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Objective: To assess the quality of the actions to control cervical cancer (CC) and its correlates. Methods: This is a cross-sectional study conducted from January to March 2019 in 19 municipalities in Bahia, Brazil, with a sample of 241 doctors and nurses from primary health care (PHC). Three dependent variables were chosen- “Performance of educational, promotion, prevention, and monitoring actions” (D1); “Access to diagnostic tests” (D2); “Non-occurrence of high grade cervical squamous intraepithelial lesions (HSIL)” (D3). Poisson regression with robust variance was used, adopting hierarchical input variables to estimate the prevalence ratios and confidence intervals of 95%. Results: The following prevalence rates were found: D1 39.8% (95% CI: 33.8-46.2); D2 73.9% (95% CI: 67.9-79.1); and D3 46.4% (95% CI: 39.9-53.0). These dimensions remained associated with the dependent variables: D1- having professional training courses on the topic; consideration to ensure that collection takes place appropriately by a professional; and women having access to medical transport; D2- nurses treating low-grade lesions; D3- recording the Papanicolaou in electronic medical records; D1 and D2- professionals joining the service through public tender; D1 and D3- working in the PHC (≥ 2 years); D2 and D3- recording Papanicolaou in physical records; and performance of Papanicolaou by residents. Conclusion: Better trained professionals and professionals working in stable work arrangements are associated with comprehensive actions to control CC. Such strategies indicate that investments in work management result in a more organized PHC and more solution-centered work processes. Therefore, working in the PHC for a longer time and nurses performing more clinical actions (collection and treatment) are favored by such organizational actions. Investments in diagnostic support contribute to perceptions of more comprehensive actions to control CC.

Objetivou-se estimar a prevalência de hipertensão arterial, como principal marcador de doença crônica não transmissível (DCNT), e identificar os fatores modificáveis associados, em trabalhadores homens. Foram utilizados dados da linha de base de um estudo longitudinal com uma amostra de 1.024 trabalhadores homens com 18 anos ou mais de um município do Nordeste do Brasil. O marcador de DCNT foi a hipertensão arterial, definida por pressão arterial sistólica ≥ 140mmHg e/ou pressão arterial diastólica ≥ 90mmHg e/ou diagnóstico prévio de hipertensão arterial e/ou uso de medicamentos anti-hipertensivos. Empregou-se a regressão de Poisson com variância robusta, adotando a entrada hierárquica de variáveis. Foram calculadas frações atribuíveis populacionais (FAP) para as variáveis de estilo de vida, a fim de dimensionar o impacto dos fatores modificáveis na saúde dos trabalhadores. A prevalência da hipertensão arterial nesta população foi de 28,6% (IC95%: 25,9-31,5), os fatores distais: idade > 40 anos, cor da pele preta e renda familiar ≥ 3 salários mínimos; fatores intermediários: consumo abusivo de álcool, consumo de tabaco, percepção de um consumo elevado de sal e inatividade física e o fator proximal: sobrepeso e obesidade associaram-se positivamente com a hipertensão arterial. O cálculo da FAP permitiu observar que se ocorresse a redução ou eliminação de hábitos e comportamentos relacionados ao estilo de vida deste público, reduziria em 56,1% a prevalência da DCNT estudada. A identificação de fatores modificáveis e como estes podem interferir negativamente na saúde de trabalhadores homens possibilita o planejamento de intervenções no próprio local de trabalho, a fim de alcançar o maior número de indivíduos, visando reduzir os efeitos deletérios das DCNT. The study aimed to estimate the prevalence of arterial hypertension as the principal marker of chronic noncommunicable diseases (NCDs) and to identify associated modifiable factors in male workers. Baseline data were used from a longitudinal study with a sample of 1,024 male workers 18 years or older in a municipality in Northeast Brazil. The marker for NCDs was arterial hypertension, defined as systolic pressure ≥ 140mmHg and/or diastolic pressure ≥ 90mmHg and/or prior diagnosis of arterial hypertension and/or use of antihypertensive medication. Poisson regression with robust variance was used, adopting hierarchical entry of variables. Population attributable fractions (PAFs) were calculated for the lifestyle variables to measure the impact of modifiable factors on workers' health. Prevalence of hypertension was 28.6% (95%CI: 25.9-31.5). Distal factors associated with hypertension were age > 40 years, black skin color, and family income ≥ 3 times the monthly minimum wage. Intermediate factors were alcohol abuse, smoking, high self-rated salt intake, and physical inactivity. Proximal factors were overweight and obesity. Calculation of PAFs showed that a reduction or elimination of unhealthy lifestyle habits and behaviors in this population group would reduce the prevalence of the target NCD, hypertension, by 56.1%. The identification of modifiable factors and the ways they can negatively impact male workers' health allows planning interventions in the workplace itself to reach the largest number of individuals, aimed at reducing the harmful effects of NCDs. El objetivo fue estimar la prevalencia de hipertensão arterial, como principal marcador de enfermedad crónica no transmisible (ECNT), así como identificar factores modificables asociados, en hombres trabajadores. Se utilizaron datos de la línea de base, procedentes de un estudio longitudinal, con una muestra de 1.024 hombres trabajadores con 18 años o más de un municipio del Nordeste de Brasil. El marcador de ECNT fue la hipertensão arterial, definida por presión arterial sistólica ≥ 140mmHg y/o presión arterial diastólica ≥ 90mmHg y/o diagnóstico previo de hipertensão arterial y/o uso de medicamentos antihipertensivos. Se empleó la regresión de Poisson con varianza robusta, adoptando la entrada jerárquica de variables. Se calcularon fracciones atribuibles poblacionales (FAP) en las variables de estilo de vida, a fin de dimensionar el impacto de los factores modificables en la salud de los trabajadores. La prevalencia de la hipertensão arterial en esta población fue de 28,6% (IC95%: 25,9-31,5), los factores distales: edad > 40 años, color de piel negra y renta familiar ≥ 3 salarios mínimos; factores intermedios: consumo abusivo de alcohol, consumo de tabaco, percepción de un consumo elevado de sal e inactividad física y el factor proximal: sobrepeso y obesidad se asociaron positivamente con la hipertensão arterial. El cálculo de la FAP permitió observar que, si se produjese una reducción o eliminación de hábitos y comportamientos relacionados con el estilo de vida de este público, se reduciría en un 56,1% la prevalencia de la ECNT estudiada. La identificación de factores modificables y cómo pueden interferir negativamente en la salud de hombres trabajadores posibilita la planificación de intervenciones en el propio lugar de trabajo, con el fin de alcanzar al mayor número de individuos para reducir los efectos mortíferos de las ECNT.

