Rosângela Minardi Mitre Cotta

Background/Objectives: Obesity is a multifactorial condition and a major public health challenge. Conventional treatment centers on caloric restriction, which is often unsustainable and may cause stigma and psychoemotional harm. This study aimed to describe the methodology and assess the effects of a multicomponent nutritional intervention not focused on caloric restriction on psychoemotional outcomes. Women were selected as the target population because of the higher prevalence of obesity-related psychoemotional distress, body dissatisfaction, and weight-related stigma in this group, as well as their greater vulnerability to the psychosocial impacts of weight-focused interventions. Methods: This randomised, parallel, open-label trial included 89 obese women from primary care in Viçosa, Brazil. The participants were allocated into three groups: Group 1 (Control), which received a personalised hypocaloric diet (from 500 to 1000 kcal/day); Group 2 (NutrirCom (NutrirCom is a multicomponent, person-centred nutritional intervention protocol that is not focused on caloric restriction, conceived by a group of researchers at the Federal University of Viçosa for the care of women with obesity in Primary Health Care. It integrates nutritional, psychoemotional, behavioural, and social strategies, with an emphasis on promoting eating autonomy, mental health, and quality of life through a humanised, integrated, and sustainable approach, aiming to enhance the effectiveness of health care delivery and clinical practice)), which received 10 individual NutrirCom-based sessions; and Group 3 (NutrirCom + Social Support), which combined individual NutrirCom sessions with monthly group meetings for social support. Randomisation was stratified by body mass index via Excel^® with concealed allocation. The six-month intervention assessed changes in stress, anxiety, depression, and self-compassion, along with anthropometric and metabolic markers. Results: All groups presented reductions in waist circumference, fasting glucose, and total body fat, with increased lean mass. Anxiety remained unchanged in Group 1 but decreased significantly in Groups 2 (p = 0.002) and 3 (p = 0.005). Only Group 2 showed a significant reduction in depression symptoms (p = 0.023). Self-compassion improved significantly in groups 2 and 3. Conclusions: NutrirCom is a low-cost, scalable, and human-centered intervention that integrates emotional, social, and nutritional aspects of care. This approach shows promise as a sustainable strategy for obesity treatment in primary health care. Registration: Brazilian Registry of Clinical Trials (ReBEC) (no. RBR-87wb8x5).

Resumo Explorar narrativas presentes nas políticas públicas de controle do Zika vírus se torna fundamental, haja visto a possibilidade de novas ondas epidêmicas e seus efeitos danosos. O objetivo deste estudo foi analisar criticamente os documentos norteadores do enfrentamento do Zika vírus, implementados pelo governo brasileiro, no período de 2016 a 2022. Trata-se de um estudo qualitativo, exploratório, documental e analítico, utilizando a abordagem What’s The Problem Represented (WPR). Da análise emergiram três categorias: (I) Representação do problema: narrativa biomédica e tecnicista no processo saúde-doença; (II) Soluções, opções políticas e os efeitos destas na operacionalização das ações e na vida das crianças e das mães e; (III) Os silêncios e a negligência das políticas na efetividade das ações: baixa integração entre os sistemas de informações e baixo enfoque em ações estruturais e coletivas, limitação do acesso a tecnologias de cuidado de maior complexidade e custo para crianças com síndrome congênita associada à infecção pelo vírus Zika; limitada rede de apoio a grupos familiares compostos por mulheres negras, de baixa renda e pouca escolaridade. A análise evidencia um conjunto de opções políticas que possuem relevância contextual e epidemiológica, porém que invisibilizam populações vulneráveis.

Exploring narratives present in public policies to control the Zika virus becomes fundamental, given the possibility of new epidemic waves and their harmful effects. The objective of this study was to critically analyze the documents guiding the fight against the Zika virus, implemented by the Brazilian government, from 2016 to 2022. This is a qualitative, exploratory, documentary and analytical study, using the What’s The Problem Represented approach (WPR). Three categories emerged from the analysis: (I) Representation of the problem: biomedical and technical narrative in the health-disease process; (II) Solutions, political options and their effects on the operationalization of actions and on the lives of children and mothers and; (III) The silence and neglect of policies in the effectiveness of actions: low integration between information systems and low focus on structural and collective actions, limited access to care technologies of greater complexity and cost for children with congenital syndrome associated with Zika virus infection; limited support network for family groups made up of black women, with low income and little education. The analysis highlights a set of policy options that have contextual and epidemiological relevance, but that make vulnerable populations invisible.

