Quality of life of Venezuelan migrants in Brazil during the COVID-19 pandemic.

The economic, social, and health crisis in Venezuela has resulted in the largest forced migration in recent Latin American history. The general scenario in host countries influence migrants' self-perception of quality of life, which can be understood as an indicator of their level of integration. The COVID-19 pandemic has exacerbated socioeconomic and health vulnerabilities, especially for forced migrants. We hypothesized that the adverse circumstances faced by Venezuelan migrants during the pandemic have deepened their vulnerability, which may have influenced their perception of quality of life. This study aims to evaluate the quality of life of Venezuelan migrants in Brazil during the COVID-19 pandemic. We assessed the quality of life of 312 adult Venezuelan migrants living in Brazil using the World Health Organization WHOQOL-BREF quality of life assessment, which was self-administered online from October 20, 2020, to May 10, 2021. The associations of quality of life and its domains with participants' characteristics were analyzed via multiple linear regression models. Mean quality of life score was 44.7 (±21.8) on a scale of 0 to 100. The best recorded mean was in the physical domain (66.2±17.8) and the worst in the environmental domain (51.1±14.6). The worst quality of life was associated with being a woman, not living with a partner, lower household income, and discrimination based on nationality. Factors associated with overall quality of life and respective domains, especially income and discrimination, were also observed in other studies as obstacles to Venezuelan migrants. The unsatisfactory quality of life among Venezuelans living in Brazil may have been worsened by the pandemic during the study period.

Vivências de gordofobia médica em serviços de saúde no Brasil / Experiences of medical fatphobia in health services in Brazil / Experiencias de gordofobia médica en servicios de salud en Brasil

Objetivo: categorizar as vivências de gordofobia médica em serviços de saúde no Brasil. Método: estudo retrospectivo e misto, com abordagem exploratório sequencial, realizado entre janeiro de 2021 e janeiro de 2022. Os dados foram coletados manualmente, por meio da ferramenta de busca avançada e através da hashtag "gordofobia médica", no Twitter e no Instagram, respectivamente. E foram analisados por meio de análise temática. Resultados: encontrou-se 476 registros e 75 foram selecionados. Teve-se como categorias temáticas, estímulo não solicitado a medidas cirúrgicas para o emagrecimento; falta de atenção às queixas principais dos pacientes; violências psicológicas, verbais e/ou físicas associadas ao excesso de peso; e gordofobia como barreira para o acesso à saúde. Além disso, foram relatadas percepções de consequências à saúde como, abandono de tratamento, prejuízos à saúde mental e prejuízos à saúde materno-infantil. Conclusão: as características dos relatos evidenciam a sub-representação dos homens em debates relacionados à obesidade, hegemonia do saber biomédico perante questões sociais, estreitamento do acesso à saúde e contribuição negativa para a saúde física e mental das pessoas.

Objective: to categorize experiences of medical fatphobia in health services in Brazil. Method: retrospective and mixed study, with a sequential exploratory approach, carried out between January 2021 and January 2022. Data were collected manually, through the advanced search tool and through the hashtag "medical fatphobia", on Twitter and Instagram, respectively. And they were analyzed through thematic analysis. Results: 476 records were found and 75 were selected. Thematic categories were: unsolicited stimulus to surgical measures for weight loss; lack of attention to patients' main complaints; psychological, verbal and/or physical violence associated with being overweight; and fatphobia as a barrier to access to health. In addition, perceptions of health consequences were reported, such as treatment abandonment, damage to mental health and consequences for maternal and child health. Conclusion: the characteristics of the reports show the underrepresentation of men in debates related to obesity, hegemony of biomedical knowledge in the face of social issues, narrowing of access to health and negative contribution to people's physical and mental health.

Tooth loss over 13 years of follow-up: Can regular dental visits reduce racial and socioeconomic inequalities?

OBJECTIVES: To assess if regular dental visits modify the effects of social and racial indicators on the incidence of tooth loss. METHODS: This is a longitudinal analysis using data from the Pro-Saude Study. In 1999-2001, 3253 civil servants responded to self-administered questionnaires, and then in 2012-2013, with 19% attrition. The outcome was any increase in self-reported tooth loss, measured in four ordered categories (none, one or few, many, all or almost all). Main variables included income, education, race/ethnicity and an adapted version of Everyday Discrimination Scale. The dental visit was dichotomized into regular and problem-oriented attenders. Potentially confounding factors were age and sex; effect modification was estimated using the relative excess of risk due to interaction (RERI). RESULTS: An increase in the tooth loss category was reported by 23.1% of the individuals over 13 years of follow-up. Among problem-oriented attenders, 27.3% reported an increase against 20.4% in regular users (p<0.01). Interaction results are inconclusive. Even though not significant, either antagonism or synergism were observed: between lower income and problem-oriented (RERI = -0.22; 95%CI: -0.75: 0.31), being Black+Brown and problem-oriented (RERI = -0.25; 95%CI: -0.64: 0.14), discrimination and problem-oriented (RERI = -0.15; 95%CI: -0.55: 0.25), and between having less than university degree and being problem-oriented (RERI = 0.21; 95%CI: -0.19: 0.62). CONCLUSIONS: Regular attenders from advantaged groups seem to benefit more from dental care than disadvantaged groups, increasing unfair inequalities. Inconsistencies in current findings warrant further investigations. CLINICAL SIGNIFICANCE: Regular attenders from advantaged groups seem to benefit more from dental care than disadvantaged groups, increasing inequities, but the effect size of the Relative Excess of Risk due to Interaction was not large and was inconclusive.

