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.

Neighborhood physical disorder and common mental disorders in adolescence.

OBJECTIVE: The aim of this study is to estimate the association between observed indicators of neighborhood physical disorder and common mental disorders in adolescents. METHODS: The study population included 2506 adolescents from three Brazilian state capitals (Rio de Janeiro, Porto Alegre, and Fortaleza) who participated in the Cardiovascular Risk Study in Adolescents (ERICA), a cross-sectional school-based study conducted in 2013-2014. Common mental disorders were assessed using the 12-item General Health Questionnaire. Measures of neighborhood physical disorder were based on the 2010 Brazilian census data and were derived using principal component analysis. RESULTS: Although associations were found between some exposure components and CMD, there were no clear or consistent trends across exposure quartiles. CONCLUSION: Overall, there was no evidence of an association between observed indicators of neighborhood physical disorder and common mental disorders. Future studies should explore alternative tools for measuring neighborhood physical disorder to minimize the likelihood of exposure misclassification.

Reliability of triage systems for paediatric emergency care: a systematic review.

OBJECTIVE: To present a systematic review on the reliability of triage systems for paediatric emergency care. METHODS: A search of MEDLINE, Cochrane Library, Latin American and Caribbean Health Sciences Literature, Scientific Electronic Library Online, Nursing Database Index and Spanish Health Sciences Bibliographic Index for articles in English, French, Portuguese or Spanish was conducted to identify reliability studies of five-level triage systems for patients aged 0-18 years published up to April 2018. Two reviewers performed study selection, data extraction and quality assessment as recommended by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. RESULTS: Twenty studies on nine triage systems were selected: the National Triage System (n=1); the Australasian Triage Scale (n=3); the paediatric Canadian Triage and Acuity Scale (PedCTAS) (n=5); the Manchester Triage System (MTS) (n=1); the Emergency Severity Index (ESI) (n=5); an adaptation of the South African Triage Scale for the Princess Marina Hospital in Botswana (n=1); the Soterion Rapid Triage System (n=1); the Rapid Emergency Triage and Treatment System-paediatric version (n=2); the Paediatric Risk Classification Protocol (n=1). Ten studies were performed with actual patients, while the others used hypothetical scenarios. The studies were rated low (n=14) or moderate (n=6) quality. Kappa was the most used statistic, although many studies did not specify the weighting. PedCTAS, MTS and ESI V.4 exhibited substantial to almost perfect agreement in moderate quality studies. CONCLUSIONS: There is some evidence on the reliability of the PedCTAS, MTS and ESI V.4, but most studies are limited to the countries where they were developed. Efforts are needed to improve the quality of the studies, and cross-cultural adaptation of those tools is recommended in countries with different professional qualification and sociocultural contexts.

Validity of triage systems for paediatric emergency care: a systematic review.

AIM: To present a systematic review on the validity of triage systems for paediatric emergency care. METHODS: Search in MEDLINE, Cochrane Library, Latin American and Caribbean Health Sciences Literature (LILACS), Scientific Electronic Library Online (SciELO), Nursing Database Index (BDENF) and Spanish Health Sciences Bibliographic Index (IBECS) for articles in English, French, Portuguese or Spanish with no time limit. Validity studies of five-level triage systems for patients 0-18 years old were included. Two reviewers performed data extraction and quality assessment as recommended by PRISMA statement. RESULTS: We found 25 studies on seven triage systems: Manchester Triage System (MTS); paediatric version of Canadian Triage and Acuity Scale (PedCTAS) and its adaptation for Taiwan (paediatric version of the Taiwan Triage and Acuity System); Emergency Severity Index version 4 (ESI v.4); Soterion Rapid Triage System and South African Triage Scale and its adaptation for Bostwana (Princess Marina Triage Scale). Only studies on the MTS used a reference standard for urgency, while all systems were evaluated using a proxy outcome for urgency such as admission. Over half of all studies were low quality. The MTS, PedCTAS and ESI v.4 presented the largest number of moderate and high quality studies. The three tools performed better in their countries or near them, showing a consistent association with hospitalisation and resource utilisation. Studies of all three tools found that patients at the lowest urgency levels were hospitalised, reflecting undertriage. CONCLUSIONS: There is some evidence to corroborate the validity of the MTS, PedCTAS and ESI v.4 for paediatric emergency care in their own countries or near them. Efforts to improve the sensitivity and to minimise the undertriage rates should continue. Cross-cultural adaptation is necessary when adopting these triage systems in other countries.

Work-Related Depression in Primary Care Teams in Brazil.

