Burden of metabolic syndrome on primary healthcare costs among older adults: A cross-sectional study.

BACKGROUND: The impact of metabolic syndrome (MetS) on healthcare costs remains unclear in the literature. OBJECTIVES: To determine the impact of MetS on primary healthcare costs of adults, as well as to identify the impact of physical activity and other covariates on this phenomenon. DESIGN AND SETTING: This cross-sectional study was conducted in the city of Presidente Prudente, State of São Paulo/Brazil, in 2016. METHODS: The sample comprised 159 older adults (> 50 years) of both sexes (110 women) who were identified from their medical records in the Brazilian National Health Service. Healthcare costs (US$) were assessed through medical records and divided into medical consultations, medications, laboratory tests, and total costs. MetS was assessed using medical records. RESULTS: The Brazilian National Health Service spent more on consultations (US$ 22.75 versus US$ 19.39; + 17.3%) and medication (US$ 19.65 versus US$ 8.32; + 136.1%) among adults with MetS than among those without MetS, but the costs for laboratory tests were similar (P = 0.343). Total costs were 53.9% higher in adults with MetS than in those without the diagnosis of the disease (P = 0.001). Regarding total costs, there was an increase of US$ 38.97 when five components of MetS were present (P = 0.015), representing an increase of approximately 700%, even after adjusting for sex, age, and physical activity. CONCLUSION: In conclusion, the presence of the MetS is responsible for increasing primary care costs among older adults, especially in those related to medicines.

The impact of early sports participation on body fatness in adulthood is not mediated by current physical activity.

OBJECTIVE: The aim was to analyze the relationship between early sports participation (ESP) and body fatness (BF) in adults, as well as to identify whether this possible relationship is directly influenced by the current physical activity (PA) level. METHODS: This cross-sectional study combined baseline data of two cohort. The BF estimated by DXA. The ESP, the subjects reported the engagement in sports during childhood (7-10 years) and adolescence (11-17 years) through two yes/no questions and current PA (described as steps) was device-measured using pedometers. Were identified as potential covariates and therefore adjusted the multivariate models: age, ethnicity, alcohol consumption, smoking, and sleep quality. Statistical analysis consisted of the chi-square test, analysis of variance/covariance, and structural equation modeling (software BioEstat version 5.0; p-value < .05). RESULTS: Adults engaged in ESP had lower BF; among women, the variance in BF explained by ESP was 25.5%; among men, it was 9.2%. Sports participation in early life (r = -.436 [95% CI: -0.527 to -0.346]) and current PA (r = -.431 [95% CI: -0.522 to -0.340]) were inversely related to BF, as well as positively related to each other (r = .328 [95% CI: 0.226 to 0.430]). In the mediation model, current PA partially mediated (18.5%) the impact of ESP on BF, while current PA and ESP remained relevant determinants of BF. CONCLUSION: Early sports participation and current PA have a significant impact on BF in adulthood, which is of similar magnitude and independent of each other.

Impact of cycling and walking on adiposity and healthcare costs among adults: longitudinal study / Impacto do ciclismo e da caminhada na adiposidade e nos custos de saúde em adultos: estudo longitudinal / Impacto de andar en bicicleta y caminar sobre la adiposidad y los costos de salud en adultos: estudio longitudinal

Abstract: Leisure-time physical activity seems relevant to prevent the development of chronic diseases and obesity. However, not much is known about the economic burden of these healthy behaviors, mainly in longitudinal designs. This study aimed to analyze the impact of walking and cycling on leisure-time on adiposity and healthcare costs among adults. This longitudinal study was conducted at a medium-size Brazilian city and included 198 participants with no missing data attended in the Brazilian Unified National Health System. Cycling and walking were assessed by a questionnaire with a face-to-face interview at four time-points (baseline, 6-month, 12-month, and 18-month). Healthcare costs were assessed using medical records. Adiposity markers included waist circumference and body fatness. Over the follow-up period, participants who were more engaged in cycling presented lower body fatness (p-value = 0.028) and healthcare costs (p-value = 0.038). However, in the multivariate model, the impact of cycling on costs was not significant (p-value = 0.507) due to the impact of number of chronic diseases (p-value = 0.001). Cycling on leisure-time is inversely related to adiposity in adults, whereas its role on preventing chronic diseases seems the main pathway linking it to cost mitigation.

Resumo: A atividade física no lazer parece relevante para prevenir o desenvolvimento de doenças crônicas e obesidade. No entanto, pouco se sabe sobre o impacto econômico destes comportamentos saudáveis, principalmente em estudos longitudinais. O objetivo deste estudo foi analisar o impacto da caminhada e do ciclismo como atividades de lazer na adiposidade e nos custos de saúde em adultos. Este estudo longitudinal foi realizado em uma cidade brasileira de médio porte e incluiu 198 participantes sem dados indisponíveis atendidos no Sistema Único de Saúde brasileiro. A caminhada e o ciclismo foram avaliados por meio de questionário e entrevista presencial em quatro momentos (linha de base, 6 meses, 12 meses e 18 meses). Os custos de saúde foram avaliados por meio de prontuários médicos. Os marcadores de adiposidade incluíram circunferência da cintura e gordura corporal. Durante o período de acompanhamento, os participantes que praticavam mais ciclismo apresentaram menos gordura corporal (p = 0,028) e custos de saúde (p = 0,038). Porém, no modelo multivariado, o impacto do ciclismo nos custos deixou de ser significativo (p = 0,507) devido ao impacto do número de doenças crônicas (p = 0,001). O ciclismo no momento de lazer está inversamente relacionado à adiposidade em adultos, enquanto o seu papel na prevenção de doenças crônicas parece ser o principal aspecto que o liga à redução de custos.