Do changes in income and social networks influence self-rated oral health trajectories among civil servants in Brazil? Evidence from the longitudinal Pró-Saúde study.

BACKGROUND: Social factors are important determinants of health. However, evidence from longitudinal studies on the possible role of changes in socioeconomic circumstances on adult's oral health is scarce. This study aimed to test whether changes in income and changes in social networks of family members and friends were associated with trajectories of self-rated oral health (SROH) among adults over a 13-year period. METHODS: A prospective cohort study (Pro-Saude Study) was conducted involving non-faculty civil servants at university campi in Rio de Janeiro, Brazil. Individual data was collected through self-completed questionnaires in four waves (1999, 2001, 2007 and 2012). SROH trajectories between 2001 and 2012 were "Good-stable SROH", "Changed SROH", "Poor-stable SROH". Per capita family income and social networks of family members and friends data obtained in 1999 and 2012 were grouped into "High stable", "Increase", "Decrease", "Low stable". Ordinal logistic regression using complete data of 2118 participants was used to estimate odds ratio (OR) and 95% CIs of changes in income and changes in social networks with SROH trajectories, adjusted for age, sex, skin colour and marital status. RESULTS: Participants in the low income-stable and small social networks-stable groups showed 2.44 (95% CI 1.68-3.55) and 1.98 (95% CI 1.38-2.85) higher odds for worst trajectory of SRHO than those in the respective high-stable groups. Those in the decrease income group and decrease social networks group were 78% (95% CI 1.25-2.54) and 58% (95% CI 1.07-2.34) more likely to worst trajectory of SRHO than those in the high income-stable and high social networks-stable groups. CONCLUSIONS: Adults reporting low income and low social networks of family members and friends over 13 years and those with income and social networks decrease during the study period were at higher risk of having worsened their self-rated oral health.

Scaling up investigation and treatment of household contacts of tuberculosis patients in Brazil: a cost-effectiveness and budget impact analysis.

Background: In Brazil, investigation and treatment of tuberculosis infection (TBI) in households contacts (HHC) of TB patients is not a priority. We estimated the cost-effectiveness and budget-impact of scaling-up an enhanced HHC management in Brazil. Methods: We conceptualized a cascade-of-care that captures how HHC of tuberculosis patients are investigated in Brazil (status quo) and two enhanced strategies for management of HHC focusing on: (1) only tuberculosis disease (TBD) detection and, (2) TBD and TBI detection and treatment. Effectiveness was the number of HHC diagnosed with TBD and completing TBI treatment. Proportions in the cascades-of-care were derived from a meta-analysis. Health-system costs (2019 US$) were based on literature and official data from Brazil. The impact of enhanced strategies was extrapolated using reported data from 2019. Findings: With the status quo, 0 (95% uncertainty interval: 0-1) HHC are diagnosed with TBD and 2 (0-16) complete TBI treatment. With strategy(1), an additional 15 (3-45) HHC would be diagnosed with TBD at a cost of US$346 each. With strategy(2), 81 (19-226) additional HHC would complete TBI treatment at a cost of US$84 each. A combined strategy, implemented nationally to enhance TBD detection and TBI treatment would result in an additional 9,711 (845-28,693) TBD being detected, and 51,277 (12,028-143,495) more HHC completing TBI treatment each year, utilizing 10.9% and 11.6% of the annual national tuberculosis program budget, respectively. Interpretation: Enhanced detection and treatment of TBD and TBI among HHC in Brazil can be achieved at a national level using current tools at reasonable cost. Funding: None.

Sociodemographic and health profile of asylum-seekers in Rio de Janeiro, 2016-2017 / Perfil sociodemográfico e de saúde de solicitantes de refúgio no Rio de Janeiro, 2016-2017

ABSTRACT OBJECTIVE To analyze the sociodemographic profile and self-reported health conditions of asylum-seekers in Rio de Janeiro. METHODS A cross-sectional study of secondary data, collected from asylum claims forms completed in 2016 and 2017, at Cáritas Arquidiocesana do Rio de Janeiro (Cáritas-RJ). Descriptive analyses were performed and absolute and relative frequencies and 95% confidence intervals were calculated. RESULTS Claims completed by 818 asylum-seekers from 49 different countries were identified, of whom 126 (20.3%) were stateless, 510 (62.7%) were male, 797 (97.4%) were adults, with a mean age of 30.5 years, 551 (73.5%) were single, 340 (44.1%) had higher education, and 27 (4.0%) were unemployed in their country of origin before coming to Brazil. Fear of persecution for political opinion, violation of human rights, and risk of torture stood out among the reasons stated for requesting asylum. To reach Brazil, 629 (80.5%) traveled only by plane. Regarding health conditions, 216 (29.0%) reported having some symptom, disease or health problem, the most frequent being pain, vision problems, infectious diseases (including HIV/AIDS), and hypertension. Only 15 individuals (2.2%) reported being in some medical or psychological treatment; 42 (6.0%) reported visual impairments, 14 (2.0%) reported physical impairments and 4 (0.6%) hearing impairments. CONCLUSIONS Unlike other countries, where forced migrants with a low level of education enter clandestinely by sea or land, asylum-seekers residing in Rio de Janeiro between 2016 and 2017 were mostly adults with higher education who migrated using air transport. They had primary care-sensitive health conditions that could be treated via access to public primary health care services.

