More than 60% of Brazilian adults are overweight, with 25.9% living with obesity. The approach to obesity is multifactorial, involving genetic, behavioral, socioeconomic, and environmental aspects. Although public policies have been implemented to address the problem, stigmatization and fatphobia persist, negatively impacting the physical and mental health of individuals. Effective care requires a comprehensive and humanized approach, considering the various dimensions that influence body weight. We aim to evaluate how the theme of weight stigma is addressed in international and national clinical guidelines for the treatment of obesity published between 2000 and 2022, as well as to understand the perception of primary health care (PHC) professionals regarding how weight stigma and fatphobia are present in the organization of care for individuals with overweight and obesity in PHC.

Article 1 was a systematic review with qualitative synthesis of recommendations from national and international clinical guidelines for the treatment of obesity published between 2000 and 2022. Most clinical guidelines do not emphasize the topic of weight stigma in their recommendations. Despite the limited emphasis on the theme, advances in the discourse of guidelines over the years are identified, and the complexity of care and weight stigma theme begins to emerge.

Article 2 has a qualitative-quantitative approach. Information was obtained through a training course for health professionals in 54 municipalities in Bahia. The study includes reflections on the obesity stigma in the participants' daily work. The research reveals that many PHC professionals consider themselves competent to care for people with overweight and obesity but recognize the potential for their approaches and units to reinforce weight stigma. There is consensus that weight loss is seen as the central focus of care, and personal acceptance of one's body can influence judgment and care for others. The lack of adequate physical structure in health units and blaming and stigmatizing reflections are points of concern in the care provided. Comprehensive training is essential, addressing not only biomedical but also social and psychological aspects, along with investments in inclusive infrastructure and public policies that promote holistic health, valuing body diversity to make care more effective and compassionate.

This dissertation aimed to identify, systematize, and analyze the implications of the Covid-19 pandemic for community health work. This is a research that included an integrative synthesis review, two document reviews, and a multiple case study on the work of Community Health Workers (CHWs) in the pandemic context. The analysis was based on the reference of community orientation and work in health and the debate around the work process, for the understanding of the organization of actions in the pandemic context and the contextual challenges in the national socio-political scenario in the most recent conjuncture. The results were presented and discussed in four articles: The first is a quick synthesis of evidence in bibliographic bases, about the work of Community Health Workers (CHWs) during the pandemic period in different countries. The second is in the form of a book chapter and aimed to provide a brief critical overview of the current perspective on the conformation of the work of CHWs during the pandemic period, based on the recommendations issued by the Ministry of Health in Brazil. However, due to the scarcity of governmental publications in the initial period of the pandemic, the third article sought to identify and analyze the recommendations for the organization of the work of CHWs, based on the analysis of guidelines and governmental and non-governmental orientations aimed at delimiting the response of PHC in Brazil. We admitted documents conveyed and made available by teaching and research institutions and/or of non-governmental nature, including videos, newsletters, taken as a source for the understanding of the research problem. Finally, although there may have been changes in the activities related to the work of CHWs, the literature brought few elements to understand the central characteristics of the work of these professionals in the response to Covid-19. Given the above, the fourth article aimed to identify the organization and characterize the work of CHWs in three municipalities in the Northeast of Brazil, between January 2020 and August 2021. When considering the set of productions derived to answer the questions of this study, this dissertation raises reflections about the role of community health workers, as part of the frontline health workforce in fighting the pandemic in several countries, contributing to unveil the potential of actions directed to the social determinants of health, beyond the control and prevention of pandemics, and especially to reflect on the potential of community guidance in situations of health crises and how it may have been underused or neglected. It is evident in Brazil that the institutional support, training, and continuing education for CHWs during the pandemic were insufficient, which culminated in their leaving their territories. The lack of clear guidelines that are based on the strengthening of the attributes inherent in the work of CHWs, according to community and territorial orientation, is a concern in face of the impossibility of carrying out resolutive actions for the consolidation of a strong and robust PHC, to adequately respond to the needs arising from localized or comprehensive health crises or the premises of the care model prioritized in Brazil. It is observed the need for research to better understand the real potentialities of community orientation, and more cost-effective forms of intervention, to evaluate the results achieved so far and to direct the reorganization of necessary processes, given the configurations of work in PHC currently, in rural and urban Brazilian territories.

Worldwide, when there is a correlation with urban populations, access to health services becomes more difficult when we consider the rurality factor. When we shed light on rural and remote regions, an abyss is perceived between what is idealized in health policies with regard to access, promotion and prevention in health, and what is put into practice in practice. The North region of Brazil, as well as other remote rural regions of the world, face adversity to guarantee equity, completeness and universality of access. In this sense, this dissertation has the general objective of rebuilding the care trajectory of women from the Cervical Cancer (CC) tracer event in the scenario of Remote Rural Municipalities (MRR) in Northern Brazil. The attempt is to analyze the access and organization of Primary Health Care actions using the CC as a tracer event, identifying strategies for accessing the Health Care Network from the perspective of users and proposing strategies for improving care and prevention of CC in rural context. This is a multiple case study, exploratory, of a qualitative nature, having as the unit of analysis the MRR in the north of the country, where family health teams work, and is part of a larger research project entitled "Primary Health Care in rural and remote territories in Brazil”. Municipalities in the territory Norte Estradas and Norte Águas were elected. In the first area, three municipalities were selected for convenience – Jacareacanga-PA, Rurópolis-PA and Assis Brasil-AC –; and seven municipalities in the second area – Aveiro-PA; Curuá-PA; Melgaço-PA; Prainha-PA; Boa Vista do Ramos-AM; Maués-AM and Vitória do Jari-AP. In all, 17 interviewees were distributed across the territory studied. The results are presented by two moments of the care journey of these women through the network: “Primary Health Care in remote rural municipalities: where does the journey begin” and “Specialized and hospital care: care must continue”. The women demonstrated that access to the Pap smear collection is facilitated, but without criteria of prioritization and necessity. Obstacles arose concerning access to test results and guidance on the researched problem, suggesting deficiencies in the organizational process and health education. In general, the users made a positive assessment of the teams' service, but from the perspective of the courtesy with which they were treated by the professionals. When there was a need for specialized care, difficulties in accessing and dismantling the network became evident, exacerbated by the lack or even lack of sanitary transport, increasing the social vulnerability already rooted in this territory, leading these women to compromise their family income and their daily lives. It is necessary to use the characteristics of the territory to develop and/or adapt health policies and practices that are consistent with the needs of remote rural populations, with adjustments in financing and promotion of technologies capable of mitigating the structural inequalities found.

Introduction: Excessive illness requires continuous care from individuals and taxes that health care modes include interprofessional and intercultural actions. Thus, they submit them to their therapeutic itineraries, both via the institutionalized sphere of health services, and through the “informal” field, such as religious practices and homemade medications. In this plot, the biomedical model is predominant in the ways services are organized, in the professionals' work processes and in the way users build their paths in the health care network – formal or informal. In this context, diabetes brings with it motivation that often changes in daily activities, in social, family and work relationships. In addition, when not controlled, it is responsible for several complications, among which the diabetic foot. Diabetic foot is a very serious problem, since it is responsible for greater chances of lower limb amputation. This study analyzes the therapeutic itineraries of individuals with lower limb amputation due to diabetic foot. Methodology: This is a qualitative research, developed with 20 people who had amputation of lower limbs due to diabetic foot, living in rural and urban areas of Vitória da Conquista, Bahia. Data production involved in-depth semi-structured interviews and data were analyzed using Thematic Content Analysis, with the Holistic Analysis of Therapeutic Itineraries as theoretical-methodological support. Results: Four dimensions were evidenced: 1) Facing the illness - senses and meanings lead behaviors. The understanding of the health-disease-care process, influenced by the sociocultural context, defined the starting moment of the search for care. The absence of symptoms delayed the search for assistance and limited knowledge about the disease conditioned the reluctant behavior. In addition, the illness brought suffering to the subjects who felt powerless when facing the complications of the disease. 2) Dealing with vulnerabilities – economic and social aspects mark therapeutic itinerary decisions. The subjects lived in socioeconomic vulnerability and this condition worsened with the amputation. The long waiting periods in the public network led the subjects to search for private services, negatively affecting the financial capacity of the families, once aggravating the health situation due to the economic impossibility of continuing the care in this way. In addition, geographic and economic barriers made it difficult to access health care in a timely manner, since there was a lack of health transport; 3) Mishaps along the way – the search for assistance in the care arenas. The search for care in the formal network was undertaken mostly by the user himself. However, the lack of guidance and referrals by primary health care (PHC) professionals to other points of care may have delayed timely care. This scenario led users to look for other gateways. Furthermore, the lack of counter-referral to the family health unit led users to seek PHC only in the face of occasional needs after the amputation. Along with care in the formal arena, the subjects concomitantly used informal care, which ranged from religious practices to domestic care; 4) Experiencing illness – assessments of care experiences. Long queues for appointments and exams delayed timely care, generating user dissatisfaction. The absence and turnover of physicians compromised longitudinality in PHC, leading users to look for these professionals in the private sector. The pandemic was also an important limiting factor in access. These obstacles generated judicialization processes, evidencing access difficulties present in therapeutic itineraries, pointing to dysfunctions in the health system. Final Considerations: The therapeutic itinerary of different people signaled the multiplicity of experiences and the (lack of) care that permeates the different arenas. The symbolic aspects constructed from the sociocultural experiences of the subjects, composed understandings about health-disease-care, defining choices and behaviors along the way. Living conditions surrounded by vulnerabilities widened the gaps in access to health, placing subjects in even more unfavorable social situations. The pathways also exposed important obstacles related to fragile arrangements in the health care network, with incipient coordination of care by the PHC, leaving users at the mercy of building their own care map.

