Self-perception of mental health, COVID-19 and associated sociodemographic-contextual factors in Latin America / Autopercepción de la salud mental, COVID-19 y factores sociodemográficos y contextuales asociados en Latinoamérica / Autopercepção da saúde mental, COVID-19 e fatores sociodemográficos e contextuais associados na América Latina

Abstract This study aimed to estimate the prevalence of alterations in self-perceived mental health during the COVID-19 pandemic and their associated factors in four Latin American countries. This is a cross-sectional study based on data collected from adults in 2021 through the Collaborative Response COVID-19 Survey by the MacDonnell Academy at Washington University in St. Louis (United States). The sample was composed of 8,125 individuals from Brazil, Colombia, Mexico, and Chile. A generalized linear model for a binary outcome variable with a logistic link and fixed country effects was used. There were 2,336 (28.75%) individuals who considered having suffered alterations in self-perceived mental health. Unemployed individuals (OR = 1.40; 95%CI: 1.24-1.58), those with bad/regular quality of life (OR = 5.03; 95%CI: 4.01-6.31), and those with high socioeconomic status (OR = 1.66; 95%CI: 1.41-1.96) had a higher risk of self-perceived mental health alterations than those with full-time employment, excellent quality, and low socioeconomic status. According to the fixed-effects model, Brazilians living in the country during the pandemic, who disagreed with their government's decisions (OR = 2.05; 95%CI: 1.74-2.42) and lacked trust in their government (OR = 2.10; 95%CI: 1.74-2.42) had a higher risk of having self-perceived mental health alterations. Nearly 30% of respondents indicated that the COVID-19 pandemic altered their self-perceived mental health. This outcome was associated with political, sociodemographic, and health risk factors. These findings should help policymakers develop post-pandemic community interventions.

Resumen Este estudio tuvo como objetivo estimar la prevalencia de alteraciones en la autopercepción de la salud mental durante la pandemia de COVID-19 y sus factores asociados en cuatro países de América Latina. Este es un estudio transversal de datos recopilados de adultos en el 2021 por medio de la investigación Respuesta Colaborativa a COVID-19 de la Academia McDonnell en la Universidad Washington en St. Louis (Estados Unidos). La muestra estuvo compuesta por 8.125 personas de Brasil, Colombia, México y Chile. El estudio utilizó un modelo lineal generalizado para una variable de desenlace binario con un enlace logístico y efectos fijos por país. En total, 2.336 (28,75%) personas consideraron que habían sufrido alteraciones en la autopercepción de la salud mental. Los desempleados (OR = 1,40; IC95%: 1,24-1,58), aquellos con calidad de vida mala/regular (OR = 5,03; IC95%: 4,01-6,31) y aquellos con alto nivel socioeconómico (OR = 1,66; IC95%: 1,41-1,96) presentaron mayor riesgo de alteraciones en la autopercepción de la salud mental que aquellos con empleo a tiempo completo, excelente calidad y bajo nivel socioeconómico. Según el modelo de efectos fijos, los brasileños que vivían en el país durante la pandemia y que no estuvieron de acuerdo con las decisiones del gobierno (OR = 2,05; IC95%: 1,74-2,42) y no confiaban en su gobierno (OR = 2,10; IC95%: 1,74-2,42) presentaron mayor riesgo de alteraciones en la autopercepción de la salud mental. Casi el 30% de los encuestados indicaron que la pandemia de COVID-19 alteró su autopercepción de la salud mental. Este desenlace se asoció con factores políticos, sociodemográficos y de riesgo a la salud. Estos hallazgos deben ayudar a los formuladores de políticas a desarrollar intervenciones comunitarias pospandémicas.