Resumen: La actividad física en el ocio parece relevante para prevenir el desarrollo de enfermedades crónicas y la obesidad. Sin embargo, poco se sabe sobre el impacto económico de estos comportamientos saludables, especialmente en estudios longitudinales. El objetivo de este estudio fue analizar el impacto de caminar y andar en bicicleta como actividades de ocio sobre la adiposidad y los costos de salud en adultos. Este estudio longitudinal se llevó a cabo en una ciudad brasileña de tamaño mediano e incluyó a 198 participantes sin datos indisponibles atendidos en el Sistema Único de Salud brasileño. Se evaluaron los hábitos de caminar y andar en bicicleta mediante un cuestionario y una entrevista cara a cara en cuatro momentos (inicial, 6 meses, 12 meses y 18 meses). Los costos de atención médica se evaluaron utilizando registros médicos. Los marcadores de adiposidad incluyeron la circunferencia de la cintura y la grasa corporal. Durante el período de seguimiento, los participantes que practicaban más ciclismo presentaron menos grasa corporal (p = 0,028) y costos de salud (p = 0,038). Sin embargo, en el modelo multivariado, el impacto del ciclismo en los costos dejó de ser significativo (p = 0,507) debido al impacto del número de enfermedades crónicas (p = 0,001). El hábito de andar en bicicleta en los momentos de ocio está inversamente relacionado con la adiposidad en los adultos, mientras que su papel en la prevención de enfermedades crónicas parece ser el principal aspecto que lo vincula con la reducción de costos.

Combined association of insufficient physical activity and sleep problems with healthcare costs: a longitudinal study

ABSTRACT BACKGROUND: The magnitude of economic losses attributed to sleep problems and insufficient physical activity (PA) remains unclear. This study aimed to investigate the association between insufficient PA, sleep problems, and direct healthcare costs. OBJECTIVE: To investigate the association between insufficient physical activity (PA), sleep problems, and direct healthcare costs among adults. DESIGN AND SETTING: Adults aged ≥ 50 years attended by the Brazilian National Health Service were tracked from 2010 to 2014. METHODS: Direct healthcare costs were assessed using medical records and expressed in US$. Insufficient PA and sleep problems were assessed through face-to-face interviews. Differences were identified using the analysis of covariance and variance for repeated measures. RESULTS: In total, 454 women and 166 men were enrolled. Sleep problems were reported by 28.9% (95%CI: 25.2% to 32.4%) of the sample, while insufficient PA was reported by 84.8% (95%CI: 82.1% to 87.6%). The combination of sleep problems and insufficient PA explained 2.3% of all healthcare costs spent on these patients from 2010 to 2014, which directly accounts for approximately US$ 4,765.01. CONCLUSION: The combination of sleep problems and insufficient PA plays an important role in increasing direct healthcare costs in adults. Public health stakeholders, policymakers, and health professionals can use these results to reinforce the need for strategies to improve sleep quality and increase PA, especially in nations that finance their National Health Systems.

Burden of metabolic syndrome on primary healthcare costs among older adults: A cross-sectional study

ABSTRACT BACKGROUND: The impact of metabolic syndrome (MetS) on healthcare costs remains unclear in the literature. OBJECTIVES: To determine the impact of MetS on primary healthcare costs of adults, as well as to identify the impact of physical activity and other covariates on this phenomenon. DESIGN AND SETTING: This cross-sectional study was conducted in the city of Presidente Prudente, State of São Paulo/Brazil, in 2016. METHODS: The sample comprised 159 older adults (> 50 years) of both sexes (110 women) who were identified from their medical records in the Brazilian National Health Service. Healthcare costs (US$) were assessed through medical records and divided into medical consultations, medications, laboratory tests, and total costs. MetS was assessed using medical records. RESULTS: The Brazilian National Health Service spent more on consultations (US$ 22.75 versus US$ 19.39; + 17.3%) and medication (US$ 19.65 versus US$ 8.32; + 136.1%) among adults with MetS than among those without MetS, but the costs for laboratory tests were similar (P = 0.343). Total costs were 53.9% higher in adults with MetS than in those without the diagnosis of the disease (P = 0.001). Regarding total costs, there was an increase of US$ 38.97 when five components of MetS were present (P = 0.015), representing an increase of approximately 700%, even after adjusting for sex, age, and physical activity. CONCLUSION: In conclusion, the presence of the MetS is responsible for increasing primary care costs among older adults, especially in those related to medicines.