RESUMO OBJETIVO Analisar o perfil sociodemográfico e as condições de saúde autorrelatadas por solicitantes de refúgio no Rio de Janeiro. MÉTODOS Estudo transversal de dados secundários, coletados de formulários de solicitação de refúgio preenchidos em 2016 e 2017, na Cáritas Arquidiocesana do Rio de Janeiro (Cáritas-RJ). Foram realizadas análises descritivas e calculadas frequências absolutas, relativas e intervalos de 95% de confiança. RESULTADOS Foram identificados formulários preenchidos por 818 solicitantes de refúgio, originários de 49 países diferentes, dos quais 126 (20,3%) eram apátridas, 510 (62,7%) do sexo masculino, 797 (97,4%) adultos, com idade média de 30,5 anos, 551 (73,5%) solteiros, 340 (44,1%) com ensino superior e 27 (4,0%) desempregados no país de origem antes da vinda para o Brasil. Entre os motivos declarados para solicitação de refúgio, destacaram-se o temor de perseguição por opinião política, violação de direitos humanos e risco de tortura. Para chegar ao Brasil, 629 (80,5%) viajaram somente de avião. Em relação às condições de saúde, 216 (29,0%) afirmaram ter algum sintoma, doença ou agravo em saúde, sendo as mais frequentes dores, problemas de visão, doenças infecciosas (incluindo HIV/aids) e hipertensão. Apenas 15 indivíduos (2,2%) relataram estar em algum tratamento médico ou psicológico; 42 (6,0%) relataram deficiências visuais, 14 (2,0%) relataram deficiências físicas e 4 (0,6%) deficiências auditivas. CONCLUSÕES Diferentemente de outros países, onde migrantes forçados de baixo grau de instrução entram por vias clandestinas marítimas ou terrestres, os solicitantes de refúgio residentes no Rio de Janeiro entre 2016 e 2017, eram, em sua maioria, adultos com ensino superior que migraram usando transporte aéreo. Apresentavam condições de saúde sensíveis à atenção primária que poderiam ser tratadas via acesso aos serviços públicos da atenção primária em saúde.

Sociodemographic determinants of food consumption pattern: Pró-Saúde Study. / Determinantes sociodemográficos do padrão de consumo de alimentos: Estudo Pró-Saúde.

AIMS: To identify dietary patterns (DP) and to investigate their association with sociodemographic aspects. METHODOLOGY: A cross-sectional data analysis of a sub-sample from Phase 4 of the Pró-Saúde Longitudinal Study (2012-2013), constituting a total of 520 participants. DP were obtained by principal component analysis from a food frequency questionnaire. Association between DP and sociodemographic aspects was analyzed by adjusted logistic regression. RESULTS: Four DP were identified: processed and ultraprocessed products; fresh food; meats and alcoholic beverages; and traditional Brazilian foods. There was a greater adherence chance to "processed and ultraprocessed products" pattern among adults ≥ 55 years and lower chance among men. The probability of adherence to "fresh food" pattern was directly associated to men, subjects with a high educational level and inversely associated to adults aged ≥ 60 years. There was a lower chance of "meats and alcoholic beverages" pattern among men and increased chance of adherence to "traditional Brazilian foods" pattern among whites, subjects with ≥ 60 years and low schooling. CONCLUSION: Sociodemographic factors were important determinants of DP, especially gender, schooling and age. Presence of a DP composed of processed and ultraprocessed products indicates the need for awareness strategies and supply limitation in this population, since it affects their health.

Pattern evolution of antidepressants and benzodiazepines use in a cohort.

OBJECTIVE: In recent decades there has been an increase in the use of antidepressants (AD) and a decrease in the use of benzodiazepines (BDZ). Prevalence, cumulative incidence, and factors associated with the incidence of AD and BDZ use in a Brazilian population were estimated in this article. METHODS: Data were collected with a self-administered questionnaire in a cohort of employees from a university in Rio de Janeiro. The prevalence of the use of AD and BDZ was calculated for 1999 (4,030), 2001 (3,574), 2006-07 (3,058), and 2012 (2,933). The cumulative incidences of the use of AD and BDZ between 1999 and 2007 were estimated by the Poisson models with robust variance estimates. RESULTS: In 1999, the prevalence of the use of AD and BDZ were 1.4% (95%CI: 1.1-1.8) and 4.7% (95%CI: 4.1-5.4), respectively; in 2012, they were 5.4% (95%CI: 5.5-6.2) and 6.8% (95%CI: 6.0-7.8). The incidence of use, between 1999 and 2007, was 4.9% (95%CI: 4.2-5.7) for AD and 8.3% (95%CI: 7.3-9.3) for BDZ. The incidences of AD and BDZ use were higher among women and participants with a positive General Health Questionnaire. CONCLUSION: In this population, the increase in the use of AD was not accompanied by a decrease in the use of BDZ, showing the prescriptions for psychotropic medication do not follow the currently recommended guidelines for treatment of common mental health disorders.