Resumo Este estudo teve como objetivo estimar a prevalência de alterações na autopercepção de saúde mental durante a pandemia de COVID-19 e seus fatores associados em quatro países da América Latina. Este é um estudo transversal de dados coletados de adultos em 2021 por meio da pesquisa Resposta Colaborativa à COVID-19 da Academia McDonnell na Universidade Washington em St. Louis (Estados Unidos). A amostra foi composta por 8.125 pessoas do Brasil, Colômbia, México e Chile. O estudo utilizou um modelo linear generalizado para uma variável de desfecho binário com uma conexão logística e efeitos fixos do país. No total, 2.336 (28,75%) pessoas consideraram ter sofrido alterações na autopercepção de saúde mental. Os desempregados (OR = 1,40; IC95%: 1,24-1,58), aqueles com qualidade de vida ruim/regular (OR = 5,03; IC95%: 4,01-6,31) e aqueles com alto nível socioeconômico (OR = 1,66; IC95%: 1,41-1,96) apresentaram maior risco de alterações na autopercepção de saúde mental do que aqueles com emprego em tempo integral, excelente qualidade e baixo nível socioeconômico. De acordo com o modelo de efeitos fixos, os brasileiros que viviam no país durante a pandemia, que discordavam das decisões do governo (OR = 2,05; IC95%: 1,74-2,42) e não confiavam em seu governo (OR = 2,10; IC95%: 1,74-2,42) apresentaram maior risco de alterações na autopercepção de saúde mental. Quase 30% dos entrevistados indicaram que a pandemia da COVID-19 alterou sua autopercepção de saúde mental. Esse desfecho estava associado a fatores políticos, sociodemográficos e de risco à saúde. Estes achados devem ajudar os formuladores de políticas a desenvolver intervenções comunitárias pós-pandemia.

When Moving Is the Only Option: The Role of Necessity Versus Choice for Understanding and Promoting Physical Activity in Low- and Middle-Income Countries.

Given its origins in high-income countries, the field of physical activity and public health research and promotion has broadly followed a choice-based model. However, a substantial amount of the physical activity occurring routinely in many settings, particularly in low- and middle-income countries (LMICs), is the result of economic necessity and is not due to true, free choices. We propose the "necessity- versus choice-based physical activity models" framework as a conceptual tool to ground physical activity and public health research and promotion efforts in LMICs, helping ensurethat these efforts are relevant, ethical, responsive, and respectful to local contexts. Identifying ways to ensure that LMIC populations can maintain high levels of active transport while increasing opportunities for active leisure must be prioritized. To promote equity, physical activity research, programs, and policies in LMICs must focus on improving the conditions under which necessity-driven physical activity occurs for a vast majority of the population.

What the Physical Activity Community Can Do for Climate Action and Planetary Health?

We are experiencing a planetary tipping point with global warming, environmental degradation, and losses in biodiversity. The burdens of these changes fall disproportionately on poor and marginalized populations. Physical activity promotion strategies need to be aligned with climate action commitments, incorporating the Intergovernmental Panel on Climate Change scenarios in physical activity action plans. The promotion strategies must consider equity a core value and promote physical activity to the most vulnerable populations so that they are protected from the ill-health impacts of a changing climate.

Ultra-fast, high throughput and inexpensive detection of SARS-CoV-2 seroconversion using Ni2+ magnetic beads.

To monitor the levels of protecting antibodies raised in the population in response to infection and/or to immunization with SARS-CoV-2, we need a technique that allows high throughput and low-cost quantitative analysis of human IgG antibodies reactive against viral antigens. Here we describe an ultra-fast, high throughput and inexpensive assay to detect SARS-CoV-2 seroconversion in humans. The assay is based on Ni2+ magnetic particles coated with His tagged SARS-CoV-2 antigens. A simple and inexpensive 96 well plate magnetic extraction/homogenization process is described which allows the simultaneous analysis of 96 samples and delivers results in 7 min with high accuracy.

An evidence-based assessment of the impact of the Olympic Games on population levels of physical activity.

