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This study examined the prevalence and sociodemographic correlates of meeting individual behavior and 24-hr movement behavior guidelines among Brazilian older adults with chronic diseases. The sample comprised 273 older adults aged ≥60 years (80.2% women) with chronic diseases from Recife, Pernambuco, Brazil. Sociodemographic variables were self-reported, while 24-hr movement behaviors were assessed by accelerometry. Participants were classified as meeting (or not meeting) individual and integrated recommendations for moderate-to-vigorous physical activity (MVPA), sedentary behavior, and sleep duration. No participant met the 24-hr movement behavior guidelines, while only 8.4% met integrated MVPA/sleep recommendations. The prevalence of meeting recommendations of MVPA, sedentary behavior, and sleep was 28.9%, 0.4%, and 32.6%, respectively. Discrepancies according to sociodemographic variables on meeting MVPA recommendations existed. The findings show the need for dissemination and implementation strategies to foster adoption of the 24-hr movement behavior guidelines among Brazilian older adults with chronic diseases.

PURPOSE: The aims of this study were to (a) describe gender inequalities in physical activity (PA) among adolescents from Global South countries, and (b) investigate the relationship between gender inequalities in PA and contextual factors, such as geographic region, human development index, gender inequality index, and unemployment rates. METHODS: We analyzed cross-sectional data from the Global School-Based Student Health Survey conducted in Global South countries between 2010 and 2020 among 13- to 17-year-old adolescents. Country-context variables were retrieved from secondary data sources (World Health Organization, World Bank, and Human Development Reports). PA was assessed by a self-administered questionnaire querying the number of days in the past week in which participants were physically active for a total of at least 60 min. PA absolute gender inequalities were evaluated by the differences in the prevalence between boys and girls, 95% confidence intervals (95%CIs) were estimated using the bootstrap method. Relative inequalities were obtained through Poisson regression. Meta-analyses with random effects were used to calculate pooled estimates of absolute and relative inequalities. RESULTS: Based on 64 Global South countries/surveys, the prevalence of PA was 6.7 percentage points (p.p.) higher in boys than in girls, ranging from 0.5 p.p. in Afghanistan to 15.6 p.p. in Laos (I2= 85.1%). The pooled ratio for all countries showed that boys presented a PA prevalence 1.58 times higher than girls (95%CI: 1.47-1.70) on average. The highest absolute and relative inequalities were observed in high income countries. Countries with higher Human Development Index rankings and lower Gender Inequality Index rankings also presented greater gender differences. CONCLUSION: Given that girls are overall less active than boys across the globe, the findings of this study reinforce that macro- and micro-level changes should be actively sought if we aim to increase population levels of PA in adolescents and promote equity in PA.

Objective This study aimed to evaluate the relationship between sleep duration trajectories from adolescence to early adulthood and working memory, schooling and income at 22 years in the Pelotas 1993 Birth Cohort. Methods Sleep duration was self-reported at ages 11, 18 and 22. Sleep trajectories were identified using finite mixture models. Schooling was recorded as the number of completed years of education. Working memory was evaluated using The Digit Span test and income was recorded for who reported have a job and received a payment for this in the previous month. All analyses were stratified by sex. Results We used crude and adjusted (for demographic, health and behavior characteristics measured at perinatal and 11-years) linear or quantile regression analyses. A total of 2915 individuals were included. Three trajectories for males were used: “increase and maintenance” (3.4%), “fast reduction and maintenance” (45.0%) and “constant reduction” (51.6%). For females, we used the trajectories: “increase and decrease” (2.4%), “fast reduction and maintenance” (25.6%) and “constant reduction” (72.0%). Males from “increase and maintenance” and females from “increase and decrease” trajectories scored, on average, 1.6 and 1.8 points lower, respectively, in working memory test. They presented a median of 1.4 and 2.6 fewer schooling years, respectively, compared to individuals from the “fast reduction and maintenance” trajectory. Regarding income, no significant association was observed. Conclusion Sleep duration during adolescence could affect cognitive and educational outcomes in early adulthood. Individuals who presented the expected sleep trajectory (decrease of sleep duration across adolescence) presented better outcomes.

Background Within-country inequalities in birth registration coverage (BRC) have been documented according to wealth, place of residence and other household characteristics. We investigated whether sex of the head of household was associated with BRC. Methods Using data from nationally-representative surveys (Demographic and Health Survey or Multiple Indicator Cluster Survey) from 93 low and middle-income countries (LMICs) carried out in 2010 or later, we developed a typology including three main types of households: male-headed (MHH) and female-led with or without an adult male resident. Using Poisson regression, we compared BRC for children aged less than 12 months living the three types of households within each country, and then pooled results for all countries. Analyses were also adjusted for household wealth quintiles, maternal education and urban-rural residence. Results BRC ranged from 2.2% Ethiopia to 100% in Thailand (median 79%) while the proportion of MHH ranged from 52.1% in Ukraine to 98.3% in Afghanistan (median 72.9%). In most countries the proportion of poor families was highest in FHH (no male) and lowest in FHH (any male), with MHH occupying an intermediate position. Of the 93 countries, in the adjusted analyses, FHH (no male) had significantly higher BRC than MHH in 13 countries, while in eight countries the opposite trend was observed. The pooled analyses showed t BRC ratios of 1.01 (95% CI: 1.00; 1.01) for FHH (any male) relative to MHH, and also 1.01 (95% CI: 1.00; 1.01) for FHH (no male) relative to MHH. These analyses also showed a high degree of heterogeneity among countries. Conclusion Sex of the head of household was not consistently associated with BRC in the pooled analyses but noteworthy differences in different directions were found in specific countries. Formal and informal benefits to FHH (no male), as well as women’s ability to allocate household resources to their children in FHH, may explain why this vulnerable group has managed to offset a potential disadvantage to their children.

BackgroundThe literature on the association between religion and immunization coverage is scant, mostly consisting of single-country studies. Analyses in low and middle-income countries (LMICs) to assess whether the proportions of zero-dose children vary according to religion remains necessary to better understand non-socioeconomic immunization barriers and to inform interventions that target zero-dose children.MethodsWe included 66 LMICs with standardized national surveys carried out since 2010, with information on religion and vaccination. The proportion of children who failed to receive any doses of a diphtheria-pertussis-tetanus (DPT) containing vaccine – a proxy for no access to routine vaccination or “zero-dose” status – was the outcome. Differences among religious groups were assessed using a test for heterogeneity. Additional analyses were performed controlling for the fixed effect of country, household wealth, maternal education, and urban-rural residence to assess associations between religion and immunization.FindingsIn 27 countries there was significant heterogeneity in no-DPT prevalence according to religion. Pooled analyses adjusted for wealth, maternal education, and area of residence showed that Muslim children had 76% higher no-DPT prevalence than Christian children. Children from the majority religion in each country tended to have lower no-DPT prevalence than the rest of the population except in Muslim-majority countries.InterpretationAnalyses of gaps in coverage according to religion are relevant to renewing efforts to reach groups that are being left behind, with an important role in the reduction of zero-dose children.

Female-headed households (FHHs) are regarded as disadvantaged. There are multiple social trajectories that can lead to women heading households. It is important to distinguish between these trajectories, as well as societal norms and contextual factors, to understand how and when are FHHs represented as a dimension of gender inequity. Our analysis defines and describes a typology of 16 FHH types (FHH16) based on demographic characteristics.This cross-sectional study used national Demographic Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS) in 103 low- and middle-income countries (LMICs) to identify a typology of FHHs based on the family composition and additional household members. We performed descriptive analyses at the household level to generate median proportions of the FHH16 types and selected household characteristics. We conducted cluster analyses to explore FHH16 patterns across naturally grouped clusters of countries and described selected social and economic indicators at the ecological level.The most common FHH16 types were those where the women household heads lived with children only, were alone, or lived with men, women, and children, but without a husband. In Africa and South Asia, the most common FHH was one where women heads resided with children only. In East Asia and the Pacific, the highest proportion of FHHs were those with men, women, and children. In MENA and Eastern EuropeCentral Asia, households with women heads living alone were the most prevalent. Latin America had more FHHs with husbands, comparatively, and the most common FHHs were those with heads living alone or with children. Our exploratory cluster analysis generated five clusters with unique FHH16 patterns. The clusters had distinct geographic, contextual and economic characteristics.Our typology showed that FHHs are heterogeneous within and between countries. The ecological analysis emphasized further variation created by different societal and cultural factors. Research around their vulnerabilities and strengths needs to consider these factors and their influence on socioeconomic status and health-related outcomes within households headed by women.

To help provide a global understanding of the role of gender-related barriers to vaccination, we have used a broad measure of women's empowerment and explored its association with the prevalence of zero-dose children aged 12-23 months across many low- and middle-income countries, using data from standardized national household surveys.We used data from Demographic and Health Surveys (DHS) of 50 countries with information on both women's empowerment and child immunisation. Zero-dose was operationally defined as the proportion of children who failed to receive any doses of the diphtheria, pertussis, and tetanus containing vaccines (DPT). We measured women's empowerment using the SWPER Global, an individual-level indicator estimated for women aged 15-49 years who are married or in union and with three domains: social independence, decision-making and attitude towards violence. We estimated two summary measures of inequality, the slope index of inequality (SII) and the concentration index (CIX). Results were presented for individual and pooled countries.In the country-level (ecological) analyses we found that the higher the proportion of women with high empowerment, the lower the zero-dose prevalence. In the individual level analyses, overall, children with highly-empowered mothers presented lower prevalence of zero-dose than those with less-empowered mothers. The social independence domain presented more consistent associations with zero-dose. In 42 countries, the lowest zero-dose prevalence was found in the high empowerment groups, with the slope index of inequality showing significant results in 28 countries. When we pooled all countries using a multilevel Poisson model, children from mothers in the low and medium levels of the social independence domain had respectively 3.3 (95% confidence interval (CI) = 2.3, 4.7) and 1.8 (95% CI = 1.5, 2.1) times higher prevalence of zero-dose compared to those in the high level.Our country-level and individual-level analyses support the importance of women's empowerment for child vaccination, especially in countries with weaker routine immunisation programs.