OBJECTIVES: To identify work-related factors associated with depressive symptoms and probable major depression in primary care teams. METHODS: Cross-sectional study among primary care teams (community health workers, nursing assistants, nurses, and physicians) in the city of São Paulo, Brazil (2011-2012; n = 2940), to assess depressive symptoms and probable major depression and their associations with job strain and other work-related conditions. RESULTS: Community health workers presented higher prevalence of probable major depression (18%) than other primary care workers. Higher odds ratios for depressive symptoms or probable major depression were associated with longer duration of employment in primary care; having a passive, active, or high-strain job; lack of supervisor feedback regarding performance; and low social support from colleagues and supervisors. CONCLUSIONS: Observed levels of job-related depression can endanger the sustainability of primary care programs. Public Health implications. Strategies are needed to deliver care to primary care workers with depression, facilitating diagnosis and access to treatment, particularly in low- and middle-income countries. Preventive interventions can include training managers to provide feedback and creating strategies to increase job autonomy and social support at work.

Violence at work and depressive symptoms in primary health care teams: a cross-sectional study in Brazil.

PURPOSE: Implementation of primary care has long been a priority in low- and middle-income countries. Violence at work may hamper progress in this field. Hence, we examined the associations between violence at work and depressive symptoms/major depression in primary care teams (physicians, nurses, nursing assistants, and community health workers). METHODS: A cross-sectional study was undertaken in the city of Sao Paulo, Brazil. We assessed a random sample of Family Health Program teams. We investigated depressive symptoms and major depression using the nine-item Patient Health Questionnaire (PHQ-9), and exposure to violence at work in the previous 12 months using a standardized questionnaire. Associations between exposure to violence and depressive symptoms/major depression were analyzed using multinomial logistic regression. RESULTS: Of 3141 eligible workers, 2940 (93 %) completed the interview. Of these, 36.3 % (95 % CI 34.6-38.1) presented intermediate depressive symptoms, and 16 % (95 % CI 14.6-17.2), probable major depression. The frequencies of exposure to the different types of violence at work were: insults (44.9 %), threats (24.8 %), physical aggression (2.3 %), and witnessing violence (29.5 %). These exposures were strongly and progressively associated with depressive symptoms (adjusted odds ratio 1.67 for exposure to one type of violence; and 5.10 for all four types), and probable major depression (adjusted odds ratio 1.84 for one type; and 14.34 for all four types). CONCLUSION: Primary care workers presenting depressive symptoms and those who have experienced violence at work should be assisted. Policy makers should prioritize strategies to prevent these problems, since they can threaten primary care sustainability.

Panorama of risky sexual behaviors in the Brazilian adult population - PNS 2019.

OBJECTIVE: To describe the risky sexual behaviors of Brazilian adults according to socioeconomic, demographic, and regional characteristics. METHODS: Data from the 2019 National Health Survey, referring to the population aged 18 years or older, were analyzed. Risky sexual behaviors were considered: early sexual initiation, before the age of 15 years, and nonuse of condoms in the last sexual intercourse. Prevalence and respective confidence intervals were calculated for the subgroups of interest. RESULTS: Early sexual initiation among adult individuals was 24% among men and 11% among women, being higher among young people with lower levels of education and household income. The nonuse of condoms was higher among married/cohabiting partners, no schooling or with some elementary school, and among older people. The prevalence of nonuse of condoms among married/cohabiting partners was the same in both sexes (75%). However, among non-cohabiting partners, gender disparity was relevant, as 39.1% of women did not use condoms in the last sexual intercourse, while among men this result was 26.9%. CONCLUSIONS: Higher prevalence of early sexual initiation for younger generations is noteworthy, especially among women. Concerning the nonuse of condoms, there are important gender disparities in the group of non-cohabiting partners, in addition to the high prevalence among older people, which should be considered in the formulation of public policies. The results of the present study are extremely relevant for understanding the adult population currently more vulnerable to sexually transmitted infections, after over five years without official statistics on this matter at the national level.

Trend in the prevalence of depressive symptoms in Brazil: results from the Brazilian National Health Survey 2013 and 2019.

