Isotemporal substitution analysis of time between sleep, sedentary behavior, and physical activity on depressive symptoms in older adults: a cross-sectional study.

BACKGROUND: Compared to young individuals, older adults participate more in sedentary behavior (SB) and less in physical activity (PA). These behaviors are associated with numerous adverse health factors. OBJECTIVE: The purpose of the study was to examine the hypothetical effects of substituting time spent sleeping, performing SB, and performing moderate-to-vigorous physical activity (MVPA) on depressive symptomatology in older adults. DESIGN AND SETTING: An analytical cross-sectional study employing exploratory survey methods was conducted in the city of Alcobaça in the state of Bahia, Brazil. METHODS: The study included 473 older adults who answered a structured questionnaire during an interview. Exposure time to SB and PA level were assessed using the International Physical Activity Questionnaire, and depressive symptoms were analyzed using the short version of the Geriatric Depression Scale. An isotemporal replacement model was used to evaluate the effects of different SB sessions on depressive symptomatology. RESULTS: An increase in the risk of depressive symptoms was observed when MVPA and sleep time were substituted for the same SB time at all times tested, with maximum values of 40% and 20%, respectively. Opposite substitution of MVPA and sleep time increments reduced the risk of depressive symptomatology by 28% and 17%, respectively. CONCLUSIONS: The results of the present study indicate that replacing SB with the same amount of sleep or MVPA may reduce depressive symptoms. The longer the reallocation time, the greater are the benefits.

Underreporting of transfusion incidents.

BACKGROUND: Blood transfusion is an effective therapeutic practice. However, even adopting all procedures for transfusion safety, there are risks, one of which is immediate adverse reactions. The aim of this study was, by active search, to evaluate the occurrence of immediate adverse reactions estimating the occurrence rate within the first 24 h. METHODS: An exploratory, descriptive, prospective study with quantitative analysis was carried out of patients undergoing surgery who received blood component transfusions during hospitalization from October 2018 to August 2019. Data on blood component request forms were collected from the transfusion agency by reviewing medical records and interviewing the patient or family members. Descriptive statistics and the chi-square test were used to analyze the association of demographic variables with the presence or absence of transfusion reactions. RESULTS: A total of 1042 blood component units were transfused in 393 transfusions performed on 184 patients. The main transfused blood component was packed red blood cells. Seventeen reactions were identified in the medical records, using the active search method, none of which had been reported. The transfusion reaction rate was 16.3 occurrences per 1000 transfused units, while the notification rate for the 9389 blood component units transfused by the transfusion agency in the study period was 3.83/1000. There was no statistically significant association between the occurrences or not of transfusion reactions and demographic variables. CONCLUSION: Through the active search method, it was possible to observe the underreporting of adverse reactions, showing inadequate compliance with current legislation, which is essential to minimize errors and increase transfusion safety.

Isotemporal substitution analysis of time between sleep, sedentary behavior, and physical activity on depressive symptoms in older adults: a cross-sectional study

ABSTRACT BACKGROUND: Compared to young individuals, older adults participate more in sedentary behavior (SB) and less in physical activity (PA). These behaviors are associated with numerous adverse health factors. OBJECTIVE: The purpose of the study was to examine the hypothetical effects of substituting time spent sleeping, performing SB, and performing moderate-to-vigorous physical activity (MVPA) on depressive symptomatology in older adults. DESIGN AND SETTING: An analytical cross-sectional study employing exploratory survey methods was conducted in the city of Alcobaça in the state of Bahia, Brazil METHODS: The study included 473 older adults who answered a structured questionnaire during an interview. Exposure time to SB and PA level were assessed using the International Physical Activity Questionnaire, and depressive symptoms were analyzed using the short version of the Geriatric Depression Scale. An isotemporal replacement model was used to evaluate the effects of different SB sessions on depressive symptomatology. RESULTS: An increase in the risk of depressive symptoms was observed when MVPA and sleep time were substituted for the same SB time at all times tested, with maximum values of 40% and 20%, respectively. Opposite substitution of MVPA and sleep time increments reduced the risk of depressive symptomatology by 28% and 17%, respectively. CONCLUSIONS: The results of the present study indicate that replacing SB with the same amount of sleep or MVPA may reduce depressive symptoms. The longer the reallocation time, the greater are the benefits.

Quantification of blood loss for the diagnosis of postpartum hemorrhage: a systematic review and meta-analysis.