Pattern evolution of antidepressants and benzodiazepines use in a cohort

ABSTRACT OBJECTIVE In recent decades there has been an increase in the use of antidepressants (AD) and a decrease in the use of benzodiazepines (BDZ). Prevalence, cumulative incidence, and factors associated with the incidence of AD and BDZ use in a Brazilian population were estimated in this article. METHODS Data were collected with a self-administered questionnaire in a cohort of employees from a university in Rio de Janeiro. The prevalence of the use of AD and BDZ was calculated for 1999 (4,030), 2001 (3,574), 2006-07 (3,058), and 2012 (2,933). The cumulative incidences of the use of AD and BDZ between 1999 and 2007 were estimated by the Poisson models with robust variance estimates. RESULTS In 1999, the prevalence of the use of AD and BDZ were 1.4% (95%CI: 1.1-1.8) and 4.7% (95%CI: 4.1-5.4), respectively; in 2012, they were 5.4% (95%CI: 5.5-6.2) and 6.8% (95%CI: 6.0-7.8). The incidence of use, between 1999 and 2007, was 4.9% (95%CI: 4.2-5.7) for AD and 8.3% (95%CI: 7.3-9.3) for BDZ. The incidences of AD and BDZ use were higher among women and participants with a positive General Health Questionnaire. CONCLUSION In this population, the increase in the use of AD was not accompanied by a decrease in the use of BDZ, showing the prescriptions for psychotropic medication do not follow the currently recommended guidelines for treatment of common mental health disorders.

History and challenges of Brazilian social movements for the achievement of the right to adequate food.

The historical struggles that Brazil faced to overcome malnutrition coincided with the empowerment of civil society and social movements which played a crucial role in the affirmation of health and food as social rights. After two decades under military dictatorship, Brazil went through a redemocratization process in the 1980s when activism emerged to demand spaces to participate in policy-making regarding the social agenda, including food and nutrition security (FNS). From 1988 onward institutional structures were established: the National Council of FNS (CONSEA) convenes government and civil society sectors to develop and monitor the implementation of policies, systems and actions. Social participation has been at the heart of structural changes achieved since then. Nevertheless, the country faces multiple challenges regarding FNS such as the double burden of disease, increasing use of pesticides and genetically modified seeds, weak regulation of ultra-processed products, and marketing practices that affect the environment, population health, and food sovereignty. This article aims at examining the development of the participatory political system and the role played by Brazilian social movements in the country's policies on FNS, in addition to outlining challenges faced by those policies.

Multimorbidade e uso de serviços de saúde em indivíduos com restrição de atividades habituais: Estudo Pró-Saúde / Multimorbidity and use of health services by individuals with restrictions on habitual activities: the Pró-Saúde Study / Multimorbilidad y uso de servicios de salud en individuos con restricción de actividades habituales: Estudio Pro-Salud

Resumo: O objetivo do estudo foi avaliar o uso de serviços de saúde e sua associação com diferentes medidas de multimorbidade. Trata-se de um estudo transversal aninhado a uma investigação longitudinal de funcionários técnico-administrativos no Município do Rio de Janeiro, Brasil: Estudo Pró-Saúde. Foram analisados dados coletados na fase 2 (2001-2002), sendo a população de estudo composta por 733 indivíduos que relataram restrição de atividades habituais por problemas de saúde nos 15 dias anteriores à coleta de dados. Busca por serviço de saúde (variável de desfecho) foi utilizada como proxy para uso de serviços de saúde. Multimorbidade foi avaliada por meio de contagem simples e de uma escala cumulativa (Cumulative Illness Rating Scale), gerando quatro variáveis de exposição: número de morbidades autorrelatadas, multimorbidade (2 ou mais morbidades), escore total e número de sistemas afetados. Nas análises estratificadas por sexo, foram utilizados modelos de regressão de Poisson com variância robusta ajustados por idade e escolaridade. Mulheres apresentaram em média valores mais altos para todas as medidas, e 51% foram classificadas com multimorbidade. Ter multimorbidade aumentou em 43% (IC95%: 1,11-1,84) a probabilidade de utilizar os serviços de saúde em homens, enquanto para as mulheres não houve associação estatisticamente significativa. Para os homens, a cada morbidade adicional, a probabilidade de utilizar serviço de saúde aumentou em 14% (IC95%: 1,05-1,24). Diferenças no uso de serviços de saúde e multimorbidade segundo sexo são evidentes. Conhecer tais padrões torna-se relevante para a prestação de um cuidado eficiente, coordenado e seguro para pessoas com multimorbidade.

