Alex Antonio Florindo

Monitoramento de fatores de risco para doenças crônicas por entrevistas telefônicas

OBJETIVO: Descrever metodos e resultados iniciais de sistema de monitoramento de fatores de risco para doencas cronicas nao transmissiveis por meio de entrevistas telefonicas. METODOS: Estudou-se amostra probabilistica (n=2.122) da populacao adulta do Municipio de Sao Paulo residente em domicilios conectados a rede de telefonia fixa, com amostragem realizada em duas etapas: sorteio de linhas telefonicas e sorteio do morador do domicilio a ser entrevistado. Foi aplicado questionario para investigar caracteristicas demograficas e socioeconomicas, padrao de alimentacao e de atividade fisica, consumo de cigarros e de bebidas alcoolicas, peso e altura recordados e auto-referencia a diagnostico medico de hipertensao arterial e diabetes, entre outros quesitos. Foram calculadas estimativas sobre a prevalencia de fatores de risco selecionados para doencas cronicas nao transmissiveis para a populacao adulta com telefone e para a populacao adulta total do municipio. Neste ultimo caso, populacao total, foram aplicados a amostra fatores de ponderacao que levaram em conta diferencas demograficas e socioeconomicas entre a populacao com telefone e a populacao total do municipio. RESULTADOS: Foram observadas diferencas substanciais entre os sexos quanto a frequencia da maioria dos fatores de risco estudados, sendo significativamente mais frequentes em homens o consumo insuficiente de frutas e hortalicas, o consumo excessivo de bebidas alcoolicas e o excesso de peso; e nas mulheres foram mais frequentes o sedentarismo e a hipertensao. Possibilidades adicionais de estratificacao da prevalencia de fatores de risco permitidas pelo sistema de monitoramento foram ilustradas a partir de exemplos abrangendo faixa etaria, nivel de escolaridade e area de residencia na cidade dos entrevistados. CONCLUSOES: O desempenho do sistema de monitoramento, avaliado a partir da representatividade e confiabilidade das estimativas obtidas e do custo por entrevista realizada, mostrou-se adequado e, de modo geral, superior a sistemas equivalentes existentes em paises desenvolvidos. O custo por entrevista realizada foi oito vezes inferior ao custo estimado por sistemas semelhantes existentes em paises desenvolvidos e quatro a oito vezes inferior ao custo de inqueritos domiciliares tradicionais realizados no Municipio de Sao Paulo.OBJECTIVE To describe methods and initial findings of a surveillance system of risk factors for chronic non-communicable diseases (CNCDs) based on telephone interviews. METHODS Interviews undertaken in a random sample of the adult population of the Municipality of Sao Paulo living in households with telephone. Sampling was done in two steps and included the random selection of households and the random selection of the household member to be interviewed. The systems questionnaire investigated demographic and socioeconomic characteristics, food consumption and physical activity patterns, smoking, consumption of alcoholic beverages, recalled weight and height and reported medical diagnoses of hypertension and diabetes, among other topics. Prevalence estimates of selected risk factors for CNCDs were calculated for the adult population with telephone and for the citys entire adult population. In this last case, we applied sample weighting factors that took into account demographic and socioeconomic differences between the adult population with telephone and the entire adult population of the municipality. RESULTS Strong differences between sexes were found for most risk factors: low consumption of fruit and vegetables, high consumption of alcohol and overweight were more frequent among men while sedentary lifestyle and hypertension were more frequent among women. Additional possibilities of stratification of risk factor prevalences allowed by the surveillance system are illustrated using age groups, schooling, and place of residence in the city. CONCLUSIONS System performance was considered as good and was better than the performance observed in similar systems operating in developed countries when evaluated with basis on the representativeness and reliability of the estimates and on costs. The cost per concluded interview was eight times lower than the cost usually seen in similar systems in developed countries and four to eight times lower than the cost of traditional household surveys undertaken in the city of Sao Paulo.