Introduction:People who are more engaged in their health are more inclined to seek and use information to support their health decisions, and Critical Thinking (CP) emerges as an element capable of assisting in the analysis of health information and decision-making from an individual perspective and collective. The teaching of critical thinking favors an emancipatory education and contextualizes the individual with the environment and society around him, gives protagonism to the student, and hopes to form citizens capable of understanding and intervening in social contexts. Objective: To analyze the context of teaching critical thinking about health, mediated by Digital Information and Communication Technologies (TDIC) in the school and health context in Brazil. Method: This is a qualitative, descriptive study, whose data were collected between February and July 2020, in Vitória da Conquista and Foz do Iguaçu, based on semi-structured interviews and document review. National documents were intentionally selected from specific government websites for the areas of health and education. The interviews followed a script developed by the research team, which was specific for each professional category. A total of 17 interviews were carried out, 12 in Vitória da Conquista and 5 in Foz do Iguaçu. The collected data were compiled and combined, from a research approach applied to public policies. Results: The inclusion of critical thinking in curricula and official documents is present, but there are difficulties in its practical application. Learning resources to teach critical thinking about health are scarce, and they focus on promoting healthy behaviors. There is great variability in the access and use of digital equipment for teaching and learning in national schools, and the main intervening factors are the stability of connections, the technological skills and attitudes of professionals in relation to the use of Digital Information and Communication Technologies (TDIC) for teaching. Although improvements in different contextual elements in Brazilian schools are being planned by local governments, these are still incipient. Conclusion: The teaching of critical thinking about health mediated by the use of TDCI is not deliberate in the Brazilian context, but there are possibilities for its insertion given its expressed potential.

Objective: To describe the tracking and monitoring of people with Hypertension (AH) and Diabetes Mellitus (DM) through health fairs within the scope of Primary Health Care in the city of Vitória da Conquista-Bahia. Methods: a cross-sectional study, part of the HealthRise project, with data collected at 23 health fairs in Family Health Units and Basic Health Units, from May/2017 to April/2018. People with AH, DM and their family members were included. In data collection, an interview was conducted and blood pressure, capillary blood glucose, glycated hemoglobin and anthropometric measurements were collected. For the analysis of article 1, a stratification by the gender variable was carried out, and descriptive analyzes of the population were carried out. A bivariate analysis was also carried out between the presence of comorbidities and the variables under study. Then, the analysis was divided into two groups: one for tracking AH and DM and one for monitoring these conditions. For the second article, a descriptive analysis of the risk score and an assessment of its internal consistency were performed. Sensitivity and specificity were calculated for three different compositions in the patient group. The Positive (PPV) and Negative (NPV) Predictive Values were also calculated. Results: 23 health fairs were held, with a greater participation of women (70.0%). Of the participants, 43.6% had only AH, 3.9% only DM and 18.2% had both diseases. Screening showed a large number of alterations suggestive of DM and AH, since 81.8% of men with AH referred for glycated hemoglobin (HbA1c) collection showed altered values, and among men with DM, 75.5% had altered BP values. In the analysis of DM monitoring in men, 65.6% of those with DM only did not have HbA1c control, and in females, there was no control in 66.0% of users with DM. In the monitoring of AH in males, it was observed that more than 60% of participants did not have control of blood pressure levels, and in the female stratum, more than 58% of users did not have this control. According to the test result, the risk of developing DM2 was present in 62.6% of the participants. Sensitivity was 86.2% when using HbA1c with values covering pre-diabetes, and specificity was 39.7% when using self-reported information. The PPV was 79.1% when considering pre-diabetes levels in the patient group, and the NPV was 68.8% when considering only DM values in the patient group. Conclusions: With the good number of participants in health fairs, and with the identification of several users with alterations in blood pressure and glycated hemoglobin, with or without prior knowledge of the disease, it is possible to confirm the importance and usefulness of health fairs. It was possible to identify users chosen for prevention and treatment measures, in a single place and time, with better management of the resources available in the SUS. It was also observed that the application of a type 2 diabetes mellitus risk test is a good tool for screening in collective approaches, such as in participants of health fairs in Primary Care. It was observed that they can identify individuals at greater risk and refer them to biochemical measurements.

This study analyzed therapeutic itineraries in oral health, in individuals belonging to black race/color, living in peripheral areas in the municipality of Vitória da Conquista – Ba, during the period of the COVID-19 pandemic. qualitative character, through the application of a semi-structured questionnaire, with 14 black and brown SUS-dependent people, attended at the study's reference UBS, during the month of October 2022. The responses were duly transcribed and subjected to content analysis and analysis lexical. The study highlighted the complexity of the therapeutic itinerary experienced by black and brown people, the structural challenges, the increase in disparities during COVID-19, the search for curative procedures, the existence of persistent barriers, underreporting in cases of structural and institutionalized racism, and the need to implement policies in favor of racial equity in health. In this context, it is concluded that the intricate relationship between race/color and access to oral health services reflects inequalities rooted in the health system, characterized by structural and institutional racism. Therefore, it is imperative that public policies and health strategies are reformulated to eliminate these disparities.

Objectives: To describe the deterioration of oral health and the frailty phenotype of the elderly population in the city of Guanambi, Bahia. Methods: Cross-sectional, home-based study carried out between March and April 2023, through interviews and collection of objective measurements. To measure the deterioration of oral health were used the indicator of tooth loss (edentulism). The frailty phenotype was defined based on five characteristics: weight loss, weakness, limited mobility of the lower limbs, exhaustion, and a low level of physical activity. The prevalences of the different categories of tooth loss and the frailty phenotype were calculated, and the associations with the explanatory variables were evaluated using multinomial logistic regression, with estimates of the prevalence ratio (PR) and 95% confidence interval (95% CI). Results: Of the 449 respondents, 53.7% had total edentulism, 20.5% were partially edentulous, and 25.8% were dentate elderly people. This factors were associated with total tooth loss: age greater than or equal to 80 years (RP=2.50); being female (RP=2.62); never having studied (RP=6.25) and having 1 to 5 years of study (RP=3.43), assessment of oral health as fair (RP=0.34) and poor and very poor (RP=0.12); and the last dental appointment was 1 year or more ago (RP=2.04). Frailty was observed in 25.6%, 51.7% were pre-frail, and 22.7% were robust elderly people. The following were positively associated with frailty: living in urban areas (RP=3.51); age 70 to 79 years (RP=3.49) and 80 years and over (RP=24.60); never having studied (RP=3.14); self-reported health as fair (RP=2.91) and poor or very poor (PR=21.69); poor physical health on at least one day in the last 30 days (RP=2.61); and a report of a diagnosis of two or more morbidities (RP=2.85). Total edentulism (RP=2.81) and self-assessment of oral health as poor/very poor (RP=3.41) showed a significant increase in the prevalence of frailty after adjusting for the region of residence. Conclusions: The elderly in Guanambi show a high degree of deterioration in oral health, revealed through extensive tooth loss. Frailty also had a high prevalence, highlighting the vulnerability of the studied population. To maintain healthy teeth in the mouths of the young and adult population and to establish the functionality of lost elements in the elderly population, we need effective policies, mainly through prosthetic rehabilitation. Furthermore, these oral health policies cannot be debated in isolation, as tooth loss is also associated with greater frailty among the elderly. Oral health policies must aim to provide comprehensive care to individuals who will benefit from them, ensuring healthy aging in conditions of dignity. 

ABSTRACT

COVID-19 is a flu-like syndrome caused by the SARS-CoV-2 virus, considered by the World Health Organisation to be a pandemic in March 2020 due to its high transmissibility, geographical extension, number of infected people and deaths. Following the WHO decree, measures to mitigate the transmission of the virus were adopted in all countries, including Brazil, such as social distancing and emergency remote teaching in primary, secondary, and higher education, where students began to take classes online from their homes. Emergency remote teaching has been a challenge for students and teachers who have had to adapt abruptly to digital technologies amid an unprecedented health crisis that has also caused mental health problems in the population. In the case of university teachers and students, the emergence or worsening of depression, anxiety, and stress during the pandemic has been observed in several international studies. This study analyzed the factors associated with negative emotional symptoms (depression, anxiety, and stress) during the COVID-19 pandemic among students and teachers at public and private higher education institutions in Brazil. It is a cross-sectional study including teachers and undergraduate students from public and private Higher Education Institutions (HEIs) in the 26 Brazilian states and the Federal District. The calculated sample was 2996 students and 2097 teachers who responded to the data collection instrument via the Survey Monkey platform during July and August 2020. The data collection form comprised the DASS-21 (Depression Anxiety Stress Scale) and socioeconomic, demographic, and lifestyle information. And Student. Mean scores were calculated for prevalence, and each participant was grouped according to severity. The cut-off point for severe symptoms was 90 percent, corresponding to a total DASS-21 score of 42 points. After this calculation, Poisson Regression was performed to analyze the prevalence ratio, using the final average DASS-21 score of each considered severe participant. The main results were that female students aged 18-39, with low incomes and low family incomes, had a higher prevalence of negative emotional symptoms, corroborating the existing literature. In the case of the group of teachers, the prevalence was observed in those participants whose income was between R$3,000.00 and R$10,000.00. This study demonstrated the importance of re-signifying higher education dynamics because of the pressures and demands on students and teachers and their repercussions on their mental health.

