Rebbeck T, Facchini LA, Wehmeister FC. Breast Cancer Mortality In Brazil: Correlation With Human Development Index

Background: Mortality from breast cancer decreased in high-income countries, while countries with middle and low incomes as Brazil still has upward trend. However, large geographical variations among the federal units are observed in the country. The aim of the study was to evaluate the trend of specific mortality from breast cancer in women over 20 years old years among different states of Brazil from 1996 to 2012.  Methods and Findings: Ecological study, using linear regression model for temporal analysis of specific mortality coefficient from malignant neoplasm of breast. We also checked the degree of its correlation with the HDI for the states of Brazil during the stated period. There was an increase in the specific mortality rate for malignant neoplasm of the breast in order of 33%, with range from 23.2 to 30.8 / 100,000 inhabitants. The states with the highest human development HDI in 2010, showed the largest specific mortality rates of breast cancer. Conclusion: Taking the trends of mortality from cancer an important role, this study confirms the need for improvements in mammography coverage, following radiological lesions suspected and access to appropriate therapy.  

Multimorbidity and mortality in older adults: A systematic review and meta-analysis

OBJECTIVE

To review literature and provide a pooled effect for the association between multimorbidity and mortality in older adults.

METHODS

A systematic review was performed of articles held on the PUBMED database published up until January 2015. Studies which used different diseases and other conditions to define frailty, evaluated multimorbidity related only to mental health or which presented disease homogeneity were not included. A meta-analysis using random effect to obtain a pooled effect of multimorbidity on mortality in older adults was conducted only with studies which reported hazard ratio (HR). Stratified analysis and univariate meta-regression were performed to evaluate sources of heterogeneity.

RESULTS

Out of 5806 identified articles, 26 were included in meta-analysis. Overall, positive association between multimorbidity and mortality [HR: 1.44 (95%CI: 1.34; 1.55)] was detected. The number of morbidities was positively related to risk of death [HR: 1.20 (95%CI: 1.10; 1.30)]. Compared to individuals without multimorbidity, the risk of death was 1.73 (95%CI: 1.41; 2.13) and 2.72 (95%CI: 1.81; 4.08) for people with 2 or more and 3 or more morbidities, respectively. Heterogeneity between studies was high (96.5%). The sample, adjustment and follow-up modified the associations. Only nine estimates performed adjustment which included demographic, socioeconomic and behaviour variables. Disabilities appear to mediate the effect of multimorbidity on mortality.

CONCLUSIONS

Multimorbidity was associated with an increase in risk of death. Multimorbidity measurement standardization is needed to produce more comparable estimates. Adjusted analysis which includes potential confounders might contribute to better understanding of causal relationships between multimorbidity and mortality.

Multimorbidity in adults from a southern Brazilian city: occurrence and patterns

OBJECTIVES

The aim of this study was to evaluate occurrences and patterns of multimorbidity in adults from a southern Brazilian city.

METHODS

A population-based cross-sectional study was carried out in 2012 through face-to-face interviews with adults (20 or more years) living in Pelotas, southern Brazil. Multimorbidity was evaluated by a list of 11 morbidities (based on medical diagnosis; Patient Health Questionnaire 9 for depression; and Anatomical Therapeutic Chemical index) and operationalized according to two cutoff points: ≥2 and ≥3 morbidities. Descriptive analysis and factor analysis (FA) were performed.

RESULTS

The sample was made up of 2927 adults. Multimorbidity reached 29.1 % (95 % CI: 27.1; 31.1) for ≥2, and 14.3 % (95 % CI: 12.8; 15.8) for ≥3 morbidities and was greater in females, older people, those with less schooling and those from lower economic classes. Four pairs (frequency ≥5 %) and four triplets (frequency ≥2 %) were observed. Two patterns of morbidities (cardiometabolic and joint problems; and respiratory diseases) explained 93 % of total variance.

CONCLUSIONS

Multimorbidity was common in the studied population. The observed patterns may be used to generate and improve Brazilian diseases guidelines.

