Physical activity levels during COVID-19 pandemic and its associated factors in patients with Chagas disease.

Background: A better understanding of the consequences of the Coronavirus Disease 2019 (COVID-19) pandemic on lifestyle of patients with Chagas disease (ChD) is of paramount importance to facilitate the implementation of intervention strategies tailored to this specific population. Objective: The present study aimed to evaluate the level of physical activity (PA) in Chagas disease (ChD) patients during the Coronavirus Disease 2019 (COVID-19) pandemic and its main associated factors. Methods: This is a cross-sectional study with 187 patients of both sexes, aged ≥18 years, followed in a national infectious disease center (Rio de Janeiro, Brazil). The level of PA was determined by the International Physical Activity Questionnaire short version and expressed in terms of total volume of physical activity (PA) (MET-minutes per week). Individuals were classified as physically active following the 2020 World Health Organization PA guideline. The exposure variables were age, sex, race, marital status, schooling, income per capita, number of rooms per domicile, number of residents per domicile, body mass index, clinical form of ChD, COVID-19 antibodies, comorbidities, self-reported anxiety, self-reported depression, self-reported fear, and self-reported sadness. The association between the exposure variables with total PA (as a continuous variable) was determined using univariate and multivariate linear regression models. Results: Mean age was 61.1 ± 11.6 years. Most (62%) were women and self-declared their race as mixed (50.8%). The percentage of physically active individuals according to was 52%. The variables independently associated with total PA levels were non-white race (Exp ß = 1.39; 95% CI 1.02 to 1.90), dyslipidemia (Exp ß = 0.73; 95% CI 0.56 to 0.95) and self-reported depression during quarantine (Exp ß = 0.71; 95% CI 0.52 to 0.96). Conclusion: Non-white race was positively associated with total levels of PA, while dyslipidemia, and self-reported depression during quarantine were negatively associated with total levels of PA. The identification of associated factors can facilitate the development of tailored strategies to increase PA levels ChD patients.

High-fidelity simulation versus case-based discussion for training undergraduate medical students in pediatric emergencies: a quasi-experimental study

Abstract Objective: To evaluate the effect of high-fidelity simulation of pediatric emergencies compared to case-based discussion on the development of self-confidence, theoretical knowledge, clinical reasoning, communication, attitude, and leadership in undergraduate medical students. Methods: 33 medical students were allocated to two teaching methods: high-fidelity simulation (HFS, n = 18) or case-based discussion (CBD, n = 15). Self-confidence and knowledge tests were applied before and after the interventions and the effect of HFS on both outcomes was estimated with mixed-effect models. An Objective Structured Clinical Examination activity was conducted after the interventions, while two independent raters used specific simulation checklists to assess clinical reasoning, communication, attitude, and leadership. The effect of HFS on these outcomes was estimated with linear and logistic regressions. The effect size was estimated with the Hedge'sg. Results: Both groups had an increase in self-confidence (HFS 59.1 × 93.6, p < 0.001; CDB 50.5 × 88.2, p < 0.001) and knowledge scores over time (HFS 45.1 × 63.2, p = 0.001; CDB 43.5 × 56.7, p-value < 0.01), but no difference was observed between groups (group*time effect in the mixed effect models adjusted for the student ranking) for both tests (p = 0.6565 and p = 0.3331, respectively). The simulation checklist scores of the HFS group were higher than those of the CBD group, with large effect sizes in all domains (Hedges g 1.15 to 2.20). Conclusion: HFS performed better than CBD in developing clinical reasoning, communication, attitude, and leadership in undergraduate medical students in pediatric emergency care, but no significant difference was observed in self-confidence and theoretical knowledge.

Chagas heart disease is associated with decreased physical activity levels: A cross-sectional analysis.

