The gout epidemic in French Polynesia: a modelling study of data from the Ma'i u'u epidemiological survey.

BACKGROUND: Gout is the most common cause of inflammatory arthritis worldwide, particularly in Pacific regions. We aimed to establish the prevalence of gout and hyperuricaemia in French Polynesia, their associations with dietary habits, their comorbidities, the prevalence of the HLA-B*58:01 allele, and current management of the disease. METHODS: The Ma'i u'u survey was epidemiological, prospective, cross-sectional, and gout-focused and included a random sample of adults from the general adult population of French Polynesia. It was conducted and data were collected between April 13 and Aug 16, 2021. Participants were randomly selected to represent the general adult population of French Polynesia on the basis of housing data collected during the 2017 territorial census. Each selected household was visited by a research nurse from the Ma'i u'u survey who collected data via guided, 1-h interviews with participants. In each household, the participant was the individual older than 18 years with the closest upcoming birthday. To estimate the frequency of HLA-B*58:01, we estimated HLA-B haplotypes on individuals who had whole-genome sequencing to approximately 5× average coverage (mid-pass sequencing). A subset of individuals who self-reported Polynesian ancestry and not European, Chinese, or other ancestry were used to estimate Polynesian-ancestry specific allele frequencies. Bivariate associations were reported for weighted participants; effect sizes were estimated through the odds ratio (OR) of the association calculated on the basis of a logistic model fitted with weighted observations. FINDINGS: Among the random sample of 2000 households, 896 participants were included, 140 individuals declined, and 964 households could not be contacted. 22 participants could not be weighted due to missing data, so the final weighted analysis included 874 participants (449 [51·4%] were female and 425 [48·6%] were male) representing the 196 630 adults living in French Polynesia. The estimated prevalence of gout was 14·5% (95% CI 9·9-19·2), representing 28 561 French Polynesian adults, that is 25·5% (18·2-32·8) of male individuals and 3·5% (1·0-6·0) of female individuals. The prevalence of hyperuricaemia was estimated at 71·6% (66·7-76·6), representing 128 687 French Polynesian adults. In multivariable analysis, age (OR 1·5, 95% CI 1·2-1·8 per year), male sex (10·3, 1·8-60·7), serum urate (1·6, 1·3-2·0 per 1 mg/dL), uraturia (0·8, 0·8-0·8 per 100 mg/L), type 2 diabetes (2·1, 1·4-3·1), BMI more than 30 kg/m2 (1·1, 1·0-1·2 per unit), and percentage of visceral fat (1·7, 1·1-2·7 per 1% increase) were associated with gout. There were seven heterozygous HLA-B*58:01 carriers in the full cohort of 833 individuals (seven [0·4%] of 1666 total alleles) and two heterozygous carriers in a subset of 696 individuals of Polynesian ancestry (two [0·1%]). INTERPRETATION: French Polynesia has an estimated high prevalence of gout and hyperuricaemia, with gout affecting almost 15% of adults. Territorial measures that focus on increasing access to effective urate-lowering therapies are warranted to control this major public health problem. FUNDING: Variant Bio, the French Polynesian Health Administration, Lille Catholic University Hospitals, French Society of Rheumatology, and Novartis.

Retention, safety and efficacy of off-label conventional treatments and biologics for chronic calcium pyrophosphate crystal inflammatory arthritis.

