Home-based gait speed and the association with sociodemographic and anthropometric variables: A national study (ELSI-Brazil).

OBJECTIVES: To investigate home-based gait speed performance for men and women stratified by age group and its associations with sociodemographic and anthropometric variables. METHODS: Data from the 2nd wave of the Brazilian Longitudinal Study of Aging (ELSI-Brazil, 2019-2021) were used. Gait speed was tested twice at home over 3.0 meters at usual pace. Associations of sociodemographic and anthropometric variables with gait speed were evaluated using gamma regression. RESULTS: Median gait speed value reduced with increasing age in both sexes [men: 0.70 m/s (50-59 years) to 0.53 m/s (≥80 years); women: 0.68 m/s (50-59 years) to 0.48 m/s (≥80 years)] and was significantly lower in women than men in the age groups of 60-69 and 70-79 years. Age group and education among men and age group, education, and waist circumference among women were significantly associated with gait speed. CONCLUSIONS: Our findings may be helpful as reference values to identify mobility limitation among older Brazilians.

Loneliness and social disconnectedness in the time of pandemic period among Brazilians: evidence from the ELSI COVID-19 initiative.

Objectives: This study aimed at estimating the pre-pandemic and pandemic prevalence of loneliness and investigating the association of loneliness with social disconnectedness during social distancing strategies in the time of the COVID-19 pandemic period.Methods: We used data from the ELSI COVID-19 initiative with participants from the Brazilian Longitudinal Study of Aging (ELSI-Brazil), which comprised 4,431 participants aged 50 years and over. Loneliness (hardly ever/some of the time/often) was assessed by the question "In the past 30 days, how often did you feel alone/lonely?". Social disconnectedness included information on social contacts through virtual talking (i.e. telephone, Skype, WhatsApp, or social media) and outside-home meetings with people living in another household. Covariates included sociodemographic and health related characteristics. Multinomial logistic regression models were used to estimate odds ratios (OR) with their 95% confidence interval (CI).Results: The overall prevalence of loneliness during the pandemic was 23.9% (95% CI 20.7-27.5); lower than in the pre-pandemic period (32.8%; 95% CI 28.6-37.4). In the pandemic period, 20.1% (95% CI 16.9-23.6) reported some of the time feeling lonely and 3.9% (95% CI 3.1-4.8) reported often feeling lonely. In the fully adjusted model, virtual talking disconnectedness (OR=1.67; 95% CI 1.09-2.56) was positively associated with some of the time feeling lonely and outside-home disconnectedness (OR=0.33; 95% CI 0.18-0.60) was negatively associated with often feeling lonely.Conclusion: Individuals with virtual talking disconnectedness and without outside-home disconnectedness are at higher risk of loneliness during the time of COVID-19 pandemic. Stimulating virtual talking connectedness might have the potential to diminish loneliness despite steep outside-home disconnectedness.

Perceived neighborhood and fall history among community-dwelling older adults living in a large Brazilian urban area: a multilevel approach.

Few studies have examined the neighborhood features related to falls in the older population in low-and-middle-income countries, including Brazil. This study aimed to evaluate if perceived neighborhood features are related to falls among older Brazilian adults living in a large urban area. This cross-sectional study was conducted using data from 834 participants (≥60 years) from a multistage household survey in Belo Horizonte, Brazil. The association between fall history in the previous year and perceived neighborhood features (quality of services, physical and social disorder, and safety) was examined using multilevel logistic regression. The fall prevalence was 13.6%. Older adults living in neighborhoods with a higher physical disorder were more likely to report fall in the previous year, even after controlling for demographic, clinical and social variables (OR = 2.59; 95% CI = 1.14-5.87). The other neighborhood features investigated were not associated with a fall history. Our findings suggest that improving the physical environment represents an important strategy to prevent falls in the Brazilian urban older population.

Perceived Neighborhood and Walking Among Older Brazilian Adults Living in Urban Areas: A National Study (ELSI-Brazil).

The study goal was to examine the association between perceived neighborhood characteristics and walking in urban older adults in Brazil. A cross-sectional study including 4,027 older adults from the baseline of the Brazilian Longitudinal Study of Aging (ELSI-Brazil) was performed. Walking was measured using the International Physical Activity Questionnaire. Neighborhood characteristics were questions about physical disorder, noise pollution, safety, violence, social cohesion, services, concerns with community mobility, and pleasantness. Multinomial logistic regression was used. Concern about taking the bus, subway, or train was inversely associated with walking for men. Violence (victim of theft, robbery, or had home broken into) and social cohesion (trust in neighbors) were positively and inversely associated with walking for women, respectively. A significant interaction term between social cohesion and number of chronic diseases was observed for women. These findings demonstrate the need for sex-specific interventions and policies to increase the walking levels among older Brazilian adults.

Perceived discrimination among older adults living in urban and rural areas in Brazil: a national study (ELSI-Brazil).

BACKGROUND: Research on discrimination and health focused on older adults has been scarce, comparatively with younger and middle-aged adults. Considering where people live matters, accurate measures of perceived discrimination might consider how the place of residence interferes on discriminatory experiences. This study aimed to assess the association between perceived discrimination and urban/rural place of residence among a representative sample of older adults in Brazil. METHODS: Data came from the baseline of the Brazilian Longitudinal Study of Aging (ELSI-Brazil), conducted in 2015/2016, with individuals aged 50 years and older. Perceived Discrimination was measured by means of the following question: "In the past 12 months have you felt a victim of any type of discrimination" with five possible answers: (1)"when you sought medical services or health care?", (2)"in social gatherings?", (3)"in the work place?", (4)"within the family?", (5)"due to where you live?". Participants who answered yes for any of the five domains were coded as having reported an experience of discrimination. The main exposure variable was the urban-rural classification of the households, carried out according to the methods employed by the Brazilian Institute of Geography and Statistics during the 2010 Population Census. Other covariates included: age, sex, skin color, household wealth and education. Multiple Poisson regression was used to estimate prevalence ratios and their respective 95% confidence interval for the association between discrimination and independent variables. RESULTS: Prevalence of any perceived discrimination among Brazilian older adults was 16.8%. Regardless the place of residence (either urban or rural), participants reported health care settings as the most common domain where discriminatory experiences occurred and the work place as the least common. According to the adjusted model, perceived discrimination was significantly higher among urban dwellers when compared to their rural counterparts, independent of sociodemographic characteristics, health status and neighborhood social environment. The outcome was significant associated with skin color, education and health status. CONCLUSIONS: Urban environment plays a core role in perceived discrimination and health care settings constitute the most common domain where discriminatory experiences occurred. Our findings may contribute to fulfill the knowledge gap on discrimination among older adults living in developing countries.

