Inácio Crochemore Mohnsam da Silva

Fatores de risco comportamentais acumulados para doenças cardiovasculares no sul do Brasil

OBJETIVO: Estimar la prevalencia e identificar factores asociados con la acumulacion de conductas de riesgo en enfermedades cardiovasculares entre adultos. METODOS: Estudio transversal de base poblacional con muestra representativa de 2.732 adultos de ambos sexos de Pelotas, Sur de Brasil, en 2010. Los factores de riesgo conductuales investigados fueron: tabaquismo; inactividad fisica en las horas de ocio; consumo habitual de grasa aparente de la carne, e consumo diario de embutidos, carne roja y leche integral. El desenlace del estudio fue el escore de aglomeracion de factores de riesgo conductuales, variando de cero a tres: ningun factor de riesgo conductual para enfermedades cardiovasculares o exposicion a 1, 2 o > 3 factores de riesgo conductuales. Se realizo regresion logistica multinomial para evaluar el efecto ajustado de las caracteristicas individuales sobre la acumulacion de factores de riesgo conductuales, teniendo como categoria de referencia individuos sin alguno de los factores. RESULTADOS: La inactividad fisica fue el factor de riesgo mas prevaleciente (75,6%), seguido del consumo habitual de grasa aparente de la carne (52,3%). Dos tercios de la poblacion presentaron dos o mas factores de riesgo conductuales. La combinacion de inactividad fisica y consumo habitual de grasa aparente de la carne ocurrio en 17,5% de la muestra; e inactividad fisica, consumo habitual de grasa aparente de la carne y tabaquismo, en 6,7%. Los odds ratios de acumulacion de dos o mas factores fueron mayores entre hombres y se asociaron inversamente con el indicador economico nacional. CONCLUSIONES: La acumulacion de factores de riesgo conductuales en enfermedades cardiovasculares es elevada en la poblacion estudiada. Son necesarias intervenciones publicas capaces de prevenir la ocurrencia simultanea de tales factores.OBJECTIVE To estimate the prevalence of, and identify factors associated with, accumulated risky behavior relating to cardiovascular diseases among adults. METHODS This was a population-based cross-sectional study on a representative sample of 2732 adults of both sexes in Pelotas, Southern Brazil, in 2010. The behavioral risk factors investigated were: smoking; leisure-time physical inactivity; habitual consumption of visible fat in meat; and daily consumption of processed meats, red meat and whole milk. The study outcome was the accumulated behavioral risk factors score, ranging from zero to three: no behavioral risk factor for cardiovascular diseases or exposure to 1, 2 or > 3 behavioral risk factors. Multinomial logistic regression was performed to evaluate the adjusted effect of individual characteristics on behavioral risk factors accumulation, taking individuals without any of these factors as the reference category. RESULTS Physical inactivity was the most prevalent risk factor (75.6%), followed by habitual consumption of visible fat in meat (52.3%). Two thirds of the population presented two or more behavioral risk factors. Combined physical inactivity and habitual consumption of visible fat in meat was observed in 17.5% of the sample; and combined physical inactivity, habitual consumption of visible fat in meat and smoking in 6.7%. The odds ratios for accumulation of two or more risk factors were higher among men and were inversely associated with a national economic indicator. CONCLUSIONS There was a high accumulation of behavioral risk factors for cardiovascular diseases among the study population. Public interventions with the capacity to prevent simultaneous occurrence of these factors are needed.OBJETIVO: Estimar a prevalencia e identificar fatores associados ao acumulo de comportamentos de risco para doencas cardiovasculares entre adultos. METODOS: Estudo transversal de base populacional com amostra representativa de 2.732 adultos de ambos os sexos de Pelotas, RS, em 2010. Os fatores de risco comportamentais investigados foram: tabagismo; inatividade fisica no lazer; consumo habitual de gordura aparente da carne; e consumo diario de embutidos, carne vermelha e leite integral. O desfecho do estudo foi o escore de aglomeracao de fatores de risco comportamentais, variando de zero a tres: nenhum fator de risco comportamental para doencas cardiovasculares ou exposicao a 1, 2 ou > 3 fatores de risco comportamentais. Realizou-se regressao logistica multinomial para avaliar o efeito ajustado das caracteristicas individuais sobre o acumulo de fatores de risco comportamentais, tendo como categoria de referencia individuos sem qualquer dos fatores. RESULTADOS: A inatividade fisica foi o fator de risco mais prevalente (75,6%), seguido do consumo habitual de gordura aparente da carne (52,3%). Dois tercos da populacao apresentaram dois ou mais fatores de risco comportamentais. A combinacao de inatividade fisica e consumo habitual de gordura aparente da carne ocorreu em 17,5% da amostra; e inatividade fisica, consumo habitual de gordura aparente da carne e tabagismo, em 6,7%. Os odds ratios de acumulo de dois ou mais fatores foram maiores entre homens e associaram-se inversamente com o indicador economico nacional. CONCLUSOES: O acumulo de fatores de risco comportamentais para doencas cardiovasculares e elevado na populacao estudada. Sao necessarias intervencoes publicas capazes de prevenir a ocorrencia simultânea desses fatores.

