RESUMEN
Suicide prevention programs delivered in school settings have been shown to reduce suicide attempts and ideation among adolescents. School-based digital interventions targeting at-risk youth are a promising avenue for suicide prevention, and some evidence has shown that blending digital and face-to-face components may improve the effectiveness. However, further evidence on its acceptability, feasibility, and effectiveness is needed, especially in Latin America, where mental health support is limited. Reframe-IT is an internet-based Cognitive Behavioral Therapy (CBT) program to reduce youth suicidal ideation in school settings. We created four complementary face-to-face CBT sessions and, through a pilot study, tested the acceptability, feasibility, and effectiveness of a blended intervention (Reframe-IT +) in adolescents (N = 52) from 6 public schools in Chile, randomized into two groups: Reframe-IT + (N = 33) and Control (N = 19). We found that the intervention was acceptable and feasible, with high degrees of satisfaction and adherence. We also observed a significant reduction in suicidal ideation and depressive symptoms in the intervention group compared to the control group at post-intervention. Our results suggest that the Reframe-IT + could be delivered as a suitable, acceptable, and effective intervention to reduce suicide ideation in adolescents in school settings. Further research is needed to confirm these preliminary results.
Asunto(s)
Terapia Cognitivo-Conductual , Estudios de Factibilidad , Ideación Suicida , Humanos , Adolescente , Chile , Proyectos Piloto , Masculino , Femenino , Prevención del Suicidio , Servicios de Salud Escolar/organización & administraciónRESUMEN
BACKGROUND: Suicide prevention programs delivered in school settings have been shown to reduce suicide attempts and ideation among adolescents. School-based digital interventions targeting at-risk youth are a promising avenue for suicide prevention, and some evidence has shown that blending digital and face-to-face components may improve the effectiveness. However, further evidence is needed, especially in Latin America, where mental health support is limited. We tested the effectiveness of the Reframe-IT+, a blended cognitive behavioral indicated intervention to reduce suicidal ideation, designed to be delivered in school settings. It includes 13 sessions, combining eight internet-based sessions and five face-to-face sessions. METHODS: We conducted a cluster RCT and delivered the Reframe-IT + among secondary students attending Years 9-11. We recruited 21 schools that were randomized into two groups: (1) Intervention Reframe-IT + Group (IG) (n = 863) and (2) Control Group (CG) (n = 683). All consented students completed online screening self-reported questionnaires at baseline. The primary outcome was suicidal ideation . Additionally, we tested the impact of the intervention on depressive and anxiety symptoms, hopelessness, and emotion regulatory strategies, including social solving-problems skills, behavioral activation, cognitive reappraisal, and emotion suppression. A total of 303 students (IG, n = 164; CG, n = 139) were identified as at risk and eligible for inclusion in the study. From those, 224 students (IG, n = 123; CG, n = 101) and their caregivers were interviewed to confirm inclusion and exclusion criteria. Finally, 48 and 47 students were allocated to control and intervention groups, respectively, and answered the online questionnaires at post-intervention. We performed an intention-to-treat analysis using repetitive measures and multilevel regression analyses. RESULTS: We found a significant reduction in suicidal ideation (b=-6.7, p = 0.015, Cohen´s d = 0.49), depressive (b=-3.1, p = 0.002, Cohen´s d = 0.81) and anxiety (b=-2.60, p < 0.001, Cohen´s d = 0.72) symptoms, and hopelessness (b=-3.7, p < 0.001, Cohen´s d = 0.70) in the intervention group compared to the control group at post-intervention. We also found improvement in solving-problems skills (b=-1.6, p = 0.002, Cohen´s d = 0.58), behavioral activation (b = 2.8, p = 0.019, Cohen´s d = 0.47), and cognitive reappraisal (b = 2.2, p = 0.029, Cohen´s d = 0.53). In the exploration of the intervention mechanisms concerning suicidal ideation, the total indirect effect of the intervention (b = -5.727923; p = 0.008) was significant, whereas the direct effect (b = - 0.03195473, p = 0.903) was not significant (Suppl 2, Table 1). Problem-solving skill (b=-2.84, p = 0.016) was a significant mediator of intervention effects on suicidal ideation (Path a*b). CONCLUSIONS: This is the first clustered RCT evaluation of the effectiveness of a blended indicated intervention to prevent suicidality in school settings in Latin America. This is the first step to informing policymakers to scale up an effective intervention for an important public health problem. TRIAL REGISTRATION: Clinical Trials NCT05229302. Registered on January 27th, 2022.
Asunto(s)
Terapia Cognitivo-Conductual , Ideación Suicida , Humanos , Adolescente , Masculino , Femenino , Terapia Cognitivo-Conductual/métodos , Chile , Prevención del Suicidio , Estudiantes/psicología , Estudiantes/estadística & datos numéricos , Depresión/prevención & control , Depresión/psicología , Ansiedad/prevención & control , Ansiedad/psicología , Servicios de Salud Escolar/organización & administración , Servicios de Salud Mental Escolar , Instituciones AcadémicasRESUMEN
Efforts are needed to better understand what are the effective pathways that can optimize success in school-based physical activity interventions. This study aimed to investigate the mediators of a school-based intervention in the practice of physical activity in Brazilian students. The Fortaleça sua Saúde [Strengthen Your Health] program followed 1,085 students (11-18 years) over a semester. This multi-component intervention included training teachers, offering physical activity opportunities, and health education. Self-reported moderate-to-vigorous physical activity and potential mediators (attitude, self-efficacy, social support, perceived neighborhood environment, and physical activity facilities at school) were assessed. The product of coefficient analysis was performed. The sample was composed of 1,085 students (51.5% boys). The total effect of the intervention was 0.706 (95%CI: 0.276; 1.136). A total of 40% of the intervention effect on moderate-to-vigorous physical activity was explained by attitude towards physical activity and social support from friends and teachers. Social support from friends was a significant mediator only among boys (ab: 0.113, 95%CI: 0.027; 0.256), and social support from teachers only among girls (ab: 0.135, 95%CI: 0.019; 0.328); indicating a statistically significant indirect effect of the program on moderate-to-vigorous physical activity via these mediators. A relevant part of the effect of a multicomponent intervention on physical activity among students from vulnerable areas is explained by changes via variables at different levels of the socioecological model, including social support from friends and teachers, and attitude towards physical activity. These results should be considered in public policies.
