Navegando por Autor "Lopes, Aline Cristine Souza"
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Item 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 SouzaThis 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.Item 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 SouzaBackground: 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.Item Cohort profile : the cohort of universities of Minas Gerais (CUME).(2018) Domingos, Ana Luiza Gomes; Miranda, Aline Elizabeth da Silva; Pimenta, Adriano Marçal; Hermsdorff, Helen Hermana Miranda; Oliveira, Fernando Luiz Pereira de; Santos, Luana Caroline dos; Lopes, Aline Cristine Souza; Martínez González, Miguel Ángel; Bressan, JosefinaItem Consumer food environment and overweight.(2019) Freitas, Patrícia Pinheiro de; Menezes, Mariana Carvalho de; Lopes, Aline Cristine SouzaObjectives: The aim of this study was to investigate the association between aspects of the consumer food environment in food stores selling fruit and vegetables (FVs) and the incidence of overweight among users of a Brazilian primary health care service. Methods: This cross-sectional study assessed individual-level and food environment variables, within the context of a representative sample of a primary health care service in a Brazilian city (the Health Academy Program [HAP]) in 2013. Users of HAP units and multiple aspects of the consumer food environment (availability, diversity, variety, quality, advertising, and price) related to FVs and ultraprocessed foods (UPFs) were examined. Multilevel logistic models were used to examine the relationships among overweight and consumer environment characteristics. We analyzed 2810 participants and audited 336 food stores. Results: More than 70% of stores had adequate diversity and variety of FVs; Regarding quality, only 24.5% of stores presented inadequate quality of fruits and 39.6% inadequate quality of vegetables. UPFs were present in 60.6% of FV stores. The results indicated a high prevalence of overweight (62.6%) in participants of the health promotion service and the multilevel models revealed an association with variety of vegetables in stores (0.99; 95% confidence interval, 0.97 0.99; P < 0.05). Conclusions: Given the importance of food environment in food choice at the time of purchase, it is important to consider consumer food environment in determining consumption. The results suggest that increased exposure to healthy foods should be included as guidelines for weight management.Item 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 LorenzoAs 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.Item Dietary self-care and hospital readmission among individuals with diabetes mellitus.(2022) Menezes, Mariana Carvalho de; Ribeiro, Márcia Machado Cunha; Coletro, Hillary Nascimento; Oliveira, Cláudia Di Lorenzo; Cardoso, Clareci Silva; Lopes, Aline Cristine SouzaBackground/Purpose Diabetes mellitus is one of the main public health problems worldwide. One important strategy for increasing the efectiveness for controlling diabetes mellitus and preventing complications is self-care supported by health- care professionals. The aim of the study was to analyze dietary self-care strategies performed by individuals with diabetes mellitus (DM) after hospitalization and their possible infuence on hospital readmissions. Methods A cross-sectional study was conducted in the public health services qualifed to hospitalize individuals with DM in a medium-sized municipality of Brazil. Adults were evaluated 24 months after discharge, assessing self-care strategies (dimensions: diet, physical activity, blood glucose monitoring, foot care, medication, and smoking); and clinical, anthropo- metric, and biochemical measurements. Results A high death rate (33.7%) was verifed after 24 months of hospitalization. Almost half (45.9%) of the 37 remaining patients were readmitted to hospital; however, during the 24 month period, only 42.0% received guidance about DM self- care from healthcare professionals. In the evaluation of dietary self-care, only 35.1% of the individuals reported taking care of their diet on 5 or more days a week. Individuals who adhered to self-care guided by health professionals presented twice the prevalence of not being readmitted to hospital (Prevalence ratio=2.52; 1.27–5.01). Conclusions After hospital discharge, individuals with DM presented poor adherence to self-care, especially regarding diet. However, when these individuals adhered to nutritional guidance, there were fewer hospital readmissions. These results reinforce the importance of interdisciplinary educational actions for DM management. However, due to the small sample size because of the high mortality, further studies for this purpose should be conducted.Item 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 SouzaObjetivou-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.Item Dimensões da escala brasileira de insegurança alimentar na atenção primária à saúde.