Weight stigma and disordered eating behaviors during the COVID-19 pandemic: the mediating role of weight gain concern and psychological distress.

OBJECTIVES: The purpose of this study is to investigate whether the relationship between weight stigma experiences and disordered eating behaviors during the COVID-19 pandemic is mediated by weight gain concern and psychological distress among university students with and without overweight. METHODS: A cross-sectional study was conducted with university students from five regions of Brazil who participated in the baseline assessment of the Online Cohort on Eating Behavior and Health (July/August 2020). Information on the frequency of binge eating episodes, food restriction, and purging, as well as experienced weight stigma, weight gain concern, and psychological distress, were recorded in an online questionnaire. Stratified structural equation modeling (SEM) analyses were performed to address the research questions of interest. RESULTS: Out of the total sample (n = 2511), 33.5% of participants reported experiencing weight stigma. The prevalence of binge eating episodes, food restriction, and purging was 43.7%, 24.1%, and 5.4%, respectively. These behaviors were more prevalent in individuals with overweight than in those without this condition. Furthermore, it was observed that weight gain concern and psychological distress mediated the relationship between weight stigma and disordered eating behaviors regardless of body weight status. CONCLUSIONS: Experiences of weight stigma and disordered eating behaviors were prevalent among Brazilian university students, especially among those with overweight. Weight gain concern and psychological distress appear to be important factors underlying the relationship between these constructs during the pandemic, and they can contribute to the development of targeted strategies for the prevention and management of disordered eating. LEVEL OF EVIDENCE: Level V, cross-sectional study.

Permanent health education in the context of obesity: a scoping review

ABSTRACT OBJETIVE To map the international literature on Permanent Health Education initiatives to care for people with obesity. METHODS In total, six databases were searched without any language or publication period restriction according to the Joana Briggs Institute manual for evidence synthesis and the Prisma extension for scoping reviews (Prisma-ScR). Articles were independently analyzed by four reviewers and data, by two authors, which were then analyzed and discussed with our research team. RESULTS After screening 8,780 titles/abstracts and 26 full texts, 10studies met our eligibility criteria. We extracted data on methodologies, themes, definitions of obesity, outcomes, and gaps. Most initiatives came from North American countries without free or universal health systems and lasted a short period of time (70%), had multidisciplinary teams (70%), and addressed sub-themes on obesity approaches (90%). Results included changes in participants' understanding, attitude, and procedures (80%) and gaps which pointed to the sustainability of these changes (80%). CONCLUSION This review shows the scarce research in the area and a general design of poorly effective initiatives, with traditional teaching methodologies based on information transmission techniques, the understanding of obesity as a disease and a public health problem, punctual actions, disciplinary fragmentation alien to the daily work centrality, and failure to recognize problems and territory as knowledge triggers and to focus on health care networks, line of care, the integrality of care, and food and body cultures.

Uma análise das representações sociais da obesidade por profissionais de saúde na atenção primária à saúde / An analysis of social representations of obesity by health professionals in primary health care

Introdução: A compreensão do que seja obesidade vai influenciar a maneira como estruturamos as políticas públicas, o processo formativo dos profissionais de saúde e, principalmente, as práticas de cuidado. Objetivo: Analisar as representações sociais sobre obesidade para profissionais de saúde da Atenção Primária do estado da Bahia, Brasil. Método: Esta comunicação breve refere-se a uma pesquisa qualitativa, ancorada na Teoria das Representações Sociais, desenvolvida no contexto de um curso sobre a qualificação do cuidado às pessoas com sobrepeso e obesidade. Para a produção dos dados, utilizaram-se um questionário semiestruturado on-line e a Técnica de Associação Livre de Palavras, a partir do estímulo "Escreva as três primeiras palavras que vêm a sua mente quando você pensa em obesidade". A análise prototípica foi realizada com a ajuda do software OpenEvoc. Resultados: Os resultados indicam que o núcleo central das representações sociais sobre obesidade foi formado pelos elementos doença, alimentação, sobrepeso e gordura, enquanto os vocábulos saúde mental, qualidade de vida, atividade física, estigma, saúde e multifatorialidade compõem o sistema periférico. Revelaram que há predominância da perspectiva patológica e individualizada, em que pesem a ampliação do conhecimento científico moderno e das orientações institucionais sobre a obesidade; a assunção dos fatores psicoemocionais no desenvolvimento da obesidade; assim como a incipiência da abordagem multifatorial, ecológica e/ou sindêmica da obesidade. Conclusão: Este estudo sugere que pesquisas aprofundem o estudo de tais representações sociais, suas motivações no campo formativo, laboral e social, bem como a análise do que consolida e provoca as novas narrativas anunciadas.

Introduction: The understanding of whatobesity is will influence the way we structure public policies, the training process of health professionals, and, mainly, care practices. Objective: To analyze the social representations of obesity among Primary Health Care professionals in the state of Bahia, Brazil. Method: This brief communication refers to qualitative research, anchored in the Theory of Social Representations, developed in the context of a course on the qualification of care for people with overweight and obesity. For data production, we used an online semi-structured questionnaire and the Free Word Association Technique, based on the stimulus "Write the first three words that come to your mind when you think about obesity". The prototypical analysis was carried out with the assistance of the OpenEvoc software. Results: The results indicate that the central core of social representations about obesity was formed by the elements disease, food, overweight and fat, while the words mental health, quality of life, physical activity, stigma, health, and multifactorial constitute the peripheral system. They revealed that the pathological and individualized perspective is predominant, despite the enhancement of modern scientific knowledge and institutional guidelines on obesity; the assumption of psycho-emotional factors in the development of obesity; as well as the incipience of the multifactorial, ecological, and/or syndemic approach to obesity. Conclusion: This study suggests that research deepens the study of such social representations, and their motivations in the educational, labor, and social field, like the analysis of what consolidates and provokes the newly announced narratives.