Asunto(s)
Ejercicio Físico , Apoyo Social , Estudiantes , Humanos , Masculino , Femenino , Adolescente , Niño , Brasil , Estudiantes/psicología , Ejercicio Físico/psicología , Promoción de la Salud/métodos , Factores Socioeconómicos , Servicios de Salud Escolar , Poblaciones Vulnerables , Conductas Relacionadas con la Salud , Autoeficacia , Instituciones AcadémicasRESUMEN
OBJECTIVE: To analyze the changes in the methodological aspects of the National Survey of School Health (PeNSE) and its comparability with the Global School-based Student Health Survey (GSHS). METHODS: This evaluative study that utilized the PeNSE questionnaires from 2009, 2012, 2015, and 2019, and the GSHS questionnaires from 2013-2017 e 2018-2020. The variables analyzed included the sample size, representativeness and geographic stratification of PeNSE, the number of questions in PeNSE, the percentage similarity of the PeNSE 2019 relative to the 2015, and its comparability with GSHS. RESULTS: Over the four editions of PeNSE, the sample size increased (from 63,411 in 2009 to 125,123 in 2019). There were changes in educational levels (exclusion of the 6th grade and inclusion of the 7th and 8th grades of primary and secondary education), geographic stratification (expanded to large regions and federation units), and the number of questions increased by 46%. Regarding the similarity between the 2015 and 2019 editions, 48 questions were added, 35 were excluded, and 4 were changed. In 2019, PeNSE presented 11 modules that were partially comparable and 3 that were potentially not to those of 2015. The PeNSE 2015 edition was more similar to the GSHS, with 10 comparable modules, whereas in 2019, this number was reduced to five. CONCLUSION: Since its creation, PeNSE has undergone several changes, including increased sample representativeness and number of questions across editions. However, changes to the questionnaires must be analyzed with caution, as they may compromise comparability with previous editions and international surveys.
Asunto(s)
Encuestas Epidemiológicas , Humanos , Encuestas Epidemiológicas/métodos , Encuestas Epidemiológicas/estadística & datos numéricos , Adolescente , Niño , Brasil , Instituciones Académicas/estadística & datos numéricos , Estudiantes/estadística & datos numéricos , Femenino , Masculino , Salud Global , Factores de Tiempo , Servicios de Salud Escolar/estadística & datos numéricosRESUMEN
This study aimed to analyze the association between the development of intersectoral actions between school/primary health care (PHC) services and the recognition of a usual source of care of PHC among Brazilian adolescents. This is a cross-sectional study, from the Brazilian National Survey of School Health (2015) conducted with a complex sampling of 97,903 adolescents. The association between intersectoral actions between PHC services and schools and the recognition of a usual source of care of PHC were estimated by the prevalence ratio (PR), using the logistic regression model and considering the sample weight factor with Stata 14.0 Of the analyzed adolescents, 72.8% of them studied in schools that developed intersectoral actions with PHC services. Among adolescent students from schools that developed intersectoral actions, an association was observed between the recognition of usual source of care of PHC and intersectoral actions (PR = 1.11; 95%CI: 1.08-1.14). When analyzed for actions of the School Health Program (PR = 1.40; 95%CI: 1.37-1.43), and the development of actions between the school and PHC services (PR = 1.08; 95%CI: 1.05-1.12). The results show that there is a positive association between the recognition of PHC services as a usual source of care and intersectoral actions. However, from the perspective of an intersectoral practice, there are challenges in the articulation between health and education sectors for implementing prevention and promoting adolescent health in school. They involve greater knowledge about the adolescents' perception of the quality of the service offered by health units.
Este estudo teve como objetivo analisar a associação entre o desenvolvimento de ações intersetoriais entre escola/serviços de saúde da atenção primária à saúde (APS) e o reconhecimento de uma fonte usual do cuidado de APS entre adolescentes brasileiros. Trata-se de um estudo transversal, a partir da Pesquisa Nacional de Saúde do Escolar de 2015, realizado com 97.903 adolescentes, com amostragem complexa. A associação entre ações intersetoriais entre serviços de APS e escolas e o reconhecimento da fonte usual do cuidado da APS foram estimadas por meio da razão de prevalência (RP), com uso do modelo de regressão logística, sendo considerado o fator de ponderação amostral, por meio do Stata 14.0 Dos adolescentes analisados, 72,8% estudavam em escolas que desenvolviam ações intersetoriais com os serviços de APS. Entre esses, observou-se associação entre o reconhecimento da fonte usual do cuidado da APS e ações intersetoriais (RP = 1,11; IC95%: 1,08-1,14). Quando analisado para ações do Programa Saúde na Escola (RP = 1,40; IC95%: 1,37-1,43) e o desenvolvimento de ações entre a escola e os serviços de APS (RP = 1,08; IC95%: 1,05-1,12). Os resultados mostram que existe uma associação positiva entre o reconhecimento dos serviços de APS como uma fonte usual do cuidado e as ações intersetoriais. Entretanto, existem desafios na articulação entre os setores de saúde e educação, na perspectiva de uma prática que se configura como intersetorial, para a implementação das ações de prevenção e de promoção da saúde ao adolescente na escola. Envolvem, ainda, maior conhecimento sobre a percepção dos adolescentes sobre a qualidade do serviço ofertado pelas unidades de saúde.
