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AimThis study seeks to build upon a prior investigation into the impact of the COVID-19 pandemic and to evaluate the prevalence of anxiety among Brazilian children, along with its associated factors, one year after the commencement of the pandemic.DesignA cross-sectional study.MethodsA survey was conducted from April–May 2021 in Brazil. Children aged 6–12 and their guardians from five Brazilian regions were included. The Children’s Anxiety Questionnaire (CAQ; scores 4–12) and Numerical Rating Scale (NRS; scores 0–10) were used to measure anxiety.ResultsOf the 906 children, 53.3% were girls (average age = 8.79 ± 2.05 years). Mothers responded for 87.1% of the children, and 70.9% were from the Southeast region. Based on a CAQ score of ≥9 and an NRS score of ≥8, the anxiety prevalence was 24.9 and 34.9%, respectively. Using logistic regression, a CAQ ≥9 score was associated with older children and children with chronic disease or disability. An NRS score of ≥8 was associated with reduced family income during the pandemic, the person caring for the children, and with children with chronic disease or disability.ConclusionThese findings suggest the need to implement public health actions aimed at children with chronic diseases and disabilities and their parents to guide them regarding the warning signs and negative emotions. This study contributes to characterizing the evolution of the pandemic in Brazil and provides a basis for comparison with the literature from other countries.

Abstract Background Healthcare and welfare systems worldwide are unprepared to accommodate the growing population of older people. Simultaneously, the cost of reactive care for older people is increasing. However, healthcare systems in many countries are reforming towards integrated and person-centred care with a focus on health promotion and proactive actions. The Integrating Health Promotion with and for Older People – eHealth (IHOPe) project aims to describe and evaluate a person-centred e-support intervention that promotes a sustainable partnership between community-dwelling frail older people and health and social care professionals. Methods The IHOPe project is designed as a randomised controlled trial comparing a control group receiving standard care with an intervention group receiving standard care and add-on person-centred care through telephone support and a digital platform. The primary outcome measure is a composite score of changes in general self-efficacy and the need for unscheduled hospital care. The project is conducted in Gothenburg, Sweden. At least 220 participants aged ≥ 75 years will be included after being screened using a frailty instrument. The study design, intervention components, digital platform, and questionnaires were developed in close collaboration with an advisory group of inter-professional researchers, stakeholders, clinicians, and older representatives. Data will mainly be collected through questionnaires at baseline and 3, 6, and 12 months after inclusion in the study. Recruitment is ongoing and should be completed during 2023. Data will be analysed using quantitative and qualitative methods. The evaluation will include effectiveness, process, and health economics. The study was approved by the Regional Ethical Review Board in Gothenburg, Sweden (Dnr 2019–05364, Dnr 2020–03550, Dnr 2021–03255). Discussion The findings will expand our knowledge of remotely integrated person-centred care for frail older people. Thereby, the IHOPe project is expected to fill highlighted knowledge gaps on intervention evaluations including the triad of person-centred, digital, and integrated care elements, as well as economic evaluations of remote health services for frail older people. The study is ongoing, and the results are not completed but if they turn out to be positive, implementation is not limited to time or location. Trial registration ClinicalTrial.gov: NCT04416815. Registered 07/06/2021.

The purpose of this study was to explore the contexts that shape obese children’s engagement in physical activity (PA) focusing on children’s perceptions. The qualitative design consisted of non-participant observations, and unstructured and semi-structured focus group and individual interviews. Data were analyzed by use of conventional content analysis. Participants were overweight/obese children from a public school in Colombia. The findings show that the main context where PA took place was during physical education (PE) classes at school and in the children’s neighborhoods. The participants perceived the PE classes to be too competitive and demotivating. PA taking place outside school was associated with fun, but occurred only on an infrequent basis and was challenged by living in insecure neighborhoods. Adapting a health promotion approach that emphasizes participation and social environments might motivate obese children to become physically active at school as well as during leisure time.

Patricia Olaya-Contreras1, Torgny Persson2, Jorma Styf11Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy at The University of Gothenburg, Sweden; 2The Lundby Hospital, Gothenburg, SwedenBackground: Chronic musculoskeletal pain (CMP) is associated with psychological distress and long-term disability. Underlying diagnoses causing long-term sickness absence due to CMP have not been explored enough. In a somatic health care setting, it is important to identify mental health comorbidity to facilitate the selection of appropriate treatment. The objectives of this study were to compare the scores of depressed mood obtained on the Beck Depression Inventory (BDI) with the diagnosis of depression made by a psychiatrist, and to study the prevalence of undiagnosed mental health comorbidity in these patients.Methods and patients: 83 consecutive patients on sick leave (mean duration 21 months) due to CMP who had been referred by the Social Insurance Office to an orthopedist and a psychiatrist for assessment of the patient’s diagnoses and capacity to work. The mean age was 45 (23–61) years, 58% were women and 52% were immigrants. The accuracy of measurements was calculated using the Diagnostic Statistical Manual of Mental Disorders IV as the Gold standard.Results: Psychiatric illness was diagnosed in 87% of the patients. The diagnosis was depression in 56%, other psychiatric illnesses in 31%, whereas 13% were mentally healthy. Of all the patients, only 10% had a previous psychiatric diagnosis. The median value of the BDI score was 26 points in depressed patients, whereas it was 23 in patients with other psychiatric diagnoses. The sensitivity of the BDI to detect depression was 87.5%. We found good agreement between the BDI score and a diagnosis of depression.Conclusion: Undiagnosed psychiatric disorders were commonly seen in patients with CMP. The high sensitivity of the BDI scores enables the screening of mental health comorbidity in patients with a somatic dysfunction. The test is a useful tool for detecting distress in patients who are on long-term sick leave due to CMP and who need additional treatment.Keywords: agreement, disability, underlying diagnoses

