Prevalence of Abdominal Obesity and Associated Factors in Urban Brazilian Women: A Comparison Between Two Population-Based Cross-Sectional Studies in 2003 and 2015.

Background: Abdominal fat accumulation is a known risk factor for cardiometabolic diseases and mortality, particularly in women. This study aimed to compare the prevalence of abdominal obesity and its associated factors in 2003 and 2015. Methods: Two cross-sectional, population-based surveys were conducted, including representative and independent samples of adult women 20-60 years of age residing in the urban area of São Leopoldo/RS municipality in 2003 (n = 981) and 2015 (n = 984). Abdominal obesity was assessed using waist circumference, with a measurement of ≥88 cm indicating its presence. Factors, such as demographics, socioeconomic status, reproductive health, family history, morbidity, and behavioral characteristics, were studied. Poisson regression was used to assess the associations. Results: The mean age of individuals in the samples was 38.5 years (±11.1 years) and 40.3 years (±11.4 years) in 2003 and 2015, respectively. The prevalence of abdominal obesity doubled from 23.3% (95% confidence interval [CI]: 20.7-26.0) in 2003 to 46.9% (95% CI: 43.7-50.0) in 2015. After adjustment, the prevalence of abdominal obesity remained higher in both 2003 and 2015 with increasing age, low family income, higher number of pregnancies, earlier age at menarche, and presence of a family history of obesity in the father and mother and in women with a history of hypertension. Conclusions: This study demonstrates an increase in the prevalence of abdominal obesity in women between 2003 and 2015 and highlights the sociodemographic, reproductive, family history, and comorbidity aspects associated with its occurrence.

Prevalence of common mental disorders in southern Brazilian women: a comparison of two population-based studies (2003 vs. 2015).

PURPOSE: To investigate the prevalence and associated factors of common mental disorders (CMD) in women, and comparing them in two periods, 2003 and 2015. METHODS: A comparative study was conducted between two surveys with representative samples of women aged 20-60 years residing in southern Brazil. The final sample included 988 and 987 women from the 2003 and 2015 surveys, respectively. The presence of CMD was assessed using the Self-Reporting Questionnaire (SRQ-20 ≥ 8) in both surveys. Poisson regression analysis was used to evaluate the associations between the outcome (CMD) and variables of interest. RESULTS: The mean age of the participants was 38.5 ± 11.1 years (2003) and 40.3 ± 11.4 years (2015). In 2003, the prevalence of CMD was 33.4% (95%CI: 30.5-36.3) and in 2015, it was 33.7% (95%CI: 30.8-36.7). Over 12 years, no significant differences were observed in the prevalence of CMD, except for a reduction in the prevalence in women of color and physically active. After adjusting, the prevalence ratios of CMD in 2003 and 2015 remained associated with low family income, a higher number of pregnancies, and tobacco use. CONCLUSIONS: This study showed a trend toward stability in the high prevalence of CMD among women.

Association between obesity and common mental disorders in women: a population-based study in Southern Brazil.

PURPOSE: The study aimed to investigate the relationship between obesity and common mental disorders (CMD) among women. METHODS: This is a cross-sectional population-based study with a representative sample of 981 adult women (20-60 years of age) living in the urban area of the municipality of São Leopoldo, RS, Brazil, in 2015. The presence of CMD was assessed using the Self-Reporting Questionnaire (SRQ-20 ≥ 8). Obesity was defined by body mass index (BMI ≥ 30.0 kg/m2). Prevalence ratios (PRs) for the association between obesity and CMD were measured by Poisson regression with robust variance, including their respective 95% confidence intervals (CIs). RESULTS: The mean age of the sample was 40.3 years (standard deviation = 11.4 years). The prevalence of CMD was 33.7% (95% CI 30.8-36.7), while obesity was 31.2% (95% CI 28.3-34.1). The occurrence of CMD was higher in women with low levels of education and belonging to lower economic class, as well as smokers and those who were insufficiently active. Obesity was more prevalent in older women (50-60 years old) with less schooling, who did not consume alcohol, and those who were insufficiently active. After adjusting for potential confounding factors, women with obesity were 22% more likely to have CMD when compared to those without obesity (PR = 1.22; 95% CI 1.02-1.45; p = 0.030). CONCLUSIONS: This study demonstrated a significant association between obesity and the presence of CMD among women. Additionally, the prevalence of obesity and CMD were high in this population group.

Multimorbidity patterns: obesity as the main modifiable risk factor in adult women in Southern Brazil.

Objective: To identify multimorbidity patterns in women in southern Brazil, and its relationship with sociodemographic, lifestyle characteristics, and nutritional status, as well as to explore the main independent risk factor for the identified patterns. Subjects and methods: This is a cross-sectional, population-based study with 1,128 women (20-69 years), southern Brazil. Chronic conditions were identified using the therapeutic and chemical anatomical classification of continuous use of medications. Multimorbidity was assessed as ≥2 or ≥3 chronic conditions to identify dyads and triads. Poisson regression was used to explore risk factors in the different adjustment models. As independent variables evaluated, in addition to sociodemographic characteristics, lifestyle variables were included: consumption of fruits and vegetables, physical activity, alcohol consumption, smoking and nutritional status. Results: Eleven dyads (frequencies between 2.0% and 6.4%) and three triads (frequencies between 1.9% and 2.1%) of morbidities were identified in the study. Aging was related to a higher prevalence of all patterns, and obesity was a risk factor for multimorbidity patterns that contained conditions related to the cardiovascular and metabolic system and mental health. After adjustment, obesity increased the probability of "hypertension + common mental disorders (CMD)" (PR 3.63; 95% CI 1.94-6.78) and "dyslipidemia + CMD" (PR 3.69; 95% CI 1.08-12.65) by more than three times. Conclusion: This study identified common and important diseases in the patterns, associated with a common risk factor, obesity, that must be addressed by public health policies to prevent multimorbidity.