OBJECTIVE: to compare the effectiveness of different diagnostic methods to estimate postpartum blood volume loss. METHODS: a systematic review of effectiveness according to PRISMA and JBI Protocol. Searches in PubMed/MEDLINE, LILACS, Scopus, Embase, Web of Science and CINAHL, with descriptor "Postpartum Hemorrhage" associated with keyword "Quantification of Blood Loss". Tabulated extracted data, presented in metasynthesis and meta-analysis was applied to quantitative data. To assess risk of bias, JBI Appraisal Tools were applied. RESULTS: fourteen studies were included, published between 2006 and 2021. Quantification of loss by any method was superior to visual estimation and is highly recommended, however the studies' high heterogeneity did not allow estimating this association. CONCLUSION: the studies' high heterogeneity, with a probable margin of error given the uncontrolled factors, indicates the need for further studies, however quantification proved to be effective in relation to visual estimate. PROSPERO registration CRD 42021234486.

Body mass index and sex differences for mortality in hospitalized COVID-19 patients: a path analysis using a brazilian national database.

Previous studies have shown that associations between obesity and other comorbidities favor worse outcomes in COVID-19. However, it is not clear how these factors interrelate and whether effects on men and women differ. We conducted an observational, cross-sectional study using a national COVID-19 inpatient database. We studied differences in direct and indirect effects of obesity and comorbidities according to sex and body mass index (BMI) categories in hospitalized COVID-19 patients in Brazil using path analysis models and logistic regression. For men, path analysis showed a direct association between BMI and death and a negative correlation of death and chronic cardiovascular disease (CCD). For women, the association of BMI and death was indirect, mediated by admission to the ICU and comorbidities and association with CCD was non-significant. In the logistic regression analyses, there was a positive association between death and BMI, age, diabetes mellitus, kidney and lung diseases and ICU admission. We highlight the need to consider the distinct impact of obesity and sex on COVID-19, of monitoring of BMI and of the design for specific male-targeted approaches to manage obesity.

Associations of Physical Activity and Sedentary Behavior With Survival Time in Older Adults: Path Analysis.

This study investigated the direct and indirect associations of physical activity and sedentary behavior with survival time in older adults. Prospective population-based cohort study used exploratory survey-type methods and physical performance tests in 319 adults aged ≥60 years. Trajectory diagrams were used to represent the initial hypothetical and final models with the relationships of independent, mediating, and dependent variables. Physical activity was indirectly associated with survival time and was mediated by instrumental activities of daily living and functional performance. In contrast, instrumental activities of daily living, functional performance, the number of hospitalizations, and medications mediated the association between duration of sedentary behavior and survival time. The explanatory power of the final model was 19%. Future efforts should focus on increasing the participation and adherence of older adults to exercise programs to improve their physical functions and general health, which may increase their health period and, consequently, their survival time.

Isotemporal substitution of sleep or sedentary behavior with physical activity in the context of frailty among older adults: a cross-sectional study

ABSTRACT BACKGROUND: Frailty syndrome is associated with various physical, cognitive, social, economic, and environmental factors. Although frailty syndrome occurs progressively with age, prevention and treatment are possible. Reducing or eliminating risks and increasing protective factors may be potential strategies for reducing the prevalence of injuries related to frailty. One of the most effective actions is to decrease the time spent in sedentary behavior (SB) by increasing regular physical activity (PA). OBJECTIVE: To examine the hypothetical effect of substitution of the time spent in sleep or SB with an equivalent time spent performing moderate or vigorous PA on frailty syndrome in the older population. DESIGN AND SETTING: An analytical cross-sectional study conducted using exploratory methods of survey, carried out in Alcobaça city, Bahia, Brazil. METHODS: A total of 456 older adults of both sexes, aged ≥ 60 years, participated in this study. Frailty syndrome was identified according to the criteria of the Study of Osteoporotic Fractures. PA and SB were assessed using the International Physical Activity Questionnaire, and sleep was assessed using the Pittsburgh Sleep Quality Index. The effects of time substitution on these behaviors were verified using Poisson regression. RESULTS: The replacement of 60 min/day of SB (prevalence ratio, PR = 0.52; 95% confidence interval, CI: 0.28-0.96) or sleep (PR = 0.52; 95% CI: 0.27-0.98) with 60 min/day of moderate PA (MPA) was associated with a 48% reduction in the prevalence of frailty syndrome. CONCLUSIONS: Replacing the time spent sitting or sleeping with the same amount of MPA time may reduce frailty; the longer the duration of time spent in the substitution of sleep or SB with MPA, the greater the benefits.