Brazilian Adults' Sedentary Behaviors by Life Domain: Population-Based Study

Background There is rapidly-emerging evidence on the harmful health effects of sedentary behaviors. The aim of this paper was to quantify time in sedentary behaviors and document socio-demographic variations in different life domains among adults. Methods A population-based survey was carried out in 2012 through face-to-face interviews with Brazilian adults aged 20+ years (N = 2,927). Information about time spent sedentary in a typical weekday was collected for five different domains (workplace, commuting, school/university, watching TV, and computer use at home). Descriptive and bivariate analyses examined variations in overall and domain-specific sedentary time by gender, age, educational attainment and socioeconomic position. Results On average, participants reported spending 5.8 (SD 4.5) hours per day sitting. The median value was 4.5 (interquartile range: 2.5–8) hours. Men, younger adults, those with higher schooling and from the wealthiest socioeconomic groups had higher overall sedentary scores. TV time was higher in women, older adults and among those with low schooling and socioeconomic position. Sedentary time in transport was higher in men, younger adults, and participants with high schooling and high socioeconomic position. Computer use at home was more frequent among young adults and those from high socioeconomic groups. Sitting at work was higher in those with higher schooling and from the wealthiest socioeconomic groups. Sedentary behavior at school was related inversely to age and directly to schooling. Conclusion Patterns of sedentary behavior are different by life domains. Initiatives to reduce prolonged sitting among Brazilian adults will be required on multiple levels for different life domains.

Accumulated behavioral risk factors for cardiovascular diseases in Southern Brazil