Pre-Olympic Games predictions commonly include an increase in population-based physical activity in the host city, as often stated in the bid, but the post-Olympic Games effects on physical activity have not been summarised. In this Series paper, we aim to do the following: examine mentions of a physical activity legacy in pre-Olympic bid documentation; analyse existing physical activity surveillance data collected before, during, and after the Olympic Games in hosting areas around the world; and evaluate Google Trends data surrounding the London 2012 Olympic Games as a case study of community interest in the topic of exercise during the time of the Olympic Games. Before 2007, little mention of physical activity was made in pre-Olympic Games documentation, but, after that, most documents had targets for population physical activity or sports participation. The synthesis of available surveillance data indicates that there was no change in the prevalence of physical activity or sports participation, except for the 2008 Summer Olympics in Beijing and the 1998 Winter Olympics in Nagano; although, the increase in participation in Nagano might not be attributable to the Olympic Games since there was no change in participation in winter sports. The Google Trends data showed an acute spike in searches with the term "Olympic" immediately associated with the London Olympic Games period and showed a sustained peri-Olympic increase in searches with the term "exercise". By themselves, the Olympic Games have not improved population-wide physical activity but might be an important missed public health opportunity. Such a legacy will require strategic planning and partnerships across the International Olympic Committee and the Olympic, sport, and public health agencies and a thorough evaluation framework implemented throughout the pre-Olympic Games and post-Olympic Games period in the host country.

Physical Activity Promotion and the United Nations Sustainable Development Goals: Building Synergies to Maximize Impact.

BACKGROUND: Many of the known solutions to the physical inactivity pandemic operate across sectors relevant to the United Nations Sustainable Development Goals (SDGs). METHODS: The authors examined the contribution of physical activity promotion strategies toward achieving the SDGs through a conceptual linkage exercise, a scoping review, and an agent-based model. RESULTS: Possible benefits of physical activity promotion were identified for 15 of the 17 SDGs, with more robust evidence supporting benefits for SDGs 3 (good health and well-being), 9 (industry, innovation, and infrastructure), 11 (sustainable cities and communities), 13 (climate action), and 16 (peace, justice, and strong institutions). Current evidence supports prioritizing at-scale physical activity-promoting transport and urban design strategies and community-based programs. Expected physical activity gains are greater for low-and middle-income countries. In high-income countries with high car dependency, physical activity promotion strategies may help reduce air pollution and traffic-related deaths, but shifts toward more active forms of travel and recreation, and climate change mitigation, may require complementary policies that disincentivize driving. CONCLUSIONS: The authors call for a synergistic approach to physical activity promotion and SDG achievement, involving multiple sectors beyond health around their goals and values, using physical activity promotion as a lever for a healthier planet.

Prognostic value of electrocardiographic abnormalities in adults from the Brazilian longitudinal study of adults' health.

OBJECTIVE: Cardiovascular diseases (CVDs) are highly preventable non-communicable diseases. ECG is a potential tool for risk stratification with respect to CVD. Our aim was to evaluate ECG's role in all-cause and cardiovascular mortality prediction. METHODS: Participants from the Brazilian Longitudinal Study of Adult Health, free of known CVD at baseline were included. A 12-lead ECG was obtained at baseline (2008-2010). Participants were followed up to 2018 by annual interviews. Deaths were independently reviewed. Cox as well as Fine and Grey multivariable regression models were applied to evaluate if the presence of any major electrocardiographic abnormality (MEA), defined according to the Minnesota Code system, would predict total and cardiovascular deaths. We also evaluated the Net Reclassification Index of adding MEA to the Systematic Coronary Risk Evaluation (SCORE). RESULTS: The 13 428 participants (median age 51 years, 45% men) were followed up for 8±1 years. All-cause and cardiovascular mortality occurred in 2.8% and 1.2% of the population, respectively. Prevalent MEA was an independent predictor of overall (HR=2.3, 95% CI 1.7 to 2.9) and cardiovascular mortality (HR=4.6, 95% CI 3.0 to 7.0) after adjustments for age, race, education and traditional cardiovascular risk factors. Adding MEA to the SCORE resulted in 9% mis-reclassification in the non-event subgroup and 33% correct reclassification in those with a fatal cardiovascular event. CONCLUSION: Presence of MEA was an independent predictor of overall and cardiovascular mortality. ECG may have a role in risk prediction of cardiovascular mortality in primary care.