[Institutional support in Primary Health Care in Brazil: an integrative review]. / Apoio institucional na Atenção Primária em Saúde no Brasil: uma revisão integrativa.

One of the great challenges of the Unified Health System is the need to transcend the disciplinary and controlling character of management and foster the democratic function, to enable greater participation of workers and the community in health management. In order to identify and synthesize institutional support definitions and practices implemented within the scope of Primary Health Care in Brazil, according to the Paidéia method, which advocates institutional democratization and the qualification of service to the population through new management arrangements and devices and the work process, an integrative literature review was carried out for the period from 2005 to 2019. The corpus of analysis included 24 publications that made incipient definitions and operational aspects explicit, weaknesses in the integration between the scope of the expanded clinic and the shared management that should assist in the dialectic between Institutional Support and Matrix Support, there should be the need to strengthen the role of institutional supporter, as a methodological mediator and to reformulate the management and strategy mechanisms for permanent health education within the scope of the Unified Health System.

Um dos grandes desafios do Sistema Único de Saúde é a necessidade de transcender o caráter disciplinador e controlador da gestão e fomentar a função democrática, para possibilitar uma maior participação de trabalhadores e comunidade na gestão em saúde. Com o intuito de identificar e sintetizar definições e práticas de apoio institucional implementadas no âmbito da Atenção Primária à Saúde no Brasil, de acordo com o método Paidéia, que preconiza democratização institucional e a qualificação do atendimento à população através de novos arranjos e dispositivos de gestão e do processo trabalho, foi desenvolvida uma revisão integrativa da literatura referente ao período de 2005 a 2019. O corpus de análise contemplou 24 publicações que explicitaram definições e aspectos operacionais incipientes, fragilidades na integração entre o âmbito da clínica ampliada e da gestão compartilhada que deveria se dar na dialética entre o Apoio Institucional e o Apoio Matricial, a necessidade de fortalecer a função do apoiador institucional, enquanto mediador metodológico e de reformular os tradicionais mecanismos de gestão e as estratégias para educação permanente em saúde no âmbito do Sistema Único de Saúde.

Apoio institucional na Atenção Primária em Saúde no Brasil: uma revisão integrativa / Institutional support in Primary Health Care in Brazil: an integrative review

Resumo Um dos grandes desafios do Sistema Único de Saúde é a necessidade de transcender o caráter disciplinador e controlador da gestão e fomentar a função democrática, para possibilitar uma maior participação de trabalhadores e comunidade na gestão em saúde. Com o intuito de identificar e sintetizar definições e práticas de apoio institucional implementadas no âmbito da Atenção Primária à Saúde no Brasil, de acordo com o método Paidéia, que preconiza democratização institucional e a qualificação do atendimento à população através de novos arranjos e dispositivos de gestão e do processo trabalho, foi desenvolvida uma revisão integrativa da literatura referente ao período de 2005 a 2019. O corpus de análise contemplou 24 publicações que explicitaram definições e aspectos operacionais incipientes, fragilidades na integração entre o âmbito da clínica ampliada e da gestão compartilhada que deveria se dar na dialética entre o Apoio Institucional e o Apoio Matricial, a necessidade de fortalecer a função do apoiador institucional, enquanto mediador metodológico e de reformular os tradicionais mecanismos de gestão e as estratégias para educação permanente em saúde no âmbito do Sistema Único de Saúde.

Abstract One of the great challenges of the Unified Health System is the need to transcend the disciplinary and controlling character of management and foster the democratic function, to enable greater participation of workers and the community in health management. In order to identify and synthesize institutional support definitions and practices implemented within the scope of Primary Health Care in Brazil, according to the Paidéia method, which advocates institutional democratization and the qualification of service to the population through new management arrangements and devices and the work process, an integrative literature review was carried out for the period from 2005 to 2019. The corpus of analysis included 24 publications that made incipient definitions and operational aspects explicit, weaknesses in the integration between the scope of the expanded clinic and the shared management that should assist in the dialectic between Institutional Support and Matrix Support, there should be the need to strengthen the role of institutional supporter, as a methodological mediator and to reformulate the management and strategy mechanisms for permanent health education within the scope of the Unified Health System.

Weight stigma in the COVID-19 pandemic: a scoping review.