Validation and reliability of the Baecke questionnaire for the evaluation of habitual physical activity in adult men

The aim of this study was to verify validity and reliability of the scores for physical exercise in leisure (PEL), leisure and locomotion activities (LLA), and total score (TS) of the Baecke habitual physical activity questionnaire in adult males. Twenty-one students of Physical Education were evaluated. For validation, the maximum oxygen uptake (O2max) and the decrease of the heart rate in percentile (%DHR) were measured through the Coopers 12-minute walk or run test, and an annual index of physical exercise (IPE), and a week index of locomotion activities (ILA). The reliability was verified through test-retest with interval of 45 days. The Pearson correlation coefficient, and partial correlation adjusted for age and body mass index were used for validation. The intraclass correlation and paired t-test were used for reliability. The results indicated that %DHR was correlated with LLA and TS (r = 0.47 and p = 0.030; r = 0.48 and p = 0.027, respectively). IPE was correlated with PEL and TS (r = 0.56 and p = 0.008; r = 0.46 and p = 0.036, respectively). ILA was correlated with LLA and TS (r = 0.64 and p = 0.002 and r = 0.51 and p = 0.017, respectively). There was no significant difference in PEL, LLA and TS means in test-retest. The intraclass correlations were r = 0.69; r = 0.80 and r = 0.77, respectively for PEL, LLA and TS. In conclusion, the Baecke questionnaire is valid and reliable to measure habitual physical activity in Brazilian adult men.

Methodology to evaluation the habitual physical activity in men aged 50 years or more

OBJETIVO: Descrever a metodologia de avaliacao da atividade fisica habitual, utilizanda em uma pesquisa em populacao masculina, por meio de um questionario ja validado. METODOS: O questionario de atividade fisica habitual de Baecke, traduzido para a lingua portuguesa e, a seguir, foi realizado o back translation. Em sua versao final o questionario foi aplicado em estudo epidemiologico transversal, realizado com 326 homens com idade igual ou superior a 50 anos. A consistencia interna entre as questoes foi analisada pelo a de Cronbach e foram calculados os coeficientes de correlacao de Spearman entre os escores de atividade fisica habitual, bem como os coeficientes de correlacao parcial, ajustados por idade, indice de massa corporal e escolaridade. RESULTADOS: A consistencia interna mostrou-se satisfatoria nas magnitudes de atividade fisica ocupacional e exercicios fisicos no lazer. Foram obtidas correlacoes significativas entre todos os escores de atividades fisicas com o escore total de atividade fisica habitual, independente da idade, escolaridade e indice de massa corporal. CONCLUSOES: O questionario Baecke mostrou-se um instrumento pratico para avaliar a atividade fisica habitual, aliando rapidez na aplicabilidade e facilidade no entendimento para as respostas, sendo indicado para estudos epidemiologicos no Brasil.OBJECTIVE To describe the methodology for evaluating habitual physical activity that was adopted for a survey among the male population utilizing a questionnaire validated earlier. METHODS The Baecke questionnaire on habitual physical activity was translated into Portuguese and then back-translated into English by two anglophone teachers. The final version of the questionnaire was applied in a cross-sectional epidemiological study done on 326 men aged 50 years or over. The internal consistency among the questions was evaluated using the Cronbach a statistic. The Spearman correlation coefficients between the habitual physical activity scores were calculated. Partial correlation coefficients with adjustments for age, body mass index and schooling were also calculated. RESULTS There was satisfactory internal consistency in relation to the magnitudes of occupational physical activity and leisure-time physical exercises. Significant correlation was obtained between all the physical activity scores and the total habitual physical activity score, independent of age, body mass index and schooling. CONCLUSIONS The Baecke questionnaire was found to be a practical instrument for assessing habitual physical activity that is quickly applied and easily understood, and it is recommended for epidemiological studies in Brazil.

