Self-perception of mental health, COVID-19 and associated sociodemographic-contextual factors in Latin America.

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.

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.

Validity and reliability of the Perceived Nutrition Environment Measures Survey (NEMS-P) for use in Brazil.

OBJECTIVE: The aim of this study is to evaluate the validity and reliability of the Perceived Nutrition Environment Measures Survey (NEMS-P) translated and adapted for use in Brazil. DESIGN: Validation of the NEMS-P questionnaire. The questionnaires were applied to assess validity and reliability, based on exploratory factor analysis, Cronbach's α coefficient and intra-class correlation, with a significance level of 95 %. SETTING: Brazil. PARTICIPANTS: Adults over 20 years of age diagnosed with hypertension were included in the internal validity and reliability test (n 176) and intra-rater reliability (subsample n 35). RESULTS: Factor analysis obtained satisfactory results. Internal consistency was acceptable for most items, with Cronbach's α ranging from 0·6 to 0·9. The intra-rater reliability of the subsample was also valid, with intra-class correlation coefficient values ranging from 0·5 to 0·9. CONCLUSION: This work reveals the usefulness of the instrument to assess the perceived food environment in the Brazilian context, being able to measure what is proposed according to its theoretical model, and reproduces the values when applied to a sample different from its original validation. However, refinement of some questions is suggested. Finally, it demonstrates the possibility of using the entire instrument or each section independently, according to the food environments to be investigated.

Association of Income Level and Ischemic Heart Disease: Potential Role of Walkability. / Associação de Nível de Renda e Doença Isquêmica do Coração: Papel Potencial da Caminhabilidade.

BACKGROUND: Association of Income Level and Ischemic Heart Disease: Potential Role of Walkability Association of ischemic heart disease (adjusted for traditional risk factors and socioeconomics variables) and income level (A), and walkability z-score (B), and association of walkability z-score and income level (C). BACKGROUND: Socioeconomic status has been linked to ischemic heart disease (IHD). High-income neighborhoods may expose individuals to a walking-promoting built environment for daily activities (walkability). Data from the association between income and IHD is lacking in middle-income countries. It is also uncertain whether walkability mediates this association. OBJECTIVES: To investigate whether income is associated with IHD in a middle-income country and whether neighborhood walkability mediates the income-IHD association. METHODS: This cross-sectional study evaluated 44,589 patients referred for myocardial perfusion imaging (SPECT-MPI). Income and walkability were derived from participants' residential census tract. Walkability quantitative score combined 4 variables: street connectivity, residential density, commercial density, and mixed land use. IHD was defined by abnormal myocardial perfusion during a SPECT-MPI study. We used adjusted mixed effects models to evaluate the association between income level and IHD, and we performed a mediation analysis to measure the percentage of the income-IHD association mediated by walkability. We considered p values below 0.01 as statistically significant. RESULTS: From 26,415 participants, those living in the lowest-income tertile census tract were more physically inactive (79.1% versus 75.8% versus 72.7%) when compared to higher-income tertile census tracts (p < 0.001). Income was associated with IHD (odds ratio: 0.91 [95% confidence interval: 0.87 to 0.96] for each 1,000.00 international dollars increase in income) for both men and women equally (p for interaction = 0.47). Census tracts with a higher income were associated with better walkability (p < 0.001); however, walkability did not mediate the income-IHD association (percent mediated = -0.3%). CONCLUSIONS: Income was independently associated with higher prevalence of IHD in a middle-income country irrespective of gender. Although walkability was associated with census tract income, it did not mediate the income-IHD association.

How do the year's seasons and specific weather indices affect physical activity and the patterns of use of public open spaces in the Brazilian context?

BACKGROUND: Public open spaces (POS) can offer various resources to promote visitation and engagement in moderate-to-vigorous physical activity (MVPA). However, the influence of seasonal variations and specific meteorological conditions on this relationship remains unclear. Thus, this study aims to investigate the effect of seasonal variations and specific meteorological elements on different days of the week and times of day on POS use and POS-based MVPA in the Brazilian context. METHODS: In 2018, repeated measurements carried out in Southern Brazil used a systematic observation to identify the presence of users in the POS and their engagement in MVPA. The meteorological elements (temperature, thermal sensation, and relative humidity), as well as seasonality (summer, autumn, winter, and spring), were aggregated into the observations. RESULTS: A total of 19,712 systematic observations were conducted across nine POS. During these observations, a total of 59,354 users were identified. Out of theses, 39,153 (66.0%) were engaged in POS-based MVPA. The presence of users was found to be more frequent during the spring season (38.7%) and on weekends (ranging from 37.6 to 50.1% across seasons). Additionally, user presence was higher in the late afternoon (ranging from 36.4 to 58.2% across seasons) and at higher temperatures with lower relative humidity (p-value < 0.001). Regarding POS-based MVPA, it was more frequent during the winter season (36.4%) and on weekdays (ranging from 73.2 to 79.9% across seasons). Similarly, MVPA was higher in the late afternoon (ranging from 58.3 to 67.5% across seasons) and at lower temperatures and thermal sensations (p-value < 0.005). CONCLUSIONS: Higher presence of users in POS, as well as their visiting, to practice POS-based MVPA, depending on the seasons and specific meteorological elements. By creating infrastructure and conducive conditions, cities can encourage individuals to adopt more active and healthy behaviors. These findings emphasize the importance of designing urban spaces that promote physical activity and contribute to overall well-being.

