Health-related patterns and chronic kidney disease in the Brazilian population: National Health Survey, 2019

Objective

The aim of this study was to identify patterns related to health and their association with chronic kidney disease (CKD) in the Brazilian population.

Methods

We used data from the National Health Survey (PNS), 2019. Participants were interviewed and answered questions related to socioeconomic and demographic information (gender, age, education, race/color), health conditions (presence of hypertension, diabetes mellitus, hyperlipidemia, cardiovascular disease, overweight and CKD) and lifestyle (smoking, alcohol consumption, physical activity and food consumption). To identify patterns, we used exploratory factor analysis. We performed logistic regression models to describe the association of CKD with each pattern in crude models and adjusted for gender, age group, education level and race/color.

Results

A total of 90,846 individuals were evaluated. The prevalence of CKD was 1.49% (95% CI: 1.3-1.6). Three health-related patterns - metabolic factors, behavioral risk factors and behavioral protective factors - were identified by factor analysis. Metabolic factors were determined by the presence of hypertension, diabetes mellitus, hyperlipidemia and cardiovascular diseases. Behavioral risk factors were determined by smoking, alcohol consumption, regular consumption of soft drinks, sweets and artificial juices, and high salt consumption. The protective behavioral factors were established by the practice of physical activity and regular consumption of vegetables and fruits. Participants of the highest tertile for metabolic factors were more likely to have CKD in the adjusted model (OR = 3.61, 95% CI: 2.69-4.85), when compared to those of the lower tertile.

Conclusion

The pattern referring to metabolic factors was associated with a higher chance of presenting CKD.

Distinguishing the milk microbiota of healthy goats and goats diagnosed with subclinical mastitis, clinical mastitis, and gangrenous mastitis

Mastitis, mainly caused by bacterial intramammary infections, is the main problem in the breeding of dairy animals. The inflammations of the mammary gland is separated by types of mastitis, being subclinical, clinical, and the most severe, gangrenous mastitis. Here, we used 16S rRNA amplicon sequencing to characterize the bacterial microbiota of goat milk in the different types of goat mastitis caused by bacteria. We used 72 goat milk samples from a region of the state of Minas Gerais in Brazil, of which 12 were from clinically healthy animals, 42 from animals diagnosed with subclinical mastitis, 16 from animals with clinical mastitis, and 2 from animals with gangrenous mastitis. The group related to gangrenous mastitis was the most divergent in terms of alpha and beta diversity. The most abundant genus among samples of the groups was Staphylococcus spp., and we found a high abundance of Mycoplasma sp. in the milk of animals diagnosed with clinical mastitis. The most statistically relevant microorganisms among the groups were Prevotella sp., Ruminococcaceae, Prevotella ruminicola sp., and Providencia sp. We highlight a new association of bacterial agents in gangrenous mastitis among Escherichia sp./Shigella sp. and Enterococcus sp. and provide the second report of the genus Alkalibacterium sp., in milk samples. Only the taxa Staphylococcus sp., Bacteroides sp., Enterococcus, and Brevidabacterium sp., were present in all groups. The superpathway of L-tryptophan biosynthesis metabolites and the sucrose degradation III (sucrose invertase) pathway were the most prominent ones among the groups. In this study, we demonstrate how a rich microbiota of goat milk from healthy animals can be altered during the aggravation of different types of mastitis, in addition to demonstrating new bacterial genera in milk not previously detected in other studies as well as new associations between agents.

Low-grade albuminuria and its relationship with cardiovascular disease risk in hypertensive and diabetic patients in primary health care

OBJECTIVE

To evaluate the presence of LGA and the relationship with the 10-year risk of a cardiovascular event in hypertensive and diabetic patients in Primary Health Care.

STUDY DESIGN

The study design used is cross-sectional.

METHODS

This study was based on the application of questionnaires, anthropometric measurements, and laboratory tests carried out from August 2017 to April 2018. Logistic regression was used to evaluate the odds ratio of the explanatory variables in relation to the highest tercile of LGA. The Framingham risk score was used to assess the 10-year risk of cardiovascular event. The comparison of this score with the LGA terciles was analyzed using ANOVA.

