Effects of Two Early Parenting Programmes on Child Aggression and Risk for Violence in Brazil: a Randomised Controlled Trial.

Violence is a major public health problem globally, with the highest rates in low- and middle-income countries (LMICs) in the Americas and southern Africa. Parenting programmes in high-income countries can diminish risk for violence, by reducing risk factors such as child aggression and harsh parenting, and increasing protective factors such as child cognitive development and school readiness. However, there is critical need to identify low-cost programmes with replicable benefits that work in real-world LMICs contexts. A three-arm, randomised, single-blind trial evaluated effects of two low-cost, group-based parenting programmes recommended for LMICs (ACT: Raising Safe Kids; DBS: dialogic book-sharing) on child aggression (primary outcome), child development, parenting, maltreatment, and stress. Participants were 369 children with medium-high levels of aggression (mean age 3.1 years at baseline) in poor households. Interventions were implemented in city health and education services in southern Brazil. Maternal reports, filmed observations, child tasks, and hair cortisol were assessed at baseline, 1-month post-intervention, and 8-month follow-up. Intention-to-treat analyses compared each of ACT and DBS with a control group. Three hundred sixty-eight (99.7%) participants completed follow-up assessments 8 months after the interventions. There was no effect of ACT (standardised mean difference, SMD 0.11, 95% CI - 0.05, 0.27) or DBS (SMD 0.05, 95% CI - 0.11, 0.21) on the primary outcome of child aggression. ACT reduced harsh parenting behaviour post-intervention (SMD - 0.23; 95% CI - 0.46, - 0.01), but not at follow-up. DBS improved book-sharing practices at both time points (e.g., maternal sensitivity at follow-up SMD 0.33; 95% CI 0.08, 0.57). There were no benefits of either programme for other parenting, child development, or stress outcomes. Two parenting programmes in Brazil had small effects on parenting practices but did not reduce child aggression or several other important risk/protective factors for violence. Effective early interventions that reduce violence in real-world LMIC settings are highly desirable but may be challenging to achieve.

The effects of a large-scale home visiting programme for child development on use of health services in Brazil.

Partnership between early childhood development interventions and primary health care services can help catalyse health care uptake by socially vulnerable families. This study aimed to assess the real-life effects of a large-scale home visiting programme [Primeira Infância Melhor (PIM)] in Brazil on the use of preventive (prenatal visits, well child visits, dentist visits and vaccination) and recovery (emergency room visits and hospitalization) health services. A quasi-experiment nested in a population-based birth cohort study was conducted. The intervention group was firstly defined as all children enrolled in PIM up to age 6 months, and afterwards stratified between those enrolled during pregnancy or after birth up to 6 months. Children receiving PIM were matched with controls on propensity scores based on 27 confounders to estimate effects on health service use from prenatal to age 2 years. Double adjustment was applied in outcome Quasi-Poisson regressions. No evidence was found for effects of PIM starting anytime up to 6 months (262 pairs), or for the children enrolled only after birth (133 pairs), on outcomes occurring after age 6 months. When the programme started during pregnancy (129 pairs), there was a 13% higher prevalence of adequate prenatal visits (prevalence ratio = 1.13; 95% confidence interval 1.01-1.27), but no effect on use of any other health service. Sensitivity analyses suggested longer participation in the programme with reduced visitor turnover might improve its impact on prenatal visits. Integration between PIM and primary health care was not adequate to affect overall patterns of contacts with health services. Nevertheless, prenatal home visits showed potential to increase health service contact during a sensitive period of development, indicating the need to start such programmes before birth, when there is more time for maternal care, and family engagement in a network of services is facilitated.

El laboratorio de fertilidad masculina, su evolución en los últimos 20 años / The male fertility laboratory, its evolution over the last 20 years / O laboratório de fertilidade masculina, sua evolução ao longo dos últimos 20 anos

Resumen La mayor accesibilidad a los tratamientos de reproducción asistida (RA) y los avances de la criobiología produjeron cambios en los laboratorios de andrología. El objetivo de este trabajo fue analizar la demanda y evolución de las variables seminales en las últimas dos décadas, caracterizar el laboratorio andrológico actual, evaluar el impacto de la incorporación del aseguramiento de la calidad y la inclusión de los sistemas computarizados (CASA). Se utilizaron datos de las medias mensuales del control de calidad interno (n=22 528) y encuestas a profesionales de laboratorios andrológicos (n=65) y a médicos especialistas en fertilidad (n=33). La demanda global se redujo significativamente con el aumento de las solicitudes de primera vez. El volumen y recuento, variables dependientes de andrógenos, disminuyeron con los años. El criterio estricto en morfología disminuyó el porcentaje de normales; la mitad de los médicos encuestados recibieron resultados entre 0 y 10% y el 40% consideró que ponía en riesgo el valor clínico de la variable. El sistema CASA permitió objetivar la cinética espermática e incrementar el porcentaje de progresivos rápidos, pero pocos laboratorios lo incorporaron. El 66% de los médicos resuelven el factor andrológico severo por tratamientos clínicos y el 95% utiliza técnicas de RA. El análisis de semen es ejecutado fundamentalmente por bioquímicos especializados, con baja adhesión a la automatización y acreditación del laboratorio, pero con participación en programas de evaluación externa de calidad. La demanda disminuyó como consecuencia del aumento del tratamiento por RA. La reducción del porcentaje de formas normales compromete su utilidad clínica.