SUMMARY OBJECTIVE: Cardiovascular risk stratification is an important clinical practice to estimate the severity of cardiovascular disease in patients with type 2 diabetes. This study aimed to compare the stratification of global cardiovascular risk with the specific risk stratification for patients with type 2 diabetes, seen at specialized outpatient clinics, and to evaluate possible differences in diagnoses and treatments. METHODS: A total of 122 patients with type 2 diabetes treated at two specialized outpatient clinics, from 2017 to 2019, were studied. The cardiovascular risk stratification calculators, global risk score, Cardiovascular Risk Stratification Calculator, and United Kingdom Prospective Diabetes Study-Risk Engine, were used to calculate the risk of death from cardiovascular disease. The agreement between these calculators was analyzed using the kappa index. The indications for the use of statins and acetylsalicylic acid for the group studied were evaluated according to the Brazilian Diabetes Society Guideline. RESULTS: There was a low degree of agreement among the three risk calculators. The global risk score calculator showed insignificant agreement with the Cardiovascular Risk Stratification Calculator (kappa=0.0816; p=0.0671). There was no agreement between the global risk score calculator and United Kingdom Prospective Diabetes Study-Risk Engine (kappa=-0.099), or between the Cardiovascular Risk Stratification Calculator and United Kingdom Prospective Diabetes Study-Risk Engine (kappa=-0.0095). CONCLUSION: The substantial disagreements among the cardiovascular risk calculators may lead to different diagnoses and may consequently influence therapeutic strategies. The findings herein highlight the need for specific validated cardiovascular risk calculators for patients with DM2 that can reliably estimate risk in these individuals.

Blood pressure measurements taken in a clinical setting are subject to errors, therefore there are advantages to monitoring blood pressure at home, especially in in patients diagnosed with hypertension. The study describes the feasibility of home monitoring to assess blood pressure in primary care and compares blood pressure measured at home and during a medical consultation. This cross-sectional study was carried out with patients whose used home blood pressure in the morning and evening, thrice for seven consecutive day sat home. Participants included patients older than 18 years with suspected whitecoat hypertension, taking antihypertensives, or those intolerant of ambulatory blood pressure monitoring, and excluded patients who did not follow the protocol, suffered from an irregular heart rate, and pregnant women. Of the 134 patients who participated in the study, 63.3% had altered blood pressure when measured at health facilities and 48% had higher blood pressure at home. The mean difference between the methods was 10.1 mmHg for systolic and 4.3 mmHg for diastolic. The prevalence of whitecoat hypertension was 19.4%. Blood pressure monitoring at home is a practicable strategy in the Brazilian healthcare system. Resumo A medição da pressão arterial no consultório está sujeita a erros; assim, a monitorização residencial da pressão arterial é utilizada para o monitoramento e diagnóstico da hipertensão. Descrever a viabilidade da monitorização residencial para avaliar a pressão arterial na atenção primária e comparar os valores da pressão arterial através da monitorização residencial e medida de consultório. Estudo transversal realizado com pacientes que utilizaram a monitorização residencial pela manhã e pela noite, em triplicata por sete dias consecutivos em domicílio. Foram incluídos pacientes maiores de 18 anos, com suspeita de hipertensão do avental branco, utilizando anti-hipertensivos ou intolerantes a monitorização ambulatorial. Foram excluídos pacientes que não seguiram o protocolo, aqueles que apresentavam ritmo cardíaco irregular ou mulheres grávidas. 134 pacientes participaram do estudo, 63,3% apresentaram pressão arterial alteradas em consultório e 48% pela monitorização residencial. A diferença média dos métodos foi de 10,1 mmHg para sistólica e 4,3 mmHg para diastólica. A prevalência de hipertensão do avental branco foi 19,4%. A monitorização residencial da pressão arterial no sistema de saúde brasileiro provou ser uma estratégia viável.