RESULTS

An increase in the 10-year risk of cardiovascular event score was observed with an increasing LGA tercile, and this pattern prevailed after adjusting for confounding variables.

CONCLUSION

An association between LGA and the 10-year risk of cardiovascular event was observed in a representative sample of hypertensive and diabetic patients.

Individual and Contextual Characteristics Associated With Alcohol Use Among Brazilian Adolescents

Objective: To analyze the association between individual and contextual characteristics with alcohol indicators of experimentation, use in the last 30 days and drunkenness in Brazilian adolescents.

Methods: Cross-sectional study based on data from 100,914 student attending 9^th grade from the 2015 National School Health Survey. Multilevel logistic regression models were performed for the outcomes: alcohol experimentation; use in the last 30 days and drunkenness; and exposures, adjusted for adolescents’ sociodemographic characteristics.

Results: Girls were more likely to experiment alcohol (OR = 1.09; 95% CI = 1.05–1.12), use it in the last 30 days (OR = 1.09; 95% CI = 1.00–1.13) and less prone to drunkenness (OR = 0.90; 95% CI = 0.87–0.93). A higher proportion of public-school students reported drinking. There was a positive association of substance use by parents, peers and the adolescents themselves with the outcomes. Having a policy of banning alcohol consumption at school was associated with a greater chance of alcohol experimentation in public schools.

Conclusion: Exposure to legal and illegal substances by friends, family members and a prohibitive school environment favored the outcomes.

Wealth Inequalities in Different Types of Violence Among Brazilian Adolescents: National Survey of School Health 2015

Studies have assessed inequalities in violence by economic status, but few studies have been done with adolescents from middle-income countries. Our objective was to analyze inequalities in verbal bullying, family physical violence, sexual violence, and fights with weapons among Brazilian adolescents in school according to wealth and stratified by sex and skin color. We used data from the Brazilian National Survey of School Health (Pesquisa Nacional de Saúde do Escolar [PeNSE]), carried out in 2015, with a representative sample of Brazilian adolescents attending ninth grade in public and private schools. We created a wealth index based on questions about access to goods and services through principal component analysis; this index was later divided into quintiles. We calculated the slope index of inequality (SII), the concentration index (CIX), and simple measures of inequality, such as ratio and difference. To identify statistically significant differences in sex and skin color inequality, we used the t test. We found high prevalence values of verbal bullying and family physical violence, 23.9% and 14.5%, respectively. In general, when comparing the types of violence according to SII and CIX, we observed a higher prevalence of violence among adolescents in the lower income quintiles, for both sexes and skin colors. We observed higher wealth inequality in sexual violence among girls (CIX = -14.89) when compared with boys (CIX = -4.63) (p = .001). We also observed higher wealth inequality in sexual violence among Whites (CIX = -15.55) when compared with Brown (CIX = -6.23) (p = .009). Wealth inequality aggravates the occurrence of violence among poorer Brazilian adolescents. Also, the identification of vulnerable groups may contribute to target public policies for fighting violence.

Association of uric acid and uric acid to creatinine ratio with chronic kidney disease in hypertensive patients

Background

Recent studies have shown that the serum uric acid/creatinine ratio (SUA/SCr) is a better predictor of chronic kidney disease (CKD) than serum uric acid (SUA) isolated. The aim of the present study was to evaluate the association of isolated SUA and the SUA/SCr with CKD in hypertensive patients.

Methods

Cross-sectional study conducted with hypertensive patients followed-up by the Primary Health Care Service (PHC). Sociodemographic, economic, lifestyle, clinical, anthropometric, and biochemical variables were evaluated. The association between SUA parameters (quartiles of SUA and quartiles of SUA/SCr) and CKD was evaluated by bivariate and multivariate logistic regression. The association between SUA parameters (SUA and SUA/SCr) and estimated glomerular filtration rate (eGFR) was evaluated by linear regression. The analyses were performed considering four adjustment models. SUA and SUA/SCr were compared by receiver operating characteristic (ROC) curve.

