Revolutionizing the Public Health Workforce-A Policy Brief in Retrospect of the World Congress on Public Health Rome 2020.

Background: The COVID-19 pandemic dramatically illustrates the consequences of inadequate prioritization of the Public Health Workforce (PHW). This Policy Brief introduces a Call for Action following the plenary session entitled "Revolutionising the Public Health Workforce (PHW) as Agents of Change" as part of the 2020 World Congress on Public Health. Policy Options and Recommendations: In order to revolutionize the PHW, five long-term key approaches are proposed: 1. Transforming public health competencies through transdisciplinary education and inter-professional training; 2. Revolutionizing educational systems by shifting the public health paradigm; 3. Linking public health education and work opportunities; 4. Overcoming the paradoxical shortage and overproduction of graduates and 5. Developing adaptable, multisectoral agents of change. Conclusion: Public health education of the future requires a paradigm shift towards a holistic understanding of public health, characterized by transdisciplinary education, inter-professional training and a closer integration of academia, health services, and communities.

[Contexts, impasses and challenges for training Public Health workers in Brazil]. / Contextos, impasses e desafios na formação de trabalhadores em Saúde Coletiva no Brasil.

An introductory comment is made on the historical background, institutional impasses and curriculum challenges for training Public Health workers in Brazil. Initially, a thesis is proposed, namely that the Brazilian state has not fulfilled its responsibility to ensure quality public services for the population, with access and equity, shaping "the four perversions of Brazilian education." Secondly, it analyzes the public health system, which is theoretically universal, but being underfunded and with acknowledged shortcomings, contributes to the increase in social exclusion. Lastly, it highlights the need for new models for training people who are technologically competent, suitable for teamwork, creative, autonomous, problem-solving, engaged in health promotion, open to social participation and committed to the humanization of health.

[Health/nursing teaching in a new proposal of academic restructuration]. / Ensinar saúde/enfermagem numa nova proposta de reestruturação acadêmica.

This study has as objective the presentation of a proposal of curricular restructure, evaluating its influence in the health instruction, focusing the nursing school. It presents, initially, the real panorama of superior education in Brazil. After that, it shows one curricular restructure proposal. Finally, it approaches the nursing/health teaching configuration in this proposal. This study points to the need of construction of a regenerated university, in its interface with the health graduation. It supports the development of educative practices adherent to the life context and to the plurality and singularity of the real social processes.

Criteria for central obesity in a Brazilian population: impact on metabolic syndrome.

OBJECTIVE: To identify and propose the optimal waist circumference cut-off points (WCp) for the diagnosis of central obesity (CO) in a Brazilian population, so as to compare these cut-off points with those recommended by the ATPIII (WC-ATPIII), and to estimate the difference in prevalence rates of metabolic syndrome (MS) using the two criteria. METHODS: Cross-sectional study conducted in a population subgroup of 1439 adults in the city of Salvador, Brazil. ROC curves of waist circumference (WC) were plotted to identify diabetes mellitus (DM) and obesity. ROC curve sensitivity and specificity values >60% and the closest to each other were used to define WCp. The prevalence of MS was estimated using WCp and WC-ATPIII. RESULTS: Eight hundred and twenty nine women comprised 57.7% of the sample. The WCp selected were 84 cm for women and 88 cm for men. These cut-off points detected DM with a 68.7% and 70% sensitivity, and a 66.2% and 68.3% specificity, respectively. For obesity, sensitivity and specificity were 79.8% and 77.6% in women and 64.3% and 71.6% in men, respectively. Using WC-ATPIII, 88 cm (for women) and 102 cm (for men), the sensitivity was 53.3% and 26.5%, respectively, to diagnose DM. For obesity, sensitivity was 66.5% (for women) and 28.6% (for men). The prevalence of MS using WCp was 23.7%, 95%CI (21.6-25.9), whereas using WC-ATPIII it was 19.0%, 95%CI (17.1-20.9), 1.2 times higher using WCp. CONCLUSION: WC-ATPIII were inappropriate and underestimated the prevalence of MS in the population studied, particularly among men. We suggest that the WC cut-off points > 84 cm for women and > 88 cm for men should be tested in other Brazilian populations.