Background: This study aimed to assess the quality of life associated with gender inequalities in formal workers and to determine the effect of sociodemographic, clinical, and behavioral factors on the quality of life (QOL). Methods: This cross-sectional study involved 1270 workers. Quality of life was measured using the EUROHIS-QOL 8-Item and assessed in terms of psychological, environmental, social, and physical domains, while demographic, socioeconomic, behavioral, and clinical variables served as explanatory variables. Analyses were performed using an ordinal logistic regression model whose significance level was 5%. Results: Of the participants, 80.2% were men, and 19.8% were women, the mean age was 34 (standard deviation: ±10) and 32 (±9) years, respectively. In all prediction scenarios, men were more likely to have a higher quality of life, especially in the physical (odds ratio: 2.16, 95% confidence interval: 1.60–2.93) and psychological (odds ratio: 2.09, 95% confidence interval: 1.51–2.91) domains. Conclusions: Men and women had significantly different levels of quality of life, and sociodemographic, clinical, and behavioral variables partially clarified these differences, which were possibly established by a socio-historical process of construction of the work role determined by gender issues.

Introduction: Overweight is an emerging problem among children and adolescents that leads to the development of several morbidities and health risks. Overweight occurs differently in different populations, especially in vulnerable groups like the rural and quilombola communities (an African-descendant population). This study aimed to estimate the prevalence of overweight and to investigate the possible associated factors in rural adolescents living in both quilombola and non-quilombola communities in Northeast Brazil.Methods: This study is a population-based cross-sectional study with a household approach carried out in 2015 with 390 adolescents (age 10–19 years) living in rural quilombola and non-quilombola communities. The nutritional status was gauged using z-scores calculated for body mass index (BMI) and varies with gender and age. Prevalence ratios (PRs) and 95% confidence intervals (95% CIs) were used to establish associations between the results and explained variables. The multivariate analysis followed a model with a hierarchical entry of covariables controlled by gender and age.Results: The study showed that 18.5% of rural adolescents were overweight, of which 17.9% were quilombolas and 19.0% were non-quilombolas. A significant difference in overweight between the samples was not found. In the multivariate-adjusted model, age ≥16 years (PR: 0.51; 95% CI: 0.28–0.95), the habit of having regular breakfast (PR: 0.58; 95% CI: 0.35–0.98), and process of attending school (PR: 0.35; 95% CI: 0.17–0.71) were associated with a lower prevalence of overweight. Stationary screen time, in contrast, was associated with a higher prevalence (PR: 1.61; 95% CI: 1.05–2.46). The process of attending school was associated with a lower prevalence of overweight (PR: 0.26; 95% CI: 0.09–0.69), even for the quilombolas.Conclusions: A low prevalence of overweight was identified in rural adolescents. Overweight was significantly associated with the habit of having regular breakfast, older age, stationary screen time, and the process of attending school. The results reveal that school is a potential space for health promotion interventions, specifically in the most vulnerable rural regions, such as the quilombola communities. Besides, the study emphasizes the importance of adopting a healthy lifestyle early in life, including cultivating the habit of having regular breakfast and reducing stationary screen time.