Harnessing Citizen Science to Assess and Improve Utilization of Metropolitan Parks: the Park Activity, Recreation, and Community Study (PARCS) in St. Louis, MO.

Access to and use of parks is associated with physical activity participation. Our Voice is a systematic method blending community-based participatory research (CBPR) and citizen science. As part of a comprehensive, mixed-methods study in St. Louis, Missouri (PARCS), we tested the feasibility of the Our Voice method for gathering community input on the barriers to and facilitators of accessibility and use of large metropolitan parks, by describing the implementation of the Our Voice method among recreational and commuter users of a large metropolitan park in St. Louis, MO. Due to challenges posed by COVID-19, the Our Voice methodology was adapted for remote participation. Twenty-three citizen scientists (14 recreational park users and 9 commuters) collected and analyzed geolocated route, photo, and audio or text data on facilitators and barriers to park use and access. They identified 6 priority themes and 12 solution ideas, and presented them to stakeholders. In contrast to previous Our Voice studies, separate user groups (recreation and commuter users) independently prioritized many of the same themes. Adaptation of the Our Voice protocol to virtual practices during COVID-19 revealed positive implications for cost, reach, and scale of studies grounded in CBPR and citizen science. We provide a set of recommended practices for using Our Voice as a method to evaluate and promote equity of access and use of metropolitan parks.

Using mixed methods to understand women's parenting practices related to their child's outdoor play and physical activity among families living in diverse neighborhood environments.

A convergent parallel mixed methods design was used to understand parenting practices for outdoor play, their influence on adolescent's physical activity and outdoor play and the role of the neighborhood and child's sex. Adolescents (n = 263) and their parents completed questionnaires and wore accelerometers. Parents (n = 30) participated in in-depth interviews. Parenting practices were examined by neighborhood disadvantage and child's sex in quantitative (Chi-square and T-tests) and qualitative (comparative thematic analysis) samples. Multi-level linear mixed models examined the associations between parenting practices and two adolescent outcomes: physical activity and outdoor play. Parents in high disadvantage neighborhoods and of female adolescents imposed more restrictions on outdoor play. Restrictive parenting practices were negatively associated with outdoor play, but not physical activity. Policy and environment change that improves neighborhood conditions may be necessary to reduce parents' fear and lessen restrictions on outdoor play.

Towards better evidence-informed global action: lessons learnt from the Lancet series and recent developments in physical activity and public health.

In the past few decades, the field of physical activity has grown and evolved in scope, depth, visibility and impact around the world. Global progress has been observed in research and practice in physical activity regarding surveillance, health outcomes, correlates/determinants, interventions, translation and policy. The 2012 and 2016 Lancet series on physical activity provide some of the most comprehensive global analysis on various topics within physical activity. Based on the Lancet series and other key developments in the field, literature searches, and expert group meetings and consultation, we provide a global summary on the progress of, gaps in and future directions for physical activity research in the following areas: (1) surveillance and trends, (2) correlates and determinants, (3) health outcomes and (4) interventions, programmes and policies. Besides lessons learnt within each specific area, several recommendations are shared across areas of research, including improvement in measurement, applying a global perspective with a growing emphasis on low-income and middle-income countries, improving inclusiveness and equity in research, making translation an integral part of research for real-world impact, taking an 'upstream' public health approach, and working across disciplines and sectors to co-design research and co-create solutions. We have summarised lessons learnt and recommendations for future research as 'roadmaps' in progress to encourage moving the field of physical activity towards achieving population-level impact globally.

Do associations of sex, age and education with transport and leisure-time physical activity differ across 17 cities in 12 countries?

