Mario Maia Bracco

Physical activity counseling in primary health care in Brazil: a national study on prevalence and associated factors

BackgroundThe aim of this study was to determine the prevalence and correlates of physical activity counseling among physicians and nurses working in primary health care in Brazil.MethodsA phone survey was carried out in 2011 with professionals working in primary health care in Brazil. The target sample consisted of 1,600 randomly selected primary care units covering all regions of the country. We successfully interviewed 529 professionals within the sampled units; 182 physicians and 347 nurses. The overall response rate was 49.6%. Multivariable logistic regression was used to estimate correlates of counseling in the whole sample and separately for physicians and nurses.ResultsThe prevalence of regular physical activity counseling for at least six months was 68.9% (95% CI 64.9; 72.8) and was significantly higher among physicians compared to nurses (p < 0.05). Most professionals (93.2%) interviewed were unfamiliar with current physical activity recommendations for health. In the adjusted analysis, physical activity counseling was more frequent among those who report assessing patient’s physical activity (OR = 2.16; 95% CI 1.41; 3.29), those reporting that lack of time was not a barrier for counseling (OR = 0.62 95% CI 0.42-0.93), those who felt prepared to provide physical activity counseling (OR = 2.34; 95% CI 1.50-3.66), and those working at primary care units offering physical activity programs for patients (OR = 2.06; 95% CI 1.33-3.20). In the stratified analysis, only assessing patient’s physical activity was a significant correlate among physicians whereas assessing patient’s physical activity, feeling prepared to provide counseling and working in units with physical activity interventions were significant correlates among nurses.ConclusionsPhysicians and nurses deemed physical activity counseling of great importance in primary health care in Brazil. However, in order to increase the quality of counseling and the number of professionals engaging in this activity, these health teams require greater knowledge about physical activity (global recommendations for health) as well as training on the application of instruments for assessing physical activity. Moreover, sufficient time must be allowed during consultations for the counseling process, and physical activity promotion programs should be implemented within the primary health care units.

Cardiorespiratory fitness and nutritional status of schoolchildren: 30-year evolution

OBJECTIVE To compare the changes in cardiorespiratory fitness in evaluations performed every ten years since 1978/1980, according to the nutritional status and gender of students in the city of Ilhabela, Brazil. METHODS The study is part of the Mixed Longitudinal Project on Growth, Development and Physical Fitness of Ilhabela. The study included 1,291 students of both genders, aged 10 to 11 years old. The study periods were: 1978/1980, 1988/1990, 1998/2000, and 2008/2010. The variables analyzed were: body weight, height, and cardiorespiratory fitness (VO2max - L.min-1 and mL.kg-1.min-1) performed using a submaximal progressive protocol on a cycle ergometer. Individuals were classified as normal weight and overweight according to curves proposed by the World Health Organization of body mass index for age and gender. Analysis of variance (ANOVA) with three factors followed by the Bonferroni method were used to compare the periods. RESULTS The number of normal weight individuals (61%) was higher than that of overweight. There was a significant decrease in cardiorespiratory fitness in both genders. Among the schoolchildren with normal weight, there was a decrease of 22% in males and 26% in females. In overweight schoolchildren, males showed a decrease of 12.7% and females, of 18%. CONCLUSION During a 30-year analysis with reviews every ten years from 1978/1980, there was a significant decrease in cardiorespiratory fitness in schoolchildren of both genders, which cannot be explained by the nutritional status. The decline in cardiorespiratory fitness was greater in individuals with normal weight than in overweight individuals.

Padrões alimentares de adolescentes na cidade de São Paulo

Artigo elaborado a partir da dissertacao de mestrado de A. G. SALVATTI, intitulada “Comparacao dos padroes de consumoalimentar entre adolescentes eutroficos e com excesso de peso”. Universidade Federal de Sao Paulo; 2010. Apoio: o presenteestudo faz parte de um projeto financiado pela Fundacao de Amparo a Pesquisa do Estado de Sao Paulo (FAPESP), protocolono 03/00415-4.