Multimorbidity patterns: obesity as the main modifiable risk factor in adult women in Southern Brazil

ABSTRACT Objective: To identify multimorbidity patterns in women in southern Brazil, and its relationship with sociodemographic, lifestyle characteristics, and nutritional status, as well as to explore the main independent risk factor for the identified patterns. Subjects and methods: This is a cross-sectional, population-based study with 1,128 women (20-69 years), southern Brazil. Chronic conditions were identified using the therapeutic and chemical anatomical classification of continuous use of medications. Multimorbidity was assessed as ≥2 or ≥3 chronic conditions to identify dyads and triads. Poisson regression was used to explore risk factors in the different adjustment models. As independent variables evaluated, in addition to sociodemographic characteristics, lifestyle variables were included: consumption of fruits and vegetables, physical activity, alcohol consumption, smoking and nutritional status. Results: Eleven dyads (frequencies between 2.0% and 6.4%) and three triads (frequencies between 1.9% and 2.1%) of morbidities were identified in the study. Aging was related to a higher prevalence of all patterns, and obesity was a risk factor for multimorbidity patterns that contained conditions related to the cardiovascular and metabolic system and mental health. After adjustment, obesity increased the probability of "hypertension + common mental disorders (CMD)" (PR 3.63; 95% CI 1.94-6.78) and "dyslipidemia + CMD" (PR 3.69; 95% CI 1.08-12.65) by more than three times. Conclusion: This study identified common and important diseases in the patterns, associated with a common risk factor, obesity, that must be addressed by public health policies to prevent multimorbidity.

Dietary pattern as a predictor of multimorbidity patterns: A population-based cross-sectional study with women.

BACKGROUND AND AIMS: Multimorbidity is a common health condition, and the relationship between different patterns of multimorbidity and food consumption through dietary patterns needs to be determined. This study aimed to investigate the association between dietary patterns and multimorbidity patterns in women. METHODS: This population-based cross-sectional study included 1128 women (aged 20-69 years) living in southern Brazil. We identified multimorbidity patterns using principal component analysis, and the main exposure of the study was three dietary patterns, as derived in a previous study: healthy, risk, and Brazilian patterns. Using Poisson regression with robust variance, the scores of multimorbidity patterns (high/low) were evaluated using different adjustment models. RESULTS: Three patterns of multimorbidity were derived: cardiometabolic (dyslipidemia, circulatory disorders, hypertension, diabetes), endocrine-articular (thyroid diseases, osteoporosis/osteopenia, rheumatic diseases), and psychosomatic (chronic pain, common mental disorders, acid-related digestive disorders). In the relationship between the dietary patterns and multimorbidity patterns, after adjustment, it was observed that a greater adherence to the Brazilian dietary pattern was associated with a lower probability of a high score for the cardiometabolic pattern (PR = 0.68; 95% CI: 0.51-0.89) and psychosomatic pattern (PR = 0.63; 95% CI: 0.47-0.84). Greater adherence to the healthy dietary pattern was associated with a higher probability of a high score for the cardiometabolic pattern (PR = 1.69; 95% CI: 1.27-2.25) and endocrine-articular pattern (PR = 2.05; 95% CI: 1.39-3.02). The risk dietary pattern did not demonstrate an association after adjustment was implemented. CONCLUSIONS: This study provides the first evidence of an association between dietary patterns and multimorbidity patterns. Greater adherence to the Brazilian dietary pattern was a protective factor for a high score for the cardiometabolic and psychosomatic pattern in women. Dietary orientation should be considered in guidelines related to multimorbidity, constituting part of the prevention and management strategies for this condition.

Fatores associados à não realização do exame clínico das mamas em São Leopoldo, RS, 2015: estudo de base populacional / Factors associated with not performing clinical breast exams in São Leopoldo, RS, 2015: a population-based study

Resumo Introdução No Sul do Brasil, a principal causa de mortalidade por neoplasias entre as mulheres está ocupada pelo câncer de mama. O exame clínico anual das mamas está recomendado como medida de rastreamento. Objetivo Investigar a prevalência de não realização do exame clínico de mamas nos últimos 12 meses e fatores associados em mulheres de 20 a 69 anos residentes no município de São Leopoldo/RS em 2015. Método Estudo transversal de base populacional, no qual foram incluídas na análise variáveis demográficas e socioeconômicas. Foram calculadas as razões de prevalência (RP) por regressão de Poisson. Resultados Entre 1.128 mulheres, a prevalência de não realização de exame clínico das mamas foi de 52,6% (IC95%: 51,1-57,2); na análise ajustada, a não realização do exame mostrou-se associada à classe econômica D/E (RP = 1,58; IC95%: 1,16-2,15) e escolaridade de 0 a 4 anos de estudo (RP = 2,16; IC95%: 1,33-3,53). Conclusão As mulheres em situação de vulnerabilidade social apresentaram maior probabilidade de não realização do exame, demonstrando a iniquidade do sistema.

