Insegurança alimentar em comunidades rurais no Nordeste brasileiro: faz diferença ser quilombola?Food insecurity in rural communities in Northeast Brazil: does belonging to a slave-descendent community make a difference?Inseguridad alimentaria en comunidades rurales en el nordeste brasileño: ¿marca la diferencia ser quilombola? Este é um artigo publicado em acesso aberto (Open Access) sob a licença Creative Commons Attribution, que permite uso, distribuição e reprodução em qualquer meio, sem restrições, desde que o trabalho original seja corretamente citado.

O objetivo deste artigo foi apresentar a metodologia, resultados descritivos preliminares e a confiabilidade dos instrumentos utilizados no Projeto COMQUISTA. Estudo transversal com indivíduos adultos (>18 anos) e crianças (até cinco anos) de comunidades quilombolas de Vitória da Conquista, Bahia. A coleta de dados compreendeu a realização de entrevistas individuais e domiciliares, aferição de medidas antropométricas e pressão arterial. Utilizou-se o questionário semiestruturado da Pesquisa Nacional de Saúde (PNS), adaptado para a população quilombola, e as entrevistas foram realizadas em computadores portáteis. Foram visitados 397 domicílios e entrevistados 797 adultos e 130 crianças. O perfil demográfico dos quilombolas foi semelhante ao dos brasileiros quanto ao sexo e idade, porém, eles apresentaram precário acesso ao saneamento básico e baixo nível socioeconômico. A análise de confiabilidade demonstrou a adequação das estratégias adotadas para garantia e controle de qualidade no estudo. A metodologia empregada foi considerada adequada para o alcance dos objetivos e pode ser utilizada em outras populações. Os resultados sugerem a necessidade da implantação de estratégias para melhorar a qualidade de vida e reduzir o grau de vulnerabilidade dos quilombolas.

IntroductionAs non-communicable disease (NCD) burden rises worldwide, community-based programmes are a promising strategy to bridge gaps in NCD care. The HealthRise programme sought to improve hypertension and diabetes management for underserved communities in nine sites across Brazil, India, South Africa and the USA between 2016 and 2018. This study presents findings from the programme’s endline evaluation.MethodsThe evaluation utilises a mixed-methods quasi-experimental design. Process indicators assess programme implementation; quantitative data examine patients’ biometric measures and qualitative data characterise programme successes and challenges. Programme impact was assessed using the percentage of patients meeting blood pressure and A1c treatment targets and tracking changes in these measures over time.ResultsAlmost 60 000 screenings, most of them in India, resulted in 1464 new hypertension and 295 new diabetes cases across sites. In Brazil, patients exhibited statistically significant reductions in blood pressure and A1c. In Shimla, India, and in South Africa, country with the shortest implementation period, there were no differences between patients served by facilities in HealthRise areas relative to comparison areas. Among participating patients with diabetes in Hennepin and Ramsey counties and hypertension patients in Hennepin County, the percentage of HealthRise patients meeting treatment targets at endline was significantly higher relative to comparison group patients. Qualitative analysis identified linking different providers, services, communities and information systems as positive HealthRise attributes. Gaps in health system capacities and sociodemographic factors, including poverty, low levels of health education and limited access to nutritious food, are remaining challenges.ConclusionsFindings from Brazil and the USA indicate that the HealthRise model has the potential to improve patient outcomes. Short implementation periods and strong emphasis on screening may have contributed to the lack of detectable differences in other sites. Community-based care cannot deliver its full potential if sociodemographic and health system barriers are not addressed in tandem.

Avaliação de interações medicamentosas potenciais em prescrições da atenção primária de Vitória da Conquista (BA), BrasilEvaluation of potential drug interactions in primary health care prescriptions in Vitória da Conquista, Bahia (Brazil)

Crude extract from the sponge Cinachyrella apion showed cross-reactivity with the polyclonal antibody IgG anti-CvL (Cliona varians lectin) and also a strong haemagglutinating activity towards human erythrocytes of all ABO groups. Thus, it was submitted to acetone fractionation, IgG anti-deglycosylated CvL Sepharose affinity chromatography, and Fast Protein Liquid Chromatography (FPLC-AKTA Purifier) gel filtration on a Superose 6 10/300 column to purify a novel lectin. C. apion lectin (CaL) agglutinated all types of human erythrocytes with preference for papainized type A erythrocytes. The haemagglutinating activity is independent of Ca2+, Mg2+ and Mn2+ ions, and it was strongly inhibited by the disaccharide lactose, up to a minimum concentration of 6.25 mM. CaL molecular mass, determined by FPLC-gel filtration on a Superose 12 10/300 column and SDS gel electrophoresis, was approximately 124 kDa, consisting of eight subunits of 15.5 kDa, assembled by hydrophobic interactions. The lectin was heat-stable between 0 and 60 degrees C and pH-stable. The N-terminal amino acid sequence of CaL was also determined and a blast search on amino acid sequences revealed that the protein showed similarity only with a silicatein. Leishmania chagasi promastigotes were agglutinated by CaL and this activity was abolished by lactose, indicating that lactose receptors could be presented in this parasite stage. These findings are indicative of the potential biotechnological application of CaL as diagnostic of pathogenic protozoa.

