual conduct.

Planning and support in the work process of PHC teams in the Northeast: analysis of the PMAQ-AB (3rd cycle). / Planejamento e apoio no processo de trabalho das equipes de atenção básica no Nordeste: análise do PMAQ-AB (3º ciclo).

This paper aims to describe the indicators related to planning and support in the work process reported by the Family Health Teams, from the 3rd cycle of the National Program for Improving Access and Quality of Primary Care (PMAQ-AB) in the Brazilian Northeast. This cross-sectional study employed secondary data from the external evaluation of the 3rd cycle of the PMAQ-AB. Sixteen indicators were used to ascertain the teams' work process actions, and 14,489 family health teams that adhered to the program were evaluated. Among the indicators assessed, we found that the teams held a meeting and planned actions and self-evaluated, monitored, and analyzed health indicators to reorganize the work process, highlighting the determining and conditioning factors. Health surveillance and the Extended Family Health Center (NASF) stand out in the indicators of institutional support and multidisciplinary support for solving complex cases. We identified improvements in the work process of the teams in the Northeast region, but the reality of fragmented and vertical work still requires a change to promote an outlook of shared teamwork, directly influencing the work process.

O objetivo deste artigo é descrever os indicadores referentes ao planejamento e apoio no processo de trabalho reportados pelas Equipes de Saúde da Família, a partir do 3º ciclo do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB) na região Nordeste do Brasil. Estudo transversal, utilizando dados secundários da avaliação externa do 3º ciclo do PMAQ-AB. Dezesseis indicadores foram utilizados para averiguar as ações do processo de trabalho das equipes. Avaliaram-se 14.489 equipes de saúde da família que aderiram ao programa. Dentre os indicadores avaliados, verificou-se que as equipes realizaram reunião e planejamento das ações, autoavaliação, monitoramento e análise dos indicadores de saúde para reorganização do processo de trabalho, evidenciando os fatores determinantes e condicionantes. Nos indicadores de apoio institucional e apoio matricial para resolução de casos complexos, destacam-se a vigilância em saúde e o Núcleo Ampliado de Saúde da Família (NASF). Identificou-se que ocorreram melhorias no processo de trabalho das equipes na região Nordeste, porém, ainda precisa mudar a realidade de trabalho fragmentada e verticalizada, favorecendo um panorama de trabalho em equipe e compartilhado, influenciando diretamente no processo de trabalho.

[Quality of primary care for child health in states in the Northeast region]. / Qualidade da Atenção Primária à Saúde infantil em estados da região Nordeste.

The scope of this article is to compare the assessment of users of health services who participated in the PMAQ-AB on child health in the states of the Brazilian Northeast. It is a cross-sectional study conducted with secondary data based on interviews with 5,116 users of 4,190 Family Health Teams in the nine states of the Northeast macroregion. Fourteen questions on the medical monitoring of children from 0 to 2 years old were evaluated. Proportions and 95% confidence intervals were calculated for each Unit of the Federation of the Brazilian Northeast. The indicators with the highest proportions were the Guthrie PKU test performed within seven days of life (84.4%), children always accompanied by the same professionals (79.1%), monitoring expected growth and development for age (84.9%), dietary guidance (86.3%) and up-to-date vaccination (95.3%). The indicators with the lowest proportions were guidance on the best position for the child to sleep in (45.7%) and whether or not the child's health handbook (46.9%) was received. In all indicators, there were significant differences between the states analyzed. There are differences in the quality of child health care on offer according to the evaluation of users participating in the PMAQ-AB between states in the Northeast.

O objetivo deste artigo é comparar a avaliação das usuárias que participaram do PMAQ-AB acerca da saúde infantil entre os estados da macrorregião Nordeste do Brasil. Estudo transversal, realizado com dados secundários, a partir de entrevista com 5.116 usuárias de 4.190 Equipes de Saúde da Família que atuam nos nove estados da macrorregião nordeste. Quatorze perguntas acerca do acompanhamento da criança de 0 a 2 anos de idade foram avaliadas. Foram calculados proporções e intervalos de confiança de 95% segundo Unidade da Federação da região Nordeste do Brasil. Os indicadores com maiores proporções foram teste do pezinho realizado em até sete dias de vida (84,4%), criança sempre consultada pelos mesmos profissionais (79,1%), acompanhamento do crescimento e desenvolvimento esperado para a idade (84,9%), orientação alimentar (86,3%), vacinação em dia (95,3%). Os indicadores com as menores proporções foram orientação sobre a melhor posição para a criança dormir (45,7%) e se recebeu a caderneta de saúde da criança (46,9%). Em todos os indicadores, houve diferenças significativas entre os estados analisados. Existem divergências na qualidade do cuidado ofertado à saúde infantil segundo a avaliação das usuárias participantes do PMAQ-AB entre estados do Nordeste.

Qualidade da Atenção Primária à Saúde infantil em estados da região Nordeste / Quality of primary care for child health in states in the Northeast region

Resumo O objetivo deste artigo é comparar a avaliação das usuárias que participaram do PMAQ-AB acerca da saúde infantil entre os estados da macrorregião Nordeste do Brasil. Estudo transversal, realizado com dados secundários, a partir de entrevista com 5.116 usuárias de 4.190 Equipes de Saúde da Família que atuam nos nove estados da macrorregião nordeste. Quatorze perguntas acerca do acompanhamento da criança de 0 a 2 anos de idade foram avaliadas. Foram calculados proporções e intervalos de confiança de 95% segundo Unidade da Federação da região Nordeste do Brasil. Os indicadores com maiores proporções foram teste do pezinho realizado em até sete dias de vida (84,4%), criança sempre consultada pelos mesmos profissionais (79,1%), acompanhamento do crescimento e desenvolvimento esperado para a idade (84,9%), orientação alimentar (86,3%), vacinação em dia (95,3%). Os indicadores com as menores proporções foram orientação sobre a melhor posição para a criança dormir (45,7%) e se recebeu a caderneta de saúde da criança (46,9%). Em todos os indicadores, houve diferenças significativas entre os estados analisados. Existem divergências na qualidade do cuidado ofertado à saúde infantil segundo a avaliação das usuárias participantes do PMAQ-AB entre estados do Nordeste.

Abstract The scope of this article is to compare the assessment of users of health services who participated in the PMAQ-AB on child health in the states of the Brazilian Northeast. It is a cross-sectional study conducted with secondary data based on interviews with 5,116 users of 4,190 Family Health Teams in the nine states of the Northeast macroregion. Fourteen questions on the medical monitoring of children from 0 to 2 years old were evaluated. Proportions and 95% confidence intervals were calculated for each Unit of the Federation of the Brazilian Northeast. The indicators with the highest proportions were the Guthrie PKU test performed within seven days of life (84.4%), children always accompanied by the same professionals (79.1%), monitoring expected growth and development for age (84.9%), dietary guidance (86.3%) and up-to-date vaccination (95.3%). The indicators with the lowest proportions were guidance on the best position for the child to sleep in (45.7%) and whether or not the child's health handbook (46.9%) was received. In all indicators, there were significant differences between the states analyzed. There are differences in the quality of child health care on offer according to the evaluation of users participating in the PMAQ-AB between states in the Northeast.