Prevalence of health promotion programs in primary health care units in Brazil

OBJECTIVE Assessment of prevalence of health promotion programs in primary health care units within Brazil’s health system. METHODS We conducted a cross-sectional descriptive study based on telephone interviews with managers of primary care units. Of a total 42,486 primary health care units listed in the Brazilian Unified Health System directory, 1,600 were randomly selected. Care units from all five Brazilian macroregions were selected proportionally to the number of units in each region. We examined whether any of the following five different types of health promotion programs was available: physical activity; smoking cessation; cessation of alcohol and illicit drug use; healthy eating; and healthy environment. Information was collected on the kinds of activities offered and the status of implementation of the Family Health Strategy at the units. RESULTS Most units (62.0%) reported having in place three health promotion programs or more and only 3.0% reported having none. Healthy environment (77.0%) and healthy eating (72.0%) programs were the most widely available; smoking and alcohol use cessation were reported in 54.0% and 42.0% of the units. Physical activity programs were offered in less than 40.0% of the units and their availability varied greatly nationwide, from 51.0% in the Southeast to as low as 21.0% in the North. The Family Health Strategy was implemented in most units (61.0%); however, they did not offer more health promotion programs than others did. CONCLUSIONS Our study showed that most primary care units have in place health promotion programs. Public policies are needed to strengthen primary care services and improve training of health providers to meet the goals of the agenda for health promotion in Brazil.

Characteristics of physical activity programs in the Brazilian primary health care system

O objetivo foi descrever as caracteristicas dos programas de atividade fisica na atencao basica de saude de acordo com a presenca de Nucleo de Apoio a Saude da Familia (NASF) no municipio e por regioes do Brasil. Foi realizado um estudo transversal por inquerito telefonico com 1.251 coordenadores de unidades de saude. Foi aplicado um questionario sobre presenca de intervencoes com atividade fisica e suas caracteristicas de funcionamento. Quatro em cada dez unidades de saude relataram ter uma intervencao com atividade fisica, especialmente grupos de caminhada. A maior parte da atividade e realizada na manha uma vez ou duas vezes por semana, com sessoes de 30 minutos ou mais. Profissionais de educacao fisica sao os principais responsaveis por supervisionar as atividades. Os programas ocorrem na unidade de saude ou outros espacos comunitarios. Estas caracteristicas, de modo geral, foram semelhantes entre unidades com ou sem NASF no municipio e apresentaram variacao entre as regioes. Os resultados desse estudo irao permitir melhor direcionamento das proximas acoes de promocao de atividade fisica na atencao basica de saude.The aim of this study was to describe the characteristics of programs that promote physical activity in the public primary care system by region of Brazil, subject to the presence or absence of multidisciplinary primary care teams (NASF). We conducted a cross sectional and population-based telephone survey of the health unit coordinators from 1,251 health care units. Coordinators were asked about the presence and characteristics of physical activity programs. Four out of ten health units reported having a physical activity intervention program, the most common involving walking groups. Most of the activities were performed in the morning, once or twice a week, and in sessions of 30 minutes or more. Physical education professionals were primarily responsible for directing the activities. Interventions occurred in the health unit itself or in adjacent community spaces. In general, these characteristics were similar between units with or without NASF, but varied substantially across regions. These findings will guide future physical activity policies and programs within primary care in Brazil.

Prevalência de anemia em pré-escolares e resposta ao tratamento com suplementação de ferro

OBJECTIVES: To assess the prevalence of anemia among children attending public preschools in Ilhabela, state of Sao Paulo, Brazil, and their response to a treatment regimen. METHODS: Between 2007 and 2008, the weight, height, and hemoglobin levels of 667 children were measured in the school setting. Anemic children were prescribed a 12-week course of ferrous sulfate, and follow-up assessment visits were scheduled for halfway through this course and the end of treatment. RESULTS: The prevalence of anemia was 25.6% (N = 170). The lowest hemoglobin level measured was 9.5 g/dL. Anemia was most prevalent (36%) in children between the ages of 60 and 65 months. Median hemoglobin levels rose to 11.8 g/dL from 10.5 g/dL after treatment; 76% of children recovered from anemia. CONCLUSION: Screening for anemia in the school setting and prompt therapy, including mid-treatment follow-up, proved to be an effective strategy for facing this major public health issue.

Physicians', nurses' and community health workers' knowledge about physical activity in Brazil: A cross-sectional study☆

Objectives To measure knowledge of current recommendations of physical activity and consequences of physical inactivity among healthcare providers throughout Brazil. Methods A phone survey of 1600 randomly selected primary healthcare units in Brazil was conducted between January and July 2011. At each unit, a physician, nurse or community healthcare worker (n = 798) responded to a 40-minute survey, eliciting information about demographics, knowledge, and health behaviors pertaining to physical activity. Results Among nurses and community healthcare workers, > 95% reported needing more information on physical activity guidelines. Among physicians this proportion was 80%. Nearly 40% of the professionals incorrectly believed 90-min of moderate-intensity physical activity per week is the recommended amount for health benefits; nearly 30% believed that 90-min of vigorous-intensity activity per week is needed for the same purpose. More than 75% of all groups reported that type II diabetes, hypertension, depression, and coronary heart disease might result from physical inactivity, but on average only 60% from each group are aware of osteoporosis as a possible consequence of physical inactivity. Conclusions Training health professionals in how to convey all relevant information about physical activity to their patients is critical for health promotion within the primary care system in Brazil.