Practice of physical activities and associated factors in adults, Brazil, 2006

OBJETIVO: Estimar a prevalencia da pratica de atividades fisicas por adultos e sua associacao com fatores sociodemograficos e ambientais. METODOS: Foram utilizados dados do Sistema de Vigilância de Fatores de Risco e Protecao para Doencas Cronicas por Inquerito Telefonico coletados em 2006. Os 54.369 adultos entrevistados residiam em domicilios com linha telefonica fixa nas capitais brasileiras e Distrito Federal. A pratica de atividades fisicas foi considerada nos dominios do lazer, trabalho, atividade domestica e deslocamento. As variaveis estudadas incluiram caracteristicas sociodemograficas dos individuos e ambientais das cidades; a associacao com as atividades fisicas foi analisada segundo sexo. RESULTADOS: As proporcoes de individuos ativos foram de 14,8% no lazer, 38,2% no trabalho, 11,7% no deslocamento e 48,5% nas atividades domesticas. Indices superiores a 60% de inativos no lazer foram observados em dez capitais. Os homens foram mais ativos que as mulheres em todos os dominios, exceto nas atividades domesticas. A proporcao de individuos ativos decresceu com o aumento da idade. A escolaridade associou-se diretamente com a atividade fisica no lazer. Os homens ativos no deslocamento tiveram maior chance de ser ativos no lazer, enquanto que as pessoas inativas no trabalho tiveram maior chance de serem ativas no lazer. A existencia de local para praticar atividades fisicas proximo a residencia associou-se a atividade fisica no lazer. CONCLUSOES: Os resultados obtidos sao importantes para o monitoramento dos niveis de atividades fisicas no Brasil. Para a promocao das atividades fisicas, deve-se considerar as diferencas entre homens e mulheres, as diferencas nas faixas etarias e nos niveis de escolaridade. Deve-se investir principalmente na promocao das atividades fisicas no lazer e como forma de deslocamento e em locais adequados para a pratica proximos as residencias.OBJECTIVE To estimate the prevalence of physical activity practice in adults and its association with sociodemographic and environmental factors. METHODS Data from the Sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (VIGITEL--Telephone-based Surveillance of Risk and Protective Factors for Chronic Diseases) were collected in 2006. All the 54,369 adults interviewed lived in households with a fixed telephone line, in the Brazilian state capitals and Federal District. Physical activity practice was considered in the leisure-time, occupational, transportation and household domains. Variables studied included sociodemographic characteristics of individuals and environmental characteristics of cities. Association with physical activities was analyzed according to sex. RESULTS Proportions of active individuals were 14.8% for leisure time, 38.2% for occupation, 11.7% for transportation, and 48.5% for household chores. Indices above 60% of inactive individuals in the leisure-time domain were observed in ten capitals. Men were more active than women in all domains, except for household chores. The proportion of active individuals decreased with age. Level of education was directly associated with physical activity in leisure time. Active men in the transportation domain were more likely to be active in their leisure time, while inactive people in the occupational domain were more likely to be active in their leisure time. The existence of places to perform physical activities near the home was associated with physical activity in leisure time. CONCLUSIONS Results obtained are important to monitor physical activity levels in Brazil. Differences between men and women and those in age groups and levels of education must be considered to promote physical activities. Promotion of physical activities in the leisure and transportation domains and in places that are adequate for physical activity practice and near the home should be encouraged.

Desenvolvimento e validação de um questionário de avaliação da atividade física para adolescentes