Isotemporal substitution of sleep or sedentary behavior with physical activity in the context of frailty among older adults: a cross-sectional study.

BACKGROUND: Frailty syndrome is associated with various physical, cognitive, social, economic, and environmental factors. Although frailty syndrome occurs progressively with age, prevention and treatment are possible. Reducing or eliminating risks and increasing protective factors may be potential strategies for reducing the prevalence of injuries related to frailty. One of the most effective actions is to decrease the time spent in sedentary behavior (SB) by increasing regular physical activity (PA). OBJECTIVE: To examine the hypothetical effect of substitution of the time spent in sleep or SB with an equivalent time spent performing moderate or vigorous PA on frailty syndrome in the older population. DESIGN AND SETTING: An analytical cross-sectional study conducted using exploratory methods of survey, carried out in Alcobaça city, Bahia, Brazil. METHODS: A total of 456 older adults of both sexes, aged ≥ 60 years, participated in this study. Frailty syndrome was identified according to the criteria of the Study of Osteoporotic Fractures. PA and SB were assessed using the International Physical Activity Questionnaire, and sleep was assessed using the Pittsburgh Sleep Quality Index. The effects of time substitution on these behaviors were verified using Poisson regression. RESULTS: The replacement of 60 min/day of SB (prevalence ratio, PR = 0.52; 95% confidence interval, CI: 0.28-0.96) or sleep (PR = 0.52; 95% CI: 0.27-0.98) with 60 min/day of moderate PA (MPA) was associated with a 48% reduction in the prevalence of frailty syndrome. CONCLUSIONS: Replacing the time spent sitting or sleeping with the same amount of MPA time may reduce frailty; the longer the duration of time spent in the substitution of sleep or SB with MPA, the greater the benefits.

Quantification of blood loss for the diagnosis of postpartum hemorrhage: a systematic review and meta-analysis / Cuantificación de la pérdida de sangre para el diagnóstico de hemorragia posparto: revisión sistemática y metanálisis / Quantificação da perda sanguínea para o diagnóstico de hemorragia pós-parto: revisão sistemática e metanálise

ABSTRACT Objective: to compare the effectiveness of different diagnostic methods to estimate postpartum blood volume loss. Methods: a systematic review of effectiveness according to PRISMA and JBI Protocol. Searches in PubMed/MEDLINE, LILACS, Scopus, Embase, Web of Science and CINAHL, with descriptor "Postpartum Hemorrhage" associated with keyword "Quantification of Blood Loss". Tabulated extracted data, presented in metasynthesis and meta-analysis was applied to quantitative data. To assess risk of bias, JBI Appraisal Tools were applied. Results: fourteen studies were included, published between 2006 and 2021. Quantification of loss by any method was superior to visual estimation and is highly recommended, however the studies' high heterogeneity did not allow estimating this association. Conclusion: the studies' high heterogeneity, with a probable margin of error given the uncontrolled factors, indicates the need for further studies, however quantification proved to be effective in relation to visual estimate. PROSPERO registration CRD 42021234486.

RESUMEN Objetivo: comparar la efectividad de diferentes métodos diagnósticos para estimar la pérdida de volumen sanguíneo posparto. Métodos: revisión sistemática de efectividad según PRISMA y Protocolo JBI. Búsquedas en bases de datos: PubMed/MEDLINE, LILACS, Scopus, Embase, Web of Science y CINAHL, con el descriptor "Postpartum Hemorrhage" asociado a la palabra clave "Quantification of Blood Loss". Los datos extraídos tabulados fueron presentados en metasíntesis y metanálisis se aplicaron a los datos cuantitativos. Para evaluar el riesgo de sesgo, se aplicaron las herramientas de evaluación de JBI. Resultados: se incluyeron 14 estudios, publicados entre 2006 y 2021. La cuantificación de pérdida por cualquier método fue superior a la estimación visual y es muy recomendable, sin embargo, la alta heterogeneidad de los estudios no permitió estimar esta asociación. Conclusión: la alta heterogeneidad de los estudios, con probable margen de error dado el descontrol de los factores, indica la necesidad de más estudios, sin embargo la cuantificación demostró ser efectiva en relación a la estimación visual. Registro PRÓSPERO CRD 42021234486.