Perspectives on urban mobility in promoting physical activity in the context of commuting in Brazil / Perspectivas sobre mobilidade urbana na promoção da atividade física no contexto dos deslocamentos no Brasil

Despite Brazil's important advances in regulatory aspects related to city planning, the disorder-ly growth of Brazilian cities makes it difficult to implement changes that would result in greater opportunities for the active commuting of the population. This essay was designed to reflect on opportunities for improvement in the urban environment to promote physical activity in the context of commuting in Brazil. From this perspective, the study identified policies that promote orderly growth and support active commuting in cities. It also suggested the use of indicators to evaluate and monitor development, with a particular emphasis on active commuting. Furthermore, it is essential to adapt and improve the urban planning process to meet the needs of Brazilian municipalities and foster closer collaboration with civil society. Thus, it will be possible to verify the changes in the urban environment and their impact on the active commuting, promoting the development of healthy and sustainable cities

Apesar do Brasil apresentar importante avanço em aspectos regulatórios relacionados ao planejamento das cidades, o crescimento desordenado das cidades brasileiras dificulta a realização de mudanças que reflitam em maiores oportunidades no deslocamento ativo da população. Este ensaio foi elaborado com objetivo de refletir sobre as oportunidades para melhorias no ambiente urbano para a promoção da atividade física no contexto do deslocamento no Brasil. Nessa perspectiva, o estudo identificou políticas que permitem o crescimento ordenado e favoreça o deslocamento ativo nas cidades, além de sugerir o uso de indicadores para avaliação e monitoramento do desenvolvimento, com especial foco no deslocamento ativo. Ademais, é imprescindível que o processo de planejamento urbano seja adaptado e aprimorado considerando as necessidades dos municípios brasileiros e com aproximação da sociedade civil. Assim, será possível verificar as modificações no ambiente urbano e seu impacto no deslocamento ativo da população, estimulando a criação de cidades saudáveis e sustentáveis

Methodology for using the Microscale Audit of Pedestrian Streetscapes-MAPS in the city of São Paulo / Metodologia de utilização do Microscale Audit of Pedestrian Streetscapes-MAPS na cidade de São Paulo

The Microscale Audit of Pedestrian Streetscapes-Global (MAPS Global) is an international instru-ment that aims to characterize the variability of pedestrian environments related to physical activity at the microscale level, being a reliable tool that allows comparisons between locations with different contexts. In this regard, the objective of the present study is to describe the methodological process adopted in the Health Survey of São Paulo or Inquérito de Saúde de São Paulo (ISA) in portu-guese ­ Physical Activity and Environment survey for the microscale environment assessment with the MAPS-Global instrument. The use of the method in São Paulo city involved several steps and adaptations relevant to the context of the study, such as: meetings with the group responsible for the validation of the method in Brazil, training of researchers for data collection, review of sections and questions and instrument hosting on Google forms, georeferencing of households and preparation of routes, training and certification of evaluators, and data collection procedures. The environment audit presented challenges, even though it was an exclusively online process, 25 months were required for all the stages development since the audit involved a considerable sample of 1,434 subjects, an increased evaluation coverage in cross-segment sections, and a team of seven evaluators. For future data collection it is suggested to consider the time available for auditing, the size of the team for the selected sample, as well as the possibility of adapting the instrument, such as the inclusion or removal of items according to the local context or reality of the study