Abstract Background In southern Brazil, the main cause of mortality from cancer among women is breast cancer. Annual clinical breast examination is recommended as a screening measure. Objective To investigate the prevalence of patients that did not perform breast exams in the last 12 months and its associated factors in women aged 20 to 69 years living in São Leopoldo/RS in 2015. Method The present research is a population-based, cross-sectional study; demographic and socio-economic variables were included in the analysis; prevalence ratios (PR) were calculated by Poisson regression. Results Among the 1128 women sampled, the prevalence of not performing clinical breast exams was of 52.6% (95%CI: 51.1-57.2); in the adjusted analysis, not performing clinical breast exams was associated with having a D/E socio-economic status (PR = 1.58; 95%CI: 1.16-2.15), as well as with having an educational level of 0 to 4 years of study (PR = 2.16; 95%CI: 1.33-3.53). Conclusion Women in social vulnerability were more likely to not perform the exams, demonstrating the inequity of the system.

Does sleep quality modify the relationship between common mental disorders and chronic low back pain in adult women?

OBJECTIVE: This study explored the association between common mental disorders (CMD) and chronic low back pain (CLBP) in women, while considering poor sleep quality as a potential effect modifier of this relationship. METHODS: A cross-sectional population-based study was conducted with a representative sample of 1068 women (age 20-69 years) living in the urban area of São Leopoldo, RS, Brazil. CLBP was defined as pain lasting for ≥3 months; CMD was assessed using the Self-Reporting Questionnaire (SRQ-20; score ≥8); poor sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI; score ≥5). Poisson regression with robust variance was used to estimate the prevalence ratios (PR) with 95% confidence intervals (CI). RESULTS: The prevalence of CLBP, CMD, and poor sleep quality was 46.8% (95% CI: 43.8-49.8), 33.5% (95% CI: 30.3-36.3), and 42.3% (95% CI: 39.3-45.2), respectively. Poor sleep quality was a significant modifier of the association between CMD and CLBP. Among women with poor sleep quality, women with CMD had a 48% higher probability of having CLBP compared to women without CMD and after adjustment for confounders (PR = 1.48; 95% CI: 1.23-1.77; p < 0.001). The relationship between CMD and CLBP was not statistically significant in women with good sleep quality. CONCLUSIONS: This study revealed a significant relationship between CMD and CLBP, wherein poor sleep quality acted as an effect modifier. Women with CMD and poor sleep quality were more vulnerable to CLBP.

Lifestyle, high Body Mass Index, and markers of socioeconomic conditions associated with multimorbidity in women.

OBJECTIVE: This study aimed to identify the prevalence of multimorbidity and its associated factors in women in southern Brazil. METHODS: We conducted a cross-sectional, population-based study with a sample of 1,128 women (age 20-69 years), living in São Leopoldo, southern Brazil. Multimorbidity was defined as two or more chronic conditions measured using the therapeutic and chemical anatomical classification of continuous use medications prescribed by a physician. Poisson regression model with robust variance was used to assess the association between sociodemographic and lifestyle variables and multimorbidity. RESULTS: The prevalence of multimorbidity was 21.7% (95%CI 19.3-24.2), and 26 chronic conditions were identified. A direct linear association was observed with age and income and an inverse association with education. Being unemployed was a risk factor for multimorbidity (PR 1.95; 95%CI 1.51-2.52). Alcohol consumption (moderate or excessive) had a protective effect. Overweight and obese women were 53% (PR 1.53; 95%CI 1.09-2.15) and 76% (PR 1.76; 95%CI 1.27-2.45) more likely to have multimorbidity than eutrophic women. CONCLUSION: Over 20% of the adult women had multimorbidity, and its occurrence was strongly associated with socioeconomic characteristics, such as fewer years of schooling, higher income, and not having an occupation. The results regarding alcohol consumption are still insufficient to propose a public policy for the prevention of multimorbidity. Excess weight was an independent risk factor and should be addressed in public health policies for the prevention and management of multimorbidity.

Prevalence of Premenstrual Syndrome and Associated Factors Among Academics of a University in Midwest Brazil.

OBJECTIVE: To investigate the prevalence of premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) in university students, the factors associated with PMS, the most prevalent symptoms, and the interference of symptoms in academic, family, social, and work activities. METHODS: This cross-sectional study included 1,115 university students aged ≥ 18 years from the University of Rio Verde, Goiás. Premenstrual syndrome and PMDD were identified using the Premenstrual Symptoms Screening Tool. Associations with sociodemographic, behavioral, reproductive, nutritional, and health factors were investigated using the Poisson regression. RESULTS: The prevalence of PMS was 46.9% (95% confidence interval [CI] 44.0-49.8), and of PMDD, 11.1% (95% CI 9.3-13.0). The most prevalent symptoms were physical, such as breast tenderness, bloating, e weight gain (73%); followed by psychological ones such as overeating/food cravings, tearful/more sensitive to rejection (> 60%). More than 30% of the patients reported that the symptoms interfered in a moderate-to-severe way in their social and academic activities. After adjusted analysis, PMS was more prevalent in those who were attending the 1st/2nd semester of college (prevalence ratio [PR] 1.44; 95% CI 1.14-1.80), those who consumed alcohol in the last 30 days (PR 1.23; 95% CI 1.04-1.47), and those who had depression (PR 1.49; 95% CI 1.30-1.71). CONCLUSION: Almost half of the university students had PMS and ∼ 11%, PMDD. Physical symptoms were the most common and interfered in a moderate-to-severe way in various aspects of life. Attending the first semesters, consuming alcohol, and having depression were risk factors for PMS. The identification of risk factors for PMS is essential to prevent symptoms and reduce the impact of the syndrome.