Abstract Increasing availability to assisted reproduction (AR) treatments in Argentina and advances in cryobiology resulted in changes in andrology laboratories. The aim of this study was to evaluate the demand and evolution of seminal variables in the last two decades, characterise the current andrology laboratory, evaluate the impact of the incorporation of quality assurance and the introduction of computer assisted semen analysis (CASA). Data were taken from internal quality control (IQC) monthly means (n=22 528) and professionals in charge of laboratories (n=65) and fertility physicians' (n=33) surveys. Overall demand decreased significantly while first-time orders increased. Sperm volume and sperm count -androgen dependent parameters- decreased over the years. Strict morphology criteria reduced the percentage of normal results; half of the physicians received results between 0 and 10% and 40% considered that it compromised the clinical value of the variable. The CASA system made it possible to objectify sperm kinetic, increasing the percentage of fast progressives, but few laboratories have incorporated it. Sixty-six percent of physicians resolve severe andrological factor by clinical treatments and 95% use AR techniques in those cases. Semen analysis is mainly performed by specialised biochemists, with low adherence to laboratory automatisation and accreditation, but with participation in external quality assessment programmes. The demand decreased because of the increase in AR treatment. The lower percentage of normal forms compromises their clinical utility.

Resumo O aumento do acesso aos tratamentos de reprodução assistida (RA) e os avanços na criobiologia levaram a mudanças nos laboratórios de andrologia. O objetivo deste trabalho foi analisar a demanda e a evolução das variáveis de sêmen nas últimas duas décadas, caracterizar o laboratório de andrologia atual, avaliar o impacto da incorporação da garantia da qualidade e a inclusão dos sistemas computadorizados (CASA). Foram utilizados dados das médias mensais do controle de qualidade interno (n= 22 528) e pesquisas a profissionais de laboratórios andrológicos e a médicos especialistas em fertilidade (n=33). A demanda geral diminuiu significativamente com o aumento das solicitações de primeira vez. O volume e a contagem de esperma, parâmetros dependentes de andrógenos, diminuíram ao longo dos anos. O critério morfológico rigoroso diminuiu a porcentagem de normais; metade dos médicos entrevistados recebeu resultados entre 0 e 10% e 40% considerou que isso comprometía o valor clínico do parâmetro. O sistema CASA, permitiu objetivar a cinética espermática e aumentar o percentual de progressões rápidas, mas poucos laboratórios o incorporaram. 66% dos médicos resolvem o fator andrológico grave por tratamentos clínicos e 95% utilizam técnicas de RA nesses casos. A análise do sêmen é realizada principalmente por bioquímicos especializados, com baixa aderência à automação e acreditação laboratorial, mas com participação em programas de avalação externa de qualidade. A demanda diminuiu como consequência do aumento do tratamento por RA. A diminuição em percentagem de formas normais compromete sua utilidade clínica.

Intersectorality in a conditional cash transfer programme: Actors, convergences and conflicts.

This study aimed to analyse intersectoral arrangements among the health, education and social assistance sectors in the operationalization of the Bolsa Família Program (BFP). A qualitative approach was carried out, in a peripheral region of a large urban centre of Southeast Brazil. Data content analysis was performed on the basis of reference in the Actor-Network Theory (ANT) using statements by the actors and considering ideas in dispute and work processes in the geopolitical territorial context. Seventeen managers of Municipal Secretariats of Health, Education and Social Assistance were interviewed, as were basic education, primary health care and social assistance professionals. One-off, episodic and discontinuous intersectoral actions were identified, with limited integration among sectors. Convergences and conflicts were found with respect to the institutional processes of BFP. The convergences referred to the conceptions shared among the actors about the role of intersectoral collaboration, as they recognize themselves as providing care to the same vulnerable population. Considering the multiple vulnerabilities of these families, the convergence of actions from different sectors can impact factors that condition inequalities. The conflicts were related to institutional conditions, to sectorized work processes and to a lack of understanding by professionals about the duties of their respective sectors.

It is time: free meals at schools for all.

The link between school feeding programmes (SFP) and the promotion of healthy eating and health is being explored in studies performed in different countries. The coronavirus disease-19 pandemic has revealed flaws and weaknesses in contemporary food systems, with many school-age children experiencing food insecurity and hunger. There is intense debate among policymakers regarding whether government SFP should be universal or targeted. Countries such as Brazil and India, which have two of the most comprehensive universal free-of-charge programmes, have shown the benefits of SFP, including improved nutritional status, support for more sustainable food systems, attendance and academic performance. Evidence shows and supports actions advocating that it is time to offer healthy and free school meals for all students.