O Microscale Audit of Pedestrian Streetscapes-Global (MAPS-Global) é um instrumento internacional que visa caracterizar a variabilidade de ambientes de pedestres relacionados à atividade física ao nível de microescala, sendo uma ferramenta confiável que permite comparações entre locais com diferentes contextos. Neste sentido, o objetivo do presente estudo é descrever o processo metodológico adotado na pesquisa Inquérito de Saúde de São Paulo (ISA) - Atividade Física e Ambiente para a avaliação da microescala do ambiente com o instrumento MAPS-Global. A utilização do método na cidade de São Paulo envolveu diversas etapas e adaptações relevantes para o contexto do estudo, inicialmente foram realizadas reuniões com o grupo responsável por validar o método no Brasil, treinamento dos pesquisadores para coletas de dados, revisão dos blocos e questões, hospedagem do instrumento no Google forms, georreferenciamento dos domicílios, elaboração das rotas, treinamento e certificação dos avaliadores e procedimentos de coletas de dados. A auditagem do ambiente apresentou desafios, mesmo se tratando de um processo exclusivamente online, foram necessários 25 meses para o desenvolvimento de todas as etapas do estudo, pois a avaliação envolveu 1.434 sujeitos, aumento da cobertura da avaliação nas seções dos segmentos e cruzamentos e uma equipe de sete avaliadores. Sugere-se para coletas futuras que seja observado o tempo disponível para auditagem, o tamanho da equipe para a amostra selecionada, bem como a possibilidade realizar adaptações no instrumento como a inclusão ou retirada de itens conforme contexto ou realidade local do estudo

Seleção de especialistas para o desenvolvimento de subconjuntos terminológicos da CIPE: uma pesquisa metodológica / Selection of experts for the development of terminological subsets of ICNP: a methodological research

OBJETIVO: Elaborar instrumentos para seleção de especialistas para etapas do desenvolvimento de subconjuntos terminológicos da Classificação Internacional para a Prática de Enfermagem (CIPE). MÉTODO: Trata-se de uma pesquisa metodológica. Os critérios identificados, na revisão integrativa da literatura, constituíram base para dois questionários, analisados por 21 avaliadores, em duas rodadas. O primeiro, organizado com seis domínios e 38 critérios, e o segundo, com cinco domínios e 23 critérios, direcionados para etapas do desenvolvimento do subconjunto terminológico. Adotou-se Índice de Validação de Conteúdo ≥ 0,80. RESULTADOS: Os critérios foram alocados em cinco domínios organizadores. Elaborados quatro instrumentos: i) mapeamento cruzado ­ 18 critérios; ii) definição operacional ­ 15 critérios; iii) validação de conteúdo ­ 17 critérios; e iv) aplicabilidade clínica ­ 13 critérios. CONCLUSÃO: Foram elaborados instrumentos com critérios para seleção de especialistas para o desenvolvimento de subconjuntos terminológicos, que se utilizados podem contribuir para o rigor da seleção de especialistas e com a segurança do processo de validação.

OBJECTIVE: To develop tools for selecting experts for stages in developing terminological subsets of the International Classification for Nursing Practice (ICNP). METHOD: This is a methodological research study. The criteria identified in the integrative literature review formed the basis for two questionnaires, analyzed by 21 evaluators in two rounds. The first questionnaire was organized with six domains and 38 criteria, and the second with five domains and 23 criteria, focusing on stages of terminological subset development. A Content Validation Index ≥ 0.80 was adopted. RESULTS: The criteria were allocated into five organizing domains. Four instruments were developed: i) cross-mapping ­ 18 criteria; ii) operational definition ­ 15 criteria; iii) content validation ­ 17 criteria; and iv) clinical applicability ­ 13 criteria. CONCLUSION: Instruments with criteria for selecting experts in the development of terminological subsets were developed, which, if used, can contribute to the rigor of expert selection and the safety of the validation process.

Status and Trends of Physical Activity Surveillance, Policy, and Research in 164 Countries: Findings From the Global Observatory for Physical Activity-GoPA! 2015 and 2020 Surveys.

BACKGROUND: Physical activity (PA) surveillance, policy, and research efforts need to be periodically appraised to gain insight into national and global capacities for PA promotion. The aim of this paper was to assess the status and trends in PA surveillance, policy, and research in 164 countries. METHODS: We used data from the Global Observatory for Physical Activity (GoPA!) 2015 and 2020 surveys. Comprehensive searches were performed for each country to determine the level of development of their PA surveillance, policy, and research, and the findings were verified by the GoPA! Country Contacts. Trends were analyzed based on the data available for both survey years. RESULTS: The global 5-year progress in all 3 indicators was modest, with most countries either improving or staying at the same level. PA surveillance, policy, and research improved or remained at a high level in 48.1%, 40.6%, and 42.1% of the countries, respectively. PA surveillance, policy, and research scores decreased or remained at a low level in 8.3%, 15.8%, and 28.6% of the countries, respectively. The highest capacity for PA promotion was found in Europe, the lowest in Africa and low- and lower-middle-income countries. Although a large percentage of the world's population benefit from at least some PA policy, surveillance, and research efforts in their countries, 49.6 million people are without PA surveillance, 629.4 million people are without PA policy, and 108.7 million live in countries without any PA research output. A total of 6.3 billion people or 88.2% of the world's population live in countries where PA promotion capacity should be significantly improved. CONCLUSION: Despite PA is essential for health, there are large inequalities between countries and world regions in their capacity to promote PA. Coordinated efforts are needed to reduce the inequalities and improve the global capacity for PA promotion.