This study evaluated prospective associations between self-reported and objectively measured physical activity (PA) and risk of falls among older adults. A cohort study started in 2014 with 1,451 community-dwelling older adults living in Pelotas, Brazil. Leisure-time PA was obtained by the International Physical Activity Questionnaire and 7-day raw accelerometer data evaluated for total, light PA, and moderate to vigorous PA. In 2016–2017, participants recorded their falls in the previous 12 months. Around 23% of the 1,161 participants followed-up in 2016–2017 experienced a fall in the last 12 months. Participants who did not spend any time in self-reported leisure-time PA at baseline had on average 34% higher risk of falls, and individuals in the lowest tertile for moderate to vigorous PA had on average 51% higher risk of falls compared to those in the highest tertile. Low levels of self-reported and objectively measured moderate to vigorous PA were related to higher risk of falling among Brazilian older adults. Objective and Self-Reported Physical Activity and Risk of Falling Among Community-Dwelling Older Adults From Southern Brazil

BackgroundThe Sustainable Development Goals (SDGs) recommend stratification of health indicators by ethnic group, yet there are few studies that have assessed if there are ethnic disparities in childhood immunisation in low- and middle-income countries (LMICs).MethodsWe identified 64 LMICs with standardized national surveys carried out since 2010, which provided information on ethnicity or a proxy variable and on vaccine coverage; 339 ethnic groups across the 64 countries were identified after excluding those with fewer than 50 children in the sample and countries with a single ethnic group. Lack of vaccination with diphtheria-pertussis-tetanus (DPT) vaccine – a proxy for no access to routine vaccination or ‘zero-dose’ status – was the outcome of interest. Differences among ethnic groups were assessed using a chi-squared test for heterogeneity. Additional analyses controlled for household wealth, maternal education and urban-rural residence.FindingsThe median gap between the highest and lowest zero-dose prevalence ethnic groups in all countries was equal to 10 percentage points (interquartile range 4-22; range 1 to 84) and the median ratio was 3.3 (interquartile range 1.8-6.7; range 1.1-30.4). In 35 of the 64 countries, there was significant heterogeneity in zero-dose prevalence among the ethnic groups. In most countries, adjustment for wealth, education and residence made little difference to the ethnic gaps, but in four countries (Angola, Benin, Nigeria, and Philippines) the high-low ethnic gap decreased by over 15 pp after adjustment. Children belonging to a majority group had 29% lower prevalence of zero-dose compared to the rest of the sample.InterpretationStatistically significant ethnic disparities in child immunisation were present in over half of the countries studied. Such inequalities have been seldom described in the published literature. Regular analyses of ethnic disparities are essential for monitoring trends, targeting resources and assessing the impact of health interventions to ensure zero-dose children are not left behind in the Sustainable Development Goals era.FundingBill & Melinda Gates Foundation, Gavi, the Vaccine Alliance, Wellcome Trust, and Associação Brasileira de Saúde Coletiva.

To evaluate time evolution of receiving advice on healthy habits among Brazilians with hypertension and diabetes mellitus. Cross-sectional study with data from the 2013 and 2019 National Health Survey. We used linear regression weighted by least squares of variance to verify time evolution of the outcome estimating the annual percentage change (APC) presented according to sex, skin color, age group, and quintiles of wealth index. The analytical sample in 2013 was 11,129 individuals with hypertension and 3,182 individuals with diabetes, and in 2019 19,107 individuals with hypertension and 6,317 individuals with diabetes. For those with hypertension, there were statistically significant reductions in receiving advice for not smoking (APC: -1.49), not drinking excessive alcoholic beverages (APC: -1.48), ingesting less salt (APC: -0.56), and for all healthy habits (APC: -1.17). For those with diabetes, statistically significant reductions were observed only for not smoking (APC: -1.13) and not drinking excessive alcoholic beverages (APC: -1.11). The results suggest a reduction in all types of advice on healthy habits evaluated for hypertension and diabetes, with greater magnitude among individuals belonging to the richest quintiles. Resumo O objetivo foi avaliar a evolução temporal do recebimento de orientações sobre hábitos saudáveis entre brasileiros com hipertensão arterial e diabetes mellitus. Estudo transversal com dados da Pesquisa Nacional de Saúde de 2013 e 2019. Para verificar a evolução temporal das prevalências de orientações sobre hábitos saudáveis, realizadas por profissionais de saúde nos atendimentos para as morbidades, utilizou-se regressão linear ponderada pelos quadrados mínimos da variância, estimando a variação percentual anual (VPA) apresentada de acordo com sexo, cor da pele, faixa etária e quintis do índice de bens. A amostra analítica, em 2013, foi de 11.129 indivíduos com hipertensão e 3.182 com diabetes, e em 2019, de 19.107 indivíduos com hipertensão e 6.317 com diabetes. Para hipertensão, observou-se reduções nas orientações para não fumar (VPA: -1.49), não ingerir bebidas alcoólicas em excesso (VPA: -1.48), ingerir menos sal (VPA: -0.56) e, ainda, para todas as orientações (VPA: -1.17). Para diabetes, foram observadas reduções estatisticamente significativas apenas para não fumantes (APC: -1.13) e para os que não consomem bebidas alcoólicas em excesso (APC: -1.11). Os resultados sugerem redução de todas as orientações avaliadas para hipertensão e diabetes, com maior magnitude entre os indivíduos pertencentes aos quintis mais ricos.

Background Gender norms greatly affect who is the main breadwinner and decision maker in a household. Commonly, in the Middle East and North Africa (MENA) region, males are the household heads and it is believed that female-headed households (FHH) are more disadvantaged compared to male-headed households (MHH). Our analysis identifies a household typology and illustrates differences in social inequalities and child health outcomes by headship gender. Methods We used DHS/MICS surveys in MENA to identify three types: MHH, and FHH with/without males. We analyzed differentials in birth registration, care-seeking for health treatment, obesity, stunting and full vaccination, wealth quintiles, head’s education and residence. Results Among nine countries with surveys since 2010, the average prevalence of FHH was 12%. Female heads were generally over 50 years and had no or primary education. FHH are generally poorer, especially FHH with no males. In Algeria, Iraq, Morocco and Yemen, the proportions of FHH with males present were larger in the richer quintiles, compared to other household types. Disparities in child indicators varied by country, and were not evident for birth registration, vaccination and obesity. Care-seeking was higher among FHH. Stunting was higher among FHH without males. Conclusions Disparities in child health indicators are not evident across the household types. However, there were differences in household wealth and head’s education by household type. Female headship is an important dimension of inequality, but there are differences within that category. Key messages Despite being socially disadvantaged, children in FHH received similar healthcare compared to children in MHH.

O objetivo do estudo foi verificar a distribuição dos diferentes tipos de práticas entre os praticantes de atividade física de uma amostra de adultos de acordo com características sociodemográficas. Estudo transversal utilizando dados da Pesquisa Nacional de Saúde (PNS) de 2013, com adultos de 18 anos ou mais, praticantes de atividade física (n = 17.350). As variáveis independentes foram sexo, faixa etária, escolaridade e regiões geográficas. As variáveis dependentes foram os tipos de atividade física mais praticadas na população. Para apresentar as frequências de prática de prática segundo região, escolaridade e idade as atividades as atividades foram divididas em três grupos: caminhada, exercício e esportes. Os dados foram analisados no STATA 12.1. Nos homens, as atividades mais comuns foram futebol (39,1%), caminhada (22,9%) e musculação (15,3%). Nas mulheres, foram a caminhada (48,9%), ginástica (19,2%) e musculação (14,2%). Nos homens, a prática de caminhada foi maior nos mais velhos, sem instrução e da região Centro Oeste (p < 0,001). Quanto a prática de exercícios, nos homens, este hábito foi mais comum entre os mais jovens, com maior escolaridade, e da região Sudeste (p < 0,001). Em relação aos esportes, a prática foi mais comum nos mais jovens, nos com maior escolaridade e da região Norte (p < 0,001), tanto nos homens quanto nas mulheres. A prática esportiva foi menos frequente nas mulheres. Os tipos de atividade têm grande influência da idade, escolaridade dos indivíduos e região do país. Estes aspectos devem ser levados em conta do planejamento de intervenções.

Objectives Use of objectively measured physical activity (PA) in older adults to assess relationship between PA and risk of all-causes mortality is scarce. This study evaluated the associations of PA based on accelerometry and a questionnaire with the risk of mortality among older adults from a city in Southern Brazil. Design A cohort study. Setting Urban area of Pelotas, Southern Brazil. Participants A representative sample of older adults (≥60 y) from Pelotas, enrolled in 2014. Measurements Overall physical activity (mg), light physical activity (LPA), and moderate to vigorous physical activity (MVPA) were estimated by raw accelerometer data. The International Physical Activity Questionnaire estimated leisure time and commuting PA. Hazard ratios (excluding deaths in the first 6 mo) stratified by sex were estimated by Cox regression analysis considering adjustment for confounders. Results From the 1451 older adults interviewed in 2014, 145 died (10%) after a follow-up of an average 2.6 years. Men and women in the highest tertile of overall PA had on average a 77% and 92% lower risk of mortality than their less active counterparts (95% confidence interval [CI] = .06-.84 and 95% CI = .01-.65, respectively). The highest tertile of LPA was also related to a lower risk of mortality in individuals of both sexes (74% and 91% lower risk among men and women, respectively). MVPA statistically reduced the risk of mortality only among women (hazard ratio [HR] = .30 and HR = .07 in the second and third tertiles). Self-reported leisure-time PA was statistically associated with a lower risk of mortality only among men. Women in the highest tertiles of commuting PA showed a lower risk of mortality than those in the reference group. Conclusion Accelerometry-based PA was associated with a lower risk of mortality among Brazilian older adults. Older individuals should practice any type of PA. J Am Geriatr Soc 68:137-146, 2019.

The aim of this study was to systematically examine the literature on physical activity and sleep in non-clinical and population-based settings. The inclusion criteria were original studies testing the association between physical activity (as exposure) and sleep (as outcome) in representative samples of the general population, workers, or undergraduate students. Sleep health included sleep duration, sleep quality and insomnia. Studies evaluating samples including only individuals with some disease or a health condition were excluded. A search was performed in the PubMed, Scopus, Lilacs, CINAHL, and SPORTdiscus databases in March 2018. Data extraction was performed using the following items: year, author, country, population, age group, sample size, study design, sleep measurement/definition, physical activity measurement/definition, adjustment and main results. A total of 57 studies were selected, which markedly used heterogeneous instruments to measure physical activity and sleep. The majority were conducted in high-income countries and with cross-sectional design. Physical activity was associated with lower odds of insomnia (observed in 10 of 17 studies), poor sleep quality (observed in 12 of 19 studies) and long sleep duration (observed in 7 of 11 studies). The results about short sleep or continuous sleep duration remain unclear. Physical activity seems to be associated with sleep quality and insomnia, especially among adult and elderly populations in which these outcomes are more usually measured. The short- and long-term effects of physical activity intensities and dose-response on sleep should be better evaluated.