Desperdicio de alimentos en comedores escolares de una región de la zona centro sur de Chile: Percepciones de manipuladoras de alimentos del Programa de Alimentación Escolar

Introducción: Los desperdicios de alimentos en los comedores escolares son un problema que afecta al uso de recursos naturales, humanos y económicos. Objetivo: Identificar las opiniones y percepciones de manipuladoras de alimentos sobre factores relacionados al desperdicio de alimentos y posibles estrategias para disminuirlo en comedores escolares del Programa de Alimentación Escolar de la Junta Nacional de Auxilio Escolar y Becas en Chile. Métodos: Diseño cualitativo mediante técnica de grupos focales, con 33 participantes. Se aplicó un protocolo de investigación cualitativo que incluyó consentimiento informado, caracterización sociodemográfica, pauta de observación y guion con las dimensiones exploradas. Cada grupo contó con moderador experto y un observador. Se grabó y transcribió el audio de cada sesión y se analizó mediante ATLAS. Ti, versión 8. Resultados: Según las manipuladoras, los alimentos menos consumidos por los estudiantes son las legumbres, verduras frescas, productos marinos y algunas salsas. Estiman que el desperdicio de alimentos oscila entre los 25 a 100 Kilos al día. Las mujeres identifican factores claves en el rechazo de los alimentos por parte de los escolares; estética, olor y sabor del plato; repetitividad del menú; y aspectos culturales. Como estrategias para reducir el desperdicio proponen variar el menú, incorporar alimentos conocidos por los escolares, educar a los padres en la importancia de ofrecer alimentos y preparaciones saludables y sostenibles; fomentar la participación de toda la comunidad educativa en el proceso alimentario. Conclusiones: El estudio reveló que el desperdicio de alimentos en los comedores escolares es un problema complejo que requiere una intervención multidimensional que involucre a todos los actores del sistema alimentario escolar.

Introduction: Food waste in school canteens is a problem that affects the use of natural, human and economic resources. Objective: Identify the opinions and perceptions of food handlers about food waste factors and possible strategies to reduce them in school canteens of the School Feeding Programme of the Junta Nacional de Auxilio Escolar y Becas in Chile. Methods: Qualitative design using a focus group technique with 33 participants. A qualitative research protocol that included informed consent, sociodemographic characterisation, observation guidelines, and a script with the dimensions explored was applied. Each group had an expert moderator and an observer. The audio of each session was recorded, transcribed, and analysed using ATLAS. Ti, version 8. Results: According to the handlers, the foods least consumed by the students are legumes, fresh vegetables, seafood, and some sauces. They estimate that food waste ranges from 25 to 100 kg per day. Women identify critical factors in the rejection of food by schoolchildren: aesthetics, smell, and taste of the dish; repetitiveness of the menu; and cultural aspects. As strategies to reduce waste, they propose varying the menu, incorporating foods familiar to schoolchildren, educating parents about the importance of offering healthy and sustainable food and preparations, and encouraging the participation of the entire educational community in the food process. Conclusions: The study revealed that food waste in school canteens is a complex problem that requires a multidimensional intervention that involves all actors in the school food system.

A systematic review of the effects of nutrition programmes in high schools

Introduction/Objectives: Obesity rates are reaching alarming levels. Adolescence is a critical period for the prevention of nutritional problems, as it is a time of development of one's own eating habits. These habits will persist into adulthood, so showing adolescents healthy lifestyle patterns is important. The ideal option would be through school-based nutrition intervention programmes. The main objective of this article is to investigate the effectiveness of intervention programmes based on nutritional knowledge and the behaviour of adolescents aged 11-19 years. Method: To carry out this systematic review we employed Scopus, PubMed, and Web of Science as databases and a search period that spanned the last 10 years, following the PRISMA statement. Subsequent to the search, 110 articles were found. Finally, 19 articles were selected for in-depth analysis after a thorough screening. Results: The results show that, in general, intervention programmers have improved the nutritional knowledge of high school students, which means an improvement in their eating behaviours. In addition, these programmes increase their levels of physical activity. However, gender differences are observed, with girls being more concerned about maintaining a balanced diet. Conclusion: In conclusion, schools are an ideal environment for developing programmes that interfere in adolescent eating behaviour.

Introducción/Objetivos: Las tasas de obesidad están alcanzando niveles alarmantes. La adolescencia es un periodo crítico para la prevención de problemas nutricionales, ya que es un momento de desarrollo de los propios hábitos alimentarios. Estos hábitos permanecerán en la edad adulta, por lo que es importante mostrarles a los adolescentes patrones de estilo de vida saludable. La opción ideal sería a través de programas de intervención nutricional en las escuelas. El objetivo principal de este artículo es investigar la efectividad de los programas de intervención basados en el conocimiento y comportamiento nutricional en adolescentes de 11 a 19 años. Métodos: Para llevar a cabo esta revisión sistemática utilizamos como bases de datos Scopus, PubMed y Web of Science y un periodo de búsqueda que abarcó los últimos diez años, siguiendo la declaración Prisma. Después de la búsqueda, se encontraron 110 artículos. Finalmente, 19 artículos fueron seleccionados para un análisis en profundidad después de una revisión exhaustiva. Resultados: Los resultados muestran que, en general, los programas de intervención han mejorado los conocimientos nutricionales de los estudiantes de secundaria, lo que significa una mejora en sus conductas alimentarias. Además, estos programas aumentan sus niveles de actividad física. Sin embargo, se observan diferencias de género, estando las chicas más preocupadas por mantener una dieta equilibrada. Conclusiones: En conclusión, las escuelas son un ambiente ideal para el desarrollo de programas que interfieren en la conducta alimentaria de los adolescentes.

After-school sports programmes and social inclusion processes in culturally diverse contexts: Results of an international multicase study.