(2021) Araújo, Melissa Luciana de; Mendonça, Raquel de Deus; Pereira, Simone Cardoso Lisboa; Lopes, Aline Cristine SouzaObjetivo: Analisar a relevância das dimensões da Escala Brasileira de Insegurança Alimentar (EBIA). Método: Conduziu-se estudo a partir da linha de base com amostra representativa de usuários do Programa Academia da Saúde de Belo Horizonte-MG. A mensuração da insegurança alimentar foi obtida pela EBIA. Utilizou-se análise fatorial para identificar as dimensões da EBIA relevantes para os usuários do Programa. Resultado: Verificou-se elevada prevalência de insegurança alimentar (31,1%), sobretudo entre as famílias com menores de 18 anos (41,0%). Foi identificada redução do percentual de respostas afirmativas segundo a gravidade de insegurança alimentar implicada na questão, sendo que itens relacionados à insegurança alimentar leve (preocupação e acesso à alimentação saudável) apresentaram maior percentual de respostas afirmativas, enquanto aqueles correlatos à insegurança alimentar severa (fome e perda de peso), menores percentuais. Foram identificados três fatores relevantes da EBIA para famílias com menores de 18 anos: preocupação, privação e crianças/adolescentes; e para as demais famílias: preocupação, privação e fome. Conclusão: Sugere-se, assim, o uso da EBIA na Atenção Primária, visando avaliar o risco de insegurança alimentar e o delineamento de ações de promoção da saúde mais abrangentes.Item Does access to healthy food vary according to socioeconomic status and to food store type? : an ecologic study.(2019) Costa, Bruna Vieira de Lima; Menezes, Mariana Carvalho de; Oliveira, Cláudia Di Lorenzo; Mingoti, Sueli Aparecida; Jaime, Patricia Constante; Caiaffa, Waleska Teixeira; Lopes, Aline Cristine SouzaBackground: The food environment can influence opportunities and barriers to food access. This study aimed to investigate whether access to healthy foods varies according to store types and the socioeconomic status of the users of the public health promotion program in Brazil, known as the Health Academy Program. Methods: A total of 18 Health Academy Program centers were selected via simple conglomerate sampling. Health Academy Program users living up to 1 km from the food stores were evaluated (n = 2831). Their socioeconomic status was investigated via face-to-face interviews. The food stores were audited through direct observation. Variables included the community nutrition environment (type and location) and consumer nutrition environment (healthy food store index, involving variables such as availability, variety, and advertising of healthy and unhealthy products). Multiple linear regression analysis was performed to examine the association between access to healthy foods, socioeconomic status, and food store type. Results: A total of 336 stores were investigated. The majority were specialty fruit and vegetable markets/stores or open-air food markets. Access to healthy food was only associated with the food store type. An increase of 1% in the availability of specialized fruits and vegetable markets or open-air food markets and supermarket raised healthy food store index values by 0.12 and 0.07, respectively. Conclusions: Public food supply policies aimed at improving the diet quality of the population and reducing inequality in access should prioritize the implementation of stores of better quality, such as specialty fruit and vegetable markets and open-air food markets.Item Does misperception of fruit and vegetable intake adequacy affect progression through the stages of behavior change after nutritional intervention?(2020) Carvalho, Maria Cecília Ramos de; Menezes, Mariana Carvalho de; Bertolin, Maria Natacha Toral; Lopes, Aline Cristine SouzaPseudomaintenance (PM) is a Transtheoretical Model (TTM) stage of change that refers to individuals who believe they eat enough fruit and vegetables (FV) despite their low FV intake. It is not known how they change behavior after usual TTM-based interventions. Thus, this randomized controlled community trial describes the effect of PM on progression through the stages of change for FV intake among adult and elderly health promotion service users after TTM-based intervention. The stage of change for FV intake was assessed; FV intake was estimated from brief validated questions at baseline (n = 3414) and follow-up (n = 1782). Individuals