OBJETIVO: Desenvolver um questionario de atividade fisica para adolescentes brasileiros e verificar sua validade e reprodutibilidade. METODOS: Participaram do estudo 94 adolescentes (30 meninos e 64 meninas) com idade entre 11 a 16 anos, em 2004. O questionario foi composto por 17 questoes sobre atividades habituais exercidas nos ultimos 12 meses (exercicios fisicos/esportes e atividades de locomocao) e foi padronizado para gerar escores semanal e anual. Como metodo de referencia utilizou-se o teste de corrida vai-e-vem de 20 metros com as variaveis tempo em minutos, velocidade maxima em km/h, consumo maximo de oxigenio e frequencia cardiaca maxima. Para a analise de validacao, foram utilizados o coeficiente de Spearman e correlacao ajustada por idade. Para a analise da reprodutibilidade, utilizou-se medida repetida com intervalo de 15 dias e coeficiente de correlacao intraclasse. RESULTADOS: Para o escore semanal de atividade fisica, os maiores coeficientes de correlacao foram obtidos com o tempo total para a analise em conjunto (r=0,19), velocidade total para os meninos (r=0,20), e consumo maximo de oxigenio e tempo total para as meninas (r=0,17). Para o escore anual de atividade fisica, os maiores coeficientes de correlacao foram obtidos com o tempo total para a analise em conjunto (r=0,30), frequencia cardiaca final apos o ajuste pela idade para os meninos (r=0,22) e tempo total para as meninas (r=0,23). Nas analises de reprodutibilidade, a correlacao do escore semanal foi de 0,61 e a do escore anual foi de 0,68. CONCLUSOES: O questionario apresentou evidencias de validade e reprodutibilidade. Recomenda-se sua utilizacao para avaliacao da atividade fisica habitual em estudos epidemiologicos com adolescentes.

Enrollment in Physical Education Is Associated with Health-Related Behavior among High School Students.

BACKGROUND Physical education (PE) plays a critical role in the healthy development of youth; however, the influence of PE classes in helping to provide students with health-related behavior patterns is not clear. This study aims to analyze whether participation in PE classes is associated with health-related behavior among high school students. METHODS A total of 4210 students attending public high schools in Pernambuco (northeast of Brazil) were selected using random 2-stage cluster sampling. Data were collected by using the Global School-based Student Health Survey. The independent variable was the frequency of participation in PE classes, whereas physical activity, television viewing, smoking, and alcohol, fruit, vegetables and soda consumption were dependent variables. Logistic regressions were carried out to perform crude and adjusted analysis of the association between enrollment in PE classes and health-related behaviors. RESULTS Sixty-five percent of students do not take part in PE classes, with a significantly higher proportion among females (67.8%). It was observed that enrollment in PE classes was positively associated with physical activity, TV viewing, and fruit consumption, but was negatively associated with soda drinking. The likelihood of reporting being active and eating fruit on a daily basis was 27% and 45% higher, respectively, among those who participate in at least 2 classes per week in comparison with those who do not. Students who participate in PE classes had 28-30% higher likelihood of reporting lower TV viewing during week days. CONCLUSIONS Findings suggest that higher levels of enrollment in PE classes could play a role in the promotion of health-related behaviors among high school students.

Prevalência de sobrepeso e obesidade abdominal em indivíduos portadores de HIV/AIDS, em uso de terapia anti-retroviral de alta potência

OBJECTIVE: To evaluate the nutritional status of HIV/AIDS patients treated with highly active antiretroviral therapy, according to gender and T CD4 + lymphocyte count. MATERIAL AND METHODS: This was a cross-sectional study, including 223 individuals (171 men and 52 women) treated with protease inhibitors, aged between 20 and 59 years. This study was developed at a HIV/AIDS reference treatment center in the city of Sao Paulo. Anthropometric data, including current weight, height, and waist circumference (WC) were collected. The body mass index (BMI) was calculated as the ratio between weight (kg) and the square of the height (m2), according to World Health Organization classification criteria. Patients were divided into three groups according to T CD4+ lymphocyte count: 350 (cel/mm3). RESULTS: The prevalence of overweight was 30.5% and of central obesity was 12.6%. Women presented a higher prevalence of overweight (36.5%) and of central obesity (32.7%) when compared to men (28.7% and 6.4% respectively). The prevalence of underweight was higher among women than in men, respectively 7.7% and 2.3%. Categories of T CD4 + lymphocyte counts were not associated with overweight and central obesity in this population. CONCLUSION: Women presented a higher prevalence of underweight, overweight and central obesity in relation to men. Obesity is the most important deviation of nutritional status, overcoming malnutrition, in these HIV/AIDS patients treated with highly active antiretroviral therapy.