This study aims to evaluate national variation in depression prevalence and in different sociodemographic groups, health behaviors, and macroregions of Brazil from 2013 to 2019. Data were obtained from two nationwide Brazilian surveys - Brazilian National Health Survey 2013 and 2019. Participants aged 18 years or older were included, totaling 60,202 individuals in 2013 and 88,531 in 2019. Depression was evaluated with the Patient Health Questionnaire-9 (PHQ-9). All estimations accounted for the population weights and the complex sampling. The findings showed that during the six years between the two surveys, the prevalence of depression in Brazil increased by 36.7%, going from 7.9% in 2013 to 10.8% in 2019, and this increase is higher among unemployed young adults, aged 18 to 24 years, with the increase in the prevalence of depression almost tripled (3.7 in 2013 and 10.3 in 2019), an increase of 178.4%. Those dwelling in urban areas had a higher increase in the prevalence of depression in the six-year period (39.8%) when compared to residents in rural areas (20.2%). There was an increase in the prevalence of depression from 2013 to 2019 for the worst categories of the three health behaviors included in the study for both men and women: heavy drinking, smoking, and not exercising the recommended level of physical activity. Our results show a significant increase in the prevalence of depression over the six years between the two surveys, mainly among the younger and unemployed men. The country's economic recession during this period may explain these findings.

[Awareness, treatment, and control of arterial hypertension: Pró-Saúde study, Brazil]. / Reconhecimento, tratamento e controle da hipertensão arterial: estudo Pró-Saúde, Brasil.

OBJECTIVE: To evaluate the prevalence, awareness, treatment, and control of hypertension in a working-age population in Brazil. METHOD: This project is part of a prospective study with employees at a university in Rio de Janeiro (Pró-Saúde Study). Based on standardized measurements of blood pressure and on the history of diagnosis and treatment of hypertension, we estimated the prevalence of hypertension in 2 384 participants from the baseline population (1999 to 2001) and determined what percentage, according to sex and age, were aware of the diagnosis of arterial hypertension, treated this condition, and had their disease controlled with anti-hypertensive drugs. RESULTS: Of the population under study, 704 people (29.6%) were classified as hypertensive; of these, 573 (81.5%) were aware of their condition (88.6% of females and 71.6% of males). Of those who were aware, 445 (77.8%; 88.8% of females and 59.1% of males) were being treated with anti-hypertensive drugs. In turn, of the hypertensive subjects being treated for this condition, 287 (60.1%; 61.5% of females and 57.4% of males) were controlled. Awareness and treatment rates were lower and control was higher in those in the lowest age range. CONCLUSION: In the study population, awareness, treatment, and control of hypertension were higher than has been reported by most national and international studies. Considering the fact that most individuals were aware of and treated their condition, a higher rate of hypertension control was expected. Adequate control of hypertension, especially among men, must be a priority of health programs and services.

Incidence, persistence and risk factors of fear of falling in older adults: cohort study (2008-2013) in Rio de Janeiro, Brazil.

OBJECTIVE: To evaluate the incidence and persistence of fear of falling in older adults and the clinical/functional, psychosocial and lifestyle-related risk factors. METHODS: A longitudinal study with 393 community-dwelling older adults aged 65 years and over (110 men/ 283 women) resident in the North Zone of the city of Rio de Janeiro, Brazil. The fear of falling was assessed by the Falls Efficacy Scale-I-BR. The explanatory variables assessed were: number of comorbidities and medicines, history of falls, fracture from falling, use of walking aids, functional dependence in basic and instrumental activities of daily living, hearing and visual impairment, hand grip strength, walking speed, self-rated health, body mass index, depressive symptoms, cognitive impairment, living alone and activity level. Incidence, persistence and risk factors were estimated. Multivariate analysis was performed using Poisson Regression, obtaining relative risks (RR) and corresponding to 95% confidence intervals. RESULTS: Among the 393 participants, fear of falling occurred in 33.5% and was persistent in 71.3%. Incidence was found to associate with using seven or more medicines and reporting worse activity level than the prior year. Risk factors for persistent fear were: using seven or more medicines, a history of one or two falls, reduced walking speed, hearing impairment, cognitive impairment, depressive symptoms and poor or very poor self-rated health. CONCLUSION: Fear of falling is a frequent and persistent condition. Many factors related to persistent fear showed no association with the incidence of fear, emphasizing the need for focused strategies to reduce risk factors that may be associated with the chronification of fear of falling.

[Dimensional structure of the Brazilian version of the Functional Activities Questionnaire (FAQ-BR)]. / Estrutura dimensional da versão brasileira do Functional Activities Questionnaire (FAQ-BR).

This study aimed to assess the dimensional structure and internal consistency of the Brazilian version of the Functional Activities Questionnaire (FAQ-BR) for measurement of functional capacity in the elderly, based on the informant's report. This was a cross-sectional study with 525 non-institutionalized elderly informants, in which confirmatory factor analyses (CFA) and exploratory/confirmatory factor analyses (E/CFA) modeled according to CFA principles were used to identify the most parsimonious model and that with the best fit. The internal consistency of the FAQ-BR was assessed by composite reliability, and correlations between its dimensions were examined to investigate discriminant factor validity. CFA did not corroborate the unidimensional structure as originally proposed. Next, E/CFA fit a bidimensional structure that was reassessed by CFA, displaying a model without cross loads as the most parsimonious and with adequate fit indices. The internal consistency of FAQ-BR was considered satisfactory, and the correlation between its dimensions was acceptable. These findings are important, since they demonstrate the scale's capacity to capture the elderly's functional capacity construct in a different sociocultural context from that in which it was originally developed. The FAQ-BR can thus be considered an appropriate bidimensional instrument for measuring the elderly's functional capacity based on the informant's report, and its use in studies with similar populations is recommended.