OBJETIVO: Estimar la prevalencia e identificar factores asociados con la acumulacion de conductas de riesgo en enfermedades cardiovasculares entre adultos. METODOS: Estudio transversal de base poblacional con muestra representativa de 2.732 adultos de ambos sexos de Pelotas, Sur de Brasil, en 2010. Los factores de riesgo conductuales investigados fueron: tabaquismo; inactividad fisica en las horas de ocio; consumo habitual de grasa aparente de la carne, e consumo diario de embutidos, carne roja y leche integral. El desenlace del estudio fue el escore de aglomeracion de factores de riesgo conductuales, variando de cero a tres: ningun factor de riesgo conductual para enfermedades cardiovasculares o exposicion a 1, 2 o > 3 factores de riesgo conductuales. Se realizo regresion logistica multinomial para evaluar el efecto ajustado de las caracteristicas individuales sobre la acumulacion de factores de riesgo conductuales, teniendo como categoria de referencia individuos sin alguno de los factores. RESULTADOS: La inactividad fisica fue el factor de riesgo mas prevaleciente (75,6%), seguido del consumo habitual de grasa aparente de la carne (52,3%). Dos tercios de la poblacion presentaron dos o mas factores de riesgo conductuales. La combinacion de inactividad fisica y consumo habitual de grasa aparente de la carne ocurrio en 17,5% de la muestra; e inactividad fisica, consumo habitual de grasa aparente de la carne y tabaquismo, en 6,7%. Los odds ratios de acumulacion de dos o mas factores fueron mayores entre hombres y se asociaron inversamente con el indicador economico nacional. CONCLUSIONES: La acumulacion de factores de riesgo conductuales en enfermedades cardiovasculares es elevada en la poblacion estudiada. Son necesarias intervenciones publicas capaces de prevenir la ocurrencia simultanea de tales factores.OBJECTIVE To estimate the prevalence of, and identify factors associated with, accumulated risky behavior relating to cardiovascular diseases among adults. METHODS This was a population-based cross-sectional study on a representative sample of 2732 adults of both sexes in Pelotas, Southern Brazil, in 2010. The behavioral risk factors investigated were: smoking; leisure-time physical inactivity; habitual consumption of visible fat in meat; and daily consumption of processed meats, red meat and whole milk. The study outcome was the accumulated behavioral risk factors score, ranging from zero to three: no behavioral risk factor for cardiovascular diseases or exposure to 1, 2 or > 3 behavioral risk factors. Multinomial logistic regression was performed to evaluate the adjusted effect of individual characteristics on behavioral risk factors accumulation, taking individuals without any of these factors as the reference category. RESULTS Physical inactivity was the most prevalent risk factor (75.6%), followed by habitual consumption of visible fat in meat (52.3%). Two thirds of the population presented two or more behavioral risk factors. Combined physical inactivity and habitual consumption of visible fat in meat was observed in 17.5% of the sample; and combined physical inactivity, habitual consumption of visible fat in meat and smoking in 6.7%. The odds ratios for accumulation of two or more risk factors were higher among men and were inversely associated with a national economic indicator. CONCLUSIONS There was a high accumulation of behavioral risk factors for cardiovascular diseases among the study population. Public interventions with the capacity to prevent simultaneous occurrence of these factors are needed.OBJETIVO: Estimar a prevalencia e identificar fatores associados ao acumulo de comportamentos de risco para doencas cardiovasculares entre adultos. METODOS: Estudo transversal de base populacional com amostra representativa de 2.732 adultos de ambos os sexos de Pelotas, RS, em 2010. Os fatores de risco comportamentais investigados foram: tabagismo; inatividade fisica no lazer; consumo habitual de gordura aparente da carne; e consumo diario de embutidos, carne vermelha e leite integral. O desfecho do estudo foi o escore de aglomeracao de fatores de risco comportamentais, variando de zero a tres: nenhum fator de risco comportamental para doencas cardiovasculares ou exposicao a 1, 2 ou > 3 fatores de risco comportamentais. Realizou-se regressao logistica multinomial para avaliar o efeito ajustado das caracteristicas individuais sobre o acumulo de fatores de risco comportamentais, tendo como categoria de referencia individuos sem qualquer dos fatores. RESULTADOS: A inatividade fisica foi o fator de risco mais prevalente (75,6%), seguido do consumo habitual de gordura aparente da carne (52,3%). Dois tercos da populacao apresentaram dois ou mais fatores de risco comportamentais. A combinacao de inatividade fisica e consumo habitual de gordura aparente da carne ocorreu em 17,5% da amostra; e inatividade fisica, consumo habitual de gordura aparente da carne e tabagismo, em 6,7%. Os odds ratios de acumulo de dois ou mais fatores foram maiores entre homens e associaram-se inversamente com o indicador economico nacional. CONCLUSOES: O acumulo de fatores de risco comportamentais para doencas cardiovasculares e elevado na populacao estudada. Sao necessarias intervencoes publicas capazes de prevenir a ocorrencia simultânea desses fatores.

The contribution of poor and rural populations to national trends in reproductive, maternal, newborn, and child health coverage: analyses of cross-sectional surveys from 64 countries

Summary Background Coverage levels for essential interventions aimed at reducing deaths of mothers and children are increasing steadily in most low-income and middle-income countries. We assessed how much poor and rural populations in these countries are benefiting from national-level progress. Methods We analysed trends in a composite coverage indicator (CCI) based on eight reproductive, maternal, newborn, and child health interventions in 209 national surveys in 64 countries, from Jan 1, 1994, to Dec 31, 2014. Trends by wealth quintile and urban or rural residence were fitted with multilevel modelling. We used an approach akin to the calculation of population attributable risk to quantify the contribution of poor and rural populations to national trends. Findings From 1994 to 2014, the CCI increased by 0·82 percent points a year across all countries; households in the two poorest quintiles had an increase of 0·99 percent points a year, which was faster than that for the three wealthiest quintiles (0·68 percent points). Gains among poor populations were faster in lower-middle-income and upper-middle-income countries than in low-income countries. Globally, national level increases in CCI were 17·5% faster than they would have been without the contribution of the two poorest quintiles. Coverage increased more rapidly annually in rural (0·93 percent points) than urban (0·52 percent points) areas. Interpretation National coverage gains were accelerated by important increases among poor and rural mothers and children. Despite progress, important inequalities persist, and need to be addressed to achieve the Sustainable Development Goals. Funding UNICEF, Wellcome Trust.

