Browsing by Author "Lopes, Mariana Souza"

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    Adherence to healthy lifestyles in the Programa Academia da Saúde.
    (2020) Mendonça, Raquel de Deus; Lopes, Mariana Souza; Carvalho, Maria Cecília Ramos de; Freitas, Patrícia Pinheiro de; Lopes, Aline Cristine Souza
    This study aims to measure healthy lifestyles according to the time of participation in the Programa Academia da Saúde (PAS). We used baseline data from a randomized controlled community trial with a representative sample of PAS users from Belo Horizonte, Brazil (n = 3,414). The data on healthy lifestyles collected were: daily fruit and vegetables intake (≥5 servings); physical activity en- gagement (≥180min/week); body mass index (18.5kg/m2 ≥ BMI ≤ 24.9kg/m2), smoking and drink- ing habits. The time of participation in the PAS was calculated by the difference between the date of registration in the program and the date of the data collection. Logistic regression models were used to evaluate associations between healthy lifestyles and time of participation in the PAS. Almost half of the participants (43.3%) had three healthy lifestyle factors. The prevalence of having all five factors varied according to the time of participation in the service; the lowest rates were in the first quartile (4.9%) and the highest rates in the fourth quartile (8.1%). Those who have attended the service for the longest time (fourth quartile) were more likely to have a healthy BMI (OR = 1.43; 95%CI: 1.14- 1.80; p = 0.002) and to avoid smoking (OR = 1.62; 95%CI: 1.06-4.49; p = 0.01), compared to those who have attended the program for less time (first quartile). The prevalence of healthy lifestyles in PAS users was low. However, a longer permanence in the program seems to favor positive changes on BMI and on smoking habits.
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    Challenges for obesity management in a unified health system : the view of health professionals.
    (2020) Lopes, Mariana Souza; Freitas, Patrícia Pinheiro de; Carvalho, Maria Cecília Ramos de; Ferreira, Nathália Luíza; Campos, Suellen Fabiane; Menezes, Mariana Carvalho de; Lopes, Aline Cristine Souza
    Background: Obesity is an increasingly prevalent chronic condition. Its multiple causes and the complexity of its treatment pose challenges for health professionals. Objective: To explore and describe the challenges for obesity management in the Brazilian Unified Health System according to health professionals. Methods: An exploratory quantitative web-based study, carried out in 2018 with health professionals, developed from the first stage of a national project that aims to examine the management of obesity in Brazil. The questionnaire was self-applied. Invitations to participate in the research were sent by the Ministry of Health, Health Department of Minas Gerais and members of the research group. We collected data on sex, age, professional category, region and level of care. The challenges were investigated using a Likert scale and categorized into structure and work process. Results: We evaluated 1323 professionals, of which about 45% were dietitians, 90.2% were women, and 83.1% self-reported working in primary health care. The main barriers cited included a high demand for curative and individual assistance, the presence of comorbidities, and the absence or insufficient access to instructional materials, professional qualification and lack of support. Conclusion: Obesity management is a critical challenge for all professionals. Barriers were related to the work process and structural aspects and reinforce the need to empower health teams. We propose that permanent education activities should be established, as well as the development of instructional materials that are applicable to routine work. Finally, the results may be used to develop policies and strategies to improve obesity management.
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    Desenvolvendo modelos para o programa de promoção da alimentação adequada e saudável : um estudo de avaliabilidade.
    (2021) Bicalho, Juliana Mara Flores; Guimarães, Eliete Albano Azevedo; Freitas, Patrícia Pinheiro de; Lopes, Mariana Souza; Menezes, Mariana Carvalho de; Lopes, Aline Cristine Souza; Oliveira, Cláudia Di Lorenzo
    As doenças crônicas não transmissíveis (DCNT) figuram-se mundialmente como importante problema de saúde pública, sendo a alimentação inadequada um de seus principais determinantes. Dessa forma, a qualificação dos profissionais de saúde para realização de ações de promoção da alimentação adequada e saudável, que sejam práticas, efetivas e viáveis, é essencial. O objetivo deste artigo foi realizar o estudo de avaliabilidade, considerando a descrição da intervenção (implantação do Programa de Promoção da Alimentação Adequada e Saudável – PPAAS na Atenção Primária à Saúde brasileira), a elaboração do modelo lógico e a identificação e validação das questões avaliativas. Adotou-se como referencial o sistema de sete elementos proposto por Thurston e Ramaliu. Foram realizadas análises de documentos, revisão teórica, reuniões para elaboração do modelo teórico lógico do Programa e a identificação das questões avaliativas, que resultou no instrumento de medidas multidimensional para avaliar sua implantação. A validação de conteúdo das questões avaliativas foi realizada por técnica Delphi. O modelo lógico desenvolvido foi essencial para compreender as premissas teóricas básicas do PPAAS, condensando em uma imagem as peculiaridades dos seus componentes e constituindo um produto que pode ser utilizado em pesquisas avaliativas posteriores. O instrumento multidimensional apresentou um índice de validação de conteúdo de 91%. O estudo fornece um modelo lógico e um instrumento multidimensional válidos, imprescindíveis para o planejamento da avaliação propriamente dita da implantação do PPAAS.
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    Diferenças no consumo alimentar nas áreas urbanas e rurais do Brasil : Pesquisa Nacional de Saúde.
