A crescente escolarização do agente comunitário de saúde: uma indução do processo de trabalho? The increasing schooling of the community health agent: an induction of the work process?

O agente comunitário de saúde (ACS) é um dos atores profissionais que compõem as equipes da Estratégia Saúde da Família (ESF), sendo sua atuação considerada fundamental para a ampliação e consolidação dessa estratégia. Desde as primeiras experiências locais com ACS em fins dos anos 1970, seu perfil sociodemográfico vem apresentando mudanças. Este artigo tem por objetivo apresentar e discutir o aspecto da escolaridade e da capacitação dos ACS que atuam na Área Programática (AP) 5.2 do município do Rio de Janeiro, articulando trabalho e educação e entendendo o trabalho como um princípio emancipatório. Este estudo foi formulado com base na ideia de triangulação metodológica, aqui alcançada a partir da formulação original de Denzin. Os dados sobre a escolaridade dos ACS foram obtidos mediante questionário autoaplicável individual, respondidos por 301 ACS dos 12 módulos de ESF e seis módulos da Estratégia de Agentes Comunitários de Saúde (EACS) da AP 5.2. A apresentação e a discussão dos dados mostram mudanças no perfil de escolaridade desse trabalhador, concluindo-se que o ACS é um trabalhador que busca alternativas de escolarização e formação profissional. Defende-se a ampliação da escolaridade e o ensino técnico como processo para a consolidação do Sistema Único de Saúde.<br>Community health agents (CHA) are among the professional players that make up the Family Health Strategy (FHS) teams, and their performance is considered as critical to the expansion and consolidation of this strategy. Since the first local experiences with CHAs in the late 1970s, their sociodemographic profile has been changing. This article aims to present and discuss the aspect of education and training of the CHAs who work in Program Area (PA) 5.2 of the city of Rio de Janeiro, integrating work and education and understanding the work as an emancipatory principle. This study was formulated based on the methodological triangulation idea, reached here based on the original formulation of Denzin. Data on the CHAs' education were obtained via an individual self-applied questionnaire answered by 301 of the CHAs of the 12 FHS modules and six Community Health Workers Strategy (CHWS) modules of PA 5.2. The presentation and discussion of the data show changes in this worker's educational profile, and it can be concluded that the CHA is a worker who is in search of alternative schooling and vocational training. An expansion of the schooling and technical education is defended as a process to consolidate the Unified Health System

Diminishing benefits of urban living for children and adolescents’ growth and development

Optimal growth and development in childhood and adolescence is crucial for lifelong health and well-being1–6. Here we used data from 2,325 population-based studies, with measurements of height and weight from 71 million participants, to report the height and body-mass index (BMI) of children and adolescents aged 5–19 years on the basis of rural and urban place of residence in 200 countries and territories from 1990 to 2020. In 1990, children and adolescents residing in cities were taller than their rural counterparts in all but a few high-income countries. By 2020, the urban height advantage became smaller in most countries, and in many high-income western countries it reversed into a small urban-based disadvantage. The exception was for boys in most countries in sub-Saharan Africa and in some countries in Oceania, south Asia and the region of central Asia, Middle East and north Africa. In these countries, successive cohorts of boys from rural places either did not gain height or possibly became shorter, and hence fell further behind their urban peers. The difference between the age-standardized mean BMI of children in urban and rural areas was <1.1 kg m–2 in the vast majority of countries. Within this small range, BMI increased slightly more in cities than in rural areas, except in south Asia, sub-Saharan Africa and some countries in central and eastern Europe. Our results show that in much of the world, the growth and developmental advantages of living in cities have diminished in the twenty-first century, whereas in much of sub-Saharan Africa they have amplified

Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults

Background: Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods: We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5-19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI &lt;18·5 kg/m2) and obesity (BMI ≥30 kg/m2). For school-aged children and adolescents, we report thinness (BMI &lt;2 SD below the median of the WHO growth reference) and obesity (BMI &gt;2 SD above the median). Findings: From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness. Interpretation: The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesity. Funding: UK Medical Research Council, UK Research and Innovation (Research England), UK Research and Innovation (Innovate UK), and European Union