Qualidade de vida e comportamentos durante a pandemia da COVID-19: Um estudo transversal / Quality of life and behaviors during the COVID-19 pandemic: A cross-sectional study

Pesquisa transversal com objetivo de analisar a associação entre qualidade de vida e comportamentos desenvolvidos por indivíduos hipertensos durante o período de isolamento social, devido à pandemia da COVID-19. O estudo foi realizado através de ligações telefônicas e avaliou adultos cadastrados na atenção primária de saúde. A prática de atividade física foi avaliada pelo Questionário Internacional de Atividade Física, sendo somadas a duração e a frequência das atividades e o tempo total sentado durante a semana e fim de semana. A qualidade de vida foi analisada através do Sistema Descritivo ­ EQ-5D, considerando o score utilidade e o estado geral de saúde. Presença de doenças e comportamentos durante o isolamento social, assim como aspecto emocional e ambiente para realização de atividades físicas foram analisados. Foram utilizados os testes t de Studant e ANOVA one way para comparação de grupos e ANCOVA para comparações entre os grupos ajustadas. A significância estatística foi pré-fixada em valores inferiores a 5%. Foram entrevistados 659 hipertensos, com idade entre 41 e 93 anos. Observou-se maior qualidade de vida naqueles que praticaram exercício físico (p = 0,015), que não relataram ter a saúde emocional afetada pela pandemia (p = 0,001) e que responderam ter ambiente favorável em casa para prática de atividade física, (p = 0,001). Em conclusão, a qualidade de vida associou-se aos comportamentos positivos dos participantes durante a pandemia, como a prática de atividade física, contudo é necessário que os órgãos públicos se atentem aos baixos níveis de atividade física da população provocados pela pandemia

Cross-sectional research with the objective of analyzing the association between quality of life and behaviors developed by hypertensive individuals during the period of social isolation, due to the COVID-19 pandemic. The study was carried out through telephone calls and evaluated adults registered in primary health care. The practice of physical activity was assessed by the International Physical Activity Questionnaire, adding the duration and frequency of activities and the total time sitting during the week and weekend. Quality of life was analyzed using the Descriptive System ­ EQ-5D, considering the utility score and general health status. Presence of diseases and behaviors during social isolation, as well as the emotional aspect and environment for carrying out physical activities were analyzed. Student's t-test and one-way ANOVA were used for group comparisons and ANCOVA for adjusted between-group comparisons. Statistical significance was pre-set at values below 5%. 659 hypertensive adults aged between 41 and 93 years were interviewed. A better quality of life was observed in hypertensive individuals who practiced physical exercise (p = 0.015), who did not report having their emotional health affected by the pandemic (p = 0.001) and who responded that they had a favorable environment at home for the practice of physical activity, (p = 0.001). In conclusion, QoL was associated with the positive behaviors of the participants during the pandemic, such as the practice of physical activity, however, it is necessary for public agencies to pay attention to the low levels of PA in the population caused by the pandemic

Association between patterns of sedentary time and academic performance in adolescents: the mediating role of self-concept / Associação entre o padrão do tempo sedentário e o desempenho acadêmico em adolescentes: o papel mediador do autoconceito

Abstract Objective: To analyze the association between the pattern of sedentary time (bouts and breaks) with academic performance, with an emphasis on the mediating role of self-concept. Methods: Participants in the cross-sectional study were 394 adolescents (208 girls), aged 10-14 years, from sixth grade from Londrina, Paraná, Brazil. The sedentary time pattern was measured through accelerometry. Definitions: sedentary bouts — uninterrupted periods of sedentary behavior; breaks — non-sedentary period between two sedentary bouts. The self-concept was estimated using the Piers-Harris II Inventory. Academic performance was obtained by school grades. Results: Short sedentary bouts were associated with higher academic performance in boys (1-4 minutes: β=0.035, p=0.007) and girls (1-4 minutes: β=0.031, p=0.014; 5-14 minutes: β=0.054, p=0.001). Long bouts (30 minutes) were associated with lower academic performance in boys (β=-0.023; p=0.011) and girls (β=-0.032; p<0.001). For girls, total and intellectual self-concept mediated the association between all sedentary pattern and academic performance (bouts 1-4 minutes [total: 39% and intellectual: 42.8%]; bouts 5-14 minutes [total: 21.5% and intellectual: 35.4%]; bouts ≥30 minutes [total: 22.6% and intellectual: 32.3%]; and breaks [total: 38.9% and intellectual: 40.7%]). For boys, the total (56.4%) and intellectual (82.9%) self-concept mediated only the association between bouts of 5-14 minute and academic performance. Conclusions: The pattern of sedentary time is associated with academic performance in adolescents and this association is mediated by self-concept, especially in girls.

Resumo Objetivo: Analisar a associação entre o padrão do tempo sedentário (bouts e breaks) e o desempenho acadêmico, com ênfase no papel mediador do autoconceito. Métodos: Participaram deste estudo transversal 394 adolescentes (208 moças), de 10 a 14 anos, da sexta série de Londrina, Paraná, Brasil. O padrão do tempo sedentário foi obtido por meio de acelerometria. Definições: bouts sedentários — períodos ininterruptos em comportamento sedentário; breaks — período não sedentário entre duas séries sedentárias. O autoconceito foi estimado usando o Inventário Piers-Harris II. O desempenho acadêmico foi obtido pelas notas escolares. Resultados: Bouts sedentários curtos foram associados com maior desempenho acadêmico em rapazes (1-4 minutos: β=0,035, p=0,007) e moças (1-4 minutos: β=0,031, p=0,014; 5-14 minutos: β=0,054, p=0,001). Bouts longos (30 minutos) foram associados a menor desempenho acadêmico em rapazes (β=-0,023; p=0,011) e moças (β=-0,032; p<0,001). Para as moças, o autoconceito total e intelectual mediou a associação entre todos os padrões sedentários e o desempenho acadêmico (bouts de 1-4 minutos [total: 39% e intelectual: 42,8%]; bouts de 5-14 minutos [total: 21,5% e intelectual: 35,4%]; bouts ≥30 minutos [total: 22,6% e intelectual: 32,3%]; e breaks [total: 38,9% e intelectual: 40,7%]). Para os rapazes, o autoconceito total (56,4%) e intelectual (82,9%) mediaram apenas a associação entre bouts de 5-14 minutos e desempenho acadêmico. Conclusões: O padrão do tempo sedentário está associado ao desempenho acadêmico em adolescentes, e essa associação é mediada pelo autoconceito, principalmente em moças.