BACKGROUND: Weight stigma is a phenomenon associated with adverse behavioural and psychological consequences. Although experts suggest that its increase during the COVID-19 pandemic may be associated with worse health outcomes for people with obesity, a thorough analysis of the main findings and gaps is still needed when relating to this subject. OBJECTIVE: We aim to answer three questions: (1) How does weight stigma manifest in the COVID-19 pandemic? (2) How can weight stigma affect people with overweight or obesity in times of COVID-19? (3) What are the perceptions and experiences of weight stigma during the pandemic in individuals who experience overweight or obesity? METHODS: We conducted a scoping review of studies addressing weight stigma and the COVID-19 pandemic in electronic databases (Medline/PubMed, CINAHL, Embase, PsycInfo, BVS/Lilacs, Scopus, Web of Science, Google Scholar, and OpenGrey) published until 10th August 2021. All relevant studies were reviewed in full by two researchers. In addition, a narrative synthesis of the data was performed. RESULTS: The results included 35 studies out of 8,090 records and identified 13 original research publications, 14 text and opinion papers, and 6 narrative reviews. The results revealed the presence of weight stigma in the media, healthcare settings, interpersonal relationships, and public campaigns during the COVID-19 pandemic. The evidence of increasing weight stigma in the COVID-19 outbreak is limited, though. Many weight discrimination consequences were described during this time, such as impairment in accessing healthcare, worst COVID-19 outcomes, and maladaptive eating. However, only maladaptive behaviours and decline in mental health outcomes were demonstrated empirically in all age groups. This effect occurred regardless of body mass index, but people with high body weight were more likely to experience weight stigma. For some people with obesity, weight stigma in the pandemic has made activities of daily routine difficult. CONCLUSIONS: The results suggest that weight stigma in the COVID-19 pandemic occurs in several settings; moreover, although weight discrimination impacts mental health, whether before or during the pandemic, this influence between the pandemic and pre-pandemic scenario is still unclear. Therefore, more research is required in this field while the pandemic lasts, especially with people with obesity. Overall, people with overweight or obesity are more vulnerable to weight stigma than individuals without overweight. In addition, weight stigma refers to discrimination or prejudice based on a person's weight and relates to several consequences, for instance, poor healthcare treatment and mental health problems. In the COVID-19 outbreak, these weight stigma effects tend to become even more critical because they may be associated with unfavourable COVID-19 outcomes and eating disorder risks. Thus, it is crucial to investigate how weight stigma occurs during the pandemic and its impact on health, mainly for the most affected people. We investigated 35 studies published between 2019 and 2021 to map and explore how weight stigma was manifested and the related consequences for people with overweight or obesity in the COVID-19 pandemic. Only about a third of them were quantitative or qualitative, limiting the evidence of weight stigma in the COVID-19 context. The available evidence suggests that weight stigma manifests in several settings such as media, healthcare, public campaigns, and is more common in people with excess weight. However, weight discrimination experiences before or during the pandemic were associated with adverse psychological and behavioural consequences across all age groups, regardless of body weight. For some people with obesity, for instance, weight stigma made it difficult to accomplish their activities of daily routine. Nevertheless, it remains unclear whether weight stigma has increased in the pandemic, thus, more studies are required, especially about people with overweight or obesity.

Entre orientações e normatizações: cartilhas brasileiras sobre alimentação e nutrição no contexto da pandemia de covid-19 / Between guidelines and standards: brazilian booklets on food and nutrition in the context of the covid-19 pandemic

Resumo A pandemia provocada pelo novo coronavírus tem causado impactos nas interações sociais e nos hábitos de vida, incluindo mudanças no contexto da alimentação. Com o intuito de promover educação em saúde, diversas cartilhas sobre alimentação e nutrição foram elaboradas para a população. Este estudo, de abordagem qualitativa, realizou uma análise reflexiva de quatro cartilhas sobre alimentação e nutrição disponibilizadas durante a pandemia de covid-19, por meio da análise de conteúdo, e identificou três eixos temáticos: (1) planejamento das refeições; (2) higienização das compras e alimentos; e (3) alimentação saudável e escolha dos alimentos. As cartilhas analisadas orientam sobre aspectos práticos da alimentação e nutrição nesse período de incertezas em relação à saúde. Contudo, observou-se uma lacuna na abordagem de temas englobando a saúde integral do indivíduo como: segurança alimentar e aspectos culturais, simbólicos e macrossociais relacionados às escolhas alimentares.

Abstract The pandemic caused by the new coronavirus has impacted social interactions and lifestyle habits, including changes in the context of food. To promote health education, several food and nutrition guides were developed for the population. This study, of qualitative approach, carried out a reflexive analysis of four food and nutrition guides made during the pandemic, by content analysis, and identified three thematic axes: (1) meal planning; (2) cleaning of purchases and food; and (3) healthy eating food choice. The analyzed guides provide guidance on practical aspects of food and nutrition in this period of uncertainty regarding health protection. However, the approach to themes encompassing the individual's integral health such as: food security and cultural, symbolic, and macrosocial aspects related to food choices, showed a gap.

Atuação de profissionais de saúde e qualidade das ações no controle de câncer cervicouterino: um estudo transversal / Tiempo de trabajo de profesionales y calidad de las acciones de control del cáncer cérvicouterino: un estudio transversal / Professionals' practice and quality of actions to control cervical cancer: a cross-sectional study

Resumo Objetivo avaliar o tempo de atuação de médicos e enfermeiros na Atenção Primária à Saúde (APS) e qualidade das ações desenvolvidas para controle do câncer cervicouterino (CC). Métodos estudo transversal, conduzido de janeiro a março de 2019 em região de saúde compreendida em 19 municípios localizada no estado da Bahia, Brasil. A amostra foi de 241 médicos e enfermeiros da APS. Utilizou-se a linha de cuidado do CC como condição traçadora. Elegeram-se o desfecho tempo de atuação na APS no mesmo município, categorizado em < 2 anos e ≥ 2 anos, e indicadores representativos da qualidade da APS. Os testes χ2 de Pearson e exato de Fisher foram empregados. Resultados a prevalência de tempo de atuação na APS foi 43,57% (IC95%: 37,40%; 49,94%) para < 2 anos e 56,43% (IC95%: 50,06%; 62,60%) para ≥ 2 anos. Observaram-se maiores prevalências, com diferença estatística significativa, dos indicadores de qualidade para o maior tempo de atuação. Conclusões e implicações para a prática a rotatividade profissional parece afetar o cuidado longitudinal de mulheres na linha de cuidado eleita. Sugere-se a ampliação do número e do papel dos enfermeiros, especialmente nos serviços de APS, para maior resolutividade e eficiência do sistema de saúde.