This research aimed to understand the role of after-school sports programs in social inclusion processes in culturally diverse contexts through a multicase study within two locations. The first location was in Spain where immigrant and Spanish students were enrolled, and the other was in Chile with Mapuche-Huilliche students, immigrant and Chilean students. The implemented programs at both sites were similar in their educational focus on socio-educational values, and teaching models (hybridization of teaching games for understanding and cooperative learning) that enhance social inclusion. Using individual and group interviews with teachers, sports coordinators, parents, and students, a qualitative approach was used to identify the factors that facilitate or hinder the social inclusion processes. In addition, the researchers used qualitative observations of the programs over six months using "notes logbook" to record their impressions during the observation process. Results indicated that the implemented sports programs successfully facilitated social inclusion processes, enabling the development of interpersonal skills and relationships between students from different cultural backgrounds. The previous training and experiences of teachers in culturally diverse contexts, and incorporation of traditional sporting games from all cultures, seems to be an important facilitator factor for the inclusion potential of the implemented programs.

Disposición hacia la colaboración médica internacional en estudiantes de Estomatología de ocho universidades cubanas / Willingness towards international medical collaboration in dental students from eight Cuban universities

Introducción: Cuba se ha caracterizado por enviar a diversos países delegaciones de salud, llamadas "misiones médicas". Sin embargo, el interés de los futuros profesionales de formar parte de esas delegaciones no se ha investigado. Objetivos: Caracterizar la disposición hacia la colaboración médica internacional e identificar los factores asociados en estudiantes cubanos de Estomatología. Métodos: Se realizó una investigación transversal, analítica de datos secundarios, en estudiantes de todos los años del curso académico 2018-2019, pertenecientes a ocho universidades. La variable dependiente fue el reporte de la disposición de ir a misiones médicas. Se calcularon las razones de prevalencia e intervalos de confianza al 95 por ciento. Resultados: Participaron 1174 estudiantes, de los cuales 830 (71 por ciento) estuvieron dispuestos a cumplir misiones médicas. Existió una mayor disposición hacia la colaboración médica conforme aumentaba la edad (RPa: 1,02; IC 95 por ciento: 1,00-1,04; p = 0,044); así como, en los estudiantes que reportaron presión familiar para estudiar la carrera (RPa: 1,17; IC 95 por ciento: 1,09-1,26; p < 0,001). Aquellos que reportaron buenas notas antes de ingresar a la universidad (RPa: 0,83; IC 95 por ciento: 0,77-0,91; p < 0,001), los de solvencia económica (RPa: 0,90; IC 95 por ciento: 0,90-0,98; p = 0,019) y los que estaban cursando el tercer y cuarto años académicos (RPa: 0,93; IC 95 por ciento: 0,88-0,97; p = 0,003) fueron los de menor disposición para colaborar; ajustado por el sexo y la universidad. Conclusión: Existe una elevada disposición hacia la colaboración médica internacional y está asociada a múltiples aspectos sociales y educativos(AU)

Introduction: Cuba has been characterized by sending health delegations to various countries, called "medical missions". However, the interest of future professionals in joining those delegations has not been investigated. Objectives: Characterize the disposition towards international medical collaboration and identify the associated factors in Cuban students of Stomatology. Methods: A cross-sectional research and secondary data analytics was carried out in students of all years of the academic year 2018-2019, belonging to eight universities. The dependent variable was the report of the willingness to go on medical missions. Prevalence ratios and 95 percent confidence intervals were calculated. Results: 1174 students participated, of which 830 (71 percent) were willing to fulfill medical missions. There was a greater willingness towards medical collaboration as age increased (RPa: 1.02; 95 percent CI 1.00-1.04; p = 0.044); as well as, in students who reported family pressure to study the career (RPa: 1.17; 95 percent CI 1.09-1.26; p < 0.001). Those who reported good grades before entering college (RPa: 0.83; 95 percent CI 0.77-0.91; p < 0.001), those of economic solvency (RPa: 0.90; 95 percent CI 0.90-0.98; p = 0.019) and those who were in the third and fourth academic years (RPa: 0.93; 95 percent CI 0.88-0.97; p = 0.003) were those with the least willingness to collaborate; adjusted by sex and college. Conclusion: There is a high disposition towards international medical collaboration and it is associated with multiple social and educational aspects(AU)

A Thousand Days-A programme for vulnerable early childhood in Argentina: Targeting, dropout risk factors and correlates of time to graduation.

BACKGROUND: Mil Días (A Thousand Days) is a programme for the first thousand days of life, from gestation to 2 years of age, targeted at highly vulnerable children and/or mothers and pregnant women. The programme was implemented in August 2015 in the municipality of San Miguel, in Argentina. Mil Días is designed in a holistic and intersectoral way. The main form of intervention is through home visits, but other benefits are available depending on the 51 vulnerability criteria by which participants are admitted to the programme, most of which are related to health issues. Exits of the programme occur when the mother and/or child have reversed the deprivation/s of the entrance-criteria. METHODS: This paper provides an analysis of the programme's primary data between August 2015 and May 2019, with a total of 1,111 programme participants. First, we perform a statistical analysis of the targeted population of the programme. Second, using a logistic regression, we study factors associated to the withdrawal from the programme. Third, using survival analysis, we study the correlates of time to graduation from the programme. RESULTS: We find that the programme is well-targeted, as participants exhibit higher deprivation levels than those exhibited by beneficiaries of social programmes in general in the same municipality. We also find that programme participants in situations of most extreme vulnerability are more likely to abandon the programme and that successful exits from the programme take longer for more complex cases. CONCLUSIONS: Mil Días-San Miguel is a programme for early childhood development in Argentina, which was pioneer when it was first introduced. It is well targeted and exhibits encouraging results despite complex cases taking longer to sucessfully exit the programme. In addition, the poorest poor participants are more likely to abandon the programme and so additional actions could be taken to retain them, as intended by the 'Leave No One Behind' 2030 commitment.