whose perception of adequacy matched the estimated intake were labeled as “concordant perception,” while those with low intake who believed that their intake was adequate were classified as being in PM. The intervention group received the intervention while the control group received usual care. The prevalence of “no stage progression” at follow-up was close to 50% for those in PM at baseline. After adjustment for demographics, randomization, self-efficacy, decisional balance, and baseline intake, users in PM at baseline had higher odds [OR = 1.53 (1.21–1.94)] of progressing to higher stages for fruit and no difference in progression for vegetables. We propose strategies to approach FV intake in future studies and reinforce the need for additional trials aimed at describing changes in FV intake among individuals in PM, in order to continue answering the scientific questions that we began to investigate.Item Efetividade de intervenção nutricional pautada no programa Promoção da Alimentação Adequada e Saudável (PAAS) na Atenção Primária : Ensaio comunitário controlado randomizado.(2021) Lima, Bianca Bastos; Menezes, Mariana Carvalho de; Menezes, Mariana Carvalho de; Lopes, Aline Cristine Souza; Mendonça, Raquel de DeusA prevalência de doenças crônicas constitui, hoje, problema de grande magnitude no Brasil e no mundo, sendo um de seus principais determinantes a alimentação inadequada. Esse cenário demanda ações efetivas e políticas públicas que garantam, além de ações assistenciais, qualificação profissional e ações de educação em saúde, sobretudo na Atenção Primária à Saúde (APS), por ser o nível de atenção prioritário para realização de atividades de promoção da saúde. O objetivo deste trabalho foi avaliar a efetividade do Programa de Promoção da Alimentação Adequada e Saudável (PAAS) conduzido por profissionais da APS dos municípios de Carmo do Cajuru - MG e de Nova Lima - MG. Trata-se de um ensaio clínico comunitário controlado com usuários da APS de 20 anos ou mais. As Unidades Básicas de Saúde nas quais os usuários estavam cadastrados, foram randomicamente divididas em grupos intervenção (GI) e grupo controle (GC). Na primeira fase, foi desenvolvida capacitação para os profissionais das unidades alocados no GI. Na segunda, foi aplicado questionário quantitativo com questões sociodemográficas e de consumo alimentar e aferidas medidas antropométricas entre os participantes do GI e GC. Na terceira fase, os usuários do GC participaram das atividades tradicionais do serviço e usuários do GI receberam a intervenção: oferta de ações de educação alimentar e nutricional pautadas no PAAS. A fase quatro constituiu na reaplicação do questionário quantitativo acrescido de questões de adesão e satisfação dos usuários. A avaliação da efetividade foi realizada por meio da investigação da evolução do consumo alimentar, das medidas antropométricas e questões de adesão e satisfação com as atividades. Foram realizadas análises descritivas e bivariadas; análises estatísticas intragrupos (McNemar e Wilcoxon) e intergrupos (T de Student e Qui-Quadrado), sendo em todas as análises consideradas o valor significante de p<0,05. Avaliou-se a evolução de 99 adultos e idosos; 39 do GC e 60 do GI, com características sociodemográficas similares. Após intervenção, os participantes do GI aumentaram o consumo semanal de alimentos in natura (3,90 vezes para 4,30; p=0,017) e consumo regular de frutas (46,70% para 73,30%; p=0,002), reduzindo o consumo semanal de alimentos ultraprocessados (1,40 vezes para 0,67; p=0,01). O GC diminuiu o consumo semanal de alimentos ultraprocessados (1,30 vezes para 0,67; p<0,01). A intervenção nutricional pautada no PAAS foi efetiva para melhora do perfil alimentar dos usuários do APS, confirmando a necessidade de se recomendar a extensão do PAAS para outros públicos.Item Effect of a transtheoretical model-based intervention on fruit and vegetable intake according to perception of intake adequacy : a randomized controlled community trial.