This dissertation aimed to systematize and validate the image-objective of the National Program for the Control of Chagas Disease (PNCDCh) and analyze the degree of implementation of the program in two municipalities in the state of Bahia, Brazil. This is a normative evaluation study carried out in two stages, delineation of the theoretical-logical model and analysis of implementation of type 1b, by means of a case study in two municipalities in Bahia. The study included a literature review to identify the technical and legal norms and describe the PNCDCh's image-objective, validation of the standards and criteria matrix and the preliminary logical theoretical model of the PNCDCh through the application of the consensus technique, and a case study in two municipalities in the southwestern state of Bahia to analyze the degree of implementation. For the analysis of the consensus technique the arithmetic mean and standard deviation were calculated for each criterion and each standard of the matrix, as well as the suggestions provided by the experts. To analyze the implementation, interviews were conducted through in locus visits to the municipalities, observation and registration of documents that prove the conduction of the PNCDCh. The excerpts were analyzed and systematized according to the dimensions and sub-dimensions outlined for the Chagas program. The calculation was obtained by the value of each standard and dimension, and the maximum points of each, which were later multiplied by 100 and classified in three levels: incipient > 25 and < 50 points; intermediate > 50 and < 75 points and; advanced > 75 points. The data from the results and discussion were presented in the form of a book chapter and three scientific articles. The first article analyzed the Brazilian scientific production on Chagas disease, from publications indexed in the Web of Science database. The interpretation of the data allowed the identification of an expressive growth of Brazilian scientific production on Chagas disease and the comprehensiveness of the theme in international journals, showing a focus on the biomedical areas of knowledge with emphasis on Parasitology and a small number of investigations directed to the areas of Public Health, Social Sciences and Pharmaceuticals. The book chapter sought to describe and analyze the temporal chain of the norms and guidelines of the PNCDCh in Brazil from 2006 to 2020 through an integrative literature review. The analysis made it possible to interpret the historical process of construction as a way to respond to the problem and its different strategies of confrontation as it identifies powerful actions and existing gaps. The second article aimed to describe the development stages and the results of the validation process of the NHCP's theoretical logic model, in which 28 experts were involved through a consensus technique. The results describe the validated contents of the matrices in three dimensions: Surveillance, Prevention and Control; Health Care; and Care Network for Chagas Disease. The structure and processes needed to carry out the actions, as well as the results expected in the short, medium, and long term, were described in the theoretical logic model. The third article aimed to analyze the implementation of the PNCDCh in two municipalities in the state of Bahia. Both municipalities showed an intermediate degree of implementation, among the facilities that stand out are the pioneering entomological surveillance in municipality 1 and the structured health care network in municipality 2. However, there are still numerous challenges in the evaluated contexts, such as incipient training and continuing education in Chagas disease, difficulties in early diagnosis and in the institution of timely specific treatment.

Diabetes mellitus (DM) is one of the main causes of mortality and morbidity in the world and its prevalence has been growing with changes in lifestyle and eating habits, besides the increase in life expectancy. This disease can affect virtually every organ in the human body; eyes can be affected by different mechanisms. Diabetic retinopathy (DR) is the leading cause of blindness in economically active populations, but if diagnosed and treated early, its risk of visual impairment can be dramatically reduced. However, the ocular disorder most frequently found in clinical practice of diabetic patients is dry eye, which causes mild discomfort to severe complications with a potential threatening to vision function. DM is associated with the development of dry eye by different factors, involving sorbitol accumulation, tear hyperosmolarity, reduced blink reflex, increased evaporation and exacerbated inflammatory process. This study is composed of two review articles. The first one is a narrative review about the importance of recognizing dry eye by visual health professionals and also by others responsible for the care of people with diabetes, in addition to the need for more information about the condition by the patients themselves. For this review, 39 studies were selected, including review articles and original ones, showing the high prevalence of dry eye and the main options of treatments available. The second article was developed in the form of a scope review concerning DR prevalence and its associated factors in Latin American countries, raising discussion how some differences found among countries may be related to different conformations in health systems due to socioeconomic reforms that took place in this zone few decades ago. This review was developed in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews and registered in Open Science Framework. We included 42 articles published between 2004 and 2020 in nine Latin American countries, with great heterogeneity among them. The overall prevalence of DR ranged from 15% to 32.7%. The risk factors for diabetic retinopathy found by this research were: duration of diabetes, increase in glycated hemoglobin levels and presence of diabetic nephropathy for both types of diabetes, in addition to arterial hypertension and increasing age for type 1 DM. It stood out the need for more studies in many Latin American countries, actions for strengthening health indicators and early detection of diabetes with screening for retinopathy.

Introduction: Toothache is an important oral health problem, considering that, despite the possibility of prevention, it has a high prevalence throughout the world, being associated with the practice of self-medication, whose growing tendency has contributed to a series of diseases in health. Objective: To analyze the occurrence of toothache in the population of northeastern Brazil and to assess the frequency of associated selfmedication. Method: The research was divided into two studies: a transversal one carried out through the analysis of information about dental care provided by Oral Health Teams, in Basic Health Units of the states of the northeast region of Brazil, during the five-year period 2017 to 2021, available in the public reports of the Health Information System for Primary Care (SISAB), of the Brazilian Ministry of Health, and a systematic review developed according to the Preferred Reporting Items for Systematic Reviews and MetaAnalyses (PRISMA). Result: 6,483,729 dental consultations were reported, among which 80.72% were related to toothache. The year 2019 had the highest number of visits (24.53%) due to toothache. The states of Bahia (20.33%), Maranhão (15.03%) and Pernambuco (12.67%) were responsible for almost half (48.03%) of dental care in the region. As for the profile of individuals who most sought this type of service, female users (61.33%) stand out, aged between 19 and 59 years (60.95%). On the other hand, elderly people aged 60 years or over (6.41%) and people aged 12 to 18 years (15.13%) were the ones who sought less frequently (for dental care for this condition. For the systematic review , 14 cross-sectional studies were included. The results showed that the prevalence of self-medication for toothache ranged from 6.5% to 100.0%, with the highest prevalences being found in studies carried out in developing countries such as India and United Arab Emirates Cultural and economic factors, access barriers, high cost of dental treatments, lack of time and money, and the perception that dental problems are not a serious health problem were among the main factors associated with the practice. , fear of the dentist, ease of access to medicines and belief in their benefits also contributed to the adoption of self-medication. used were paracetamol, mainly anti-inflammatory drugs, mainly ibuprofen, and analgesics administered orally. Conclusion: Toothache is an important oral health problem in northeastern Brazil, with an occurrence of 80.72%, which may affect the adoption of self-medication, whose studies have shown variable prevalence with higher rates in developing countries.

Mental Disorders (MD) are diseases that are difficult to diagnose and affect people of practically all age groups, sex, present in all continents and in different social classes. They are divided into two groups: Common Mental Disorder (CMD) and Severe Mental Disorder (GMD), which behave in different ways, but which cause changes in the individual's general performance. Objective: To present the clinical and epidemiological profile of patients treated at a hospital specializing in mental health in a municipality in the interior of the Brazilian Northeast, in addition to the possible factors associated with the outcomes studied in the present population. Results: The population consisted of 44.0% men and 56.0% women, 59.2% patients with TMG and 40.8% with CMD. There was a predominance of age over 40 years, marital status “without a partner”, individuals who declared themselves as “non-white”, less than 3 years of schooling, not engaged in paid work and with a prescription for benzodiazepines. The final multivariate logistic model showed in article 1 that the variables alcohol consumption, smoking and prescription of benzodiazepines were independently associated with CMD, having GMT as a reference. Conclusion: In article 1, the characteristics of the population pointed to the already known stigmatization of patients with mental illness. Important relationship of CMD with alcoholism and smoking that was associated and the high prevalence of prescription of benzodiazepines whose use has been questioned on several aspects in different MDs. For article 2, the results revealed a higher prevalence of female patients aged over 40 years. However, for the other sociodemographic variables, gender and males showed lower education, less exercise of paid activity and less frequency of marital relationship, opposing what the literature exposes. The investigation and the behavior profile of these patients showed the importance of tracing an epidemiological panorama of this population, where it presented dimensions that permeate clinical, individual and social spheres, in which all subjects and institution are directly or indirectly related in the care of the patient. their health.