RESUMO Objetivo: comparar a efetividade de diferentes métodos diagnósticos para estimar a perda volêmica sanguínea pós-parto. Métodos: revisão sistemática de efetividade, de acordo com protocolo PRISMA e JBI. Buscas nas bases PubMed/MEDLINE, LILACS, Scopus, Embase, Web of Science e CINAHL, com o descritor "Postpartum Hemorrhage" associado à palavra-chave "Quantification of Blood Loss". Dados extraídos tabulados, apresentados em metassíntese, e aplicou-se metanálise para dados quantitativos. Para avaliar o risco de viés, aplicou-se o JBI Appraisal Tools. Resultados: incluídos 14 estudos, publicados entre 2006 e 2021. A quantificação da perda por qualquer método apresentou superioridade em relação à estimativa visual, sendo altamente recomendada, porém a alta heterogeneidade dos estudos não permitiu estimar essa associação. Conclusão: a alta heterogeneidade dos estudos, com provável margem de erro dado aos fatores não controlados, indica a necessidade de realização de novos estudos, contudo a quantificação se mostrou efetiva em relação à estimativa visual. Registro PROSPERO CRD 42021234486.

Reallocation of time spent on sedentary behavior by time spent on physical activity reduces dynapenia in older adults: a prospective cohort study

ABSTRACT BACKGROUND: Dynapenia is characterized by mobility limitations in the older population when combined with aggravating behavioral factors that can increase the risk of morbidity and mortality. OBJECTIVE: To investigate the hypothetical effects of reallocation of time spent on sedentary behavior (SB), moderate-to-vigorous physical activity (MVPA), and sleep on dynapenia in older adults. DESIGN AND SETTING: A prospective cohort study using exploratory surveys in Alcobaça City, Bahia State, Brazil. METHODS: In total, 176 older adults (≥ 60 years) of both sexes participated in this study. Dynapenia was assessed using the handgrip strength test with cutoff points of < 27 kg for men and < 16 kg for women. MVPA and SB were assessed using the International Physical Activity Questionnaire, and sleep was assessed using the Pittsburgh Sleep Quality Index. RESULTS: Effects on reallocation were found for the shortest times, such as 10 minutes (odds ratio (OR) 0.92; 95% confidence interval (CI): 0.85-0.99); substituting MVPA with SB increased the chances of dynapenia by 58.0% (95% CI: 1.01-2.49). Analyzing the substitution of 60 minutes/day of SB with 60 minutes/day of MVPA revealed a protective effect, with a lower OR for dynapenia of 37.0% (OR 0.63; 95% CI: 0.40-0.99). The reallocation of sleep time did not significantly reduce dynapenia. CONCLUSIONS: Substituting the time spent sitting with the same amount of time spent on MVPA can reduce dynapenia, and a longer reallocation time confers greater health benefits in older adults.

Reallocation of time spent on sedentary behavior by time spent on physical activity reduces dynapenia in older adults: a prospective cohort study.

BACKGROUND: Dynapenia is characterized by mobility limitations in the older population when combined with aggravating behavioral factors that can increase the risk of morbidity and mortality. OBJECTIVE: To investigate the hypothetical effects of reallocation of time spent on sedentary behavior (SB), moderate-to-vigorous physical activity (MVPA), and sleep on dynapenia in older adults. DESIGN AND SETTING: A prospective cohort study using exploratory surveys in Alcobaça City, Bahia State, Brazil. METHODS: In total, 176 older adults (≥ 60 years) of both sexes participated in this study. Dynapenia was assessed using the handgrip strength test with cutoff points of < 27 kg for men and < 16 kg for women. MVPA and SB were assessed using the International Physical Activity Questionnaire, and sleep was assessed using the Pittsburgh Sleep Quality Index. RESULTS: Effects on reallocation were found for the shortest times, such as 10 minutes (odds ratio (OR) 0.92; 95% confidence interval (CI): 0.85-0.99); substituting MVPA with SB increased the chances of dynapenia by 58.0% (95% CI: 1.01-2.49). Analyzing the substitution of 60 minutes/day of SB with 60 minutes/day of MVPA revealed a protective effect, with a lower OR for dynapenia of 37.0% (OR 0.63; 95% CI: 0.40-0.99). The reallocation of sleep time did not significantly reduce dynapenia. CONCLUSIONS: Substituting the time spent sitting with the same amount of time spent on MVPA can reduce dynapenia, and a longer reallocation time confers greater health benefits in older adults.

Pedometers and Accelerometers in Multiple Sclerosis: Current and New Applications.