Results

In the fully adjusted model, SUA was positively associated with the presence of CKD (OR = 6.72 [95 % CI 1.96–22.96]) and inversely associated with eGFR (β Coef. = -2.41 [95 % CI -3.44; -1.39]). SUA/SCr was positively associated with eGFR (β Coef. = 2.39 [1.42; 3.36]). According to the ROC curve, the SUA is a better predictor of CKD than the SUA/SCr.

Conclusions

Elevated levels of isolated SUA were associated with CKD and eGFR. However, the SUA/SCr was not associated with CKD. We do not recommend using the SUA/SCr to predict CKD in hypertensive patients.

Educational disparities in hypertension, diabetes, obesity and smoking in Brazil: a trend analysis of 578 977 adults from a national survey, 2007-2018

OBJECTIVES

Our study aimed to assess social inequality trends for hypertension, diabetes mellitus, smoking and obesity from 2007 to 2018 in adults from Brazilian capitals.

SETTING

Data from the Surveillance of Risk and Protection Factors for Chronic Diseases by Telephone Survey study, a cross-sectional telephone survey, conducted annually from 2007 to 2018.

PARTICIPANTS

We used data from 578 977 Brazilian adults (≥18 years).

DESIGN

Cross-sectional surveys conducted annually from 2007 to 2018.

PRIMARY OUTCOME MEASURES

Participants responded to a questionnaire about medical diagnosis of hypertension and diabetes, smoking status, weight and height. Educational inequalities (0-3, 4-8, 9-11 and 12 or more years of study) by sex and skin colour were assessed trough absolute, Slope Index of Inequality (SII) and relative measures of inequality, Concentration Index and trends were tested by Prais-Winsten.

RESULTS

All outcomes were more prevalent in the least educated. The largest absolute educational inequality was observed for hypertension (SII_total=-37.8 in 2018). During 2007-2018, the total educational disparity remained constant for hypertension, increased for diabetes and smoking, and decreased for obesity. Overall, inequality was higher among women and non-whites, compared with men and whites. We found a reduction in absolute inequality for hypertension among non-whites, an increase for diabetes in all strata, and an increase for smoking in women and non-whites. The relative inequality decreased in women and whites and increased for smoking in all strata, except among men.

CONCLUSION

The educational inequality reduced for obesity, remained constant for hypertension and increased for diabetes and smoking from 2007 to 2018 in Brazilian adults.

Prevalence of chronic kidney disease in Brazilians with arterial hypertension and/or diabetes mellitus

The present study aimed to evaluate the prevalence of chronic kidney disease (CKD) in individuals with arterial hypertension (AH) and/or diabetes mellitus (DM) accompanied by Primary Health Care (PHC) in Brazil. The estimated glomerular filtration rate (eGFR) based on creatinine, and urinary albumin-to-creatinine ratio (ACR) were measured in 841 subjects with AH and/or DM, followed by PHC in the city of Viçosa. The CKD was diagnosed according to KDIGO criteria. Sociodemographic, clinical, and anthropometric factors related to the prevalence of CKD were investigated through multiple logistic regression. The prevalence of hidden CKD was 15.4%. Of these, 7.5% were identified by albuminuria (ACR ≥30 mg/g) with slightly decreased eGFR. Age, baseline disease, waist circumference (WC), and systolic blood pressure remained associated with CKD after multivariate analysis. The two major risk factors for hidden CKD were the presence of AH in association with DM and an increase in age. Hidden CKD was more common within people with AH and DM, and with high WC, glycosylated hemoglobin, and serum phosphorus as well as male gender and decreased serum albumin. This knowledge of risk associations can help avoid progression to CKD.

Survival and analysis of predictors of mortality in patients undergoing replacement renal therapy: a 20-year cohort

Background

optimal management of end-stage renal disease (ESRD) in hemodialysis (HD) patients should be more studied because it is a serious risk factor for mortality, being considered an unquestionable global priority.