Age at natural menopause and its associated characteristics among Brazilian women: cross-sectional results from ELSI-Brazil.

OBJECTIVES: This study aimed to determine the median age at natural menopause and analyze lifestyle, anthropometric, and dietary characteristics associated with the age at natural menopause among Brazilian women. METHODS: This cross-sectional study involved 2,731 women 50 years and over, drawn from the baseline of the Brazilian Longitudinal Study of Aging (ELSI-Brazil, 2015/16). Nonparametric Kaplan-Meier cumulative survivorship estimates were used to assess the median timing of natural menopause. Cox proportional hazards regression models were employed to estimate the associations between age at natural menopause and exposure variables. RESULTS: The overall median age at natural menopause was 50 years. In the adjusted Cox model, current smoking (hazard ratio [HR], 1.11; 95% CI, 1.01-1.23) and underweight (HR, 1.34; 95% CI, 1.12-1.61) were associated with earlier natural menopause. Conversely, performing recommended levels of physical activity in the last week (HR, 0.88; 95% CI, 0.80-0.97), being overweight (HR 0.86; 95% CI, 0.74-0.99), and adhering to two or three healthy eating markers (HR, 0.80; 95% CI, 0.66-0.97; HR, 0.76; 95% CI, 0.61-0.94, respectively) were associated with later age at natural menopause. Binge drinking and waist circumference were not associated with age at natural menopause. CONCLUSIONS: Lifestyle, anthropometric, and dietary characteristics are significant factors that affect the age at natural menopause. Our findings can contribute to public policies targeted at Brazilian women's health.

[Discrimination perceived by elderly adults in the use of health services: an integrative review]. / Discriminação percebida por adultos mais velhos no uso de serviços de saúde: uma revisão integrativa.

This paper analyzes the current evidence on discrimination perceived by elderly adults (> 50 years) in the use of health services and identifies factors associated with this discriminatory experience. It involved an integrative literature review, carried out on the Biblioteca Virtual de Saúde, CINAHL, Medline, Scopus, and Web of Science search websites, in June/2021. The key words used were social discrimination or ageism; middle-aged, or aged 80 and over or elderly; health services or health services for the elderly, including synonyms, in Portuguese, English, and Spanish. The search strategy identified 1,165 articles; 19 met the eligibility and inclusion criteria and were included in this integrative review. They comprise quantitative and qualitative studies published between 2002 and 2021; about 60% carried out in the United States and Australia. The prevalence of discrimination in the use of health services ranged from 2% to 42%. The report of discriminatory practices was associated with ethnic-racial characteristics, sex, age, sexual orientation, physical appearance, and social class. By giving visibility to the theme, this work aims to stimulate the definition of concrete ways to tackle discrimination, in an attempt to interrupt the perpetration of inequities in the health care area.

Este trabalho analisa as evidências atuais sobre a discriminação percebida por adultos mais velhos (> 50 anos) no uso de serviços de saúde e identifica os fatores associados a essa experiência. Trata-se de uma revisão integrativa da literatura, realizada a partir de pesquisa nos sítios eletrônicos Biblioteca Virtual de Saúde, CINAHL, Medline, Scopus e Web of Science, em junho de 2021. Foram utilizados os descritores: discriminação social ou ageismo; pessoa de meia-idade ou idoso de 80 anos ou mais ou idoso; e serviço de saúde ou serviço de saúde para idosos, incluindo sinônimos, nos idiomas português, inglês e espanhol. A estratégia de busca identificou 1.165 artigos; 19 cumpriram os critérios de elegibilidade e inclusão. O acervo inclui estudos quantitativos e qualitativos publicados entre 2002 e 2021; cerca de 60% realizados nos Estados Unidos e Austrália. A prevalência de discriminação no uso de serviços de saúde variou de 2% a 42%. O relato de práticas discriminatórias se mostrou associado a características étnico-raciais, sexo, idade, orientação sexual, aparência física e classe social. Ao dar visibilidade ao tema, este trabalho visa estimular a definição de formas concretas de enfrentamento à discriminação e interromper a perpetração de iniquidades no âmbito da atenção à saúde.

Differences in determinants of active aging between older Brazilian and English adults: ELSI-Brazil and ELSA.

This study aimed to investigate differences in determinants of active aging between older Brazilian and English adults and to verify the association of behavioral, personal, and social determinants with physical health. This cross-sectional study was based on the ELSI-Brazil (2015-2016) and ELSA (2016-2017) cohorts. Active aging determinants included behavior (smoking, sedentary lifestyle, and poor sleep quality), personal (cognitive function and life satisfaction), and social determinants (education, loneliness, and volunteering), according to the World Health Organization. Physical health included activities limitation and multimorbidity. We estimated age- and sex-adjusted prevalence for each indicator and mean score, and used the negative binomial regression for statistical analysis. We included 16,642 participants, 9,409 from Brazil and 7,233 from England. Overall, all active aging determinants were worse in Brazil than in England, except for life satisfaction (no difference). The most remarkable difference was found for social determinants score in Brazil (mean difference of 0.18; p < 0.05), mainly due to a significantly lower education level in Brazil (70.6%; 95% confidence interval - 95%CI: 69.7-71.5) than England (37.1%; 95%CI: 35.1-39.1). All determinants (behavioral, personal, and social) were associated with health in Brazil and in England. However, the behavioral domain was stronger associated with health in England (coefficient = 2.76; 95%CI: 2.46-3.10) than in Brazil (coefficient = 1.38; 95%CI: 1.26-1.50; p < 0.001). Older English adults beneficiate more from healthier behaviors than Brazilians, which depend more on social policies.