The need for curricular innovation, especially in university education, is incorporated into the agenda of universities for undergraduate health courses, w

Background: Brazil must make progress toward eliminating tuberculosis as a public health problem and achieving the goal of reducing treatment interruption to below 5%. Improving adherence requires a thorough understanding of the factors that influence this outcome. Objectives: To identify epidemiological, socioeconomic, and health service-related factors associated with tuberculosis treatment interruption in Brazilian municipalities from 2018 to 2022. Methods: This ecological study utilized secondary data from all Brazilian municipalities. Independent variables were organized into three blocks: epidemiological, health service coverage, and socioeconomic. A zero-inflated beta regression model was employed to analyze both the proportion and zero-inflated components. Results: The mean treatment interruption rate was 8.1%. Interruption was associated with the proportion of laboratory-confirmed cases, Family Health Strategy coverage, and the proportion of the population residing in rural areas. Tuberculosis incidence, sputum smear microscopy, molecular rapid tests, contact investigation, directly observed therapy, AIDS detection rate, Gini index, household crowding, and illiteracy were associated with treatment adherence. In the zero-inflated component, directly observed therapy, consultations per inhabitant, illiteracy, and the proportion of the population residing in rural areas increased the probability of a zero-interruption rate, whereas TB incidence, AIDS detection, municipal population, and household crowding decreased that probability. Conclusions: Tuberculosis treatment interruption in Brazil is shaped by socioeconomic, epidemiological, and health service factors, highlighting the need for integrated strategies that combine social protection with strengthened primary care to improve adherence and progress toward elimination goals.

Introduction: La colaboración interprofesional es esencial en el Sistema Único de Salud (SUS), especialmente en la Atención Primaria de Salud (APS), para promover prácticas integradas frente a los desafíos que imponen los determinantes sociales. Objective: Analyze the dimensions of Partnership, Cooperation and Coordination to identify efficient areas and gaps, in addition to discussing the role of Interprofessional Education in Health (IPE) in strengthening collaborative practices in the SUS. Theoretical Framework: It is based on the integration between Complexity and Social Constructivism in the field of Interprofessionality, a framework that enhances the understanding of the phenomena of collaboration and collective learning as structuring dimensions of health processes. Method: Se utilizó la Escala de Evaluación de Colaboración en Equipos Interprofesionales (AITCS II-BR) para analizar las dimensiones de Asociación, Cooperación y Coordinación en los equipos de salud de APS. Results and Discussion: Los resultados indicaron que la Dimensión de Cooperación presentó índices altos entre los profesionales, mientras que la Dimensión de Asociación mostró debilidades que apuntan a dimensiones que requieren mejoras. A su vez, la Dimensión de Coordinación se clasificó como una Zona de Peligro, que requiere acciones que orienten estratégicamente la capacitación en la práctica sanitaria. Research Implications: IPE enhances collaboration between professionals, promoting integrated practices and improving health care. Originality/Value: The application of the AITCS II-BR Scale provides qualified data for both managers and the interprofessional team, highlighting strategic areas related to the dynamics of health work, favoring the development of innovation actions and process improvement.

A Educação Interprofissional em Saúde – EIP é uma abordagem definida como uma relação de aprendizagem e de partilha de conhecimentos entre duas ou mais profissões, com o enfoque na assistência do cuidado qualificado. O objetivo deste estudo é descrever a produção cientifica sobre os métodos de avaliação e a efetividade da Educação Interprofissional em Saúde. A revisão sistemática foi orientada pelo protocolo Preferred Reporting Items for Systematic Reviews and Meta Analysis, a partir, das bases dados: Medical Literature Analysis and Retrieval System Online, Excerpta Medica dataBASE, Science Direct e Education Resources Information Center. Na seleção, não houve restrição temporal, local e/ou idiomática. A qualidade metodológica dos artigos foi mensurada por meio de um instrumento do Joanna Briggs Institute. Resultaram 4.417 estudos, destes, 18 atenderam aos critérios de elegibilidade. A Educação Interprofissional em Saúde aprimora as práticas assistenciais e o contexto de formação em saúde com uma diversidade de estratégias e de métodos para mensuração.