Este estudo teve por objetivo avaliar a estrutura dimensional e a consistência interna da versão brasileira do Functional Activities Questionnaire (FAQ-BR) para aferição da capacidade funcional do idoso, com base no relato de informante. Trata-se de um estudo seccional desenvolvido com 525 informantes de idosos não institucionalizados, em que análises fatoriais confirmatórias (AFC) e análises fatoriais exploratórias (AFC/E), modeladas segundo os princípios da AFC, foram usadas para identificar o modelo mais parcimonioso e mais bem ajustado. A consistência interna do FAQ-BR foi avaliada pela confiabilidade composta, e correlações entre suas dimensões foram examinadas a fim de investigar validade fatorial discriminante. A AFC não corroborou a estrutura unidimensional originalmente proposta. Em seguida, a AFC/E ajustou uma estrutura bidimensional que foi reavaliada por AFC, evidenciando um modelo sem cargas cruzadas como o mais parcimonioso e com adequados índices de ajuste. A consistência interna do FAQ-BR foi considerada satisfatória, e a correlação entre suas dimensões, aceitável. Esses achados são importantes, pois revelam a capacidade de a escala capturar o construto capacidade funcional do idoso em um contexto sociocultural distinto daquele em que foi desenvolvido. Portanto, o FAQ-BR pode ser considerado um instrumento bidimensional apropriado para aferir a capacidade funcional do idoso com base no relato do informante, e seu uso em pesquisas com populações semelhantes é recomendado.

El objetivo de este artículo fue evaluar la estructura dimensional y la consistencia interna de la versión brasileña del Functional Activities Questionnaire (FAQ-BR) para la valoración de la capacidad funcional del anciano, en base al relato del informante. Se trata de un estudio seccional, desarrollado con 525 informantes de ancianos no institucionalizados, donde los análisis factoriales confirmatorios (AFC) y análisis factoriales exploratorios (AFC/E), fueron modelados según los principios de la AFC, así como usados para identificar el modelo más parsimonioso y más bien ajustado. La consistencia interna del FAQ-BR se evaluó por la fiabilidad compuesta, y se examinaron las correlaciones entre sus dimensiones, a fin de investigar la validez factorial discriminante. La AFC no corroboró la estructura unidimensional originalmente propuesta. En seguida, la AFC/E ajustó una estructura bidimensional que se reevaluó por parte de la AFC, evidenciando un modelo sin cargas cruzadas como el más parsimonioso y con adecuados índices de ajuste. La consistencia interna del FAQ-BR se consideró satisfactoria, y la correlación entre sus dimensiones, aceptable. Estos hallazgos son importantes, pues revelan la capacidad de la escala de aprehender el constructo capacidad funcional del anciano en un contexto sociocultural distinto de aquel en el que se desarrolló. Por ello, el FAQ-BR puede ser considerado un instrumento bidimensional, apropiado para evaluar la capacidad funcional anciano, basándose en el relato del informante, y se recomienda su uso en investigaciones con poblaciones semejantes.

VALIDITY AND RELIABILITY OF A NEW TRIAGE SYSTEM FOR PEDIATRIC EMERGENCY CARE: CLARIPED. / VALIDADE E CONFIABILIDADE DE UM NOVO SISTEMA DE CLASSIFICAÇÃO DE RISCO PARA EMERGÊNCIAS PEDIÁTRICAS: CLARIPED.