Pedometers and accelerometers have become commonplace for the assessment of physical behaviors (e.g., physical activity and sedentary behavior) in multiple sclerosis (MS) research. Current common applications include the measurement of steps taken and the classification of physical activity intensity, as well as sedentary behavior, using cut-points methods. The existing knowledge and applications, coupled with technological advances, have spawned new opportunities for using those motion sensors in persons with MS, and these include the utilization of the data as biomarkers of disease severity and progression, perhaps in clinical practice. Herein, we discuss the current state of knowledge on the validity and applications of pedometers and accelerometers in MS, as well as new opportunities and strategies for the improved assessment of physical behaviors and disease progression, and consequently, personalized care.

Profile of hemotherapy care and the safety of the transfusion process.

OBJECTIVE: This study aimed to evaluate the safety of the transfusion process in a public teaching hospital and to outline the profile of the hemotherapy care provided. METHODS: This was an exploratory, descriptive, and prospective study with a quantitative approach and grounded in field research. Data were obtained from medical and nursing records and active search. RESULTS: Concentrated red blood cells were the most transfused blood component. Inadequate indications of blood components were detected in 15% of Concentrated red blood cells transfusions, 20% of fresh plasma, 29.2% of platelet concentrates, and 36.4% of cryoprecipitates. Filling out the blood component request forms, the nursing checklist and the entry book were inadequate in 88.3, 92.8, and 69.5% of the procedures, respectively. CONCLUSIONS: Faults were identified throughout the transfusion process, revealing inadequate compliance with current standards and legislation, essential in minimizing the occurrence of errors and maximizing the safety of transfusion. Studies of this nature reinforce the need for continued research in this field.

Profile of hemotherapy care and the safety of the transfusion process

SUMMARY OBJECTIVE: This study aimed to evaluate the safety of the transfusion process in a public teaching hospital and to outline the profile of the hemotherapy care provided. METHODS: This was an exploratory, descriptive, and prospective study with a quantitative approach and grounded in field research. Data were obtained from medical and nursing records and active search. RESULTS: Concentrated red blood cells were the most transfused blood component. Inadequate indications of blood components were detected in 15% of Concentrated red blood cells transfusions, 20% of fresh plasma, 29.2% of platelet concentrates, and 36.4% of cryoprecipitates. Filling out the blood component request forms, the nursing checklist and the entry book were inadequate in 88.3, 92.8, and 69.5% of the procedures, respectively. CONCLUSIONS: Faults were identified throughout the transfusion process, revealing inadequate compliance with current standards and legislation, essential in minimizing the occurrence of errors and maximizing the safety of transfusion. Studies of this nature reinforce the need for continued research in this field.

Dynapenia in all-cause mortality and its relationship with sedentary behavior in community-dwelling older adults.

The aim of the present study was to investigate the relationship of dynapenia combined with sedentary behavior (SB) on the risk of mortality in older adults living in a Brazilian community. A total of 322 participants aged ≥ 60 years from the ELSIA (Longitudinal Study of Elderly Health in Alcobaça) prospective cohort were included. Dynapenia was diagnosed when the handgrip strength was < 27 â€‹kg for men and < 16 â€‹kg for women. The exposure time to SB was assessed considering the total time spent sitting during one day in the week and one day on the weekend. When combined with dynapenia, we derived the construction of four groups: best behavior (absence of dynapenia and low SB), intermediate behavior (absence of dynapenia and high SB; presence of dynapenia and low SB) and worst behavior (presence of dynapenia and high SB). Mortality was assessed by the follow-up time until death and/or censorship. During the 5-year follow-up of the study, 55 participants progressed to death. In the adjusted models, the dynapenia and the time spent exposed to SB were analyzed in a combined way, the older adults with worse behavior (high SB and dynapenia) had higher risk ratios for mortality (hazard ratio 2.46; 95% confidence interval 1.01-5.97) than the best behavior group. Older adults with dynapenia are at greater risk for all-cause mortality, which is aggravated by the addition of longer exposure to SB.

Using structural equation modeling in the understanding of functional disability in older adults.

OBJECTIVE: to analyze functional disability and its associated factors among community-dwelling older adults. METHOD: a cross-sectional study, conducted with 1,635 older adults distributed in the following age groups: 60 to 69, 70 to 79, and 80 years old or more, living in a health macro-region of the state of Minas Gerais. Descriptive and trajectory analysis was carried out (p<0.05). The parameters were estimated by the Maximum Likelihood method. RESULTS: the highest percentage was female, with a monthly income of 1 minimum wage and living with a companion. In the age groups from 60 to 69 and from 70 to 79 years old, older adults with a partner predominated; and, among those aged 80 years old or more, widowed individuals prevailed. In the three groups, functional disability occurred hierarchically. Lower schooling, frailty and depressive symptomatology were factors directly associated with functional disability in the advanced activities; frailty and sedentary behavior were directly associated with functional disability in the instrumental activities. In the older adults aged between 60 and 69 years old and from 70 to 79 years old, sedentary behavior was associated with greater dependence on the basic activities. CONCLUSION: the expanded understanding of the factors in the functional disability of the older adults, according to age group, helps the health professional in the development of preventive measures for this disease.