The objective of the study was to carry out a comparative analysis between different definitions of indicators for the evaluation of feeding practices and to verify the factors associated with the prevalence of adequacy of national indicators in children at 12 months. This is a cross-sectional study nested within a prospective cohort entitled “Monitoring of breastfeeding practices and complementary feeding in children under two years old residing in the municipality of Vitória da Conquista- Bahia”, carried out between 2017 and 2019. Data collection started in maternity hospitals, with subsequent follow-up through home visits at 30 days, 6, 12 and 24 months. For article 1, information collected at 12 months of age about food consumed the day before the interview was used. For article 2, in addition to the aforementioned food data, we used maternal socioeconomic/demographic information and characteristics of the infants collected at the maternity ward; from the collection at 12 months, the receipt of guidance on complementary feeding, maternal marital status, maternal work, duration of Exclusive Breastfeeding (EBF) and the person responsible for feeding the child were included. To compare the prevalence of indicators according to different definitions, the McNemar test and the Kappa index were used to assess agreement. The analyzes of the factors associated with the prevalence of adequacy of the indicators were performed using Poisson regression with robust variance, estimating the prevalence ratios (PR) and the 95% confidence intervals (95%CI). The results and discussion were organized into two articles. In the first article, the prevalence of minimum diet diversity, minimum meal frequency and minimally acceptable diet showed statistically significant differences regarding the different definitions (P<0.05), with higher prevalence of the indicators defined by the World Health Organization in comparison with the of the Ministry of Health. The minimum meal frequency indicator showed poor agreement (kappa=0.05); for the indicators minimum diet diversity and minimum milk meal frequency for non-breastfed children, the agreement was weak (kappa=0.34 and 0.39 respectively). In the second article, the adequacy to the indicators was 38.8% for the minimum diet diversity, 47.9% for the minimum meal frequency and 18.5% for the minimally acceptable diet. The factors associated with the adequacy of the indicators were family income >1 minimum wage; EBF until 6 months of age and receiving guidance on complementary feeding. From the results, it can be concluded that the national recommendations are more detailed to consider the adequacy of infant feeding in the Brazilian context. In addition, it is noted that the population studied has low adequacy to indicators of healthy eating practices in the first year of life, being affected by modifiable factors such as maintaining exclusive breastfeeding until the 6th month of life and providing adequate information. Therefore, the importance of monitoring these practices is highlighted to guide the identification of gaps in public actions and policies aimed at promoting healthy complementary food in the country.

This dissertation aimed to identify, systematize, describe and analyze the personal, social and organizational implications in the work activity of health professionals and the strategies for suicide prevention in the context of Primary Health Care - PHC, given the changes imposed by the pandemic of COVID-19. This is a research that contemplated two integrative literature reviews for the critical evaluation and the construction of a synthesis of the available evidence on the investigated theme, being its product the current state of knowledge. For the analysis we used categories of analysis that guided the discussion of results: a) profile of health professionals most impacted by the pandemic; b) experiences of PHC workers in the context of the pandemic; c) challenges of health work in PHC in the context of the pandemic; d) main factors related to working conditions during the pandemic of COVID-19: personal, organizational and social, between prescribed norms and the demands of the real; e) risk factors for suicide during the COVID-19 pandemic; f) interventions for suicide prevention in primary health care in the context of the COVID-19 pandemic. The results were presented and discussed in two articles: in the first, the implications on the mental health of Primary Health Care - PHC workers, as a result of changes in the work activity during the pandemic of COVID-19, the absence of congruent training with the pandemic moment and the lack of Personal Protective Equipment (PPE) were evidenced; in the second, the adaptations in the strategies of prevention of suicidal behavior during the pandemic of COVID-19 in the context of Primary Health Care - PHC were identified. The use of the ergological approach when considering the subject in its singularity, in its actions, highlighting that these actions, despite occurring in differentiated historical, social and institutional contexts, are always singular and in a permanent process of renormalization, allowed to promote reflections about the real work and the implications for the mental health of health professionals. Therefore, the experiences of workers, culture, values, environmental conditions, personal relationships and permanent variability are central to ergology, and urge us to reflect on its property to assist in understanding the complexity involved in the work of PHC. Thus, we expect to shed light on the need to identify risk factors, implementation and adaptation of strategies of interdisciplinary nature, mediated by resources of Information and Communication Technology (ICT) for the continuity of mental health care of users and interventions in mental health as part of the planning of health work management, especially in PHC, a neglected locus in the current pandemic context.

Introduction: Public Physical Activity (PA) programs aim to expand access to the practice of PA. However, a considerable percentage of Brazilians do not know about and do not participate in these programs and list several barriers to participation, with emphasis on the Northeast region, a pioneer in the implementation of public PA programs. Objectives: To investigate the prevalence and factors associated with knowledge and participation of adults in the Northeast and Brazil in public PA programs and the main barriers to participation in them. Methods: Cross-sectional study of the National Health Survey (2019), with adults from the Northeast (30,702), who answered the question about knowledge of public PA programs, and with adults from Brazil (n=17,652) and the Northeast (n=6,197), who they knew about but did not participate in these programs. Poisson Regression method with robust variance was used to estimate the association between household, sociodemographic, social support, and health-related variables with knowledge of and participation in public PA programs. To compare the prevalence of barriers to participation according to sociodemographic variables, the chi-square test was used. Results: The prevalence of knowledge of public PA programs was 24.3% (95%CI: 23.2-25.4) and the prevalence of participation among those who knew about it was 9.7% (95%CI: 8.8 -10.7). Higher per capita family income, receiving visits from the Social Health Team, female gender, age over 34 years, higher education, having a paid job, having social support in social mobilization activities, overweight/obesity and reporting one or more chronic diseases associated with it. if positively to the knowledge of public PA programs. For participation in public PA programs, paid work was negatively associated and greater social support in social mobilization activities was positively associated. The main barriers to participation in public PA programs in Brazil (BR) and in the Northeast (NE) were, lack of interest (42.2% BR and 45.1% NE), opening hours (32.8% BR and 30.6% NE), distance from home (11.2% BR and 11.8% NE) and health problems or physical disability (8.1% BR and 8.4% NE). The variables gender, age, marital status, education, per capita family income and paid work were those that were associated with the main barriers in both geographic areas. Conclusion: The findings of this study indicate the need to restructure public PA programs with a view to acting on the factors that interfere with knowledge and participation in these programs and strategies that minimize barriers to participation in them.

Introduction: Acetaminophen is one of the most consumed non-steroidal anti-inflammatory drugs (NSAIDs) by pregnant women worldwide. This medication is the first choice for treating fever and pain during pregnancy as it is considered to be safe to use throughout pregnancy in clinical practice. However, acetaminophen can cause risks for the pregnant woman and the conceptus, considering that this drug crosses the placental barrier after the administration of therapeutic doses and, consequently, can affect fetal liver function, resulting in impaired growth and development of the fetus. Objective: To investigate the association between acetaminophen use during pregnancy and the development of pregnancy outcomes as preterm birth (PB), low birth weight (LBW), and small for gestational age (SGA). Methodology: To answer the objective, two methods were used, which will be presented in article format. The first article is a systematic review and meta-analysis, developed following the Meta-analysis Of Observational Studies in Epidemiology (MOOSE), whose protocol was submitted to the International Prospective Register of Systematic Reviews (PROSPERO), and registered under the number CRD42020159638. Only observational studies that evaluated the association between acetaminophen use during pregnancy and the development of pregnancy outcomes (PB, BPN, and PIG) were included. The searches were carried out in the bases PubMed, Embase, Ovid, Scopus, Web of Science, and BVS, on April 05, 2020, without time and language restrictions. The quality of the evidence was assessed by the Newcastle-Ottawa Scale and the Methodological Index for Non-Randomized Studies (MINORS). Relative risk and 95% confidence intervals for each outcome was estimated using the fixed or random-effects model. The second article used data from the NISAMI Cohort, a prospective cohort of pregnant women attended by Basic Health Units of the Unified Health System in the municipality of Santo Antônio de Jesus, in Bahia, from June 2012 to February 2014. Logistic regression was used to estimate the association between acetaminophen use during pregnancy and pregnancy outcomes, and linear regression to verify the association between acetaminophen exposure in pregnancy and birth weight. The analyzes were adjusted for socioeconomic, maternal, gestational, and newborn confounding factors. Results: The first article identified that acetaminophen use during pregnancy is associated with a reduced risk of LBW and SGA. The second article found evidence about the association between exposure to acetaminophen during pregnancy and decreased LBW. Conclusion: It is necessary to conduct studies that control for all confounding factors described in the literature and that evaluate the associations considering the exposure dose and the frequency of use of acetaminophen.

Objective: The present study investigated the association between pre-gestational obesity with the interruption of exclusive breastfeeding (EBF) in the first month of life, and with the introduction of processed and ultra-processed food in the first 6 month of life, in binomials of mothers and children, in the urban area of Vitória da Conquista. Methodological Elements: prospective cohort, including 300 pairs of mothers and their babies, recruited at the four maternity hospitals of the city, making up the baseline of the cohort and followed up on home visits at 30 days and 6 months of life. Demographic, socioeconomic, perinatal variables on breastfeeding, food introduction and use of pacifiers and bottles were collected. To assess the incidence and duration of EBF, as well as the introduction of processed and ultra-processed foods, the Kaplan-Meier survival analysis was used. Cox Hierarchical regression was used to verify the association between pre-gestational obesity and the incidence of EBF, as well as the association between pre-gestational obesity and the introduction of processed and ultra-processed foods. The analyzes were performed using the STATA 14.0 software. Results: The prevalence of pre-gestational obesity was 12%, with an average duration of EBF lower among these mothers (p <0.05). The risk of interrupting EBF in the first month of life was 1.76 times higher among obese mothers (95% CI 1.04–2.98). The incidence of the introduction of processed and ultra-processed foods was 75.7%, with the time of this introduction being shorter among obese mothers (p <0.05). The risk of introducing processed and ultra-processed foods in the first 6 months of life was 2.47 times higher in mothers with pre-pregnancy obesity (95% CI: 1.15–5.26). Conclusions: the findings of the present study shows an association between pre-pregnancy obesity and interruption of EBF in the first month of life, as well as an association between pre-pregnancy obesity and the introduction of processed and ultra-processed foods in the first 6 months of life. These results point to the need for strategies that address the importance of healthy eating practices in the first months of life for obese women of childbearing age.