Management results of a cohort of rheumatoid arthritis patients in a specialized comprehensive healthcare institution in Colombia / Resultados de gestión en una cohorte de pacientes con artritis reumatoide en una institución de atención integral especializada en Colombia

ABSTRACT Objective: To determine the management results in a cohort of patients with rheumatoid arthritis in a specialized integral healthcare institution for this disease in Colombia. Materials and methods: Descriptive cross-sectional study based on a cohort of rheumatoid arthritis patients according to ACR/EULAR 2010 criteria. The information was analysed based on consolidated data from clinical records and national reports in the period 2015-2018. Administrative records related to medication authorizations and prescriptions were considered. Sociodemographic variables, outcome indicators related to disease activity status and medication use percentage were evaluated. Results: As of June 30th 2018, 698 patients were identified, of which the female sex represented 83.8%, the general average age was 55.47 years, and the highest number of cases were in the 60-64 year age group. Of the patients, 68.3% were between remission and low disease activity. Seventy-three point one percent were managed with conventional disease-modifying antirheumatic drugs and a reduction in the use of biological therapy was recorded from 27.2% in 2016 to 17.8% at the end of the period. Conclusions: This study presents the management results of a comprehensive care model for patients with rheumatoid arthritis in Colombia, which managed to maintain the highest proportion of patients in low activity and remission as they had a longer follow-up time, to decrease the percentage of biological DMARDs use, and establish conventional DMARDs as the main therapeutic alternative.

RESUMEN Objetivo: Conocer los resultados de gestión en una cohorte de pacientes con artritis reumatoide en una institución de atención integral especializada en esta enfermedad en Colombia. Materiales y métodos: Estudio descriptivo de corte transversal, a partir de una cohorte de pacientes de artritis reumatoide, según criterios ACR/EULAR 2010. La información se analizó con base en los datos consolidados de historia clínica y reportes nacionales en el periodo 2015-2018. Se tuvieron en cuenta los registros administrativos relacionados con autorizaciones y prescripciones de medicamentos. Se evaluaron variables sociodemográficas, indicadores de resultado relacionados con el estado de actividad de la enfermedad y porcentaje de uso de medicamentos. Resultados: A 30 de junio de 2018, se identificaron 698 pacientes, de los cuales el 83,8% correspondió a sexo femenino; el promedio general de edad fue de 55,47 años y el grupo de edad de 60 a 64 años concentró el mayor número de casos. El 68,3% se ubicó entre remisión y actividad baja de la enfermedad. El 73,1% se encontró manejado con fármacos antirreumáticos modificadores de enfermedad convencionales y se registró una reducción de uso de terapia biológica desde el 27,2% en 2016 al 17,8% al final del periodo. Conclusiones: Este estudio presenta los resultados de gestión de un modelo de atención integral para pacientes con artritis reumatoide en Colombia, que logró mantener la mayor proporción de pacientes en actividad baja y remisión a medida que estos contaban con mayor tiempo de seguimiento, también logró disminuir el porcentaje de uso de FARME biológicos y establecer los FARME convencionales como la principal alternativa terapéutica.

Representaciones sociales sobre el Programa Mais Médicos entre consejeros municipales de salud de Brasil / Social representations on Mais Médicos Program among municipal health councelors of Brazil

Introducción: La atención primaria de salud en Brasil se considera una prioridad. En el año 2013 se creó el Programa Mais Médicos, de formación en servicio y de ampliación de la cantidad de médicos en el país. La cooperación cubana, gestionada por la Organización Panamericana de la Salud fue quien envió la mayor cantidad de profesionales. Objetivo: Analizar las representaciones sociales de los consejeros de salud sobre el Programa Mais Médicos, en municipios en los que prestaron atención a su población médicos provenientes de Cuba. Métodos: Estudio de caso descriptivo de corte transversal abordado con metodología cualitativa. La muestra fue intencional. Se trabajó con 58 entrevistas semiestructuradas y el análisis fue realizado mediante el software gratuito Iramuteq con la técnica de análisis lexical. Resultados: Se pudo distinguir cuatro grupos de representaciones, sobre el funcionamiento de los consejos municipales de salud, sobre las representaciones del Programa Mais Médicos, sobre las redes de atención y sobre los médicos brasileños y cubanos. El estudio aporta evidencias de la aplicación de un nuevo modelo de atención para los consejeros que objetivaron y anclaron en el concepto de nacionalidad. El modelo cubano incorpora características de humanismo, atributos que no estaban contenidos en las representaciones sobre los médicos locales. Conclusiones: Las representaciones sociales sobre el Programa Mais Médicos aluden a una acción que mejora la calidad de los servicios, no obstante, la literatura sobre atención básica aún deja ver algunos problemas de acceso y tránsito por la red del sistema único de salud(AU)