Abstract: The study aimed to assess the use of health services and the association with different measures of multimorbidity. This was a cross-sectional study nested in the Pró-Saúde Study, a longitudinal study of municipal technical and administrative employees in Rio de Janeiro, Brazil. Data were analyzed from phase 2 (2001-2002), and the study population consisted of 733 individuals who reported restrictions on habitual activities due to health problems in the 15 days prior to the data collection. The search for a health service (outcome variable) was used as the proxy for use of health services. Multimorbidity was assessed by simple count and the Cumulative Illness Rating Scale, generating four exposure variables: number of self-reported diseases, multimorbidity (2 or more diseases), and total score and number of systems affected. The analyses stratified by sex used Poisson regression models with robust variance, adjusted by age and schooling. Women showed higher mean values than men for all the measures, with 51% classified as having multimorbidity. In men, multimorbidity increased by 43% (95%CI: 1.11-1.84) the probability of using health services, while there was no statistically significant association in women. For men, each additional disease increased the probability of use of a health service by 14% (95%CI: 1.05-1.24). There were evident differences in the use of health services and multimorbidity according to sex. Explaining these patterns becomes relevant for the provision of efficient, coordinated, and safe care for persons with multimorbidity.

Resumen: El objetivo del estudio fue evaluar el uso de servicios de salud y su asociación con diferentes medidas de multimorbilidad. Se trata de un estudio transversal, anidado en una investigación longitudinal de funcionarios técnico-administrativos, en el municipio de Rio de Janeiro, Brasil: Estudio Pro-Salud. Se analizaron los datos recogidos en la fase 2 (2001-2002), estando la población de estudio compuesta por 733 individuos que relataron restricción de actividades habituales por problemas de salud, durante los 15 días anteriores a la recogida de datos. Búsqueda de un servicio de salud (variable de desenlace) se utilizó como proxy para el uso de servicios de salud. La multimorbilidad se evaluó mediante cómputo simple y una escala acumulativa (Cumulative Illness Rating Scale), generando cuatro variables de exposición: número de morbilidades autoinformadas, multimorbilidad (2 o más morbilidades), puntuación total y número de sistemas afectados. En los análisis estratificados por sexo se utilizaron modelos de regresión de Poisson con variancia robusta ajustados por edad y escolaridad. Las mujeres presentaron de media valores más altos para todas las medidas, siendo que un 51% fueron clasificadas con multimorbilidad. Tener multimorbilidad aumentó en un 43% (IC95%: 1,11-1,84) la probabilidad de utilizar los servicios de salud en hombres, mientras que para las mujeres no hubo asociación estadísticamente significativa. Para los hombres, con cada morbilidad adicional, la probabilidad de utilizar un servicio de salud aumentó en un 14% (IC95%: 1,05-1,24). Las diferencias en el uso de servicios de salud y multimorbilidad según sexo son evidentes. Conocer estos patrones es relevante para la prestación de un cuidado eficiente, coordinado y seguro para personas con multimorbilidad.

Consumo alimentar segundo o grau de processamento e características sociodemográficas: Estudo Pró-Saúde / Food consumption according to degree of processing and sociodemographic characteristics: Estudo Pró-Saúde, Brazil

RESUMO: Objetivo: Investigar o consumo alimentar segundo o grau de processamento e associações com características sociodemográficas. Métodos: Estudo transversal de subamostra do Estudo Pró-Saúde, com 520 funcionários públicos de campi universitários, Rio de Janeiro, 2012-13. Questionário de frequência alimentar foi utilizado para classificar o consumo alimentar: 1) in natura, minimamente processados, preparações culinárias à base desses alimentos; 2) alimentos processados; 3) alimentos ultraprocessados. Determinou-se a contribuição energética relativa de cada grupo, e foi utilizado modelo de regressão seemingly unrelated equations regression (SUR) para estimar associações com as características sociodemográficas. Resultados: O grupo de alimentos in natura (1) contribuiu com 59% do consumo energético e foi diretamente associado à idade [45-49 anos (β = 1,8 intervalo de confiança de 95% - IC95% -1,2; 4,8); 50-54 (β = 1,5 IC95% -1,5; 4,5); 55-59 (β = 2,9 IC95% -0,4; 6,3) e ≥ 60 (β = 4,6 IC95% 1,1; 8,2)], comparado à idade ≤ 44. Em contraste, ultraprocessados contribuíram com 27% e foram inversamente associados à idade [45-49 (β = -1,7 IC95% -4,3; 0,9); 50-54 (β = -1,8 IC95% -4,3; 0,9); 55-59 (β = -4,9 IC95% -8,0; -2,0); ≥ 60 (β = -4,5 IC95% -7,6; -1,5)]. Sexo, renda e escolaridade não foram associados ao consumo alimentar. Conclusão: Adultos mais jovens apresentaram maior consumo de ultraprocessados, indicando a necessidade de intervenções principalmente nessa faixa etária. A ausência de associação com demais características sociodemográficas pode ser por conta da influência de fatores contextuais.