OBJETIVO: Investigar a prevalência de síndrome pré-menstrual (SPM) e do transtorno disfórico pré-menstrual (TDPM) em alunas universitárias, os fatores associados à SPM, os sintomas mais prevalentes e a interferência dos sintomas nas atividades acadêmicas, familiares, sociais e de trabalho. MéTODOS: Este estudo transversal incluiu 1.115 estudantes universitárias ≥ 18 anos da Universidade de Rio Verde, Goiás. Síndrome pré-menstrual e TDPM foram identificados por meio do Premenstrual Symptoms Screening Tool. As associações com fatores sociodemográficos, comportamentais, reprodutivos, nutricionais e de saúde foram investigadas utilizando-se a regressão de Poisson. RESULTADOS: A prevalência de SPM foi de 46,9% (intervalo de confiança [IC] de 95% 44,0­49,8) e de TDPM, 11,1% (IC 95% 9,3­13,0). Os sintomas mais prevalentes foram físicos, como sensibilidade mamária, distensão abdominal e ganho de peso (73%); seguidos por psicológicos, como comer demais/desejos por comida, chorar/mais sensível à rejeição (> 60%). Mais de 30% relataram que os sintomas interferiam de forma moderada a grave em suas atividades sociais e acadêmicas. Após análise ajustada, a SPM foi mais prevalente naquelas que estava cursando o 1°/2° semestre da faculdade (razão de prevalência [RP] 1,44; IC 95% 1,14­1,80), as que haviam consumido álcool nos últimos 30 dias (RP 1,23; IC 95% 1,04­1,47), e as que tinha depressão (RP 1,49; IC 95% 1,30­1,71). CONCLUSãO: Quase metade das universitárias tinha SPM e cerca de 11%, TDPM. Os sintomas físicos foram os mais comuns e interferiram de forma moderada a grave em vários aspectos da vida. Frequentar os primeiros semestres, consumir álcool e ter depressão foram fatores de risco para SPM. A identificação dos fatores de risco para a SPM é essencial para prevenir os sintomas e reduzir o impacto da síndrome.

Lifestyle, high Body Mass Index, and markers of socioeconomic conditions associated with multimorbidity in women

ABSTRACT: Objective: This study aimed to identify the prevalence of multimorbidity and its associated factors in women in southern Brazil. Methods: We conducted a cross-sectional, population-based study with a sample of 1,128 women (age 20-69 years), living in São Leopoldo, southern Brazil. Multimorbidity was defined as two or more chronic conditions measured using the therapeutic and chemical anatomical classification of continuous use medications prescribed by a physician. Poisson regression model with robust variance was used to assess the association between sociodemographic and lifestyle variables and multimorbidity. Results: The prevalence of multimorbidity was 21.7% (95%CI 19.3-24.2), and 26 chronic conditions were identified. A direct linear association was observed with age and income and an inverse association with education. Being unemployed was a risk factor for multimorbidity (PR 1.95; 95%CI 1.51-2.52). Alcohol consumption (moderate or excessive) had a protective effect. Overweight and obese women were 53% (PR 1.53; 95%CI 1.09-2.15) and 76% (PR 1.76; 95%CI 1.27-2.45) more likely to have multimorbidity than eutrophic women. Conclusion: Over 20% of the adult women had multimorbidity, and its occurrence was strongly associated with socioeconomic characteristics, such as fewer years of schooling, higher income, and not having an occupation. The results regarding alcohol consumption are still insufficient to propose a public policy for the prevention of multimorbidity. Excess weight was an independent risk factor and should be addressed in public health policies for the prevention and management of multimorbidity.

Avaliação da atenção primária em Sapucaia do Sul: comparação entre o modelo tradicional e a Estratégia Saúde da Família / Evaluation of primary care in Sapucaia do Sul: comparison between the traditional model and the Family Health Strategy

Resumo Introdução O uso de métodos de avalição é uma forma de qualificação do sistema de saúde. Objetivo Avaliou-se a qualidade dos serviços de atenção primária à saúde e compararam-se os atributos entre as unidades básicas de saúde com Estratégia Saúde da Família (ESF) com aquelas de modelo tradicional, em Sapucaia do Sul, RS, permitindo a identificação dos atributos mais vulneráveis. Método Trata-se de estudo transversal de avaliação da APS utilizando-se o instrumento PCATool - Brasil, versão profissionais de saúde. Os respondentes foram enfermeiros da rede. As unidades foram comparadas mediante o uso de médias dos escores observados nos atributos e seus intervalos de confiança de 95%. Resultados Das 24 unidades avaliadas, 20 (83,3%) apresentaram escore geral médio maior que 6,60. O escore geral das unidades com ESF foi 7,24 (IC95% 7,0-7,3), enquanto a média das BHU tradicionais foi 6,70 (IC95% 6,1-7,0). Na maioria dos atributos, houve melhor desempenho nas equipes com ESF, embora a diferença tenha sido constatada nos atributos integralidade-serviços disponíveis e orientação comunitária. A acessibilidade atingiu o desempenho menos satisfatório nos dois modelos. Conclusão Apontou-se a necessidade de se melhorar o acesso e de se incrementar o sistema de referência, e foram mostradas ações para aperfeiçoar o desempenho.