Atividade física para idosos: Guia de Atividade Física para a População Brasileira / Physical activity for older adults: Physical Activity Guidelines for the Brazilian Population

Por iniciativa do Ministério da Saúde, em colaboração com pesquisadores nacionais, elaborou-se o primeiro Guia de Atividade Física (AF) para a População Brasileira, incluindo recomendações para as várias fases da vida e populações especiais. O objetivo deste estudo é apresentar o processo me-todológico e os resultados do capítulo de recomendações de AF para idosos. O Grupo de Trabalho Idosos (GT Idosos) contou com a participação de 11 pesquisadores/profissionais que realizaram reuniões virtuais semanais, revisão sistemática de revisões, que incluiu 50 artigos ao final, e escutas com profissionais de Educação Física (n = 143), gestores (n = 17) e com idosos (n = 22), de todas as regiões do país, por meio de entrevistas telefônicas e formulários eletrônicos. Baseado nos resultados da revisão e das escutas, elaborou-se uma primeira versão das recomendações de AF para idosos, que foi submetida à consulta pública. No total foram recebidas 46 sugestões válidas, das quais 34 foram aceitas e incorporadas ao texto final por possuírem relevância técnica e/ou social. Como resultados, o Guia destaca os principais benefícios da AF para idosos, como melhora dos aspectos físicos, mentais e sociais, e recomenda um mínimo de 150 minutos por semana de AF de intensidade moderada, ou 75 minutos de intensidade vigorosa, considerando as AF no tempo livre, no deslocamento, no trabalho/estudo ou nas tarefas domésticas. Acredita-se que o Guia auxiliará os idosos e profissionais de saúde a conhecerem os benefícios da AF, a quantidade recomendada e as diversas possibilidades de prática, por meio de mensagens e exemplos culturalmente apropriados

At the Ministry of Health initiative, in collaboration with national researchers, the first Physical Activity (PA) Guidelines for the Brazilian Population was prepared, including recommendations for the various stages of life and special populations. This study aims to present the methodological process of the chapter on PA recommendations for the elderly. The Elderly Work Group had 11 researchers/professionals who held weekly virtual meetings, made a systematic review of reviews, which included 50 articles, and promoted a listening among elderly (n = 22), managers (n = 17) and professionals (n = 143) from all country regions, through telephone interviews and online forms. Based on the review and the listening results, a first version of the PA Guidelines for the elderly was elaborated, which was submitted to public consultation. Forty-six valid suggestions were received for the Guide's writing, of which 34 were accepted and incorporated into the final text since they had technical and/or social relevance. As results, the Guidelines highlight the major benefits of PA for the elderly, such as enhancement of the physical, mental and social aspects, and recommends a minimum of 150 minutes of moderate PA or 75 minutes of vigorous PA per week, considering PA in leisure time, commuting and domestic activities, as well as in work/study time. It is believed that these Guidelines will help the elderly and health professionals to get to know the benefits of PA, the recommended amount, and the different possibilities of practice through culturally appropriate messages and examples. Politically, it will reinforce the central role of PA in the prevention and control of chronic non-communicable diseases, boosting actions for its dissemination and implantation

Physical activity, sedentary behavior and functionality in older adults: A cross-sectional path analysis.

Disability is negatively associated with the health of older adults, and it can be mediated by healthy lifestyles and behaviors throughout one's life. In this context, understanding the interrelationships between sedentary behavior, physical activity and functionality may assist in the implementation of effective public health actions. Thus, the aim of the present study was to investigate the relationships between both physical activity and sedentary behavior and functionality in older adults and the possible mediators. The variables analyzed were selected according to the content analysis of International Classification of Functioning, Disability and Health model, and included activity, participation, health conditions, body functions and structures, environmental factors and personal factors. 419 individuals participated in the study. Physical activity was directly associated with disability in instrumental activities of daily living (IADL), and the association was mediated by self-esteem, aerobic endurance, and agility/balance. Sedentary behavior was indirectly associated with IADL disability, and the association was mediated by aerobic resistance, nutritional status, and agility/balance. Regarding the basic activities of daily living (BADL), physical activity showed an indirect association mediated by aerobic resistance and IADL. The association of sedentary behavior with BADL was mediated by aerobic resistance and lower limb flexibility. These results reinforce the idea that functionality is multidimensional, and the mediating factors must be considered when strategies for promoting physical activity and reducing sedentary behavior are designed.