Estudos sobre desigualdades na prática de esporte e atividades físicas são uma importante ferramenta para embasar políticas públicas. Assim como abordagens de nível nacional, análises específicas de acordo com regiões se fazem necessárias. O objetivo deste estudo foi verificar as desigualdades em termos de sexo, cor da pele, área de residência e escolaridade na prática de esporte ou atividades físicas de acordo com as regiões do Brasil. Foram analisados os dados da investigação suplementar da Pesquisa Nacional por Amostra de Domicílios de 2015, uma amostra representativa da população de adultos brasileiros. As análises contemplaram a prática de esporte e atividades físicas durante o ano anterior à entrevista e análises simples e complexas de desigualdade foram realizadas de acordo com cada região do país. Homens, pessoas de cor de pele branca, moradores da zona urbana e com maior escolaridade apresentaram maior prática em todas as regiões. Em termos de magnitude das desigualdades, as regiões que apresentaram maiores desigualdades foram a norte (prática entre homens 12,9 pontos percentuais – p.p., maior que entre mulheres) e a sul (41,1 p.p. de diferença entre os grupos extremos de escolaridade e 13,4 p.p. entre zona urbana e rural). Pessoas de cor da pele branca apresentaram 4,9 p.p. a mais de prevalência em relação às pretas ou pardas, sem diferenças marcantes entre as regiões. Os resultados identificaram a presença de desigualdades sistematicamente na direção de grupos privilegiados social e economicamente em nossa sociedade em todas as regiões do país, embora magnitudes diferentes sejam observadas regionalmente.

Background: This study aims to describe changes in gender and wealth inequalities in leisure-time physical activity (PA) of Brazilians during a 6-year interval. It also aims to evaluate inequalities regarding PA public programs awareness, participation, and access to public spaces for PA. Methods: Data from 2 population-based surveys conducted in 2013 and 2019 were used. Leisure-time PA prevalence was assessed considering those reporting ≥150 minutes per week. The authors evaluated gender inequalities calculating differences and ratios, and wealth inequalities using the slope index of inequality and the concentration index— assessing changes over time. Results: National levels of leisure-time PA increased from 2013 to 2019, and an increase in inequalities was observed; women and the poorest groups still presented lower prevalence. A decline in socioeconomic inequalities was observed from 2013 to 2019 regarding the availability of public spaces and awareness about public programs. However, outcomes remained more common among the richest group. Inequalities did not vary for participation in public programs. Conclusion: Although leisure-time PA increased from 2013 to 2019 at a national level, there were no improvements in gender inequalities, and wealth inequalities worsened over time. Indicators of public strategies for PA increased for the population, but inequalities remain.

Objective To describe socio-economic inequalities in dental pain and dental caries in 5 and 12-year-old children enrolled in a birth cohort. Methods This prospective study was carried out with children enrolled in a birth cohort in Pelotas, Brazil. The main outcome was history of dental pain in the last six months, collected at 5 and 12 years of age. Dental caries was evaluated as a secondary outcome. Inequalities dimensions were investigated using maternal education and family income. The inequalities indicators used were the slope index of inequality (SII) and the concentration index (CIX). Results Some 1,114 and 990 children were included in the analyses at the 5- and 12-year follow-ups, respectively. The prevalence of dental pain was 16.5% (95% CI 14.4-18.8) at 5 years and 31.6% (95% CI 28.7-34.6) at 12 years. Regarding SII, the difference in the prevalence of dental pain was 14 and 11 percentage points at 5 and 12 years, respectively, when comparing the less to the more maternal schooled strata. Relative inequalities (CIX) were found for dental pain only at age 12, considering family income (-5.8 CI95% -11.0; -0.6). Absolute socio-economic inequalities were also observed for dental caries in both ages. Conclusion Dental pain in the last six months and dental caries was unequally distributed. Economically disadvantaged groups had the highest prevalence of dental pain and dental caries in both dentitions. Actions to tackle socio-economic inequalities must be designed throughout life.

Studies of inequalities in child health have given limited attention to household structure and headship. The few existing reports on child outcomes in male and female-headed households have produced inconsistent results. The aim of our analyses was to provide a global view of the influence of sex of the household head on child health in cross-sectional surveys from up to 95 LMICs. Studied outcomes were full immunization coverage in children aged 12–23 months and stunting prevalence in under-five children. We analyzed the most recent nationally-representative surveys for each country (since 2010) with available data. After initial exploratory analyses, we focused on three types of households: a) male-headed household (MHH) comprised 73.1% of all households in the pooled analyses; b) female Headed Household (FHH) with at least one adult male represented 9.8% of households; and c) FHH without an adult male accounted for 15.0% of households. Our analyses also included the following covariates: wealth index, education of the child’s mother and urban/rural residence. Meta-analytic approaches were used to calculate pooled effects across the countries with MHH as the reference category. Regarding full immunization, the pooled prevalence ratio for FHH (any male) was 0.99 (0.97; 1.01) and that for FHH (no male) was 0.99 (0.97; 1.02). For stunting prevalence, the pooled prevalence ratio for FHH (any male) was 1.00 (0.98; 1.02) and for FHH (no male) was 1.00 (0.98; 1.02). Adjustment for covariates did not lead to any noteworthy change in the results. No particular patterns were found among different world regions. A few countries presented significant inequalities with different directions of association, indicating the diversity of FHH and how complex the meaning and measurement of household headship may be. Further research is warranted to understand context, examine mediating factors, and exploring alternative definitions of household headship in countries with some association., Highlights • Globally, living in a female-headed household showed no effect on child outcomes. • A small group of countries presented inequalities in stunting and immunization. • The direction of female headed household effect on child outcomes varied widely.

BackgroundThe Sustainable Development Goals (SDGs) recommend stratification of health indicators by ethnic group, yet there are few studies that have assessed if there are ethnic disparities in childhood immunisation in low-income and middle-income countries (LMICs).MethodsWe identified 64 LMICs with standardised national surveys carried out since 2010, which provided information on ethnicity or a proxy variable and on vaccine coverage; 339 ethnic groups were identified after excluding those with fewer than 50 children in the sample and countries with a single ethnic group. Lack of vaccination with diphtheria–pertussis–tetanus vaccine—a proxy for no access to routine vaccination or ‘zero-dose’ status—was the outcome of interest. Differences among ethnic groups were assessed using a χ2 test for heterogeneity. Additional analyses controlled for household wealth, maternal education and urban–rural residence.FindingsThe median gap between the highest and lowest zero-dose prevalence ethnic groups in all countries was equal to 10 percentage points (pp) (IQR 4–22), and the median ratio was 3.3 (IQR 1.8–6.7). In 35 of the 64 countries, there was significant heterogeneity in zero-dose prevalence among the ethnic groups. In most countries, adjustment for wealth, education and residence made little difference to the ethnic gaps, but in four countries (Angola, Benin, Nigeria and Philippines), the high–low ethnic gap decreased by over 15 pp after adjustment. Children belonging to a majority group had 29% lower prevalence of zero-dose compared with the rest of the sample.InterpretationStatistically significant ethnic disparities in child immunisation were present in over half of the countries studied. Such inequalities have been seldom described in the published literature. Regular analyses of ethnic disparities are essential for monitoring trends, targeting resources and assessing the impact of health interventions to ensure zero-dose children are not left behind in the SDG era.

The aim of this study was to assess trends in inequalities regarding sex and educational levels in accumulated behavioral risk factors in the Brazilian state capitals. Repeated surveys from a Vigitel surveillance initiative carried out from 2008 to 2018 including adults (≥ 18 years) living in the 26 Brazilian state capitals and in the Federal District were analyzed (n = 569246). Accumulation of at least two behavioral risk factors including physical inactivity, inadequate diet, tobacco use and abusive alcohol consumption. Simple and complex measures of inequality were calculated according to sex and educational level, in addition to assessing intersectionality between age groups and regions of the country. The accumulated risk factor prevalence between 2008 and 2018 decreased from 51.6% to 41.2% among males and from 45.3% to 30.8% among females. Despite the observed decreasing trends in the prevalence of accumulated risk factors over time, inequalities of sex and educational levels persisted. Adult males and people with lower levels of education persistently presented higher prevalence of accumulated risk factors, highlighting not only the need for monitoring strategies of such inequalities, but also for actions aiming at reducing this trend.O objetivo do estudo foi avaliar as tendências das desigualdades de sexo e escolaridade no acúmulo de fatores de risco comportamentais nas capitais brasileiras. Foram analisados repetidos inquéritos do Vigitel, entre os anos de 2008 e 2018, com adultos (≥ 18 anos) residentes nas capitais dos 26 estados brasileiros e no Distrito Federal (n = 569.246). O acúmulo de ao menos dois fatores de risco comportamentais contemplou inatividade física, alimentação inadequada, tabagismo e consumo abusivo de álcool. Foram utilizadas medidas simples e complexas de desigualdade (de sexo e escolaridade). As interseccionalidades de sexo e escolaridade por faixa etária e região também foram consideradas. Entre 2008 e 2018, a prevalência do acúmulo em adultos diminuiu de 51,6% para 41,2% entre os homens, e de 45,3% para 30,8% entre as mulheres. Embora uma tendência de redução do acúmulo dos fatores de risco ao longo do tempo tenha sido observada, as desigualdades de sexo e escolaridade em geral persistiram. Homens adultos e pessoas com menor escolaridade apresentam de forma sistemática maiores prevalências de acúmulo, reforçando a necessidade de monitoramento das desigualdades e de ações para sua redução.