Este estudio tuvo como objetivo analizar la asociación entre el desarrollo de acciones intersectoriales entre el colegio/servicios de salud de la atención primaria de salud (APS) y el reconocimiento de un recurso habitual de atención de la APS entre los adolescentes brasileños. Se trata de un estudio transversal, basado en la Encuesta Nacional de Salud del Escolar (2015) realizada a 97.903 adolescentes, con muestreo complejo. La asociación entre las acciones intersectoriales entre los colegios/servicios de APS y el reconocimiento de un recurso habitual de atención de la APS se estimaron por la razón de prevalencia (RP), a partir del modelo de regresión logística y del factor de ponderación de la muestra mediante el Stata 14.0 El 72,8% de los adolescentes estudiaban en colegios que desarrollaron acciones intersectoriales con los servicios de APS. Entre los estudiantes de colegios que desarrollaron acciones intersectoriales, se observó una asociación entre el reconocimiento de recurso habitual de atención de APS y las acciones intersectoriales (RP = 1,11; IC95%: 1,08-1,14). En el análisis de las acciones del Programa Salud en la Escuela (RP = 1,40; IC95%: 1,37-1,43), hubo un desarrollo de acciones entre el colegio y los servicios de APS (RP = 1,08; IC95%: 1,05-1,12). Los resultados apuntan a una asociación positiva entre el reconocimiento de los servicios de APS como recurso habitual de atención y las acciones intersectoriales. Sin embargo, se encuentran desafíos en la articulación entre los sectores de salud y educación desde una acción intersectorial para implementar acciones de prevención y promoción de la salud para adolescentes escolares. Esto también implica un mayor conocimiento sobre la percepción de los adolescentes sobre la calidad del servicio que prestan los centros de salud.
Asunto(s)
Atención Primaria de Salud , Servicios de Salud Escolar , Humanos , Adolescente , Brasil , Estudios Transversales , Femenino , Masculino , Factores Socioeconómicos , Niño , Servicios de Salud del Adolescente/organización & administraciónRESUMEN
BACKGROUND: This study evaluated stakeholders' perceptions regarding the initial implementation process of the health promoting school model proposed by the affordable health initiative (AHI HPS model) in schools of Belo Horizonte/BRA. METHODS: The model has been implemented since 2019, by an implementation committee (IC) with members from university, health, and education sectors. Data were collected from records of the IC meetings (n = 10) and interviews with 5 IC members to evaluate the model's acceptability, adoption, appropriateness, and feasibility. The material was decomposed by content analysis. RESULTS: Two categories and 7 subcategories emerged, suggesting that stakeholders found the model straightforward and well-suited to schools. Facilitators (teamwork, motivation, commitment, teacher's central role, inclusive decision-making, intersectoral responsibility pact, model alignment with school context) and barriers (family involvement, time constraints for curriculum integration, financial resource, school infrastructure, records difficulties, university unawareness of the school context) to implementation were presented. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: The results highlight the need to involve civil society and decision-makers to make the program feasible. CONCLUSION: Participants showed they accept and intend to contribute to implementing the model. They believe in the program's feasibility as long as teacher involvement is prioritized, and identified barriers are overcome.
Asunto(s)
Servicios de Salud Escolar , Humanos , Brasil , Servicios de Salud Escolar/organización & administración , Promoción de la Salud/organización & administración , Instituciones Académicas/organización & administraciónRESUMEN
La presente publicación describe las pautas relacionados con las prácticas diarias de numerosas actividades que contribuyen a promover la salud y el bienestar de los estudiantes, las familias y las comunidades. Existen claras evidencias de los beneficios que aporta el enfoque de las escuelas promotoras de la salud (EPS), no solo para mejorar los resultados de salud integral (física, mental y social) de la comunidad educativa, sino también para obtener mejores resultados de aprendizaje. El cierre de las escuelas durante la pandemia de COVID-19 ha destacado este rol de las escuelas y la estrecha vinculación entre la salud, el bienestar y la educación. Asimismo, las características de los respectivos contextos que introducen las bases conceptuales y operativas de la iniciativa de EPS e incentivar la motivación de los equipos que coordinan su implementación, y brindar herramientas conceptuales y metodológicas que permitan potenciar la iniciativa de EPS de forma crítica y contextualizada
Asunto(s)
Humanos , Servicios de Salud Escolar , Instituciones Académicas , Características de la Residencia , Determinantes Sociales de la Salud , Desarrollo Sostenible , Promoción de la SaludRESUMEN
DESTAQUES â Este mapa de evidências apresenta resultados de efetividade de intervenções realizadas em escolas, recuperadas da literatura científica global. â Foram incluídos 217 revisões sistemáticas (RS) e 3 estudos primários que avaliaram os efeitos de treze ações relativas à Promoção da Saúde em Escolas. â Quanto à qualidade metodológica, as RS foram assim classificadas: 9 de confiança alta, 14 moderada, 16 baixa e 178 criticamente baixas. â As intervenções foram categorizadas segundo as ações previstas no Programa Saúde na Escola (PSE): 1) Combate ao Aedes aegypti; 2) Promoção da atividade física; 3) Promoção da cidadania ; 4) Prevenção da Covid-19; 5) Promoção de direitos sexuais e reprodutivos; 6) Controle de doenças negligenciadas; 7) Ações de saúde auditiva; 8) Ações de saúde bucal; 9) Ações de saúde ocular; 10) Promoção da alimentação saudável; 11) Monitoramento da situação vacinal; 12) Prevenção e uso de substâncias e 13) Prevenção de violências e acidentes.
HIGHLIGHTS â This evidence map presents results on the effectiveness of interventions carried out in schools, retrieved from the global scientific literature. â A total of 217 systematic reviews (SRs) and 3 primary studies that evaluated the effects of thirteen actions related to Health Promotion in Schools were included. â Regarding methodological quality, the SRs were classified as follows: 9 with high confidence, 14 moderate, 16 low and 178 critically low. â The interventions were categorized according to the actions provided for in the Brazilian School Health Program (PSE): 1) Combating Aedes aegypti; 2) Promoting physical activity; 3) Promoting citizenship; 4) Preventing Covid-19; 5) Promoting sexual and reproductive rights; 6) Controlling neglected diseases; 7) Hearing health actions; 8) Oral health actions; 9) Eye health actions; 10) Promoting healthy eating; 11) Monitoring vaccination status; 12) Prevention and use of substances and 13) Prevention of violence and accidents.