ABSTRACT: Objective: To investigate the food consumption according to the degree of processing and associations with sociodemographic characteristics. Methods: A cross-sectional study of the Estudo Pró-Saúde (Pro-Health Study), with 520 civil servants of university campuses, Rio de Janeiro, 2012-13. A food frequency questionnaire was used to classify food consumption: 1) in natura, minimally processed, food preparations based on these foods; 2) processed foods; 3) ultra-processed foods. The relative energy contribution of each group was determined, and a seemingly unrelated equations regression (SUR) regression model was used to estimate associations with sociodemographic characteristics. Results: The in natura food group (1) contributed with 59% of the energy consumption and was directly associated with age [45-49 years (β = 1.8 confidence interval of 95% - 95%CI -1.2; 4.8); 50-54 (β = 1.5 95%CI -1.5; 4.5); 55-59 (β = 2.9 95%CI -0.4; 6.3) and ≥ 60 (β = 4.6 95%CI 1.1; 8.2)], compared to age ≤ 44. In contrast, the group of ultra-processed foods contributed 27% and were inversely associated with age [45-49 (β = -1.7 95%CI -4.3; 0.9); 50-54 (β = -1.8 95%CI -4.3; 0.9); 55-59 (β = -4.9 95%CI -8.0; -2.0); ≥ 60 (β = -4.5 95%CI -7.6; -1.5)]. Gender, income and schooling were not associated with food consumption. Conclusion: Younger adults had higher consumption of ultra-processed foods, indicating the need for interventions mainly in this age group. The absence of association with other sociodemographic characteristics may be due to the influence of contextual factors.

Associations of neighborhood socioeconomic, natural and built environmental characteristics with a 13-year trajectory of non-work physical activity among civil servants in Rio de Janeiro, Brazil: The Pro-Saude Study.

Positive influences of natural and built environment characteristics on human physical activity have been observed mainly in high-income countries, but mixed results exist. We explored these relationships in Rio de Janeiro, Brazil, where exuberant nature coexists with high levels of social inequality and urban violence. Data originated from questionnaires self-administered by 1731 civil servants at university campuses who participated in 4 waves (1999, 2001, 2007, 2012) of a longitudinal study, and had their residential addresses geocoded. In multinomial regression models, adjusted for individual sociodemographic characteristics, mutually adjusted associations were estimated between 13-year trajectories of non-work physical activity and 8 contextual variables: distances from waterfronts, cycle paths, outdoor gym equipment, and squares; 2 indicators of exposure to greenness (a vegetation index - NDVI - derived from satellite images, and trees close to home); an indicator of walkability (street density), and neighborhood average income. Compared to participants living in the upper quartile of distance to waterfronts, those living in its lowest quartile had 2.6-fold higher odds (aOR: 2.62, 95% CI: 1.37-5.01) of reporting non-work PA in all 4 study waves. Similar results were observed in relation to distance to cycle paths; no independent associations were observed with other natural and built environment variables.

Focusing neighborhood context and self-rated health in the Pró-Saúde Study.

The influence of neighborhood characteristics on self-rated health has been little studied. A multilevel approach using hierarchical models was applied to analyze the relationship between the socioeconomic characteristics in 621 neighborhoods (level 2) in the city of Rio de Janeiro, Brazil, and the self-rated health of 3,054 university employees (level 1) from the baseline of the Pró-Saúde Study. Neighborhoods were created using the SKATER algorithm (Spatial 'K'luster Analysis by Tree Edge Removal) to cluster census tracts according to four indicators and a minimum population of 5,000 people. After adjustment for individual factors (per capita income, schooling, age, sex, ethnicity, health-related behavior and chronic diseases), low level of neighborhood income and higher numbers of members per household were significantly associated with poor self-rated health. Participants living in medium income-level neighborhoods were 34% more likely to self-rate their health as being poor. Those living in areas with a higher density of members per household were 50% more likely to present poor self-rated health. Neighborhood context influences self-rated health, beyond the effect of individual factors. Worsening neighborhood socioeconomic conditions affect health adversely, which in turn increasing the chance of poor self-rated health.

Educational inequality in Rio de Janeiro and its impact on multimorbidity: evidence from the Pró-Saúde study. A cross-sectional analysis.

BACKGROUND: Information about multimorbidity is scarce in developing countries. This study aimed to estimate the association of educational attainment with occurrences of multimorbidity in a population of public employees on university campuses in Rio de Janeiro. DESIGN AND SETTING: We conducted cross-sectional analyses on baseline data (1999-2001) from 3,253 participants in the Pró-Saúde study, conducted in Brazil. METHODS: The prevalence of multimorbidity, defined as a self-reported history of medical diagnoses of two or more chronic conditions, was estimated according to sex, age, smoking, obesity and educational level. The association between education and multimorbidity was estimated using odds ratios (OR) and the relative and slope indices of inequality, in order to quantify the degree of educational inequality among individuals with multimorbidity in this population. RESULTS: Greater age, female sex, smoking and obesity had direct associations with multimorbidity; and tobacco exposure and obesity also showed direct relationships with poorer educational level. There was a monotonic inverse linear trend between educational level and the presence of multimorbidity among women, with twice the odds (OR 2.47; 95% confidence interval, CI: 1.42-4.40) between extremities of schooling categories. There was excess multimorbidity of 22% at the lowest extremity of schooling, thus showing that women with worse educational status were more affected by the outcome. No trend and no excess multimorbidity was seen among men. CONCLUSIONS: Educational inequality is an important determinant for development of multimorbidity. Men and women experience its effect differently. Researchers need to consider that sex may be an effect modifier in multimorbidity studies.

