A oferta de práticas integrativas e complementares cresce na crise: uma abordagem de ciência de dados / The delivery of integrative and complementary practices grows in times of crisis: a data science approach

Utilizando dados do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ) observamos, com uma análise descritiva, que a oferta de Práticas Integrativas e Complementares (PICs) na Atenção Básica do Sistema Único de Saúde, pelas Equipes de Saúde da Família (eSF) cresceu continuamente entre 2012 e 2018, período marcado por crise econômica e política. Por outro lado, o crescimento da oferta de PICs não foi uniforme entre as regiões do país, sendo menor nas regiões Centro-Oeste e Norte. Observamos que a oferta de PICs está associada à região, ao porte municipal e ao IDH municipal. Observamos também que a oferta de PICs é maior quando há Núcleo de Apoio à Saúde da Família estruturado no município, quando as eSF participam do Programa Academia da Saúde e quando o gestor da saúde não é formado em medicina. Receber apoio do gestor municipal de saúde, receber ações de educação permanente e realizar planejamento das suas ações também está associado à oferta de PICs pelas eSF. Além disso, utilizando uma estrutura de análise causal baseada no uso de gráficos acíclicos direcionados e análise de sensibilidade, concluímos que a formação do gestor influencia diretamente a oferta de PICs, privilegiando gestores formados em odontologia e psicologia. Utilizando uma abordagem de aprendizagem de máquina, identificamos modelos capazes de prever a oferta de PICs (área sob a curva ROC variando entre 0,70 e 0,88) pelas eSF. Estes modelos mostraram que, dentre outras características, o tamanho populacional, o IDH municipal e a distribuição de renda são relevantes em prever a expansão da oferta de PICs.

Using data from the National Program for Improving Access and Quality of Primary Care (PMAQ), we observed, through descriptive analysis, that the provision of Integrative and Complementary Practices (ICPs) in the Basic Care of the Unified Health System, by Family Health Teams (FHTs), grew continuously between 2012 and 2018, a period marked by economic and political crisis. On the other hand, the growth in the provision of ICPs was not uniform across the country's regions, being lower in the Central-West and Northern regions. We observed that the provision of ICPs is associated with the region, municipal size, and municipal Human Development Index (HDI). We also noted that the provision of ICPs is higher when there is a structured Family Health Support Center in the municipality, when FHTs participate in the Health Academy Program, and when the health manager is not a medical professional. Receiving support from the municipal health manager, undergoing continuous education actions, and planning their actions are also associated with the provision of ICPs by FHTs. Additionally, using a causal analysis framework based on directed acyclic graphs and sensitivity analysis, we concluded that the managers education directly influences ICP provision, favoring managers with backgrounds in dentistry and psychology. Using a machine learning approach, we identified models capable of predicting the provision of ICPs (area under the ROC curve ranging between 0.70 and 0.88) by FHTs. These models showed that, among other characteristics, population size, municipal HDI, and income distribution are relevant in predicting the expansion of ICP provision.

Body fat equations and electrical bioimpedance values in prediction of cardiovascular risk factors in eutrophic and overweight adolescents.

The aim of this study was to analyze body fat anthropometric equations and electrical bioimpedance analysis (BIA) in the prediction of cardiovascular risk factors in eutrophic and overweight adolescents. 210 adolescents were divided into eutrophic group (G1) and overweight group (G2). The percentage of body fat (% BF) was estimated using 10 body fat anthropometric equations and 2 BIA. We measured lipid profiles, uric acid, insulin, fasting glucose, homeostasis model assessment-insulin resistance (HOMA-IR), and blood pressure. We found that 76.7% of the adolescents exhibited inadequacy of at least one biochemical parameter or clinical cardiovascular risk. Higher values of triglycerides (TG) (P = 0.001), insulin, and HOMA-IR (P < 0.001) were observed in the G2 adolescents. In multivariate linear regression analysis, the % BF from equation (5) was associated with TG, diastolic blood pressure, and insulin in G1. Among the G2 adolescents, the % BF estimated by (5) and (9) was associated with LDL, TG, insulin, and the HOMA-IR. Body fat anthropometric equations were associated with cardiovascular risk factors and should be used to assess the nutritional status of adolescents. In this study, equation (5) was associated with a higher number of cardiovascular risk factors independent of the nutritional status of adolescents.