Evening chronotype predicts dropout of physical exercise: a prospective analysis.

Purpose: Eveningness preference to sleep/wake and perform physical/cognitive activities has been associated with worse health outcomes, when compared to morningness preference. Physical activity is one potential mediator that could explain this relationship; however, most of these evidences come from cross-sectional design studies. Our goal was to assess whether chronotype could predict the risk of dropout of physical exercise programs. Methods: We followed 153 newly enrolled volunteers at three different gyms, from both sexes, aged between 18 and 65 years, during 12 weeks. The daily frequency of exercises in the programs was objectively measured (gym's electronic turnstiles). Using questionnaires, we collected data of variables related to demographic characteristics, health, physical activity, sleep, anthropometric and chronobiological parameters (Morningness-Eveningness Questionnaire-MEQ). Two multivariate models were created using Cox regression analysis to test the risk of dropout of physical exercise practice. Both models accounted for age, educational level, civil status, membership plan duration, physical exercise practice frequency during week 1 and chronotype (MEQ score and chronotypes). Results: Model 1 results showed that higher MEQ score was associated with a lower chance of quitting the program (HR = 0.98; CI95% 0.95-1.00; p = 0.046). Considering the chronotypes, E-types showed the highest dropout risk compared to that of M-types (HR = 2.22; CI95% 1.09-4.52; p = 0.027). Conclusion: Our results suggest that chronotype is another variable to be considered in future studies on promoting PAs in formal environments. Likewise, the practice frequency during week 1 and duration of membership plan also deserve more attention in additional studies.

Associação de Nível de Renda e Doença Isquêmica do Coração: Papel Potencial da Caminhabilidade / Association of Income Level and Ischemic Heart Disease: Potential Role of Walkability

Resumo Fundamento O nível socioeconômico tem sido associado à doença isquêmica do coração (DIC). Bairros de alta renda podem expor os indivíduos a um ambiente construído que promova caminhadas para atividades diárias (caminhabilidade). Faltam dados sobre a associação entre renda e DIC em países de renda média. Também é incerto se a caminhabilidade medeia essa associação. Objetivos Investigar se a renda está associada à DIC em um país de renda média e se a caminhabilidade dos bairros medeia a associação entre renda e DIC. Métodos O presente estudo transversal avaliou 44.589 pacientes encaminhados para imagem de perfusão miocárdica (SPECT-MPI). A renda e a caminhabilidade foram derivadas do setor censitário residencial dos participantes. A pontuação quantitativa da caminhabilidade combinou as seguintes 4 variáveis: conectividade viária, densidade residencial, densidade comercial e uso misto do solo. A DIC foi definida pela presença de perfusão miocárdica anormal durante um estudo SPECT-MPI. Utilizamos modelos ajustados com efeitos mistos para avaliar a associação entre nível de renda e DIC e realizamos uma análise de mediação para medir o percentual da associação entre renda e DIC mediada pela caminhabilidade. Consideramos valores de p abaixo de 0,01 como estatisticamente significativos. Resultados Dos 26.415 participantes, aqueles que residiam no setor censitário do tercil de menor renda eram mais fisicamente inativos (79,1% versus 75,8% versus 72,7%) quando comparados aos setores censitários do tercil de maior renda (p < 0,001). A renda foi associada à DIC (odds ratio: 0,91 [intervalo de confiança de 95%: 0,87 a 0,96] para cada aumento de 1000,00 dólares internacionais na renda), para homens e mulheres igualmente (p para interação = 0,47). Os setores censitários com maior renda estiveram associados a uma melhor caminhabilidade (p < 0,001); no entanto, a caminhabilidade não mediou a associação entre renda e DIC (porcentagem mediada = −0,3%). Conclusões A renda foi independentemente associada a maior prevalência de DIC em um país de renda média, independentemente de gênero. Embora a caminhabilidade tenha sido associada à renda do setor censitário, ela não mediou a associação entre renda e DIC.