OBJECTIVES: Very little is known on the efficacy and safety of drugs for the management of chronic calcium pyrophosphate (CPP) crystal inflammatory arthritis. The objectives of this work were to describe the drugs used in the management of chronic CPP crystal inflammatory arthritis in expert European centres, and to examine treatment retention. METHODS: This was a retrospective cohort study. Charts from patients with a diagnosis of persistent inflammatory and/or recurrent acute CPP crystal arthritis were reviewed in seven European centres. Baseline characteristics were collected, and visits at months 3, 6, 12 and 24 included an assessment of treatment response and safety. RESULTS: One hundred and ninety-four treatments were initiated in 129 patients. Colchicine (used first-line in n = 73/86), methotrexate (used first-line in n = 14/36), anakinra (n = 27) and tocilizumab (n = 25) were the most prescribed treatments, while long-term corticosteroids, hydroxychloroquine, canakinumab and sarilumab were used occasionally. The 24-month on-drug retention was higher for tocilizumab (40%) than anakinra (18.5%) (P < 0.05), while the difference between colchicine (29.1%) and methotrexate (44.4%) was not statistically significant (P = 0.10). Adverse events led to 14.1% of colchicine discontinuations (100% of diarrhoea), 4.3% for methotrexate, 31.8% for anakinra and 20% for tocilizumab; all other discontinuations were related to insufficient response or losses to follow-up. Efficacy outcomes did not differ significantly between treatments throughout follow-up. CONCLUSION: Daily colchicine is the first-line therapy used in chronic CPP crystal inflammatory arthritis, which is considered efficient in a third to half of cases. Second-line treatments include methotrexate and tocilizumab, which have higher retention than anakinra.

Limited benefit of systematic head CT for mild traumatic brain injury in patients under antithrombotic therapy.

BACKGROUND AND PURPOSE: Mild traumatic brain injury (mTBI) in patients on antiplatelet (AP), anticoagulant (AC) or direct oral anticoagulant (DOAC) medication has become a systematic indication for head CT. However, the over-risk and impact of the intracranial hemorrhages (IH) detected with CT in this population remain unclear and need to be assessed. MATERIALS AND METHODS: We prospectively assessed head CTs performed in adults taking AP/AC/DOAC referred after a mTBI to our Emergency Departments between September 2016 and January 2018. Frequency, type and severity of IH were described and frequency was analyzed as a function of treatment. RESULTS: 840 patients were prospectively included. 58.9% were treated with AP, 23.7% with AC, 11.7% with DOAC and 5.7% with a combination of antithrombotic agents. The rate of IH detected with head CT was 5.8% (n...=...49), of which 81.6% (n...=...40) and 18.4% (n...=...9) with minor and intermediate severity respectively. No patient required surgical care and no death occurred. No statistically significant difference was found in treatment distribution between patients with or without IH (p...=...0.98). Among the patients who discontinued their antithrombotic treatment after mTBI, three experienced thrombotic events during the hospitalization. CONCLUSIONS: Our results showed a low frequency and severity of IH in mTBI patients indifferently treated with AP, AC or DOAC, without secondary neurological deterioration, death or need of surgical care. Our study suggests the limited benefit of systematic CT head scan as a standard practice for the management of mTBI patients under antithrombotic therapy.

Will videoteleconsultation have been just a stopgap in French orthopedics-traumatology? A national survey of 280 surgeons.

INTRODUCTION: There have been no studies assessing French orthopedic surgeons' satisfaction with video and telephone consultations. These were encouraged during the coronavirus pandemic. We therefore performed a prospective study to assess (1) the profile of physicians using videoteleconsultation (VTC) during the pandemic and factors influencing use, (2) satisfaction with VTC, and (3) the pros, cons and prospects of VTC. HYPOTHESIS: The study hypothesis was that VTC in orthopedics-traumatology is sufficiently satisfying to be used in everyday practice outside of pandemic contexts. MATERIAL AND METHOD: A French nationwide survey was conducted in the form of an assessment of professional practices. Orthopedic and traumatology surgeons were sent a digital questionnaire, using the mailing lists of some of the French professional and scientific societies, with an estimate of 2000 practitioners who could be reached. The survey concerned use of VTC, modalities and satisfaction and the practitioner's profile. On the basis of the questionnaire responses, a Net Promoter Score (NPS) was calculated, evaluating the number (from -100 to +100) of respondents likely to recommend VTC. RESULTS: In total 280 of the estimated 2000 practitioners who were contacted (14.0%) responded. Their mean age was 47.7±10.0years (range: 30-84years). The rate of use of VTC rose from 8.9% (n=25/280) before the pandemic to 55.3% (n=155/280) during it. In the 155 practitioners who had used VTC, NPS was -46.4. Only 51% (n=79/155) were in favor of continuing VTCs outside of pandemic settings. Likewise, 50.3% (n=78/155) reported that clinical examination was more time-consuming via VTC than in face-to-face consultation, and 57.4% (n=89/155) said the same about visualizing complementary examinations. Finally, 98.1% (n=152/155) found VTC less satisfying than face-to-face consultation for clinical examination, and only 18.1% (n=28/155) scheduled surgery after VTC alone. CONCLUSION: To date in French orthopedics-traumatology, VTC does not satisfy surgeons, with its virtual rather than physical clinical examination; even so, it offers a solution in pandemic settings. LEVEL OF EVIDENCE: IV; prospective study without control group.