[Access to medicines prescribed for acute health conditions in adults in South and Northeast Brazil]

This was a cross-sectional study within Brazil's Project for the Expansion and Consolidation of Family Health, 2005, with the objective of universal and free access to the medication prescribed in the last medical appointment for acute health problems and to estimate the degree to which access may have improved with inclusion of the medicines in prevailing policies and programs. The sample included 4,060 adults living in the area of primary health care units in 41 municipalities in South and Northeast Brazil. Access was greater in the South (83.2%) than in the Northeast (71%), and free access was similar (37%), with a greater share by the Family Health Program (FHP) when compared to the traditional model, especially in the Northeast. Some 60% of prescribed medicines and 50% of those on the National List of Essential Medicines (RENAME) were paid for. No variation was observed in the proportion of medicines present on the prevailing RENAME list and access. However, 40% of the medicines that were paid for can currently be obtained through the Popular Pharmacy Program. The latter program appears to emerge as a new way to guarantee access to medicines prescribed in the health system.

Prevalência da assistência domiciliar prestada à população idosa brasileira e fatores associados

Avaliar a prevalência e os fatores associados à assistência domiciliar na população idosa brasileira. Estudo transversal de base populacional com indivíduos de 60 anos ou mais, residentes na área urbana de 100 municípios, localizados em 23 estados brasileiros. Foi utilizado modelo de regressão de Poisson para análise bruta e ajustada. Foram entrevistados 6.624 idosos e a prevalência da assistência domiciliar foi de 11,7%. Após ajuste, a ocorrência foi maior entre as mulheres, nos mais velhos, com menor escolaridade e poder aquisitivo, com diagnóstico de morbidade crônica, história de queda, hospitalização prévia e consulta médica nos últimos três meses. Os resultados destacam a maior utilização da assistência domiciliar por idosos mais vulneráveis. Esse achado indica uma contribuição da assistência domiciliar à promoção da equidade na atenção à saúde no país, principalmente em decorrência da expansão da Estratégia Saúde da Família. Os resultados podem subsidiar a organização do processo de trabalho de profissionais e gestores na atenção básica à saúde.

Associação do trabalho infantil com transtornos de comportamento do tipo introversão e extroversão: um estudo transversal no Sul do Brasil

Resumo Objetivo avaliar a associação entre trabalho infantil e transtornos de comportamento do tipo introversão e extroversão. Métodos estudo transversal com entrevistas domiciliares e aplicação do Child Behavior Check List em 1.608 jovens de 10 a 13 anos e 1.530 jovens de 14 a 17 anos da área urbana de Pelotas, Sul do Brasil. Resultados a prevalência do trabalho foi de 7,3% entre os mais jovens e de 20,7% entre os de mais idade, e a de transtornos de comportamento, de introversão, 25%, e de extroversão, 22%, sem diferença por idade. Análise multivariada (Poisson), estratificada por idade, mostrou associação entre extroversão e trabalho, com prevalência maior entre os mais novos e menor entre os mais velhos. Extroversão associou-se diretamente, nos mais novos, com serviços domésticos e construção civil, e inversamente, nos mais velhos, com serviços não domésticos. Não houve associação com introversão em nenhuma das faixas de idade. Para os mais velhos, o trabalho foi protetor para extroversão, em particular nos serviços não domésticos, porém há possibilidade de causalidade reversa. Discussão o prejuízo ao comportamento na faixa de 10 a 13 anos indica a necessidade de erradicação do trabalho infantil, com atenção especial ao serviço doméstico e à construção civil; o trabalho de adolescentes mais velhos em serviços não domésticos pode trazer benefícios ao comportamento.

Multimorbidity in older adults: magnitude and challenges for the Brazilian health system

BACKGROUND

Multimorbidity is a public health problem with high prevalence and important consequences. The aim of this paper was to verify the prevalence and distribution of multimorbidity in Brazilian older adults.

METHODS

A population-based survey was carried out in 2008 through face-to-face interviews with 1593 older adults (aged 60 or over) living in Bagé, a medium-sized city in Southern Brazil. Multimorbidity was evaluated by 17 morbidities and operationalized according to two cutoff points: 2 or more and 3 or more morbidities. Descriptive analysis examined the occurrence of multimorbidity by demographic, socioeconomic and health services variables. Observed and expected dyads and triads of diseases were calculated.