Resumen Objetivo evaluar el tiempo de actuación de médicos y enfermeros en la Atención Primaria de Salud (APS) y la calidad de las acciones desarrolladas para el control del cáncer cérvicouterino (CC). Métodos estudio transversal realizado de enero a marzo de 2019, en una región sanitaria que comprende 19 municipios en el estado de Bahía, Brasil. La muestra fue de 241 médicos y enfermeros de APS. La línea de cuidados de CC fue la condición trazadora. Se eligió el resultado tiempo trabajando en APS en el mismo municipio, categorizado en < 2 años y ≥ 2 años e indicadores representativos de calidad de APS. Se utilizaron pruebas exactas de chi-cuadrado de Pearson y Fisher. Resultados la prevalencia del tiempo de actuación en APS fue del 43,57% (IC95%: 37,40%; 49,94%) para < 2 años y del 56,43% (IC95%: 50,06%; 62,60%) para ≥ 2 años, considerado incipiente. Se observó una mayor prevalencia, con diferencia estadísticamente significativa, de los indicadores de calidad para un mayor tiempo de actuación. Conclusiones e implicaciones para la práctica la rotación de profesionales parece afectar la atención longitudinal de las mujeres en la línea de cuidado elegida. Se sugiere la ampliación del número y el papel de enfermería, especialmente en los servicios de APS, para una mayor resolutividad y eficiencia del sistema sanitario.

Abstract Objective to assess the working length of physicians and nurses in Primary Health Care (PHC) and the quality of actions taken to control cervical cancer (CC). Methods this is a cross-sectional study, conducted from January to March 2019, in a health region comprised of 19 municipalities located in the state of Bahia, Brazil. The sample consisted of 241 PHC physicians and nurses. The CC care line was used as a tracer condition. The outcome experience length in PHC in the same municipality was chosen, categorized as < 2 years and ≥ 2 years and representative indicators of PHC quality. Pearson's χ2 and Fisher's exact tests were used. Results the prevalence of length of experience in PHC was 43.57% (95%CI: 37.40%; 49.94%) for < 2 years, and 56.43% (95%CI: 50.06%; 62.60%) for ≥ 2 years. There was a higher prevalence, with a statistically significant difference, of the quality indicators for the longest working length. Conclusions and implications for practice professional turnover seems to affect the longitudinal care of women in the chosen care line. It is suggested to expand the number and role of nurses, especially in PHC services, for greater resolution and efficiency of the health system.

A voz da comunidade no enfrentamento da Covid-19: proposições para redução das iniquidades em saúde / The voice of the community in confronting Covid-19: proposals for reducing health inequities

RESUMO Este artigo se propõe a discutir o papel do engajamento comunitário, a ação dos movimentos sociais e da sociedade civil para o enfrentamento de emergências em saúde. As questões norteadoras que balizaram a construção deste artigo foram: qual é o papel do engajamento comunitário no enfrentamento da Covid-19? O que o engajamento comunitário pode oferecer frente aos eventos de emergências globais em saúde? Quais ações têm sido desenvolvidas pela sociedade civil? Trata-se de um ensaio teórico, construído a partir da articulação de ideias da literatura científica e de documentos técnico-operacionais sobre engajamento e governança comunitária e a crise sanitária decorrente da Covid-19. Constata-se que, nos contextos internacional e nacional, a governança comunitária subsidiada pelo fortalecimento de canais de comunicação fomentados por instituições e/ou influenciadores sociais pode contribuir para ampliação do engajamento de coletivos organizados como retórica e prática ético-política comprometida com a cidadania. No cenário brasileiro, observa-se que o mecanismo necropolítico que tem operado as políticas de enfrentamento da Covid-19, no âmbito do governo federal, contrapõe as ações e a capacidade de resposta das populações. Ainda assim, as ações dos movimentos sociais têm mobilizado esforços para mitigar iniquidades e proteger os mais vulneráveis, mesmo na ausência de uma liderança sanitária nacional.

ABSTRACT This article aims to discuss the role of community engagement, the action of social movements and civil society to face health emergencies. The guiding questions that guided the construction of this article were: what is the role of community engagement in confronting Covid-19? What can community engagement offer in the face of global health emergency events? What actions have been taken by civil society? This is a theoretical essay, built from the articulation of ideas from scientific literature and technical-operational documents on community engagement and governance and the health crisis arising from Covid-19. It appears that, in the international and national context, community governance subsidized by the strengthening of communication channels fostered by institutions and/or social influencers can contribute to expanding the engagement of organized collectives as rhetoric and ethical-political practice committed to citizenship. In the Brazilian scenario, it is observed that the necropolitical mechanism that has operated Covid-19's coping policies, within the federal government, opposes the actions and response capacity of the populations. Still, the actions of social movements have mobilized efforts to mitigate inequities and protect the most vulnerable, even in the absence of national health leadership.

Quality of Actions to Control Cervical Cancer in Bahia, Brazil.