INTRODUCCIÓN: El cáncer de mama desde 1992 ha sido la segunda causa de muerte femenina en Colombia (tasa promedio anual de 4,5*100.000 hab.) y se reporta una tendencia ascendente por este tipo de neoplasia, y la información sobre los potenciales factores de riesgo del cáncer de la mama en los países Latinoamericanos es escasa. Los objetivos del trabajo fueron probar la protección ofrecida por la lactancia materna, y establecer los factores reproductivos asociados al cáncer de mama en Colombia. MÉTODOS: Se realizó un estudio de casos y controles hospitalarios pareados por edad (+ 2 años) de Julio 1995 a Marzo 1996 en Bogotá. La población de estudio quedó constituída por 171 casos histopatológicamente definidos y 171 controles. La historia reproductiva y sociodemográfica fué recolectada a través de un cuestionario y se utilizó la técnica de regresión logística condicionada para el análisis estadístico de la información. RESULTADOS: Se encontraron como factores de riesgo: la nuliparidad , al contrario de las mujeres con paridades mayores de 3 hijos (OR=3,35 IC 1,4 - 8,0), la edad al primer nacimiento (>20 años vs. menores de 20. OR= 1,83 IC 0,7 - 4,8), el antecedente familiar de cáncer de mama y la lactancia al primer hijo (OR=0,09 IC 0,01-0,64 de 1-11 meses y OR= 0,01 IC 0,00-0,14 para los 12 meses) y la lactancia acumulada por encima de los 24 meses (p=0,001 prueba de tendencia) como principales factores protectores de la enfermedad. CONCLUSIONES: El estudio confirma la importancia de enfocarse en la promoción de la lactancia prolongada y ratifica que el nivel socioeconómico puede determinar los estilos de vida y los eventos reproductivos de las mujeres, explicando el aumento en la mortalidad por cáncer de mama en los países Latinoamericanos, con perfiles de fecundidad y factores de riesgo para el cáncer de mama, similares a los de los países desarrollados.