(2021) Carvalho, Maria Cecília Ramos de; Menezes, Mariana Carvalho de; Bertolin, Maria Natacha Toral; Lopes, Aline Cristine SouzaInterventions based on the Transtheoretical Model (TTM) are usually effective at increasing fruit and vegetable (FV) intake, but it is not known whether individuals with misperceived intake [e.g., in pseudomaintenance (PM)] for FV intake also benefit from these interventions. This study aims to describe the effectiveness of a TTM-based intervention for FV intake according to baseline perception of intake adequacy. A randomized controlled com- munity trial was carried out with 3414 users of a health promotion service in Belo Horizonte, Brazil, aged 20 years or over, in 2013–2014. FV intake was estimated using a validated instrument. PM was identified when participants had insufficient FV intake and thought their intake was adequate. The intervention group (IG) received a TTM-based intervention, and the control group (CG) received usual care. Baseline FV intakes were lower among individuals in PM compared to those with a concordant perception (CP). In both the IG and CG, FV intake increased among those in PM. Fruit intake remained stable, and vegetable intake decreased among those with CP. Generalized estimating equations revealed a significant effect of the intervention on fruit intake at follow-up, which was slightly higher among those in PM. We conclude that participants in PM were partially sensitive to the intervention and improved fruit intake at follow-up. We suggest that future studies emphasize vegetable intake and elucidate how TTM pillars (self-efficacy, decisional balance, processes of change) can be best used to increase FV intake.Item Fatores associados ao consumo inadequado de frutas e hortaliças entre usuários da Atenção Primária à Saúde no Brasil.(2022) Silva, Sarah Liduário Rocha; Mendonça, Raquel de Deus; Lopes, Aline Cristine SouzaIntrodução: O consumo inadequado de frutas e hortaliças (FH) pode derivar de questões individuais, culturais, socioeconômicas e ambientais. Objetivo: Este estudo tem como objetivo identificar os fatores associados ao consumo inadequado de frutas e hortaliças entre homens e mulheres na Atenção Primária à Saúde brasileira. Métodos: Trata-se de um estudo transversal com amostra representativa do Programa Academia da Saúde - PAS. O consumo de FH foi avaliado por um questionário validado, incluindo a frequência e o número de porções consumidas. O consumo inadequado foi classificado como frutas <3 porções/dia; hortaliças<2 porções/dia. Foram investigados o perfil sociodemográfico, de saúde, antropométrico, e relacionado à compra de frutas e hortaliças. Resultados: O consumo inadequado de frutas (mulheres: 61,4%; homens: 68,1%) e hortaliças (mulheres: 40,6%; homens: 51,1%) foi elevado. Entre as mulheres, os fatores associados ao consumo inadequado de FH foram: ser idosa, considerar a sua qualidade de vida como boa e ter conhecimento sobre a safra dos alimentos; e para frutas, ter diabetes. Para os homens, os fatores associados ao consumo inadequado de frutas foram: ser idoso e tentativa atual de emagrecer; e para hortaliças, qualidade de vida boa e risco de complicações metabólicas. Conclusão: Foram identificados fatores iguais e diferentes para mulheres e homens associados ao consumo inadequado de FH. Esses resultados mostram a importância de ações de promoção da alimentação saudável que considerem as diferenças no consumo desses alimentos de acordo com o sexo dos participantes.Item 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 SouzaThis 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.Item Intervention for promoting intake of fruits and vegetables in Brazilians : a randomised controlled trial.(2021) Mendonça, Raquel de Deus; Mingoti, Sueli Aparecida; Bethony, Maria Flávia Gazzinelli; Martínez González, Miguel Ángel; Bes Rastrollo, Maira; Lopes, Aline Cristine SouzaObjective: To evaluate the effectiveness of a nutritional intervention to promote fruit and vegetable (FV) intake. Design: A randomised controlled community trial was conducted to evaluate the effectiveness of a 7-month nutritional intervention and to promote FV intake, separately and together. All participants attended physical exercise sessions. The intervention was based on the transtheoretical model and Paulo Freire’s pedagogy. The interventions included group educational sessions, motivational cards and informational materials. The primary outcome was a change in FV intake (g/d), and secondary outcomes included stages of change, self-efficacy, decisional balance and knowledge on FV. All data were collected face-to-face; and FV intake was assessed using a validated brief questionnaire. Setting: Health promotion services of Brazilian Primary Health Care. Participants: 3414 users of Brazilian Primary Health Care (1931 in the control group and 1483 in the intervention group (IG)). Results: At baseline, the average daily FV intake was 370·4 g/d (95 % CI 364·2, 376·6). The increase in FV intake (23·4 g/d; 95 % CI 6·7, 40·0) and fruit intake (þ17·3 g/d; 95 % CI 5·1, 29·4; P = 0·01) was greater in the IG among participants in the lowest baseline intake. Participants in the IG also showed progression in the stages of change (P < 0·001), increased self-efficacy (P < 0·001) and improved knowledge of FV crops (P < 0·001). Conclusions: The nutritional intervention was effective in increasing FV intake and fruits intake among individuals with a lower intake at baseline and in maintaining FV intake among those who reported consuming FV as recommended (400 g/d).Item 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 SouzaThis 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.Item Redução da desigualdade de acesso ás ações de promoção da saúde na atenção primária brasileira : Programa Academia da Saúde.