A decreased trajectory of loneliness among Brazilians aged 50 years and older during the COVID-19 pandemic: ELSI-Brazil.

This study aimed to estimate prevalence of loneliness among older Brazilian adults over the first seven months of the COVID-19 pandemic and to identify the predictors of loneliness trajectories. Pre-pandemic data derived from face-to-face interviews of participants of the 2019-2020 Brazilian Longitudinal Study of Aging (ELSI-Brazil), which is a nationally representative study of community-dwelling individuals aged 50 years and over. Pandemic data were based on three rounds of telephone interviews among those participants, conducted from May to October 2020. Loneliness was measured by a single-item question, considering those who had at least two repeated measures. Explanatory variables included depression, living alone, leaving home in the last week, and virtual connectedness in the last month. Mixed-effects logistic regression was used to estimate odds ratios with their 95% confidence intervals (95%CI) and to investigate loneliness trajectories and their predictors. In total, 5,108 participants were included. The overall prevalence of loneliness in the pre-pandemic period was 33.1% (95%CI: 29.4-36.8), higher than the pandemic period (round 1: 23.6%, 95%CI: 20.6-26.9; round 2: 20.5%, 95%CI: 17.8-23.5; round 3: 20.6%, 95%CI: 17.1-24.6). A significant interaction (p ≤ 0.05) was evidenced only between depression and time; participants with depression showed a greater reduction in loneliness levels. Although loneliness levels in Brazil have decreased during the pandemic, this pattern is not present for all older adults. Individuals with depression had a more significant reduction, probably due to feeling closer to their social network members during the stay-at-home recommendations.

From wet nurses to orphaned mothers: reflections on the right to maternity in Brazil. / Das amas de leite às mães órfãs: reflexões sobre o direito à maternidade no Brasil.

This article addresses the compulsory seizing of children from vulnerable women in Brazil. Its objectives were: to discuss the violation of the right to maternity; to present the imposed restrictions especially on poor, black and indigenous women; the strategic control over their lives and children, and the resistance movements that oppose segregation. The sources of the research were: narratives of women in vulnerable situations, family members and health workers; interviews with strategic actors; document analysis; field journal. It became evident that vulnerabilities -linked to the criminalization of poverty and racial prejudice- have justified these separations. The lack of responsibility that State and society practice towards the support network for women, the devaluation of non-hegemonic productions of maternity, and the reinforcement of a 'reason of the world', that produces violence as a tool for exclusion establishing practical limits on the right to maternity. Women and children are disregarded in their singularities. Resistance movements have shown that intersectoral dialogues are an alternative to overcome discrimination and vulnerabilities.

O artigo aborda a retirada compulsória de filhos de mulheres em situação de vulnerabilidade no Brasil. Objetivou-se refletir sobre a violação do direito à maternidade; apresentar os limites impostos, especialmente às mulheres pobres, negras e indígenas e as estratégias de controle sobre sua vida e de seus filhos; e os movimentos de resistência que se contrapõem às segregações. Foram fontes da pesquisa: narrativas de mulheres em situação de vulnerabilidade, de familiares e trabalhadores da saúde; entrevistas com atores estratégicos; análise documental; diários de campo. Evidenciou-se que vulnerabilidades atreladas à criminalização da pobreza e ao preconceito racial têm justificado as separações. A desresponsabilização do Estado e da sociedade quanto à formação de uma rede de apoio às mulheres, a desvalorização de produções não hegemônicas de maternidades e o reforço de uma razão de mundo que produz a violência como ferramenta para exclusão vão conformando limites práticos quanto ao direito à maternidade. Mulheres e seus filhos são desconsiderados em suas singularidades. Os movimentos de resistência mostraram que diálogos intersetoriais são uma alternativa para superar discriminações e vulnerabilidades.

Relationship between work before the epidemic and having gone out to work during the epidemic among participants in the Brazilian Longitudinal Study of Aging: results of the ELSI-COVID-19 initiative. / Relação entre trabalho antes da epidemia e ter saído para trabalhar durante esse período entre participantes do Estudo Longitudinal da Saúde dos Idosos Brasileiros: resultados da iniciativa ELSI-COVID-19.

The objective of this study was to examine the prevalence of going out to work during the COVID-19 epidemic, and the factors associated with this, among adults aged 50 years and over who were in paid employment before its onset. We used data from the second wave of the Brazilian Longitudinal Study of Aging (ELSI-Brazil), conducted through face-to-face interviews between August 2019 and March 2020 (before the onset of the epidemic), in a representative national sample of adults aged 50 and over, and data obtained through telephone interviews carried out among the same participants (ELSI-COVID-19 initiative), conducted between May 26 and June 8, 2020 (during the epidemic). The analyses were based on odds ratios (OR) estimated by logistic regression. The participants' mean age was 59.9 years (SD = 6.5). The prevalence of going out to work in the previous seven days was 38.4% (95%CI: 31.3-46.1), 50.2% among men and 25.1% among women (formal work, self-employment, and informal work). The results showed that among men, the likelihood of going out to work was lower among those aged 60 to 69 years compared to those aged 50 to 59 years (OR = 0.27; 95%CI: 0.15-0.48). Among women, the likelihood was lower among those who were self-employed (OR = 0.28; 95%CI: 0.12-0.64) or in informal employment before the epidemic (OR = 0.25; 95%CI: 0.09-0.69), compared to those in formal employment. One of the hypotheses to explain this association is that women in informal employment were more likely to be dismissed, and that self-employed women have stopped working during the epidemic.