RESULTS

From total sample, 6 % did not have morbidities. Mean morbidity was 3.6. Morbidities showing higher prevalence were high blood pressure - HBP - (55.3 %) and spinal column disease (37.4 %). The percent of participants with multimorbidity was 81.3 % (95 % CI: 79.3; 83.3) for 2 or more morbidities and 64.0 % (95 % CI: 61.5; 66.4) for 3 or more morbidities. In both measures occurrence was higher among women, the more elderly, less socioeconomic status, the bedridden, those who did not have a health private plan, those who used health services and those living in Family Health Strategy catchment areas. We found 22 dyads of morbidities with prevalence 10 % or more and 35 triads with prevalence 5 % or more. The most prevalent observed pair and triplet of morbidities were HBP and spinal column disease (23.6 %) and HBP, rheumatism/arthritis/arthrosis and spinal column disease (10.6 %), respectively.

CONCLUSIONS

Multimorbidity frequency was high in the sample studied, in keeping with percentage found in other countries. The social inequities identified increase the health system challenges for the management of multimorbidity, requiring a comprehensive and multidimensional care. The combinations of diseases can provide initial input to include multimorbidity in Brazilian clinical protocols.

Prevalence of cognitive impairment and associated factors among the elderly in Bage, Rio Grande do Sul, Brazil

It is estimated that until 2020 the elderly will represent 13% of the total Brazilian population, and there is increasing concern about healthy aging and low rates of cognitive impairment. This cross-sectional study aimed to identify the prevalence of cognitive impairment, using the Mini-Mental State Examination (MMSE) in a sample of 1,593 elderly aged 60 years old and more who were living in the community of the city of Bagé, Southern Brazil, in 2008. The Poisson regression model was used for estimating crude and adjusted prevalence ratios; their related 95% confidence intervals and p-values lower than 0.05 were considered statistically significant. The prevalence of cognitive impairment was of 34% and statistically associated with gender (female), age (older), schooling (less educated), lower economic classes, without retirement, with depression and functional limitation. The high magnitude with increased occurrence among poor and vulnerable groups contributes to the implementation of public policies in order to improve care, prevent diseases and promote the independence and autonomy of the elderly population.

Socioeconomic inequalities in the access to and quality of health care services

OBJECTIVE To assess the inequalities in access, utilization, and quality of health care services according to the socioeconomic status. METHODS This population-based cross-sectional study evaluated 2,927 individuals aged ≥ 20 years living in Pelotas, RS, Southern Brazil, in 2012. The associations between socioeconomic indicators and the following outcomes were evaluated: lack of access to health services, utilization of services, waiting period (in days) for assistance, and waiting time (in hours) in lines. We used Poisson regression for the crude and adjusted analyses. RESULTS The lack of access to health services was reported by 6.5% of the individuals who sought health care. The prevalence of use of health care services in the 30 days prior to the interview was 29.3%. Of these, 26.4% waited five days or more to receive care and 32.1% waited at least an hour in lines. Approximately 50.0% of the health care services were funded through the Unified Health System. The use of health care services was similar across socioeconomic groups. The lack of access to health care services and waiting time in lines were higher among individuals of lower economic status, even after adjusting for health care needs. The waiting period to receive care was higher among those with higher socioeconomic status. CONCLUSIONS Although no differences were observed in the use of health care services across socioeconomic groups, inequalities were evident in the access to and quality of these services.

A inclusão social pelo trabalho no processo de minimização do estigma social pela doença

Com o objetivo de refletir sobre a importância da inclusão social pelo trabalho no processo de redução do estigma social pela doença, este artigo apresenta a narrativa de três usuárias, vinculadas às Oficinas de Geração de Trabalho e Renda da Reabilitação Trabalho e Arte (Retrate), que sofrem com o preconceito e a discriminação por serem portadoras de transtornos mentais. Pautando-se nas contribuições teóricas de Erving Goffman e valendo-se da proposta metodológica trazida pela sociologia da vida cotidiana e pela história oral de vida, o resultado obtido aponta que a inclusão social pelo trabalho é o principal meio para a positivação da identidade dos portadores de transtornos mentais e para a redução da estigmatização social pela doença. Ao sentirem-se reconhecidos por seu trabalho e conceberem o grupo como uma "família", esses sujeitos têm a baixa autoestima, os sentimentos de anormalidade, o medo e a desvalorização visivelmente minimizados.

Lack of access and continuity of adult health care: a national population-based survey

OBJECTIVE

To describe the lack of access and continuity of health care in adults.