Educational inequality in Rio de Janeiro and its impact on multimorbidity: evidence from the Pró-Saúde study. A cross-sectional analysis

ABSTRACT BACKGROUND: Information about multimorbidity is scarce in developing countries. This study aimed to estimate the association of educational attainment with occurrences of multimorbidity in a population of public employees on university campuses in Rio de Janeiro. DESIGN AND SETTING: We conducted cross-sectional analyses on baseline data (1999-2001) from 3,253 participants in the Pró-Saúde study, conducted in Brazil. METHODS: The prevalence of multimorbidity, defined as a self-reported history of medical diagnoses of two or more chronic conditions, was estimated according to sex, age, smoking, obesity and educational level. The association between education and multimorbidity was estimated using odds ratios (OR) and the relative and slope indices of inequality, in order to quantify the degree of educational inequality among individuals with multimorbidity in this population. RESULTS: Greater age, female sex, smoking and obesity had direct associations with multimorbidity; and tobacco exposure and obesity also showed direct relationships with poorer educational level. There was a monotonic inverse linear trend between educational level and the presence of multimorbidity among women, with twice the odds (OR 2.47; 95% confidence interval, CI: 1.42-4.40) between extremities of schooling categories. There was excess multimorbidity of 22% at the lowest extremity of schooling, thus showing that women with worse educational status were more affected by the outcome. No trend and no excess multimorbidity was seen among men. CONCLUSIONS: Educational inequality is an important determinant for development of multimorbidity. Men and women experience its effect differently. Researchers need to consider that sex may be an effect modifier in multimorbidity studies.

Focusing neighborhood context and self-rated health in the Pró-Saúde Study / O foco no contexto da vizinhança na autoavaliação da saúde no Estudo Pró-Saúde / Analizando el contexto del vecindario y autoevaluación de salud en el Estudio Pró-Saúde

The influence of neighborhood characteristics on self-rated health has been little studied. A multilevel approach using hierarchical models was applied to analyze the relationship between the socioeconomic characteristics in 621 neighborhoods (level 2) in the city of Rio de Janeiro, Brazil, and the self-rated health of 3,054 university employees (level 1) from the baseline of the Pró-Saúde Study. Neighborhoods were created using the SKATER algorithm (Spatial 'K'luster Analysis by Tree Edge Removal) to cluster census tracts according to four indicators and a minimum population of 5,000 people. After adjustment for individual factors (per capita income, schooling, age, sex, ethnicity, health-related behavior and chronic diseases), low level of neighborhood income and higher numbers of members per household were significantly associated with poor self-rated health. Participants living in medium income-level neighborhoods were 34% more likely to self-rate their health as being poor. Those living in areas with a higher density of members per household were 50% more likely to present poor self-rated health. Neighborhood context influences self-rated health, beyond the effect of individual factors. Worsening neighborhood socioeconomic conditions affect health adversely, which in turn increasing the chance of poor self-rated health.

Existem relativamente poucos estudos sobre a influência das características de vizinhança sobre a auto-avaliação da saúde. Foi aplicada uma abordagem multinível com modelos hierárquicos para analisar a relação entre as características socioeconômicas de 621 vizinhanças (nível 2) da cidade do Rio de Janeiro, Brasil, e a auto-avaliação da saúde de 3.054 servidores universitários (nível 1) da linha de base do Estudo Pró-Saúde. As vizinhanças foram criadas pela aplicação do algoritmo SKATER (Spatial 'K'luster Analysis by Tree Edge Removal) aos setores censitários, de acordo com quatro indicadores e uma população mínima de 5 mil habitantes. Depois de ajustar para fatores individuais (renda per capita, escolaridade, idade, sexo, raça/cor, comportamentos relacionados à saúde e doenças crônicas), houve uma associação significativa entre renda baixa e número maior de pessoas por domicílio na vizinhança e autoavaliação da saúde "ruim". Os residentes de vizinhanças de renda média apresentaram probabilidade 34% maior de avaliar a própria saúde como "ruim". Aqueles que viviam em vizinhanças com maior número médio de pessoas por domicílio mostraram uma probabilidade 50% maior de autoavaliação da saúde "ruim". Para além de fatores individuais, o contexto de vizinhança influencia a autoavaliação da saúde. Piores condições socioeconômicas da vizinhança afetam negativamente a saúde, que por sua vez aumenta as chances de autoavaliação da saúde "ruim".