Healthcare integration strategy implementation based on distance education and communication for health professionals in São Paulo City, Brazil: study protocol

The Brazilian healthcare system aims for universal access for the whole population, equity to prioritize health actions, and integrality in all assistance levels. The purpose of this research project is to promote and to evaluate intervention based on capacitation in clinical management focused on diseases that are part of the Brazilian list of ambulatory care sensitive conditions (ACSC). It will be delivered throughout a distance education course to health professionals who are based in a public hospitals and to 85 Family Health Strategy teams spread out over 18 Primary care Units (PCU), covering around 300,000 people, in the southern zone of Sao Paulo City. It will evaluate the use of communication tools, as a free internet-based platform and telemedicine, that will be made available to the health providers that can afford continuity and integrality of care to the patients who are followed by both health services. Also, health professionals learning and application of knowledge in the clinical practice as well as patient outcomes, will be evaluated. Quasi-experimental cohort design with historical controls study of adult patients hospitalized by ACSC and will be followed up 1 year after the hospital discharge. Data collection will be performed on hospital and PCU patient’s health records and will be applied the Primary Care Attention Tool, the World Health Organization Quality of Life, and Sociodemographic questionnaires, to patients and health professionals, for social and environmental characterization, treatment plan adherence, disease monitoring and access to the health services. Data analysis will evaluate as outcomes the hospital readmissions of the followed patients, the use of the communication tools by the health providers, demographic, social and environmental variables, and hospitalization rates, patient’s time of hospitalization and mortality rates related to the patients. This project is funded by the Brazilian Ministry of Health and Sao Paulo State Research Agency.

Rheumatic Fever: a neglected and underdiagnosed disease. New perspective on diagnosis and prevention

Rheumatic Fever: a neglected and underdiagnosed disease. New perspective on diagnosis and prevention Carlos Eduardo de Barros Branco,1 Roney Orismar Sampaio,1 Mario Maia Bracco,2,3 Samira Saady Morhy,2 Marcelo Luiz Campos Vieira,1,2 Luiza Guilherme,1 Luiz Vicente Rizzo,2 Flavio Tarasoutch1, 2 Instituto do Coração InCor,1 São Paulo, SP; Hospital Israelita Albert Einstein2, São Paulo, SP; Centro de Estudos e Pesquisas Dr. João Amorim (CEJAM)3 Brazil

Características de programas de atividade física na atenção básica de saúde do Brasil

O objetivo foi descrever as caracteristicas dos programas de atividade fisica na atencao basica de saude de acordo com a presenca de Nucleo de Apoio a Saude da Familia (NASF) no municipio e por regioes do Brasil. Foi realizado um estudo transversal por inquerito telefonico com 1.251 coordenadores de unidades de saude. Foi aplicado um questionario sobre presenca de intervencoes com atividade fisica e suas caracteristicas de funcionamento. Quatro em cada dez unidades de saude relataram ter uma intervencao com atividade fisica, especialmente grupos de caminhada. A maior parte da atividade e realizada na manha uma vez ou duas vezes por semana, com sessoes de 30 minutos ou mais. Profissionais de educacao fisica sao os principais responsaveis por supervisionar as atividades. Os programas ocorrem na unidade de saude ou outros espacos comunitarios. Estas caracteristicas, de modo geral, foram semelhantes entre unidades com ou sem NASF no municipio e apresentaram variacao entre as regioes. Os resultados desse estudo irao permitir melhor direcionamento das proximas acoes de promocao de atividade fisica na atencao basica de saude.The aim of this study was to describe the characteristics of programs that promote physical activity in the public primary care system by region of Brazil, subject to the presence or absence of multidisciplinary primary care teams (NASF). We conducted a cross sectional and population-based telephone survey of the health unit coordinators from 1,251 health care units. Coordinators were asked about the presence and characteristics of physical activity programs. Four out of ten health units reported having a physical activity intervention program, the most common involving walking groups. Most of the activities were performed in the morning, once or twice a week, and in sessions of 30 minutes or more. Physical education professionals were primarily responsible for directing the activities. Interventions occurred in the health unit itself or in adjacent community spaces. In general, these characteristics were similar between units with or without NASF, but varied substantially across regions. These findings will guide future physical activity policies and programs within primary care in Brazil.