BACKGROUND: Leisure-time and transport activity domains are studied most often because they are considered more amenable to intervention, but to date evidence on these domains is limited. The aim of the present study was to examine patterns of socio-demographic correlates of adults' leisure-time and transport physical activity and how these associations varied across 17 cities in 12 countries. METHODS: Participants (N = 13,745) aged 18-66 years in the IPEN Adult study and with complete data on socio-demographic and self-reported physical activity characteristics were included. Participants reported frequency and duration of leisure-time and transport activities in the last 7 days using the self-administered International Physical Activity Questionnaire-Long Form. Six physical activity outcomes were examined in relation with age, education, and sex, and analyses explored variations by city and curvilinear associations. RESULTS: Sex had the most consistent results, with five of six physical activity outcomes showing females were less active than males. Age had the most complex associations with self-report transport and leisure-time physical activity. Compared to older people, younger adults were less likely to engage in transport physical activity, but among those who did, younger people were likely to engage in more active minutes. Curvilinear associations were found between age and all three leisure-time physical activity outcomes, with the youngest and the oldest being more active. Positive associations with education were found for leisure-time physical activity only. There were significant interactions of city with sex and education for multiple physical activity outcomes. CONCLUSIONS: Although socio-demographic correlates of physical activity are widely studied, the present results provide new information. City-specific findings suggest there will be value in conducting more detailed case studies. The curvilinear associations of age with leisure-time physical activity as well as significant interactions of leisure-time activity with sex and education should be further investigated. The findings of lower leisure-time physical activity among females as well as people with low education suggest that greater and continued efforts in physical activity policies and programs tailored to these high-risk groups are needed internationally.

Public open spaces and physical activity: disparities of resources in Florianópolis.

OBJECTIVE: To analyze the association between sociodemographic characteristics of census tracts and the presence/quality of public open spaces and physical activity facilities. METHODS: A cross-sectional study was conducted in 643 census tracts in Florianópolis, Brazil, the presence and quality of public open spaces and physical activity facilities were objectively analyzed and the data by census tracts using Geographic Information Systems was treated. Outcomes were analyzed considering the census tracts as having: ≥ 1 public open spaces; ≥ 1 public open spaces with high quality; ≥ 2 physical activity facilities and high-quality physical activity facilities. Sociodemographic characteristics were the independent variables. Logistic regression analysis was performed. RESULTS: Census tracts with a medium-income (OR = 1.8; 95%CI 1.1-3.0) and high-income (OR = 2.4; 95%CI 1.4-4.0), in those with medium (OR = 1.7; 95%CI 1.0-2.7) and high residential density (OR = 2.0; 95%CI 1,2-3.3), and with higher proportions of older adults (OR = 3.3; 95%CI 1.9-5.7) had a higher proportion of public open spaces. Census tracts with higher proportions of children/adolescents (OR = 0.3; 95%CI 0.2-0.6) and non-white residents (OR= 0.6; 95%CI 0.3-0.9) were less likely to contain public open spaces. The tracts with medium (OR = 4.0; 95%CI 1.4-11.3) and high-income (OR = 3.6; 95%CI 1.2-10.2) were more likely to contain public open spaces with ≥ 2 structures for physical activity, compared with those with low-income. We observed the inverse in sectors with a high proportion of non-white residents (OR = 0.3; 95%CI 0.1-0.9). CONCLUSIONS: Census tracts with higher proportions of children or adolescents, non-white individuals and those in the low-income strata had lower odds of containing public open spaces and physical activity facilities.

The clinical and economic burden among caregivers of patients with Alzheimer's disease in Canada.