Asunto(s)
Servicios de Salud Escolar , RevisiónRESUMEN
BACKGROUND: The aim of our study was to evaluate the impact of the ActTeens Program on physical activity and health-related physical fitness among adolescents in Brazil. METHODS: The "ActTeens Program" was conducted using a cluster-randomized controlled trial during 24-week school term. The sample consisted of 317 adolescents (52.7% girls; 13.61 ± 0.70 years) from four secondary schools that were randomly assigned to intervention group (N = 169) or control group (N = 148). This school-based physical activity (PA) intervention involved two components: (i) structured physical activity sessions delivered within physical education (PE) and (ii) healthy lifestyle guidance (mHealth). The primary outcome was PA assessed using Physical Activity Questionnaire for Adolescents (PAQ-A); secondary outcomes included muscular (MF) and cardiorespiratory fitness (CRF) assessed using 90-push-up, handgrip dynamometer, standing long jump, and 20 m PACER shuttle run test. Assessments were conducted at baseline, 12- and 24-week. Intervention effects were assessed using linear mixed models (LMM). RESULTS: For the primary outcome (PA), no significant group-by-time effects were observed for physical education based-PA (0.3 score; 95%CI: -0.1; 0.6; and - 0.01 score; 95%CI: -0.03; 0.03, at 12-wk and 24-wk respectively) and total PA (-0.02 score; 95%CI: -0.2; 0.2; and - 0.01score; 95%CI: -0.2; 0.2, at 12 and 24 weeks respectively). After 24 weeks, we observed a significant group by time effects for lower body muscular fitness (12.9 cm; 95%CI, 3.2 to 22.2). CONCLUSION: The implementation of aerobic and muscle-strengthening exercises used in the ActTeens intervention did not lead to improvements in physical activity. The intervention resulted in improved lower body muscular fitness, however, we found no significant differences for upper body muscular and cardiorespiratory fitness.
Asunto(s)
Ejercicio Físico , Educación y Entrenamiento Físico , Aptitud Física , Humanos , Femenino , Masculino , Adolescente , Ejercicio Físico/fisiología , Brasil , Educación y Entrenamiento Físico/métodos , Capacidad Cardiovascular/fisiología , Servicios de Salud Escolar , Promoción de la Salud/métodos , Evaluación de Programas y Proyectos de Salud , Estilo de Vida SaludableRESUMEN
OBJECTIVE: To evaluate the feasibility and accuracy of an unprecedented COVID-19 antigen testing program in schools, which required a healthcare provider order, laboratory director, a Clinical Laboratory Improvement Amendments certificate of waiver, as well as training of school personnel. STUDY DESIGN: Descriptive report of a point-of-care, school-based antigen testing program in California from August 1st, 2021 through May 30, 2022, in which participants grades K-12 self-swabbed and school personnel performed testing. Participants included 944 009 students, personnel, and community members from 4022 California kindergarten through high schools. Outcomes measured include sensitivity and specificity (with polymerase chain reaction [PCR] as comparator) of the Abbott BinaxNOW antigen test, number of tests performed, and active infections identified. RESULTS: Of 102 022 paired PCR/antigen tests, the overall sensitivity and specificity for the antigen test was 81.2% (95% CI: 80.5%-81.8%) and 99.6% (95% CI: 99.5%-99.6%), respectively, using cycle threshold values <30. During January through March 2022, the highest prevalence period, the positive predictive value of antigen testing was 94.7% and the negative predictive value was 94.2%. Overall, 4022 school sites were enrolled and 3 987 840 million antigen tests were performed on 944 009 individuals. A total of 162 927 positive antigen tests were reported in 135 163 individuals (14.3% of persons tested). CONCLUSIONS: Rapidly implementing a school-based testing program in thousands of schools is feasible. Self-swabbing and testing by school personnel can yield accurate results. On-site COVID-19 testing is no longer necessary in schools, but this model provides a framework for future infectious disease threats.
Asunto(s)
COVID-19 , Pruebas en el Punto de Atención , Sensibilidad y Especificidad , Humanos , COVID-19/diagnóstico , COVID-19/epidemiología , California , Niño , Adolescente , Instituciones Académicas , Femenino , Masculino , Prueba de COVID-19/métodos , Prueba Serológica para COVID-19/métodos , Servicios de Salud Escolar , SARS-CoV-2 , Estudios de FactibilidadRESUMEN
BACKGROUND: There is general agreement that sexuality is a central aspect of human development; it is key in sexual health and reproductive education during adolescence. However, in spite of the existing interventions on this topic and the evidence generated, the inclusion of a gender focus in sexuality is relatively recent and there is little evidence available, thus structured and corroborated interventions with a gender-transforming perspective in sexuality are required. METHODS: We will use a mixed method experimental design with a parallel cluster-randomized trial (GRTs) that will evaluate the effectiveness of a comprehensive gender-transformative intervention of sexual education (ENFOCATE -Focus-on-), which will be complemented with qualitative studies to understand the implementation process. The participants will be 609 10th and 11th-grade students. The randomization will be by grade, and the data will be collected at three moments (pre-intervention, post-intervention, and a 3-month follow-up). DISCUSSION: Comprehensive, gender-focused, and culturally pertinent interventions in sexuality are needed for adolescents of countries with high, middle, and low incomes. These produce better results in terms of sexual health, and including a gender-transformative focus contributes to equity in health. Focus-on is unique since it uses a comprehensive gender-transformative intervention in sexual education that will allow putting into practice a program based both on international evidence and that which arises from the object population. It also uses a culturally-sensitive focus, since it is designed based on the characteristics of the object population; it will allow adapting some activities to the needs of the context in which it is developed. TRIAL REGISTRATION: The study was prospectively registered on June 6, 2023, at ClinicalTrials.gov ID: NCT05896540. Protocol version number 1.0. May 22, 2023.