OBJECTIVE: To assess the validity and reliability of a triage system for pediatric emergency care (CLARIPED) developed in Brazil. METHODS: Validity phase: prospective observational study with children aged 0 to 15 years who consecutively visited the pediatric emergency department (ED) of a tertiary hospital from July 2 to 18, 2013. We evaluated the association of urgency levels with clinical outcomes (resource utilization, ED admission rate, hospitalization rate, and ED length of stay); and compared the CLARIPED performance to a reference standard. Inter-rater reliability phase: a convenience sample of patients who visited the pediatric ED between April and July 2013 was consecutively and independently double triaged by two nurses, and the quadratic weighted kappa was estimated. RESULTS: In the validity phase, the distribution of urgency levels in 1,416 visits was the following: 0.0% red (emergency); 5.9% orange (high urgency); 40.5% yellow (urgency); 50.6% green (low urgency); and 3.0% blue (no urgency). The percentage of patients who used two or more resources decreased from the orange level to the yellow, green, and blue levels (81%, 49%, 22%, and 2%, respectively, p<0.0001), as did the ED admission rate, ED length of stay, and hospitalization rate. The sensitivity to identify patients with high urgency level was 0.89 (confidence interval of 95% [95%CI] 0.78-0.95), and the undertriage rate was 7.4%. The inter-rater reliability in 191patients classified by two nurses was substantial (kw2=0.75; 95%CI 0.74-0.79). CONCLUSIONS: The CLARIPED system showed good validity and substantial reliability for triage in a pediatric emergency department.

OBJETIVO: Avaliar a validade e a confiabilidade de um sistema de classificação de risco para emergências pediátricas (CLARIPED) desenvolvido no Brasil. MÉTODOS: Fase de validade: estudo observacional prospectivo em crianças de 0 a 15anos atendidas consecutivamente no serviço de emergência pediátrica (SEP) de um hospital terciário entre 2 e 18de julho de 2013. Avaliou-se a associação dos níveis de urgência com desfechos clínicos (utilização de recursos, taxa de admissão no SEP, taxa de hospitalização e tempo de permanência no SEP); e comparou-se o desempenho do CLARIPED com um padrão de referência. Fase de confiabilidade interobservadores: uma amostra de conveniência de pacientes atendidos entre abril e julho de 2013 foi submetida a duas classificações de risco consecutivas e independentes, e estimou-se o Kappa ponderado quadrático. RESULTADOS: Em 1.416 atendimentos realizados na fase de validade, a distribuição de níveis de urgência foi: 0,0% vermelho/emergência; 5,9% laranja/muito urgente; 40,5% amarelo/urgente; 50,6% verde/pouco urgente; e 3,0% azul/sem urgência. Ospercentuais de pacientes que usaram dois ou mais recursos diminuíram do nível laranja para o amarelo, verde e azul (81, 49, 22 e 2%, respectivamente, p<0,0001), assim como a taxa de admissão no SEP, o tempo de permanência no SEP e a taxa de admissão hospitalar. Asensibilidade para discriminar pacientes muito urgentes foi de 0,89 (intervalo de confiança de 95%- IC95% 0,78-0,95), e a taxa de subtriagem foi de 7,4%. Aconfiabilidade interobservadores em 191 pacientes classificados por duas enfermeiras foi substancial (kw2=0,75; IC95% 0,74-0,79). CONCLUSÕES: O sistema CLARIPED mostrou boa validade e substancial confiabilidade para classificação de risco em um serviço de emergência pediátrica.

Panorama of risky sexual behaviors in the Brazilian adult population - PNS 2019 / Panorama dos comportamentos sexuais de risco na população adulta brasileira - PNS 2019

ABSTRACT OBJECTIVE To describe the risky sexual behaviors of Brazilian adults according to socioeconomic, demographic, and regional characteristics. METHODS Data from the 2019 National Health Survey, referring to the population aged 18 years or older, were analyzed. Risky sexual behaviors were considered: early sexual initiation, before the age of 15 years, and nonuse of condoms in the last sexual intercourse. Prevalence and respective confidence intervals were calculated for the subgroups of interest. RESULTS Early sexual initiation among adult individuals was 24% among men and 11% among women, being higher among young people with lower levels of education and household income. The nonuse of condoms was higher among married/cohabiting partners, no schooling or with some elementary school, and among older people. The prevalence of nonuse of condoms among married/cohabiting partners was the same in both sexes (75%). However, among non-cohabiting partners, gender disparity was relevant, as 39.1% of women did not use condoms in the last sexual intercourse, while among men this result was 26.9%. CONCLUSIONS Higher prevalence of early sexual initiation for younger generations is noteworthy, especially among women. Concerning the nonuse of condoms, there are important gender disparities in the group of non-cohabiting partners, in addition to the high prevalence among older people, which should be considered in the formulation of public policies. The results of the present study are extremely relevant for understanding the adult population currently more vulnerable to sexually transmitted infections, after over five years without official statistics on this matter at the national level.