METHODS

A cross-sectional population-based study was performed on a sample of 12,402 adults aged 20 to 59 years in urban areas of 100 municipalities of 23 states in the five Brazilian geopolitical regions. Barriers to the access and continuity of health care and were investigated based on receiving, needing and seeking health care (hospitalization and accident/emergency care in the last 12 months; care provided by a doctor, by other health professional or home care in the last three months). Based on the results obtained by the description of the sample, a projection is provided for adults living in Brazilian urban areas.

RESULTS

The highest prevalence of lack of access to health services and to provision of care by health professionals was for hospitalization (3.0%), whilst the lowest prevalence was for care provided by a doctor (1.1%). The lack of access to care provided by other health professionals was 2.0%; to accident and emergency services, 2.1%; and to home care, 2.9%. As for prevalences, the greatest absolute lack of access occurred in emergency care (more than 360,000 adults). The main reasons were structural and organizational problems, such as unavailability of hospital beds, of health professionals, of appointments for the type of care needed and charges made for care.

CONCLUSIONS

The universal right to health care in Brazil has not yet been achieved. These projections can help health care management in scaling the efforts needed to overcome this problem, such as expanding the infrastructure of health services and the workforce.

Estrutura e processo de trabalho na prevenção do câncer de colo de útero na Atenção Básica à Saúde no Brasil: Programa de Melhoria do Acesso e da Qualidade – PMAQ

Resumo Objetivos: descrever e analisar a adequação da estrutura e processo das equipes do Programa de Melhoria do Acesso e da Qualidade (PMAQ-AB) na prevenção do câncer de colo de útero na Atenção Básica no Brasil. Métodos: estudo transversal conduzido em todas as unidades básicas de saúde (UBS), entre 2012 e 2013. Estimou-se a prevalência da adequação da estrutura (insumos/materiais) e do processo de trabalho para o exame de Papanicolau. A associação da adequação com características das unidades e equipes foi estimada pela razão de prevalência (RP) e intervalos de confiança de 95% (IC95%). Resultados: foram estudadas 38.812 UBS e 17.202 equipes de saúde. A prevalência de adequação da estrutura e do processo de trabalho foi 49% e 30%, respectivamente. A adequação da estrutura e o processo estiveram associados ao maior porte do município e IDH. A prevalência de adequação da estrutura foi maior nas unidades da Estratégia de Saúde da Família (RP=1,35; IC95%:1,33-1,38), cuja adequação do processo de trabalho esteve associada à população adscrita <4.000 pessoas e equipe mínima completa. Conclusões: a estrutura e o processo de trabalho para o rastreamento do câncer de colo uterino necessitam ser aprimoradas. As equipes de saúde carecem de maior qualificação das ações relacionadas a esta ação programática.

Perfil de utilização de serviços de saúde por crianças de zona urbana no Brasil: estudo transversal de base nacional

Objetivos: descrever o perfil de utilização de serviços de saúde em crianças brasileiras menores de cinco anos. Métodos: estudo seccional de base populacional realizado em 2009, com crianças residentes em 100 municípios de cinco regiões brasileiras. Investigou-se o uso dos seguintes tipos de atendimento de saúde: domiciliar e médico ambulatorial - últimos três meses - e de urgência e internação hospitalar - últimos doze meses. As variáveis independentes foram: sexo, idade, classificação econômica familiar, escolaridade materna, família beneficiada pelo Programa Bolsa Família, ter apresentado problema agudo de saúde, estado nutricional, porte do município e região. Análises brutas e ajustadas para associação entre a utilização de serviços de saúde e classe econômica foram realizadas por meio de regressão de Poisson com ajuste robusto da variância. Resultados: das 6360 crianças, 3422 (54%) foram atendidas por médico, 506 (8%) receberam atendimento domiciliar, 2144 (34%) foram atendidas em serviços de urgência/emergência e 681 (11%) foram hospitalizadas. Crianças das classes A/B consultaram mais com o médico, tiveram menos atendimento domiciliar, usaram mais serviços de urgência do que crianças das classes C e D/E. Não houve diferença na hospitalização segundo classe econômica. Conclusões: os achados destacam importantes desigualdades no uso de serviços de saúde por crianças brasileiras.

Depressive symptoms in elderly living in areas covered by Primary Health Care Units in urban area of ​​​​Bagé, RS

OBJECTIVE

To identify the prevalence of depressive symptoms and associated factors in elderly.