Introduction: Tuberculosis, although curable, presents challenges related to treatment adherence, which compromises treatment effectiveness. Individual, social and structural barriers interfere with patients' ability to properly follow the therapeutic regimen, thereby impacting treatment outcomes. Given the limitations of the conventional healthcare model, which relies primarily on in‐person consultations and standard treatment protocols without additional adherence support technologies, new approaches have been explored to improve patient outcomes. This study seeks to identify effective communication approaches in this context.Objective: To identify the most effective communication strategies to optimise treatment adherence and improve therapeutic success in patients diagnosed with tuberculosis.Methods: A systematic review with meta‐analysis was conducted. We included studies available in the MEDLINE (via PubMed), EMBASE and SCOPUS databases, with publication dates between January 2005 and December 2024. The primary outcomes were adherence to and success in tuberculosis treatment.Results: This systematic review included 17 studies on tuberculosis treatment adherence. Of these, 12 were included in the meta‐analysis for adherence and 8 for treatment success. The most effective strategies for adherence were community education (2 studies; RR: 0.25, 95% CI: 0.11–0.56) and video observed therapy (VDOT) (2 studies; RR: 0.29, 95% CI: 0.21–0.40). The combination of electronic devices with SMS also showed positive results (3 studies; RR: 0.53, 95% CI: 0.37–0.77). SMS alone (5 studies) and electronic devices alone (3 studies) were not effective. For treatment success, only the combination of electronic devices with SMS (RR: 0.31, 95% CI: 0.17–0.55) and community education (RR: 0.51, 95% CI: 0.40–0.64) were effective.Conclusion: The combination of electronic devices with SMS and community education is an effective strategy for improving adherence and therapeutic success in tuberculosis treatment. Isolated interventions with SMS or electronic technologies did not show significant results. Adapting approaches to local realities is crucial for optimising outcomes.

The objective was to analyze the effectiveness of school mental health assessment scales by means of a systematic review and meta-analysis carried out in accordance with the Preferred Reporting Items for Systematic Reviews and MetaAnalyses (PRISMA) protocol. The search was carried out in the Embase, ERIC, PubMed and SciELO databases, generating a total of 5683 studies, of which 39 were included in the systematic review and 5 in the meta-analysis. It was found that actions to promote mental health in the school environment produced positive effects, especially the feeling of belonging to the school. Race and lifestyle were associated with psychological factors. Sex was related to mental health, with girls standing out in the systematic review and meta-analysis as having lower well-being and higher anxiety. The results reinforce the need to identify the best screening methods for the school population, as well as highlighting the importance of developing and implementing consistent public policies aimed at schoolchildren, especially girls, which take into account gender issues and life contexts and prioritize humane referral, aiming at collective health, social protection and the well-being of schoolchildren at risk of mental health problems.

Resumo Este artigo objetiva apresentar e descrever as técnicas do varal da saúde mental e da roda de diálogos, como estratégias participativas, dialógicas e significativas da investigação qualitativa em saúde e educação. Considerando a importância de inclusão da diversidade e pluralidade de vozes e experiências, os métodos e técnicas ativas representam uma abordagem ampla e contextualizada para este fim. Trata-se de uma pesquisa qualitativa, que utilizou as duas técnicas ativas e participativas para indagar sobre a saúde mental de educadores de uma comunidade escolar. O “Varal da Saúde Mental” objetiva a compreensão de experiências negativas e positivas relacionadas à saúde mental das pessoas. As “Rodas de Diálogo” são utilizadas como técnicas formativas, promovendo a expressão de sentimentos, pensamentos e comportamentos relacionados à saúde e educação. Os principais núcleos de sentido relacionados às experiências negativas dos educadores foram as vivências de enfermidades e conflitos no trabalho e pessoais. Os positivos foram os relacionamentos pessoais e profissionais e a esperança. A vivência dialógica, levou os participantes a trabalharem os significados a partir de um enfoque mais profundo de saúde mental, produzindo conhecimento sensível com acolhimento.