(2021) Caram, Carolina da Silva; Mendonça, Raquel de Deus; Marques, Rayane Jeniffer Rodrigues; Brito, Maria José Menezes; Lopes, Aline Cristine SouzaIntrodução: A situação de saúde marcada pela elevada prevalência de doenças crônicas não transmissíveis revela a necessidade de reestruturar a atenção à saúde. Nesse sentido, serviços como o Programa Academia da Saúde (PAS) foram implantados na Atenção Primária à Saúde (APS) brasileira. Objetivo: Analisar, sob a perspectiva dos usuários, o PAS como oportunidade de redução das desigualdades de acesso às ações de promoção da saúde na APS. Método: Trata-se de estudo qualitativo realizado na primeira unidade do PAS implantada em Belo Horizonte-MG, com ingressantes no serviço entre 2007 a 2011. A coleta de dados foi realizada mediante entrevista semiestruturada. Realizaram-se descrição dos dados sociodemográficos e análise de conteúdo do tipo temática. Resultado: Ingressaram no PAS, entre 2007 e 2011, 1.059 usuários, a maioria mulheres, adultos de meia idade, com baixa renda e elevadas prevalências de doenças crônicas não transmissíveis. Na perspectiva dos usuários, o PAS possibilitou o acesso às ações de promoção da saúde na APS, oportunizando a construção de escolhas mais saudáveis e mudanças nos modos de viver, sobretudo relacionados à atividade física e alimentação adequada e saudável, promovendo o empoderamento dos usuários. No entanto, foram identificadas limitações na integração do PAS com a Unidade Básica de Saúde adstrita. Conclusão: O PAS tem potencial para favorecer o acesso às ações de promoção da saúde na APS, embora ainda seja necessária maior integração com os demais pontos de atenção à saúde visando fortalecer o cuidado integral em rede e as ações de promoção da saúde.Item 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 Vasconcellos de Paula; Lopes, Mariana Souza; Freitas, Patrícia Pinheiro de; Campos, Suellen Fabiane; Lopes, Aline Cristine SouzaObjectives: 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.Item The transtheoretical model is an effective weight management intervention : a randomized controlled trial.(2020) Freitas, Patrícia Pinheiro de; Menezes, Mariana Carvalho de; Santos, Luana Caroline dos; Pimenta, Adriano Marçal; Ferreira, Adaliene Versiani Matos; Lopes, Aline Cristine SouzaBackground: Given the current worldwide epidemic of obesity, there is a demand for interventions with higher impact, such as those carried out in the primary health care (PHC) setting. Here we evaluate the effect of intervention performed according to the stages of change of the transtheoretical model (TTM) for weight management. Methods: This randomized controlled trial in Brazilian PHC offered free physical exercise and nutrition education. The participants were women, aged 20 years or older who were obese or overweight, users in PHC service. The intervention group (IG, n = 51) received the same orientation as the comparison group (CG, n = 35) plus individual health counseling based on the TTM aimed at weight loss, which lasted 6 months. The outcome measures were anthropometric, food, and nutrient profiles. Inflammatory parameters were evaluated in a random subsample. The inter-group and intra-group differences were evaluated using interntion-to-treat analysis, and analysis of covariance (ANCOVA) used to assess intervention effectiveness. Results: There was a difference between groups of − 1.4 kg (CI95%: − 2.5; − 0.3) in body weight after the intervention. About 97% of women in the IG reported benefits of the intervention and presented positive changes in diet, biochemical markers, and anthropometry. The IG showed better body mass index, resistine, and blood glucose results compared to the CG during follow-up. Conclusion: The individualized TTM-based intervention, combined with usual care, was an effective strategy in PHC. These results should encourage the use of interdisciplinary practices; nevertheless, research to identify additional strategies is needed to address barriers to weight maintenance among obese low-income women. Trial registration: The trial is registered with Brazilian clinical trials under the code: RBR-8t7ssv, Registration date: 12/12/2017 (retrospectively registered).