Background: This study aimed to identify the factors associated with the quality of life of young workers of a Social Work of Industry Unit. Methods: This was a cross-sectional study conducted on 1270 workers. Data were collected using a digital questionnaire built on the KoBoToolbox platform that included the EUROHIS-QOL eight-item index to assess quality of life. Demographic, socioeconomic, behavioral, and clinical variables were considered explanatory. The associations were analyzed using the ordinal logistic regression model at a 5% significance level. Results: Men and women had a mean quality of life of 31.1 and 29.4, respectively. Workers that rated their health as “very good” had an odds ratio of 7.4 (95% confidence interval (CI) = 5.17–10.81), and those who rated it as “good” had an odds ratio of 2.9 (95% CI = 2.31–3.77). Both these groups of workers were more likely to have higher levels of quality of life as compared to workers with “regular”, “poor”, or “very poor” self-rated health. Physically active individuals were 30% more likely to have higher levels of quality of life (odds ratio = 1.3, 95% CI = 1.08–1.65). After adjusting the model by gender, age group, marital status, socioeconomic class, self-rated health, nutritional status, and risky alcohol consumption, the odds ratio of active individuals remained stable (odds ratio = 1.3, 95% CI = 1.05–1.66). Conclusions: In the present study, self-rated health, physical activity, and gender were associated with young workers’ quality of life.

Objective: We evaluated the cost-effectiveness of the point-of-care A1c (POC-A1c) test device vs. the traditional laboratory dosage in a primary care setting for people living with type 2 diabetes.Materials and Methods: The Markov model with a 10-year time horizon was based on data from the HealthRise project, in which a group of interventions was implemented to improve diabetes and hypertension control in the primary care network of the urban area of a Brazilian municipality. A POC-A1c device was provided to be used directly in a primary care unit, and for a period of 18 months, 288 patients were included in the point-of-care group, and 1,102 were included in the comparison group. Sensitivity analysis was performed via Monte Carlo simulation and tornado diagram.Results: The results indicated that the POC-A1c device used in the primary care unit was a cost-effective alternative, which improved access to A1c tests and resulted in an increased rate of early control of blood glucose. In the 10-year period, POC-A1c group presented a mean cost of US$10,503.48 per patient and an effectiveness of 0.35 vs. US$9,992.35 and 0.09 for the traditional laboratory test, respectively. The incremental cost was US$511.13 and the incremental effectiveness was 0.26, resulting in an incremental cost-effectiveness ratio of 1,947.10. In Monte Carlo simulation, costs and effectiveness ranged between $9,663.20–$10,683.53 and 0.33–0.37 for POC-A1c test group, and $9,288.28–$10,413.99 and 0.08–0.10 for traditional laboratory test group, at 2.5 and 97.5 percentiles. The costs for nephropathy, retinopathy, and cardiovascular disease and the probability of being hospitalized due to diabetes presented the greatest impact on the model’s result.Conclusion: This study showed that using POC-A1c devices in primary care settings is a cost-effective alternative for monitoring glycated hemoglobin A1c as a marker of blood glucose control in people living with type 2 diabetes. According to our model, the use of POC-A1c device in a healthcare unit increased the early control of type 2 diabetes and, consequently, reduced the costs of diabetes-related outcomes, in comparison with a centralized laboratory test.