Immediate hypersensitivity reactions to iodinated contrast media: The diagnosis of allergy by skin testing.

Among 74 patients with an immediate hypersensitivity reaction (IHR) to iodinated contrast media (ICM), the rate of allergic patients confirmed by positive prick test or diluted intradermal test (IDT) was 8.1%. 12.5% of re-exposed patients had a recurrent IHR despite negative skin tests. Investigations on pure IDT to ICM and development of drug provocation test may provide additional safety nets to uncover recurrent ICM reactors. Agreements among allergists are needed to unify practices.

Simple Application and Adherence to Gout Guidelines Enables Disease Control: An Observational Study in French Referral Centres.

Background: In a context of therapeutic inertia, the French Society of Rheumatology (SFR) published its first recommendations on gout in 2020, which were deliberately simple and concise. The objectives of the study were to determine the profile of patients referred to French gout-expert centres, and to examine the results of their management and the factors leading to those results. Methods: Three hundred patients attending a first visit for gout management in three French referral centres were retrospectively and randomly included in this multicentre observational study. Visits were performed at baseline (M0) and scheduled for month 6 (M6), month 12 (M12), and month 24 (M24). Results: Patients were 81% male and had a mean age 62.2 ± 15.2 years. Management followed French recommendations after the baseline visit in 94.9% of cases. SU levels were below 6.0 mg/dL in 59.4% of patients at M6, 67.9% at M12, and 78.6% at M24, with increasing clinical improvement (i.e., flare decrease) over 2 years of follow-up. At M24, 50% of patients were treated with allopurinol (313 ± 105 mg/d), which exceeded renal restrictions of doses in 61.5% of them, and 48.2% received febuxostat (84 ± 36 mg/d). The need for a sufficient dosage of ULT was the only predictive factor found for successful achievement of SU levels < 6.0 mg/dL at a given visit. Conclusions: Simple application of gout-management guidelines is feasible in clinical practice and is efficient, with a majority of patients achieving SU targets and clinical improvement.

A Sensor-Based Multichannel FES System to Control Knee Joint and Reduce Stance Phase Asymmetry in Post-Stroke Gait.

Most of the studies using functional electrical stimulation (FES) in gait rehabilitation have been focused on correcting the drop foot syndrome. Using FES to control the knee joint in individuals with central nervous system (CNS) disorders could also play a key role in gait recovery: spasticity decrease, higher range of motion, positive effect on balance, limiting hyperextension and flexion in stance phase, reducing joint overload, etc. In stance phase, an accurate timing and a fine tuning of stimulation parameters are however required to provide a proper control of the knee stimulation while ensuring a safe and efficient support. In this study, 11 participants were equipped with inertial measurements units (IMU) and foot pressure insoles after supratentorial ischemic or hemorrhagic stroke, informing on knee angle and gait events used to online adapt FES during a 10 m walking protocol. Asymmetry of stance time and weight bearing were monitored as well as gait quality and physiological cost through a series of relevant markers. Vertical trunk motion has been significantly reduced during gait with FES (p-value = 0.038). Despite no significant improvement of stance phase asymmetry has been found, this preliminary work shows evidence of promising technical and rehabilitative potentials of a sensor-based multichannel FES system to control knee joint in post-stroke gait.