O objetivo do estudo foi examinar a prevalência e fatores associados a ter saído para trabalhar durante a epidemia da COVID-19, entre adultos com 50 anos ou mais que exerciam trabalho remunerado antes do seu início. Foram utilizados dados da segunda onda do Estudo Longitudinal da Saúde dos Idosos Brasileiros (ELSI-Brasil), conduzida por meio de entrevista face a face, entre agosto de 2019 e março de 2020 (antes do início da epidemia), em amostra nacional representativa de adultos com 50 anos ou mais, e dados obtidos por meio de entrevistas telefônicas realizadas entre esses participantes (iniciativa ELSI-COVID-19), conduzidas entre 26 de maio e 8 de junho de 2020 (durante a epidemia). As análises foram baseadas nas odds ratios (OR) estimadas pela regressão logística. A média de idade dos participantes foi 59,9 anos (DP = 6,5). A prevalência de ter saído para trabalhar nos sete dias anteriores foi de 38,4% (IC95%: 31,3-46,1), 50,2% entre os homens e 25,1% entre as mulheres (trabalho formal, por conta própria e informal). Os resultados mostraram que, entre os homens, a chance de ter saído para trabalhar foi menor entre aqueles de 60 a 69 anos em comparação com aqueles de 50 a 59 anos (OR = 0,27; IC95%: 0,15-0,48). Entre as mulheres, a probabilidade de ter saído para trabalhar foi menor entre aquelas que trabalhavam por conta própria (OR = 0,28; IC95%: 0,12-0,64) ou tinham vínculo informal de trabalho antes da epidemia (OR = 0,25; IC95%: 0,09-0,69), em comparação àquelas com vínculo formal de trabalho. Uma das hipóteses para explicar essa associação é que as mulheres com vínculo informal tenham sido dispensadas e aquelas que trabalhavam por conta própria tenham deixado de trabalhar durante a epidemia.

El objetivo del estudio fue examinar la prevalencia y factores asociados a haber salido para trabajar durante la epidemia de la COVID-19, entre adultos con 50 años o más, que ejercían trabajo remunerado antes del inicio de la misma. Se utilizaron datos de la segunda fase del Estudio Brasileño Longitudinal del Envejecimiento (ELSI-Brasil), llevada a cabo mediante una entrevista cara a cara, entre agosto de 2019 y marzo de 2020 (antes del inicio de la epidemia), en una muestra nacional representativa de adultos con 50 años o más, y datos obtenidos por medio de entrevistas telefónicas realizadas entre estos participantes (iniciativa ELSI-COVID-19), realizadas entre el 26 de mayo y 8 de junio de 2020 (durante la epidemia). Los análisis se basaron en las odds ratios (OR) estimadas por regresión logística. La media de edad de los participantes fue 59,9 años (DP = 6,5). La prevalencia de haber salido para trabajar durante los siete días anteriores fue de un 38,4% (IC95%: 31,3-46,1), 50,2% entre hombres y un 25,1% entre las mujeres (trabajo formal, por cuenta propia e informal). Los resultados mostraron que, entre los hombres, la oportunidad de haber salido a trabajar fue menor entre aquellos con edades comprendidas entre los 60 a 69 años, en comparación con aquellos de 50 a 59 años (OR = 0,27; IC95%: 0,15-0,48). Entre las mujeres, la probabilidad de haber salido a trabajar fue menor entre aquellas que trabajaban por cuenta propia (OR = 0,28; IC95%: 0,12-0,64) o tenían un vínculo laboral informal antes de la epidemia (OR = 0,25; IC95%: 0,09-0,69), en comparación con aquellas con un vínculo laboral formal. Una de las hipótesis para explicar esta asociación es que las mujeres con un vínculo informal fueron dispensadas del servicio y aquellas que trabajaban por cuenta propia hayan dejado de trabajar durante la epidemia.

Discriminação percebida por adultos mais velhos no uso de serviços de saúde: uma revisão integrativa / Discrimination perceived by elderly adults in the use of health services: an integrative review

Resumo Este trabalho analisa as evidências atuais sobre a discriminação percebida por adultos mais velhos (> 50 anos) no uso de serviços de saúde e identifica os fatores associados a essa experiência. Trata-se de uma revisão integrativa da literatura, realizada a partir de pesquisa nos sítios eletrônicos Biblioteca Virtual de Saúde, CINAHL, Medline, Scopus e Web of Science, em junho de 2021. Foram utilizados os descritores: discriminação social ou ageismo; pessoa de meia-idade ou idoso de 80 anos ou mais ou idoso; e serviço de saúde ou serviço de saúde para idosos, incluindo sinônimos, nos idiomas português, inglês e espanhol. A estratégia de busca identificou 1.165 artigos; 19 cumpriram os critérios de elegibilidade e inclusão. O acervo inclui estudos quantitativos e qualitativos publicados entre 2002 e 2021; cerca de 60% realizados nos Estados Unidos e Austrália. A prevalência de discriminação no uso de serviços de saúde variou de 2% a 42%. O relato de práticas discriminatórias se mostrou associado a características étnico-raciais, sexo, idade, orientação sexual, aparência física e classe social. Ao dar visibilidade ao tema, este trabalho visa estimular a definição de formas concretas de enfrentamento à discriminação e interromper a perpetração de iniquidades no âmbito da atenção à saúde.

Abstract This paper analyzes the current evidence on discrimination perceived by elderly adults (> 50 years) in the use of health services and identifies factors associated with this discriminatory experience. It involved an integrative literature review, carried out on the Biblioteca Virtual de Saúde, CINAHL, Medline, Scopus, and Web of Science search websites, in June/2021. The key words used were social discrimination or ageism; middle-aged, or aged 80 and over or elderly; health services or health services for the elderly, including synonyms, in Portuguese, English, and Spanish. The search strategy identified 1,165 articles; 19 met the eligibility and inclusion criteria and were included in this integrative review. They comprise quantitative and qualitative studies published between 2002 and 2021; about 60% carried out in the United States and Australia. The prevalence of discrimination in the use of health services ranged from 2% to 42%. The report of discriminatory practices was associated with ethnic-racial characteristics, sex, age, sexual orientation, physical appearance, and social class. By giving visibility to the theme, this work aims to stimulate the definition of concrete ways to tackle discrimination, in an attempt to interrupt the perpetration of inequities in the health care area.