Objective: to analyze factors associated with the monitoring of actions to control cervical cancer in the Family Health Strategy, in a health region of northeastern Brazil. Method: a cross-sectional study conducted from January to March 2019 by means of interviews with 241 physicians and nurses from the Family Health Teams of the Vitória da Conquista health region, Bahia, Brazil. Adequate monitoring was assessed by the degree of actions taken to promote, prevent and actively seek to control cervical cancer. Three blocks of variables were tested as explanatory: professional characterization and training; organization of the unit and access to cytopathological exam; and care coordination and integration. Poisson regression with robust variance was employed, adopting hierarchical entry of variables. Results: 51.9% (95% CI: 45.5-58.2) of the professionals performed adequate monitoring for the control of cervical cancer. Being a nurse, working in the municipality’s primary care network (≥2 years), disclosure of results collection through posters and other communication means, existence of a high-grade lesion, time to perform the biopsy ≤1 month, and agility in the release of the reports were elements associated to the outcome. Conclusion: even with the extended coverage of the Family Health Strategy, small municipalities in the Northeast have characteristics that impose obstacles to comprehensiveness, favoring the incidence of high-grade lesions and greater difficulty in the control of cervical cancer. Assessing the assistance quality in this level revealed challenges in the regionalized network. RESUMEN Objetivo: analizar factores asociados al monitoreo de las acciones para el control del cáncer cervical en la Estrategia de Salud de la Familia, en una región de salud del noreste de Brasil. Método: estudio transversal realizado entre enero y marzo de 2019, por medio de entrevistas con 241 médicos y enfermeros de los Equipos de Salud de la Familia de la región de salud de Vitória da Conquista, Bahía, Brasil. El monitoreo adecuado se evaluó por medio del grado en el que se realizaron acciones de promoción, prevención y búsqueda activa para el control del cáncer cervical. Se probaron tres bloques de variables como explicativos: caracterización y capacitación profesional; organización de la unidad y acceso al examen citopatológico; y coordinación de la atención e integración asistencial. Se usó regresión de Poisson con varianza robusta, adoptando entrada jerárquica de variables. Resultados: 51,9% (IC 95%: 45,5-58,2) de los profesionales realizaban un monitoreo adecuado para el control del cáncer cervical. Ser enfermero, desempeñarse en el sector de atención primaria del municipio (≥2 anos), la exposición de los resultados de los exámenes a través de posters y otros medios de comunicación, la existencia de lesiones de alto grado, el tiempo para realizar la biopsia ≤1 mes, y la agilidad en la emisión de los informes fueron elementos asociados al resultado. Conclusión: incluso con extensa cobertura de la Estrategia de Salud de la Familia, los municipios pequeños del noreste acumulan características que imponen obstáculos a la integralidad, lo que favorece la incidencia de lesiones de alto grado y mayor dificultad para controlar el cáncer cervical. Evaluar la calidad de la asistencia en este nivel dejó al descubierto desafíos en la red regionalizada. RESUMO Objetivo: analisar fatores associados ao monitoramento das ações para controle do câncer cervicouterino na Estratégia Saúde da Família, em região de saúde do Nordeste brasileiro. Método: estudo transversal realizado de janeiro a março de 2019, por meio de entrevistas com 241 médicos e enfermeiros das Equipes de Saúde da Família da região de saúde de Vitória da Conquista, Bahia, Brasil. O monitoramento adequado foi mensurado pelo grau de realização de ações de promoção, prevenção e busca ativa para controle do câncer cervicouterino. Três blocos de variáveis foram testados como explicativos: caracterização e capacitação profissional; organização da unidade e acesso ao citopatológico; e coordenação do cuidado e integração assistencial. Empregou-se a regressão de Poisson com variância robusta, adotando a entrada hierárquica de variáveis. Resultados: 51,9% (IC95%: 45,5-58,2) dos profissionais realizavam monitoramento adequado para controle do câncer cervicouterino. Ser enfermeiro, atuar na atenção primária do município (≥2 anos), divulgação da coleta por cartazes e outros veículos de comunicação, existência de lesão de alto grau, tempo de realização da biópsia ≤1 mês e agilidade na liberação dos laudos foram elementos associados ao desfecho. Conclusão: mesmo com alta cobertura da Estratégia Saúde da Família, municípios de pequeno porte do Nordeste acumulam características que conferem obstáculos à integralidade, favorecendo a incidência de lesão de alto grau e maior dificuldade de controle do câncer cervicouterino. Avaliar a qualidade da assistência nesse nível revelou desafios em rede regionalizada.

Objectives: to determine the prevalence and analyze the factors associated with newborns drinking tea in a birth cohort. Methods: A cross-sectional study with nested prospective cohort was conduct with 329 puerperal women and their newborns in Vitória da Conquista, Bahia. Sociodemographic and information about the newborn's diet and mothers/babies was obtained at a maternity and 30 days after birth, at home visits. The prevalence ratios (PR) and its respective confidence intervals (CI95%) were estimated with Poisson regression models according to the hierarchical conceptual model. Results: the prevalence of tea consumption up to 30 days of life was 34.6% (CI95%=29.7; 40.0%). The sociodemographic and maternal characteristics associated with the outcome were not having a partner (PR = 1.39; CI95%=1.03-1.88), more than eight years of schooling (PR=1.38; CI95%=1.03-1.84), lower income (PR=2.21; CI95%=1.31-3.73), primiparous (PR=1.48; CI95%=1.01-2.17) and does not have any experience with breastfeeding before (PR=2.25; CI95%=1.48-3.41). As for the child, there was a higher prevalence of tea consumption than among those who received artificial milk in the first month of life (PR= 2.10; CI95%=1.62-2.73). Conclusions: the offer of tea in the first month of life was high. Tea consumption was positively associated with sociodemographic, maternal and newborn feeding factors. Resumo Objetivos: determinar a prevalência e analisar fatores associados ao uso de chá em recém-nascidos em uma coorte de nascimento. Métodos: estudo transversal aninhado a uma coorte prospectiva conduzida em 329 puérperas e recém-nascidos em Vitória da Conquista, Bahia. Informações sociodemográficas, relativas à alimentação do recém-nascido e relacionadas aos pares mães-bebês foram obtidas na maternidade e aos 30 dias de nascimento, durante visita domiciliar. As razões de prevalência (RP) e seus respectivos intervalos de confiança (IC95%) foram estimados em modelos de regressão de Poisson conforme modelo conceitual hierárquico. Resultados: a prevalência do uso de chá até os 30 dias de vida foi de 34,6% (IC95%=29,7; 40,0%). As características sociodemográficas e maternas associadas ao desfecho foram não possuir companheiro (RP = 1,39; IC95%= 1,03-1,88), ter até oito anos de estudo (RP=1,38; IC95%= 1,03-1,84), menor renda (RP = 2,21; IC95%= 1,31-3,73), ser primípara (RP=1,48; IC95%= 1,01-2,17) e não possuir experiência anterior com amamentação (RP=2,25; IC95%= 1,48-3,41). Quanto à criança, houve maior prevalência de uso de chá entre as que receberam leite artificial no primeiro mês de vida (RP = 2,10; IC95%=1,62-2,73). Conclusões: a oferta do chá no primeiro mês de vida foi elevada. O uso do chá associou-se positivamente a fatores sociodemográficos, maternos e da alimentação do recém-nascido.