Association of congenital anomalies in live births with their obstetric-neonatal and sociodemographic profiles / Asociación entre anomalías congénitas en nacidos vivos y sus perfiles obstétrico-neonatal y sociodemográfico / Associação de anomalias congênitas em nascidos vivos com seus perfis obstétrico-neonatal e sociodemográfico

ABSTRACT Objective: to identify the association of congenital anomalies in live births with the obstetric-neonatal and sociodemographic profile. Methods: an ecological study, conducted in 2019, with 251,444 live births, identified through the database of the Live Birth Information System of the Minas Gerais Health Secretariat. Descriptive statistics and binary logistic regression were adopted for the analysis. Results: 1,865 cases of anomalies (0.7%) were found, with predominance of deformity of the musculoskeletal system in 789 (42.3%) live births. The variables that presented a significant association with congenital anomalies were single mothers, age ≥35 years old, inadequately performed prenatal care initiated in the third trimester of pregnancy, double (or more) pregnancy, preterm births, cesarean delivery, fetal breech presentation, exclusive assistance by the medical professional during delivery, newborn with high-risk 5-minute Apgar score, low birth weight, and male gender. Conclusion: in 2019, the congenital malformations in the state of Minas Gerais were associated with single women, aged ≥35 years old, who underwent inadequate and late prenatal care, and with double or more pregnancies. In relation to the newborns, the malformations were associated with a high risk for late sequelae, weight between ≤1,000 g and <2.500 g, and male gender.

RESUMEN Objetivo: identificar la asociación entre las anomalías congénitas en nacidos vivos y el perfil obstétrico-neonatal y sociodemográfico. Métodos: estudio ecológico realizado en el año 2019 con 251.444 nacidos vivos, identificados por medio de la base de datos del Sistema de Información sobre Nacidos Vivos de la Secretaría de Salud de Minas Gerais. Para el análisis, se adoptaron estadística descriptiva y regresión logística binaria. Resultados: se encontraron 1.865 casos de anomalías (0,7%), con predominio de deformidad del sistema osteomuscular en 789 (42,3%) nacidos vivos. Las variables que presentaron una asociación significativa con las anomalía congénitas fueron las siguientes: madres solteras, edad ≥35 años, cursar atención pre-natal inadecuada e iniciada en el tercer trimestre de embarazo, embarazo de gemelos o más bebés, nacimientos prematuros, parto por cesárea, presentación fetal pelviana, asistencia exclusiva de un médico durante el parto, recién nacido con Apgar de alto riesgo al quinto minuto, bajo peso al nascer y sexo masculino. Conclusión: en el año 2019, las malformaciones congénitas en el estado de Minas Gerais estuvieron asociadas a mujeres solteras, con edad ≥35 años, que cursaron atención pre-natal inadecuada y tardía, con embarazos de gemelos o más bebés. En relación con los recién nacidos, las malformaciones estuvieron asociadas con alto riesgo de secuelas tardías, peso entre ≤1.000 g y <2.500 g y ser del sexo masculino.

RESUMO Objetivo: identificar a associação das anomalias congênitas em nascidos vivos com o perfil obstétrico-neonatal e sociodemográfico. Método: estudo ecológico, realizado em 2019, com 251.444 nascidos vivos, identificados por meio do banco de dados do Sistema de Informações de Nascidos Vivos da Secretaria de Saúde de Minas Gerais. Para análise, adotaram-se a estatística descritiva e a regressão logística binária. Resultados: foram encontrados 1.865 casos de anomalias (0,7%), com predominância de deformidade do sistema osteomuscular em 789 (42,3%) nascidos vivos. As variáveis que apresentaram associação significativa com a anomalia congênita foram mães solteiras, idade ≥35 anos, pré-natal realizado de forma inadequada, iniciado no terceiro trimestre de gestação, gestação dupla ou mais, nascimentos pré-termo, parto cesárea, apresentação fetal pélvica, assistência exclusiva do profissional médico durante o parto, recém-nascido com Apgar de alto risco no quinto minuto, baixo peso ao nascer e sexo masculino. Conclusão: em 2019, as malformações congênitas no estado de Minas Gerais associaram-se às mulheres solteiras, com idade ≥35 anos, que realizaram pré-natal inadequado e tardio, com gestações duplas ou mais. Em relação aos recém-nascidos, as malformações foram associadas com alto risco para sequelas tardias, peso entre ≤1.000g e <2.500g e ser do sexo masculino.