Methods

we performed a retrospective cohort study from the Nephrology Service in Brazil evaluating the survival of patients with ESRD in HD during 20 years. Kaplan-Meier method with the Log-Rank and Cox’s proportional hazards model explored the association between survival time and demographic factors, quality of treatment and laboratory values.

Results

Data from 422 patients were included. The mean survival time was 6.79 ± 0.37. The overall survival rates at first year was 82,3%. The survival time correlated significantly with clinical prognostic factors. Prognostic analyses with the Cox proportional hazards regression model and Kaplan-Meier survival curves further identified that leukocyte count (HR = 2.665, 95% CI: 1.39–5.12), serum iron (HR = 8.396, 95% CI: 2.02–34.96), serum calcium (HR = 4.102, 95% CI: 1.35–12.46) and serum protein (HR = 4.630, 95% CI: 2.07–10.34) as an independent risk factor for the prognosis of survival time, while patients with chronic obstructive pyelonephritis (HR = 0.085, 95% CI: 0.01–0.74), high ferritin values (HR = 0.392, 95% CI: 0.19–0.80), serum phosphorus (HR = 0.290, 95% CI: 0.19–0.61) and serum albumin (HR = 0.230, 95% CI: 0.10–0.54) were less risk to die.

Conclusion

survival remains low in the early years of ESRD treatment. The present study identified that elevated values of ferritin, serum calcium, phosphorus, albumin, leukocyte, serum protein and serum iron values as a useful prognostic factor for the survival time.

Efect of vitamin A suplementation: a systematic review

To evaluate the effect of vitamin A supplementation in postpartum infants and women on serum retinol levels and breast milk. The databases Medline, PubMed, Lilacs and SciELO were consulted. The descriptors used were vitamin A, dietary supplement, child, postpartum period, infant and nutrition programs policies. Search found 7432 articles. After elimination of duplicity and application of eligibility criteria, 8 studies remained. All evaluated the effect of vitamin A supplementation on immediate postpartum, five studies used retinyl palmitate supplementation, one with retinyl palmitate and two did not specify the form of supplementation. Six studies evaluated colostrum and two included supplementation of children. It was found that supplementation in the puerperium increases the concentrations of serum retinol and breast milk, however, this result was in the short term and was relevant when the previous concentrations of the mother were low. When maternal serum concentrations are adequate, the retinol content in milk does not change, with little relevance for children. Further studies should be performed to evaluate the effect of megadoses supplementation on serum concentrations of children.

[Process of Accreditation of Health Promoting Schools worldwide: A Systematic Review]

The scope of this article is to analyze the accreditation criteria of the studies that evaluated actions of health promotion and risk factor prevention of Health Promoting Schools (HPS). A systematic review was conducted based on the recommendations proposed in the "Preferred Reporting Items for Systematic Reviews and Meta-Analyses (Prisma)" protocol of articles that assessed HPS in the following databases: SciELO, Lilacs, Medline, PubMed and Portal Capes. From the analysis of the three pillars for accreditation of HPS, three of the studies analyzed did not include all the criteria for certification as HPS on the "Planning Process" and "Health Promotion Activities Developed" pillars. The schools cited in these studies perform health education, prevention and/or health promotion activities, however, it is misleading to refer to themselves as HPS. The main challenges for implementation, development and continuity of HPS were identified as being intersectionality and insufficient financial and qualified human resources. HPS need to be certified and submitted to an ongoing evaluation process. It is also suggested the topic of health promotion be included in the syllabuses of training courses of health education teachers and other health education professionals.