This case report aims to describe the conception and preliminary data of the implementation of a telescreening and telemonitoring program of covid-19 for users of the Unified Health System with risk conditions. A system of telerscreening was implemented through which undergraduate students in the health area contact patients by telephone, according to periodicity and predefined criteria, to monitor the evolution of the condition. In eight weeks, 2,190 attempts at remote contact were made with individuals from five health units. The effective number of individuals monitored at the time this writing is 802.

Background: In Brazil, the use of electronic medical records in primary care has been expanding, improving the supply of information and data storage, and allowing the analysis of various aspects and prediction of future outcomes. Aim: To develop a predictive model for the glycemic level of people with type 2 diabetes mellitus based on data from electronic medical records in primary care. Methods: Data mining techniques were applied to choose response variables and potential predictors. Afterwards, data modelling was performed using Artificial Neural Networks (ANN), which are mathematical models inspired by the neural structure of intelligent organisms that acquire knowledge through experience. They detect non-linear relationships between the response variable and the explanatory variables without these variables having been defined. Results: The highest probability of model accuracy was observed in the capillary blood glucose range between 100 and 300mg/dL. Model predictors and relative importance of each variable are shown in Figure 1. Conclusion: Applying predictive modelling to data available in primary care electronic medical records can help the early identification of individuals with difficulty in glycemic control, and increase the efficiency in the allocation of efforts to treat diabetes. Disclosure S. Mistro: None. T.V.O. Aguiar: None. V.V. Cerqueira: None. K.O. Silva: None. J.A. Louzado: None. C.N. Kochergin: None. D.A. Soares: None. W.W. Amorim: None. D.S. Medeiros: None. V.M. Bezerra: None. V.H. Carvalho: None. E. Amaro: None. M.G. Oliveira: None. M.L. Cortes: None. Funding SUS Institutional Development Support Program; Brazil Ministry of Health; Israelite Hospital; Albert Einstein (25000.028646/2018-10); Medtronic Foundation

Resumo Objetivo: analisar a prevalência e fatores associados ao aleitamento materno na primeira hora de vida (AMPHV) em nascidos vivos a termo em Vitória da Conquista, BA, Brasil. Métodos: estudo transversal aninhado a uma coorte; os dados foram coletados por meio de questionário aplicado às mães e prontuário, de fevereiro a agosto de 2017; empregou-se análise multivariável hierarquizada com regressão de Poisson. Resultados: foram incluídos 388 pares mãe-nascido vivo; a prevalência de AMPHV foi de 49,5%; associaram-se ao desfecho a escolaridade materna ≥12 anos (RP=0,63 - IC95% 0,46;0,87), orientações no pré-natal sobre pega e posicionamento da criança (RP=1,44 - IC95% 1,07;1,95), nascido vivo levado até a mãe logo após o parto (RP=1,41 - IC95%1,04;1,92), alojamento conjunto (RP=2,42 - IC95% 1,09;5,36) e parto realizado em Hospital Amigo da Criança (RP=2,43 - IC95% 1,72;3,43). Conclusão: a AMPHV associou-se a fatores maternos, atenção pré-natal e assistência hospitalar. Resumen Objetivo: analizar la prevalencia y factores asociados a la lactancia materna en la primera hora de vida (LMPHV) en nacidos vivos a término en Vitória da Conquista, BA, Brasil. Métodos: estudio transversal anidado en una cohorte; los datos fueron recolectados por un cuestionario aplicado a las madres y en historial médico, entre febrero y agosto de 2017; se utilizó análisis multivariante jerárquico con regresión de Poisson. Resultados: se incluyeron 388 pares madre-nacido vivo; la prevalencia de LMPHV fue de 49,5%; educación materna ≥12 años (RP=0,63 - IC95%0,46;0,87), orientación prenatal sobre agarre y posicionamiento del niño (RP=1,44 - IC95%1,07;1,95), llevar al nacido vivo a la madre inmediatamente después del parto (RP=1,41 - IC95%1,04;1,92), alojamiento conjunto (RP=2,42 - IC95%1,09;5,36) y parto en el Hospital Amigo del Niño (RP=2,43 -IC95%1,72;3,43). Conclusión: La LMPHV se asoció con factores maternos, atención prenatal y atención hospitalaria. Abstract Objective: to analyze prevalence and factors associated with maternal breastfeeding in the first hour of life (MBFFHL) in full-term live births in Vitória da Conquista, BA, Brazil. Methods: this was a cohort-nested cross-sectional study; data were collected between February and August 2017 using a questionnaire answered by mothers as well as medical records; hierarchical multivariable analysis with Poisson regression was used. Results: the study included 388 mother-liveborn baby pairs; MBFFHL prevalence was 49.5%; outcome was associated with maternal education ≥12 years (PR=0.63 - 95%CI 0.46;0.87), prenatal guidance on child holding and positioning (PR=1.44 - 95%CI 1.07;1.95), liveborn baby taken to its mother soon after delivery (PR=1.41 - 95%CI 1.04;1.92), mother and baby kept together in the same room (PR=2.42 - 95%CI 1.09;5.36), and delivery at a Baby-Friendly Hospital (PR=2.43 - 95%CI 1.72;3.43). Conclusion: MBFFHL was associated with maternal factors, prenatal care and hospital care.