Methodological description of accelerometry for measuring physical activity in the 1993 and 2004 Pelotas (Brazil) birth cohorts

The aim of this study was to characterize the methodology of data collection on physical activity using accelerometry in two birth cohorts (2004 and 1993) in Pelotas, Rio Grande do Sul State, Brazil, at the 6-7 and 18-year follow-up visits, respectively. During visits to the study headquarters for a health evaluation, cohort subjects received the accelerometer to be worn on the wrist for 5 to 8 days, after which the device was retrieved at their homes. Genea and GENEActiv triaxial estimators of gravity (g) acceleration were employed. Accelerometry data were collected from 3,331 children (93.7% of those included in follow-up) and 3,816 adolescents (99% of those in follow-up). The study characterizes the data collection methodology in more than 7,000 individuals and discusses issues in its implementation. It thus provides a methodological framework aimed at helping to plan future population-based studies with the use of such technology and to improve understanding of physical activity in the context of epidemiological studies.

Descrição metodológica do uso de acelerometria para mensurar a prática de atividade física nas coortes de nascimentos de Pelotas, Rio Grande do Sul, Brasil, 1993 e 2004

O objetivo deste trabalho e caracterizar a metodologia de coleta de atividade fisica por meio de acelerometria nas coortes de nascidos em 2004 e 1993 em Pelotas, Rio Grande do Sul, Brasil, nos acompanhamentos dos 6-7 e 18 anos, respectivamente. Ao visitarem a sede para um amplo estudo de saude, esses individuos receberam o acelerometro e a posterior busca foi realizada no domicilio por meio de motociclistas da equipe de pesquisa. Os modelos utilizados foram o GENEA e GENEActiv, estimadores triaxiais da aceleracao da gravidade (g), utilizados no punho de criancas e adolescentes por um periodo de 5 a 8 dias. O numero de individuos com dados de acelerometria nas coortes foi de 3.331 criancas (93,7% do acompanhamento) e 3.816 jovens (92,9% do acompanhamento). Ao caracterizarmos a coleta de acelerometria em mais de 7.000 individuos, apresenta-se um arcabouco metodologico para o planejamento de novos estudos populacionais no tema, descrevendo situacoes especificas dessa experiencia e qualificando a compreensao da atividade fisica no contexto de estudos epidemiologicos.

Physical activity and safety from crime among adults: a systematic review

BACKGROUND The aim of this study was to review the evidence to date on the association between physical activity and safety from crime. METHODS Articles with adult populations of 500+ participants investigating the association between physical activity and safety from crime were included. A methodological quality assessment was conducted using an adapted version of the Downs and Black checklist. RESULTS The literature search identified 15,864 articles. After assessment of titles, abstracts and full-texts, 89 articles were included. Most articles (84.3%) were derived from high-income countries and only 3 prospective articles were identified. Articles presented high methodological quality. In 38 articles (42.7%), at least one statistically significant association in the expected direction was reported (ie, safety from crime was positively associated with physical activity). Nine articles (10.1%) found an association in the unexpected direction and 42 (47.2%) did not find statistically significant associations. The results did not change when we analyzed articles separately by sex, age, type of measurement, or domains of physical activity evaluated. CONCLUSION The current evidence, mostly based on cross-sectional studies, suggests a lack of association between physical activity and safety from crime. Prospective studies and natural experiments are needed, particularly in areas with wide crime variability.