OBJECTIVE: To assess the quality of the actions to control cervical cancer (CC) and its correlates. METHODS: This is a cross-sectional study conducted from January to March 2019 in 19 municipalities in Bahia, Brazil, with a sample of 241 doctors and nurses from primary health care (PHC). Three dependent variables were chosen- "Performance of educational, promotion, prevention, and monitoring actions" (D1); "Access to diagnostic tests" (D2); "Non-occurrence of high grade cervical squamous intraepithelial lesions (HSIL)" (D3). Poisson regression with robust variance was used, adopting hierarchical input variables to estimate the prevalence ratios and confidence intervals of 95%. RESULTS: The following prevalence rates were found: D1  39.8% (95% CI: 33.8-46.2); D2  73.9% (95% CI: 67.9-79.1); and D3  46.4% (95% CI: 39.9-53.0). These dimensions remained associated with the dependent variables: D1- having professional training courses on the topic; consideration to ensure that collection takes place appropriately by a professional; and women having access to medical transport; D2- nurses treating low-grade lesions; D3- recording the Papanicolaou in electronic medical records; D1 and D2- professionals joining the service through public tender; D1 and D3- working in the PHC (≥ 2 years); D2 and D3- recording Papanicolaou in physical records; and performance of Papanicolaou by residents. CONCLUSION: Better trained professionals and professionals working in stable work arrangements are associated with comprehensive actions to control CC. Such strategies indicate that investments in work management result in a more organized PHC and more solution-centered work processes. Therefore, working in the PHC for a longer time and nurses performing more clinical actions (collection and treatment) are favored by such organizational actions. Investments in diagnostic support contribute to perceptions of more comprehensive actions to control CC. 
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Public expenditure on hospitalizations for COVID-19 treatment in 2020, in Brazil.

OBJECTIVE: Describe the expenditure resulting from hospitalizations for clinical treatment of users diagnosed with COVID-19 in the Unified Health System (SUS) between February and December 2020. METHODS: This is a descriptive study based on data from the Hospital Information System about government expenditure on hospitalizations for clinical treatment of users diagnosed with COVID-19 and causes included in the ICD-10 chapters. We obtained the number of hospitalizations, average length of stay, lethality rate, and total expenditure considering hospital services, professional services and average expenditure per hospitalization. RESULTS: In the period evaluated, SUS registered 462,149 hospitalizations, 4.9% of them for COVID-19 treatment. Total expenditure exceeded R$ 2.2 billion, with 85% allocated to hospital services and 15% to professional services. Expenditure for treating COVID-19 was distributed differently between the country's regions. The Southeast region had the highest number of hospitalizations, highest total amount spent, highest average length of stay in days, and highest lethality rate; the South region, in turn, recorded the highest percentage of spending on non-profit hospitals (58%) and corporate hospitals (15%). CONCLUSIONS: Hospitalizations for clinical treatment of coronavirus infection were more costly compared to those for treatment of acute respiratory failure and pneumonia or influenza. Our results show the disparities in hospitalization expenditure for similar procedures between the regions of Brazil, underlining the vulnerability and the need for strategies to reduce the differences in access, use, and distribution of SUS resources, ensuring equanimity, and considering the unfair inequalities between the country's regions.

Monitoring of cervical cancer control actions and associated factors / Monitoreo de las acciones de control para el cáncer cervical y factores asociados / Monitoramento das ações de controle do câncer cervicouterino e fatores associados

ABSTRACT Objective: to analyze factors associated with the monitoring of actions to control cervical cancer in the Family Health Strategy, in a health region of northeastern Brazil. Method: a cross-sectional study conducted from January to March 2019 by means of interviews with 241 physicians and nurses from the Family Health Teams of the Vitória da Conquista health region, Bahia, Brazil. Adequate monitoring was assessed by the degree of actions taken to promote, prevent and actively seek to control cervical cancer. Three blocks of variables were tested as explanatory: professional characterization and training; organization of the unit and access to cytopathological exam; and care coordination and integration. Poisson regression with robust variance was employed, adopting hierarchical entry of variables. Results: 51.9% (95% CI: 45.5-58.2) of the professionals performed adequate monitoring for the control of cervical cancer. Being a nurse, working in the municipality's primary care network (≥2 years), disclosure of results collection through posters and other communication means, existence of a high-grade lesion, time to perform the biopsy ≤1 month, and agility in the release of the reports were elements associated to the outcome. Conclusion: even with the extended coverage of the Family Health Strategy, small municipalities in the Northeast have characteristics that impose obstacles to comprehensiveness, favoring the incidence of high-grade lesions and greater difficulty in the control of cervical cancer. Assessing the assistance quality in this level revealed challenges in the regionalized network.

RESUMEN Objetivo: analizar factores asociados al monitoreo de las acciones para el control del cáncer cervical en la Estrategia de Salud de la Familia, en una región de salud del noreste de Brasil. Método: estudio transversal realizado entre enero y marzo de 2019, por medio de entrevistas con 241 médicos y enfermeros de los Equipos de Salud de la Familia de la región de salud de Vitória da Conquista, Bahía, Brasil. El monitoreo adecuado se evaluó por medio del grado en el que se realizaron acciones de promoción, prevención y búsqueda activa para el control del cáncer cervical. Se probaron tres bloques de variables como explicativos: caracterización y capacitación profesional; organización de la unidad y acceso al examen citopatológico; y coordinación de la atención e integración asistencial. Se usó regresión de Poisson con varianza robusta, adoptando entrada jerárquica de variables. Resultados: 51,9% (IC 95%: 45,5-58,2) de los profesionales realizaban un monitoreo adecuado para el control del cáncer cervical. Ser enfermero, desempeñarse en el sector de atención primaria del municipio (≥2 anos), la exposición de los resultados de los exámenes a través de posters y otros medios de comunicación, la existencia de lesiones de alto grado, el tiempo para realizar la biopsia ≤1 mes, y la agilidad en la emisión de los informes fueron elementos asociados al resultado. Conclusión: incluso con extensa cobertura de la Estrategia de Salud de la Familia, los municipios pequeños del noreste acumulan características que imponen obstáculos a la integralidad, lo que favorece la incidencia de lesiones de alto grado y mayor dificultad para controlar el cáncer cervical. Evaluar la calidad de la asistencia en este nivel dejó al descubierto desafíos en la red regionalizada.