Among men, hypertension stands out as a specific public health problem, as this population has lower rates of treatment, knowledge, and disease control, and less adherence to medication. It was used baseline data from a longitudinal study, conducted with a sample of 1,024 male workers aged 18 years or older from a municipality in Northeast Brazil. Hypertension was defined as systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg, and/or prior diagnosis of hypertension and/or use of antihypertensive drugs. Population attributable fractions (PAFs) were calculated for the associated lifestyle factors. The prevalence of hypertension in this population was of 28.6% (95% CI: 25.9-31.5); the distal factors were age, skin color/ethnicity, and household income; intermediate factors: alcohol abuse, tobacco consumption, perception of high salt intake, and physical inactivity; and the proximal factor body mass index were positively associated with hypertension in male workers. Higher PAFs were observed among workers with tobacco and alcohol abuse, perceived high salt intake, physically inactive, and overweight and obese. Is necessary to take specific actions geared to orientation, prevention, and health promotion in workplaces to reduce complications from hypertension and improve lifestyle among this male population.

Background: Point-of-care (POC) devices allow to assess HbA1c results in a single visit and facilitates the physicians’ decision making for DM control. This study aimed to assess the cost-effectiveness of POC in comparison to standard laboratory (HPLC method) for HbA1c testing in Brazilian primary care. Methods: A Markov model was developed in a 10-year time horizon for the perspective of the public health system. Effectiveness was assessed by the rate of HbA1c control after 6-months follow-up. Data were obtained from an ongoing cohort. Controlled and uncontrolled subjects were included in transition states for negative outcomes (cardiovascular diseases and complications). Probabilities and costs of transition states were extracted from a literature review. Results: Estimated annual cost for patients monitored by HPLC was U.S. $4,884.92 (SD 629.46) for an effectiveness of 0.39. For those monitored by POC, cost and effectiveness were U.S. $5,960.64 (SD 2,514.00) and 0.91, respectively. The evolution of the net monetary benefit is presented in the chart below. Conclusions: HbA1c tested by POC appears to be cost-effective in comparison with laboratory testing to improve glycemic control and prevent DM-related cardiovascular diseases and complications. Disclosure D.S. Medeiros: None. L.S. Rosa: None. S. Mistro: None. C.N. Kochergin: None. D.A. Soares: None. K.O. Silva: None. J.A. Louzado: None. M.L. Cortes: None. V.M. Bezerra: None. W.W. Amorim: None. M.G. Oliveira: None. Funding Medtronic Foundation

Background: Ultra-processed foods are industrial formulations made from food extracts or constituents with little or no intact food and often containing additives that confer hyper-palatability. The consumption of these products increases the risk of chronic non-communicable diseases. Stressed people may engage in unhealthy eating as a way to cope. This study aimed to verify whether ultra-processed food consumption was associated with perceived stress levels in industrial and retail workers from Vitoria da Conquista, Brazil. Methods: This was a cross-sectional study carried out between July 2017 and August 2018. During the study period, 1270 participants completed a survey administered by an interviewer. Stress levels were assessed using the Perceived Stress Scale. Information regarding weekly ultra-processed food consumption was collected. Ultra-processed foods were classified into four groups: sugary drinks, sugary foods, fast foods, and canned foods, frozen foods, or processed meat. The Student’s t-test or one-way analysis of variance was used to assess the differences in stress levels and ultra-processed food consumption. Ordinal regression was used to determine the association between the degrees of stress and ultra-processed food consumption levels. Results: Factors such as a young age, being unmarried, smoking, high-risk alcohol consumption, negative health perception, and high perceived stress level indicated higher rates of ultra-processed food consumption. Ordinal regression analysis showed that high stress levels were associated with increased odds of higher ultra-processed food consumption (odds ratio: 1.94, 95% CI: 1.54–2.45). Conclusions: These findings could help identify appropriate target areas for interventions aimed at mental health promotion and healthier food consumption.