This article aims to analyze the association between sleep time and handgrip strength in adolescents belonging to the 1997/1998 São Luís Birth Cohort. This was a cross-sectional study nested in a birth cohort study. One thousand two hundred sixty-nine individuals (18 and 19 years) wore an Actigraph® GTX3+ accelerometer on their wrist 24 hr/day for 7 consecutive days. Handgrip strength was measured using a digital hand dynamometer. We used directed acyclic graphs (DAG) to identify confounding variables. This sample of adolescents was mostly composed of men, with brown skin color, economic class C, which did not work, did not consume alcohol, did not smoke, and never used drugs. The mean value of handgrip strength was 28.2 (±9.3) kgf, and the mean of sleep time was 6 (±1.0) hours per day. The crude analysis showed an association between sleep time and muscle strength. An increase of one hour of sleep reduced the handgrip strength by 1.95 kgf (95%CI:-2.51;-1.39). However, after adjustment for confounders, the association was not maintained (β:-0.07; 95%CI:-0.48;0.36). Sleep time is not associated with handgrip strength in adolescents in São Luís. Resumo O objetivo deste artigo é analisar a associação entre tempo de sono e força de preensão manual em adolescentes da Coorte de Nascimentos de São Luís 1997/1998. Estudo transversal aninhado a um estudo de coorte de nascimentos. Mil duzentos e sessenta e nove indivíduos (18 e 19 anos) usaram um acelerômetro Actigraph® GTX3 + em seu pulso 24 horas/dia por sete dias consecutivos. A força de preensão manual foi medida por meio de um dinamômetro digital de mão. Usou-se gráficos acíclicos direcionados (DAG) para identificar variáveis de confusão. A amostra de adolescentes foi composta em sua maioria por homens, de cor da pele parda, classe econômica C, que não trabalhava, não consumiam álcool, não fumavam e nunca usaram drogas. O valor médio da força de preensão manual foi de 28,2 (±9,3) kgf, e a média do tempo de sono foi de seis (±1,0) horas por dia. A análise bruta mostrou associação entre tempo de sono e força muscular. O aumento de uma hora de sono reduziu a força de preensão manual em 1,95 kgf (IC95%:-2,51;-1,39). No entanto, após o ajuste para fatores de confusão, a associação não foi mantida (β:-0,07; IC95%:-0,48;0,36). O tempo de sono não foi associado à força de preensão manual em adolescentes de São Luís.

This article aims to measure socioeconomic inequalities regarding access to health services, contact with health professionals, and specific health interventions. This was a cross-sectional population-based study with individuals aged 18 years or older, living in the city of Rio Grande. The outcomes were the following: Family Health Strategy (FHS) coverage; having a health insurance plan; receiving a visit of a community health worker; medical consultation; dental consultation; dietary counseling; having a class with a physical education professional; flu vaccination; mammography, cytopathological and prostate exams. Relative and absolute measures were used to assess inequalities in the distribution of the outcomes. There was a response rate of 91% (1,300 adults were interviewed). Coverage indicators ranged from 16.1%, for having a class with a physical education professional, to 80.0% for medical consultation. FHS coverage and visit of a community health agent presented higher proportions among the poorest while outcomes regarding contact with health professionals, screening exams and flu vaccine were more prevalent among richest group. We observed low coverage levels of access to health services and professionals in addition to marked socioeconomic inequalities. Resumo O objetivo deste artigo é mensurar desigualdades socioeconômicas no acesso a serviços de saúde, no contato com profissionais e em intervenções específicas. Estudo transversal de base populacional com indivíduos (18 anos ou mais) vivendo em Rio Grande. Os desfechos mensurados foram: cobertura da Estratégia de Saúde da Família (ESF), plano de saúde, visita do agente comunitário de saúde, consulta médica, consulta com dentista, aconselhamento nutricional, aula com professor de educação física, vacina da gripe, mamografia, exames citopatológico e de próstata. Medidas de desigualdade absolutas e relativas foram utilizadas para avaliar a distribuição dos desfechos. A taxa de resposta foi de 91% (1.300 adultos entrevistados). A cobertura dos indicadores variou de 16,1%, para ter aula com professor de educação física, a 80,0%, para consulta médica. Cobertura de ESF e visita do agente comunitário de saúde apresentaram maior proporções entre os mais pobres, enquanto desfechos de contato com profissionais de saúde, exames de rastreamento e vacina da gripe foram mais prevalentes entre os mais ricos. Foram observadas baixas coberturas de acesso aos serviços e contato com profissionais, bem como desigualdades sociodemográficas importantes.

This study aimed to describe leisure-time physical activity (LPA) during the COVID-19 pandemic in a municipality of Rio Grande do Sul state, southern Brazil, according to gender, level of education, and adherence to social distancing. A population-based and cross-sectional descriptive study was carried out in Bagé (RS), Brazil. LPA during the pandemic, place of activity, and Physical Education professional's supervision, were described. The sample included 377 adults, and 24.4% reported LPA during the pandemic. Marked inequalities were observed. LPA prevalence among men was 20 percentage points (pp) higher than women and 40 pp higher among those with higher schooling than those with lower schooling. Among those reporting LPA, 53.5% practiced at home, and 64.8% did not report Physical Education professional supervision. No differences were observed between LPA and level of social distancing. Besides the recurrent discourse that people should include physical activity in the pandemic context, in the light of the marked inequalities observed, this study addressed sociocultural aspects and emphasized that LPA promotion initiatives require humanized approaches that consider the unequal living conditions of Brazilians.O objetivo deste estudo foi descrever a prática de atividade física de lazer (AFL) em meio a pandemia do COVID-19 em cidade do Rio Grande do Sul, avaliando desigualdades entre os sexos e grupos de escolaridade e diferenças de acordo com o nível de distanciamento social. Trata-se de um estudo descritivo de corte transversal e base populacional com adultos no município de Bagé. Foram descritas a prática de AFL durante a pandemia, local de prática e orientação profissional. Na amostra de 377 adultos, 24,4% relataram prática de AFL durante a pandemia. Foram observadas marcantes desigualdades; a prevalência de AFL entre homens foi 20 pontos percentuais (pp) maior do que entre as mulheres, e 40 pp maior no grupo de maior escolaridade comparado ao grupo de menor escolaridade. Entre os que praticaram AFL durante a pandemia, 53,5% relataram a prática em casa e 64,8% não teve auxílio de um profissional de Educação Física. Não houve diferença na AFL de acordo com níveis de distanciamento social. Para além da reprodução do discurso de que as pessoas devam praticar atividade física no contexto da pandemia, este estudo buscou discutir aspectos socioculturais, enfatizando, à luz das desigualdades observadas, que a promoção de AFL necessita de olhar humanizado e atento à vida desigual das pessoas no Brasil.

The scope of this paper was to identify patterns of food consumption and associated factors among children under two years of age in Brazil. It involved a cross-sectional, population-based study using data from the National Health Survey conducted in 2013. Food consumption was measured by dichotomous questions, listing the food ingested solely on the day prior to the interview. The patterns were identified through principal component analysis. Poisson regression was used to obtain a crude and adjusted prevalence ratio. The sample design effect was considered in the analyses that were stratified according to age. Among the 5,052 children, three patterns were identified, being defined as: a "healthy food consumption pattern," a "milk consumption pattern" and an "unhealthy food consumption pattern." There was an association between the patterns in each age group, mainly related to skin color, gender, schooling of the head of the family, area of residence and region. A quarter of the children from 12 to 23 months consumed soft drinks, more than a third drank artificial juices and almost half ate candies the day before the interview. Three dietary patterns were identified, besides observing early food ingestion among children under six months of age.Objetivou-se identificar os padrões de consumo alimentar e os fatores associados em crianças menores de dois anos no Brasil. Estudo transversal, de base populacional, utilizando dados da Pesquisa Nacional de Saúde realizada em 2013. O consumo alimentar foi mensurado por questões dicotômicas, listando os alimentos, considerando apenas o dia anterior à entrevista. Os padrões foram identificados por meio de análise de componentes principais. Utilizou-se regressão de Poisson para obtenção de razão de prevalência bruta e ajustada. Considerou-se o efeito de delineamento amostral nas análises que foram estratificadas de acordo com a idade. Dentre as 5.052 crianças, foram identificados três padrões, sendo denominados como: “padrão de consumo de alimentos saudáveis”, “padrão de consumo de leites” e “padrão de consumo de alimentos não saudáveis”. Observou-se associação entre os padrões em cada faixa etária, principalmente com cor da pele, sexo, escolaridade do chefe da família, zona de residência e região. Um quarto das crianças de 12 a 23 meses ingeriu refrigerantes, mais de um terço sucos artificiais e quase metade doces no dia anterior à entrevista. Foram identificados três padrões alimentares, além de observar introdução alimentar precoce em crianças menores de seis meses de idade.

This study aimed to describe longitudinal trajectories of sleep duration, among adolescents and adults from the Pelotas (Brazil) 1993 Birth Cohort, as well as characterize different trajectories groups according to socioeconomic, demographic and behavior characteristics. Sleep duration, hours per day (from Monday to Friday), bedtime and wake-up time were self-reported by participants at ages 11, 18 and 22 years. Covariables included socioeconomic, demographic, health and behavior characteristics. Trajectory analysis was performed using a semi-parametric, group-based modelling approach. Prevalence and 95% confidence interval were obtained to describe covariables and sleep trajectory groups. Chi-square test was employed in statistical analysis and all analyses were stratified by sex. A total of 3.395 individuals were included in the analysis. In both sexes, bedtime became later across years, while wake-up time presented little variation. Differences according sex were more pronounced from 18 years onwards. Three trajectories of sleep duration from 11 to 22 years were identified for males: "increase and maintenance" (3.4%), "fast reduction and maintenance" (45.0%) and "constant reduction" (51.6%). While in females the trajectories identified were: "increase and decrease" (2.4%), "fast reduction and maintenance" (25.6%) and "constant reduction" (72.0%). Men and women who belong to trajectories with longer sleep durations were more likely to present higher percentages of some risk behaviors and poor socioeconomic condition. Our results have provided longitudinal information regarding sleep duration trajectories in a medium-sized city in Brazil, aiming at filling an existing gap in literature from low- and middle-income countries.

Objective The objective of the present study was to investigate the associated factors with short and long sleep duration at ages 11 (pre-adolescence) and 22 years old (early adulthood). Methods Participants of the 1993 Pelotas birth cohort with self-reported sleep records at 11 (n = 4442) and 22 (n = 3800) years were included. The total sleep time duration was categorised as short ( 11 for 11 years and >9 for 22 years) and recommended according to the National Sleep Foundation criteria. Multinomial regression analyses were applied according to a hierarchical approach in order to investigate the associated factors with sleep duration patterns. All analyses were stratified by sex. Results Higher income was associated with higher odds of short sleep duration in 11-year-old boys [OR = 1.54 (CI95%: 1.08; 2.19)] and girls [OR = 1.45 (CI95%: 1.03; 2.06)] and also with lower odds of long sleep duration in both ages. At 22 years, common mental health disorders were associated with higher odds of short sleep duration in both men [OR = 1.56 (CI95%: 1.18; 2.06)] and women [OR = 1.48 (CI95%: 1.11; 1.99)]. Sleep duration was also related to screen time and physical activity showing different association patterns according to sex and age. Conclusions Different factors may be associated with sleep duration patterns in pre-adolescence and early adulthood. Our results emphasise the importance of considering stratification analyses to identify associated factors with sleep duration since they may vary according to age and sex.