Background: Studies evaluating physical activity (PA) levels in individuals with Chagas disease (CD) are still scarce. The present study aimed to evaluate PA levels in CD individuals and examine their association with Chagas heart disease (ChHD). Methods: We included patients with CD regularly followed in a reference center for treatment of infectious diseases. PA levels were assessed using the short version of the International Physical Activity Questionnaire (IPAQ). ChHD was determined following the Brazilian Consensus on Chagas Disease. The association between ChHD and levels of PA (total, walking, moderate, and vigorous) as a continuous variable was fitted using generalized linear models. Logistic regression models were fitted to evaluate the association between ChHD and meeting WHO's PA recommendations. Results: Among the 361 participants included in the analysis (60.7 ± 10.7 years; 56.2 % women), 58.1 % (n = 210) complied with the WHO's PA recommendations. After adjustments for potential confounders, regression analyses revealed that ChHD without heart failure was significantly associated with reduced vigorous PA (Exp ß 0.32 95 % CI 0.10 to 0.98). ChHD with heart failure had significantly lower levels of total (Exp ß 0.61 95 % CI 0.44 to 0.84) and moderate (Exp ß 0.59 95 % CI 0.39 to 0.89) PA. ChHD with heart failure had a lower odd of meeting the PA recommendation in comparison to those with no cardiac involvement (OR 0.48 95 % CI 0.24 to 0.97). Conclusions: We found low levels of PA among individuals with CD. Presence of ChHD (mainly with HF) was associated with decreased levels of PA.

High-fidelity simulation versus case-based discussion for training undergraduate medical students in pediatric emergencies: a quasi-experimental study.

OBJECTIVE: To evaluate the effect of high-fidelity simulation of pediatric emergencies compared to case-based discussion on the development of self-confidence, theoretical knowledge, clinical reasoning, communication, attitude, and leadership in undergraduate medical students. METHODS: 33 medical students were allocated to two teaching methods: high-fidelity simulation (HFS, n = 18) or case-based discussion (CBD, n = 15). Self-confidence and knowledge tests were applied before and after the interventions and the effect of HFS on both outcomes was estimated with mixed-effect models. An Objective Structured Clinical Examination activity was conducted after the interventions, while two independent raters used specific simulation checklists to assess clinical reasoning, communication, attitude, and leadership. The effect of HFS on these outcomes was estimated with linear and logistic regressions. The effect size was estimated with the Hedge's g. RESULTS: Both groups had an increase in self-confidence (HFS 59.1 × 93.6, p < 0.001; CDB 50.5 × 88.2, p < 0.001) and knowledge scores over time (HFS 45.1 × 63.2, p = 0.001; CDB 43.5 × 56.7, p-value < 0.01), but no difference was observed between groups (group*time effect in the mixed effect models adjusted for the student ranking) for both tests (p = 0.6565 and p = 0.3331, respectively). The simulation checklist scores of the HFS group were higher than those of the CBD group, with large effect sizes in all domains (Hedges g 1.15 to 2.20). CONCLUSION: HFS performed better than CBD in developing clinical reasoning, communication, attitude, and leadership in undergraduate medical students in pediatric emergency care, but no significant difference was observed in self-confidence and theoretical knowledge.

Treatment of childhood obesity based on the reduction of ultra-processed foods plus energy restriction: A randomised controlled trial based on the Brazilian guidelines.

Reducing ultra-processed foods (UPF) improves diet quality and may curb energy consumption. This study aimed to compare an intervention based on the reduction of UPF, according to the Dietary Guideline for the Brazilian Population (DGBP), with and without advice on energy intake. A parallel and randomised controlled trial was carried out with children with obesity from 7 to 12 years old. Both control (CG) and intervention groups (IG) participated monthly in 6 standardised educational activities based on the 10 steps of the DGBP. An individualised food plan was also provided to the IG. The rate of change for body mass index (BMI), waist circumference, body weight, and UPF consumption were investigated based on mixed-effect models. At the end of the study, the BMI declined in the IG (Δ = -0.27 kg/m2) compared to the CG (Δ = + 0.53 kg/m2) (p = .0002). Both groups showed a decline in grams of UPF until the fourth month and a gradual increase in the following months. Combining the qualitative approach of the DGBP with counselling on energy restriction through the diet plan proved to be effective in reducing childhood obesity. Clinical Trial Registration: This trial is registered at the Brazilian Registry of Clinical Trials (REBEC), under the RBR-3st5sn registry, available at http://www.ensaiosclinicos.gov.br/rg/RBR-3st5sn/. The datasets generated by the current study are not publicly available but are available from the corresponding author on reasonable request.

Sleep duration and quality during the COVID-19 pandemic and the association with physical activity and screen time among Brazilian college students.