Abstract Background Socioeconomic status has been linked to ischemic heart disease (IHD). High-income neighborhoods may expose individuals to a walking-promoting built environment for daily activities (walkability). Data from the association between income and IHD is lacking in middle-income countries. It is also uncertain whether walkability mediates this association. Objectives To investigate whether income is associated with IHD in a middle-income country and whether neighborhood walkability mediates the income-IHD association. Methods This cross-sectional study evaluated 44,589 patients referred for myocardial perfusion imaging (SPECT-MPI). Income and walkability were derived from participants' residential census tract. Walkability quantitative score combined 4 variables: street connectivity, residential density, commercial density, and mixed land use. IHD was defined by abnormal myocardial perfusion during a SPECT-MPI study. We used adjusted mixed effects models to evaluate the association between income level and IHD, and we performed a mediation analysis to measure the percentage of the income-IHD association mediated by walkability. We considered p values below 0.01 as statistically significant. Results From 26,415 participants, those living in the lowest-income tertile census tract were more physically inactive (79.1% versus 75.8% versus 72.7%) when compared to higher-income tertile census tracts (p < 0.001). Income was associated with IHD (odds ratio: 0.91 [95% confidence interval: 0.87 to 0.96] for each 1,000.00 international dollars increase in income) for both men and women equally (p for interaction = 0.47). Census tracts with a higher income were associated with better walkability (p < 0.001); however, walkability did not mediate the income-IHD association (percent mediated = −0.3%). Conclusions Income was independently associated with higher prevalence of IHD in a middle-income country irrespective of gender. Although walkability was associated with census tract income, it did not mediate the income-IHD association.

Cross-cultural adaptation of the Brazilian-Portuguese version of the Perceived Nutrition Environment Measures Survey / Adaptação transcultural da versão brasileira do Perceived Nutrition Environment Measures Survey

ABSTRACT Objective The objective of this study was to cross-culturally adapt the Perceived Nutrition Environment Measures Survey for use in the Brazilian context. Methods Independent translations into Portuguese of the original version and respective back-translations into English were performed. The steps were evaluated by an expert committee and the translated version was applied in a group of both genders, of different ages and education. Results After suggested modifications in the translation processes, the expert committee considered that the translated and adapted version presented conceptual and semantic equivalence. The translated version was applied to a sample of twenty people and only one question related to the amount of fat in the food required a new round to obtain understanding and clarity. Conclusion We present an adapted version of Perceived Nutrition Environment Measures Survey for the Brazilian context, which has adequate conceptual, cultural, and semantic equivalence, being objective and comparable to the original version. Future studies should confirm clarity, reliability, and validity.

RESUMO Objetivo O objetivo deste estudo foi adaptar transculturalmente o Perceived Nutrition Environment Measures Survey para uso no contexto brasileiro. Métodos Foram realizadas traduções independentes da versão original para o português e respectivas retrotraduções para o inglês. As etapas foram avaliadas por um comitê de especialistas e a versão traduzida foi aplicada em um grupo com pacientes de ambos os sexos, de diferentes idades e níveis de escolaridade. Resultados Após modificações sugeridas nos processos de tradução, o comitê de especialistas considerou que a versão traduzida e adaptada apresentou equivalência conceitual e semântica. A versão traduzida foi aplicada a uma amostra de 20 pessoas e apenas uma questão, relacionada à quantidade de gordura no alimento, requereu nova rodada para obter compreensão e clareza. Conclusão Uma versão do Perceived Nutrition Environment Measures Survey adaptada ao contexto brasileiro, a qual possui equivalências conceitual, cultural e semântica adequadas, sendo objetiva e comparável à versão original, é apresentada. Futuros estudos devem confirmar a clareza, confiabilidade e validade.

Worse sleep quality predicts early drop out from physical exercise programs.

Introduction and Objective: Sleep quality (SQ) benefits from regular physical exercise (PE) practice, but the effect of SQ over behavioral aspects of PE is not well known. In this study, we tested whether sleep variables can predict the drop out risk for PE programs during a six-week critical period for habit formation at gyms. Material and Methods: We assessed 153 volunteers, freshly enrolled at three different gyms and from both sexes, with average age of 33.6 (±11.9) years. Questionnaires provided sociodemographic, health, sleep, physical activity and circadian rhythmicity information. Daily PE practice frequency was monitored using the gym's turnstiles electronic records. We created a multivariate model using Cox regression in order to test the risk of PE program drop out during the first six weeks. Results: Worse SQ predicted a higher drop out risk (HR=1.11; 95%CI = 1.02-1.21; p<0.05), even when adjusted for other potential confounding variables. Conclusion: We found that worse SQ predicted a higher early drop out from PE programs in the formal context of gyms during the first six weeks, along with other variables related to PE practice.

El entorno construido en los programas diseñados para promover la actividad física entre las niñas, niños y jóvenes latinos que viven en Estados Unidos y América Latina.