Collective portfolio: assessment of teaching and learning in health undergraduate courses

The potential of the reflective collective portfolio as a method of teaching, learning and assessment needs to be emphasized. The objectives is to assess and validate the quality of the collective portfolio as a method of teaching, learning and assessment in the training of health professional. Portfolio quality was analyzed using an inventory of analysis that was adapted and tested for this study. In total, 70 portfolios were analyzed. The Kappa test was used to analyze reproducibility, confirming the level of agreement between the appraisers. Descriptive analysis and the t-test were performed to compare results from the years the portfolios were produced. The constructs (layout and organization, comprehensive, reflective, critical and creative thought) exhibited Cronbach alpha values above 0.7, confirming the high reliability of the tool. The weighted Kappa test revealed an elevated and significant agreement (+90%) between the appraisers. Notably, certain items and constructs exhibited significant differences over the years. All of the constructs were assessed better from 2011 onwards, when the assessment and self-assessment tool was implemented. The success of the portfolio depends on strategies that provide students with greater clarity and forms of developing the method.

Performance of primary health care according to PCATool instrument: a systematic review

This study aims to analyze studies that evaluated the performance of Primary Health Care (PHC) services by using the Primary Care Assessment Tool (PCATool) under a worldwide user perspective. This is a systematic review that implemented the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) model, from the following databases: Lilacs, Medline, SciELO, PubMed and the Coordination for the Improvement of Higher Education Personnel (CAPES) Journals Website, using descriptors Primary Care Assessment Tool and PCATool. Considering inclusion and exclusion criteria, we analyzed 22 research papers published from 2007 to 2015. The best-evaluated attributes were cultural competence, first contact use and longitudinality. On the other hand, the worst evaluated were first contact accessibility, family orientation, community orientation and comprehensiveness. Most of the health services evaluated were from Brazil, applied to "traditional" primary care clinic (UBS) and the Health Family Strategy (FHS). Services evaluated should strengthen structure and process components to achieve a better performance in PHC.

[Analysis of three health education strategies for patients with arterial hypertension]

The scope of this article is to compare the effect of three health and nutrition education strategies on adherence to the non-pharmacological treatment of systemic arterial hypertension (SAH), using anthropometric, biochemical, clinical and dietetic parameters. It is a longitudinal intervention study of the comparative and quantitative approach community test. The sample was comprised of 212 individuals diagnosed with SAH, who met the inclusion/exclusion criteria. Participants were allocated into three groups, in order to evaluate different methods of intervention, carried out on a monthly basis, for twelve months. The Kolmogorov-Smirnov, ANOVA and Kruskal-Wallis tests were performed for the analyses. Educational interventions in Group 1 and 2 provided the best results on adherence to the non-pharmacological treatment of SAH. In the comparative analysis of different groups, the reduction of glucose showed statistical significant difference, with Group 2 showing the best evolution. Group 1 and 2 had better results on adherence to non-pharmacological treatment of SAH. It is important to stress that in health service practices there is a challenge to promote health education able to intervene on the issue of adherence to the treatment of SAH.

[The positive deviance approach to change nutrition behavior: a systematic review]

OBJECTIVE

To conduct a systematic review of the literature describing the use of the positive deviance approach to change nutrition behavior in order to identify the potentials of this method for health and nutrition education.

METHODS

Cochrane Library, LILACS, MEDLINE, SciELO, PubMed, and Scopus were searched. The following search terms were used: positive deviance, desvio positivo, positive deviance inquiry and positive deviants. Inclusion criteria were: reporting primary data, clearly defined methods, and availability of full text. The main results of the studies selected for inclusion were described and examined based on psychosocial (socioeconomic and health status, hygiene and nutrition habits), anthropometric (weight, height), and biochemical and clinical (presence of morbidity and biochemical tests) criteria to determine the potential and limitations of the positive deviance approach to change nutrition behavior.

RESULTS

Of the 47 studies identified, nine met the inclusion criteria. The positive deviance method was used for prevention and rehabilitation of child and maternal malnutrition in areas of socioeconomic vulnerability and for the treatment of overweight and obesity in adults. An improvement in maternal and child nutrition and the maintenance of beneficial behaviors over time were underscored as positive impacts of the method.