Asunto(s)
Ensayos Clínicos Controlados Aleatorios como Asunto , Servicios de Salud Escolar , Educación Sexual , Salud Sexual , Humanos , Adolescente , Educación Sexual/métodos , Femenino , Masculino , Conducta del Adolescente , Conducta Sexual , Factores Sexuales , Conocimientos, Actitudes y Práctica en Salud , Factores de TiempoRESUMEN
El documento contiene las disposiciones para el desarrollo del Servicio Rural y urbano Marginal de Salud - SERUMS, de los profesionales de psicología, en las instituciones educativas públicas, en el marco del artículo 3 de la Ley N° 29719, Ley que promueve la convivencia sin violencia en las instituciones educativas, modificado mediante la Ley N° 31902.
Asunto(s)
Servicios de Salud Escolar , Salud MentalRESUMEN
Information on how school-based programs is implemented and sustained during crises is limited. In this study, we assessed the impact of the COVID-19 pandemic on the implementation of a HIV prevention intervention in The Bahamas. Data were collected from 139 Grade 6 teachers in 2021-2022. Teachers attended virtual training and received implementation monitoring from coordinators. On average, teachers taught 26.4 (SD = 9.2) of the 35 core activities, and 7.4 (SD = 2.4) out of 9 sessions. More than half (58.3%) of teachers completed 28 or more core activities; 69.1% covered eight or all nine sessions, which is equivalent to 80% of the HIV intervention curriculum. Almost half of the teachers (43%) reported that the pandemic negatively impacted their ability to teach the program; 72% of teachers maintained that the program remained "very important" during times of crisis. Greater self-efficacy and supports increased implementation fidelity.
Asunto(s)
COVID-19 , Infecciones por VIH , SARS-CoV-2 , Maestros , Humanos , Infecciones por VIH/prevención & control , Infecciones por VIH/epidemiología , COVID-19/prevención & control , COVID-19/epidemiología , Femenino , Maestros/psicología , Bahamas/epidemiología , Masculino , Adulto , Servicios de Salud Escolar/organización & administración , Persona de Mediana Edad , Evaluación de Programas y Proyectos de Salud , Curriculum , Percepción , Pandemias/prevención & control , AutoeficaciaRESUMEN
O Programa Saúde na Escola (PSE) e a Pesquisa Nacional de Saúde do Escolar (PeNSE) merecem destaque entre as ações de promoção e monitoramento da saúde de estudantes brasileiros. Nesse contexto, a promoção da atividade física em escolas integra as ações do PSE, além de ser monitorada pela PeNSE. O presente estudo verificou a associação entre características do indivíduo, socioeconômicas, de ações de promoção da atividade física e da saúde na escola, incluindo a adesão escolar ao PSE, com os comportamentos ativo e sedentário de estudantes brasileiros matriculados em escolas públicas, participantes da PeNSE 2019. Trata-se de estudo com dados secundários. A amostra contou com 48.204 adolescentes, com idades entre 13 e 18 anos. As variáveis foram coletadas através de questionário. A adesão da escola ao PSE é uma das variáveis de maior centralidade da rede, com destaque para a sua medida de força (1,433); entretanto, apresentou-se pouco conectada aos indicadores de atividade física e ao comportamento sedentário dos jovens. A análise de redes mostrou que o gênero feminino participa menos das atividades físicas em aulas de Educação Física (-0,176) e em tempo livre (-0,283), assim como ter internet em casa foi a principal variável associada com o maior tempo de exposição aos comportamentos sedentários (0,225). Os resultados apontam para a importância da adesão escolar ao PSE e para a necessidade do desenvolvimento de ações efetivas de promoção da atividade física como estratégia de promoção da saúde no âmbito do PSE.
The School Health Program (SHP) and the National School Health Survey (PeNSE) deserve to be high-lighted among actions to promote and monitor the health of Brazilian students. In this context, the promo-tion of physical activity in schools represents part of the SHP actions, in addition to being monitored by the PeNSE. The present study verified the association between individual and socioeconomic characteristics, and actions to promote physical activity and health in school, including school adherence to the SHP, with the active and sedentary behaviors of Brazilian students enrolled in public schools, participants of the PeNSE 2019. This is a study with secondary data, of 48,204 adolescents, aged between 13 and 18 years. The variables were collected using a questionnaire. The school 's adherence to the SHP is one of the variables with the highest centrality in the network, with emphasis on its measure of strength (1.433); however, it was poorly connected to indicators of physical activity and sedentary behavior in young people. Network analysis showed that females participate less in physical activities in Physical Education classes (-0.176) and in free time (-0.283). In addition, having internet at home was the main variable associated with longer exposure time to sedentary behaviors (0.225). The results point to the importance of school adherence to the SHP and the need to develop effective actions to promote physical activity as a health promotion strategy within the scope of the SHP.
Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Servicios de Salud Escolar , Promoción de la Salud , Ejercicio Físico , Estilo de Vida , Actividad MotoraRESUMEN
Esta pesquisa teve como objetivo descrever as ações do Programa Saúde na Escola em 2022 no município de Pelotas, Rio Grande do Sul, segundo a perspectiva de profissionais da educação. Trata-se de um estudo transversal, contemplando 51 das 60 escolas de Ensino Fundamental de nível municipal. Foram utilizados dois questionários estruturados administrados aos responsáveis pelo Programa ou membros da equipe gestora das instituições por meio telefônico, ou presencial. Os temas abordados com diretores, vice-diretores, orientadores educacionais e coordenadores pedagógicos incluíram a existência do Programa, as temáticas desenvolvidas, sua frequência, capacitação, envolvimento de profissionais de saúde e educação, articulação entre setores, apoio, autonomia de estudantes e barreiras para implementação do programa. Entre as 51 escolas analisadas, 41 (80,5%) delas possuíam o programa, com frequência das ações prevalentes a cada 3 meses (39,0%) e sendo a ação de Promoção da saúde bucal (90,2%) a mais apontada. Em 70,7% das escolas foram realizadas ações de promoção de atividade física. Além disso, observou-se o setor saúde como principal responsável pelas ações (87,8%), limitada participação dos alunos na escolha das temáticas (34,0%) e escassez de capacitações aos educadores (36,6%). Embora uma instituição universitária tenha se apresentado como fonte de apoio (53,7%) e todas as escolas com o programa registraram ao menos uma ação realizada, a sobrecarga (36,6%) e a necessidade de articulação (34,1%) foram as barreiras mais relatadas. Apesar dos desafios e dificuldades em diversos indicadores, foram identificadas iniciativas que configuram o Programa como importante ferramenta para promoção da saúde de escolares no município.