Differences in determinants of active aging between older Brazilian and English adults: ELSI-Brazil and ELSA / Diferenças nos determinantes do envelhecimento ativo entre idosos brasileiros e ingleses: ELSI-Brasil e ELSA / Diferencias en los determinantes del envejecimiento activo entre personas mayores brasileñas e inglesas: ELSI-Brasil y ELSA

Abstract: This study aimed to investigate differences in determinants of active aging between older Brazilian and English adults and to verify the association of behavioral, personal, and social determinants with physical health. This cross-sectional study was based on the ELSI-Brazil (2015-2016) and ELSA (2016-2017) cohorts. Active aging determinants included behavior (smoking, sedentary lifestyle, and poor sleep quality), personal (cognitive function and life satisfaction), and social determinants (education, loneliness, and volunteering), according to the World Health Organization. Physical health included activities limitation and multimorbidity. We estimated age- and sex-adjusted prevalence for each indicator and mean score, and used the negative binomial regression for statistical analysis. We included 16,642 participants, 9,409 from Brazil and 7,233 from England. Overall, all active aging determinants were worse in Brazil than in England, except for life satisfaction (no difference). The most remarkable difference was found for social determinants score in Brazil (mean difference of 0.18; p < 0.05), mainly due to a significantly lower education level in Brazil (70.6%; 95% confidence interval - 95%CI: 69.7-71.5) than England (37.1%; 95%CI: 35.1-39.1). All determinants (behavioral, personal, and social) were associated with health in Brazil and in England. However, the behavioral domain was stronger associated with health in England (coefficient = 2.76; 95%CI: 2.46-3.10) than in Brazil (coefficient = 1.38; 95%CI: 1.26-1.50; p < 0.001). Older English adults beneficiate more from healthier behaviors than Brazilians, which depend more on social policies.

Resumo: Este estudo transversal objetivou investigar as diferenças nos determinantes do envelhecimento ativo entre idosos brasileiros e ingleses, e verificar a associação de determinantes comportamentais, pessoais e sociais com a saúde física. A pesquisa baseou-se nas coortes ELSI-Brasil (2015-2016) e ELSA (2016-2017). Os determinantes do envelhecimento ativo incluíram os determinantes comportamentais (tabagismo, sedentarismo e má qualidade do sono), pessoais (função cognitiva e satisfação com a vida) e sociais (educação, solidão e voluntariado), de acordo com a Organização Mundial da Saúde. A saúde física incluiu limitação de atividades e multimorbidade. Prevalências ajustadas por idade e sexo foram calculadas para cada indicador e escores médios, utilizando-se a regressão binomial negativa para a análise estatística. A pesquisa incluiu 16.642 participantes, sendo 9.409 do Brasil e 7.233 da Inglaterra. No geral, todos os determinantes do envelhecimento ativo foram piores no Brasil do que na Inglaterra, exceto a satisfação com a vida (sem diferença). A diferença mais marcante refere-se ao escore de determinantes sociais no Brasil (diferença média de 0,18; p < 0,05), principalmente devido à escolaridade significativamente menor no Brasil (70,6%; intervalo de 95% de confiança - IC95%: 69,7-71,5) do que na Inglaterra (37,1%; IC95%: 35,1-39,1). Todos os determinantes (comportamentais, pessoais e sociais) estiveram associados à saúde no Brasil e na Inglaterra. No entanto, o domínio comportamental foi mais fortemente associado à saúde na Inglaterra (coeficiente = 2,76; IC95%: 2,46-3,10) do que no Brasil (coeficiente = 1,38; IC95%: 1,26-1,50) (p < 0,001). Idosos ingleses se beneficiam mais de comportamentos mais saudáveis do que os brasileiros, que dependem mais de políticas sociais.

Resumen: Este estudio transversal tuvo como objetivo investigar las diferencias en los determinantes del envejecimiento activo entre personas mayores brasileñas e inglesas, y verificar la asociación de determinantes conductuales, personales y sociales con la salud física. La investigación se basó en las cohortes ELSI-Brasil (2015-2016) y ELSA (2016-2017). Los determinantes del envejecimiento activo incluyeron determinantes conductuales (tabaquismo, sedentarismo y mala calidad del sueño), personales (función cognitiva y satisfacción con la vida) y sociales (educación, soledad y voluntariado), según la Organización Mundial de la Salud. La salud física incluyó la limitación de actividades y la multimorbilidad. Se calcularon las prevalencias ajustadas por edad y sexo para cada indicador y los puntajes medios, usando la regresión binomial negativa para el análisis estadístico. La encuesta incluyó a 16.642 participantes, 9.409 de Brasil y 7.233 de Inglaterra. En general, todos los determinantes del envejecimiento activo fueron peores en Brasil que en Inglaterra, salvo la satisfacción con la vida (sin diferencia). La diferencia más llamativa se refiere al puntaje de los determinantes sociales en Brasil (diferencia media de 0,18; p < 0,05), sobre todo debido al nivel educativo significativamente más bajo en Brasil (70,6%; intervalo de 95% de confianza - IC95%: 69,7-71,5) que en Inglaterra (37,1%; IC95%: 35,1-39,1). Todos los determinantes (conductuales, personales y sociales) se asociaron con la salud en Brasil y en Inglaterra. Sin embargo, el dominio conductual se asoció más fuertemente con la salud en Inglaterra (coeficiente = 2,76; IC 95% 2,46-3,10) que en Brasil (coeficiente = 1,38; IC95%: 1,26-1,50) (p < 0,001). Las personas mayores inglesas se benefician más de comportamientos más saludables que los brasileños, que dependen más de las políticas sociales.