RESUMO OBJETIVO Descrever os comportamentos sexuais de risco dos adultos brasileiros segundo características socioeconômicas, demográficas e regionais. MÉTODOS Foram analisados dados da Pesquisa Nacional de Saúde 2019, referente à população de 18 anos de idade ou mais. Considerou-se como comportamentos sexuais de risco: a iniciação sexual precoce, antes dos 15 anos, e o não uso de preservativo na última relação sexual. Foram calculadas as prevalências e respectivos intervalos de confiança para os subgrupos de interesse. RESULTADOS A iniciação sexual precoce entre indivíduos adultos foi de 24% entre os homens e 11% entre as mulheres, sendo mais alta entre jovens com menores níveis de instrução e rendimento domiciliar. O não uso de preservativo se mostrou maior entre os casados/coabitantes, sem instrução ou com nível fundamental incompleto, e entre os mais velhos. A prevalência do não uso de preservativo entre casados/coabitantes foi igual em ambos os sexos (75%). No entanto, entre os não coabitantes, a disparidade entre os sexos se mostrou relevante uma vez que 39,1% das mulheres não usaram preservativo na última relação sexual, enquanto entre os homens esse resultado foi de 26,9%. CONCLUSÃO Nota-se, especialmente entre as mulheres, maiores prevalências de iniciação sexual precoce para as gerações mais novas. No que se refere ao não uso de preservativo, há disparidades de sexo importantes no grupo dos não coabitantes, além da alta prevalência entre os mais velhos, que devem ser consideradas na elaboração das políticas públicas. Os resultados do presente estudo são extremamente relevantes para compreensão da população adulta atualmente mais vulnerável às infecções sexualmente transmissíveis, após mais de cinco anos sem estatísticas oficiais a respeito em âmbito nacional.

[Gender and age differences in social support and body mass index in adults in Greater Metropolitan Rio de Janeiro, Brazil]. / Diferenças de gênero e idade no apoio social e índice de massa corporal em adultos na Região Metropolitana do Rio de Janeiro, Brasil.

The objective was to investigate gender and age differences in the association between dimensions of social support and body mass index (BMI) in a sample of 1,465 adults (20 to 59 years) in a population-based study in Duque de Caxias, Rio de Janeiro State, Brazil. Anthropometry was conducted by trained evaluators and social support obtained by the Medical Outcomes Study, adapted and validated for the Brazilian population. The analyses were performed with multiple linear regressions, stratified by gender and age bracket, considering the sample's expansion factor and complex design. Obesity prevalence was 28% in women and 16.2% in men. After adjusting for confounders, a negative association was observed between social support and BMI in men 40-49 years of age, and in emotional support/information (ß = -2.04), and positive social interaction (ß = -2.40). There was a positive association for social support and BMI in men 50-59 years of age in emotional support/information (ß = 1.84). The study indicates that social support can protect against obesity in men in some dimensions and age brackets. However, social support does not appear to be a protective factor in women.

Trend in the prevalence of depressive symptoms in Brazil: results from the Brazilian National Health Survey 2013 and 2019 / Tendência na prevalência de sintomas depressivos no Brasil: resultados da Pesquisa Nacional de Saúde, 2013 e 2019 / Tendencia en la prevalencia de síntomas depresivos en Brasil: resultados de las Encuesta Nacional de Salud de 2013 y 2019

This study aims to evaluate national variation in depression prevalence and in different sociodemographic groups, health behaviors, and macroregions of Brazil from 2013 to 2019. Data were obtained from two nationwide Brazilian surveys - Brazilian National Health Survey 2013 and 2019. Participants aged 18 years or older were included, totaling 60,202 individuals in 2013 and 88,531 in 2019. Depression was evaluated with the Patient Health Questionnaire-9 (PHQ-9). All estimations accounted for the population weights and the complex sampling. The findings showed that during the six years between the two surveys, the prevalence of depression in Brazil increased by 36.7%, going from 7.9% in 2013 to 10.8% in 2019, and this increase is higher among unemployed young adults, aged 18 to 24 years, with the increase in the prevalence of depression almost tripled (3.7 in 2013 and 10.3 in 2019), an increase of 178.4%. Those dwelling in urban areas had a higher increase in the prevalence of depression in the six-year period (39.8%) when compared to residents in rural areas (20.2%). There was an increase in the prevalence of depression from 2013 to 2019 for the worst categories of the three health behaviors included in the study for both men and women: heavy drinking, smoking, and not exercising the recommended level of physical activity. Our results show a significant increase in the prevalence of depression over the six years between the two surveys, mainly among the younger and unemployed men. The country's economic recession during this period may explain these findings.