Association of parents' physical activity and weight status with obesity and metabolic risk of their offspring / Associação do status de atividade física e peso dos pais com os indicadores de obesidade e risco metabólico dos filhos

Abstract Our aim was to analyze the joint association of parental characteristics and offspring obesity indicators with metabolic risk in adolescents. A cross-sectional study was carried out with 972 adolescents and their parents. We observed that overweight adolescents who have a normal weight mother show lower metabolic risk in comparison with their counterparts with overweight mothers. In conclusion, mother's weight status moderates the relationship between offspring' obesity indicators and metabolic risk in adolescents.

Resumo Nosso objetivo foi analisar a associação combinada entre características dos pais e indicadores de adiposidade dos filhos com o risco metabólico em adolescentes. Foi realizado estudo transversal com 972 adolescentes e seus pais. Observamos que adolescentes com sobrepeso que possuem mãe com peso normal apresentaram menor risco metabólico em comparação com seus pares com mães que apresentam sobrepeso. Concluímos que o status de peso da mãe modera a relação entre indicadores de obesidade e risco metabólico dos adolescentes.

Ballet clássico adaptado para mulher com hérnia de disco na região lombar: um relato de caso / Classical ballet adapted for women with disc herniation in the lower back: case report

Introdução: A hérnia discal lombar é o diagnóstico mais comum dentre as alterações degenerativas da coluna lombar. Dentre diversas formas de prevenção e tratamento para hérnia de disco, estão anti-inflamatórios, fisioterapia, acupuntura, antidepressivos, morfina e psicoterapia. O exercício físico pode ser efetivo, de baixo custo e um meio não farmacológico no tratamento. No entanto, existem muitas barreiras para a aceitação no uso específico da atividade física fora do ambiente clínico, como a dança e o esporte. Objetivo: Esse estudo de caso teve como objetivo analisar as contribuições do ballet clássico adaptado para a melhoria do quadro clínico da hérnia de disco lombar. Método: O estudo de caso foi composto por um roteiro feito pelos avaliadores e utilizado em uma mulher com 32 anos de idade, sem experiência na prática do Ballet Clássico. Os exercícios tiveram duração de 13 semanas, realizadas duas vezes por semana (duas horas em cada sessão), totalizando 26 sessões e um total de 52 horas de intervenção. Resultados: Mediante aos laudos médicos de ressonância magnética obtida pós-intervenção, constatou-se que, em relação ao exame anterior, houve redução das dimensões da hérnia discal no nível L4-L5. Já a escala de avaliação de dor visual analógica (EVA) foi de "dor máxima" no período pré intervenção para "sem dor" no pós intervenção. A escala de dor visual numérica (EVN) pré intervenção foi estabelecida em 9 "com dor" e pós intervenção em 2 "sem dor". A escala de dor de facial (EDF) pré intervenção foi estabelecida em fator 6 "com dor" e pós intervenção como fator 2 "sem dor". Conclusão: É possível concluir que após realização do programa de Ballet Clássico adaptado foi possível observar a diminuição dos valores na escala de dor e na dimensão da hérnia de disco da paciente avaliada.

Introduction: A herniated disc in the lower back is the most common diagnosis among degenerative alterations in the lumbar spine. Various forms of treatment for improvement of lumbar disc herniation, such as anti-inflammatories, physical therapy, acupuncture, antidepressants, morphine, and cognitive behavioral therapy. The physical exercise is an effective, inexpensive, and non-pharmacological tool. Although, there are still several barriers to accepting the use of specific physical exercises outside the clinical environment, such as dance and sports. Objective: This study aimed to analyze the contributions of classical ballet adapted to improve the clinical framework of lumbar disc herniation in a beginner student of classical ballet. Method: The case study composed for one script made by the evaluators was applied to an adult woman with 32 years old, who until that point had not practiced classical ballet. The exercises were performed twice a week (two hours for session) for a period of 13 weeks, totaling 26 sessions, giving a total exposure during the intervention of 52 hours. Results: The magnetic image obtained from medical reports after the intervention found that compared to the previous examination the disc herniation at level L4 ­ L5 was reduced in size. In addition, the visual analog pain scale (EVA) assessment pre intervention was maximum pain and post intervention was no pain. The numeric pain scale rating (NPS) pre intervention was number 9 with pain, and post intervention, number 2 painless. The Faces Pain Scales (FPS) pre intervention had a factor of 6 with pain, and post-intervention factor 2, painless. Conclusion: It is possible to conclude that the present script made by the evaluators was sufficient for cause the of herniation reduction in the evaluated patient post intervention.

Self-perceived social relationships are related to health risk behaviors and mental health in adolescents.