A dinâmica das violências na separação compulsória de mães e filhos em situação de vulnerabilidade / The dynamics of violence in the compulsory separation of mothers from children in situations of vulnerability / La dinámica de las violencias en la separación obligatoria de madres e hijos en situación de vulnerabilidad

Este artigo analisa dinâmicas inseridas no processo de separação compulsória de mães e filhos em situação de vulnerabilidade em Belo Horizonte. Trata-se de um exercício cartográfico que pretendeu captar regimes de verdade, práticas de dominação e estratégias de governo para controle da vida de mulheres, em sua maioria, pobres e negras. Foram fontes utilizadas: narrativas de mulheres em situação de vulnerabilidade e trabalhadores da saúde; entrevistas com atores estratégicos; análise documental; e diários de campo. Foram identificados movimentos indutores de segregação inseridos no cotidiano de serviços públicos e outros espaços sociais. Foi possível analisar a relação entre as segregações de determinada produção de mundo e interrogar certezas sobre possibilidades de vida e a produção da maternidade. Esse percurso constituiu oportunidade para dar visibilidade às estratégias de sobrevivência destas mulheres e provocar reflexões sobre a produção de territórios acolhedores para essas pessoas.(AU)

This article analyzes the dynamics of the process of compulsory separation of mothers from children in situations of vulnerability in Belo Horizonte, Brazil. We conducted a cartographic study to capture regimes of truth, practices of domination, and government strategies to control the lives of these women, who were predominantly poor and black. We used the following techniques: narratives of women in situations of vulnerability and health workers; interviews with key actors; document analysis; field diaries. We identified drivers of segregation embedded in everyday practices in health services and other social settings. It was possible to analyze the segregations determined by a hegemonic way of producing the world and to question certainties about the possibilities of life and motherhood. The findings shed light on the survival strategies used by these women and prompt reflection on the production of welcoming spaces for these people.(AU)

Este artículo analiza dinámicas inseridas en el proceso de separación obligatoria de madres e hijos en situación de vulnerabilidad en Belo Horizonte. Se trata de un ejercicio cartográfico que pretendió captar regímenes de verdad, prácticas de dominación y estrategias de gobierno para el control de la vida de mujeres, en su mayoría pobres y negras. Las fuentes utilizadas fueron: narrativas de mujeres en situación de vulnerabilidad y trabajadores de la salud, entrevistas con actores estratégicos, análisis documental, diarios de campo. Se identificaron movimientos inductores de segregación inseridos en el cotidiano de servicios públicos y otros espacios sociales. Fue posible analizar la relación entre las segregaciones de determinada producción de mundo e interrogar certezas sobre posibilidades de vida y la producción de la maternidad. Ese recorrido constituyó una oportunidad para dar visibilidad a las estrategias de supervivencia de esas mujeres y provocar reflexiones sobre la producción de territorios acogedores para ellas.(AU)

Das amas de leite às mães órfãs: reflexões sobre o direito à maternidade no Brasil / From wet nurses to orphaned mothers: reflections on the right to maternity in Brazil

Resumo O artigo aborda a retirada compulsória de filhos de mulheres em situação de vulnerabilidade no Brasil. Objetivou-se refletir sobre a violação do direito à maternidade; apresentar os limites impostos, especialmente às mulheres pobres, negras e indígenas e as estratégias de controle sobre sua vida e de seus filhos; e os movimentos de resistência que se contrapõem às segregações. Foram fontes da pesquisa: narrativas de mulheres em situação de vulnerabilidade, de familiares e trabalhadores da saúde; entrevistas com atores estratégicos; análise documental; diários de campo. Evidenciou-se que vulnerabilidades atreladas à criminalização da pobreza e ao preconceito racial têm justificado as separações. A desresponsabilização do Estado e da sociedade quanto à formação de uma rede de apoio às mulheres, a desvalorização de produções não hegemônicas de maternidades e o reforço de uma razão de mundo que produz a violência como ferramenta para exclusão vão conformando limites práticos quanto ao direito à maternidade. Mulheres e seus filhos são desconsiderados em suas singularidades. Os movimentos de resistência mostraram que diálogos intersetoriais são uma alternativa para superar discriminações e vulnerabilidades.

Abstract This article addresses the compulsory seizing of children from vulnerable women in Brazil. Its objectives were: to discuss the violation of the right to maternity; to present the imposed restrictions especially on poor, black and indigenous women; the strategic control over their lives and children, and the resistance movements that oppose segregation. The sources of the research were: narratives of women in vulnerable situations, family members and health workers; interviews with strategic actors; document analysis; field journal. It became evident that vulnerabilities -linked to the criminalization of poverty and racial prejudice- have justified these separations. The lack of responsibility that State and society practice towards the support network for women, the devaluation of non-hegemonic productions of maternity, and the reinforcement of a 'reason of the world', that produces violence as a tool for exclusion establishing practical limits on the right to maternity. Women and children are disregarded in their singularities. Resistance movements have shown that intersectoral dialogues are an alternative to overcome discrimination and vulnerabilities.

A decreased trajectory of loneliness among Brazilians aged 50 years and older during the COVID-19 pandemic: ELSI-Brazil / Trajetória de diminuição da solidão entre brasileiros com 50 anos ou mais durante a pandemia de COVID-19: ELSI-Brasil / Trayectoria decreciente de la soledad entre los brasileños de 50 años o más durante la pandemia de COVID-19: ELSI-Brasil

This study aimed to estimate prevalence of loneliness among older Brazilian adults over the first seven months of the COVID-19 pandemic and to identify the predictors of loneliness trajectories. Pre-pandemic data derived from face-to-face interviews of participants of the 2019-2020 Brazilian Longitudinal Study of Aging (ELSI-Brazil), which is a nationally representative study of community-dwelling individuals aged 50 years and over. Pandemic data were based on three rounds of telephone interviews among those participants, conducted from May to October 2020. Loneliness was measured by a single-item question, considering those who had at least two repeated measures. Explanatory variables included depression, living alone, leaving home in the last week, and virtual connectedness in the last month. Mixed-effects logistic regression was used to estimate odds ratios with their 95% confidence intervals (95%CI) and to investigate loneliness trajectories and their predictors. In total, 5,108 participants were included. The overall prevalence of loneliness in the pre-pandemic period was 33.1% (95%CI: 29.4-36.8), higher than the pandemic period (round 1: 23.6%, 95%CI: 20.6-26.9; round 2: 20.5%, 95%CI: 17.8-23.5; round 3: 20.6%, 95%CI: 17.1-24.6). A significant interaction (p ≤ 0.05) was evidenced only between depression and time; participants with depression showed a greater reduction in loneliness levels. Although loneliness levels in Brazil have decreased during the pandemic, this pattern is not present for all older adults. Individuals with depression had a more significant reduction, probably due to feeling closer to their social network members during the stay-at-home recommendations.