O estudo objetiva avaliar a variação nacional na prevalência geral da depressão e em diferentes grupos sociodemográficos, comportamentos de saúde e macrorregiões do Brasil entre 2013 e 2019. Os dados foram obtidos de dois inquéritos brasileiros de abrangência nacional, a Pesquisa Nacional de Saúde (PNS) 2013 e a 2019. Entre os participantes com idade de 18 anos ou mais, houve 60.202 indivíduos em 2013 e 88.531 em 2019. A depressão foi avaliada com o Questionário de Saúde do Paciente-9 (PHQ-9). Todas as estimativas levaram em conta os pesos populacionais e a amostragem complexa. Os achados mostraram que durante os seis anos entre as duas edições da PNS, a prevalência de depressão no Brasil aumentou em 36,7%, de 7,9% em 2013 para 10,8% em 2019, com um aumento ainda maior em adultos jovens, no grupo etário de 18 a 24 anos, e naqueles que não estavam trabalhando, onde houve um aumento de quase três vezes na prevalência de depressão (3,7% em 2013 e 10,3% em 2019), ou seja, um aumento de 178,4%. Indivíduos residindo em áreas urbanas tiveram um aumento maior na prevalência de depressão ao longo do período de seis anos (39,8%), em comparação com os residentes em áreas rurais (20,2%). Houve um aumento na prevalência de depressão entre 2013 e 2019 para as piores categorias dos três comportamentos de saúde incluídos no estado, tanto em homens quanto em mulheres: etilismo, tabagismo e sedentarismo. Nossos resultados mostram um aumento significativo na prevalência de depressão nos seis anos entre as duas edições da PNS, principalmente entre homens mais jovens e desempregados. A recessão econômica no Brasil durante o período pode explicar esses achados.

El objetivo de este estudio es evaluar la variación nacional en la prevalencia general de depresión, así como en diferentes grupos sociodemográficos, comportamientos de salud, y macrorregiones del país entre 2013-2019. Los datos se obtuvieron de dos encuestas nacionales brasileñas -Encuesta Nacional de Salud 2013 y 2019-. Los participantes con edades entre los 18 años y con más edad incluyeron a 60 202 personas en 2013 y 88 531 en 2019. La depresión se evaluó mediante el Cuestionario de Salud del Paciente-9 (PHQ-9). Todas las estimaciones justificaron los pesos de la población y el muestreo complejo. Los resultados mostraron que durante seis años entre las dos encuestas, la prevalencia de depresión en Brasil se incrementó en un 36,7%, yendo de un 7,9% en 2013 a un 10,8% en el 2019, y este incremento es mayor entre adultos jóvenes, de 18 a 24 años de edad, que no estaban trabajando, donde casi había un incremento tres veces superior en la prevalencia de depresión (3,7 en 2013 y 10,3 en 2019), un incremento de un 178,4%. Aquellos que vivían en áreas urbanas tenían un incremento mayor en la prevalencia de depresión durante el período de seis años (39,8%), cuando se comparó con los residentes en áreas rurales (20,2%). Hubo un incremento en la prevalencia de depresión entre 2013-2019 para las peores categorías de los tres comportamientos de salud incluidos en el estudio para tanto hombres como mujeres: consumo excesivo de alcohol, fumar, y no practicar deporte al nivel recomendado de actividad física. Nuestros resultados muestran un significado incremento en la prevalencia de depresión durante los seis años entre las dos encuestas, principalmente entre los hombres más jóvenes y desempleados. La recesión económica del país durante este periodo puede explicar estos resultados.

Different patterns of social support perceived and their association with physical (hypertension, diabetes) or mental diseases in the context of primary health care. / Distintos padrões de apoio social percebido e sua associação com doenças físicas (hipertensão, diabetes) ou mentais no contexto da atenção primária.

This work discusses the relationship between hypertension, diabetes, anxiety, depression, and social support in primary health care. This research aimed to identify the association between physical disease, mental disease, support network and perceived social support in the research sample. This is a cross-sectional study inserted in a larger research project funded by the Pan American Health Organization and carried out in 2002 in Petrópolis, RJ. The sample consisted of 714 patients with ages ranging from 18 to 65 years old. Results showed association between variables from support network either with evidence of hypertension or diabetes, or with the existence of common mental disorders, but with different patterns. Associations with the perceived support were positive in patients with hypertension and diabetes; Common Mental Disorder patients showed negative associations, inversely associated to the level of mental disease.

Depression and health behaviors in Brazilian adults - PNS 2013.