Although changes have been observed in social relationships in the recent years, especially among younger generations, little evidence is available concerning factors associated with adolescents' perceived social relationships. In this study we investigated the association between self-perceived social relationships, health-related behaviors, biological maturation, and mental health in adolescents. This is a cross-sectional study conducted with 1,336 adolescents (605 boys and 731 girls) aged between 10 to 17 years from public schools. Self-perceived social relationships (family, friends, and teachers), feelings of stress and sadness, academic performance, tobacco smoking, alcohol and fat consumption, physical activity, and screen time were evaluated by a questionnaire. Biological maturation was assessed by the peak height velocity. We observed that worse perceived social relationships were associated with tobacco smoking (family and teachers), alcohol drinking (teachers), higher consumption of fat (teachers), greater feelings of stress (family and teachers) and sadness (family and friends), and poor academic achievement (friends and teachers).

Self-perceived social relationships are related to health risk behaviors and mental health in adolescents / A percepção dos relacionamentos sociais está relacionada à comportamentos de risco associados à saúde e à saúde mental em adolescentes

Abstract Although changes have been observed in social relationships in the recent years, especially among younger generations, little evidence is available concerning factors associated with adolescents' perceived social relationships. In this study we investigated the association between self-perceived social relationships, health-related behaviors, biological maturation, and mental health in adolescents. This is a cross-sectional study conducted with 1,336 adolescents (605 boys and 731 girls) aged between 10 to 17 years from public schools. Self-perceived social relationships (family, friends, and teachers), feelings of stress and sadness, academic performance, tobacco smoking, alcohol and fat consumption, physical activity, and screen time were evaluated by a questionnaire. Biological maturation was assessed by the peak height velocity. We observed that worse perceived social relationships were associated with tobacco smoking (family and teachers), alcohol drinking (teachers), higher consumption of fat (teachers), greater feelings of stress (family and teachers) and sadness (family and friends), and poor academic achievement (friends and teachers).

Resumo Apesar das mudanças observadas nos relacionamentos sociais nos últimos anos, especialmente entre as gerações mais novas, pouca evidência está disponível sobre os fatores associados à percepção dos relacionamentos sociais. Neste estudo nós investigamos a associação entre a percepção das próprias relações sociais, comportamentos associados à saúde, maturação biológica e indicadores de saúde mental em adolescentes. Este é um estudo transversal conduzido com 1.336 adolescentes (605 meninos e 731 meninas) com idades entre 10 e 17 anos, alunos de escolas públicas. A percepção dos relacionamentos sociais (família, amigo e professores), frequência de sentimentos de estresse e tristeza, o desempenho acadêmico, consumo de álcool, tabaco e alimentos gordurosos, bem como o nível de atividade física e tempo de tela foram avaliados por questionário. A maturação biológica foi estimada a partir do pico de velocidade de crescimento. Observamos que as piores relações sociais percebidas estiveram relacionadas ao consumo de tabaco (família e professores), de álcool (professores), alto consumo de alimentos gordurosos (professores), sentimentos de estresse (família e professores) e de tristeza (família e amigos) mais frequentes, e pior percepção do desempenho acadêmico (amigos e professores).

Characterization of subclinical diastolic dysfunction by cardiac magnetic resonance feature-tracking in adult survivors of non-Hodgkin lymphoma treated with anthracyclines.

BACKGROUND: The use of anthracycline-based chemotherapy is associated with the development of heart failure, even years after the end of treatment. Early detection of cardiac dysfunction could identify a high-risk subset of survivors who would eventually benefit from early intervention. Cardiac magnetic resonance feature-tracking (CMR-FT) analysis offers a practical and rapid method to calculate systolic and diastolic strains from routinely acquired cine images. While early changes in systolic function have been described, less data are available about late effects of chemotherapy in diastolic parameters by CMR-FT. The main goal of this study was to determine whether left ventricular (LV) early diastolic strain rates (GDSR-E) by CMR-FT are impaired in long-term adult survivors of non-Hodgkin lymphoma (NHL). Our secondary objective was to analyze associations between GDSR-E with cumulative anthracycline dose, systolic function parameters and myocardial tissue characteristics. METHODS: This is a single center cross-sectional observational study of asymptomatic patients in remission of NHL who previously received anthracycline therapy. All participants underwent their CMR examination on a 3.0-T scanner, including cines, T2 mapping, T1 mapping and late gadolinium enhancement imaging. Derived myocardial extracellular volume fraction was obtained from pre- and post-contrast T1 maps. CMR-FT analysis was performed using Trufi Strain software. The data obtained were compared between anthracycline group and volunteers without cardiovascular disease or neoplasia. RESULTS: A total of 18 adult survivors of NHL, 14 (77.8%) males, at mean age of 57.6 (± 14.7) years-old, were studied 88.2 (± 52.1) months after exposure to anthracycline therapy (median 400 mg/m2). Compared with controls, anthracycline group showed impaired LV global early diastolic circumferential strain rate (GCSR-E) [53.5%/s ± 19.3 vs 72.2%/s ± 26.7, p = 0.022], early diastolic longitudinal strain rate (GLSR-E) [40.4%/s ± 13.0 vs 55.9%/s ± 17.8, p = 0.006] and early diastolic radial strain rate (GRSR-E) [- 114.4%/s ± 37.1 vs - 170.5%/s ± 48.0, p < 0.001]. Impaired LV GCSR-E, GLSR-E and GRSR-E correlated with increased anthracycline dose and decreased systolic function. There were no correlations between GDSR-E and myocardial tissue characteristics. CONCLUSIONS: Left ventricular early diastolic strain rates by CMR-FT are impaired late after anthracycline chemotherapy in adult survivors of non-Hodgkin lymphoma.