INTRODUCCIÓN: El cáncer de mama desde 1992 ha sido la segunda causa de muerte femenina en Colombia (tasa promedio anual de 4,5*100.000 hab.) y se reporta una tendencia ascendente por este tipo de neoplasia, y la información sobre los potenciales factores de riesgo del cáncer de la mama en los países Latinoamericanos es escasa. Los objetivos del trabajo fueron probar la protección ofrecida por la lactancia materna, y establecer los factores reproductivos asociados al cáncer de mama en Colombia. MÉTODOS: Se realizó un estudio de casos y controles hospitalarios pareados por edad (+ 2 años) de Julio 1995 a Marzo 1996 en Bogotá. La población de estudio quedó constituída por 171 casos histopatológicamente definidos y 171 controles. La historia reproductiva y sociodemográfica fué recolectada a través de un cuestionario y se utilizó la técnica de regresión logística condicionada para el análisis estadístico de la información. RESULTADOS: Se encontraron como factores de riesgo: la nuliparidad , al contrario de las mujeres con paridades mayores de 3 hijos (OR=3,35 IC 1,4 - 8,0), la edad al primer nacimiento (>20 años vs. menores de 20. OR= 1,83 IC 0,7 - 4,8), el antecedente familiar de cáncer de mama y la lactancia al primer hijo (OR=0,09 IC 0,01-0,64 de 1-11 meses y OR= 0,01 IC 0,00-0,14 para los 12 meses) y la lactancia acumulada por encima de los 24 meses (p=0,001 prueba de tendencia) como principales factores protectores de la enfermedad. CONCLUSIONES: El estudio confirma la importancia de enfocarse en la promoción de la lactancia prolongada y ratifica que el nivel socioeconómico puede determinar los estilos de vida y los eventos reproductivos de las mujeres, explicando el aumento en la mortalidad por cáncer de mama en los países Latinoamericanos, con perfiles de fecundidad y factores de riesgo para el cáncer de mama, similares a los de los países desarrollados.INTRODUÇÃO: O câncer de mama, desde 1992, tem sido a segunda causa de morte feminina na Colômbia (taxa média anual de 4,5*/100.000 hab.) mostrando tendência ascendente por este tipo de neoplasia, sendo poucas as informações sobre fatores de risco potenciais de câncer de mama nos países da América Latina. O estudo realizado objetivou testar a proteção da amamentação materna contra essa doença, e estabelecer fatores reprodutivos a ela associados. MÉTODOS: Realizou-se estudo de casos-controle hospitalares pareados por idade, de julho 1995 a março 1996. A população de estudo foi constituída por 171 casos histologicamente confirmados e 171 controles. A história reprodutiva e sociodemográfica foi coletada através de um questionário e adotada a técnica de regressão logística para efetuar a análise estatística dos dados. RESULTADOS: Como fatores de risco foram encontrados: nuliparidade, quando comparada com mulheres com mais de três filhos (OR=3,35 IC 1,4 - 8,0); idade do primeiro nascimento (>20 anos vs. menores de 20. OR= 1,83 IC 0,7 - 4,8); antecedente familiar de câncer mamário e amamentação do primeiro filho (OR=0,09 IC 0,01-0,64 de 1-11 meses e OR= 0,01 IC 0,00-0,14 para os 12 meses), e amamentação acumulada por mais de 24 meses (p=0,001 prova de tendência) como um dos principais fatores protetores da doença. CONCLUSÕES: O estudo confirma a importância de promover a amamentação prolongada e ratifica que o nível socioeconômico pode determinar o estilo de vida e os eventos reprodutivos das mulheres, explicando o aumento na mortalidade por câncer mamário nos países Latino-americanos, com perfil de fecundidade e fatores de risco para o câncer mamário, similares a dos países desenvolvidos.INTRODUCTION: As of 1992, breast cancer has been the second cause of death in Columbian women, with a rising trend in mortality due to this type of neoplasm (average annual rate 4.5*/100.000 inhabitants). Information about potential risk factors for breast cancer in Latin American countries is scarce. The objectives of the project were to test the breastfeeding protection against breast cancer and to establish the reproductive factors associated with breast cancer in Columbia. METHODS: A hospital case-control study was carried out from July 1995 to March 1996 in Bogotá, Columbia, using paring by age groups. The study population consisted of 171 histopathologically confirmed cases and 171 controls. Reproductive history and sociodemographic data were collected through a questionnaire, and logistic regression models were used for statistical analysis of the data. RESULTS: The following associated factors were found as principal results: nuli-parousness as compared with women with over 3 children (OR=3.35 CI 1.40-8.0), age at first birth (OR=1.83 CI 0.70- 4.80), breast cancer history, breastfeeding the first child (OR=0.09 CI 0.01-0.64 for 1-11 months) and with a highly significant trend for accumulated breastfeeding above 24 months (p=0.001). CONCLUSIONS: This study indicates the importance of focusing on the promotion of prolonged breastfeeding by women identified as being at higher risk, and confirms that socio-economic level can determine life styles and reproductive events among women (such as breastfeeding time); this could explain the increase in breast cancer mortality in Latin American countries, similar to that in developed countries in terms of fertility and risk factors for breast cancer. The epidemiological information produced by this study will be useful for planning and carrying out early diagnosis and treatment of breast cancer in women identified as being at high risk of this disease.

INTRODUCCIÓN: El cáncer de mama desde 1992 ha sido la segunda causa de muerte femenina en Colombia (tasa promedio anual de 4,5*100.000 hab.) y se reporta una tendencia ascendente por este tipo de neoplasia, y la información sobre los potenciales factores de riesgo del cáncer de la mama en los países Latinoamericanos es escasa. Los objetivos del trabajo fueron probar la protección ofrecida por la lactancia materna, y establecer los factores reproductivos asociados al cáncer de mama en Colombia. MÉTODOS: Se realizó un estudio de casos y controles hospitalarios pareados por edad (+ 2 años) de Julio 1995 a Marzo 1996 en Bogotá. La población de estudio quedó constituída por 171 casos histopatológicamente definidos y 171 controles. La historia reproductiva y sociodemográfica fué recolectada a través de un cuestionario y se utilizó la técnica de regresión logística condicionada para el análisis estadístico de la información. RESULTADOS: Se encontraron como factores de riesgo: la nuliparidad , al contrario de las mujeres con paridades mayores de 3 hijos (OR=3,35 IC 1,4 - 8,0), la edad al primer nacimiento (>20 años vs. menores de 20. OR= 1,83 IC 0,7 - 4,8), el antecedente familiar de cáncer de mama y la lactancia al primer hijo (OR=0,09 IC 0,01-0,64 de 1-11 meses y OR= 0,01 IC 0,00-0,14 para los 12 meses) y la lactancia acumulada por encima de los 24 meses (p=0,001 prueba de tendencia) como principales factores protectores de la enfermedad. CONCLUSIONES: El estudio confirma la importancia de enfocarse en la promoción de la lactancia prolongada y ratifica que el nivel socioeconómico puede determinar los estilos de vida y los eventos reproductivos de las mujeres, explicando el aumento en la mortalidad por cáncer de mama en los países Latinoamericanos, con perfiles de fecundidad y factores de riesgo para el cáncer de mama, similares a los de los países desarrollados.