Abstract Introduction The use of evaluation methods is a way of qualifying the health system. Objective The objective of the present study was to evaluate the quality of primary health care (PHC) services and compare health units with Family Health Strategy with those units with a traditional model, in Sapucaia do Sul, RS. This study identified the most vulnerable attributes among units. Methods This is a cross-sectional study of PHC assessment using the PCATool - Brazil instrument, version of health professionals. Respondents were network nurses. The units were compared using the average scores observed in the attributes and their 95% confidence intervals. Results 20 (83.3%) of the 24 units evaluated, had an average general score greater than 6.60. The general score of units with FHS was 7.24 (95% CI 7.0-7.3), while the average of traditional basic health units (BHU) was 6.70 (95% CI 6.1-7.0). In most of the attributes, there was a better performance in teams with FHS, although the difference was found in the integrality attributes - available services and community guidance. Accessibility achieved the least satisfactory performance in both models. Conclusion The need was pointed out to improve access, to increase the reference system, and actions were shown to improve performance.

Prevalence of self-reported diabetes mellitus in women and associated factors: a population-based study in São Leopoldo, Rio Grande do Sul, Brazil, 2015. / Prevalência de diabetes mellitus autorreferido em mulheres e fatores associados: estudo de base populacional em São Leopoldo, Rio Grande do Sul, 2015.

Objective to analyze the prevalence of Diabetes Mellitus (DM) and associated factors in women aged 20 to 69 years in São Leopoldo, RS, Brazil. Method this was a population-based cross-sectional study, the outcome of which was self-reported medical diagnosis of DM. Poisson regression was used. Results 1,128 women took part, 8.16% (95%CI2.56;13.74) reported DM diagnosis; in the adjusted analysis association was found between the outcome and the 50-59 years age group (PR=15.73 - 95%CI4.84;71.00) and the over 60s (PR=8.95 - 95%CI1.98;40.49), economic classes D/E (PR=2.37 - 95%CI1.17;4.83), obesity (PR=1.41 - 95%CI0.85;2.32), arterial hypertension (PR=2.78 - 95%CI1.73;4.46), common mental disorders (PR=1.47 - 95%CI1.04;2.05), dyslipidemia (PR=2.16 - 95%CI1.45;3.23), regular/poor self-perception of health (PR=2.80 - 95%CI1.20;6.56), and not working (PR=1.98 - 95%CI1.11;3.53). Conclusion DM was associated with situations of economic and social vulnerability, such as poverty and being outside the labor market, as well as with the presence of other diseases.

Prevalência de diabetes mellitus autorreferido em mulheres e fatores associados: estudo de base populacional em São Leopoldo, Rio Grande do Sul, 2015 / Prevalencia de diabetes mellitus auto-referida en mujeres y factores asociados: estudio poblacional en São Leopoldo, Rio Grande do Sul, Brasil, 2015 / Prevalence of self-reported diabetes mellitus in women and associated factors: a population-based study in São Leopoldo, Rio Grande do Sul, Brazil, 2015

Resumo Objetivo analisar a prevalência de diabetes mellitus (DM) e fatores associados nas mulheres de 20 a 69 anos de idade residentes em São Leopoldo, RS, Brasil. Métodos estudo transversal de base populacional, cujo desfecho foi o diagnóstico médico de DM autorreferido; empregou-se regressão de Poisson. Resultados participaram 1.128 mulheres, das quais 8,16% (IC95%2,56;13,74) referiram diagnóstico de DM; na análise ajustada, verificou-se associação do desfecho com as idades de 50 a 59 (RP=15,73 - IC95%4,84;71,00) e 60 ou mais anos (RP=8,95 - IC95%1,98;40,49), classes econômicas D/E (RP=2,37 - IC95%1,17;4,83), obesidade (RP=1,41 - IC95%0,85;2,32), hipertensão arterial (RP=2,78 - IC95%1,73;4,46), transtornos mentais comuns (RP=1,47 - IC95%1,04;2,05), dislipidemia (RP=2,16 - IC95%1,45;3,23), autopercepção de saúde regular/ruim (RP=2,80 - IC95%1,20;6,56) e ao fato de não trabalhar (RP=1,98 - IC95%1,11;3,53). Conclusão o DM esteve associado a situações de vulnerabilidade socioeconômica, como pobreza e não inserção no mercado de trabalho, e à presença de outras doenças.