RESUMO Objetivo: analisar fatores associados ao monitoramento das ações para controle do câncer cervicouterino na Estratégia Saúde da Família, em região de saúde do Nordeste brasileiro. Método: estudo transversal realizado de janeiro a março de 2019, por meio de entrevistas com 241 médicos e enfermeiros das Equipes de Saúde da Família da região de saúde de Vitória da Conquista, Bahia, Brasil. O monitoramento adequado foi mensurado pelo grau de realização de ações de promoção, prevenção e busca ativa para controle do câncer cervicouterino. Três blocos de variáveis foram testados como explicativos: caracterização e capacitação profissional; organização da unidade e acesso ao citopatológico; e coordenação do cuidado e integração assistencial. Empregou-se a regressão de Poisson com variância robusta, adotando a entrada hierárquica de variáveis. Resultados: 51,9% (IC95%: 45,5-58,2) dos profissionais realizavam monitoramento adequado para controle do câncer cervicouterino. Ser enfermeiro, atuar na atenção primária do município (≥2 anos), divulgação da coleta por cartazes e outros veículos de comunicação, existência de lesão de alto grau, tempo de realização da biópsia ≤1 mês e agilidade na liberação dos laudos foram elementos associados ao desfecho. Conclusão: mesmo com alta cobertura da Estratégia Saúde da Família, municípios de pequeno porte do Nordeste acumulam características que conferem obstáculos à integralidade, favorecendo a incidência de lesão de alto grau e maior dificuldade de controle do câncer cervicouterino. Avaliar a qualidade da assistência nesse nível revelou desafios em rede regionalizada.

[Food insecurity in rural communities in Northeast Brazil: does belonging to a slave-descendent community make a difference?] / Insegurança alimentar em comunidades rurais no Nordeste brasileiro: faz diferença ser quilombola?

This study aimed to measure the prevalence of food insecurity in a rural area of Northeast Brazil and investigate this outcome according to residence in quilombola communities (descendants of African slaves) versus non-quilombola communities. This was a cross-sectional study in 21 rural communities, 9 of which quilombolas, in 2014, using the Brazilian Food Insecurity Scale (EBIA). Prevalence rates and prevalence ratios were estimated for food insecurity, and Poisson multiple regression analysis with robust variance was performed. Food insecurity was found in 52.1% of the families: 64.9% in quilombola communities and 42% in the others. Food insecurity was associated with belonging to a quilombola community (PR = 1.25), lower economic status (PR = 1.89; 2.98, and 3.22 for status C2, D, and E, respectively), beneficiaries of Bolsa Família program (PR = 1.52), and four or more household members (PR = 1.20). Food insecurity prevalence was high in the entire population, but it was even higher in quilombola communities, even though they belonged to the same coverage area. The results emphasize this population's vulnerability.

Insegurança alimentar em comunidades rurais no Nordeste brasileiro: faz diferença ser quilombola? / Food insecurity in rural communities in Northeast Brazil: does belonging to a slave-descendent community make a difference? / Inseguridad alimentaria en comunidades rurales en el nordeste brasileño: ¿marca la diferencia ser quilombola?

Resumo: Este artigo objetivou identificar a prevalência de insegurança alimentar em uma área rural do Nordeste do Brasil e investigar este desfecho de acordo com a residência em comunidades quilombolas e não quilombolas. Foi um estudo transversal com 21 comunidades rurais, sendo nove quilombolas, em 2014, utilizando a Escala Brasileira de Insegurança Alimentar (EBIA). Foram estimadas prevalências e razões de prevalência para insegurança alimentar, e a análise múltipla foi conduzida por regressão de Poisson com variância robusta. A situação de insegurança alimentar foi encontrada em 52,1% das famílias estudadas, sendo 64,9% entre quilombolas e 42% entre as demais. Insegurança alimentar foi associada a ser quilombola (RP = 1,25); ter nível econômico mais baixo (RP = 1,89; 2,98 e 3,22 para os níveis C2, D e E, respectivamente); ser beneficiário do Programa Bolsa Família (RP = 1,52); e ter quatro residentes ou mais no domicílio (RP = 1,20). A prevalência de insegurança alimentar foi elevada em toda a população, no entanto as comunidades quilombolas, apesar de pertencerem à mesma área de abrangência das outras comunidades, apresentaram uma prevalência ainda maior de insegurança alimentar, reforçando a vulnerabilidade dessa população.

Abstract: This study aimed to measure the prevalence of food insecurity in a rural area of Northeast Brazil and investigate this outcome according to residence in quilombola communities (descendants of African slaves) versus non-quilombola communities. This was a cross-sectional study in 21 rural communities, 9 of which quilombolas, in 2014, using the Brazilian Food Insecurity Scale (EBIA). Prevalence rates and prevalence ratios were estimated for food insecurity, and Poisson multiple regression analysis with robust variance was performed. Food insecurity was found in 52.1% of the families: 64.9% in quilombola communities and 42% in the others. Food insecurity was associated with belonging to a quilombola community (PR = 1.25), lower economic status (PR = 1.89; 2.98, and 3.22 for status C2, D, and E, respectively), beneficiaries of Bolsa Família program (PR = 1.52), and four or more household members (PR = 1.20). Food insecurity prevalence was high in the entire population, but it was even higher in quilombola communities, even though they belonged to the same coverage area. The results emphasize this population’s vulnerability.