Introduction: Primary health care in Brazil is considered a priority. In 2013, Mais Médicos Program was created, providing in-service training and expanding the number of doctors in the country. Cuban cooperation, managed by the Pan American Health Organization, sent the largest number of professionals. Objective: Analyze the social representations of health counselors on Mais Médicos Program, in municipalities in which doctors from Cuba cared to their population. Methods: Descriptive cross-sectional case study approached with qualitative methodology. The sample was intentional. It was conducted a work with 58 semi-structured interviews and the analysis was carried out using the free software Iramuteq with the lexical analysis technique. Results: Four groups of representations could be distinguished: on the functioning of the municipal health councils, on the representations of Mais Médicos Program, on the care networks and on Brazilian and Cuban doctors. The study brings evidence of the application of a new model of care for counselors who objectified and anchored in the concept of nationality. The Cuban model incorporates characteristics of humanism, attributes that were not contained in the representations about local doctors. Conclusions: The social representations on Mais Médicos Program allude to an action that improves the quality of services, however, the literature on basic care still shows some problems of access and transit through the network of the health system(AU)

Qualitative evaluation of a scalable early childhood parenting programme in rural Colombia.

BACKGROUND: Integrating early childhood parenting programmes into existing government services is a key strategy for reducing the loss of children's developmental potential in low- and middle-income countries. There is limited evidence of participants' perceptions of these programmes, especially when implemented at scale. We integrated an intervention into an existing government programme targeting pregnant women and mothers of children up to 2 years of age and their families in rural Colombia. METHODS: As part of a cluster randomized trial, 171 government workers (facilitators) implemented the intervention. The intervention included four components: (1) structured curricula, (2) play materials, (3) nutrition and (4) training and supervision. In this qualitative evaluation of the programme, we conducted semi-structured interviews with beneficiary mothers (n = 62), facilitators (n = 40) and supervisors (n = 8). Topic guides were developed to collect information on participants' perspectives of the acceptability, feasibility and effectiveness of the intervention and the enablers and barriers to implementation. All interviews were audiotaped and transcribed, and data were analysed using the framework approach. RESULTS: Participants' responses indicated that the intervention was acceptable, feasible and effective. Key enablers to implementation were (1) the use of evidence-based behaviour change techniques leading to interactive, fun and participatory sessions; (2) structured curricula with easy to use, simple activities and materials; (3) the focus on positive, supportive relationships; and (4) the perceived benefits of the programme to the beneficiary mothers, children and families, facilitators and programme supervisors. The main barriers were (1) facilitators took time to become comfortable and competent in using the new participatory methodology and (2) the logistics related to making and distributing the play materials. CONCLUSION: Providing structured curricula and play materials with training and ongoing supervision to enhance an existing programme targeting mothers, families and children was reported as acceptable, feasible and effective by beneficiary mothers and programme staff.

The Project Appropriate Birth and a reduction in caesarean section rates: an analysis using the Robson classification system.

OBJECTIVE: The objective of this study was to assess caesarean section (CS) rates before and after the implementation of the Project Appropriate Birth (PPA), based on the Robson ten group classification system. DESIGN: A before-and-after study. SETTING: Maternity hospital in South Brazil. POPULATION: All pregnant women attending from April 2016 to April 2017 (period 1, pre-implementation of PPA) and from June 2017 to June 2018 (period 2, post-implementation of PPA). METHODS: Maternal and obstetric characteristics were evaluated, including Robson's classification, based on the characteristics of pregnancy and childbirth. A chi-square test and crude and adjusted relative rates were used to analyse the study variables. The significance level was set at 5%. MAIN OUTCOME MEASURES: The CS rate for each group, their contribution to the overall CS rate and the differences in these contributions before and after PPA implementation. RESULTS: The CS rates decreased from 62.4 to 55.6%, which represented a 10.9% reduction after the implementation of the PPA. Pregnant women in Robson classification groups 1-4 had a 21.4% reduction in CS rates, ranging from 49.1 to 38.6%. The greatest contributors to the overall CS rates were group 5 and group 2, accounting for more than 60% of the CS deliveries. CONCLUSION: The study results suggest that Project Appropriate Birth had an impact on the reduction of CS rates, especially in Robson classification groups 1 through 4, which indicates that providing mothers with evidence-based interventions for labour and childbirth assistance contributed to reduce CS rates. TWEETABLE ABSTRACT: The Project Appropriate Birth is an innovative project that has demonstrated promising results, suggesting that interventions based on scientific evidence can lead to real changes in childbirth care, contributing to reduce CS rates. The aim of the PPA is to promote activities to improve childbirth care and encourage vaginal delivery. In this study, 6238 pregnant women admitted to the hospital for delivery were included and classified into one of the Robson 10-group classification. Findings revealed a 10.9% reduction in the overall CS rate and a 21.4% reduction for pregnant women in Robson classification groups 1 through 4, after the implementation of the PPA.

Clinical and laboratory characteristics in outpatient diagnosis of COVID-19 in healthcare professionals in Rio de Janeiro, Brazil.