This study aims to analyze the performance of the Community Health Workers (CHW) in remote rural municipalities from the essential attributes and derivatives of Primary Health Care (PHC) and from the perspective of nurses and PHC users. For identification and analysis of the practice of CHW, 40 semi-structured interviews were analyzed with CHAs, nurses, and users linked to Family Health Teams (EqSF) of Basic Health Units (UBS) located in the headquarters of four municipalities and in their respective rural areas, in the semi-arid northeast of the state of Bahia (3) and Piauí (1). The results show a strong performance of the CHW in relation to the attributes of first contact and integrality, with a broader scope, especially in rural areas of the MRR. The intermediation and facilitation of access occurs through the CHW strong bond with the territories and families and in the absence of other assistance resources. Individual actions through home visits were more prevalent at the expense of collective and community actions. The performance of home procedures by rural CHW was identified, such as blood pressure measurement and dressings. In the absence of integrated information systems, the CHW also acted in horizontal coordination actions. Regarding the practices developed for each line of care studied, they all develop effective practices in the care of each group, with greater emphasis on pregnant women. They are primarily responsible for scheduling the Pap smear and use strategies to enable the correct and rational use of medication by hypertensive users. Rural populations have more severe barriers to accessing health care, in a strict and expanded sense, and it is legitimate and desired that the practices of CHW and family health teams are forged based on the real needs identified in the territories. Recognizing such specificities and valuing them through permanent education strategies, symbolic and financial recognition, provision of adequate means for their development in synchrony with the other actions of the teams, of which it is an essential component, can even be a way to enhance other components of the PHC recognized as strategic for facing social inequalities in health.

Objective: Compare the profile and prevalence of hospital admissions in Brazil
according to estimates from the 2013 and 2019 National Health Survey.
Methods: serial cross-sectional study that used data from the 2013 and 2019
National Health Survey. The outcome was having been hospitalized for 24 hours or
more in the past 12 months. We calculated the prevalence of hospitalization
according to geographic, socioeconomic and health conditions; we calculated the
proportion of the population in the different categories of age group, presence or
absence of chronic diseases, and perception of health status, and compared the
estimates from the two editions of the National Health Survey using Student's t test
for independent samples. We considered the differences significant when the p value
was less than 0.01. We estimated the total number of hospitalizations and the
proportion corresponding to each age group, chronic disease and perceived health status. And finally we analyzed hospitalization estimates with administrative data to assess data consistency. Results: The prevalence of hospitalizations increased significantly between the two surveys and the increases were greater in the Southeast Region and among people who have a private health plan. We observed that the proportion of chronically ill patients in the population increased from 15.04% to 31.48%. This group accounted for 36.76% of total admissions in 2013 and 57.61% in 2019. A discrepancy was found between administrative data and survey estimates. Obstetric admissions and admissions for health insurance were underestimated. Conclusion: There was an increase in overall hospitalization rates in the period between the 2013 and 2019 National Health Survey, especially among people with better access to health services. The hospitalization profile has also changed - in the 2013 National Health Survey hospitalizations of people without chronic diseases predominated. This was reversed in 2019 National Health Survey.

Introduction: Growth monitoring process has been widely used to diagnose the health conditions of population. In premature neonates, growth failure during the postnatal period, known as Extrauterine Growth Restriction (EUGR), is a marker of severe nutritional deficit during the first weeks of life and it can have serious consequences in the short and long term. The use of drug therapy in preterm infants admitted to neonatal units also draws attention due to the high prevalence of off label or unlicensed drug use and the susceptibility of this group to the occurrence of adverse pharmacological or toxic effects.

Objectives: To estimate the incidence of EUGR and investigate its associated risk factors in a population of preterm infants admitted to Neonatal Intensive Care Units (NICU) in the city of Vitoria da Conquista - Bahia. To evaluate the use of off-label and unlicensed medications in premature newborns hospitalized in these units.

Methods: This was a non-concurrent cohort study, with analysis of medical records of hospitalized premature infants followed up during the neonatal period. The occurrence of EUGR in preterm infants at 36 weeks corrected gestational age (CGA) during the period of stay in the NICU was evaluated. Associations between EUGR and maternal disease, characteristics of birth, neonatal morbidities and clinical practices were analyzed. The use and number of medications were recorded and categorized according to Anatomical Therapeutic Chemical classification. Descriptive and bivariate analyzes of the data were performed to assess associations between the number of drugs used (total, off label and unlicensed) and the explanatory variables of interest.

Results: Out of the 91 premature infants, 59.3% (CA95% 48.9-69.0%) developed EUGR. Vertically transmitted infection (VTI) were observed in 4.4% of the population; all infants affected had EUGR. The VTI found were syphilis, cytomegalovirus disease (CMV) and toxoplasmosis. The final analysis has showed a positive association between VTI and EUGR (RR = 1.57); the covariables female (RR = 1.49), moderate premature classification (RR = 1.41) and small premature classification for gestational age (RR = 2.69) have also influenced this outcome. The 400 premature infants used 16,143 medications, with 86 different specialties; 51.9% of these items were classified as off label and 23.5% as unlicensed. The most prescribed were gentamicin and ampicillin (17.5% and 15.5% of off-label, respectively) and caffeine (75.5% of unlicensed). The study demonstrated significant associations between the use of off-label medications with lower gestational age, low birth weight, lower Apgar score at the 5th minute, advanced resuscitation maneuver in the delivery room and death. With unlicensed drugs, associations were found with lower gestational age, low birth weight and Apgar score of the 5th minute less than 7.

Conclusion: In this study, we found VTI as an important morbidity factor, conditioning the increased incidence of EUGR. These are diseases that can be avoided or have their consequences minimized by optimizing actions for family planning, prenatal care and neonatal health care. Neonates admitted to the NICU are highly exposed to the use of off-label and unlicensed drugs. Greater investments in studies are needed to achieve greater safety and quality of drug therapy used in neonatology.

This research aimed to analyze the experience of coordination of care between doctors in Primary Health Care (PHC) and Specialized Care (SC), related factors and the knowledge / use of mechanisms for integration between assistance levels.This is a cross-sectional study with the application of the COORDENA-BR® questionnaire, a sample of 64 doctors from Primary Health Care (PHC) and 56 from specialized care (SC) from the public network in a medium-sized municipality in the Northeast. The following were addressed: coordination of information and clinical management between assistance levels in the experience of doctors and labour factors, organizational, attitude towards work and related interaction factors; and the knowledge, frequency of sending/receiving and participation/use, purpose, characteristics and difficulties in using the mechanisms of feedback/mutual adaptation and standardization to promote integration between assistance levels. A descriptive analysis of the variables present in the instrument was performed, by assistance level, by means of absolute (n) and relative (%) frequencies. The differences between the proportions were assessed using Pearson's chi-square test and Fisher's exact test. Qualitative data, from open responses, were categorized. The results show a limited articulation of care in the Health Care Network (HCN), with differences between PHC and SC. There is no exchange of information on diagnosis, treatment and examinations. Doctors from PHC agree more with the treatments indicated in the SC than the other way around. Most doctors from SC do not provide guidance for PHC, which in turn, does not clarify doubts with the professional from SC. Both refer long waiting times for specialized consultation. Temporary employment contracts are more frequent in PHC. Consultation time was considered insufficient for coordination. Dissatisfaction with wages and work is high. Doctors do not know each other personally and specialists do not identify the PHC doctor as the care coordinator. Instruments of feedback/mutual adjustment such as reference and counter-reference forms, hospital discharge summary and whatsapp^® are widely known by professionals from both levels. Despite this, traditional reference and counter-reference guides are not widely used. Clinical sessions and protocols are poorly recognized, especially in SC, which presupposes low use of standardization mechanisms to obtain greater coordination of care. Assistance pressure, low institutionalization, lack of time were barriers identified for the incorporation of mechanisms of care coordinating to the work process in PHC and SC, in addition to those related to the provision of services in the network. In this scenario, policies and actions to guarantee structural conditions for improving access, working conditions and mutual adaptation that favor knowledge, institutionalization and the effective use of coordination mechanisms need to be implemented in a systemic way for all services and workers from National Health Service (SUS).