This research aimed to describe the actions of the School Health Program in 2022 in the municipality of Pe-lotas, Rio Grande do Sul, Brazil, from the perspective of education professionals. This is a cross-sectional, as-sessing 51 of the 60 municipal elementary schools. Two structured questionnaires were administered to those responsible for the Program or members of the management team of the institutions by telephone or face-to-face. Topics addressed with principals, vice-principals, educational advisors and pedagogical coordinators included the description of the existence of the Program, the themes developed, as well as its frequency, train-ing, involvement of health and education professionals, articulation between sectors, support, autonomy of students and barriers to the implementation of the program. Among the 51 schools analyzed, 41 (80.5%) of them had the program, with the frequency of prevalent actions every 3 months (39.0%) and the Oral Health Promotion action (90.2%) being the most pointed out. In 70.7% of the schools, actions to promote physical activity were carried out. In addition, the health sector was the main responsible for the actions (87.8%), limited participation in the choice of themes (34.0%) and scarcity in the provision of training for educa-tors (36.6%). Although a local university was a strong support (53.7%) and all schools with the program recorded at least one action taken, overload (36.6%) and the need for articulation (34.1%) were the most reported barriers. Despite the challenges and difficulties in several indicators, initiatives were identified that configure the Program as an important tool for promoting the health of schoolchildren in the municipality.
Asunto(s)
Humanos , Masculino , Femenino , Servicios de Salud Escolar , Instituciones Académicas , Política de SaludRESUMEN
INTRODUCTION: The prevalence of overweight and obesity in children has increased in recent years, associated with substituting plain water intake with sugar-sweetened beverages. The aim of the study was to evaluate the impact of a school-based intervention that aimed to replace sugar-sweetened beverages with water on Mexican scholars. METHODS: We included 314 children aged 9-11 from three public schools of the State of Hidalgo, Mexico, randomized to intervention (two schools from the municipality of Apan; six classes with 146 participants) or control group (one school from the municipality of Emiliano Zapata; six classes with 168 participants) and followed for 6 months. The intervention consisted of placing drinking fountains at schools and classrooms with nutritional education lessons to increase water consumption and decrease sugar-sweetened beverages. Mixed models for repeated measures were used to assess the impact of the intervention. RESULTS: At the end of the study, water consumption was higher (200 mL/day, p = 0.005), and flavored milk consumption was lower (94 mL/day, p = 0.044) in the intervention group compared with the control group. There was also a statistically significant reduction in energy (p = 0.016) and sugar intake (p = 0.007). CONCLUSIONS: The school-based intervention favorably modified the consumption pattern of sugar-sweetened beverages and water in Mexican students.
Asunto(s)
Instituciones Académicas , Bebidas Azucaradas , Humanos , México , Niño , Masculino , Femenino , Ingestión de Líquidos , Servicios de Salud Escolar , Obesidad Infantil/prevención & control , Obesidad Infantil/epidemiología , Agua Potable , BebidasRESUMEN
INTRODUÇÃO: O consumo de substâncias psicoativas durante a adolescência é um importante problema de saúde pública em todo mundo, devido as suas graves consequências, assim como pela imensa vulnerabilidade desta fase para iniciar esse comportamento. Por isso, não pode ser encarado de forma reducionista ou simplista, pois é um fenômeno social multifacetado, que envolve a complexidade do ser humano e suas relações. OBJETIVOS ESPECÍFICOS: Caracterizar os determinantes sociais da saúde dos adolescentes escolares do município do Rio de Janeiro; Comparar as desigualdades entre os determinantes sociais de escolas públicas e privadas; Conhecer os determinantes sociais do consumo atual do álcool, tabaco e drogas ilícitas por adolescentes escolares. OBJETIVO GERAL: Analisar o uso de substâncias psicoativas por adolescentes escolares do município do Rio de Janeiro, na perspectiva dos Determinantes Sociais da Saúde segundo o modelo de Solar e Irwin (OMS, 2011). Método: Tratou-se de um estudo transversal que fez uso dos dados da Pesquisa Nacional de Saúde do Escolar (PeNSE) 2019 referentes ao município do Rio de Janeiro, realizado com adolescentes escolares de 13 a 17 anos de idade, cujo n amostral foi 3.158. Os dados foram submetidos à análise descritiva e cálculo da prevalência. A comparação entre as diferenças dos grupos estudados foi mensurada por meio do teste do qui-quadrado de Pearson, com nível de significância de 5%. As variáveis de exposição do estudo foram organizadas de acordo com o referencial teórico adotado, o modelo de Solar e Irwin (OMS, 2011), organizadas para operacionalização e análise dos dados da pesquisa, comparadas segundo a dependência administrativa da escola. As variáveis de desfecho do presente estudo foram: o consumo de álcool, tabaco e drogas ilícitas. Utilizou-se análise de regressão logística múltipla, calculando-se as OR ajustadas, com seus respectivos IC95%. RESULTADOS: Os determinantes sociais estudados apresentam diferenças significativas em relação ao tipo de escola, além de todas as substâncias estudadas terem apresentado maior prevalência nas escolas públicas. Destacou-se maior chance de consumo de álcool e tabaco por adolescentes do sexo feminino e pelos não brancos, em ambas as escolas. Outro resultado importante e que foi unanimidade nas substâncias estudadas, diz respeito a maior chance em casos de comportamento de risco, como o consumo de outras substâncias, atividade sexual e falta às aulas sem permissão dos pais, além de maior chance de consumo entre os adolescentes mais velhos. CONCLUSÃO: Os dados encontrados reforçam a importância do tipo de escola como um marcador de desigualdades sociais no município do Rio de Janeiro, assim como elevadas prevalências de consumo de substâncias pelos adolescentes escolares e a importância das políticas públicas destacarem seus olhares sobre as questões de gênero e raça no consumo das mesmas. Reforça-se a multidimensionalidade da problemática, cuja prevenção abrange diversos setores da sociedade. Esse olhar poderá contribuir para ampliar o olhar dos profissionais de saúde, especialmente ligados à atenção básica, assim como gestores e pesquisadores sobre a necessidade de abordar o fenômeno de forma abrangente.