BACKGROUND: As a result of social isolation during the COVID-19 pandemic, changes in sleep patterns have been observed in many countries, as well as changes in physical activity and screen time. The objective was to investigate sleep duration and quality during the COVID-19 pandemic and its association with physical activity and screen time. METHODS: Cross-sectional study with students from a University in Rio de Janeiro who answered an online questionnaire between August 2020 and March 2021. Physical activity was assessed using IPAQ-SF. Sleep was investigated based on questions about duration and sleep quality change, and screen time through self-reported questions. Multinomial logistic regression was performed to assess the association between physical activity and screen time with sleep duration and quality. Secondary analyses investigated the influence of the isolation time on this association. The confounding factors used were diagnosis of COVID-19, time of isolation, anxiety, depression, skin color, and gender. RESULTS: A total of 771 college students with a mean age of 24.5 years (±8.6) answered the questionnaire. About 75% reported more than 8 h of screen time per day and 49.8% were physically inactive. Regarding sleep, 54.9% had worsening sleep, while 40.6% had inadequate sleep duration during the pandemic. Physical activity was associated with improved sleep quality (Odds ratio (OR) 1.72; confidence interval (95% CI) 1.05-2.97). Also, physically active students who spent more than 14 weeks in social isolation demonstrated improved sleep quality (OR 1.99; 95% CI 1.02-3.78) compared to physically inactive individuals. No association was observed for sleep duration. No association was observed between screen time and sleep quality, or sleep duration. CONCLUSION: During the COVID-19 pandemic, there was considerable worsening of sleep quality, and physical activity was positively associated with improved sleep quality.

Environment modification at school to promote physical activity among adolescents: a cluster randomized controlled trial / Modificação do ambiente para a promoção da atividade física em adolescentes brasileiros: ensaio controlado randomizado em cluster

ABSTRACT: Objective: To assess the effect of modifications of the school environment on physical activity in Brazilian adolescent students. Methods: Seven public schools in Duque de Caxias (Brazil) were randomized into control and intervention groups. The intervention group underwent modifications in the school environment (painting of hopscotch and school courts) and the provision of sports equipment (balls, basketball table, soccer goalpost, volleyball nets, and others) to stimulate physical activity. Additionally, footsteps towards the court and materials were painted, and a superhero character called Super Active was introduced. Total physical activity was measured using a validated questionnaire for adolescents. Generalized linear models were used to evaluate the effect of the intervention, adjusted by sex. Results: The sample consisted of 975 adolescents, with a mean age of 11.52 years (standard deviation — SD 1.43), and 56.7% were boys. After the one-month intervention, both groups' total physical activity time increased. The estimated changes from baseline were not different between the intervention and control groups (Δ=102.75 and Δ=99.76, respectively; p=0.52). Conclusion: The painting, supply of equipment and other strategies to encourage physical activity in the school environment did not promote a positive effect on improving physical activity among adolescents. Future research is necessary to evaluate the effect of the intervention in the long-term period, particularly in other population contexts in middle-income countries.

RESUMO: Objetivo: Avaliar o efeito da modificação do ambiente escolar sobre a atividade física em estudantes adolescentes brasileiros. Métodos: Sete escolas públicas em Duque de Caxias (Brasil) foram aleatorizadas em grupos controle e intervenção. O grupo de intervenção sofreu modificações no ambiente escolar (pintura de quadra esportiva e amarelinhas) e no fornecimento de equipamento esportivo (bolas, tabela de basquete, gol, rede para vôlei e outros) para estimular a atividade física. Além disso, foram pintados passos em direção à quadra e materiais, e foi introduzida uma personagem de super-herói chamada Super Ativa. A atividade física total foi medida com o uso de um questionário validado para adolescentes. Foram utilizados modelos lineares generalizados para avaliar o efeito da intervenção, ajustados por sexo. Resultados: A amostra consistiu em 975 adolescentes, com idade média de 11,52 anos (desvio padrão — DP 1,43) e 56,7% eram meninos. Após a intervenção de um mês, o tempo total de atividade física aumentou em ambos os grupos. Contudo, as mudanças estimadas em relação à linha de base não foram diferentes entre os grupos de intervenção e controle (Δ=102,75 e Δ=99,76, respectivamente; p=0,52). Conclusão: A pintura, o fornecimento de equipamentos e as demais estratégias de estímulo à prática de atividade física no ambiente escolar não promoveram efeito positivo na melhoria da atividade física entre os adolescentes. São necessários estudos futuros para avaliar o efeito da intervenção em longo prazo, particularmente em outros contextos populacionais, em países de média renda.