Este estudo teve como objetivo estimar a prevalência de solidão entre idosos brasileiros nos primeiros sete meses da pandemia de COVID-19 e identificar os preditores das trajetórias de solidão, usando dados pré-pandemia oriundos de entrevistas presenciais de participantes do Estudo Longitudinal da Saúde dos Idosos Brasileiros (ELSI-Brasil) de 2019-2020, um estudo de representatividade nacional com residentes da comunidade com 50 anos ou mais. Os dados durante a pandemia foram coletados em três rodadas de entrevistas telefônicas com os participantes, realizadas de maio a outubro de 2020. A solidão foi medida por uma questão de item único, considerando os casos com pelo menos duas medidas repetidas. As variáveis explicativas incluíram depressão, morar sozinho, sair de casa na última semana e conexão virtual no último mês. A regressão logística de efeitos mistos foi utilizada para estimar as razões de chances com seus intervalos de 95% de confiança (IC95%) e investigar trajetórias de solidão e seus preditores. Foram incluídos 5.108 participantes. A prevalência global de solidão no período pré-pandemia foi de 33,1% (IC95%: 29,4-36,8), um valor superior ao período pandêmico (rodada 1: 23,6%, IC95%: 20,6-26,9; rodada 2: 20,5%, IC95%: 17,8-23,5; rodada 3: 20,6%, IC95%: 17,1-24,6). Uma interação significativa (p ≤ 0,05) foi encontrada apenas entre depressão e tempo; participantes com depressão apresentaram maior redução dos níveis de solidão. Embora os níveis de solidão no Brasil tenham diminuído durante a pandemia, esse padrão não se aplica a todos os idosos. Indivíduos com depressão tiveram uma redução mais significativa provavelmente por se sentirem mais próximos aos membros de suas redes sociais durante as recomendações de ficar em casa.

Este estudio tuvo como objetivo estimar la prevalencia de la soledad entre los adultos mayores brasileños durante los primeros siete meses de la pandemia de COVID-19 e identificar los predictores de las trayectorias de la soledad. Los datos prepandémicos proceden de entrevistas cara a cara de los participantes del Estudio Longitudinal Brasileño sobre el Envejecimiento (ELSI-Brasil) de 2019-2020, que es un estudio nacionalmente representativo de los habitantes de la comunidad de 50 años o más. Los datos de la pandemia se basaron en tres rondas de entrevistas telefónicas entre esos participantes, realizadas de mayo a octubre de 2020. La soledad se midió con una pregunta de un solo ítem, teniendo en cuenta los que tenían al menos dos indicativos repetidos. Las variables explicativas incluían la depresión, el hecho de vivir solo, salir de casa en la última semana y la conexión virtual en el último mes. Se utilizó una regresión logística de efectos mixtos para estimar las odds ratios con sus intervalos del 95% de confianza (IC95%) y para investigar las trayectorias de la soledad y sus predictores. Se incluyeron 5.108 participantes. La prevalencia global de la soledad en el periodo prepandémico fue del 33,1% (IC95%: 29,4-36,8), superior a la del periodo pandémico (ronda 1: 23,6%, IC95%: 20,6-26,9; ronda 2: 20,5%, IC95%: 17,8-23,5, ronda 3: 20,6; IC95%: 17,1-24,6). Sólo se evidenció una interacción significativa (p ≤ 0,05) entre la depresión y el tiempo; los participantes con depresión mostraron una mayor reducción de los niveles de soledad. Aunque los niveles de soledad en Brasil han disminuido durante la pandemia, este patrón no se da en todos los adultos mayores. Aquellos individuos con depresión tuvieron una reducción más significativa, probablemente debido a que se sintieron más cerca de los miembros de su red social durante las recomendaciones de quedarse en casa.

Social Inequalities on Selected Determinants of Active Aging and Health Status Indicators in a Large Brazilian City (2003-2010).

OBJECTIVE: To assess trends in social inequalities among 2,624 elderly living in Belo Horizonte, Brazil, in three domains of the World Health Organization's Active Aging model (physical environment, social determinants, use of health services) and health status indicators. METHOD: Data came from two representative household surveys conducted in 2003 and 2010. Social inequality was measured by the slope and the relative index of inequality. Educational level was used to define socioeconomic status. RESULTS: Significant improvements were observed in the prevalence rates of 7 out of 12 indicators. However, the social inequalities persisted through 10 out of 12 selected active aging and health status indicators, except for fear of falling on the sidewalks/crossing the streets and fear of being robbed. DISCUSSION: Social inequalities persistence might be assigned to the continuity of unequal distribution of resources among groups with different educational levels.