Resumen: Este artículo tuvo como objetivo identificar la prevalencia de la inseguridad alimentaria en un área rural del Nordeste de Brasil e investigar este resultado, de acuerdo con la residencia en comunidades quilombolas y no quilombolas. Fue un estudio transversal con 21 comunidades rurales, siendo 9 quilombolas, en 2014, utilizando Escala Brasileña de Inseguridad Alimentaria (EBIA). Se estimaron prevalencias y razones de prevalencia para inseguridad alimentaria, y el análisis múltiple fue dirigido por regresión de Poisson con variancia robusta. La situación de inseguridad alimentaria se encontró en un 52,1% de las familias estudiadas, siendo un 64,9% entre quilombolas y un 42% entre las demás. Inseguridad alimentaria se asoció a ser quilombola (RP = 1,25); tener un nivel económico más bajo (RP = 1,89; 2,98 y 3,22 para los niveles C2, D y E, respectivamente); ser beneficiario del programa Beca Familia (RP = 1,52); y la existencia de 4 residentes o más en el domicilio (RP = 1,20). La prevalencia de inseguridad alimentaria se elevó en toda la población, no obstante, las comunidades quilombolas, a pesar de pertenecer a la misma área de alcance de las otras comunidades, presentaron una prevalencia incluso mayor de inseguridad alimentaria, reforzando la vulnerabilidad de esa población.

Uso de medidas autorreferidas de peso, altura e índice de massa corporal em uma população rural do nordeste brasileiro / Use of self-reported measures of height, weight and body mass index in a rural population of Northeast Brazil

OBJETIVO: Avaliar a validade do uso de dados antropométricos autorreferidos para o diagnóstico do estado nutricional em adultos de uma população rural do nordeste brasileiro. MÉTODOS: Foi realizado um inquérito de base populacional em uma amostra de 797 indivíduos com 18 anos de idade ou mais. Obteve-se a proporção de indivíduos que conheciam as medidas antropométricas. Para as análises da concordância entre os que informaram as medidas foram calculadas: diferenças entre médias, coeficiente de correlação intraclasse (CCI), estatística Kappa, sensibilidade, especificidade, valor preditivo positivo (VPP) e valor preditivo negativo (VPN). Obteve-se também os gráficos de Bland e Altman. RESULTADOS: Não sabiam relatar informações sobre peso e estatura 58,5% dos entrevistados. O peso foi a medida mais conhecida em comparação às demais. A magnitude da diferença entre as médias foi pequena para peso, altura e índice de massa corporal (IMC) (0,43 kg, 0,31cm, 0,32 kg/m2, respectivamente), evidenciado uma boa concordância intrapares e uma tendência de superestimação das medidas. Os CCI para peso, altura e IMC foram, respectivamente, 0,96; 0,60 e 0,53. A estatística Kappa indicou bom acordo para os estratos avaliados. As medidas gerais de sensibilidade, especificidade, VPP e VPN foram 84,2; 82; 90,7; e 71,3%, respectivamente. Apresentaram menor acurácia nas medidas os idosos, pessoas com escolaridade inferior a quatro anos e que não se pesam frequentemente. CONCLUSÃO: Recomenda-se o uso com cautela de medidas autorreferidas em estudos epidemiológicos em populações rurais. .

OBJECTIVE: To assess the validity of using self-reported anthropometric data for diagnosis of nutritional status of adults in a rural population of northeast Brazil. METHODS: A population-based survey was conducted on a sample of 797 individuals aged 18 years or more. The proportion of individuals who knew their anthropometric measures was calculated. For agreement analysis between those who reported their measures the following indicators were obtained: differences between averages (weight, height, body mass index), intra-class correlation coefficient (ICC), Kappa statistic, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (VPN). Bland-Altman graphics were also obtained. RESULTS: More than half of the respondents (58.5%) did not know their weight or height. Weight was the most known measure among all. The magnitude of the mean difference for weight, height and body mass index (BMI) (0.43 kg, 0.31 cm, 0.32 kg/m2, respectively) was small, indicating good agreement, with a trend toward overestimation. ICC for weight, height and BMI were 0.96; 0.60; and 0.53, respectively. Kappa statistic indicated good agreement in all strata. General measures of sensitivity, specificity, PPV and NPV were 84.2; 82; 90.7 and 71.3%, respectively. Elderly, those with low schooling and those who do not often weigh were less accurate on their measures. CONCLUSION: The use of self-reported measures should be done with caution in epidemiological studies in rural populations. .

Use of self-reported measures of height, weight and body mass index in a rural population of Northeast Brazil.

OBJECTIVE: To assess the validity of using self-reported anthropometric data for diagnosis of nutritional status of adults in a rural population of northeast Brazil. METHODS: A population-based survey was conducted on a sample of 797 individuals aged 18 years or more. The proportion of individuals who knew their anthropometric measures was calculated. For agreement analysis between those who reported their measures the following indicators were obtained: differences between averages (weight, height, body mass index), intra-class correlation coefficient (ICC), Kappa statistic, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (VPN). Bland-Altman graphics were also obtained. RESULTS: More than half of the respondents (58.5%) did not know their weight or height. Weight was the most known measure among all. The magnitude of the mean difference for weight, height and body mass index (BMI) (0.43 kg, 0.31 cm, 0.32 kg/m2, respectively) was small, indicating good agreement, with a trend toward overestimation. ICC for weight, height and BMI were 0.96; 0.60; and 0.53, respectively. Kappa statistic indicated good agreement in all strata. General measures of sensitivity, specificity, PPV and NPV were 84.2; 82; 90.7 and 71.3%, respectively. Elderly, those with low schooling and those who do not often weigh were less accurate on their measures. CONCLUSION: The use of self-reported measures should be done with caution in epidemiological studies in rural populations.