METHODS

Cross-sectional study of population-based sample of 1,593 individuals aged 60 years or more in the urban area of Bagé, Rio Grande do Sul, Brazil, in 2008. Data were collected in household interviews. The prevalence of depressive symptoms was assessed using the Geriatric Depression Scale. The analysis was performed using Poisson regression with robust variance estimation.

RESULTS

The prevalence of depressive symptoms was 18.0%, with the 95% confidence interval 16.1 - 19.9. The majority of the sample consisted of women (62.8%). The mean age was 70 years, with a 8.24 standard deviation (SD); 25.1% of seniors aged 60 to 64 years and 31.2% were 75 years or older. In the adjusted analysis, depressive symptoms were significantly associated (p value < 0.05) with the elderly female, yellow, brown or indigenous descendancy, lower economic status, retired, with history of heart problems, incapacity to basic and instrumental activities of daily living, worse self-rated health and dissatisfaction with life in general. Age, marital status, education, self-reported hypertension and diabetes were not associated with depressive symptoms after adjusting for confounders.

CONCLUSION

The high prevalence of depressive symptoms in the population requires investment in preventive actions, noting the need for practices that promote active aging with the maintenance of functional activity, improving self-rated health and life satisfaction.

Padrões de utilização de atendimento médico-ambulatorial no Brasil entre usuários do Sistema Único de Saúde, da saúde suplementar e de serviços privados

Indicadores de oferta, acesso e utilização são úteis para caracterizar os serviços, planejar ações e organizar a demanda. Este estudo descreve padrões de utilização de atendimento médico-ambulatorial e associação com variáveis sociodemográficas, de morbidade, porte do município e região, de acordo com a natureza jurídica do serviço. Trata-se de um estudo transversal de base populacional com 12.402 adultos brasileiros entre 20 e 59 anos, residentes nas áreas urbanas de 100 municípios nas cinco regiões brasileiras. A prevalência de atendimento médico-ambulatorial nos três meses anteriores à entrevista foi de 34,6%. O Sistema Único de Saúde foi responsável por mais da metade (53,6%) dos atendimentos, algum convênio de saúde foi utilizado por 34% da amostra e os serviços privados por 12,4%, independentemente da região, do porte populacional e da morbidade referida. Os padrões de utilização de serviços de saúde continuam socialmente determinados, resultando da oferta, das características sociodemográficas e do perfil de saúde dos usuários.

[Use of health services in Brazil: association with overweight and body fat indicators]

The aim of the study was to analyze the association between use of health services and obesity in Brazilian adults. We carried out a population-based cross-sectional study in 100 districts of five Brazilian regions. The outcomes were: home care, use of medical services in the primary health care, use of medical services outside of the primary health care, use of emergency services and hospitalization. Excess weight was assessed by measurement of BMI and waist circumference (WC). Among the 8,603 subjects studied, the medical care in the primary health care was 14% and 18% higher among obese and high risk of WC, respectively, after controlled for socio-demographic variables and physical inactivity, but lost significance when adjusted for hypertension and diabetes. For the emergency services, both exposures resulted in increase of nearly 20% in the use of this service, after adjustments. The excess weight increased the use of medical services in the primary health care and emergency services.

Green tobacco sickness among tobacco farmers in southern Brazil

BACKGROUND

Despite being the second largest tobacco producer in the world, Brazil does not have prevalence studies about green tobacco sickness (GTS).

METHODS

A cross-sectional study was carried out on a sample of Brazilian tobacco workers. The sample was described according to socio-demographic, behavioral, and occupational variables. Gender-stratified multivariate analyses examined variables associated with GTS.

RESULTS

GTS prevalence among men in the previous month was 6.6%, while among women it was 11.9%. Among men, age, being a non-smoker, hanging tobacco sticks in the barn, harvesting wet leaves, and exposure to physical exertion were risk factors for GTS. Among women, tying hands of tobacco, transporting bales, harvesting wet leaves, having had contact with pesticides, and exposure to physical exertion were positively associated with GTS.

CONCLUSION

Research is required to improve methods for GTS screening, as well as the ability to distinguish GTS from pesticide poisoning. Health professionals should be trained to diagnose and treat GTS.