OBJECTIVE: To estimate the clinical and direct medical economic burden among Alzheimer disease (AD) caregivers using real-world, longitudinal patient-level data in Canada. METHODS/DESIGN: This retrospective observational study assessed the clinical and direct medical economic burden among individuals who cohabitate with AD patients ("AD caregiver cohort") compared with older adults who were cohabiting with another adult without dementia ("comparison cohort") using real-world data from the Southwestern Ontario database, a representative Canadian electronic health record (EHR) longitudinal EHR. RESULTS: The AD caregiver cohort (n = 2749; mild AD: n = 2254, moderate AD: n = 302, and severe AD, n = 193) had a similar or higher level of clinical and economic burden than the comparison cohort (n = 12 152). The overall AD cohort and caregivers of patients with mild AD had a similar clinical burden to the comparison cohort. Those caregiving for more severely affected AD patients had an increased risk of comorbidities and required more medication, physician attention, and hospital encounters compared with caregivers of less severe AD patients and the comparison cohort. Mean annual costs were higher among the AD caregiver cohort than the comparison cohort, and those caregiving for moderate and severe AD patients incurred the highest costs. Overall mortality was higher in the AD caregiver cohort compared with the comparison cohort. CONCLUSIONS: Caregivers of patients with mild AD had a similar clinical and direct economic burden to older adults who were not dementia caregivers, whereas the burden among caregivers of moderate and severe AD patients was much greater.

Association Between Neighborhood Income, Patterns of Use, and Physical Activity Levels in Fitness Zones of Curitiba, Brazil.

Background: Socioeconomic characteristics of locations where physical activity equipment is installed may affect the activity level of users. The purpose of this study was to verify patterns of use and physical activity levels in fitness zones installed in low- and high-income neighborhoods in the city of Curitiba, Brazil. Methods: Over 1200 observations were conducted in 20 fitness zones in the city of Curitiba, Brazil. Data were collected during the months of November and December 2012, in 4 periods of the day (8 AM, 11 AM, 2 PM, and 5 PM), on 2 weekdays and 2 weekend days. Results: A total of 2232 people were observed in the fitness zones. Age group, level of physical activity in the area, use of fitness zones during weekend days, and occupation of spaces were significantly associated with neighborhood income. Moreover, users of fitness zones located in high-income neighborhoods showed higher odds ratio (OR = 1.74; 95% confidence interval, 1.46-2.07) of moderate to vigorous physical activity than light or sedentary activities, regardless of gender or day of the week. Conclusions: The sole presence of equipment does not seem to favor the use of fitness zones in low-income neighborhoods. Future studies should investigate intrinsic factors for the use of fitness zones for physical activity.

A cross-country study of mis-implementation in public health practice.

BACKGROUND: Mis-implementation (i.e., the premature termination or inappropriate continuation of public health programs) contributes to the misallocation of limited public health resources and the sub-optimal response to the growing global burden of chronic disease. This study seeks to describe the occurrence of mis-implementation in four countries of differing sizes, wealth, and experience with evidence-based chronic disease prevention (EBCDP). METHODS: A cross-sectional study of 400 local public health practitioners in Australia, Brazil, China, and the United States was conducted from November 2015 to April 2016. Online survey questions focused on how often mis-termination and mis-continuation occur and the most common reasons programs end and continue. RESULTS: We found significant differences in knowledge of EBCDP across countries with upwards of 75% of participants from Australia (n = 91/121) and the United States (n = 83/101) reporting being moderately to extremely knowledgeable compared with roughly 60% (n = 47/76) from Brazil and 20% (n = 21/102) from China (p < 0.05). Far greater proportions of participants from China thought effective programs were never mis-terminated (12.2% (n = 12/102) vs. 1% (n = 2/121) in Australia, 2.6% (n = 2/76) in Brazil, and 1.0% (n = 1/101) in the United States; p < 0.05) or were unable to estimate how frequently this happened (45.9% (n = 47/102) vs. 7.1% (n = 7/101) in the United States, 10.5% (n = 8/76) in Brazil, and 1.7% (n = 2/121) in Australia; p < 0.05). The plurality of participants from Australia (58.0%, n = 70/121) and the United States (36.8%, n = 37/101) reported that programs often mis-continued whereas most participants from Brazil (60.5%, n = 46/76) and one third (n = 37/102) of participants from China believed this happened only sometimes (p < 0.05). The availability of funding and support from political authorities, agency leadership, and the general public were common reasons programs continued and ended across all countries. A program's effectiveness or evidence-base-or lack thereof-were rarely reasons for program continuation and termination. CONCLUSIONS: Decisions about continuing or ending a program were often seen as a function of program popularity and funding availability as opposed to effectiveness. Policies and practices pertaining to programmatic decision-making should be improved in light of these findings. Future studies are needed to understand and minimize the individual, organizational, and political-level drivers of mis-implementation.