This study sought to evaluate the prevalence of unawareness of arterial hypertension (AH) and associated factors among the quilombola population and to describe aspects of the non-pharmacological management of AH. It involved a cross-sectional study with a sample of 358 people with AH aged 18 years or more. AH was considered systolic blood pressure (BP) ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg and/or reported use of antihypertensive drugs. Unawareness of AH was classified as persons answering negatively when asked if they suffered from AH. Poisson regression was then used. The prevalence of unawareness of AH was 44.1% (95% CI: 38.9-49.3). Among those who already knew the diagnosis and had drug treatment only 24.8% had controlled BP. The unawareness of AH was positively associated with the male sex and Stage 1 of AH and negatively with increasing age, overweight, negative self-perception of health and medical visits. For non-pharmacological management, low percentages of quilombola reported appropriate standard recommendations of care. Arterial hypertension is a serious public health issue among the quilombola population, revealing great vulnerability in health due to poor levels of awareness, treatment and control.

In this study we assessed the role of Bezold–Jarisch reflex (BJR) in the regulation of blood pressure (BP) of malnourished (MN) and control rats (CN) with sino-aortic denervation (SAD). Fischer rats were fed diets containing either 6% (MN) or 15% (CN) protein for 35 days after weaning. These rats underwent sham or SAD and catheterization of femoral artery and vein for BP measurements and drug injection. Phenylbiguanide (PBG 5 μg/kg, i.v.) for activation BJR, produced bradycardia (− 317 ± 22 bpm for CN vs. − 372 ± 16 bpm for MN) and hypotension (− 57 ± 4 mm Hg for CN vs. − 54 ± 6 mm Hg for MN. After SAD, MN rats had reduced hypotensive (− 37 ± 7 mmHg for MN vs. − 82 ± 6 mm Hg for CN) and bradycardic (− 124 ± 17 for MN vs. − 414 ± 20 bpm CN) responses to BJR activation. To evaluate the contribution of the parasympathetic component due to BJR for the fall in BP, methyl atropine bromide, was given between two injections of PBG (5 μg/kg) separated by 10 min each other. Both bradycardic (− 216 ± 21 bpm before and − 4±3 bpm after for CN − 226±43 bpm before and − 9±20 bpm after for MN) and hypotensive (− 42±4 mm Hg before and − 6±1 mm Hg after for CN − 33±9 mm Hg before and − 5±2 mm Hg after for MN) responses were abolished in CN and MN groups. These data indicate that dietary protein malnutrition changes the relation between baroreflex and BJR required for maintenance of the BP during malnourishment.

Malnutrition affects cardiovascular reflexes, including chemoreflex and baroreflex. In this study we assessed the hypothesis that malnourishment changes the responses in mean arterial pressure (MAP), heart rate (HR) and renal sympathetic nerve activity (RSNA) evoked from Bezold–Jarisch reflex (BJR). Fischer rats were fed diets containing either (6% malnourished or 14% control) protein for 35 days after weaning. There were no differences in baseline MAP (102 ± 4 vs. 95 ± 3 mmHg) whereas higher baseline HR (478 ± 18 vs. 360 ± 11 bpm; P < 0.05,) and reduced sympathoinhibition (� RSNA = −54 ± 9 vs. −84 ± 7%; P= 0.0208) to BJR activation were found in malnourished rats. We conclude that malnutrition affects the sympathetic control of BJR. © 2010 Elsevier Ireland Ltd. All rights reserved.

Objectives: to assess the use of pacifier and feedingbottle and their determinants in children from a municipality of Southwest Bahia. Methods: a cross-sectional study was performed with 354 children younger than 12 months old. The event was categorized in: exclusive use of pacifier, exclusive use of feeding bottle,use of pacifier and feeding bottle, and not use any of them. Multinomial analysis with logistic regression was applied, and those who did not use any artificial nipples were thereference variable. Results: it was observed that 11.9% of the children exclusively used pacifiers, 21.2% only use bottles and 32.8% used both of them. The following factors were associated with the exclusive use of pacifiers: low maternal schooling level (eight or less years of education), lack of previous experience with breastfeeding, difficulty in postpartum breastfeeding, and lack of incentive to breastfeeding in puericulture. The exclusive use of feeding bottle was associated with unmarried mothers, aged 35 years old or older, and with less years of education (eight or less years). Women who worked outside home and had difficulty in breastfeeding had greater chance of giving both artificial nipples to the children. Conclusions: the findingspresent different featuresrelated to the exclusive or combined use of pacifiers and feeding bottles, being important to direct health professionals conducts towards mothers’ orientation.