PurposeThe present study aims to estimate the minimum number of accelerometer measurement days needed to estimate habitual physical activity (PA) among 6- (2010), 18- (2011) and 30- (2012) year-old participants, belonging to three population-based Brazilian birth cohorts.MethodPA was assessed by triaxial wrist-worn GENEActiv accelerometers and the present analysis is restricted to participants with at least 6 consecutive days of measurement. Accelerometer raw data were analyzed with R-package GGIR. Description of PA measures (overall PA, moderate-to-vigorous PA (MVPA), light PA (LPA)) on weekdays and weekend days were conducted, and statistical differences were tested with chi-squared and Kruskal-Wallis tests. Spearman Brown Formulae was applied to test reliability of different number of days of accelerometer use.ResultsDifferences between week and weekend days regarding LPA, MVPA and overall PA, were only observed among 30-year-olds. Higher levels of MVPA (p = 0.006) and overall PA (p0.70, two and three days of measurement were needed in adults and children, respectively. For LPA, a reliability coefficient >0.70 was achieved with five days in 6-year-old children, three days in 18-year-old young adults, and four days in 30-year-old adults. Considering MVPA, four days would be necessary to represent a week of measurement among all cohort groups.ConclusionOur results show that four and five measurement days are needed to estimate all habitual PA constructs, for children and adults, respectively. Also, among 30-year-old adults, it is important to make efforts towards weekend days measurement.

Background Regular physical activity (PA) is an important behavior in improving sleep health. However, the short-term effects of PA on sleep are still controversial. This study aims to verify the effect of different intensities of PA practiced in different periods of the day on the subsequent sleep night in a population-based cohort of young adults. Methods : Prospective analyses were conducted for PA performed during the day and its effect on the following sleep night using data from the 22-year follow-up of the 1993 Pelotas Birth Cohort in Brazil (mean age of participants: 22.6 years). Wrist-worn accelerometry was used to measure both PA and sleep parameters. Regarding intensity, we analyzed the sleep effect of light PA (LPA), moderate PA, and vigorous PA, stratified by sex. Sleep variables were sleep time window (STW; the difference between sleep onset and sleep end), total sleep time (TST; the sum of minutes classified as sleep in STW), and sleep percent (SP; SP = (TST/STW) × 100). We performed generalized estimating equations using Stata software. Results : The means of STW, TST, and SP were 443.6 min/day, 371.1 min/day, and 84%, respectively. Time spent in moderate PA and vigorous PA in the morning and afternoon was not associated with sleep variables. Among men, 10 min/day of morning LPA increased TST by 2.56 min/day. Among women, 10 min/day of morning LPA increased SP by 0.15 percentage points. Afternoon LPA also increased SP by 0.09 percentage points for women. Night PA seems to have an inverse effect on sleep variables for any intensity and both sexes. Conclusion : The effect of PA on sleep health is intrinsically related to the period of the day in which it is performed. The effect magnitude is different between sexes. For better sleep health, it is preferable that PA be performed during the day.

Background: inappropriate sleep time has been related to negative health outcomes and chronic diseases. Aim: to determine groups for inappropriate sleep time trajectories during adolescence to early adulthood and characterize them in the Pelotas 1993 Birth Cohort, Brazil. Methods: sleep time were recorded in the follow up visits at ages 11, 18 and 22 years old. The sleep time was obtained subtracting the time when the individual went to bed and the time of wake up. Inappropriate sleep time was defined as 12 hours at age 11 and 11 at ages 18 and 22 year. Trajectories were obtained from generalized linear models with several options tested through the routine “traj” in Stata software. Results: from de 5249 original cohort members, we analyzed 3395 individuals. The model with best fit was a four-group model for inappropriate sleep time, named as: quick increase, then maintenance (27.0%); slow increase, then slow decrease (35.3%); slow decrease, starting with intermediate proportion (10.8%;) and slow decrease, starting with high proportion (26.9%). There were differences among the groups regarding sex (57% of females in the group slow decrease, starting with high proportion, p=0.002), overweight/obesity (33% in the group slow decrease, starting with intermediate proportion, p=0.041), wheezing in past 12 months at ages 18 (p=0.005), and 22 years (p=0.018) higher in the group slow decrease, starting with high proportion (14% and 12% respectively). Conclusions: four groups of modelled based trajectories were identified with different patterns. There were important differences in biological, behavioral and clinical characteristics among these groups.

Objectives: To determine the coverage of the meningococcal C vaccine in children younger than one year of age in the states and regions of Brazil in 2012, and to correlate these findings with socioeconomic variables and the coverage of the Family Health Strategy. Methods: This was an ecological study. The vaccination coverage was calculated by dividing the number of vaccine doses administered in 2012 (numerator), which was determined from the data available in the Information System of the National Immunization Program, by the resident population less than one year also in 2012 (denominator). The Pearson correlation coefficient (r) was calculated for the vaccination coverage and socioeconomic variables. Results: The North and Northeast regions did not reach the recommended vaccination coverage (95%). The vaccination coverage showed a positive and moderate correlation with family income (r=0.6) and a negative and moderate correlation with the Gini coefficient (r=-0.5). Conclusion: Educational programs and policies are required to increase vaccination coverage and reduce the incidence of meningococcal disease. In addition, studies with more robust designs are necessary.

To describe the sleep time window (STW), total sleep time (TST), and sleep percent [SP = (TST/STW) × 100] by accelerometry in a population-based young adult cohort in Brazil.Cross-sectional analysis with a 22-year sample (N = 2462). Sleep variables were measured using an accelerometer. The devices were worn on the non-dominant wrist for approximately seven days. A raw data analysis using the GGIR package was performed. The following sleep variables were extracted: TST, STW, and SP. Linear regression was used to adjust averages. All analyses were stratified according to sex. A comparison between weekday and weekend averages was also conducted.The means of TST, STW, and SP for men were 5.9 h, 7.1 h, and 83.1%, respectively. For women, the means of TST, STW, and SP were 6.4 h, 7.6 h, and 84.6%, respectively. Women presented a higher means of all outcomes compared to men (p 0.001). After adjusting for both sexes, white skin color and not working or studying were associated with higher TST. Individuals not working or studying presented higher means of STW and lower sleep SP. Women with children who were less than two years of age presented lower values of three evaluated outcomes. Regarding behavior and health condition variables, obesity was associated with lower STW only for men. Physical activity was associated with higher SP and risk drinking with lower TST and STW only for women.Differences between sexes were observed in TST, STW, and SP. In all outcomes women presented a higher means. Socioeconomic variables were associated with both sexes, but having children and behavior/health conditions differed between sexes.

Supplemental digital content is available in the text., Purpose This study aimed to evaluate methods for infants’ physical activity measurement based on accelerometry, including the minimum number of measurement days and placement of a wrist or ankle device. We also evaluated the acceptability of the device among infants and mothers. Methods A cross-sectional mixed-methods study was conducted on a convenience sample of 90 infants. Physical activity was measured using the Actigraph GT3X+ accelerometer placed on the wrist and/or ankle for 7 consecutive days (worn for 24 h), and a qualitative interview was performed to verify acceptability. The intraclass correlation coefficient (ICC) method and the Bland and Altman’s dispersion diagram were used to verify the minimum number of measurement days. All analyses were stratified by walking status. Results The mean (SD) age was 12.9 (1.70) months; the mean acceleration varied between 25.8 mg (95% confidence interval (CI), 14.3–52.7) and 27.3 mg (95% CI, 17.9–44.5) using the wrist placement, and between 24.9 mg (95% CI, 10.6–48.4) and 26.2 mg (95% CI, 11.7–65.6) using the ankle placement. The ICC results showed a lower acceleration variability between days among infants incapable of walking; they achieved an ICC of 0.80 with 1 d of measurement in both placements. Among those capable of walking, the minimum number of days to achieve an ICC of 0.80 was 2 d measured at the wrist (0.85; 95% CI, 0.71–0.93) and 3 d measured at the ankle (0.92; 95% CI, 0.84–0.96). The qualitative results pointed to the wrist placement as the preferred placement among the overall sample. Conclusions Two and three measurement days with the accelerometer placed on the wrist and ankle, respectively, seemed to adequately represent a week of measurement. The accelerometer placed on the wrist had better acceptance by the infants and mothers.