Socioeconomic status moderates the association between perceived environment and active commuting to school.

OBJECTIVE: To analyze the moderator effect of socioeconomic status in the association between the perceived environment and active commuting to school. METHODS: A total of 495 adolescents and their parents were interviewed. Perceived environment was operationalized in traffic and crime safety and assessed with the Neighborhood Environment Walkability Scale. Active commuting was self-reported by the adolescents, categorized in walking, bicycling or skating at least one time/week. Socioeconomic status was used as moderator effect, reported from adolescents' parents or guardians using Brazilian standardized socioeconomic status classification. Analyses were performed with Poisson regression on Stata 12.0. RESULTS: Prevalence of active commuting was 63%. Adolescents with low socioeconomic status who reported "it is easy to observe pedestrians and cyclists" were more likely to actively commute to school (PR = 1.18, 95%CI 1.03-1.13). Adolescents with low socioeconomic status whose parents or legal guardians reported positively to "being safe crossing the streets" had increased probability of active commuting to school (PR = 1.10, 95%CI 1.01-1.20), as well as those with high socioeconomic status with "perception of crime" were positively associated to the outcome (PR = 1.33, 95%CI 1.03-1.72). CONCLUSIONS: Socioeconomic status showed moderating effects in the association between the perceived environment and active commuting to school.

Evidence-based decision making and promotion of physical activity among directors of local health departments.

OBJECTIVE: To describe the steps involved in evidence-based decision making for the implementation of programs aimed at the promotion of physical activity. METHODS: It is a descriptive, cross-sectional study with quali-quantitative approach, held with municipal health secretaries chosen deliberately by regional health representatives of the state of Paraná. A total of 27 secretaries participated in a telephone interview consisting of 17 open questions. Content analysis was conducted according to the categories of an evidence-based decision-making model consisting of seven steps. RESULTS: None of the participants employed every step of the evidence-based decision-making model. The steps that were most often mentioned included: evaluation of the program (33.3%), use of evidence from the literature (22.2%) and identification of the problem (22.2%). The steps that were reported the least included: quantification of the problem (14.8%), development and prioritization of actions (14.8%), development of the plan of action (14.8%) and evaluation of the community (3.7%). CONCLUSIONS: The use of evidence-based decision making in the context of the promotion of physical activity was shown to be incipient among the health secretaries of the state of Paraná. We suggest widening dissemination and training on the use of evidence-based decision making among municipal administrators to increase the effectiveness of actions for promotion of physical activity.

Characteristics of the environmental microscale and walking and bicycling for transportation among adults in Curitiba, Paraná State, Brazil.

The aim of this study was to analyze the association between the characteristics of the built and social and environmental microscale and walking and bicycling for transportation in adults in Curitiba, Paraná State, Brazil. A cross-sectional study was performed in 2009 with a household survey that included 1,419 adults. Objective evaluation of environment was performed on the resident's street segments, using an instrument for systematic observation consisting of six dimensions: "land use", "public transportation", "streetscape", "conditions and aesthetics", "places for walking and bicycling", and "social environment". The score for each dimension was obtained as the sum of positive items related to physical activity. The items for "public transportation" (≥ 1 items) and "places for walking and bicycling on the streets" (≥ 3 items) were dichotomized, while the scores for the other items were classified in tertiles. Walking and bicycling for transportation were assessed with the International Physical Activity Questionnaire (IPAQ). The data were analyzed using multilevel Poisson regression. Medium "streetscape" score was inversely associated with walking ≥ 150min/week (PR = 0.60; 95%CI: 0.40-0.91; VPC = 12%) and bicycling (PR = 0.54; 95%CI: 0.29-0.99; VPC = 60%). In conclusion, only "streetscape" was associated with walking and bicycling for transportation in adults.