Resumen Objetivo analizar la prevalencia de Diabetes Mellitus (DM) y factores asociados en mujeres de 20 a 69 años en São Leopoldo, RS, Brasil. Métodos estudio poblacional transversal, cuyo resultado fue diagnóstico médico de DM auto-referida; se utilizó la regresión de Poisson. Resultados participaron 1.128 mujeres, 8,16% (IC95%2,56;13,74) presentaron DM; en el análisis ajustado, hubo una asociación con la edad de 50 a 59 (RP=15,73 - IC95%4,84;71,00) y 60 o más (RP=8,95 - IC95%1,98;40,49), clases económicas D/E (RP=2,37 - IC95%1,17;4,83), obesidad (RP=1,41 - IC95%0,85;2,32), hipertensión (RP=2,78 - IC95%1,73;4,46), trastornos mentales comunes (RP=1,47 - IC95%1,04;2,05), dislipidemia (RP=2,16 - IC95%1,45;3,23), autopercepción de salud regular/deficiente (RP=2,80 - IC95%1,20;6,56) y a no trabajar (RP=1,98 - IC95%1,11;3,53). Conclusión la DM se asoció con situaciones de vulnerabilidad económica y social, como la pobreza y la no inserción en el mercado laboral, y la presencia de otras enfermedades.

Abstract Objective to analyze the prevalence of Diabetes Mellitus (DM) and associated factors in women aged 20 to 69 years in São Leopoldo, RS, Brazil. Method this was a population-based cross-sectional study, the outcome of which was self-reported medical diagnosis of DM. Poisson regression was used. Results 1,128 women took part, 8.16% (95%CI2.56;13.74) reported DM diagnosis; in the adjusted analysis association was found between the outcome and the 50-59 years age group (PR=15.73 - 95%CI4.84;71.00) and the over 60s (PR=8.95 - 95%CI1.98;40.49), economic classes D/E (PR=2.37 - 95%CI1.17;4.83), obesity (PR=1.41 - 95%CI0.85;2.32), arterial hypertension (PR=2.78 - 95%CI1.73;4.46), common mental disorders (PR=1.47 - 95%CI1.04;2.05), dyslipidemia (PR=2.16 - 95%CI1.45;3.23), regular/poor self-perception of health (PR=2.80 - 95%CI1.20;6.56), and not working (PR=1.98 - 95%CI1.11;3.53). Conclusion DM was associated with situations of economic and social vulnerability, such as poverty and being outside the labor market, as well as with the presence of other diseases.

Food environment, income and obesity: a multilevel analysis of a reality of women in Southern Brazil.

The objective of this study was to explore relationships between the neighborhood food environment and obesity in urban women living in São Leopoldo, Rio Grande do Sul State, Brazil. A cross-sectional survey was carried out. This study was conducted with 1,096 women. Structured interviews were conducted using a standard pre-tested questionnaire. Obesity was defined as body mass index (BMI) ≥ 30kg/m2. Circular buffers of 400m in radius were created based on the centroid of the women's houses who participated, in the 45 census tracts inhabited by them. Neighborhood food establishments were identified through systematic survey of all streets in the study areas and geographical coordinates of shops were collected. Establishments were evaluated using the NEMS tool. The prevalence of obesity was 33% among the women participants. After adjusting for individual variables, supermarkets and healthy food establishments were positively associated with obesity, PR = 1.05 (95%CI: 1.01-1.10), PR = 1.02 (95%CI: 1.00-1.04), respectively, while mean buffer income was negatively associated, PR = 0.64 (95%CI: 0.49-0.83). Neighborhood food environment factors were associated with obesity even after controlled for individual variables, as socioeconomic variables, behavioral and food purchase.

Factors associated with not having Pap Smears in São Leopoldo, Rio Grande do Sul, Brazil, 2015: a cross-sectional population-based study. / Fatores associados a não realização de exame citopatológico em São Leopoldo, Rio Grande do Sul, 2015: estudo transversal de base populacional.

OBJECTIVE: to estimate the prevalence of Pap tests not performed in the last three years and never performed in women and to analyze factors. METHODS: this was a cross-sectional study with women aged 20 to 69 years living in São Leopoldo, RS, Brazil, in 2015; prevalence ratios (PR) were calculated using Poisson regression. RESULTS: among 919 women, prevalence of delayed testing was 17.8% (95% confidence interval [95%CI]15.4;20.3) and never tested prevalence was 8.1% (95%CI6.3%;9.8%); in the adjusted analysis, the increase in the prevalence of delayed testing was associated with economic class D/E (PR=2.1 - 95%CI1.3;3.5), being aged 20-29 years (PR=3.2 - 95%CI2.1;4.9) and not having had a medical appointment (PR=3.0 - 95%CI2.1;4.1); never having tested was associated with economic class D/E (PR=2.6 - 95%CI1.4;5.0), being aged 20-29 years (PR=24.1 - 95%CI6.4;90.9), and not having had a medical appointment (PR=2.9 - 95%CI1.7;4.8). CONCLUSION: coverage of the test was high but characterized by social inequality.

Fatores associados a não realização de exame citopatológico em São Leopoldo, Rio Grande do Sul, 2015: estudo transversal de base populacional / Factores asociados a la no realización de examen citopatológico en São Leopoldo, Rio Grande do Sul, Brasil, 2015: estudio transversal de base poblacional / Factors associated with not having Pap Smears in São Leopoldo, Rio Grande do Sul, Brazil, 2015: a cross-sectional population-based study