Prevenir la obesidad entre los jóvenes latinos que viven en Estados Unidos y en países latinoamericanos requiere reconocer la especificidad de los contextos y las interacciones entre actividad física (AF) y entorno construido (EC). El objetivo de este artículo es avanzar en la agenda de investigación sobre el EC y la AF con el fin de prevenir la obesidad en Latinoamérica y entre los jóvenes latinos de Estados Unidos mediante (1) la identificación de indicadores del entorno que contribuyan en el diseño de intervenciones y políticas; (2) la identificación de enfoques metodológicos interdisciplinarios para el estudio de la relación compleja que se establece entre el EC y la AF y (3) la presentación de estudios de casos sobre programas de EC que promueven la AF. Un grupo de científicos estadounidenses y latinoamericanos trabajó en colaboración para proponer nuevos indicadores sobre el EC, establecer enfoques metodológicos que permitan estudiar la relación compleja entre EC y AF, y revisar estudios de caso sobre programas de EC que promueven la AF en ambas regiones. Como resultado, se identificaron lagunas de conocimiento, se propusieron indicadores del entorno (como el paisaje, el diseño de las calles, los patrones de movilidad, la delincuencia y la seguridad), se revisaron enfoques metodológicos (análisis de redes sociales, métodos de ciencia ciudadana) y se analizaron estudios de caso de programas del EC que promueven la AF (calles para el juego, desplazamiento activo a la escuela e intervenciones en el entorno escolar). La prevención de la obesidad entre los jóvenes latinos y latinoamericanos exige una investigación avanzada del EC y de la AF que aborde las prioridades específicas de cada contexto y permita intercambiar las lecciones aprendidas.

International evaluation of the Microscale Audit of Pedestrian Streetscapes (MAPS) Global instrument: comparative assessment between local and remote online observers.

OBJECTIVES: The use of online imagery by non-local observers to conduct remote, centralized collection of streetscape audit data in international studies has the potential to enhance efficiency of collection and comparability of such data for research on built environments and health. The objectives of the study were to measure (1) the consistency in responses between local in-field observers and non-local remote online observers and (2) the reliability between in-country online observers and non-local remote online observers using the Microscale Audit of Pedestrian Streetscapes Global tool to characterize pedestrian-related features along streets in five countries. METHODS: Consistency and inter-rater reliability were analyzed between local and non-local observers on a pooled database of 200 routes in five study regions (Melbourne, Australia; Ghent, Belgium; Curitiba, Brazil; Hong Kong, China; and Valencia, Spain) for microscale environmental feature subscales and item-level variables using the intraclass correlation coefficient (ICC). RESULTS: A local in-field versus remote online comparison had an ICC of 0.75 (95 % CI: 0.68-0.80) for the grand total score. An ICC of 0.91 (95 % CI: 0.88-0.93) was found for the local online versus remote online comparison. Positive subscales yielded stronger results in comparison to negative subscales, except for the similarly poor-performing positive aesthetics/social characteristics. CONCLUSIONS: This study demonstrated remote audits of microscale built environments using online imagery had good reliability with local in-field audits and excellent reliability with local online audits. Results generally supported remote online environmental audits as comparable to local online audits. This identification of low-cost and efficient data acquisition methods is important for expanding research on microscale built environments and physical activity globally.

Built environment in programs to promote physical activity among Latino children and youth living in the United States and in Latin America.

To prevent obesity among Latino youth in the United States and Latin America, it is necessary to understand the specific context and interplay of physical activity (PA) and the built environment (BE). This paper aims to advance the research agenda of BE and PA for obesity prevention in Latin America and among Latino youth in the United States by (1) identifying environmental indicators to inform the design of interventions and policy, (2) identifying interdisciplinary methodological approaches for the study of the complex association between BE and PA, and (3) presenting case studies of PA-promoting BE programs. A group of U.S. and Latin American scientists collaboratively worked to propose innovative indicators of the BE, methodological approaches for the study of the complex association between BE and PA, and review case studies of PA-promoting BE programs in both regions. The results identified gaps in knowledge, proposed environmental indicators (e.g., landscape, street design, mobility patterns, and crime and safety), reviewed methodological approaches (social network analysis, citizen science methods), and case studies illustrating PA-promoting BE programs (i.e., play streets, active school transport, and school setting interventions). The obesity prevention among Latino and Latin American youth requires advanced research on BE and PA addressing context-specific priorities and exchanging lessons learned.

Risk stratification and geographical mapping of Brazilian inflammatory bowel disease patients during the COVID-19 outbreak: Results from a nationwide survey.