Discrimination still prevents trasvestis and trans women from effectively accessing health services and technologies, thus being a factor that may be responsible for increasing vulnerability to HIV / AIDS. The aim of this study was to assess the effect of gender discrimination on medical visits and HIV testing in the past year in this population. This is a cross-sectional study carried out in 2016, with 864 travestis and trans women from three capitals in northeastern Brazil. Recruitment was carried out using the Respondent-Driven Sampling (RDS) method, and data collection was based on the application of a structured questionnaire. The variables used as the outcome were medical visits and HIV testing in the past year. The main exposure was to have suffered gender discrimination in life, and other covariates were used to adjust the association. Logistic regression was used to determine the Odds Ratio (OR) of the associations. 67.0% of the interviewees reported having consulted a doctor in the past year, while 45.8% reported having had an HIV testing, also in the past year. Gender discrimination significantly reduced medical visits (OR 0.29; 95% CI 0.14-0.63) and HIV testing (OR 0.41; 95% CI 0.22-0.78), regardless other factors analyzed. It is necessary to consider stigma as a producer of health inequities so that it is possible to act on the vulnerability of these populations.

Introduction: Syphilis is an infectious, systemic, chronic disease that has Treponema pallidum as its causative agent. . Transmission can occur through several routes, in most cases through sexual contact and by vertical transmission, resulting in congenital syphilis, with the occurrence of prematurity, stillbirth and abortions. Vertical transmission can occur due to a recontamination of the pregnant woman due to lack of treatment by her partner, this represents one of the main obstacles to the control of syphilis and interruption of the transmission chain. On average in Brazil and in the world, 60% of the partners are not treated. Objective: To identify the prevalence and factors associated with therapeutic adherence in partners of pregnant women diagnosed with syphilis in a municipality in the southwest of Bahia. Method: This is a cross-sectional study, with the participation of the binomial 46 pregnant women with syphilis and their partners, in the municipality of Itapetinga-Ba, from January to June 2019. The questionnaire was applied at the interviewees' home and was collected information on prenatal cards, medical records and health unit record books. Descriptive analysis, univariate analysis was performed using the EPI INFO statistical package (version 7.2) and multivariate analysis using SPSS version 22.0. Results: Of the 46 partners of pregnant women with syphilis, approximately 74%, did not perform the appropriate treatment, the main one reason for not treating was the negative test result. The univariate analysis was associated with non-treatment: pregnant women without a partner, with less than 8 years of schooling and those who underwent up to two exams for syphilis. In the final model, there was a significant association for non-treatment among non-white pregnant women. For the partners, both in the uni and multivariate analysis, there was a significant association for non-treatment among those who reported schooling below 8 years and with income up to half the minimum wage. Conclusion: The findings of this study signal for greater attention from managers and health professionals to the population group with unfavorable socioeconomic conditions that directly influence access to health services and compromise adherence to the treatment of partners of pregnant women with syphilis. Thus, it is necessary to include partners in prenatal care and invest in strategic and educational actions to qualify professionals.

The present dissertation aimed to evaluate the quality of the actions geared towards cervical cancer (CC) control in the health region of Vitória da Conquista, Bahia. This is a cross-sectional study, from January to March 2019, with 241 physicians and nurses belonging to the Family Health Strategy. The quality of the actions and adequate monitoring were measured considering: a) performance of cervical cancer (CC) control actions within the Family Health Strategy; b) access to diagnostic tests; c) absence of high-grade intraepithelial lesions. Descriptive analyzes of absolute and relative frequencies were conducted and the Pearson’s chi-square test assessed the differences between the proportions. The analysis of associated factors was performed using Poisson regression with robust variance, estimating the gross and adjusted prevalence ratios (PR), the p-value and the respective 95% confidence intervals (95% CI). The results and discussion are presented in two articles. A conceptual model of determination was built in order to analyze the factors associated with the outcomes, with three hierarchical blocks: "Characterization and professional training", "Organization of the unit and access to cytopathology" and "Coordination of care and assistance integration". Variables with a significance level ≤0.20 were included in the regression model and adjusted to the next higher level higher, considering a significance of 5%. The Akaike’s Information Criterion test was used to assess the fit of the final model. In the first article, the following factors were associated with adequate monitoring: being a nurse; working in the primary health care of the municipality (PHC) for two years or more; dissemination by the team of the performance of cytopathology by posters and other means of communication; existence of cases of high-grade squamous intraepithelial lesions (HSIL); time of biopsy ( ≤ 1 month); and professional understanding that the laboratory is agile "sometimes" or "always" in the release of reports. In the second article, the factors associated with the elected outcomes were "Performance of educational, promotion, prevention, and monitoring actions" (outcome 1- D1); "Access to diagnostic tests" (outcome 2- D2); "Non-occurrence of high-grade cervical squamous intraepithelial lesions (HSIL)" (outcome 3- D3): 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. The findings indicate that the municipalities have a very fragile integration of services, in addition to incipient communication mechanisms between levels of care with serious problems for clinical coordination. Therefore, the municipalities in the region under study accumulate synergistic characteristics - small, poor and rural - contributing to the incidence of HSIL and, consequently, greater difficulty in CC control, even with high coverage of the Family Health Strategy. Furthermore, the monitoring of CC control actions depends on organized and integrated primary health care, therefore, assessing the quality of care at this level showed the challenges that need to be overcome in a regionalized network.

The general objective of this study is to analyze the association between excessive alcohol consumption and dissatisfaction with body image. The main hypothesis is that dissatisfaction with body image of adolescents and young people is a predictor of excessive alcohol consumption. It was necessary to identify how it is characterized in the literature the excessive consumption of alcohol. Therefore, a review of the literature was carried out in order to systematize the current knowledge about excessive alcohol consumption in the adolescent and young population, being this the first product of this dissertation. In order to test the hypothesis, according to the product of this dissertation, a simple and complex analysis of a cross-sectional study, conducted in the city of Camaçari-Bahia, between October 2011 and January 2012, with a population between 15 and 24 years. The study material was obtained through cluster sampling in two stages, respectively, microarea and individuals. Sociodemographic and contextual variables such as: gender, age, race / color, schooling, religion, work, state conjugal, children, number of friends and relatives were used as confounders and adjusted in complex analyzes through logistic regression. Descriptive analyzes of the population, stratified by sex, were absolute and relative frequencies and use of the X2 test by Pearson. The final sample consisted of 1582 subjects. It is hoped by this study, to motivate the amplification of debates which indicate the need for targeted interventions for the population of adolescents and young people - in the scope of Primary Health Care.

Introduction: Evidence about the body and cognitive and psychic abilities in the occupational setting may present as work-related illnesses, including noncommunicable chronic diseases. The inability to work generates an economic and economic burden on society. About 40% of the world population is arterial hypertension (AH), with an important risk factor for cardiovascular diseases and mortality of people at full productive capacity. Objective: To evaluate the lifestyle and prevalence of work in the health area and evaluation of prevalence in men and women in the city of Vitória da Conquista - BA. Method: A cross-sectional study, launched in August 2017 and ending in 2018, which met the health profile and its determinants in a population of workers. Blood pressure was measured using the oscillometric method using the Omron digital sphygmomanometer model HEM-7113. Three blood pressure measurements were combined (with a one-minute interval between each measurement). The mean of the last two measurements was performed in the analyzes. What is it that is so good SBP ≥ 140 mmHg and / or DBP ≥90 mmHg and / or have reported use of antihypertensive drugs and who respond negatively to a question:)? Already the HA was emanated from the positive affirmation in a question "Has the doctor ever had the diagnosis of hypertension (high pressure)?" and ≥ 140 mmHg and / or diastolic blood pressure ≥ 90 mmHg and / or used antihypertensive drugs. Variance and multivariate analysis were performed with Prevalence Ratios (RP) and p-value and confidence interval data were collected by means of Poisson regression with robust variance. The statistics were performed in Stata 12.0 and adopted in 5% as a level of significance. The result was 63.4% (95% CI: 58.1-68.4). It was shown that work-positive results were reported as three or more unhealthy eating habits and were classified as physically active. Individuals with overweight and obesity were associated with a lack of knowledge of HA. The men, 28.6% (95% CI: 25.9-31.5) were classified as hypertensive. The following rights were maintained: age greater than 40 years, black self-declared race, higher income at lower wages, abusive alcohol consumption, tobacco consumption, high salt intake, being physically inactive and overweight and obese. Conclusion: The results presented in this dissertation were revealed in the prevalence of discomfort in workers, as well as in the prevalence of males in the male sex. It is known that they are more vulnerable to risk threats due to less access to health services, higher weekly workload, stress and the adoption of unhealthy lifestyle. These attacks reveal the consequences and the serious complications that are exposed to a large part of the economically active population.