OBJECTIVE:To characterize the medication use by the quilombola population. METHODS:A population-based cross-sectional study was conducted with 797 adult quilombola in Vitória da Conquista, BA, Northeastern Brazil, in 2011. Analysis of variance was used to compare means of drugs by subject, according to demographic, socioeconomic and health-related behavior variables. Prevalence, prevalence ratios and their 95% confidence intervals were estimated. Multivariate analysis was carried out using Poisson regression with robust variance. RESULTS:The most widely consumed drugs by the population were those for the cardiovascular and nervous systems. Prevalence of medication use was 41.9%, significantly higher among women (50.3%) than men (31.9%). After adjusted analysis, medication use was associated with being female gender, being aged 60 or older, higher economic level, worse self-rated health, greater number of self-reported diseases and number of medical appointments. CONCLUSIONS:Strategies to improve rational drug use should preferentially focus on women and older adults. Thus, special attention should be given to promote rational prescription in everyday health services.

ObjectiveTo investigate the association between sedentary behavior (SB) and sociodemographic, social support, behavioral, and health variables among Brazilian adolescents. MethodsThe 2015 National Adolescent School-based Health Survey (PeNSE) was a cross-sectional study consisting of 102,072 Brazilian ninth-graders (mainly aged 13-15 years). SB was defined as the time (in hours) watching television, using a computer, playing video games, talking to friends, or doing other activities in a sitting position. For analysis purposes, SB was categorized into different cut-offs as per the sample distribution quartiles: >2 versus <2 (25 th percentile); >4 versus <4 (50 th 26 percentile) and >6 versus <6 (75 th 27 percentile). We employed Poisson univariate and multivariate regression analyses with robust variance and hierarchical entry of variables for each cut-off point. ResultsThe prevalence rates of each SB cut-off point were 68.15% (CI: 67.44-68.86), 44.15% (CI: 43.40-44.90) and 24.97% (CI:24.37-25.57) for >2, >4 and >6 hours, respectively. The following characteristics were positively and significantly associated with each SB cut-off point in the final models: females, current employment, higher household economic status and higher maternal schooling, lower levels of parents checking homework, tobacco and alcohol use, soft drink and fruit consumption, and regular, poor or very poor self-assessed health status. Conversely, students who self-declared brown were less likely to be classified as a SB cut-off point. Significant associations with age, report of close friends, and physical activity varied by different SB cut-off points.

OBJECTIVE:To describe the sexual behavior and to identify associated factors in adolescents from rural communities in Bahia, Brazil.METHODS:This is a cross-sectional, population-based, and household-based study, carried out in 2015 with adolescents aged 10 to 19 years. We described the variables of sexual intercourse in life and in the last 12 months, age at first intercourse, condom use and number of partners, guidance on pregnancy, AIDS, or other sexually transmitted infections, and guidance on how to get condoms. The analysis was performed for the total sample and for the quilombola and nonquilombola strata. We used Poisson regression, with robust variance, to estimate the prevalence ratios for sexual intercourse in relation to the explanatory variables.RESULTS:A total of 390 adolescents were interviewed, of them 42.8% were quilombolas, 51.3% females, and the median age was 14.8 years. Of these adolescents, 26.4% reported sexual intercourse (28.1% quilombolas and 25.1% non-quilombolas), and the median age of the first relation was 15 years; 77.7% of them mentioned condom use in the last intercourse and more than half received guidance on pregnancy, AIDS, or other sexually transmitted infections and received no guidance on how to get free condoms. Age (PR = 1.42) and alcohol use experimentation (PR = 2.41) were positively associated with sexual intercourse after adjustment. In the quilombola stratum, age (RP = 1.37), having three or more close friends (PR = 1.37), and experimentation with alcohol (PR = 2.60) were associated. In the non-quilombola stratum, age (PR = 1.43), black persons (PR = 2.06), and alcohol use experimentation (PR = 2.68) were associated.CONCLUSIONS:Lack of information and exposure to behaviors such as alcohol use experimentation are conditions that need to be addressed in health promotion strategies and in strategies for the prevention of sexual health problems in rural adolescents. Intersectoral partnerships between education and health also need to be strengthened to promote the autonomous and safe exercise of sexuality in this population.