BACKGROUND: Coronavirus disease 2019 (COVID-19) pandemic is still evolving globally, and Brazil is currently one of the most affected countries. It is still debated whether patients with inflammatory bowel disease (IBD) are at a higher risk for developing COVID-19 or its complications. AIM: To assess geographical distribution of IBD patients at the highest risk and correlate these data with COVID-19 mortality rates in Brazil. METHODS: The Brazilian IBD Study Group (Grupo de Estudos da Doença Inflamatória Intestinal do Brasil) developed a web-based survey adapted from the British Society of Gastroenterology guidelines. The included categories were demographic data and inquiries related to risk factors for complications from COVID-19. Patients were categorized as highest, moderate or lowest individual risk. The Spearman correlation test was used to identify any association between highest risk and mortality rates for each state of the country. RESULTS: A total of 3568 patients (65.3% females) were included. Most participants were from the southeastern and southern regions of Brazil, and 84.1% were using immunomodulators and/or biologics. Most patients (55.1%) were at moderate risk, 23.4% were at highest risk and 21.5% were at lowest risk of COVID-19 complications. No association between the proportion of IBD patients at highest risk for COVID-19 complications and higher mortality rates was identified in different Brazilian states (r = 0.146, P = 0.467). CONCLUSION: This study indicates a distinct geographical distribution of IBD patients at highest risk for COVID-19 complications in different states of the country, which may reflect contrasting socioeconomic, educational and healthcare aspects. No association between high risk of IBD and COVID-related mortality rates was identified.

Barreiras para a prática de atividade física em idosos: revisão de escopo de estudos brasileiros / Barriers to physical activity in elderly: scoping review of Brazilian studies

Com objetivo de identificar as barreiras à prática de atividade física (AF) em idosos, foi conduzida uma revisão de escopo, com buscas em sete bases de dados eletrônicas e em listas de referências, abrangendo artigos disponíveis até dezembro de 2020. Procurou-se por estudos originais, desenvolvi-dos no Brasil, que investigaram barreiras à prática de AF em amostras de pessoas ≥ 60 anos. Dos 911 artigos iniciais, 13 compuseram a síntese, envolvendo idosos participantes de grupos de convivência, institucionalizados e participantes de projetos de AF, com predominância de mulheres. Foram iden-tificadas 31 barreiras, sendo 18 delas classificadas como intrapessoais (58,1%). "Doença, dor ou lesão" foi a barreira mais frequentemente mencionada entre os estudos (n = 9), estando também associada à inatividade física em um artigo. Também merecem destaque: "falta de segurança" (n = 6), "medo de cair/se machucar" (n = 3) e "sentir-se suficientemente ativo" (n = 3). As barreiras intrapessoais são as mais percebidas pelos idosos brasileiros, sendo a barreira "dor, doença e/ou lesão" a mais fre-quentemente mencionada, seguida das barreiras "falta de segurança"; "medo de cair/se machucar" e "sentir-se suficientemente ativo". Mesmo que esta evidência esteja amparada, em sua maior parte, por dados provenientes da região Sul do país, o reconhecimento destas barreiras pode ser incorporada nos distintos cenários de oferta da AF para idosos. Complementarmente, futuros estudos são importan-tes, tanto para apresentação das principais barreiras para a AF nas distintas regiões do país, quanto para a análise das suas possíveis associações à inatividade física

In order to identify barriers to physical activity (PA) in the elderly, we conducted a scoping review, with searches in seven electronic databases and reference lists, covering articles available until December 2020. We searched for original studies, developed in Brazil, that investigated barriers to PA in samples of ≥ 60 years people. Of the 911 initial results, 13 composed the synthesis, involving elderly participants of sociali-zation groups, institutionalized and participants of PA projects, with a predominance of women. Thirty-one barriers were identified, 18 of which were classified as intrapersonal (58.1%). "Disease, pain or injury" was the most frequently mentioned barrier among the studies (n = 9), being also associated with physical inactivity in one article. Also noteworthy were "lack of safety" (n = 6), "fear of falling/injury" (n = 3), and "feeling active enough" (n = 3). Intrapersonal barriers are the most perceived by Brazilian elderly, with "pain, illness and/or injury" being the most frequently mentioned barrier, followed by "lack of safety", "fear of falling/injury", and "feeling active enough". Even though this evidence is mostly supported by data from the Southern region of the country, the recognition of these barriers can be incorporated into the different scenarios of PA supply for the elderly. In addition, future studies are important, both for the presentation of the main barriers to PA in different regions of the country, and for the analysis of their possible associations with physical inactivity

Comparison of the Results of Manual and Automated Processes of Cross-Mapping Between Nursing Terms: Quantitative Study.