High discrepancies in the mortality of hospitalized patients with COVID-19 in the two most economically important states in Brazil / Alta discrepância na mortalidade de pacientes hospitalizados por COVID-19 nos dois estados economicamente mais importantes do Brasil

ABSTRACT: Objective: The aim of this study was to compare the proportion of deaths among hospitalized cases of COVID-19 in São Paulo and Rio de Janeiro, stratified by private and public services. Methods: Hospitalization data for severe acute respiratory syndrome (SARS) were obtained using the SIVEP-Gripe Database. All hospitalized adults who were diagnosed as COVID-19 or unspecified SARS, between January and December 2020, were included in the analysis. Logistic regression models were fitted to evaluate the risk of death between Rio de Janeiro and São Paulo, adjusted for age, sex, and comorbidities. Results: A total of 388,657 hospital registers for Rio de Janeiro and São Paulo (91,532 and 297,125, respectively) were analyzed. Missing data are frequent in the database and it was greater in Rio de Janeiro, at the state and capital levels. Adjusting for confounders, the odds ratio of dying by COVID-19, comparing the state of Rio de Janeiro with São Paulo, was 2.51 in the private hospitals and 2.29 in the public ones. For the capitals, the scenario is worse. The lethality among hospitalized patients with COVID-19 is at least twice in Rio de Janeiro than São Paulo, both at the states and capitals. The public or private services showed important differences, with odds ratios of 2.74 and 3.46, respectively. Conclusion: It appears that the worst governance in the health sector in Rio de Janeiro, more than lack of resources, explains the excess mortality of hospitalized COVID-19 patients in Rio de Janeiro.

RESUMO: Objetivo: Comparar a proporção de óbitos entre os casos de COVID-19 hospitalizados em São Paulo e Rio de Janeiro, estratificados por serviços públicos e privados. Métodos: Os dados de hospitalização por Síndrome Respiratória Aguda Grave (SRAG) foram obtidos do banco de dados SIVEP-Gripe. Todos os adultos hospitalizados com diagnóstico de COVID-19 ou SRAG não especificado, entre janeiro e dezembro de 2020, foram incluídos na análise. Modelos de regressão logística foram usados para avaliar o risco de morte entre Rio de Janeiro e São Paulo, ajustados para idade, sexo e comorbidades. Resultados: Foram analisados 388.657 registros hospitalares do Rio de Janeiro e de São Paulo (91.532 e 297.125, respectivamente). Os dados faltantes no banco são frequentes e maiores no Rio de Janeiro (estado e capital). Ajustando para fatores de confusão, a razão de chance de morrer por COVID-19, comparando o estado do Rio de Janeiro com o de São Paulo, foi de 2,51 nos hospitais privados e de 2,29 nos públicos. Para as capitais, o cenário é pior. A letalidade entre pacientes internados com COVID-19 no Rio de Janeiro é pelo menos o dobro da de São Paulo, tanto para os estados quanto para as capitais. Os serviços públicos ou privados apresentaram diferenças importantes, com razão de chance de 2,74 e 3,46, respetivamente. Conclusão: Parece que a pior governança do setor da saúde no Rio de Janeiro, mais do que a falta de recursos, explica o excesso de mortalidade de pacientes internados com COVID-19 no Rio de Janeiro.

