Top PDF Abstract The scope of this article was to identify

the boundaries of the autonomy of local admi- nistration in the context of the federal pact in the Brazilian Unified Health System and the impor- tance and potential for promoting innovation, creativity and evidence-based decision-making by local governments. The methodology used was to ask questions that favored dialogue with the specific literature to identify the influence of centrally-formulated policies in spaces of local autonomy and then to identify strategies to fos- ter innovation, creativity and the systematic use of evidence-based research in health policy im- plementation. A gradual reduction in municipal decision-making autonomy was detected due to increased financial commitment of the munici- palities resulting from responsibilities assumed, albeit with the possibility of reverting this trend in the more recent context. Some determinants and challenges for the dissemination of innovative practices were analyzed and some relevant natio- nal and international experiences in this respect were presented. The conclusion drawn is that it is possible to make local decision-making more ef- fective provided that initiatives are consolidated to promote this culture and the formulation and implementation of evidence-based health policies. Key words Decentralization, Local government, Health systems, Innovation, Evidence in health Silvio Fernandes da Silva 1

and embarrassment. Some workers may choose not to give an honest answer to a question for fear of being condemned as prejudiced, since sexist attitudes are socially unacceptable and may lead to criticisms. Research into behaviors that are deemed worth of reproach or that are illegal may have inaccurate results and statisti- cal biases. However, there is very little research in the literature about how such limitations might be assuaged. In order to address this risk, the researchers carried out a full explanation of the research objectives and methodology before applying the research instruments, and insisted upon the guarantee of confidentiality. In addi- tion, the questionnaires were completed by the respondents themselves, in a quiet place where other people would not disturb them. The re- spondent always replied on an individual basis, therefor avoiding any kind of intimidation or embarrassment, either on the part of the respon- dent themselves or of a third party who might try to influence the answers. Crömbach’s alpha was also used for the statistical analysis in order to measure the reliability of the results.

Abstract The objective of this study was to rese- arch the existence of sexism against women among primary healthcare (PHC) workers and to identify associated factors. This was a cross-sectional study in which 163 PHC professionals of both sexes par- ticipated, all of whom were aged over 18 and had completed their primary or secondary education. The Gender Stereotyping and Ambivalent Sexism Inventory questionnaires were used. The average scores were more than 50% of the maximum score: Gender Stereotyping – 53.8%, hostile sexism – 58.2%, benevolent sexism – 64.1%. The average scores stratified by sociodemographic variables were higher. Significant differences in the hostile sexism score were found for sex (men scored higher than women), religion (higher scores for evangelical Christians) and among those who drank alcohol. For benevolent sexism, differences were found for schooling (greater scores for those who had only completed their primary education), religion (hi- gher scores for evangelical Christians and Catho- lics) and area of work (greater for those working in general services). The stratification of the Gender Stereotyping scores did not point to significant diffe- rences. Sexist prejudice was found to exist for hostile sexism, benevolent sexism and gender stereotyping. This finding could have a negative influence on the service-user relationship, leading to greater inequi- ties in health as a result of gender inequality. Key words Women’s health, Sexism, Health ine- quality, Healthcare staff, Health services

16. Thompson SJ, Bender KA, Lewis CM, Watkins R. Run- away and pregnant: risk factors associated with preg- nancy in a national sample of runaway/homeless fe- male adolescents. J Adolesc Health 2008; 43(2):125-132. 17. Noto AR, Galduróz JCF, Nappo SA, Fonseca, AM, Car- lini CMA, Moura YG, Carlini EA, organizadores. Le- vantamento nacional sobre o uso de drogas entre crianças e adolescentes em situação de rua nas 27 capitais brasilei- ras, 2003. São Paulo: Centro Brasileiro de Informações sobre Drogas Psicotrópicas; 2004.

As the main limitation, the study presents the application of a questionnaire to the users of emergency services, because they are there in the condition of being a patient, and therefore, not all were shown to be fully willing to collabo- rate. In view of this, one must consider that not all the responses were faithful, and the possibility of uncertainty of the information, seeing that the capacity of the individuals to remember could be diminished. The effect of this factor was mini- mized by collecting the data on the electronic re- cord charts, in spite of some being very concise, and the use of a period of time of 10 days for the interviewer to remember about medications.

Para calcular as diferenças de médias de bem -estar subjetivo (escalas SLSS, PWI-SC, OLS) em função das variáveis: a) sociodemográficas sexo (menino/menina); ano escolar (6º/7º) titularida- de (público/privado), territorialidade da escola (urbano/rural); b) contextos de desenvolvimento (casa, escola, bairro); c) clima escolar (ambien- te, regras, relacionamento), por nível baixo/alto (acima ou abaixo da média), utilizamos o teste t de Student (nível de significância p < 0,05). No caso das diferenças de médias de bem-estar em função da tipologia bullying (não envolvidos, ví- timas, agressores, vítimas-agressores), utilizamos ANOVA de um fator com a prova Scheffé como contraste (p < 0,05). Resultados analisados atra- vés do uso do software Statistical Package for the Social Sciences (SPSS), versão 19.

still little investigated in Brazil. Even when they are included in certain analyses, the social deter- minants of health are not highlighted because they do not have the same strength as biological variables. However, hierarchical analysis brings to light the interrelationships and mediation ef- fects between these determinants and the ones traditionally known to be involved in the oc- currence of LBW in the children of adolescent mothers, while also enabling the identification of when it is that they have the greatest impact on LBW. As such, it can demonstrate the relation- ship between inequalities and social inequities in perinatal health.