Estudo transversal com o objetivo de investigar a associação entre comportamento sedentário e consumo de alimentos ultraprocessados (AUP) em adolescentes brasileiros. Foram utilizados dados da Pesquisa Nacional de Saúde do Escolar (PeNSE) realizada em 2015. O consumo diário de pelo menos um grupo de AUP representou o desfecho, e a exposição principal foi o tempo diário de comportamento sedentário (horas em atividades sentado, excluído o tempo dispendido na escola). Foram calculadas prevalências, razões de prevalências e intervalos de 95% de confiança (IC95%). As análises foram ajustadas para sexo, idade, cor da pele, escolaridade materna, índice de bens, região geográfica e dependência administrativa da escola. Cerca de 40% dos escolares reportaram consumo diário de pelo menos um grupo de AUP (39,7%; IC95%: 39,2-40,3) e 68,1% (IC95%: 67,7-68,7) referiram > 2 horas/dia de comportamento sedentário. Entre os escolares com comportamento sedentário > 2 horas/dia, a prevalência de consumo diário de AUP foi de 42,8% (IC95%: 42,1-43,6%), maior do que entre os sem comportamento sedentário (29,8%; IC95%: 29,0-30,5%). Quanto maior o tempo de comportamento sedentário, maior a prevalência de consumo de AUP (valor de p para tendência linear < 0,001). Estratégias que promovam a alimentação saudável e a diminuição de comportamentos sedentários, bem como regulamentações da publicidade de AUP, tornam-se necessárias a fim de evitar que estilos de vida não saudáveis perdurem à idade adulta. Estudio transversal con el objetivo de investigar la asociación entre el comportamiento sedentario y el consumo de alimentos ultraprocesados (AUP) en adolescentes brasileños. Se utilizaron datos de la Encuesta Nacional de Salud del Escolar (PeNSE), realizada en 2015. El consumo diario de por lo menos un grupo de AUP representó el resultado, y la exposición principal fue el tiempo diario de comportamiento sedentario (horas en actividades sentado, excluido el tiempo transcurrido en la escuela). Se calcularon las prevalencias, razones de prevalencias e intervalos de 95% de confianza (IC95%). Los análisis se ajustaron por sexo, edad, color de la piel, escolaridad materna, índice de bienes, región geográfica y dependencia administrativa de la escuela. Cerca de un 40% de los escolares informaron un consumo diario de por lo menos un grupo de AUP (39,7%; IC95%: 39,2-40,3) y 68,1% (IC95%: 67,7-68,7) informaron > 2 horas/día de comportamiento sedentario. Entre los escolares con un comportamiento sedentario > 2 horas/día, la prevalencia de consumo diario de AUP fue de un 42,8% (IC95%: 42,1-43,6%), mayor que entre quienes no tenían comportamiento sedentario (29,8%; IC95%: 29,0-30,5%). Cuanto mayor es el tiempo de comportamiento sedentario, mayor la prevalencia de consumo de AUP (valor de p para tendencia lineal < 0,001). Estrategias que promuevan la alimentación saludable y la disminución de comportamientos sedentarios, así como una regulación de la publicidad de AUP, fueron necesarias, a fin de evitar que estilos de vida no saludables perduren en la edad adulta. The aim of this cross-sectional study was to investigate the association between sedentary behavior and consumption of ultra-processed foods (UPF) among Brazilian adolescents. The study used data from the 2015 edition of the Brazilian National School Health Survey (PeNSE). Daily consumption of at least one group of UPF was the outcome, and the principal exposure was daily time spent in sedentary behavior (hours spent sitting, except for time sitting at school). We calculated prevalence rates, prevalence ratios, and 95% confidence intervals (95%CI). The analyses were adjusted for gender, age, skin color, maternal schooling, household assets index, major geographic region, and school’s administrative jurisdiction (public versus private). Forty percent of the schoolchildren reported daily consumption of at least one group of UPF (39.7%; 95%CI: 39.2-40.3), while 68.1% (95%CI: 67.7-68.7) reported > 2 hours/day of sedentary behavior. Among schoolchildren with sedentary behavior > 2 hours/day, prevalence of daily consumption of UPF was 42.8% (95%CI: 42.1-43.6%), higher than among those without sedentary behavior (29.8%; 95%CI: 29.0-30.5%). Longer time spent in sedentary behavior was associated with higher prevalence of consumption of UPF (p-value for linear trend < 0.001). Strategies to promote healthy eating and decrease sedentary behavior, as well as regulation of advertising for UPF, are necessary to prevent unhealthy lifestyles from persisting into adulthood.

Background Physical exercise interventions have been extensively advocated for the treatment of obesity; however, clinical trials evaluating the effectiveness of exercise interventions on weight control show controversial results. Compensatory mechanisms through a decrease in energy expenditure and/or an increase in caloric consumption is a possible explanation. Several physiological mechanisms involved in the energy balance could explain compensatory mechanisms, but the influences of physical exercise on these adjustments are still unclear. Therefore, the present trial aims to evaluate the effects of exercise on non-exercise physical activity energy expenditure, energy intake and appetite sensations among active overweight/obese adults, as well as, to investigate hormonal changes associated with physical exercise. Methods This study is a randomized controlled trial with parallel, three-group experimental arms. Eighty-one overweight/obese adults will be randomly allocated (1:1:1 ratio) to a vigorous exercise group, moderate exercise group or control group. The trial will be conducted at a military institution and the intervention groups will be submitted to exercise sessions in the evening, three times a week for 65 min, during a 2-week period. The primary outcome will be total spontaneous physical activity energy expenditure during a 2-week period. Secondary outcomes will be caloric intake, appetite sensations and laboratorial biomarkers. Intention-to-treat analysis will be performed using linear mixed-effects models to evaluate the effect of treatment-by-time interaction on primary and secondary outcomes. Data analysis will be performed using SAS 9.3 and statistical significance will be set at p

[Abstract] Objective: To measure the prevalence of various care services offered to the elderly with diabetes mellitus in Brazil, and to assess the social inequalities in these services. Methods: This cross-sectional, population-based study was carried out in 2013. The care services offered were evaluated in terms of the following eight indicators: recommendations to lower carbohydrates, to measure blood glucose, and to examine the feet; requests made for blood tests, for glycated hemoglobin tests, and for glycemic curve tests; and whether service users had had their eyes or feet examined in the previous year. We used the slope index of inequality and the concentration index to assess the inequalities among wealth quintiles. Results: A total of 1 685 elderly persons with diabetes were evaluated. Overall, 41.7% of them had had their eyes examined in the preceding year, 35.4% had had their feet examined in the preceding year, and 10.9% had been offered all eight of the care services. The largest absolute differences (in percentage points) between the first (poorest) and fifth (richest) wealth quintiles in terms of the care services that were offered to the users were for: a recommendation to measure blood glucose (25.8), a glycated hemoglobin test request (27.4), a glycemic curve test request (31.9), having the eyes examined in the preceding year (29.3), and having the feet examined in the preceding year (27.0). Conclusion: There were notable inequalities in the prevalences of the care services. In the future, measurement of blood glucose and examination of the feet should be emphasized, especially for elderly persons in a lower socioeconomic level. [Resumen] Objetivo: Medir la prevalencia de los diversos servicios de atención que se ofrecen a las personas mayores con diabetes mellitus en Brasil y evaluar las desigualdades sociales en dichos servicios. Métodos: Este estudio transversal y basado en la población se llevó a cabo en el 2013. Los servicios de atención que se ofrecen se evaluaron en cuanto a los siguientes ocho indicadores: recomendaciones para reducir los carbohidratos, medir la glucemia y revisarse los pies; solicitudes de análisis de sangre, pruebas de glucohemoglobina y pruebas de la curva de glucemia; y si a los usuarios de los servicios les habían examinado los ojos o los pies en el último año. Usamos el índice de pendiente de la desigualdad y el índice de concentración para evaluar las desigualdades entre los quintiles de riqueza. Resultados: Se evaluó en total a 1.685 personas mayores con diabetes. En términos generales, en el último año les habían examinado los ojos a 41,7% de ellos, en el último año les habían examinado los pies a 35,4% y les habían ofrecido los ocho servicios de atención a 10,9%. Las mayores diferencias absolutas en puntos porcentuales entre el primer quintil de riqueza (los más pobres) y el quinto (los más ricos) en cuanto a los servicios de atención ofrecidos a los usuarios se encontraron en la recomendación de medir la glucemia (25,8), la solicitud de pruebas de glucohemoglobina (27,4), la solicitud de pruebas de curvas de glucemia (31,9), el examen de los ojos en el último año (29,3) y el examen de los pies en el último año (27,0). Conclusiones: Hubo notables desigualdades en la prevalencia de los servicios de atención. En el futuro, debe hacerse énfasis en la medición de la glucemia y el examen de los pies, especialmente en las personas mayores de un nivel socioeconómico bajo. [Resumo] Objetivo: Medir a prevalência de vários serviços de atenção oferecidos a idosos portadores de diabetes mellitus no Brasil e avaliar desigualdades sociais nestes serviços. Métodos: Estudo transversal, de caráter populacional, realizado em 2013. Os serviços de atenção oferecidos foram avaliados quanto aos oito indicadores a seguir: recomendação de diminuir o consumo de carboidratos, medir a glicemia e examinar os pés; pedido de exames de sangue, hemoglobina glicada e curva glicêmica; e realização de exame dos olhos ou pés nos usuários do serviço durante o ano anterior. Foram utilizados o índice absoluto de desigualdade e o índice de concentração para avaliar as desigualdades entre quintis de renda. Resultados: Foram avaliados 1.685 idosos com diabetes. Destes, 41,7% haviam sido submetidos a exame dos olhos no ano anterior, 35,4% a exame dos pés, e a 10,9% haviam sido oferecidos todos os oito serviços de atenção. As maiores diferenças absolutas (em pontos percentuais) entre o primeiro (mais pobre) e quinto (mais rico) quintis de renda foram constatadas para os seguintes serviços de atenção: recomendação de medir a glicemia (25,8), pedido de exame de hemoglobina glicada (27,4), pedido de exame de curva glicêmica (31,9), exame de olhos no ano anterior (29,3) e exame dos pés no ano anterior (27,0). Conclusão: Foram constatadas desigualdades notáveis na prevalência dos serviços de atenção. Futuramente, deve-se dar ênfase à medição da glicemia e do exame dos pés, principalmente em idosos de nível socioeconômico mais baixo.

Lower socioeconomic level is positively related to multimorbidity and it is possible that the clustering of health conditions carries the same association. The aim of this study was to identify prevalence of multimorbidity and clusters of health conditions among elderly, as well the underlying socioeconomic inequalities. This was a cross-sectional population-based study carried out with 60-year-old individuals. Multimorbidity was defined as the presence of 2+, 3+, 4+ or 5+ health conditions in the same individual. Schooling levels and the National Economic Index were used to investigate inequalities in the prevalence of multimorbidities among elderly. Slope and concentration indexes of inequality were used to evaluate absolute and relative differences. A factorial analysis was performed to identify disease clusters. In every ten older adults, about nine, eight, seven and six presented, respectvely, 2+, 3+, 4+ and 5+ health conditions. Three clusters of health conditions were found, involving musculoskeletal/mental/functional disorders, cardiometabolic, and respiratory factors. Higher inequalities were found the higher amount of health conditions (5+), when considering economic level, and for 3+, 4+ and 5+, when considering educational level. These findings show high multimorbidity prevalence among elderly, highlighting the persistence of health inequalities in Southern Brazil. Strategies by the health services need to focus on elderly at lower socioeconomic levels. O nível socioeconômico baixo está relacionado diretamente à multimorbidade, e é possível que a aglomeração de morbidades apresente a mesma associação. O estudo teve como objetivo identificar a prevalência da multimorbidade e de clusters de morbidades entre idosos, além das desigualdades socioeconômicas subjacentes. Este foi um estudo transversal de base populacional em indivíduos com 60 anos ou mais. Multimorbidade foi definida como a presença de 2+, 3+, 4+ ou 5+ condições de saúde no mesmo indíviduo. O nível de escolaridade e o Índice Econômico Nacional foram usados para medir desigualdades na prevalência de multimorbidade entre idosos. Foram utilizados os índices de desigualdades slope e concentration para avaliar as diferenças absolutas e relativas. A análise fatorial foi realizada para identificar clusters de doenças. Em cada dez idosos, nove, oito, sete e seis apresentavam 2+, 3+, 4+ e 5+ condições de saúde, respectivamente. Foram identificados três clusters de morbidades, correspondendo aos transtornos musculoesqueléticos/mentais/funcionais e doenças cardiometabólicas e respiratórias. Maiores desigualdades foram encontradas para o maior número de condições de saúde (5+), considerando nível economômico, e para 3+, 4+ e 5+, considerando nível de escolaridade. Os achados revelam a alta prevalência de multimorbidade entre idosos, destacando a persistência de desigualdades de saúde no Sul do Brasil. As estratégias dos serviços de saúde devem priorizar os idosos de nível socioeconômico mais baixo. Un nivel socioeconómico más bajo está positivamente relacionado con la multimorbilidad y es posible que la acumulación de estos problemas de salud provenga de esta misma asociación. El objetivo de este estudio fue identificar la prevalencia de multimorbilidad y los grupos de afecciones de salud entre ancianos, así como sus inequidades socioeconómicas subyacentes. Se trata de un estudio transversal, basado en población, que se llevó a cabo con personas de 60 años. Multimorbilidad se definió como la presencia de 2+, 3+, 4+ ó 5+ condiciones de salud en el mismo individuo. Los niveles de escolaridad y el Índice Económico Nacional fueron utilizados para investigar inequidades en la prevalencia de multimorbilidad entre ancianos. Los índices de inequidad slope y concentration se usaron para evaluar las diferencias absolutas y relativas. Se realizó un análisis factorial para identificar los grupos de enfermedades. En cada diez ancianos, nueve, ocho, siete y seis tenían 2+, 3+, 4+ y 5+ condiciones de salud, respectivamente. Se encontraron tres grupos de afecciones de salud, que conllevaban enfermedades musculoesquelético/mental/funcionales, cardiometabólicas, además de factores respiratorios. Se encontraron mayores desigualdades para el mayor número de condiciones de salud (5+), cuando se consideraba el nivel económico, y para 3+, 4+ y 5+, cuando se tenía en consideración el nivel educativo. Estos hallazgos mostraron una alta prevalencia de multimorbilidad entre adultos de avanzada edad, resaltando la persistencia de inequidades de salud en el sur de Brasil. Las estrategias por parte de los servicios de salud necesitan centrarse en ancianos con niveles socioeconómicos más bajos.