AIMS: This study aimed to identify the symptoms associated with early stage SARS-CoV-2 (COVID-19) infections in healthcare professionals (HCPs) using both clinical and laboratory data. METHODS: A total of 1297 patients, admitted between 18 March and 8 April 2020, were stratified according to their risk of developing COVID-19 using their responses to a questionnaire designed to evaluate symptoms and risk conditions. RESULTS: Anosmia/hyposmia (p<0.0001), fever (p<0.0001), body pain (p<0.0001) and chills (p=0.001) were all independent predictors for COVID-19, with a 72% estimated probability for detecting COVID-19 in nasopharyngeal swab samples. Leucopenia, relative monocytosis, decreased eosinophil values, C reactive protein (CRP) and platelets were also shown to be significant independent predictors for COVID-19. CONCLUSIONS: The significant clinical features for COVID-19 were identified as anosmia, fever, chills and body pain. Elevated CRP, leucocytes under 5400×109/L and relative monocytosis (>9%) were common among patients with a confirmed COVID-19 diagnosis. These variables may help, in the absence of reverse transcriptase PCR tests, to identify possible COVID-19 infections during pandemic outbreaks. SUMMARY: From 19 March to 8 April 2020, 1297 patients attended the Polyclinic Piquet Carneiro for COVID-19 detection. HCP data were analysed, and significant clinical features were anosmia, fever, chills and body pain. Elevated CRP, leucopenia and monocytosis were common in COVID-19.

Three easy fixes for sire use can enhance genetic progress in community-based breeding programmes.

We analysed options to optimize the use of sires in sheep and goat community-based breeding programmes (CBBP) for three scenarios occurring under field conditions: premature sale of selection candidates, fixed service periods of selected sires and incomplete sire pedigrees. The first scenario was studied by looking at the outcome of combinations of selection pressures in successive selection stages. A compromise of early sale of sire candidates and genetic progress can be obtained by selecting in two stages, such that selection pressure in the first stage is chosen in terms of achieving an acceptable selection potential after the second stage. Simulations showed the dependency of this compromise on selection accuracies and correlation between selection criteria. For a typical sheep CBBP, only 20% of the top three months weighting male lambs need to be retained to achieve 80% of the potential selection differential on six months weight. For the second scenario, two alternatives to fixed service periods were analysed. When across-age BLUP EBVs are not available, individual sires can be programmed to stay in service according to their initial ranking. In typical sheep, CBBPs genetic progress can be increased by about 9% over response to selection with optimum fixed sire service periods. When BLUP EBVs are available, a simulated retrospective analyses of across-age selection of sires in two current sheep CBBPs increased more than twofold the average breeding values actually observed. Thirdly, we studied the benefit of considering possible sires and their mating probabilities when estimating BLUP breeding values instead of setting such sires as unknown. In a current goat CBBP with up to three possible sires included in the pedigree, the accuracy of breeding values nears the accuracy when sires are known and are higher than accuracies when sires are unknown or when possible sires are ignored.

Programa Bolsa Família e saneamento: uma revisão sistemática dos efeitos na diarreia e na desnutrição / Bolsa Família Program and environmental health: a systematic review of the effects on diarrhea and malnutrition

Resumo O Programa Bolsa Família e intervenções em saneamento são políticas públicas que podem ter efeito combinado positivo no enfrentamento das iniquidades em saúde. O Programa Bolsa Família busca propiciar melhoria das condições de saúde, diminuição da insegurança alimentar e aumento da renda familiar. Intervenções em saneamento objetivam garantir a saúde pública e a proteção do meio ambiente. O estudo objetivou revisar a literatura, procurando indícios de interações entre estas duas intervenções, influenciando nos desfechos morbidade e mortalidade por diarreia e desnutrição em menores de cinco anos. Foi realizada busca nas bases LILACS, SciELO e PubMed e a metodologia dos artigos foi avaliada por meio de escores da escala de Downs & Black adaptada. Foram identificados 1.658 artigos, dos quais quatro apresentaram todos os critérios para inclusão no estudo. Os estudos selecionados mostraram evidências do efeito positivo do Programa Bolsa Família e de intervenções em saneamento relacionados aos desfechos de interesse, quando analisados de forma independente um do outro. No entanto, nenhum artigo apresentou resultados que pudessem esclarecer o efeito conjunto destas políticas públicas em um modelo de interação, revelando lacuna na literatura nestas doenças particularmente atribuíveis à pobreza.

Abstract The Bolsa Família Programme and environmental health interventions are public policies that can have a combined positive effect on health inequities. The Bolsa Família Programme is designed to improve health conditions, reduce food insecurity and increase family incomes. Environmental health interventions aim to ensure public health and environmental protection. This study reviewed the literature for possible interactions between these two types of intervention that influence morbidity and mortality outcomes due to diarrhoea and malnutrition in the under-fives. A total of 1,658 articles were identified in the LILACS, SciELO and PubMed databases. The studies' methodologies were evaluated by scores on an adapted Downs & Black scale and four met all the study inclusion criteria. The findings showed evidence of the positive independent effects of the Bolsa Família Programme and of environmental health interventions in reducing illness and death from diarrhoea and malnutrition in the study age group. However, none of the articles offered results that might elucidate a joint effect of these public policies on an interaction model, revealing a gap in the literature on these diseases attributable particularly to poverty.

Has yield plasticity already been exploited by soybean breeding programmes in Argentina?