Introduction: prematurity is an important worldwide public health priority and its complications accounted for 18% of deaths in children under 5 in the world in 2016. Conditions related to prenatal care and delivery and neonatal clinical features may interfere with the survival chances of at-risk neonates. The identification of the different factors that interfere in the reduction of potentially avoidable deaths and of complications of prematurity leads to the possibility of elaboration of interventions and improvement of care flows during pregnancy and the neonatal period. Objective: to investigate the effect of the characteristics of preterm infants, health conditions and neonatal care received on the death and survival of preterm infants hospitalized in neonatal intensive care units in the neonatal period. Method: this is a non-concurrent cohort study, including all premature infants admitted to three neonatal ICUs in the city of Vitória da Conquista, BA, from January 1 to December 31st, 2016. The population was monitored from the day of admission until discharge, transference or death, respecting the censorship of 27 days of life. The data were obtained through the analysis of medical records stored in the Medical and Statistical Archive Service of the three hospitals. Results: 181 preterm infants, whose gestational age ranged from 23 ^0/7 to 36 weeks ^6/7, with a median of 32 weeks, weight of 455 to 3,965 g, with a median of 1,741 g, and of 18 days of hospitalization in the UTI neonates. Of the total, 18.8% died during their stay in the units. Multivariate analysis was performed through the Poisson regression, obtaining the relative risk (RR) for the occurrence of death and its respective 95% confidence interval (95% CI). The following variables were maintained in the final model (p <5%): gestational age between 28 and 32 weeks (RR: 5.66, 95% CI: 2.08- 15.40) and less than 28 weeks (RR: 9.24, 95% CI: 3.27 -26.12),5th minute Apgar less than 7 (RR: 2.15; 95% CI: 1.23 to 3.74), mechanical ventilation for 4 or more days (RR: 2.19; 95% CI: 1.18-4.04). The clinical conditions were: late sepsis (RR: 3.72, 95% CI: 1.77-7.83), acute respiratory distress syndrome (RR: 2.86, 95% CI: 1.49-5.46) , pulmonary hemorrhage (RR: 1.97, 95% CI: 1.40-2.77) and necrotizing enterocolitis (RR: 3.41; 95% CI: 1.70-6.83)were also statistically significant. Considering only the neonatal period, the survival rate was 85.1%, 59.3% in the early neonatal period. They presented significantly lower survival in this period: extreme premature infants (45.5%), extremely low weight (72.0%), Apgar of 5 minutes less than 7 (65.6%) who received advanced resuscitation maneuvers , 0%), with moderate hypothermia at admission (67.7%) and who received 4 or more days of invasive mechanical ventilation (70.2%). Conclusions: the results show that death and survival rates were similar to those observed in national studies, but different from those observed in international studies. These findings suggest the need to strengthen cost-effective interventions in perinatal care, with emphasis on the situations inherent to care at the time of delivery and in the first days of life, since we evidenced a higher number of deaths in this period, besides the adequacy of care protocols to the local context and based on the best scientific evidence.

This study aimed to identify the incidence of the exclusive breastfeed in six month and the factors for interruption, and also to verify the prevalence and factors associated with the introduction of sugar in infants at six months of age. A prospective cohort conducted in the city of Vitória da Conquista, Bahia, enrolled 300 mother-infant pairs were recruited from the four maternity wards of the municipality, composing the baseline of the cohort, and followed up at home visits at 30 days of age and 6 months. The data were collected through digitalized questionnaires at all stages. For to evaluate the incidence and duration of the exclusive breast feed it was used the Kaplan-Meir survive analyse and to verify the risk factors for interruption exclusive breastfeed it was used Cox regression. For the study of sugar consumption, data of 292 pairs of mother and baby were used and to evaluate the factors associated with the introduction of sugar, it was used Poisson regression with robust variance. The analyzes were performed in the STATA 14.0 software. The incidence of exclusive breastfeeding at 6 months was 16%. The risk factors for this interruption were: problems with breastfeeding at 30 days (HR: 1.39, CI: 1.08-1.79) and pacifier use until the sixth month of life (HR: 1.44, CI : 1.11- 1.86). Protection factors were: paternal age ≥ 20 and <35 years (HR: 0.25; CI: 0.10-0.64) and those older than 35 years (HR: 0.21; CI: 0.08 -0.53); maternal schooling ≥ 12 years (HR: 0.59; CI: 0.37-0.94). In relation to the introduction of sugar, the prevalence at 6 months was 31%, and it were associated factors: cow's milk consumption (RP: 2.14, CI: 1.20-3.83), use of sucrose (RP: 2.01; CI: 1.16-3.49) and tea intake (RP: 2.03; CI: 1.18-3.48). Protection factors were children of parents aged ≥ 20 and <35 years and those over 35 years of age (RP: 0.25, 95% CI: 0.10-0.64) and (PR: 0.42 , 95% CI: 0.26-0.67), and paternal schooling ≥ 12 years (RP: 0.39; CI: 0.18-0.84), from 9 to 11 years (RP: 0.44; CI: 0.32-0.62) and from 5 to 8 years of study (RP: 0.51; CI: 0.34-0.75). The findings of this study show that the practice of exclusive breastfeeding in this municipality is still below recommendations, factors not investigated in the literature as well higher paternal age was favorable to the practice of Exclusive breastfeeding. In relation to sugar consumption, the introduction of foods not recommended at the beginning of life was associated with higher sugar intake, in addition paternal variables were also negatively associated with the introduction of this carbohydrate. The results also point out that strategies should be adopted to minimize the use of pacifiers and problems with breastfeeding.

Introduction: Non-adherence to treatment is common in patients with chronic illnesses, decreasing the likelihood of positive clinical health outcomes. Although hypertension (HTN) and Diabetes mellitus (DM) present incidence, prevalence and management related to work, few studies evaluate the control profile and adherence in occupational health. Aims: to evaluate the prevalence of self-reported medication adherence and factors associated, as well as clinical health outcomes for industry workers in a Brazilian city. Methods: Article 1 - a literature review was conducted including articles published from January 2009 to May 2019 in the main databases on the proportion of adherence to medications and clinical health outcomes in workers with HTN and DM, as well as factors associated. Article 2 - This is a cross-sectional study of 137 industry workers with HTN and/or DM. The data were collected through in-person interviews and physical examination. The control of HTN and DM was defined through the values of blood pressure and capillary glycemia. Data were descriptively analysed and the factors associated with adherence were evaluated using the Poisson model with robust variance to calculate prevalence ratios. Variables with a statistical significance level lower than 0.05 were analysed using the attributable fraction. Results: Article 1 - 12 articles were selected to compose the review. Article 2 - The prevalence of self-reported medication adherence was 79.55% and the prevalence of disease control was 53.79%. There was no statistically significant association between the two variables. In the controlled disease group, non-adherence was associated with being under 40 years of age, not having a partner, and having a risky alcohol consumption habit. In the uncontrolled disease group, adherence was highest for participants aged 40 years and older. Results from the attributable fraction analysis showed that adherence in the controlled disease group was explained by being over 40 years old, followed by having a partner. Conclusion: The prevalence of self-reported medication adherence was high, but the prevalence of disease control was low and not associated with this data, indicating that the self-reported adherence measure may be inaccurate. Further studies will be necessary to identify the factors that effectively influence these outcomes.

This research aimed to understand the organization of the dental Specialty centers (CEO) and its interface with primary health care, in the health region of “Vitória da Conquista”, Bahia. This is a case study, with a qualitative approach, in a critical-analytical perspective. For the data production we carried out semi-structured interviews with managers, dentists of the Family Health Strategy Program and dentists of the CEO’s), observations in the CEO’s and documental analysis. The data were interpreted from the thematic content analysis. The results showed that the offer of specialized oral health care, through the CEO, in the health region of Vitoria da Conquista, was incipient, with little perspective of growth, since the topic of oral health was not a priority in the agendas of local and state governments. There were difficulties in establishing an intergovernmental cooperation in the region capable of deploying the CEO in the regional perspective and building a network of oral health care that would meet the population at different levels of care. The existing CEO presented a low performance and a need for adequacy in the supply of specialties according to the needs of the population. There were problems in the organization of the service, such as the lack of supply of inputs, no replacement of the missing patients, failure to comply with the workload by specialists and difficulties in access due to geographic barriers. In relation to its interface with the family health strategy, the CEO was characterized as autonomous services, in which the professionals work alone, with no communication flows between them and the professionals of other levels of care. All these challenges have represented obstacles to integrality in oral health actions in the region and, therefore, to guarantee the continuity of care. The results showed that the offer of specialized oral health care, through the CEO, in the health region of Vitoria da Conquista, was incipient, with little perspective of growth, since the topic of oral health was not a priority in the agendas of Governments Local and state. There were difficulties in establishing an intergovernmental cooperation in the region, capable of deploying the CEO in the regional perspective and building a network of oral health care that would meet the population at different levels of care. The existing CEO presented low performance and need for adequacy in the supply of specialties according to the needs of the population. There were problems in the organization of the service such as the lack of supply of inputs, not replacement of the missing patients, failure to comply with the workload by specialists and difficulties in access due to geographic barriers. In relation to its interface with the family health strategy, the CEO was characterized as autonomous services, in which the professionals work alone, with no communication flows between them and the professionals of other levels of care. All these challenges have represented obstacles to integrality in oral health actions in the region and, therefore, to guarantee the continuity of care.