CONCLUSIONS

The positive deviance approach may help change nutrition behaviors with the aim of reversing child malnutrition and overweight and obesity in adults. This approach seems effective to promote health education in areas of socioeconomic vulnerability.

[Health promotion and primary prevention strategies to fight chronic disease: a systematic review]

OBJECTIVE

To analyze health promotion and primary prevention strategies in the global fight against chronic noncommunicable diseases (NCDs) and to reflect on the challenges of overcoming these diseases.

METHODS

In this systematic literature review, studies were analyzed on health programs identified by the Brazilian Health Ministry as the main global community intervention initiatives: the North Karelia Project, in Finland; the Stanford Three-Community Study, Stanford Five-City Project, Minnesota Heart Health and Pawtucket Heart Health Program, in the United States; the CINDI project, in Europe and Canada; CARMEN in South America; Mirame, in Chile; and Tianjin, in China. The LILACS, Medline, and SciELO databases were searched, as well as the Brazilian Health Ministry, Pan American Health Organization, and World Health Organization websites. Only original articles analyzing primary data were included. The outcomes evaluated in the studies were cholesterol, blood pressure, obesity, physical activity level, tobacco use, dietary habits, and other risk factors for NCDs.

RESULTS

Seventeen studies were selected. The North Karelia Project, Three Community Study, and Five-City Multifactor Risk Reduction Project contributed to decrease tobacco use, cholesterol levels, and blood pressure levels. The Minnesota Heart Health Program and the Pawtucket Heart Health Program had moderate success in reducing the risk factors for NCD. The CINDI and CARMEN programs demonstrated the importance of integrated actions for decreasing the main risk factors. The Mirame project, which focused on educational interventions for school children, reached 30,000 students in 2001 without requiring a large financial investment. The Tianjin project was able to reduce salt intake, prevalence of arterial hypertension, and obesity by restructuring primary health care services.

CONCLUSIONS

These successful experiences in community health improvement may serve as models for the implementation of more effective health policies, aiming at the development of actions that integrate health promotion and primary prevention of the main risk factors for NCDs.

A problemática da adesão na prevenção da anemia ferropriva e suplementação com sais de ferro no município de Viçosa (MG)

Foi analisada a apreensão das mães/responsáveis por lactentes suplementados com sulfato ferroso, sobre a anemia e suas consequências, por grau de adesão à suplementação. Pesquisa populacional, prospectiva e quanti-qualitativa. Selecionou-se crianças não anêmicas e que não estivessem recebendo suplementação. As mães/responsáveis foram orientadas a administrarem a suplementação profilática de ferro por seis meses e a adesão foi avaliada após o período. Dentre as 133 crianças elegíveis inicialmente para a pesquisa, foi possível reavaliar 90 pares crianças/responsáveis e realizaram-se entrevistas semiestruturadas com os responsáveis. Das crianças avaliadas, 56,7% apresentaram alta adesão e 43,3% baixa, sendo que 23,3% destas tinham interrompido a suplementação, sendo os motivos mais frequentes a ausência de orientação e apoio do serviço de saúde. Dentre as mães/responsáveis, um baixo percentual reconheceu o sulfato ferroso como forma de prevenção da anemia, e ambos os grupos demonstraram pouco conhecimento acerca da anemia, suas formas de prevenção e consequências à saúde da criança. Há necessidade de mais informação através de atividades de promoção e educação em saúde incluindo estratégias participativas, acompanhamento dos profissionais de saúde e avaliação da percepção dos indivíduos envolvidos na suplementação.