This study focuses on the impact of genetic improvement of seed yield plasticity in soybean (Glycine max L.) in high-yielding environments (between 4000 kg ha-1 and 7000 kg ha-1) of Central Argentina. The association between seed yield and its plasticity was analysed with (i) a historical collection of 148 genotypes released to the market between 1980 and 2013 and (ii) 165 currently available commercial genotypes. The impact on seed yield of soybean breeding programmes in Argentina reveals higher genetic progress of the lowest (1.7% year-1) rather than the highest yielding genotypes (0.9% year-1). At the same time, seed yield plasticity has been exploited indirectly. Increased seed yield plasticity over time contributed to a reduction in genotypic seed yield variability (P<0.0001). Seed yield plasticity was related to seed yield in high-yielding environments (>5500 kg ha-1). Plastic genotypes showed a positive correlation with the length of the seed-filling period (r=0.5), suggesting that a longer seed-filling period could be required to maximize seed yield plasticity under high-yielding environments. To increase productivity, clarifying the value of plasticity will aid genotype selection for target environments, as well as the development of high-yielding cultivars specifically adapted to high-yielding conditions.

A desired gains approach for the prediction of genetic gain in resistance to gastrointestinal nematodes in a multi-trait breeding objective in Uruguayan Merino sheep.

Gastrointestinal nematodes (GIN) constitute a problem in many sheep production systems, including those in Uruguay, causing reduced productivity and increased expenses. The main strategy to control GIN has consisted of the use of anthelmintics. However, GINs have developed resistance to anthelmintics, reducing their effectiveness. Genetic resistance to GINs has been found in flocks of different breeds. To date, there have been no reports about GINs breaking down genetic resistance in sheep. Heritability estimates of resistance to GIN within breeds are generally moderate, so that achieving genetic gain within a flock is possible. In this study, we predicted genetic gain in worm egg count (WEC), an indirect (and generally preferred) criterion of resistance to GIN, following different strategies. A multi-trait breeding objective including wool and meat traits was assumed and genetic gain over 10 years of selection in a Merino flock was estimated. We used a desired gains approach, examining situations in which the economic contribution of genetic gain in resistance to GIN in percentage terms was 0, 25, 50, 75 or 100. Except when the level of infestation with GIN was low, a considerable amount of emphasis had to be placed on selection for low WEC in order to reach the threshold below which the administration of anthelmintics is not required. High emphasis on reducing WEC lead to a reduction in genetic gain in wool and meat traits, or to their deterioration in the extreme case of 100 per cent emphasis on WEC. Given this finding, coupled with the difficulties encountered in accurately recording and selecting for WEC, we concluded that in addition to embarking upon a programme of within flock selection, sheep breeders interested in improving genetic resistance to GIN should also consider using breeding stock identified as superior for both resistance and production traits in across flock genetic evaluations.

Factores de no adherencia al Programa de atención integral de salud para adolescentes, Santa Ana, El Salvador / Factors of non-adherence to the Comprehensive Health Care Program for Adolescents, Santa Ana, El Salvador

Introducción: La adolescencia se considera una etapa fundamental para el desarrollo del sujeto. Desde el 2015 en El Salvador se instauró un programa de atención integral para el adolescente. Objetivo: Caracterizar los principales factores asociados a la no adherencia al Programa de atención integral de salud para adolescente de 11 a 15 años, del municipio Santa Ana del El Salvador. Métodos: Estudio descriptivo transversal en el primer nivel de atención del municipio de Santa Ana, entre enero y marzo de 2018. Se aplicó un instrumento confeccionado por los autores. La muestra fue de 247 adolescentes que recibieron control e inscripción. Resultados: La mayoría de los adolescentes eran del sexo femenino, el 65,2 por ciento residían en el área rural, el 96 por ciento estudiaba, solo el 32,8 por ciento conocía el programa y de estos lo utilizaban el 48,1 por ciento (15,8 por ciento del total de entrevistados), la vía por la que lo conoció fue el promotor de salud (63 por ciento). Los principales factores relacionados con el no conocimiento del programa fueron; residir en el área urbana, nivel de estudios secundarios, ser estudiante, vivir cerca del centro de salud y no tener promotor de salud. Solo el trabajar resultó significativo (razón de prevalencia 1,71 IC 95 por ciento 1,17-2,51) para no ser adherente. Conclusiones: A pesar de los esfuerzos del Estado, los servicios de salud para adolescente deben ser reorientados de acuerdo con los principios y lineamientos de los documentos regulatorios y el marco legal del país, enfatizando en acciones de promoción de la demanda temprana y prestación de servicios de atención integral(AU)

Introduction: Adolescence is considered a fundamental stage for the development of the individual. Since 2015, a comprehensive health care program for adolescents has been established in El Salvador. Objective: Characterize the main factors associated with non-adherence to the Comprehensive Health Care Program for adolescents aging 11 to 15 years, from Santa Ana municipality, El Salvador. Methods: Cross-sectional descriptive study at the first level of care of Santa Ana municipality, from January to March 2018. An instrument made by the authors was applied. The sample was of 247 adolescents who were controlled and registered. Results: Most adolescents were females, 65.2 percent lived in rural areas, 96 percent were studying, only 32.8 percent knew about the programme and it was being used by 48.1 percent (15.8 percent of all interviewees), and the way they knew about it was by the health promoter (63 percent). The main factors related to not knowing on the program were: living in the urban area, junior high school level, being a student, living near the health center and not having health promoter. Only work was significant (prevalence rate 1.71 CI 95 percent 1.17-2.51) for not being adherent. Conclusions: Despite the efforts of the State, health services for adolescents should be redirected in accordance with the principles and guidelines of the country's regulatory documents and legal framework, emphasizing in actions to promote early demand and provide comprehensive care services(AU)