Due to continuous organizational changes and the introduction of new technologies, there is an increase in sedentary work activities that contribute to the development of chronic noncommunicable diseases among workers. Workers can spend most of their work hours performing tasks in a sitting position that are related to increased morbidity and mortality from all causes. A cross-sectional baseline study of a longitudinal study was conducted with a worker population from August 2017 to July 2018. The daily sitting time reported was the event studied, the measurement was obtained through a question regarding the total sitting time present in the International Physical Activity Questionnaire - IPAQ, in its short version. Sitting time was categorized as less than 6 hours per day sitting, considered non-sedentary and 6 hours or more per day, sedentary. Sociodemographic variables related to habits and behaviors and health and disease were tested as explanatory. Bivariate and multivariate analyzes were performed, with estimates of prevalence ratios (PR) and calculation of the respective p-values and confidence intervals using Poisson regression with robust variance. All analyzes were performed in Stata 14.2 and adopted 5% as significance level. The prevalence of sitting time was 24.22% (95% CI: 21.6 - 26.9). They remained associated with sitting time: education higher than or equal to 9 years of schooling, income greater than or equal to 3 minimum wages, individuals who had a worse perception of quality of life and workers classified as overweight and obese. Individuals aged 30 years and older and those classified as physically active were negatively associated with the outcome. The results of this study are important for understanding the factors related to sitting time among male workers. Research such as this is relevant to aid in planning and actions, which can reduce any damage caused by overtime, such as aggravation and illness, as well as health care costs. In addition, they can guide the companies with which behaviors should be elaborated, so that workers can adopt healthier habits, avoiding spending a lot of time sitting, either in their workplace or in their leisure time.

Sedentary lifestyle, worker, male.

The performance of the Community Health Worker (CHW) as a strategic actor of Primary Health Care is still permeated by a set of uncertainties that hamper the characterization and organization of work, as well as the establishment of the specific disciplinary core of this profession. In light of the foregoing, the overall objective of this study was to analyze the work of the Community Health Workers in the Family Health Strategy in relation to the dimensions of supervision/evaluation, working practices and working conditions. This study has a qualitative approach and was conducted in the town of Vitória da Conquista, Bahia. Information was obtained through 03 focus groups, 32 semi-structured interviews, participant observation of supervision activities, and documentary analysis. The study participants were 41 CHW, 08 supervisors and 05 nurses. The field stage took place between February and March 2018. In order to analyze data and information, we used an analytical matrix composed by the dimensions on work supervision, work organization and working conditions of CHW and their respective variables. The results of this study are organized in two scientific articles. In the first article, we analyzed the supervisory mechanisms of the work of CHW. The results highlighted a predominance of supervision as control and inspection of work focused on the productivist perspective. The evaluative mechanisms exerted a strong influence on the work organization. Supervision also exerts a supportive role by contributing towards the enhancement of work, which entails greater satisfaction and social support. Moreover, we identified the educational perspective of supervision, but with occasional training and instrumental activities, which are concerned with the control of disorders. In the second article, we analyzed the work performance of CHW from the developed actions, work practices and working conditions. We identified that CHW perform multiple tasks with different approaches. The multiplicity of attributions has been shown to hamper the delimitation of the scope of practices and the planning of daily activities. The growing bureaucratization was associated with the disfigurement and the misunderstanding of the work of CHW.  We found that the execution of bureaucratic and health care tasks have gained centrality and compromised the time allocated for community work. It was revealed that these workers exert their activities in inadequate working conditions, with overload of people under their responsibility and in areas of great social vulnerability, which is worsened by gender relationships. The work of CHW has proved to be complex due to the high number of attributions and the inadequate structural and supportive conditions in which it is exerted, which hampers the establishment of the object and the work organization.

Ingestion of water and food contaminated by uranium is the main form of human exposure. And in health, its consequences range from fetal malformation to global developmental delays, as well as morbidities such as cancer, kidney disease and autism. OBJECTIVE: To identify child developmental delays associated with uranium exposure in breast milk. METHODS: This is a retrospective cohort study with 222 children, followed up to five years of age, breastfed by nursing mothers who had the presence of uranium in a breast milk sample from the municipality of Caetité-Bahia and non-uranium breast-fed children. of Caculé. In the original article, a subset of the initial cohort of 123 children under 66 months was used. Breast milk biomarker was used for uranium dosage and for screening for developmental delay, the modified ASQ-3 was applied to the Brazilian culture. Exploratory analyzes were used to evaluate the distribution of variables, chi-square test in bivariate and logistic regression in multivariate. RESULTS: The prevalence of suspected developmental delay was 21.54% in exposed children and 15.52% in non-uranium exposed children with an association of 1.49 (95% CI: 0.60 - 3.77). Positively, developmental delay was associated with family income below one minimum wage (OR: 10.14; 95% CI: 1.25 - 82.52). 

Introduction: Risk behaviors (CR) are present in adolescence, since during this phase of life several changes occur in the physiological, psychological and social environments that impel the adolescent to seek new experiences and an adaptation to the social environment in which they live. Objective: To estimate the prevalence of sedentary behavior and associated factors in Brazilian adolescents and a possible relationship between the family context and the coexistence of health risk behaviors. Method: The present study was a cross-section of the data obtained through the 3rd edition of the National Survey of School Health-PeNSE, with a cross-sectional design, carried out in 2015. The microdata used were related to the 102,072 students who attended the 9th year of elementary school ( sample 1). Adolescents who spent more than 2 hours / day sat watching television, using a computer, playing video games, talking to friends or doing other sitting activities were classified as sedentary (CS) behavior. The coexistence of CR was defined based on the sum of the presence of sedentary behavior, regular consumption of alcohol and tobacco, and low fruit consumption. For descriptive statistical analysis frequency and its confidence intervals were used. In the multivariate analysis for factors associated with sedentary behavior, Poisson regression with robust variance was used, adopting the hierarchical input of variables. To test the association of family context variables and the coexistence of CR, we used the partial odds logistic regression. All analyzes were performed in Stata 12.0, and 5% was adopted as a level of significance. Result: The prevalence of sedentary behavior was 68.15% (95% CI: 67.45-68.86). They were associated with CS being female, aged 13 years or less, self-referred black, brown or indigenous color, those classified in the third tertile of economic level, having a mother with incomplete high school or higher, not working, having three or more friends, parents who accompanied household activities never or rarely, be physically active, consume alcohol regularly, smoke regularly, consume less fruits and more sodas, self assess their health as regular or very bad bad. Considering the other CRs, the prevalence of low fruit consumption (67.2%), sedentary behavior (68.1%), regular consumption of alcohol (23.4%) and tobacco (5.6%) was found. The coexistence of CR was present in 91.3% of adolescents, with 34.5% presenting CR, 42.7% two and 14.1% three or four. Adolescents who reported having mothers with higher schooling, living with their father or mother and not living with their parents, had parents who sometimes, never or rarely understood their problems and concerns, and followed the duty of coexisting CR. home, and conduct meals with parents or guardians 4 days or less per week. Conclusion: Understanding the CRs and associated factors for their adoption among Brazilian adolescents becomes important in order to promote the construction of strategies to deal with problems and health problems and contribute to the improvement of public policy for this population.

Objectives: estimate the prevalence of cesarean sections, describe the factors related to cesarean sections and check the existence of relationships between cesarean section and neonatal outcomes: prematurity, low birth weight (LBW) and macrosomia. Methods: A population-based study with pregnant women aged 18 or older from the urban area of Santo Antônio de Jesus town, Bahia, in the period from 2012 to 2014. We obtained demographic and socioeconomic data, medical and obstetric records and obstetric characteristics (n=938). We carried out a descriptive, exploratory and multivariate analysis by using a logistic regression. The analyzes were conducted with the help of Stata 12.0 software. Results: The prevalence of cesarean sections was 63.74%. After adjustments, we noticed that there were more chances of cesarean sections among women aged 35 years or over, who were said to have a partner, who were overweight, who had prenatal care and with differentiated characteristics of gestation such as pelvic or transverse presentation of the fetus and multiple pregnancy type. We observed that caesarean section can reduce cases of prematurity by 8.3%. There was a negative relationship between cesarean section and LBW. A positive relationship was observed for macrosomia among mothers over 24 years of age and with normal BMI (body mass index) and also among overweight mothers. The proportion of macrosomia cases attributed to cesarean sections was 62.5%. Conclusions: It was possible to observe that the prevalence of cesarean section is above acceptable rates. Besides, we could identify which clinical and non-clinical factors are associated with this practice among women receiving care in the public sector; notice the existence of cesarean section as a protection factor for the occurrence of LBW and prematurity and identify a greater chance of macrosomic babies being born by cesarean section.

This study was aimed to evaluate the performance of the municipal health council of Vitória da Conquista my means of the application and testing of an evaluative matrix based on five priority dimensions of the activity of the councils: autonomy, organization, representativeness, community engagement and political influence. This is an evaluative research based on the spidergram method. From the evaluation of the indicators, we estimated the performance value of each dimension and placed it in the five-axis graph. The data were obtained through observation of the council meetings, analysis of official minutes and documents, besides a semi-structured interview with 18 health counselors. The results of the study are structured in two scientific papers. In the first paper, which has a theoretical conceptual nature, we discussed the deliberative effectiveness approach and performed the systematization of the dimensions related to the monitoring and evaluation of the participatory instances. In the second paper, we reveal the results of the empirical study. The council demonstrated an advanced level of autonomy, with appropriate structural conditions, but with limitations regarding financial independence. The organization dimension reached a maximum level of performance, with regular meetings, availability of information for counselors and operation of thematic committees. The representativeness showed low performance, with fragile relation of the representatives with the entities. The community engagement dimension demonstrated a high level of participation and a proactive profile. The political influence dimension obtained an intermediate performance, with a low ability to comply with the policies. The matrix used proved to appropriate and feasible for evaluating the performance of the health councils.