Impact of physical activity during weekdays and weekends on fat mass among adults: 12-month cohort study

ABSTRACT BACKGROUND: Physical activity (PA) practices seem to differ between weekdays and weekends and these pattern changes can affect body fat differently. However, previous studies did not assess the mediation effect of weekday and weekend PA on maintenance of body fat using sophisticated statistical models. OBJECTIVE: To analyze the mediation effect of PA during weekdays and weekends on maintenance of fat mass over a 12-month follow-up. DESIGN AND SETTING: Longitudinal cohort study (12 months) conducted at a public university in Presidente Prudente, Brazil. METHODS: A sample of 225 adults (117 females) was used. Body fatness and fat mass were assessed using dual-energy X-ray absorptiometry. PA levels were assessed using a pedometer. The statistical analysis consisted of paired-sample t tests, independent-sample t tests, Pearson correlations and mediation models. RESULTS: After 12 months, weekend PA had decreased while body composition indicators remained stable (without changes). The correlation between fat mass at baseline and follow-up was high for both sexes (men: 0.966; women: 0.941; P-value = 0.001 for both). Moreover, PA indices were inversely but moderately related to fat mass at baseline and follow-up. Lastly, weekend PA mediated the association between fat mass at baseline and follow-up (P-value < 0.05) by around 2% and 4%. CONCLUSION: Weekend PA mediated the association between fat mass at baseline and fat mass after one year of follow-up among these adults. Further studies are required to investigate the association between physical activity, body fat and other variables such as dietary patterns and sleep time.

Association of sedentary behaviour patterns with dietary and lifestyle habits among public school teachers: a cross-sectional study.

OBJECTIVES: To analyse the association of sedentary behaviour patterns with dietary and lifestyle habits among public school teachers. DESIGN: Cross-sectional study. PARTICIPANTS: A sample of 245 teachers (186 women and 59 men) with mean age of 45.2 (±10.4) were randomly selected from public schools. PRIMARY AND SECONDARY OUTCOME MEASURE: Sedentary behaviour was assessed by hours spent watching television, computer and cellphone/tablet use and in sitting position. Sedentary breaks were reported in a Likert scale in domains of work and leisure time. Dietary habits were assessed by weekly consumption of fruits, vegetables, dairy products, fried foods, sweets, grains, cereals, white meat, soft drinks and snacks. Physical activity, smoking, alcohol consumption and socioeconomic status were assessed by using questionnaires. RESULTS: The prevalence of high sedentary behaviour, high sedentary breaks at work and at leisure was 57.9%, 67.7% and 70.2% in the sample, respectively. No relationship was observed of high sedentary behaviour with dietary and lifestyle habits in adjusted analysis. However, high sedentary breaks at work were associated with high consumption of dairy products (OR=1.93 (CI 1.07 to 3.51)) and cereals (OR=2.49 (CI 1.05 to 5.92)) and with being high physically active (OR=2.57 (CI 1.14 to 5.77)). High sedentary breaks at leisure time were associated with high consumption of fruits (OR=2.33 (CI 1.28 to 4.23)) and vegetables (OR=1.91 (CI 1.05 to 3.49)) and with be high physically active (OR=2.34 (CI 1.03 to 5.35)). High sedentary breaks were associated with better dietary habits even among teachers with high sedentary behaviour. CONCLUSION: High sedentary breaks were associated with better dietary habits and with high levels of physical activity among public school teachers, even those with high sedentary behaviour.

Neuromuscular fitness in early life and its impact on bone health in adulthood: a systematic review / Aptidão neuromuscular na juventude e o impacto na saúde óssea na idade adulta: uma revisão sistemática

ABSTRACT Objective: To systematically review the literature to verify the relationship between neuromuscular fitness indicators in childhood/adolescence and bone strength variables in adulthood. Data sources: A systematic review was conducted in PUBMED, SCOPUS, SPORTDiscus, Web of Science, PsycINFO, LILACS, and SciELO, covering the entire period until March 2019. Data synthesis: The search identified 1149 studies. After duplicity analysis and eligibility criteria, four studies were reported. In one study, baseline was childhood and, in the others, adolescence. In childhood, when adjusting the model for age and body mass index, a statistically significant relation was found for girls: standing long jump with quantitative ultrasound index (β=0.11; p<0.05) and with speed of sound (β=0.14; p<0.01). However, when controlling muscular performance in adulthood, the relationship was no longer significant. In adolescence, coefficients ranged from 0.16 for neuromotor battery and bone mineral density (BMD) in the lumbar region to 0.38 for hanging leg lift test and BMD of arms. The explained variance varied between 2% (bent arm hang for BMD total) and 12% (hanging leg-lift for BMD arms), therefore, a higher performance in neuromuscular fitness in adolescence was associated with better bone strength in adulthood. Conclusions: In adults, bone strength variables showed significant correlation from low to moderate magnitude with neuromuscular fitness indicators in adolescence, but not in childhood, after controlling for adult performance in neuromuscular fitness. However, there is limited evidence to support the neuromuscular fitness in early life as a determinant of bone strength in adulthood.