The prevalence of sexual violence was initial- ly calculated with its respective confidence inter- vals of 95% (CI95%). To verify these associated factors, bivariate analyses were carried out with estimates of the Odds Ratio (OR) and its re- spective CI95% to the significance level of 0.05. Following this, a multivariate analysis was con- ducted for an outcome inserted into the model of independent variables that presented association with the outcomes at a significance level inferi- or to 0.20, calculating the adjusted ORs (ORa) and its respective CI95%. All of the analyses were done in the program SPSS version 2.0, utilizing procedures of the Complex Samples Modules, suitable for analysis of data obtained by a com- plex sampling plan.

The Spearman correlation between the WHOQOL-Bref domains (Physical, Psycholog- ical, Social Relations, and Environment) and global QOL, considering the total number of elderly individuals, showed that all domains correlated positively and significantly with the global domain, although the correlations are of low magnitude. Thus, multiple linear regression analysis was performed to verify the contribution of each domain to the global QOL (dependent variable); the four domains together account for 40.5% of the global QOL. The Social Rela- tions domain presented the lowest contribution (6.0%), followed by Psychological (7.5%) and Environment (9.9%), not presenting statistical significance. The domain that most impacted on the overall QOL is the Physical domain (17.1%), with a statistically significant difference (Table 4). Table 5 presents the estimates of the Spear- man correlation coefficients between the WHO- QOL-Old dimensions (Sensory Skills, Autonomy, Past, Present, and Future Activities, Social Partic- ipation, Death and Dying, and Intimacy) and the OLD general score, considering the 48 elderly, demonstrating that all dimensions correlated

The food list presented in the questionnaire included examples of foods presented in the sec- ond edition of the Brazilian Dietary Guidelines with modifications for some of their names. For example, biscuit was denominated cream-filled biscuit, and nugget-type breading was called breaded chicken. Examples of the food defini- tions given in these Guidelines were also used in this study: food preserved in brine or salt and vinegar solution (pickled olive), dried fruit (dried apricots), canned fruit (peaches preserved in syrup), ready frozen dough (frozen ready-to- eat lasagne) and breads made with wheat flour, yeast, water and salt (French bread). These pre- cautions were taken to avoid using examples of foods not covered by the guidelines.

Abstract The objective of this work was to pres- ent the theory, propose the practice and evaluate the difficulties of the new food classification sys- tem that was presented in the second edition of the Dietary Guidelines for the Brazilian Popu- lation. The questionnaire used included a list of 30 foods divided into four groups: in natura or minimally processed foods (I), culinary ingredi- ents (C), processed foods (P) and ultra-processed foods (U). The participants categorized the foods before and after a mini-course. The correct clas- sification score in the Global Assessment (C, I, U, P) was significantly higher after the mini-course (Median = 23) than before the mini-course (Me- dian = 13) (Wilcoxon Signal Test; z = -7.33; p = 0.000; Cliff ’s Delta = 0.96). The low percentage of correct answers before the mini-course justifies the wide dissemination of the theme and the need for more similar courses for students, professionals and the general population.

Esses métodos são robustos às populações não estáveis. Contudo, quando as populações são abertas à migração, alguns cuidados devem ser tomados. Os fatores de correção, derivados dos graus de cobertura utilizados neste trabalho, seguem a recomendação para minimizar o efei- to da migração, que consiste em adotar a média das estimativas geradas pelos métodos anteriores, bem como desconsiderar as idades mais afetadas pela migração 16 .

The predictors in the present study were com- ponents of time spent in sedentary behavior, in- cluding television viewing, playing video games, using the computer and non-screen activities (talking to friends, playing cards or dominoes, talking on the phone, driving, or as a passenger, reading or studying). The mean time spent in each of these behaviors (in a typical week) was asked separately for weekdays and weekends, assigning weight 5 to weekdays and weight 2 to weekends and dividing the result by 7 to obtain the mean time in minutes per day 14 . Screen entertainment

assesses the global, objective and subjective bur- den, based on independent scores. Elements of the individual’s family life are assessed separate- ly, enabling the assessor to identify the areas of greatest and least burden sustained by the family member in their role as caregiver. The level of burden is thus evaluated across five elements of the caregiver’s life: A) care in the patient’s daily life; B) supervision of the patient’s problematic behaviors; C) financial onus borne by the fami- ly member due to the patient; D) impact on the family’s daily routine; and E) family member’s concerns with the patient. The questions for each one of the elements relates to the 30 days prior to the application of the scale. Objective burden is analyzed in relation to the frequency of care provided to the patient and includes subscales A, B and D. Subjective burden evaluated the level of inconvenience felt by the family member and re- lates to subscales A, B and E.