Hipertensão arterial e orientação domiciliar: o papel estratégico da saúde da família

OBJETIVO: Analisar a importância, a efetividade e as limitações de estratégias participativas de educação em saúde sobre a problemática da adesão ao tratamento da hipertensão arterial. MÉTODOS: Estudo de caso, intervencional, de abordagem qualiquantitativa com duração de 4 meses. Participaram do estudo 27 mulheres portadoras de hipertensão arterial, com idade entre 45 e 60 anos e cadastradas no Programa de Saúde da Família de Porto Firme, Minas Gerais. Foram comparadas duas modalidades de intervenção visando à orientação de mudanças dietéticas indicadas no tratamento da hipertensão arterial: uma baseada em atividades educativas em grupo, realizadas na Unidade de Atenção Primária à Saúde; e outra combinada pelas atividades educativas em grupo e por orientações domiciliares. Os dados foram obtidos por grupos focais e entrevistas individuais. Para avaliar os dados qualitativos relacionados à adesão, foram analisados, antes e após a intervenção, o peso corporal, o índice de massa corporal, a circunferência de cintura, a pressão arterial, a glicemia e o consumo alimentar. Os dados foram examinados por análise de conteúdo e estatística descritiva. As variáveis coletadas antes e depois da intervenção foram analisadas pelos testes não-paramétricos de Wilcoxon e Mann Whitney. RESULTADOS: As duas estratégias de educação em saúde tiveram efeito positivo sobre a adesão às orientações nutricionais, o que favoreceu mudanças nos hábitos alimentares e na percepção das mulheres em relação à problemática da doença. CONCLUSÃO: A orientação domiciliar destacou-se como importante indutor da consciência sanitária e como fator de envolvimento dos familiares no processo terapêutico, facilitando a adesão ao tratamento da hipertensão arterial.

Construção de portfólios coletivos em currículos tradicionais: uma proposta inovadora de ensino-aprendizagem

Tradicionalmente, a educação em saúde se baseia em metodologias de transmissão de conhecimentos. Porém, agora se exige a formação de profissionais com perfil crítico-reflexivo e capazes de trabalhar em equipes. O que requer novas metodologias de ensino-aprendizagem, tendo na problematização um instrumento de transformação. É relatada experiência utilizando a construção de portfólios coletivos na aprendizagem, como mudança de atitudes e na avaliação de alunos de graduação, em contexto de estrutura curricular tradicional e por disciplinas. Estudo exploratório descritivo, com abordagem quali-quantitativa, fundamentado na análise de portfólios coletivos (n= 9), construídos pelos acadêmicos da disciplina Políticas de Saúde, complementado com a aplicação de um questionário aberto aos alunos (n=58) e com a realização de grupos focais (n=3). Os portfólios coletivos mobilizaram o pensamento crítico-reflexivo sobre a política do Sistema Único de Saúde, ampliando a concepção sobre o processo saúde-doença e as práticas relacionadas aos serviços de saúde, valorizando o trabalho em equipe e a busca ativa na construção do conhecimento, destacando-se os exercícios da alteridade, resiliência e empoderamento.

Implantação e impacto do Programa Nacional de Suplementação de Ferro no município de Viçosa - MG

Objetivou-se avaliar a implantação do Programa Nacional de Suplementação de Ferro no município de Viçosa/MG e seu impacto em lactentes não anêmicos de 6 a 18 meses de idade, atendidos pelas Equipes de Saúde da Família. Realizou-se entrevistas aos profissionais de nível superior e às mães/responsáveis pelas crianças. As crianças não anêmicas e que não recebiam suplementação anteriormente (n=133) foram suplementadas com xarope de sulfato ferroso por seis meses. Realizou-se dosagem de hemoglobina, avaliação antropométrica e de condições socioeconômicas, antes e após os seis meses. Classificou-se como alta adesão as crianças que ingeriram 75% ou mais da dose prescrita e como baixa adesão as demais, de acordo com o referido pelas mães. Sobre a implantação do PNSF no município, observou-se que o sistema de distribuição nem sempre foi acessível ao grupo prioritário e houve ausência de capacitação e motivação da maioria dos Agentes Comunitários de Saúde; sobre o grupo prioritário observou-se ausência de divulgação para promoção do PNSF, além de sensibilização e educação somente de parte das mães; quanto ao suplemento as crianças tiveram baixa adesão e a dosagem não foi efetiva na prevenção da anemia. Portanto, a implantação do PNSF no município revelou entraves operacionais importantes.