Arterial hypertension in the adult population of Salvador (BA)--Brazil.

OBJECTIVE: To estimate the prevalence of hypertension (H) and its association with other cardiovascular risk factors in a highly multiracial population. METHODS: A cross-sectional study carried out in Salvador, Brazil, in a population sample of 1439 adults > or = 20 years of age. All participants completed a questionnaire at home and had the following measurements taken: blood pressure, body weight, height, waist circumference (WC), and serum glucose and lipids. Hypertension was defined as mean SBP > or = 140 and/or DBP > or = 90 mmHg. Hypertension prevalence was estimated with a 95% confidence interval (CI). The associations were measured by the adjusted odds ratio (AOR), using regression analysis. RESULTS: Overall prevalence of HA was 29.9%: 27.4% CI (23.9-31.2) in men and 31.7%, CI (28.5-34.9) in women. Among black men, this prevalence was 31.6%, and among black women, 41.1%. Among white men it was 25.8%, and among white women, 21.1%. Arterial hypertension was significantly associated with age > or = 40, overweight/obesity (aOR = 2.37[1.57-3.60]) for men and 1.62 (1.02-2.58) for women. Among men, HA was associated with a high level of education and among women, with dark brown and black skin, abdominal obesity, aOR = 2.05 CI (1.31-3.21), diabetes aOR = 2.16 CI (1.19-3.93), and menopause. CONCLUSION: Arterial hypertension predominated among black people of both genders, and in women. Those variables that remained independently associated with AH differed in both genders, except overweight/obesity. Our results suggest the need for an in-depth study of AH among black people and early, continuing educational interventions.

[Family environment and child's cognitive development: an epidemiological approach]. / Ambiente familiar e desenvolvimento cognitivo infantil: uma abordagem epidemiológica.

OBJECTIVE: To assess the association between quality of stimulation in the family environment and child's cognitive development considering the impact of mother's schooling on the quality of stimulation. METHODS: A cross-sectional study comprising 350 children aged 17-42 months was carried out in central and peripheral areas of Salvador, Northeastern Brazil, in 1999. A socio-economic questionnaire was used, along with the Home Observation for Measurement of the Environment Scale (HOME Inventory), and the Bayley Scale for Infant Development. Bivariate and multivariate analyses were carried out through linear regression at 5% level of significance. RESULTS: There was a positive (beta=0.66) and statistically significant association between quality of stimulation in the family environment and child's cognitive development. Part of the effect was mediated by the mother's working circumstances and educational level. It was verified that a better quality of stimulation is provided for those who come early in the birth order in family, and live with only a few others under five years of age. This pattern of stimulation is better among children who live with their parents and whose mothers have better education, have a job and a partner involved in the family environment. CONCLUSIONS: Quality of stimulation in the family environment is crucial for child's cognitive development, besides the significant role of the available resources and family dynamics. The study findings show the pertinence to cognitive development of interventions which improve the quality of the environment and the child-caregiver relationship.

[Mental health and normality: popular conceptions in a northern coastal area of Bahia, Brazil]. / Concepções populares de normalidade e saúde mental no litoral norte da Bahia, Brasil.

This study focuses on signs, meanings, and practices related to mental normality and health in a northern coastal area of Bahia, Brazil. It discusses local conceptions about the non-existence or exclusive existence of mental normality, as well as points of view concerning total mental normality. It identifies the prototypes of normality, like "normal", "almost normal", and "false normal", as signs for distinguishing mentally normal persons. The article discusses the underlying values and concepts in local personal classification of mental normality and proposes a structural health device consisting of moral, scientific, religious, environmental, and social elements. It analyzes local normalization and mental health promotion actions and the local system of signs, meanings, and practices of normality. Finally, the article analyzes the primary, secondary, and tertiary levels of health. All these goals are met by comparing local conceptions with the scientific literature on medical epistemology, psychoanalysis, sociological labeling theory, and medical anthropology.