OBJECTIVE: To evaluate the prevalence of health-related behaviors according to presence and type of depression in Brazilian adults. METHODS: Based on a sample of 49,025 adults (18 to 59 years) from the National Survey on Health 2013 (PNS 2013), we estimated the prevalence of health-related behaviors (smoking; passive smoking; frequent or risky alcohol consumption; leisure time physical activity; time watching TV; and eating pattern indicators), according to the presence of depression (minor and major), evaluated by the Patient Health Questionnaire - 9 (PHQ-9), and the report of depressive mood (in up to seven days or more than seven days) over a two-week period. Prevalence ratios were estimated by Poisson regression. RESULTS: Evaluated by the PHQ-9 scale, 9.7% of the Brazilian adults had depression and 3.9% presented major depression. About 21.0% reported depressive mood and, in 34.9% of them, that feeling has been present for more than seven days. In individuals with major depression (PHQ-9), higher prevalence was found in almost all unhealthy behaviors analyzed, in particular, smoking (PR = 1.65), passive smoking (PR = 1.55), risk alcohol consumption (PR = 1.72), TV for ≥ 5 hours/day (PR = 2.13), consumption of fat meat (PR = 1.43) and soft drink (PR = 1.42). The prevalence ratios tended to be lower in those with minor depression. Similar results were observed in adults with depressive mood. CONCLUSIONS: This study detected relevant association between depression and health behaviors, in particular for smoking and physical activity. The associations found with the PHQ were similar to those observed with the application of a single question about depressive mood. Our results indicate the importance of assessing the presence of depression and the frequency and severity of symptoms when implementing actions for the promotion of healthy behaviors.

OBJETIVO: Avaliar a prevalência de comportamentos relacionados à saúde segundo a presença e tipo de depressão em adultos brasileiros. MÉTODOS: Com base em amostra de 49.025 adultos (18 a 59 anos) da Pesquisa Nacional de Saúde 2013, foram estimadas as prevalências de comportamentos relacionados à saúde (tabagismo, fumo passivo, consumo frequente ou de risco de álcool, atividade física de lazer, horas de TV e indicadores de padrão alimentar), segundo a presença de depressão (menor e maior), avaliada pela escala PHQ-9, e o relato de humor depressivo (em até sete dias ou em mais de sete dias) em um período de duas semanas. Razões de prevalências foram estimadas por meio de regressão de Poisson. RESULTADOS: Avaliados pela escala PHQ-9, 9,7% dos adultos brasileiros apresentaram depressão, e 3,9%, depressão maior. Cerca de 21,0% relataram humor depressivo e em 34,9% deles esse sentimento esteve presente por mais de sete dias. Nos indivíduos com depressão maior (PHQ-9), foram constatadas prevalências mais elevadas de quase todos os comportamentos não saudáveis analisados, principalmente tabagismo (RP = 1,65), fumo passivo (RP = 1,55), consumo de risco de álcool (RP = 1,72), horas de TV ≥ 5 h/dia (RP = 2,13), consumo de carne gordurosa (RP = 1,43) e refrigerante (RP = 1,42). As razões de prevalência tenderam a ser menores na depressão menor. Resultados similares foram observados nos adultos com humor depressivo. CONCLUSÕES: O estudo detectou relevante associação entre depressão e comportamentos de saúde, em especial, para tabagismo e atividade física. As associações encontradas com o uso do PHQ foram similares às observadas com a aplicação de uma única pergunta sobre humor depressivo. Os resultados do estudo sinalizam a importância da avaliação da presença de depressão e da frequência e gravidade dos sintomas quando da implementação de ações para a promoção de comportamentos saudáveis.

CLARIPED: a new tool for risk classification in pediatric emergencies. / CLARIPED: um novo instrumento para classificação de risco em emergências pediátricas.

OBJECTIVE: To present a new pediatric risk classification tool, CLARIPED, and describe its development steps. METHODS: Development steps: (i) first round of discussion among experts, first prototype; (ii) pre-test of reliability, 36 hypothetical cases; (iii) second round of discussion to perform adjustments; (iv) team training; (v) pre-test with patients in real time; (vi) third round of discussion to perform new adjustments; (vii) final pre-test of validity (20% of medical treatments in five days). RESULTS: CLARIPED features five urgency categories: Red (Emergency), Orange (very urgent), Yellow (urgent), Green (little urgent) and Blue (not urgent). The first classification step includes the measurement of four vital signs (Vipe score); the second step consists in the urgency discrimination assessment. Each step results in assigning a color, selecting the most urgent one for the final classification. Each color corresponds to a maximum waiting time for medical care and referral to the most appropriate physical area for the patient's clinical condition. The interobserver agreement was substantial (kappa=0.79) and the final pre-test, with 82 medical treatments, showed good correlation between the proportion of patients in each urgency category and the number of used resources (p<0.001). CONCLUSIONS: CLARIPED is an objective and easy-to-use tool for simple risk classification, of which pre-tests suggest good reliability and validity. Larger-scale studies on its validity and reliability in different health contexts are ongoing and can contribute to the implementation of a nationwide pediatric risk classification system.