RESUMO Objetivo: Revisar sistematicamente a literatura para verificar a relação entre indicadores da aptidão neuromuscular na infância/adolescência e variáveis de resistência óssea na idade adulta. Fonte de dados: Revisão sistemática com pesquisa de artigos conduzida no PUBMED, SCOPUS, SPORTDiscus, Web of Science, PsycINFO, LILACS and SciELO, abrangendo todo o período da base até março de 2019. Síntese dos dados: A busca identificou 1.149 estudos, após análise de duplicidade e dos critérios de elegibilidade, quatro estudos foram relatados. Em um dos estudos, o baseline foi a infância e, nos demais, a adolescência. Na infância, ao ajustar o modelo por idade e índice de massa corporal, foi encontrada relação estatisticamente significativa para as meninas: salto em distância com índice quantitativo de ultrassom (β=0,11; p<0,05) e com velocidade do som (β=0,14; p<0,01). Entretanto, ao se fazer o controle do desempenho muscular na idade adulta, a relação deixou de ser significativa. Na adolescência, coeficientes variaram de 0,16 para bateria neuromotora e densidade mineral óssea (DMO) lombar a 0,38 para o teste de elevação de pernas em suspensão e a DMO dos braços. Variação explicada entre 2% (suspensão na barra e DMO do corpo total) e 12% (elevação de pernas em suspensão e DMO dos braços), portanto, melhor desempenho na aptidão neuromuscular na adolescência, mais resistência óssea na idade adulta. Conclusões: Em adultos, variáveis de resistência óssea apresentaram correlação significativa em magnitude baixa a moderada com indicadores da aptidão neuromuscular na adolescência, mas não na infância, após controlar pelo desempenho adulto na aptidão neuromuscular. No entanto, existe evidência limitada para apoiar a aptidão neuromuscular na juventude como fator determinante da resistência óssea na fase adulta.

Sleep pattern, obesity and healthcare expenditures in Brazilian adults / Padrões do sono, obesidade e despesas em saúde com brasileiros adultos

Abstract The aim of this study was to analyze the relationship between sleep pattern and healthcare expenditures in adults, as well as to identify whether physical activity, biochemical markers and obesity affect this relationship. The sample was composed of 168 adults aged ≥ 50 years attended by two Basic Healthcare Units in Presidente Prudente, SP, Brazil. Health expenditure, sleep pattern, anthropometry, adiposity index, physical activity, metabolic and cardiovascular variables were assessed. Statistical analyses were performed using Kruskal-Wallis, Mann-Whitney and Spearman tests. Sleep disorders were positively correlated to higher costs with medicines and negatively correlated to costs with laboratory tests, even after adjusts by confounders. In addition, healthcare costs were also correlated to physical activity score, blood pressure, obesity and metabolic variables. Severe sleep disorders and high percentage of body fat were associated with increased use of medications. Sleep pattern is correlated to primary care healthcare costs, obesity and physical activity level.

Resumo O objetivo deste estudo foi analisar a relação entre padrão de sono e despesas de saúde em adultos, bem como identificar se atividade física, marcadores bioquímicos e obesidade afetam esse relacionamento. A amostra foi composta por 168 adultos com idade ≥ 50 anos atendidos por duas unidades básicas de saúde em Presidente Prudente, SP, Brasil. Foram avaliadas as despesas de saúde, padrões do sono, antropometria, atividade física, variáveis metabólicas e cardiovasculares. Foram utilizados Kruskal-Wallis, Mann-Whitney e Spearman. Os distúrbios do sono foram correlacionados positivamente com os custos mais elevados com medicamentos e negativamente com os custos com testes laboratoriais, mesmo após ajuste por fatores de confusão. Além disso, os custos de saúde também foram correlacionados ao escore de atividade física, pressão arterial, obesidade e variáveis metabólicas. Distúrbios graves do sono e alta porcentagem de gordura corporal foram associados ao aumento do uso de medicamentos. O padrão de sono está correlacionado com os custos de cuidados de saúde primários, obesidade e atividade física.

Tracking of cardiorespiratory fitness from childhood to early adolescence: moderation effect of somatic maturation / Tracking da aptidão cardiorrespiratória da infância para a adolescência: moderação pela maturação biológica

ABSTRACT Objective: To evaluate cardiorespiratory fitness' tracking from childhood to adolescence, as well as to test the moderation role of somatic maturation. Methods: Our sample was composed by 375 children (197 boys), with a baseline age between 7 and 10 years old. The children were followed-up over three years. Body mass and stature were measured as anthropometric indicators and were used to estimate maturity status through Moore's method. Cardiorespiratory fitness was evaluated through 9-minute running test. Body adiposity was estimated through the subcutaneous skinfold method, with measures of triceps and subscapular skinfolds and used as a covariate. Sample was categorized into tertiles. Thereafter, the Kappa (k) coefficient and Lin's concordance correlation coefficient (LCCC) tests were adopted to verify stability. Dummy variable in regression was used to test moderation effects. All analyses were conducted in Stata 14.0, adopting p<0.05. Results: Cardiorespiratory fitness presented a moderate to low tracking from childhood to adolescence (k=0.294; LCCC=0.458). Moreover, maturity status significantly moderated the association between cardiorespiratory fitness at childhood and adolescence (regardless of cohort and body adiposity) among boys (β=0.644; p=0.003) and role sample (β=0.184; p=0.020), but not girls (-0.217; p=0.413). Conclusions: Tracking of cardiorespiratory fitness from childhood to adolescence is moderate to low in both sexes. Moreover, maturity status moderated the relationship between cardiorespiratory fitness at baseline and in adolescence. A lower age at peak height velocity was associated to a greater cardiorespiratory fitness.