Recent studies have identified a relationship between maternal body mass index during prepregnancy (BMI) and exclusive breastfeeding (EBF), which is less common among mothers with higher BMI. The purpose of this literature review is to provide a pooled effect for the association between maternal excess weight during prepregnancy and cessation of exclusive breastfeeding. A systematic review was performed using articles present in six databases (PubMed, Scopus, Web off Science, Science direct, CINAHL and LILACS) published till February 2017. Studies investigating the association between excess maternal weight during prepregnancy and cessation of exclusive breastfeeding were included in the review. A meta-analysis using random effects to obtain a pooled effect of the studied association was conducted only with studies reporting odds ratio (OR) or available data for the calculation. Univariate meta-regression was performed to evaluate possible sources of heterogeneity. Egger's tests were also performed to verify possible publication bias. From the 6889 studies identified, 102 were read in full and 17 were included in the meta-analysis, providing 28 estimates for the association. Overall, a positive association was observed between maternal excess weight during prepregnancy and cessation of exclusive breastfeeding (ES: 1.60 (95% CI: 1.47, 1.74), I2: 93.2%). According to the used independent variables, no sources of heterogeneity were identified between studies Bias in publication was found. Maternal excess weight during prepregnancy was associated with cessation of exclusive breastfeeding. A standardized measure for exclusive breastfeeding is still needed for estimating its duration, in addition to further studies in developing countries to understand what could explain the heterogeneity of the findings.

The objective of this study was to identify inequalities in leisure-time physical activity and active commuting to school in Brazilian adolescents, as well as trends according to gender, type of school, maternal schooling, and geographic region, from 2009 to 2015. This was a descriptive study based on data from the Brazilian National School Health Survey (PeNSE) in 2009, 2012, and 2015. Students were defined as active in their leisure time when they practiced at least 60 minutes of physical activity a day on five or more of the seven days prior to the interview. Active commuting to school was defined as walking or biking to school on the week prior to the interview. The outcomes were stratified by gender, type of school, maternal schooling, and geographic region. Inequalities were assessed by differences and ratios between the estimates, as well as summary inequality indices. The 2009, 2012, and 2015 surveys included 61,301, 61,145, and 51,192 schoolchildren, respectively. Prevalence of leisure-time physical activity was 13.8% in 2009, 15.9% in 2012, and 14.7% in 2015; the rates for active commuting to school were 70.6%, 61.7%, and 66.7%, respectively. Boys showed 10 percentage points higher prevalence of leisure-time physical activity and 5 points higher active commuting to school than girls. Children of mothers with more schooling showed a mean of 10 percentage points higher prevalence of leisure-time physical activity than children of mothers with the lowest schooling and some 30 percentage points lower in relation to active commuting to school. The observed inequalities remained constant over the course of the period. The study identified socioeconomic and gender inequalities that remained constant throughout the period and which were specific to each domain of physical activity.

The aim of this cross-sectional study was to investigate the association between sedentary behavior and consumption of ultra-processed foods (UPF) among Brazilian adolescents. The study used data from the 2015 edition of the Brazilian National School Health Survey (PeNSE). Daily consumption of at least one group of UPF was the outcome, and the principal exposure was daily time spent in sedentary behavior (hours spent sitting, except for time sitting at school). We calculated prevalence rates, prevalence ratios, and 95% confidence intervals (95%CI). The analyses were adjusted for gender, age, skin color, maternal schooling, household assets index, major geographic region, and school's administrative jurisdiction (public versus private). Forty percent of the schoolchildren reported daily consumption of at least one group of UPF (39.7%; 95%CI: 39.2-40.3), while 68.1% (95%CI: 67.7-68.7) reported2 hours/day of sedentary behavior. Among schoolchildren with sedentary behavior2 hours/day, prevalence of daily consumption of UPF was 42.8% (95%CI: 42.1-43.6%), higher than among those without sedentary behavior (29.8%; 95%CI: 29.0-30.5%). Longer time spent in sedentary behavior was associated with higher prevalence of consumption of UPF (p-value for linear trend0.001). Strategies to promote healthy eating and decrease sedentary behavior, as well as regulation of advertising for UPF, are necessary to prevent unhealthy lifestyles from persisting into adulthood.Estudo transversal com o objetivo de investigar a associação entre comportamento sedentário e consumo de alimentos ultraprocessados (AUP) em adolescentes brasileiros. Foram utilizados dados da Pesquisa Nacional de Saúde do Escolar (PeNSE) realizada em 2015. O consumo diário de pelo menos um grupo de AUP representou o desfecho, e a exposição principal foi o tempo diário de comportamento sedentário (horas em atividades sentado, excluído o tempo dispendido na escola). Foram calculadas prevalências, razões de prevalências e intervalos de 95% de confiança (IC95%). As análises foram ajustadas para sexo, idade, cor da pele, escolaridade materna, índice de bens, região geográfica e dependência administrativa da escola. Cerca de 40% dos escolares reportaram consumo diário de pelo menos um grupo de AUP (39,7%; IC95%: 39,2-40,3) e 68,1% (IC95%: 67,7-68,7) referiram2 horas/dia de comportamento sedentário. Entre os escolares com comportamento sedentário2 horas/dia, a prevalência de consumo diário de AUP foi de 42,8% (IC95%: 42,1-43,6%), maior do que entre os sem comportamento sedentário (29,8%; IC95%: 29,0-30,5%). Quanto maior o tempo de comportamento sedentário, maior a prevalência de consumo de AUP (valor de p para tendência linear0,001). Estratégias que promovam a alimentação saudável e a diminuição de comportamentos sedentários, bem como regulamentações da publicidade de AUP, tornam-se necessárias a fim de evitar que estilos de vida não saudáveis perdurem à idade adulta.Estudio transversal con el objetivo de investigar la asociación entre el comportamiento sedentario y el consumo de alimentos ultraprocesados (AUP) en adolescentes brasileños. Se utilizaron datos de la Encuesta Nacional de Salud del Escolar (PeNSE), realizada en 2015. El consumo diario de por lo menos un grupo de AUP representó el resultado, y la exposición principal fue el tiempo diario de comportamiento sedentario (horas en actividades sentado, excluido el tiempo transcurrido en la escuela). Se calcularon las prevalencias, razones de prevalencias e intervalos de 95% de confianza (IC95%). Los análisis se ajustaron por sexo, edad, color de la piel, escolaridad materna, índice de bienes, región geográfica y dependencia administrativa de la escuela. Cerca de un 40% de los escolares informaron un consumo diario de por lo menos un grupo de AUP (39,7%; IC95%: 39,2-40,3) y 68,1% (IC95%: 67,7-68,7) informaron2 horas/día de comportamiento sedentario. Entre los escolares con un comportamiento sedentario2 horas/día, la prevalencia de consumo diario de AUP fue de un 42,8% (IC95%: 42,1-43,6%), mayor que entre quienes no tenían comportamiento sedentario (29,8%; IC95%: 29,0-30,5%). Cuanto mayor es el tiempo de comportamiento sedentario, mayor la prevalencia de consumo de AUP (valor de p para tendencia lineal0,001). Estrategias que promuevan la alimentación saludable y la disminución de comportamientos sedentarios, así como una regulación de la publicidad de AUP, fueron necesarias, a fin de evitar que estilos de vida no saludables perduren en la edad adulta.

The aim of this study was to assess the preventive potential of major lifestyle risk factors for acute myocardial infarction (AMI) in middle-aged men. Among 10,981 men in the Heidelberg cohort of the European Prospective Investigation into Cancer and Nutrition, aged 40.2–65.8 years when recruited, 378 developed first-ever AMI during a median follow-up period of 11.4 years. Current smoking, excess body weight, being physically inactive, but not high alcohol consumption, were identified as the major lifestyle risk factors for AMI using Cox regression analysis. A competing AMI risk model built from cause-specific Cox regression models and considering the risk of death predicted 353 AMI cases, 182 (51.6 %) of which were estimated as preventable through adherence to a healthy lifestyle profile (never smoking, normal body weight, physically active, and moderate alcohol consumption). The calculated age-specific 5-year incidence rates for AMI in the actual cohort and in a hypothetical, comparable cohort with all men following the healthy lifestyle profile were 128 and 39, respectively, per 100,000 person-years for the age group 40–44, increasing to 468 and 307 per 100,000 person-years for the age group 65–69. The estimated AMI incidence rates for men with the healthy lifestyle profile are still somewhat higher than the average rates reported for documented low-incidence regions, such as parts of Japan. Our analysis confirms the strong primary preventive potential for AMI based on avoidance of smoking and excess body weight, and on regular physical activity.