BACKGROUND: Cross-mapping establishes equivalence between terms from different terminology systems, which is useful for interoperability, updated terminological versions, and reuse of terms. Due to the number of terms to be mapped, this work can be extensive, tedious, and thorough, and it is susceptible to errors; this can be minimized by automated processes, which use computational tools. OBJECTIVE: The aim of this study was to compare the results of manual and automated term mapping processes. METHODS: In this descriptive, quantitative study, we used the results of two mapping processes as an empirical basis: manual, which used 2638 terms of nurses' records from a university hospital in southern Brazil and the International Classification for Nursing Practice (ICNP); and automated, which used the same university hospital terms and the primitive terms of the ICNP through MappICNP, an algorithm based on rules of natural language processing. The two processes were compared via equality and exclusivity assessments of new terms of the automated process and of candidate terms. RESULTS: The automated process mapped 569/2638 (21.56%) of the source bank's terms as identical, and the manual process mapped 650/2638 (24.63%) as identical. Regarding new terms, the automated process mapped 1031/2638 (39.08%) of the source bank's terms as new, while the manual process mapped 1251 (47.42%). In particular, manual mapping identified 101/2638 (3.82%) terms as identical and 429 (16.26%) as new, whereas the automated process identified 20 (0.75%) terms as identical and 209 (7.92%) as new. Of the 209 terms mapped as new by the automated process, it was possible to establish an equivalence with ICNP terms in 48 (23.0%) cases. An analysis of the candidate terms offered by the automated process to the 429 new terms mapped exclusively by the manual process resulted in 100 (23.3%) candidates that had a semantic relationship with the source term. CONCLUSIONS: The automated and manual processes map identical and new terms in similar ways and can be considered complementary. Direct identification of identical terms and the offering of candidate terms through the automated process facilitate and enhance the results of the mapping; confirmation of the precision of the automated mapping requires further analysis by researchers.

Development and reproducibility of an instrument to assess behavioral and environmental aspects related to cyclist safety / Desenvolvimento e reprodutibilidade de um instrumento para avaliar aspectos comportamentais e ambientais relacionados à segurança do ciclista

Abstract In urgency and emergency services, the bicycle is the second means of transportation more widely used by the victims at the time of the accident. However, aspects associated with major and minor accidents are poorly understood. The aim was to develop an instrument and test its reproducibility, in order to evaluate behavioral and environmental aspects related to cyclist safety. The instrument was based on footage taken through a camera attached to the cyclist helmet and from a review of literature. Take part in the study academics that used the bicycle to travel at least once a week. Participants were instructed to indicate any safety-critical events on their way and situations of minor gravity based on the perception of real imminence of an accident. In order to identify aspects related to cyclist safety, the routes were divided in periods of 30 seconds. In order to test inter-rater reproducibility, two researchers received theoretical-practical training and performed the instrument in a sample of 100 periods. In order to evaluate the intra-rater reproducibility, one of the evaluators performed a second application after 07 days. The reproducibility of the categorical variables of the instrument were tested through general agreement and Kappa index. For the variables with continuous measuring range, the Intraclass Correlation Coefficient (ICC) was used. The percentage agreement varied between 88-100% and the Kappa values varied ​​between 0.76-1.00. The ICC values ​​ranged from 0.96-0.99. The developed instrument presents adequate reproducibility for use in research to evaluate the cyclist safety in urban contexts.

Resumo Em serviços de urgência e emergência a bicicleta é o segundo meio de locomoção mais utilizado pelas vítimas na hora do acidente. No entanto, os aspectos associados aos acidentes de maior e menor gravidade são pouco conhecidos. O objetivo deste trabalho foi desenvolver e testar a reprodutibilidade de um instrumento para avaliar aspectos comportamentais e ambientais relacionados à segurança de ciclistas. O instrumento foi baseado em filmagens realizadas através de câmera acoplada no capacete e a partir de revisão de literatura. Participaram do estudo universitários que utilizavam a bicicleta para deslocamento ao menos um dia por semana, foram orientados a indicar no trajeto eventos críticos, situações de menor gravidade baseadas na percepção de iminência real de acidente. Para identificar os aspectos relacionados à segurança, os trajetos foram fracionados em períodos de 30 segundos. Para testar a reprodutibilidade interavaliador dois pesquisadores receberam treinamento teórico-prático e realizaram a aplicação do instrumento em uma mostra de 100 períodos. Para avaliar a reprodutibilidade intra-avaliador, um dos avaliadores realizou uma segunda aplicação após 07 dias. A reprodutibilidade das variáveis categóricas do instrumento foi testada através da concordância geral e índice Kappa. Para as variáveis com escala de medida contínua foi utilizado o coeficiente de correlação intraclasse. Os percentuais de concordância variaram entre 88, e 100% e os valores de Kappa entre 0,76 e 1,00. Os valores de CCI variaram entre 0,96 e 0,99. O instrumento desenvolvido apresenta reprodutibilidade adequada para o emprego em pesquisas para avaliação da segurança de ciclistas em contextos urbanos.