Prevalence of overweight and associated factors in under-five-year-old children in urban population in Brazil

Objectives: To estimate the prevalence of overweight in children under five years old from urban households and to investigate associated factors. Methods: Cross-sectional population-based study carried out in the five regions of Brazil with a sample of 6,397 children. The World Health Organization 2006 Growth Curves were used and children were considered overweight when Z-score was higher than two standard deviations of weight for height. The following variables were investigated: family income, mothers' education level, race, age, gender, number of siblings, weight at birth and duration of exclusive breastfeeding. Proportions were compared with the χ2 test and reasons of prevalence were calculated. Logistic regression was used for the adjusted analysis. Results: The prevalence of overweight was of 12%. After adjustments, this prevalence was significantly higher among males (p = 0.030) and inversely proportional to the child's age (p = 0.032). White children presented 22% higher overweight prevalence than non-white ones. A linear direct association was verified between weight at birth and overweight (p = 0.000). Children who were breastfed until 120 days presented 34% more prevalence of overweight when compared to the ones who were breastfed for a longer time. Conclusions: Overweight prevalence was higher in male, under one year old, white children, with more than 3,500 grams of weight at birth and who were exclusively breastfed until 120 days.

Insegurança alimentar no Nordeste e Sul do Brasil: magnitude, fatores associados e padrões de renda per capita para redução das iniquidades

O artigo analisa a insegurança alimentar em domicílios urbanos com crianças menores de sete anos de idade. Por meio de estudo transversal localizou-se, nas áreas de abrangência de unidades básicas de saúde, 5.419 domicílios na Região Nordeste e 5.081 na Região Sul do Brasil. A insegurança alimentar foi avaliada usando-se a Escala Brasileira de Insegurança Alimentar. A prevalência de insegurança alimentar moderada ou grave foi 22,9% no Nordeste e 7,5% no Sul. Em ambas as regiões, na análise ajustada, a maior probabilidade de insegurança alimentar moderada e grave foi identificada em domicílios chefiados por mulheres, com cor da pele materna preta e parda/mestiça, com menor escolaridade materna, menor renda familiar per capita e beneficiários do Bolsa Família. A insegurança alimentar moderada ou grave seria reduzida em 59,5% no Nordeste e em 45,4% no Sul, com uma renda familiar per capita mínima de R$ 175,00 ao mês. O aumento da renda familiar dos mais pobres e a melhor focalização do Bolsa Família são essenciais para a diminuição da insegurança alimentar no país.

[Physical activity during commuting by adults and elderly in Brazil: prevalence and associated factors]

Evidence in the literature shows that physical activity associated with commuting (routine coming and going) can have a positive impact on health. The current study describes physical activity during commuting and some associated factors. A cross-sectional population-based study was conducted with 12,402 adults and 6,624 elderly in 100 municipalities (counties) from 23 States of Brazil. The outcome was based on the commuting section from the long version of the International Physical Activity Questionnaire (IPAQ). Prevalence of insufficient physical activity during commuting (< 150 minutes per week) was 66.6% in adults and 73.9% in the elderly. Among the elderly, the very old showed 25 times higher odds of being insufficiently active as compared to younger elders. Individuals with self-reported "white" skin color were less active in commuting. The findings show that prevalence of physical activity in commuting in Brazil is low, and that encouraging physically active commuting can be an effective strategy for increasing levels of physical activity and improving health.

Advice for salt, sugar and fat intake habits among adults: a national-based study

INTRODUCTION : A healthy diet is recognized as an important strategy for promoting health as an essential part of non-pharmacological therapy of various health problems. OBJECTIVE : To analyze the reported advice for the intake of salt, sugar and fat for the Brazilian adults living in urban areas. METHODOLOGY : National-based cross-sectional study with 12,402 adults interviewed in 100 Brazilian cities. RESULTS : The most prevalent advice was to low fat intake (38%), followed by the advice to low salt and sugar intake (36%) and sugar (29%). The percentage of receiving different advice was similar and more common among women, older people, those with a partner, higher economic class, former smokers, active and in person with physician diagnoses of hypertension, diabetes and overweight. People with white skin color received more advice to eat healthy food, except for the orientation to low salt intake. CONCLUSION : The results show a low prevalence of advice, which configures a missed opportunity to prevent health problems. Although dietary counseling should not be understood only as the transmission of advice regarding some nutrients, it is important to develop actions in order to qualify services and health professionals, allowing the population to have access to qualified information about the benefits of having healthy lifestyles.