(Roldán-Ruiz, 2001). Some advantages of gliadin alleles for wheat genotype identification over up-to-date molecular markers have been discussed (Metakovsky et al., 1997). Although located on only two chromosomes of seven homologous groups, gliadin genes (Payne et al., 1982) show many more multiple alleles than other wheat genes: more than 30 allelic variants were described and catalogued for some Gli loci (Metakovsky et al., 1991), while only a few alleles were found for the most polymorphic DNA markers (Talbert et al., 1994; Röder et al., 1995). Therefore, using gliadin alleles enables investigation of wheat cultivars to reveal much more intraspecific genetic polymorphism.

scribe and analyze factors associated with sexu- al violence (SV) among primary school students in Brazil. Data from the National School Health Survey (PeNSE in Portuguese) in 2015 was ana- lyzed. The prevalence of total and disaggregated SV was calculated according to variables such as sociodemographic data, family context, mental health, risk behaviors, safety, and physical activ- ity. The Odds Ratios of suffering SV were estimat- ed according to variables that were statistically associated (p < 0.05) by means of multivariate analysis. The prevalence of SV was 4.0%. SV among school-age adolescents was associated with characteristics such as: age of < 13 years old; fe- male; black skin color; working; being assaulted by family members; having insomnia; feeling lonely; not having friends; consuming tobacco / alcohol regularly; having tried drugs; having started sex- ual activity; feeling insecure on the way to or at school; and having suffered bullying. Studying in a private school, having a mother with higher education, living with parents, and supervision by relatives were protective factors to SV. It was possible to identify students’ vulnerabilities to SV, which can support researchers, professionals, and families in the prevention of this type of violence. Key words Adolescents, School health, Sexual vi- olence, Health survey

No presente estudo, a prevalência de sintomas depressivos, medidos pela Escala de Depressão Geriátrica – EDG, foi de 18,3%. As maiores preva- lências de sintomas depressivos estavam relacio- nadas aos idosos que apresentavam de 1 a 9 dentes na cavidade bucal, a percepção de boca seca e a percepção de dor na boca. Cabe ressaltar que tan- to possibilidade do acesso aos cuidados de saúde bucal quanto a prevalência dos sintomas depres- sivos dos idosos avaliados são semelhantes ao da população de idosos do município. No que diz respeito ao acesso aos serviços de saúde bucal, os idosos avaliados apesar de apresentarem cadastro nas unidades de saúde família, no momento do estudo, estas unidades não tinham equipes de saú- de bucal e não havia dentistas em algumas delas. Deste modo, não era garantindo o acesso aos cui- dados de saúde bucal, semelhante ao que acontece para todos os idosos do município. Em relação à prevalência de sintomas depressivos, os resultados deste estudo são semelhantes a um estudo de base populacional realizado com idosos neste mesmo município em 2014 2 . Diante dessas informações e

Abstract The scope of this article is to analyze the accreditation criteria of the studies that eval- uated 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 Re- porting Items for Systematic Reviews and Me- ta-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 in- clude 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, preven- tion and/or health promotion activities, howev- er, it is misleading to refer to themselves as HPS. The main challenges for implementation, devel- opment 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 pro- motion be included in the syllabuses of training courses of health education teachers and other health education professionals.

deste estudo. O fato de os cardápios do PNAE serem elaborados por nutricionistas, conforme os preceitos de uma alimentação saudável, deve- ria colaborar para uma associação significativa com o consumo de alimentos protetores, resul- tado que não foi encontrado. Vale destacar que o consumo de alimentos da escola foi avaliado por meio de apenas um Recordatório de 24 horas, o que pode ter colaborado para não se encontrar associação entre as variáveis. Uma pesquisa com 2.314 escolares dos Estados Unidos da América aponta que consumidores do School Lunch Pro- gram (SLP) e do School Breakfast Program (SBP) apresentam melhor perfil dietético na escola. De acordo com os autores, escolares usuários do SLP consomem mais leite, frutas, sucos naturais e menos sobremesas e snacks (p < 0,01), enquan- to usuários do SBP ingerem mais leite, frutas e

Uma das principais limitações deste estudo refere-se à não quantificação da ingestão dos ali- mentos referidos. A aplicação de um questioná- rio de frequência alimentar que quantificasse os alimentos consumidos pela população estudada seria o mais apropriado para inferir nas inges- tões atuais dos adolescentes e compará-las com as recomendações para o sexo e idade. No entan- to, como o objetivo era descrever alguns hábitos alimentares e as possíveis diferenças entre qui- lombolas e não quilombolas, não foram utiliza- das ferramentas para estimar valores precisos de ingestão dos alimentos.