Prática de atividades físicas e fatores associados em adultos, Brasil, 2006

OBJETIVO: Estimar a prevalencia da pratica de atividades fisicas por adultos e sua associacao com fatores sociodemograficos e ambientais. METODOS: Foram utilizados dados do Sistema de Vigilância de Fatores de Risco e Protecao para Doencas Cronicas por Inquerito Telefonico coletados em 2006. Os 54.369 adultos entrevistados residiam em domicilios com linha telefonica fixa nas capitais brasileiras e Distrito Federal. A pratica de atividades fisicas foi considerada nos dominios do lazer, trabalho, atividade domestica e deslocamento. As variaveis estudadas incluiram caracteristicas sociodemograficas dos individuos e ambientais das cidades; a associacao com as atividades fisicas foi analisada segundo sexo. RESULTADOS: As proporcoes de individuos ativos foram de 14,8% no lazer, 38,2% no trabalho, 11,7% no deslocamento e 48,5% nas atividades domesticas. Indices superiores a 60% de inativos no lazer foram observados em dez capitais. Os homens foram mais ativos que as mulheres em todos os dominios, exceto nas atividades domesticas. A proporcao de individuos ativos decresceu com o aumento da idade. A escolaridade associou-se diretamente com a atividade fisica no lazer. Os homens ativos no deslocamento tiveram maior chance de ser ativos no lazer, enquanto que as pessoas inativas no trabalho tiveram maior chance de serem ativas no lazer. A existencia de local para praticar atividades fisicas proximo a residencia associou-se a atividade fisica no lazer. CONCLUSOES: Os resultados obtidos sao importantes para o monitoramento dos niveis de atividades fisicas no Brasil. Para a promocao das atividades fisicas, deve-se considerar as diferencas entre homens e mulheres, as diferencas nas faixas etarias e nos niveis de escolaridade. Deve-se investir principalmente na promocao das atividades fisicas no lazer e como forma de deslocamento e em locais adequados para a pratica proximos as residencias.OBJECTIVE To estimate the prevalence of physical activity practice in adults and its association with sociodemographic and environmental factors. METHODS Data from the Sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (VIGITEL--Telephone-based Surveillance of Risk and Protective Factors for Chronic Diseases) were collected in 2006. All the 54,369 adults interviewed lived in households with a fixed telephone line, in the Brazilian state capitals and Federal District. Physical activity practice was considered in the leisure-time, occupational, transportation and household domains. Variables studied included sociodemographic characteristics of individuals and environmental characteristics of cities. Association with physical activities was analyzed according to sex. RESULTS Proportions of active individuals were 14.8% for leisure time, 38.2% for occupation, 11.7% for transportation, and 48.5% for household chores. Indices above 60% of inactive individuals in the leisure-time domain were observed in ten capitals. Men were more active than women in all domains, except for household chores. The proportion of active individuals decreased with age. Level of education was directly associated with physical activity in leisure time. Active men in the transportation domain were more likely to be active in their leisure time, while inactive people in the occupational domain were more likely to be active in their leisure time. The existence of places to perform physical activities near the home was associated with physical activity in leisure time. CONCLUSIONS Results obtained are important to monitor physical activity levels in Brazil. Differences between men and women and those in age groups and levels of education must be considered to promote physical activities. Promotion of physical activities in the leisure and transportation domains and in places that are adequate for physical activity practice and near the home should be encouraged.