Using structural equation modeling in the understanding of functional disability in older adults / Uso da modelagem de equações estruturais na compreensão da incapacidade funcional em idosos / Uso de modelos de ecuaciones estructurales para comprender la incapacidad funcional en los adultos mayores

Objective: to analyze functional disability and its associated factors among community-dwelling older adults. Method: a cross-sectional study, conducted with 1,635 older adults distributed in the following age groups: 60 to 69, 70 to 79, and 80 years old or more, living in a health macro-region of the state of Minas Gerais. Descriptive and trajectory analysis was carried out (p<0.05). The parameters were estimated by the Maximum Likelihood method. Results: the highest percentage was female, with a monthly income of 1 minimum wage and living with a companion. In the age groups from 60 to 69 and from 70 to 79 years old, older adults with a partner predominated; and, among those aged 80 years old or more, widowed individuals prevailed. In the three groups, functional disability occurred hierarchically. Lower schooling, frailty and depressive symptomatology were factors directly associated with functional disability in the advanced activities; frailty and sedentary behavior were directly associated with functional disability in the instrumental activities. In the older adults aged between 60 and 69 years old and from 70 to 79 years old, sedentary behavior was associated with greater dependence on the basic activities. Conclusion: the expanded understanding of the factors in the functional disability of the older adults, according to age group, helps the health professional in the development of preventive measures for this disease.

Objetivo: analisar a incapacidade funcional e seus fatores associados entre idosos na comunidade. Método: estudo transversal, com 1.635 idosos distribuídos nas faixas etárias: 60 a 69, 70 a 79 e 80 ou mais, residentes em uma macrorregião de saúde do Estado de Minas Gerais. Procedeu-se à análise descritiva e de trajetórias (p<0,05). Os parâmetros foram estimados pelo método da Máxima Verossimilhança. Resultados: o maior percentual era do sexo feminino, com renda mensal de 1 salário mínimo e morava acompanhado. Nas faixas etárias de 60 a 69 e 70 a 79 anos predominaram os idosos com companheiro, e entre aqueles com 80 anos ou mais os viúvos. Nos três grupos, a incapacidade funcional se deu de forma hierárquica. A menor escolaridade, a fragilidade e a sintomatologia depressiva foram fatores associados diretamente à incapacidade funcional nas atividades avançadas; a fragilidade e o comportamento sedentário associaram-se diretamente à incapacidade funcional nas atividades instrumentais. Nos idosos com idade entre 60 e 69 anos e 70 a 79 anos, o comportamento sedentário associou-se à maior dependência nas atividades básicas. Conclusão: a compreensão ampliada dos fatores atuantes na incapacidade funcional dos idosos, segundo faixa etária, auxilia o profissional de saúde no desenvolvimento de medidas preventivas desse agravo.

Objetivo: analizar la incapacidad funcional y sus factores asociados entre adultos mayores de la comunidad. Método: estudio transversal, con 1.635 adultos mayores distribuidos en rangos etarios: 60 a 69, 70 a 79 y 80 o más, residentes en una macrorregión de salud del Estado de Minas Gerais. Se realizó análisis descriptivo y de trayectoria (p<0,05). Los parámetros se estimaron mediante el método de máxima verosimilitud. Resultados: el mayor porcentaje fue de sexo femenino, con un ingreso mensual de 1 salario mínimo y vivía acompañado. En los rangos etarios de 60 a 69 y de 70 a 79 años predominaron los adultos mayores con pareja, y entre los de 80 años o más, los viudos. En los tres grupos, la incapacidad funcional se presentó de forma jerárquica. Menor educación, fragilidad y síntomas de depresión fueron factores directamente asociados con la incapacidad funcional en actividades avanzadas; la fragilidad y el sedentarismo se asociaron directamente con la incapacidad funcional en las actividades instrumentales. En los adultos mayores de 60 y 69 años y de 70 a 79 años, el sedentarismo se asoció con una mayor dependencia de las actividades básicas. Conclusión: una mayor comprensión de los factores que influyen en la incapacidad funcional del adulto mayor, según el rango etario, ayuda a los profesionales de la salud en el desarrollo de medidas preventivas de esta enfermedad.