Participação social na Estratégia de Saúde da Família: análise da percepção de conselheiros de saúde / Social participation in the Family's Health Strategy: analysis of the health counselors' perceptions

O estudo objetiva analisar as percepções de conselheiros de saúde com relação à participação na Estratégia de Saúde da Família. Trata-se de uma pesquisa qualitativa, com realização de entrevistas com representantes de conselhos de Unidades de Saúde da Família. Os resultados evidenciaram que os conselhos são percebidos como instrumento da melhoria da assistência e também como espaço de promoção da saúde. Evidenciou-se existir um sentimento de desinteresse das comunidades pelas práticas participativas. Alguns fatores contribuem para o pouco envolvimento da população, a exemplo das debilidades assistenciais e da percepção da esterilidade do conselho na resolução dos problemas comunitários.

This study aims to analyze the health counselors' perceptions with regard to the participation in Family's Health Strategy. This is a qualitative research, with the realization of interviews with the counselors representatives of the Family's Health Units. The results have evidenced that councils are noticed as a tool for the improvement of the assistance and also as a place for health promotion. It has become clear the existence of a community's lack of interest for the participative practices. Some factors contribute to the few engagement of the population, following the example of the healthcare debilities and the council's sterility perception in the resolution of community problems.

[Health survey in Quilombola communities (descendants of Afro-Brazilian slaves who escaped from slave plantations that existed in Brazil until abolition in 1888) in Vitória da Conquista in the state of Bahia (COMQUISTA Project), Brazil: methodological aspects and descriptive analysis]. / Inquérito de Saúde em Comunidades Quilombolas de Vitória da Conquista, Bahia, Brasil (Projeto COMQUISTA): aspectos metodológicos e análise descritiva.

The scope of this article was to present the methodology, preliminary descriptive results and the reliability of the instruments used in the COMQUISTA Project. It involved a cross-sectional study with adults (>18 years) and children (up to 5 years old) of Quilombola communities in Vitória da Conquista, Bahia. Data collection consisted of individual and household interviews, anthropometric and blood pressure measurements. A semi-structured questionnaire adapted from the Brazilian National Health Survey (PNS) was used and the interviews were conducted using handheld computers. 397 housing units were visited and 797 adults and 130 children were interviewed. The demographic profile of the Quilombolas was similar to the Brazilian population with respect to sex and age, however, they had precarious access to basic sanitation and a low socioeconomic status. The analysis of reliability revealed the adequacy of strategies adopted for quality assurance and control in the study. The methodology used was considered adequate to achieve the objectives and can be used in other populations. The results indicate the need for implementing strategies to improve the quality of life and reduce the degree of vulnerability of the Quilombolas.

Inquérito de Saúde em Comunidades Quilombolas de Vitória da Conquista, Bahia, Brasil (Projeto COMQUISTA): aspectos metodológicos e análise descritiva / Health survey in Quilombola communities (descendants of Afro-Brazilian slaves who escaped from slave plantations that existed in Brazil until abolition in 1888) in Vitória da Conquista in the state of Bahia (COMQUISTA Project), Brazil: methodological aspects and descriptive analysis

O objetivo deste artigo foi apresentar a metodologia, resultados descritivos preliminares e a confiabilidade dos instrumentos utilizados no Projeto COMQUISTA. Estudo transversal com indivíduos adultos (>18 anos) e crianças (até cinco anos) de comunidades quilombolas de Vitória da Conquista, Bahia. A coleta de dados compreendeu a realização de entrevistas individuais e domiciliares, aferição de medidas antropométricas e pressão arterial. Utilizou-se o questionário semiestruturado da Pesquisa Nacional de Saúde (PNS), adaptado para a população quilombola, e as entrevistas foram realizadas em computadores portáteis. Foram visitados 397 domicílios e entrevistados 797 adultos e 130 crianças. O perfil demográfico dos quilombolas foi semelhante ao dos brasileiros quanto ao sexo e idade, porém, eles apresentaram precário acesso ao saneamento básico e baixo nível socioeconômico. A análise de confiabilidade demonstrou a adequação das estratégias adotadas para garantia e controle de qualidade no estudo. A metodologia empregada foi considerada adequada para o alcance dos objetivos e pode ser utilizada em outras populações. Os resultados sugerem a necessidade da implantação de estratégias para melhorar a qualidade de vida e reduzir o grau de vulnerabilidade dos quilombolas.

The scope of this article was to present the methodology, preliminary descriptive results and the reliability of the instruments used in the COMQUISTA Project. It involved a cross-sectional study with adults (>18 years) and children (up to 5 years old) of Quilombola communities in Vitória da Conquista, Bahia. Data collection consisted of individual and household interviews, anthropometric and blood pressure measurements. A semi-structured questionnaire adapted from the Brazilian National Health Survey (PNS) was used and the interviews were conducted using handheld computers. 397 housing units were visited and 797 adults and 130 children were interviewed. The demographic profile of the Quilombolas was similar to the Brazilian population with respect to sex and age, however, they had precarious access to basic sanitation and a low socioeconomic status. The analysis of reliability revealed the adequacy of strategies adopted for quality assurance and control in the study. The methodology used was considered adequate to achieve the objectives and can be used in other populations. The results indicate the need for implementing strategies to improve the quality of life and reduce the degree of vulnerability of the Quilombolas.