INTRODUCTION: The consumption of psychoactive substances during adolescence is an important public health problem worldwide, due to its serious consequences, as well as the immense vulnerability of this phase to initiate this behavior, which is why it cannot be viewed in a reductionist or simplistic way, as it is a multifaceted social phenomenon, which involves the complexity of human beings and their relationships. SPECIFIC OBJECTIVES: Characterize the social determinants of health among school adolescents in the city of Rio de Janeiro; Compare inequalities between social determinants of public and private schools; Know the social determinants of the current consumption of alcohol, tobacco and illicit drugs by school adolescentes. GENERAL OBJECTIVE: To analyze the use of psychoactive substances by school adolescents in the city of Rio de Janeiro, from the perspective of Social Determinants of Health according to the Solar and Irwin model (WHO, 2011). Method: This was a cross-sectional study that used data from the National School Health Survey (PeNSE) 2019 for the city of Rio de Janeiro, carried out with school adolescents aged 13 to 17 years old, whose sample size was 3,158. The data were subjected to descriptive analysis and prevalence calculation, the comparison between the differences between the studied groups was measured by using Pearson's chi-square test, with a significant level of 5%. The study's exposure variables were organized according to the adopted theoretical framework, the Solar and Irwin model (WHO, 2011), organized for operationalization and analysis of research data, according to the administrative dependency of the school. The outcome variables of the present study were: consumption of alcohol, tobacco and illicit drugs. Multiple logistic regression analysis was used, calculating the adjusted ORs, with their respective 95% CI. RESULTS: The social determinants studied present significant differences in relation to the type of school, in addition to all the substances studied having a higher prevalence in public schools. A greater chance of alcohol and tobacco consumption was highlighted by female adolescents and non-whites, in both schools, another important result, which was unanimous in the substances studied, concerns the greater chance in cases of risk behavior, such as consumption of other substances, sexual activity and missing classes without parental permission, in addition to a greater chance of consumption among older adolescents. CONCLUSION: The data found reinforces the importance of the type of school as a marker of social inequalities in the city of Rio de Janeiro, as well as the high prevalence of substance use by school adolescents and the importance of public policies highlighting gender issues and race in their consumption. The multidimensionality of the problem is reinforced, and that its prevention covers different sectors of society. This view may contribute to broadening the perspective of health professionals, especially those linked to primary care, as well as managers and researchers on the need to address the phenomenon in a comprehensive manner.
Asunto(s)
Servicios de Salud Escolar , Adolescente , Trastornos Relacionados con Sustancias , Determinantes Sociales de la Salud , Factores Sociológicos , PsicotrópicosRESUMEN
Shorter sleep duration can negatively impact children's daytime functioning and health. Latino children living near urban areas in the Mainland U.S. and Island Puerto Rico (PR) can be exposed to urban poverty and sociocultural stressors that challenge optimal sleep outcomes. Interventions to improve urban Latino children's sleep health should consider families' cultural background and environmental context to enhance acceptability and feasibility. This work describes our stepwise, multimethod approach to adapting a culturally and contextually tailored "School Intervention to Enhance Latino Students' Time Asleep (SIESTA)" for sixth- to eighth-grade Latino children residing in Greater Providence and San Juan and findings from a pilot randomized control trial (RCT) demonstrating SIESTA's efficacy. Results indicated high acceptability and greater improvement of sleep duration and behaviors in SIESTA versus control participants. The SIESTA shows potential to improve sleep outcomes in urban Latino middle schoolers. Results will inform a large-scale RCT to evaluate SIESTA's effectiveness and barriers to implementation.
Asunto(s)
Hispánicos o Latinos , Higiene del Sueño , Adolescente , Niño , Femenino , Humanos , Masculino , Hispánicos o Latinos/estadística & datos numéricos , Proyectos Piloto , Puerto Rico , Servicios de Salud Escolar , Sueño , Población Urbana , Rhode IslandRESUMEN
Large-scale, evidence-based interventions face challenges to program fidelity of implementation. We developed implementation strategies to support teachers implementing an evidence-based HIV prevention program in schools, Focus on Youth in The Caribbean (FOYC) and Caribbean Informed Parents and Children Together (CImPACT) in The Bahamas. We examined the effects of these implementation strategies on teachers' implementation in the subsequent year after the initial implementation during the COVID-19 pandemic. Data were collected from 79 Grade 6 teachers in 24 government elementary schools. Teachers completed training workshops and a pre-implementation questionnaire to record their characteristics and perceptions that might affect their program fidelity. School coordinators and peer mentors provided teachers with monitoring, feedback, and mentoring. In Year 1, teachers on average taught 79.3% of the sessions and 80.8% of core activities; teachers in Year 2 covered 84.2% of sessions and 72.9% of the core activities. Teachers with "good" or "excellent" school coordinators in the second year taught significantly more sessions on average (7.8 vs. 7.0, t = 2.04, P < 0.05) and more core activities (26.3 vs. 23.0, t = 2.41, P < 0.05) than teachers with "satisfactory" coordinators. Teachers who had a "good" or "satisfactory" mentor taught more sessions than teachers who did not have a mentor (7.9 vs. 7.3; t = 2.22; P = 0.03). Two-level mixed-effects model analysis indicated that teachers' program fidelity in Year 1, confidence in the execution of core activities, and school coordinators' performance were significantly associated with Year 2 implementation dose. Implementation of FOYC + CImPACT was significantly associated with improved student outcomes. Teachers maintained high fidelity to a comprehensive HIV prevention program over 2 years during the COVID-19 pandemic. Future program implementers should consider additional implementation support to improve the implementation of school-based programs.