Resumo: O objetivo do estudo foi descrever a simultaneidade de fatores de risco para doenças crônicas não transmissíveis em idosos (60 anos ou mais), residentes em uma cidade do Sul do Brasil. Trata-se de um estudo transversal, de base populacional, realizado em 1.451 idosos em 2013. Com uma abordagem de análise de clusters, foi avaliado o agrupamento entre os fatores de risco em estudo (tabagismo, consumo de álcool, excesso de peso e inatividade física). Para a avaliação da associação da simultaneidade dos fatores de risco com variáveis sociodemográficas, foi utilizada regressão logística. O agrupamento mais frequente entre os homens (18,1%) e mulheres (30,7%) foi inatividade física + excesso de peso. As combinações consumo de álcool + excesso de peso excederam o esperado entre os homens (O/E = 1,27; IC95%: 1,01; 1,59) e mulheres (O/E = 1,72; IC95%: 1,35; 2,20). A presença de dois ou mais fatores de risco na população idosa (88,1%) aponta para a necessidade de intervenções específicas para esta população voltadas ao combate simultâneo dos fatores de risco e não de forma isolada. Abstract: This study aimed to describe the simultaneity of risk factors for chronic non-communicable diseases among the elderly (≤ 60 years) in a city in Southern Brazil. This was a cross-sectional, population-based study of 1,451 elderly in 2013. Cluster analysis was applied to selected risk factors (smoking, alcohol consumption, excess weight, and physical inactivity). Logistic regression was used to assess the association between simultaneity of risk factors and socio-demographic variables. The most frequent cluster in men (18.1%) and women (30.7%) was physical inactivity + excess weight. The cluster alcohol consumption + excess weight exceeded the expected level in men (O/E = 1.27; 95%CI: 1.01; 1.59) and women (O/E = 1.72; 95%CI: 1.35; 2.20). The presence of two or more risk factors in the elderly population (88.1%) points to the need for specific interventions for this population to fight risk factors simultaneously rather than separately. Resumen: El objetivo del estudio fue describir la simultaneidad de factores de riesgo para enfermedades crónicas no transmisibles en ancianos (60 años o más), residentes en una ciudad del Sur de Brasil. Se trata de un estudio transversal, de base poblacional, realizado en 1.451 ancianos en 2013. Con un enfoque de análisis de clusters, fue evaluado el agrupamiento entre los factores de riesgo en un estudio (tabaquismo, consumo de alcohol, exceso de peso e inactividad física). Para la evaluación de la asociación de la simultaneidad de los factores de riesgo con variables sociodemográficas, se utilizó la regresión logística. El agrupamiento más frecuente entre los hombres (18.1%) y mujeres (30,7%) fue inactividad física + exceso de peso. Las combinaciones consumo de alcohol + exceso de peso excedieron lo esperado entre los hombres (O/E = 1,27; IC95%: 1,01; 1,59) y mujeres (O/E = 1,72; IC95%: 1,35; 2,20). La presencia de dos o más factores de riesgo en la población anciana (88,1%) apunta la necesidad de intervenciones específicas para esta población dirigidas al combate simultáneo de los factores de riesgo y no de forma aislada.

In 2009, a working group of the International Agency for Research on Cancer classified formaldehyde as carcinogenic to humans (Group 1) and concluded that formaldehyde causes cancer of the nasopharynx (NPC) and leukemia. The results of a large cohort study of industrial workers exposed to formaldehyde, conducted by the U.S. National Cancer Institute, mainly contributed to the available body of epidemiologic evidence. In their recent updated re-analysis of these cohort data published in your journal, Dr Marsh and his colleagues concluded that the results of the original analysis of NPC-risk are misleading because they are based on inappropriate regression analyses. In our view the reason for the elevated NPC risk reported in the original analysis might be also another one - a diagnostic bias. Therefore, it would be very helpful if the authors provided results for all other sub-categories (as three-digit categories of the International Classification of Diseases) of the pharynx to verify the hypothesis described and, hence, to clarify the relationship between exposure to formaldehyde and the risk of NPC.

Background Low levels of physical activity are currently observed in all age groups around the world. Among older adults physical activity is even lower, potentially influencing quality of life, incidence of diseases and premature mortality. The aim of this study was to describe objectively measured physical activity levels among older adults residents in a Southern city of Brazil. Methods A population-based study was carried out including people aged 60+ years living in the urban area of Pelotas. Face-to-face interviews, anthropometric measures and triaxial accelerometry (non-dominant wrist) were used to collect sociodemographic, anthropometric and physical activity, respectively. For descriptive purposes, overall physical activity was expressed as daily averages of acceleration. Time spent in light physical activity (LPA) and moderate-to-vigorous physical activity (MVPA) using different bout criteria (non-bouted, and in 1-, 5- and 10-min bouts) were calculated. Crude and adjusted analyses were performed using simple linear regression to examine the association between physical activity and exposure variables. Results Overall, 971 individuals provided valid accelerometry data. Women spent on average more time on LPA (136.2 vs. 127.6 min per day). Men and women respectively accumulated, in average, 64.5 and 56.7 min per day of non-bouted MVPA, while these daily averages were 14.9 and 9.46 min using 5-min, and 8.1 and 4.5 min using 10-min bout MVPA. In adjusted analyses, men aged 80 years or more spent in average 45 min less LPA per day when compared to men 60-69 years and, among women, this difference was 65 min. Considering time in 5-min MVPA bouts, the youngest age group and those with a better self-perceived health accumulated more MVPA. Specifically among men, socioeconomic status was inversely associated with 5-min bout MVPA. Conclusion The present study showed low levels of physical activity among Brazilian older adults, even lower in more advanced ages, and a different pattern for physical activity intensity between men and women.

to analyze the simultaneity of two groups of risk behaviors for sexually transmitted infections in Brazilian adolescents.cross-sectional study with data from the National Adolescent School-based Health Survey 2012; the outcomes were (1) simultaneous consumption of alcohol, tobacco and drugs (at least two), and (2) no use of condom and having two or more sexual partners.simultaneity of consumption of alcohol, tobacco and drugs was present in 14.7% of the boys and 21.5% of the girls, and was more prevalent among white individuals, with more educated mothers, and who did not live with their parents; approximately 12.0% of the adolescents presented simultaneity of no use of condom and having two or more sexual partners; this was more common among younger boys, not white (PR=1.22; 95%CI 1.10;1.36), and who did not live with their parents (PR=1.78; 95%CI 1.48;2.16), whilst among girls, this outcome was associated with higher age.both outcomes were associated with different characteristics, depending on the sex of the adolescent.analisar a simultaneidade de dois grupos de comportamentos de risco para infecções sexualmente transmissíveis em adolescentes brasileiros.estudo transversal com dados da Pesquisa Nacional de Saúde do Escolar 2012; os desfechos foram (1) simultaneidade de consumo de álcool, fumo e drogas (pelo menos dois) e (2) não uso de camisinha e relação sexual com dois ou mais parceiros.a simultaneidade de consumo de álcool, fumo e drogas foi de 14,7% nos meninos e 21,5% nas meninas, mais prevalente em brancos, com mães mais escolarizadas, que não moravam com os pais; aproximadamente 12,0% dos adolescentes apresentaram simultaneidade de não uso de camisinha e dois ou mais parceiros, sendo mais frequente nos meninos mais novos, não brancos (RP=1,22; IC95% 1,10;1,36) e que não moravam com os pais (RP=1,78; IC95% 1,48;2,16), enquanto nas meninas, esse desfecho associou-se a maior idade.ambos desfechos associaram-se a diferentes características, dependendo do sexo do adolescente.analizar la simultaneidad de dos grupos de comportamientos de riesgo para infecciones de transmisión sexual, en adolescentes brasileños.estudio transversal con datos de la Investigación en Salud Escolar Nacional, 2012; las variables de desenlace fueron (1) simultaneidad de alcohol, tabaco y drogas (al menos dos) y (2) no uso de condones y relaciones sexuales con dos o más compañeros.14,7% de los niños y 21,5% de las niñas presentaron simultaneidad de alcohol, tabaco y drogas, fue más frecuente entre blancos, con madres más educadas, y que no viven con sus padres; aproximadamente 12,0% de los adolescentes mostraron simultaneidad de no usar condón y dos o más compañeros sexuales, más común entre más jóvenes, no blancos [RP=1,22 (IC95% 1,10;1,36) ] y que no viven con sus padres [RP=1,78 (IC95% 1,48;2,16) ], en las niñas, este resultado se asoció con un aumento de la edad.ambos resultados se asociaron con diferentes características, en función del sexo de los adolescentes.

to analyze dengue incidence trend in Brazil from 2002 to 2012.this was an ecological study with data of the Information System for Notifiable Diseases (Sinan); the incidence rate was calculated by age groups, states and macroregions, through Prais-Winsten regression.dengue incidence rates in Brazil, in 2002 and 2012, were of 401.6 and 301.5 per 100,000 inhabitants, respectively; annual increment rates were stable (21.4%; 95%CI -19.8;83.7) in most of the states, except for Alagoas (38.9%; 95%CI 5.1;83.5) and Tocantins (50.4%; 95%CI 12.6;100.7); the North Region was the only region to present increase trend in the incidence of dengue.although rates have remained stable in most of the states, they are still high in Brazil; broader public policies focusing on new dengue control strategies are necessary.

Background:Physical inactivity in elderly is a public health problem. The purpose of this study is to describe and test the association between social support and leisure-time physical activity among the elderly.Methods:A cross-sectional, population-based study with 1,285 subjects (60+ years old) living in a city in southern Brazil was carried out in 2014. Physical activity practice was measured using the International Physical Activity Questionnaire [leisure domain: at least 150 minutes per week of walking + moderate physical activity + 2(vigorous physical activity)], while social support was measured using the Physical Activity Social Support Scale.Results:The prevalence of elderly who reached the recommendations of leisure-time physical activity was 18.4%. The elderly persons who had the company of family or friends to walk had a 2.45 times higher prevalence of reaching the recommendations of physical activity in leisure than those who did not. Those who had company of friends to practice moderate-to-vigorous physical activity (MVPA) were 3.23 times more likely to reach physical activity recommendations than their counterparts. The least common social support was the joint practice for walking and for MVPA.Conclusions:Strategies that incentivize family members and friends to provide social support to the elderly for physical activity focusing on joint practice must be encouraged.