Socioeconomic status moderates the association between perceived environment and active commuting to school

ABSTRACT OBJECTIVE: To analyze the moderator effect of socioeconomic status in the association between the perceived environment and active commuting to school. METHODS: A total of 495 adolescents and their parents were interviewed. Perceived environment was operationalized in traffic and crime safety and assessed with the Neighborhood Environment Walkability Scale. Active commuting was self-reported by the adolescents, categorized in walking, bicycling or skating at least one time/week. Socioeconomic status was used as moderator effect, reported from adolescents' parents or guardians using Brazilian standardized socioeconomic status classification. Analyses were performed with Poisson regression on Stata 12.0. RESULTS: Prevalence of active commuting was 63%. Adolescents with low socioeconomic status who reported "it is easy to observe pedestrians and cyclists" were more likely to actively commute to school (PR = 1.18, 95%CI 1.03-1.13). Adolescents with low socioeconomic status whose parents or legal guardians reported positively to "being safe crossing the streets" had increased probability of active commuting to school (PR = 1.10, 95%CI 1.01-1.20), as well as those with high socioeconomic status with "perception of crime" were positively associated to the outcome (PR = 1.33, 95%CI 1.03-1.72). CONCLUSIONS: Socioeconomic status showed moderating effects in the association between the perceived environment and active commuting to school.

Evidence-based decision making and promotion of physical activity among directors of local health departments / Tomada de decisão baseada em evidências e promoção da atividade física entre secretários municipais de saúde

ABSTRACT OBJECTIVE To describe the steps involved in evidence-based decision making for the implementation of programs aimed at the promotion of physical activity. METHODS It is a descriptive, cross-sectional study with quali-quantitative approach, held with municipal health secretaries chosen deliberately by regional health representatives of the state of Paraná. A total of 27 secretaries participated in a telephone interview consisting of 17 open questions. Content analysis was conducted according to the categories of an evidence-based decision-making model consisting of seven steps. RESULTS None of the participants employed every step of the evidence-based decision-making model. The steps that were most often mentioned included: evaluation of the program (33.3%), use of evidence from the literature (22.2%) and identification of the problem (22.2%). The steps that were reported the least included: quantification of the problem (14.8%), development and prioritization of actions (14.8%), development of the plan of action (14.8%) and evaluation of the community (3.7%). CONCLUSIONS The use of evidence-based decision making in the context of the promotion of physical activity was shown to be incipient among the health secretaries of the state of Paraná. We suggest widening dissemination and training on the use of evidence-based decision making among municipal administrators to increase the effectiveness of actions for promotion of physical activity.

RESUMO OBJETIVO Descrever o emprego das etapas da tomada de decisões baseada em evidências para implementação de programas de promoção da atividade física. MÉTODOS Trata-se de um estudo descritivo, transversal, com abordagem quali-quantitativa, realizado com secretários municipais de saúde escolhidos intencionalmente por representantes das regionais de saúde do estado do Paraná. Ao todo, 27 secretários participaram de uma entrevista telefônica composta por 17 questões abertas. A análise de conteúdo foi conduzida segundo as categorias de um modelo de tomada de decisões baseada em evidências composto de sete etapas . RESULTADOS Nenhum dos participantes empregou todas as etapas do modelo de tomada de decisões baseada em evidências. As etapas mais mencionadas foram: avaliação do programa (33,3%), uso de evidências da literatura (22,2%) e identificação do problema (22,2%). As etapas menos reportadas foram: quantificação do problema (14,8%), desenvolvimento e priorização de ações (14,8%), desenvolvimento do plano de ação (14,8%) e avaliação da comunidade (3,7%). CONCLUSÕES O emprego da tomada de decisões baseada em evidências no contexto da promoção da atividade física apresentou-se incipiente entre os secretários de saúde do estado do Paraná. Sugere-se ampliar a disseminação e o treinamento para o uso de tomada de decisões baseada em evidências entre os gestores municipais a fim de ampliar a efetividade das ações de promoção da atividade física.