Índice de Desenvolvimento Humano e prevenção secundária de câncer de mama e colo do útero: um estudo ecológico

This ecological study assessed mammography and Papanicolaou test (Pap smear) screening rates and their association with the Human Development Index (HDI) in Brazilian state capitals and Federal District in 2011, based on VIGITEL telephone survey data. More than 70% of women had a mammogram some time in life in all the state capitals, while the Pap smear rates any time in life and in the previous three years fell short of the 80% target in most state capitals. There was a strong positive correlation between HDI and the test rates (r = 0.52 and 0.66 for mammogram any time in life and in the previous two years and r = 0.66 and 0.71 for Pap smear any time in life and in the previous three years, respectively). Prevalence ratio (PR) for mammogram in the previous two years was 1.06 (95%CI: 1.01-1.10) and PR for Pap smear in the previous three years was 1.07 (IC95%: 1.04-1.10). The promotion of public health policies that encourage Brazils urban economic and social development should help increase coverage for these tests.Estudo ecologico que analisou a proporcao da realizacao de mamografia e do exame de Papanicolaou e a associacao destes com o Indice de Desenvolvimento Humano (IDH), nas 26 capitais brasileiras e Distrito Federal, em 2011, com dados do VIGITEL. A proporcao de mamografia em algum momento da vida esteve acima de 70% para todas as capitais estudadas. Entretanto, poucas capitais atingiram a meta de 80% para o Papanicolaou, tanto para a realizacao em algum momento da vida como nos ultimos tres anos. Houve forte correlacao positiva entre IDH e as proporcoes desses exames (r = 0,52 e 0,66 para realizacao de mamografia em algum momento da vida e nos ultimos dois anos e r = 0,66 e 0,71 para realizacao do Papanicolaou em algum momento da vida e nos ultimos tres anos, respectivamente). A razao de prevalencia de mamografia nos ultimos dois anos foi 1,06 (IC95%: 1,01-1,10) e para o Papanicolaou nos ultimos tres anos foi 1,07 (IC95%: 1,04-1,10). A promocao de politicas publicas que incentivem o desenvolvimento socioeconomico das cidades brasileiras favoreceria o aumento da cobertura desses exames.

Physical activity and perceived insecurity from crime in adults: a population-based study

Background The present study aimed to describe the perception of safety from crime in the neighborhood and to evaluate its association with leisure-time and transport-related physical activity in adults. Methods A cross-sectional population based study was conducted in the urban area of Pelotas, Brazil, in 2012. Perceived insecurity from crime in the neighborhood was measured using the Neighborhood Environment Walkability Scale (NEWS) and the City Stress Inventory (CSI). Physical activity was measured using an adapted version of the leisure and transportation sections of the long version of the International Physical Activity Questionnaire. Results Overall, 52.3% (95%CI49.0; 55.6) of the participants reported perceived exposure to an unsafe neighborhood. Subjects who practiced 150 or more minutes per week of physical activity during leisure-time and transportation were 10.5% (95%CI9.0; 12.0) and 51.7% (95%CI 48.7; 54.7), respectively. There were no significant associations between physical activity (leisure-time or transport-related) and perceived insecurity from crime, neither in unadjusted nor in adjusted analyses. Conclusion There was no evidence that the perception of safety from crime is associated to higher physical activity levels among Brazilian adults.

Trends in Leisure-Time Physical Activity in a Southern Brazilian City: 2003-2010

BACKGROUND Most of physical activity surveillance data are derived from high-income countries. The aim of the current study was to report time trends in leisure-time physical activity. METHODS Population-based surveys were conducted in the city of Pelotas, Brazil in 2003 and 2010, including individuals aged 20+ years. Physical activity was assessed using the leisure-time section of the long version of the IPAQ. A cut-off point of 150 min/wk was used in the analyses. Methodologies were virtually identical in both surveys. RESULTS In 2003, 26.8% (95% CI 24.3; 29.2) of the participants were classified as active in leisure-time, as compared with 24.4% (95% CI 22.6; 26.2) in 2010. The proportion of subjects reporting 0 minutes per week of walking, moderate- and vigorous-intensity physical activity practice also did not vary between 2003 and 2010. However, the proportion of active adults decreased from 39.9% (95% CI 33.0; 42.7) in 2003 to 29.7% (95% CI 24.9; 34.5) in 2010 among high-income participants. Males were more active than females in both surveys. CONCLUSIONS Leisure-time physical activity is stable among adults living in the South of Brazil, but high-income participants are becoming less active over time. Scaling up effective and promising physical activity interventions is urgently needed in Brazil.