La influencia de las características del vecindario en la salud autoevaluada se ha estudiado escasamente. Se aplicó un análisis multinivel usando modelos jerárquicos para analizar la relación entre las características socioeconómicas en 621 vecindarios (nivel 2), dentro de la ciudad de Río de Janeiro, Brasil, y la salud autoevaluada de 3.054 empleados universitarios (nivel 1), procedentes de la base de referencia del Estudio Pró-Saúde. Se crearon vecindarios con el uso del algoritmo SKATER (Spatial 'K'luster Analysis by Tree Edge Removal), con el fin de agrupar secciones del censo, de acuerdo con cuatro indicadores y una población mínima de 5.000 personas. Tras el ajuste por factores individuales (ingresos per cápita, escolarización, edad, sexo, etnia, comportamiento informado de salud y enfermedades crónicas), el bajo nivel de ingresos en el vecindario y el alto número de miembros por hogar estuvieron significativamente asociados a un escasa salud autoevaluada. Los participantes que vivían en vecindarios con un nivel de ingresos medios tuvieron una probabilidad un 34% mayor de autoevaluar su salud más bien como mala. Quienes estaban viviendo en vecindarios con una densidad más alta de miembros por vivienda tuvieron una probabilidad de un 50% mayor de presentar una salud autoevaluada mala. El contexto del vecindario influencia la salud autoevaluada, además del efecto de los factores individuales. Un empeoramiento de las condiciones socioeconómicas en el vecindario afecta adversamente a la salud, que a su vez aumenta la oportunidad de una salud autoevaluada como mala.

Breastfeeding duration and associated factors between 1960 and 2000 / Duração do aleitamento materno e fatores associados entre 1960 e 2000

Abstract Objective: To describe a historical series on the median duration of breastfeeding in a population of mothers whose children were born from the 1960s onwards, identifying factors associated with the interruption of breastfeeding in each decade. Methods: Data were analyzed from the Pró-Saúde Study, a longitudinal epidemiological investigation started in 1999 among technical and administrative employees of a university in the state of Rio de Janeiro. Breastfeeding duration was collected in two study phases: Phase 1 (1999), and phase 4 (2011-2012). Of these, those who had at least one child and reported the duration of breastfeeding for the first child were selected (n = 1539). To analyze the duration of breastfeeding, survival curves were constructed using the Kaplan-Meier method and the effect of covariates on the duration of breastfeeding was estimated by Cox regression model. Results: It was found that the median duration of breastfeeding was higher in the 1990s and 2000s and lower in the 1970s, compared to the 1960s. In addition, there was an association between higher income and maternal age with breastfeeding interruption, which was focused in the 1970s. Conclusion: There was shorter duration of breastfeeding in the 1970s compared to the 1960s. Increased duration and prevalence of breastfeeding from the 1970s onwards coincided with the national trend and the promotion of this practice since 1980.

Resumo Objetivo: Descrever uma série histórica sobre a duração mediana da amamentação em população de mães com crianças nascidas a partir da década de 1960 e identificar fatores associados à sua interrupção em cada década. Métodos: Foram analisados dados de 1.539 participantes do Estudo Pró-Saúde (EPS), uma investigação epidemiológica longitudinal iniciada em 1999 entre trabalhadores técnico-administrativos de uma universidade no Estado do Rio de Janeiro. Foram usadas informações sobre duração do aleitamento materno do primeiro filho coletadas em duas fases do EPS (1999 e 2011-12). Para análise da duração do aleitamento materno foram construídas curvas de sobrevida pelo método de Kaplan-Meier e sua associação com covariáveis foi estimada pelo modelo de regressão de Cox. Resultados: Verificou-se que a duração mediana do aleitamento materno foi maior nas décadas de 1990 e 2000 e menor na década de 1970, em comparação com a década de 1960. Além disso, houve associação entre maior renda e faixa etária maternas com interrupção do aleitamento materno, que se concentrou na década de 1970. Conclusão: Observou-se menor duração do aleitamento materno na década de 1970 em relação à década de 1960. O aumento da duração e das prevalências de amamentação a partir da década de 1970 coincidiu com a tendência nacional e com a promoção dessa prática a partir de 1980.

Breastfeeding duration and associated factors between 1960 and 2000.

OBJECTIVE: To describe a historical series on the median duration of breastfeeding in a population of mothers whose children were born from the 1960s onwards, identifying factors associated with the interruption of breastfeeding in each decade. METHODS: Data were analyzed from the Pró-Saúde Study, a longitudinal epidemiological investigation started in 1999 among technical and administrative employees of a university in the state of Rio de Janeiro. Breastfeeding duration was collected in two study phases: Phase 1 (1999), and phase 4 (2011-2012). Of these, those who had at least one child and reported the duration of breastfeeding for the first child were selected (n=1539). To analyze the duration of breastfeeding, survival curves were constructed using the Kaplan-Meier method and the effect of covariates on the duration of breastfeeding was estimated by Cox regression model. RESULTS: It was found that the median duration of breastfeeding was higher in the 1990s and 2000s and lower in the 1970s, compared to the 1960s. In addition, there was an association between higher income and maternal age with breastfeeding interruption, which was focused in the 1970s. CONCLUSION: There was shorter duration of breastfeeding in the 1970s compared to the 1960s. Increased duration and prevalence of breastfeeding from the 1970s onwards coincided with the national trend and the promotion of this practice since 1980.