Percepção do ambiente e prática de atividade física no lazer entre idosos

OBJETIVO: Analisar a associacao da pratica de atividades fisicas no lazer com a percepcao do ambiente por idosos. METODOS: Estudo transversal realizado com 385 idosos com 60 anos ou mais residentes do distrito de Ermelino Matarazzo no municipio de Sao Paulo, SP, em 2007. Para a avaliacao das atividades fisicas no lazer foi utilizado o Questionario Internacional de Atividades Fisicas versao longa, acrescida de questoes especificas para o estudo. A avaliacao do ambiente foi realizada por meio de escala de percepcao adaptada do instrumento Neighborhood Environmental Walkability Scale. Para a analise estatistica, modelos de analise de regressao logistica multipla foram estratificados segundo sexo, controlados por escolaridade. Para a classificacao de ativo no lazer, foi utilizado o ponto de corte de 150 min semanais de atividade fisica. RESULTADOS: A proporcao de idosos fisicamente ativos no lazer foi de 15,2% (19,1% e 12,5%, para homens e mulheres, respectivamente). A presenca de quadras (OR=2,95), agencias bancarias (OR=3,82) e postos de saude (OR=3,60), boa percepcao de seguranca durante o dia (OR=4,21) e receber convite de amigos para fazer atividade fisica (OR=3,13) tiveram associacao com a pratica de atividade fisica no lazer nos homens. Presenca de igrejas ou templos religiosos (OR=5,73), academias (OR=2,49) e pracas (OR=3,63) tiveram associacao com a pratica de atividade fisica no lazer em mulheres. CONCLUSOES: Programas de promocao de atividades fisicas para a populacao idosa devem considerar as variaveis relacionadas as estruturas publicas e privadas (academias, pracas, quadras, postos de saude e bancos), locais que congregam reunioes sociais (igrejas), ao suporte social (ser convidado por amigos para praticar atividade fisica) e percepcao de seguranca.OBJECTIVE To analyze the association between leisure-time physical activity and perception of the environment in the elderly. METHODS Cross-sectional study performed with 385 elderly individuals aged 60 years or older, living in the district of Ermelino Matarazzo, in the city of São Paulo, Southeastern Brazil, in 2007. The long version of the International Physical Activity Questionnaire, in addition to specific questions for the study, was used to assess leisure-time physical activity. Assessment of the environment was performed using a perception scale adapted from the Neighborhood Environment Walkability Scale. For statistical analysis, multiple logistic regression models were stratified by sex and controlled by level of education. The cut-off point of 150 minutes of physical activity per week was used to classify individuals who were active during leisure time. RESULTS The proportion of elderly individuals active during leisure time was 15.2% (19.1% and 12.5% for men and women, respectively). Presence of sports courts (OR=2.95), banks (OR=3.82) and health clinics (OR=3.60), good perception of safety during the day (OR=4.21) and invitation from friends to exercise (OR=3.13) were associated with leisure-time physical activity in men. Presence of churches or religious temples (OR=5.73), gyms (OR=2.49) and squares (OR=3.63) were associated with leisure-time physical activity in women. CONCLUSIONS Programs to promote physical activities for the elderly population must consider the variables associated with public and private structures (gyms, squares, sports courts, health clinics and banks), places where there are social gatherings (churches), social support (invitation from friends to exercise) and perception of safety.

Time trends of physical activity in Brazil (2006-2009)

OBJECTIVE To examine time trends in physical activity (PA) in Brazilian state capitals from 2006 to 2009. METHODS This analysis is based on data from the Telephone-based Surveillance of Risk and Protective Factors for Chronic Diseases (VIGITEL) accounting for an annual sample of approximately 54,000 individuals. PA indicators were analyzed in free time (leisure), work, home and transportation, time spent in front of the television and inactivity considering all PA domains. Poisson regression models were used to measure the variation of indicators over time. We considered the changes corresponding to a regression coefficient different from zero as being statistically significant (p<0.05). RESULTS The percentage of active commuters increased from 11.7 to 14.4% (p<0.001) whereas the proportion of physically inactive individuals in the four domains decreased from 11.7 to 8.7% (p<0.001). There were no significant changes in the other indicators. Women were less active than men in all indicators, except for household chores. However, in this indicator the percentage of active women decreased from 71.4 to 67.1% (p<0.001). Between 2006 and 2009, PA levels in the Brazilian population were stable during free time and household chores, but increased in transportation, resulting in a decrease in the percentage of inactive individuals. CONCLUSION The continued monitoring and strengthening of VIGITEL are public health priorities, and PA is a key part of it. In the long run, PA evolution may be re-evaluated.