Objetivo: estimar a prevalência de exame citopatológico não realizado nos últimos três anos e de nunca realizado em mulheres, e analisar fatores associados. Métodos: estudo transversal, com mulheres de 20 a 69 anos de idade, em São Leopoldo, RS, Brasil, em 2015; calcularam-se as razões de prevalência (RP) por regressão de Poisson. Resultados: entre 919 mulheres, a prevalência de exame atrasado foi 17,8% (intervalo de confiança de 95% [IC95%15,4;20,3), e de nunca realizado, 8,1% (IC95%6,3;9,8); na análise ajustada, o aumento na prevalência de exame atrasado mostrou-se associado à classe econômica D/E (RP=2,1 - IC95%1,3;3,5), idade de 20-29 anos (RP=3,2 - IC95%2,1;4,9) e nenhuma consulta realizada (RP=3,0 - IC95%2,1;4,1); nunca ter realizado exame associou-se com classe econômica D/E (RP=2,6 - IC95%1,4;5,0), idade de 20-29 anos (RP=24,1 - IC95%6,4;90,9) e nenhuma consulta (RP=2,9 - IC95%1,7;4,8). Conclusão: a cobertura de exame foi alta e com iniquidade.

Objetivo: estimar la prevalencia de examen en mujeres, no realizado en los últimos tres años y de nunca realizado, y analizar factores asociados. Métodos: estudio transversal con mujeres de 20 a 69 años de edad de São Leopoldo, RS, Brasil, en 2015; se calcularon las razones de prevalencia (RP) por la regresión de Poisson. Resultados: entre 919 mujeres, la prevalencia de examen retrasado fue 17,8% (intervalo de confianza del 95% [IC95%]15,4;20,3) y de nunca realizado fue del 8,1% (IC95%6,3;9,8); en el análisis ajustado, el aumento en la prevalencia de examen retrasado se asoció con clase económica D/E (RP=2,1 - IC95%1,3;3,5), a edad entre 20-29 años (RP=3,2 - IC95%2,1;4,9) y ninguna consulta (RP=3,0 - IC95%2,1;4,1); nunca haber realizado examen se asoció con clase D/E (RP=2,6 - IC95%1,4;5,0), a 20-29 años de edad (RP=24,1 - IC95%6,4;90,9) y ninguna consulta (RP=2,9 - IC95%1,7;4,8). Conclusión: la cobertura de examen fue alta y con inequidad.

Objective: to estimate the prevalence of Pap tests not performed in the last three years and never performed in women and to analyze factors. Methods: this was a cross-sectional study with women aged 20 to 69 years living in São Leopoldo, RS, Brazil, in 2015; prevalence ratios (PR) were calculated using Poisson regression. Results: among 919 women, prevalence of delayed testing was 17.8% (95% confidence interval [95%CI]15.4;20.3) and never tested prevalence was 8.1% (95%CI6.3%;9.8%); in the adjusted analysis, the increase in the prevalence of delayed testing was associated with economic class D/E (PR=2.1 - 95%CI1.3;3.5), being aged 20-29 years (PR=3.2 - 95%CI2.1;4.9) and not having had a medical appointment (PR=3.0 - 95%CI2.1;4.1); never having tested was associated with economic class D/E (PR=2.6 - 95%CI1.4;5.0), being aged 20-29 years (PR=24.1 - 95%CI6.4;90.9), and not having had a medical appointment (PR=2.9 - 95%CI1.7;4.8). Conclusion: coverage of the test was high but characterized by social inequality.

Food environment, income and obesity: a multilevel analysis of a reality of women in Southern Brazil / Ambiente alimentar, renda e obesidade: uma análise multinível da realidade de mulheres no Sul do Brasil / Entorno alimentario, renta y obesidad: un análisis multinivel de la realidad de mujeres en el Sur de Brasil

The objective of this study was to explore relationships between the neighborhood food environment and obesity in urban women living in São Leopoldo, Rio Grande do Sul State, Brazil. A cross-sectional survey was carried out. This study was conducted with 1,096 women. Structured interviews were conducted using a standard pre-tested questionnaire. Obesity was defined as body mass index (BMI) ≥ 30kg/m2. Circular buffers of 400m in radius were created based on the centroid of the women's houses who participated, in the 45 census tracts inhabited by them. Neighborhood food establishments were identified through systematic survey of all streets in the study areas and geographical coordinates of shops were collected. Establishments were evaluated using the NEMS tool. The prevalence of obesity was 33% among the women participants. After adjusting for individual variables, supermarkets and healthy food establishments were positively associated with obesity, PR = 1.05 (95%CI: 1.01-1.10), PR = 1.02 (95%CI: 1.00-1.04), respectively, while mean buffer income was negatively associated, PR = 0.64 (95%CI: 0.49-0.83). Neighborhood food environment factors were associated with obesity even after controlled for individual variables, as socioeconomic variables, behavioral and food purchase.

O estudo teve como objetivo explorar as relações entre o ambiente alimentar da vizinhança e obesidade em mulheres na área urbana de São Leopoldo, Rio Grande do Sul, Brasil, através de um inquérito transversal. O estudo teve uma amostra de 1.096 mulheres. Foram realizadas entrevistas estruturadas com um questionário padronizado e previamente testado. A obesidade foi definida como índice de massa corporal (IMC) ≥ 30kg/m2. Foram criadas zonas-tampão com raio de 400m em torno do centroide das residências das participantes nos 45 setores censitários. Os estabelecimentos varejistas com venda de alimentos na vizinhança foram identificados através de uma pesquisa sistemática das áreas do estudo, e foram coletadas as coordenadas geográficas dessas lojas. Os estabelecimentos foram avaliados com a ferramenta NEMS. A prevalência de obesidade foi 33% entre as participantes. Depois de ajustar para as variáveis individuais, os supermercados e os estabelecimentos com alimentos saudáveis mostraram uma associação positiva com a obesidade, RP = 1,05 (IC95%: 1,01-1,10), RP = 1,02 (IC95%: 1,00-1,04), respectivamente, enquanto que a renda média da zona-tampão mostrou associação negativa, RP = 0,64 (IC95%: 0,49-0,83). Os fatores de ambiente alimentar da vizinhança estiveram associados à obesidade, mesmo depois de controlar para as variáveis individuais, socioeconômicas, comportamentais e de compra de alimentos.