    (2021) Costa, Danielle Vasconcellos de Paula; Lopes, Mariana Souza; Mendonça, Raquel de Deus; Malta, Deborah Carvalho; Freitas, Patrícia Pinheiro de; Lopes, Aline Cristine Souza
    Objetivou-se identificar diferenças no consumo alimentar, segundo marcadores de ali- mentação saudável e não saudável, entre adultos residentes nas áreas urbanas e rurais do Brasil. Realizou-se estudo transversal com dados da Pes- quisa Nacional de Saúde (2013). A alimentação foi avaliada por marcadores de alimentação sau- dável e não saudável. Estimou-se as prevalências (%) e modelos de regressão logística sequencial fo- ram ajustados para estimar odds ratio (OR) e in- tervalos de confiança (IC95%). Verificou-se maior consumo de frutas e hortaliças, peixes, refrigeran- tes e substituições de refeições nas áreas urbanas, enquanto que, o consumo de carne com gorduras e feijão foi maior nas áreas rurais. Análises ajusta- das mostraram maior consumo regular de feijão e de carne com excesso de gordura; e menor con- sumo de refrigerantes, de frutas e hortaliças e de substituição de refeições por lanches nas áreas ru- rais em comparação com as urbanas. Tendências semelhantes foram observadas nas macrorregiões do país. As diferenças no consumo alimentar de brasileiros residentes em áreas rurais e urbanas denotam a importância de fomentar políticas de alimentação que respeitem e valorizem as tradi- ções e a cultura alimentar.
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    Healthy lifestyle by race/skin color and educational level in Brazil.
    (2021) Lopes, Mariana Souza; Freitas, Patrícia Pinheiro de; Silva, Caroline Otoni da; Mendonça, Raquel de Deus; Campos, Suellen Fabiane; Malta, Deborah Carvalho; Lopes, Aline Cristine Souza
    This study aimed to describe the prevalence of healthy lifestyles and examine its association to the combined effects of race and educational level in Brazil. Cross-sectional study. Data were obtained from the 2013 NationalHealth Survey. Race was categorized as white, brown, or black, and educational level as low, medium, or high. To assess the combined effects of race and educational level, a combined variable was created. Healthy lifestyle factors were: non current smoker;non risk use of alcohol; daily consumption of fruit, and vegetables and being active. Lifestyle status was categorized as less healthy or healthier. Of the 59,249 participants, 18.4% of the whites and 6.8% of blacks reported higher education, respectively. Healthy lifestyle status differed by race and educational level. The prevalence of 3 or more parameters were higher than 80% among individuals with high educational levels, regardless of race. The association of healthy lifestyle status with the combined effects of both race and educational levels remained significant after adjustments, except in blacks and browns with high educational levels. Education may be one of an important structural determinant of health status in Brazil, especially among blacksand browns. Investments in education can be helpfull to reduce racial inequalities.
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    Is the management of obesity in primary health care appropriate in Brazil?
    (2021) Lopes, Mariana Souza; Freitas, Patrícia Pinheiro de; Carvalho, Maria Cecília Ramos de; Ferreira, Nathália Luíza; Menezes, Mariana Carvalho de; Lopes, Aline Cristine Souza
    This study aims to describe the adequacy of basic health units (UBS) in Brazil regarding structure and work process for obesity management and to evalu- ate user satisfaction with primary health care services. This cross-sectional study was conducted with data from the 2013-2014 National Program for Im- proving Primary Care Access and Quality (PMAQ) – an initiative to assess primary health care teams’ performance. Data were collected between 2013 and 2014 through interviews with primary health care teams and users. All indicators of adequate care for obesity were defined within the article scope, based on data from the PMAQ. Of the 24,055 UBS analyzed, located in 4,845 different cities, only 7.6% had adequate structure for obesity management. Likewise, only 26.6% of the 114,615 users interviewed reported adequate ac- cess, and 27.8% of the UBS showed adequate service organization. Healthcare was considered as “good” or “very good” by 82.4% of users. These indicators varied according to geographic region, showing better results for the South and Southeast. Our results suggest that the country may still be at the ini- tial stage of systematizing care with obesity, presenting significant disparities among regions.
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    A systematic review of effects, potentialities, and limitations of nutritional interventions aimed at managing obesity in primary and secondary health care.
    (2020) Menezes, Mariana Carvalho de; Duarte, Camila Kümmel; Costa, Danielle V. de P.; Lopes, Mariana Souza; Freitas, Patrícia Pinheiro de; Campos, Suellen Fabiane; Lopes, Aline Cristine Souza
    Objectives: Obesity has been identified as an important risk factor for cardiovascular disease and other chronic diseases. However, dietary treatment of obesity is far from being a closed issue. Therefore, it is critical to identify the most appropriate obesity management approaches. The aim of this review was to summarize the effects, potentialities, and limitations of nutritional interventions aimed at managing obesity in primary and secondary health care settings, highlighting the most effective strategies and theories. Methods: This systematic review of randomized controlled trials evaluated nutritional interventions aimed at achieving weight loss in primary and secondary health care patients. All screening and extraction processes were conducted according to PRISMA. Results: From an initial 7816 studies that were identified, 28 met the criteria and were included in the review. Most studies were conducted in a developed country in primary care, with a higher proportion of women. Most of the nutrition interventions maintained continuous contacts during follow-up, and telephone calls were the most commonly used technology. A physical activity component was included in most studies, and the most common dietary approaches used were energy restrictions, changes in macronutrient distribution, and diet self-monitoring. Regarding theories, interventions mainly incorporated Social Cognitive Theory and Motivational Interviewing. Most trials presented significant and moderate weight loss (~5%), in which the key contributors were behavioral theories, the dietary approach of calorie restriction, and interventions delivered by dietitians and psychologists. Conclusions: Most trials presented better weight loss results with the association of calorie restrictions and theory-based interventions delivered by dietitians or psychologists. We identified the need to develop inter- ventions in other contexts, such as low- and middle-income countries; further trials comparing a theory- versus not-theorydriven intervention; group-based versus individually based intervention; and interven- tion using or not using technology.