RESUMO Objetivo: Avaliar o tracking da aptidão cardiorrespiratória da infância à adolescência, bem como testar a via de moderação pela maturação somática. Métodos: A amostra foi composta de 375 crianças (197 meninos), com idades entre 7 e 10 anos na linha de base. Os sujeitos foram acompanhados por três anos. Massa corporal e estatura foram mensuradas como indicadores antropométricos e usadas para estimar a maturação somática pelo método de Moore. Aptidão cardiorrespiratória foi avaliada pelo teste de 9 minutos de corrida. Adiposidade corporal foi estimada pelo método de dobras subcutâneas, com medidas das dobras tricipital e subescapular, além de ter sido utilizada como covariável. A amostra foi categorizada em tercis, e então o coeficiente Kappa (k) e o coeficiente de correlação de concordância de Lin (LCCC) foram adotados para verificar estabilidade. Foram criadas variáveis dummy nas regressões para estimar o efeito de moderação. Todas as análises foram conduzidas no Stata 14.0, adotando p<0,05. Resultados: A aptidão cardiorrespiratória apresentou tracking baixo a moderado da infância para a adolescência (k=0,294; LCCC=0,458). Além disso, o status de maturação moderou significativamente a associação entre aptidão cardiorrespiratória na infância e adolescência (independentemente da coorte e adiposidade) em meninos (β=0,644; p<0,003) e na amostra total (β=0,184; p<0,020), mas não em meninas (-0,217; p=0,413). Conclusões: O tracking da aptidão cardiorrespiratória da infância à adolescência é baixo a moderado em ambos os sexos. Ainda, o estado maturacional moderou a associação entre aptidão cardiorrespiratória na infância e adolescência. Menor idade do pico de velocidade de crescimento foi associada à maior aptidão cardiorrespiratória.

Prenatal, biological and environmental factors associated with physical activity maintenance from childhood to adolescence / Fatores pré-natais, biológicos e ambientais associados à manutenção da atividade física da infância à adolescência

Abstract Our aim was to identify prenatal, biological and environmental correlates of child to adolescence physical activity maintenance in 1,186 Brazilian youth (525 boys) aged between 10 and 16 years. Current and former physical activity levels were obtained cross-sectionally through questionnaires. As potential correlates, parent's activity levels, socioeconomic status and offspring's birth weight were self-reported by parents. Somatic maturation was estimated by the peak of height velocity. Logistic regression analyses revealed that, regardless of chronological age, males were more likely to be active in childhood (OR = 1.73 [CI 95% = 1.33 to 2.27]) and to maintain physical activity (adjusted by chronological age, sex, birth weight and mother's physical activity) (OR = 3.58 [CI 95% = 2.32 to 5.54]), as well as late maturing adolescents (OR = 2.52 [CI 95% = 1.02 to 6.22]). Adolescents whose mother was inactive (OR = 0.31 [CI 95% = 0.11 to 0.86]) also had a lower probability of maintaining physical activity. Thus, girls, adolescents born with low weight and those with inactive mother are less likely to maintain physical activity levels from childhood to adolescence.

Resumo O nosso objetivo foi identificar correlatos pré-natais, biológicos e ambientais da manutenção da prática de atividade física da infância à adolescência em 1.186 adolescentes (525 meninos), com idade entre 10 e 16 anos. Prática de atividade física na infância (retrospectiva) e adolescência (atual) foi obtida através de questionários. O nível de atividade física dos pais, nível socioeconômico e peso ao nascer dos filhos foram relatados pelos pais. Maturação somática foi estimada por meio do pico de velocidade de crescimento. Regressões logísticas revelam que independentemente da idade cronológica, meninos apresentaram maior probabilidade de ser ativos na infância (OR = 1.73 [CI 95% = 1.33 - 2.27]) e manter a prática de atividade física (ajustado por idade cronológica, sexo, peso ao nascer e atividade física da mãe) (OR = 3.58 [CI 95% = 2.32 - 5.54]), bem como adolescentes com maturação tardia (OR = 2.52 [CI 95% = 1.02 - 6.22]), adolescentes com a mãe inativa (OR = 2.52 [CI 95% = 1.02 - 6.22]), também apresentaram menor probabilidade de manter o nível de atividade física. Portanto, meninas, adolescentes nascidos com baixo peso e aqueles cuja mãe é inativa possuem menor probabilidade de manter o nível de atividade física da infância à adolescência.

Sedentary behaviour is associated with diabetes mellitus in adults: findings of a cross-sectional analysis from the Brazilian National Health System.

BACKGROUND: Sedentary behaviour (SB) may contribute to the development of several chronic diseases, such as hypertension, diabetes mellitus (DM) and all-cause mortality. The aim of this study is to investigate the association between different domains of SB with diabetes among adult users of the Brazilian National Health System (NHS). METHODS: Cross-sectional study from the primary care system of the Brazilian NHS in the city of Bauru, Brazil. SB, physical activity (PA), DM and other chronic diseases were assessed by face-to-face interviews and medical records. As potential confounders in the adjusted model, we used gender, age, economic status, smoking status, hypertension, hypercholesterolaemia and PA. RESULTS: The study was composed of 147 men and 410 women. The fully adjusted model showed that Brazilian adults spending ≥3 h per day in television viewing (OR = 1.61 [95% CI: 1.11-2.33]) and overall SB (OR = 1.60 [95% CI: 1.09-2.36]) had increased prevalence of DM compared to those spending <3 h per day. CONCLUSIONS: TV viewing and overall SB was associated with higher prevalence of DM in Brazilian adults from the NHS, even after controlling for potential confounders including PA.