El objetivo de este estudio fue investigar las relaciones entre el entorno alimentario del vecindario y la obesidad en mujeres que viven en áreas urbanas de São Leopoldo, Rio Grande do Sul, Brasil. Se llevó a cabo un estudio transversal. Este estudio se realizó con 1.096 mujeres. Se realizaron entrevistas estructuradas, usando un cuestionario estándar probado previamente. La obesidad se definió como un índice de masa corporal (IMC) ≥ 30kg/m2. Se crearon amortiguadores circulares en un radio de 400m, basados en el centroide de las casas de las mujeres que participaron, en los 45 distritos censales donde residían. Los establecimientos de comida del vecindario fueron identificados mediante un estudio sistemático de todas las calles en las áreas de estudio y también se recabaron las coordenadas geográficas de las tiendas. Los establecimientos fueron evaluados usando el instrumento NEMS. La prevalencia de obesidad fue de un 33% entre las mujeres participantes. Tras el ajuste de las variables individuales, los supermercados y los establecimientos de comida sana estuvieron positivamente asociados con la obesidad, RP = 1,05 (IC95%: 1,01-1,10), RP = 1,02 (IC95%: 1,00-1,04), respectivamente, mientras que un promedio de renta media estuvo negativamente asociado, RP = 0,64 (IC95%: 0,49-0,83). Los factores del vecindario en el entorno alimentario estuvieron asociados con la obesidad incluso después de ser controlados por variables individuales como: socioeconómicas, comportamentales y de compra de comida.

Characteristics of women who do not consult a doctor: a population-based study.

OBJECTIVE To analyze the prevalence of not consulting a doctor within a year. METHODS Cross-sectional population-based study, including women aged 20-60 years, living in the urban area of São Leopoldo, state of Rio Grande do Sul, in 2015. The association between variables and outcome was assessed using prevalence ratios and 95% confidence intervals (95%CI). The adjusted analysis was performed using Poisson regression with robust variance. RESULTS Among the 1,127 women participating in the study, 954 (84.6%, 95%CI 82.5-86.7) reported having consulted a physician in the year prior to the interview, 173 (15.4%, 95%CI 13.2-17.5) did not. Women belonging to lower income classes D and E, younger, and smokers had higher prevalences of no medical visits. The participants with hypertension had a higher prevalence of consultations. CONCLUSIONS There was no expected evolution in the local health system, despite the emergence of the policies implemented in this period. It is necessary to provide care for those in less favored socioeconomic conditions and for younger women.

Characteristics of women who do not consult a doctor: a population-based study / Características das mulheres que não consultam com médico: estudo de base populacional

ABSTRACT OBJECTIVE To analyze the prevalence of not consulting a doctor within a year. METHODS Cross-sectional population-based study, including women aged 20-60 years, living in the urban area of São Leopoldo, state of Rio Grande do Sul, in 2015. The association between variables and outcome was assessed using prevalence ratios and 95% confidence intervals (95%CI). The adjusted analysis was performed using Poisson regression with robust variance. RESULTS Among the 1,127 women participating in the study, 954 (84.6%, 95%CI 82.5-86.7) reported having consulted a physician in the year prior to the interview, 173 (15.4%, 95%CI 13.2-17.5) did not. Women belonging to lower income classes D and E, younger, and smokers had higher prevalences of no medical visits. The participants with hypertension had a higher prevalence of consultations. CONCLUSIONS There was no expected evolution in the local health system, despite the emergence of the policies implemented in this period. It is necessary to provide care for those in less favored socioeconomic conditions and for younger women.

RESUMO OBJETIVO Analisar a prevalência de não consultar com médico no período de um ano. MÉTODOS Estudo transversal de base populacional, incluindo mulheres de 20 a 60 anos, residentes na zona urbana de São Leopoldo, RS, em 2015. A associação entre as variáveis e o desfecho foi avaliada por meio das razões de prevalência e dos intervalos de 95% de confiança (IC95%). A análise ajustada foi realizada por meio da regressão de Poisson com variância robusta. RESULTADOS Entre as 1.127 mulheres participantes do estudo, 954 (84,6%; IC95% 82,5-86,7) referiram consultar com médico no ano anterior à entrevista, 173 (15,4%; IC95% 13,2-17,5) não consultaram. As mulheres inseridas nas classes econômicas D e E, com menor idade, e fumantes apresentaram maiores prevalências de não consulta médica. As participantes com hipertensão arterial tiveram maior prevalência de consultas. CONCLUSÕES Não houve a esperada evolução no sistema local de saúde, apesar do surgimento das políticas implantadas nesse período. É necessário provimento da atenção para os indivíduos em condições socioeconômicas menos favorecidas e para as mulheres mais jovens.