Asunto(s)
COVID-19 , Infecciones por VIH , Servicios de Salud Escolar , Humanos , Infecciones por VIH/prevención & control , COVID-19/prevención & control , Servicios de Salud Escolar/organización & administración , Femenino , Masculino , SARS-CoV-2 , Bahamas , Niño , Evaluación de Programas y Proyectos de Salud , Maestros , Región del Caribe , Adolescente , AdultoRESUMEN
A reforma do ensino médio tem como proposta a Base Nacional Comum Curricular que orienta a elaboração dos Currículos de cada Estado, e assim foi concebido o Currículo Referência de Minas Gerais. O foco deste estudo está na parte flexível do Novo Ensino Médio, que são os Itinerários Formativos, em específico o Itinerário Formativo Saúde Integral (IFSI). Por meio da ferramenta da árvore de problemas, identificou-se como situação-problema o desconhecimento do processo de implementação do IFSI nas escolas estaduais de Minas Gerais (MG). Assim o objetivo geral deste estudo foi identificar os facilitadores e barreiras da implementação do IFSI do novo Ensino Médio em escolas estaduais de Minas Gerais e como objetivo específico: compreender a percepção dos professores em relação à implementação do IFSI nas escolas estaduais de ensino médio. Empregou-se método qualitativo baseado na abordagem fenomenológica. Os participantes são 16 professores da rede pública estadual que desenvolveram o IFSI no período de fevereiro a dezembro de 2023. Os dados foram coletados, por meio de entrevista semiestruturada, de forma remota, com os professores no período de setembro a dezembro de 2023. As entrevistas foram guiadas por roteiro orientador, buscou-se conhecer a concepção dos professores sobre conceitos relacionados a saúde, promoção da saúde, políticas de saúde e educação, articulação dos conteúdos da saúde no currículo, e estratégias de ensino aprendizagem. Quando se identificou a saturação dos dados a realização das entrevistas se encerrou. As entrevistas foram gravadas, transcritas e analisadas pela análise de conteúdo de Graneheim e Lundman. Do processo de análise, emergiram 8 categorias, que foram condensadas em 3 temas. O tema "Aprender para ensinar a saúde" com as categorias: "O que os professores compreendem sobre saúde?" e "Ensinando o SUS"; o tema "Caminhos e táticas para a construção da colaboração intersetorial" com as categorias: "Parcerias da escola com outros equipamentos sociais, setores e voluntários", e "PSE"; e o tema "Saúde integral no currículo: construção, estratégias, análise crítica, fortalezas e dificultadores" composto das categorias "IFSI", "Saúde como tema transversal na educação", "Metodologia de ensino aprendizagem no contexto do IFSI", e "Facilitadores e barreiras". A integração dos conteúdos de saúde no currículo escolar, quando bem estruturada e apoiada por recursos adequados, tem o potencial de desenvolver uma educação integral e significativa. As percepções dos professores indicam que, com ajustes e melhorias, o IFSI pode ser uma ferramenta relevante para a consolidação da promoção da saúde na escola, contribuindo para a formação de cidadãos ativos e engajados. Como produto Técnico desta dissertação foi desenvolvida a proposta de um curso intitulado "Promoção da Saúde na Escola" que visa capacitar profissionais da educação e da saúde na implementação de estratégias de promoção da saúde no ambiente escolar. Apresenta carga horária de 20 horas e ficará disponível na Plataforma da Escola de Formação e Desenvolvimento Profissional de Educadores da Secretaria de Estado de Educação de Minas Gerais.
Health promotion at school: a qualitative study on the implementation of the integral health training itinerary in state schools in Minas Gerais The high school reform proposes the National Common Curricular Base which guides the development of each state's curriculum, thus the Reference Curriculum of Minas Gerais was conceived. This study focuses on the flexible component of the New High School, which are the Formative Itineraries, specifically the Integral Health Formative Itinerary (IFSI). Through the problem tree tool, the lack of awareness about the implementation process of IFSI in state schools in Minas Gerais (MG) was identified as the problem situation. Therefore, the general objective of this study was to identify the facilitators and barriers to implementing the Integral Health Formative Itinerary (IFSI) of the new High School curriculum in state schools in Minas Gerais. The specific objective was to understand teachers' perceptions regarding the implementation of IFSI in state high schools. A qualitative method based on the phenomenological approach was employed. The participants were 16 teachers from the state public school system who developed the Integral Health Formative Itinerary (IFSI) from February to December 2023. Data were collected through remote semi-structured interviews with the teachers from September to December 2023. The interviews followed an interview guide aimed at understanding the teachers' perspectives on concepts related to health, health promotion, health policies, and education, as well as the integration of health content into the curriculum and teaching-learning strategies. Data saturation was reached, determining the conclusion of the interviews. The interviews were recorded, transcribed, and analyzed using Graneheim and Lundman's content analysis method. From the analysis process, 8 categories emerged, which were condensed into 3 themes. The theme "Learning to teach health" included the categories "What teachers understand about health?" and "Teaching the Unified Health System (SUS)"; the theme "Paths and tactics for building intersectoral collaboration" included the categories "School partnerships with other social services, sectors, and volunteers" and "School Health Program (PSE)"; and the theme "Integral health in the curriculum: construction, strategies, critical analysis, strengths, and challenges" comprised the categories "IFSI", "Health as a cross-cutting theme in education", "Teaching-learning methodology in the context of IFSI", and "Facilitators and barriers". The integration of health content into the school curriculum, when well-structured and supported by adequate resources, has the potential to foster comprehensive and meaningful education. Teachers' perceptions indicate that, with adjustments and improvements, IFSI can be a relevant tool for consolidating health promotion in schools, contributing to the development of active and engaged citizens. As a technical product of this master thesis, a course proposal titled "Health Promotion in Schools" was developed. The course aims to train education and health professionals in implementing health promotion strategies in the school environment. It consists of 20 hours of instruction and will be available on the Escola de Formação e Desenvolvimento Profissional de Educadores Platform of the Secretaria de Estado de Educação de Minas Gerais.