Relação entre trabalho antes da epidemia e ter saído para trabalhar durante esse período entre participantes do Estudo Longitudinal da Saúde dos Idosos Brasileiros: resultados da iniciativa ELSI-COVID-19 / Relación entre trabajo antes de la epidemia y haber salido a trabajar durante la misma entre participantes del Estudio Brasileño Longitudinal del Envejecimiento: resultados de la iniciativa ELSI-COVID-19 / Relationship between work before the epidemic and having gone out to work during the epidemic among participants in the Brazilian Longitudinal Study of Aging: results of the ELSI-COVID-19 initiative

Resumo: O objetivo do estudo foi examinar a prevalência e fatores associados a ter saído para trabalhar durante a epidemia da COVID-19, entre adultos com 50 anos ou mais que exerciam trabalho remunerado antes do seu início. Foram utilizados dados da segunda onda do Estudo Longitudinal da Saúde dos Idosos Brasileiros (ELSI-Brasil), conduzida por meio de entrevista face a face, entre agosto de 2019 e março de 2020 (antes do início da epidemia), em amostra nacional representativa de adultos com 50 anos ou mais, e dados obtidos por meio de entrevistas telefônicas realizadas entre esses participantes (iniciativa ELSI-COVID-19), conduzidas entre 26 de maio e 8 de junho de 2020 (durante a epidemia). As análises foram baseadas nas odds ratios (OR) estimadas pela regressão logística. A média de idade dos participantes foi 59,9 anos (DP = 6,5). A prevalência de ter saído para trabalhar nos sete dias anteriores foi de 38,4% (IC95%: 31,3-46,1), 50,2% entre os homens e 25,1% entre as mulheres (trabalho formal, por conta própria e informal). Os resultados mostraram que, entre os homens, a chance de ter saído para trabalhar foi menor entre aqueles de 60 a 69 anos em comparação com aqueles de 50 a 59 anos (OR = 0,27; IC95%: 0,15-0,48). Entre as mulheres, a probabilidade de ter saído para trabalhar foi menor entre aquelas que trabalhavam por conta própria (OR = 0,28; IC95%: 0,12-0,64) ou tinham vínculo informal de trabalho antes da epidemia (OR = 0,25; IC95%: 0,09-0,69), em comparação àquelas com vínculo formal de trabalho. Uma das hipóteses para explicar essa associação é que as mulheres com vínculo informal tenham sido dispensadas e aquelas que trabalhavam por conta própria tenham deixado de trabalhar durante a epidemia.

Resumen: El objetivo del estudio fue examinar la prevalencia y factores asociados a haber salido para trabajar durante la epidemia de la COVID-19, entre adultos con 50 años o más, que ejercían trabajo remunerado antes del inicio de la misma. Se utilizaron datos de la segunda fase del Estudio Brasileño Longitudinal del Envejecimiento (ELSI-Brasil), llevada a cabo mediante una entrevista cara a cara, entre agosto de 2019 y marzo de 2020 (antes del inicio de la epidemia), en una muestra nacional representativa de adultos con 50 años o más, y datos obtenidos por medio de entrevistas telefónicas realizadas entre estos participantes (iniciativa ELSI-COVID-19), realizadas entre el 26 de mayo y 8 de junio de 2020 (durante la epidemia). Los análisis se basaron en las odds ratios (OR) estimadas por regresión logística. La media de edad de los participantes fue 59,9 años (DP = 6,5). La prevalencia de haber salido para trabajar durante los siete días anteriores fue de un 38,4% (IC95%: 31,3-46,1), 50,2% entre hombres y un 25,1% entre las mujeres (trabajo formal, por cuenta propia e informal). Los resultados mostraron que, entre los hombres, la oportunidad de haber salido a trabajar fue menor entre aquellos con edades comprendidas entre los 60 a 69 años, en comparación con aquellos de 50 a 59 años (OR = 0,27; IC95%: 0,15-0,48). Entre las mujeres, la probabilidad de haber salido a trabajar fue menor entre aquellas que trabajaban por cuenta propia (OR = 0,28; IC95%: 0,12-0,64) o tenían un vínculo laboral informal antes de la epidemia (OR = 0,25; IC95%: 0,09-0,69), en comparación con aquellas con un vínculo laboral formal. Una de las hipótesis para explicar esta asociación es que las mujeres con un vínculo informal fueron dispensadas del servicio y aquellas que trabajaban por cuenta propia hayan dejado de trabajar durante la epidemia.

Abstract: The objective of this study was to examine the prevalence of going out to work during the COVID-19 epidemic, and the factors associated with this, among adults aged 50 years and over who were in paid employment before its onset. We used data from the second wave of the Brazilian Longitudinal Study of Aging (ELSI-Brazil), conducted through face-to-face interviews between August 2019 and March 2020 (before the onset of the epidemic), in a representative national sample of adults aged 50 and over, and data obtained through telephone interviews carried out among the same participants (ELSI-COVID-19 initiative), conducted between May 26 and June 8, 2020 (during the epidemic). The analyses were based on odds ratios (OR) estimated by logistic regression. The participants' mean age was 59.9 years (SD = 6.5). The prevalence of going out to work in the previous seven days was 38.4% (95%CI: 31.3-46.1), 50.2% among men and 25.1% among women (formal work, self-employment, and informal work). The results showed that among men, the likelihood of going out to work was lower among those aged 60 to 69 years compared to those aged 50 to 59 years (OR = 0.27; 95%CI: 0.15-0.48). Among women, the likelihood was lower among those who were self-employed (OR = 0.28; 95%CI: 0.12-0.64) or in informal employment before the epidemic (OR = 0.25; 95%CI: 0.09-0.69), compared to those in formal employment. One of the hypotheses to explain this association is that women in informal employment were more likely to be dismissed, and that self-employed women have stopped working during the epidemic.

[Intra-urban differences in vulnerability among the elderly population]. / Diferenciais intra-urbanos de vulnerabilidade da população idosa.

This study examined the adequacy of a health vulnerability index (HVI) for identifying intra-urban differences in vulnerability in the elderly population. Study participants (n = 1,055) were selected by probabilistic sampling of residents in the city of Belo Horizonte, Minas Gerais State, Brazil, aged 60 years or older (mean = 70.1 years). The HVI was constructed with indicators of socioeconomic conditions and premature mortality at the census tract level. Based on its location and HVI value, each participant's household was classified as low, medium, or high-risk. Results of multivariate ordinal logistic regression models showed graded and statistically significant associations between the household's risk level and the social and physical environment, health conditions and behaviors, and health service needs (adjusted prevalence ratios ranging from 1.17; 95% CI: 1.02-1.34 to 1.65; 95% CI: 1.45-1.88). The HVI appears to be a useful instrument for identifying health and social service needs among the elderly.