Efeito compensatório do exercício físico nas atividades físicas diárias e no consumo alimentar em jovens adultos com excesso de peso: um ensaio controlado randomizado / Compensatory effect of exercise on daily physical activity and energy intake in young adults with overweight: a randomised controlled trial

O efeito compensatório do exercício físico nas atividades físicas espontâneas e no consumo alimentar tem sido apontado como uma possível explicação para os resultados negativos ou abaixo do esperado na variação do peso corporal. Além disso, o efeito da intensidade do exercício físico no efeito compensatório ainda foi pouco estudado. Portanto, o objetivo deste estudo é avaliar o efeito de diferentes intensidades do exercício físico no volume de atividades físicas em homens com excesso de peso. Os indivíduos (n= 72; média ± DP, idade 21.4 ± 1.68 anos, IMC 27.9 ± 2.13 kg/m2) foram randomizados em três grupos experimentais: grupo de exercício moderado (GEM); grupo de exercício vigoroso (GEV); e grupo controle (GC). Durante 2 semanas, os grupos GEM e GEV realizaram 3 sessões de exercício físico por semana, com duração de 60 minutos por sessão, em intensidade moderada (40 a 59%VO2R) ou vigorosa (60 a 89%VO2R). O volume de atividades físicas foi avaliado através de acelerômetros triaxiais (ActiGraph GT3x-BT) durante 13 dias. O consumo alimentar foi avaliado através de recordatório alimentar de 24h durante 4 dias e a fome/saciedade através da Escala Visual Analógica. Análises por intenção de tratamento foram realizadas utilizando modelos lineares de efeitos mistos no SAS. Após 13 dias de seguimento, GEM e GEV apresentaram compensação no volume de atividades físicas, quando comparados ao GC (GEM vs. GC e GEV vs. GC; p=0.01). Não houve diferença na taxa de variação entre GEM e GEV (p=0.97). Com relação ao consumo alimentar, a taxa de variação não foi diferente entre os grupos (p=0.18), entretanto, o GEM apresentou maior consumo energético durante esse período quando comparado ao grupo controle (ß = 491 kcal; p = 0.01) e ao grupo vigoroso (ß = 319 kcal; p = 0.07). As taxas de variação da fome e da saciedade não foram diferentes entre os grupos durante o período da intervenção (p=0.92 e p=0.52, respectivamente). Com base nesses resultados, GEV apresentou maior redução do peso corporal quando comparado ao GEM (p=0.03) e ao GC (p=0.07). Sessões de 60 minutos de exercícios físicos aeróbios, realizadas três vezes por semana, promoveram um efeito compensatório no volume total de atividades físicas ao longo das duas semanas da intervenção, independentemente da intensidade do exercício realizado. Apesar do efeito compensatório em ambos os grupos de exercício, GEV apresentou maior redução do peso corporal.

The compensatory effect of physical exercise on spontaneous physical activity and food intake has been pointed out as a possible explanation for the negative or lower than expected results in body weight variation. Also, the effect of exercise intensity on the compensatory effect has not been well studied. Therefore, this study aims to evaluate the effect of different intensities of physical exercise on the total volume of physical activity in men with overweight. Subjects (n = 72; mean ± SD, age 21.4 ± 1.68 years, BMI 27.9 ± 2.13 kg / m2) were randomized into three experimental groups: moderate exercise group (GEM); vigorous exercise group (GEV); and control group (CG). For 2 weeks, the GEM and GEV groups performed 3 exercise sessions per week, lasting 60 minutes per session, at moderate (40 to 59% VO2R) or vigorous (60 to 89% VO2R) intensity. The volume of physical activity was assessed by triaxial accelerometers (ActiGraph GT3x-BT) for 13 days. Food intake was assessed through 24-hour food recall for 4 days and hunger/satiety through the Visual Analog Scale. Intent-to-treat analyses were performed using linear mixed-effects models in SAS. After 13 days of follow-up, GEM and GEV showed compensation in the volume of physical activity when compared to CG (GEM vs. GC and GEV vs. GC; p = 0.01). There was no difference in the rate of change between GEM and GEV (p = 0.97). Regarding food consumption, the variation rate was not different between groups (p = 0.18), however, GEM presented higher energy consumption during this period when compared to the control group (ß = 491 kcal; p = 0.01) and to vigorous group (ß = 319 kcal; p = 0.07). The rates of change in hunger and satiety were not different between groups during the intervention period (p = 0.92 and p = 0.52, respectively). Based on these results, GEV showed greater reduction in body weight when compared to GEM (p = 0.03) and CG (p = 0.07). 60-minute sessions of aerobic exercise performed three times a week promoted a compensatory effect on the total volume of physical activity over the two weeks of intervention, regardless of the intensity of the exercise performed. Despite the compensatory effect in both exercise groups, GEV showed the greatest reduction in body weight.