Diagnostic performance of suction drainage fluid culture for acute surgical site infection after aseptic instrumented spine surgery: a retrospective analysis of 363 cases.

PURPOSE: Analyze the diagnostic performance of suction drainage fluid culture for acute surgical site infection, which has not been specifically reported in spine surgery patients. METHOD: This was a retrospective single-center observational study including data from 363 patients who underwent aseptic instrumented spine surgery between 2015 and 2017. A suction drain was inserted in all cases. Data analyzed were patient age, gender, ASA score, indication for surgery (degenerative disease, tumor, trauma), spine level (cervical, thoracic, lumbar), procedure performed and spine level, operative time, body temperature, postoperative C-reactive protein time-curve, clinical aspect of surgical scar, bacteriology results of suction drainage fluid, and in case of revision surgery, lavage fluid. Major criteria for periprosthetic infection proposed by the Musculoskeletal Infection Society (MSIS) were accepted as the gold standard for the diagnosis of acute surgical site infection. RESULTS: The overall rate of surgical site infection was 6.9% (5.76% for 1- or 2-level fusion, 5.81% for 3- or 4-level fusion, and 15.6% for 5-level fusion and above). The suction drain was withdrawn on the second postoperative day in 44.1% of cases and the third day in 39.1%. The sensitivity of suction drainage fluid culture for the diagnosis of surgical site infection was 20% [95%CI 6.8-40.7%] with a 96.2% [95%CI 93.2-97.9] specificity. CONCLUSION: The diagnostic performance of suction drainage fluid culture after aseptic instrumented spine surgery for acute surgical site infection is insufficient to warrant its use in routine practice.

Usefulness of a Visual Analog Scale for Measuring Anxiety in Hospitalized Patients Experiencing Pain: A Multicenter Cross-Sectional Study.

BACKGROUND: Anxiety is common in hospitalized patients and can worsen pain or lead to unsuccessful pain relief. AIMS: The purpose of this study was to evaluate the usefulness of measuring anxiety with a visual analog scale (VAS) in the hospitalized patient experiencing pain. DESIGN: We conducted a multiple-center cross-sectional study. PARTICIPANTS/SUBJECTS: Adult inpatients experiencing moderate to severe pain defined by a pain VAS score ≥40 of 100 were included. METHODS: Pain and anxiety data were collected using the following instruments: pain VAS, anxiety VAS, State Anxiety Scale of the Spielberger State-Trait Anxiety Inventory (STAI-YA) and Anxiety Subscale of the Hospital Anxiety and Depression Scale (HAD-A). RESULTS: Data were collected from 394 patients. Of those patients, 43.6% (171 of 392) and 36.6% (143 of 391) had significant anxiety according to STAI-Ya and HAD-A, respectively. Correlation was good between anxiety-VAS and STAI-YA (ρ = 0.67 [95% confidence interval 0.61-0.72]) and moderate between anxiety VAS and HAD-D (ρ = 0.48 [0.39-0.56]). The main factor predictive of situational anxiety was history of anxiety-depression symptoms (odds ratio = 2.95 [1.93-4.56]). For anxiety VAS score ≥ 40 of 100, the sensitivity for detecting anxiety was 81% with 70% specificity. CONCLUSION: This study confirmed the high prevalence of anxiety among inpatients experiencing pain, demonstrated the capacity of a VAS to assess this anxiety, determined an anxiety VAS cutoff level to screen for significant anxiety, and identified risk factors of anxiety in this population. Anxiety VAS has been found to be an easy-to-use method familiar to caregivers, with all the advantages needed for an effective screening instrument. An anxiety VAS score ≥40 of 100 would thus warrant particular attention to adapt care to the patient's anxiety-related pain and initiate specific therapeutic interventions.

Difficult-to-treat gout flares: eligibility for interleukin-1 inhibition in private practice is uncommon according to current EMA approval.

OBJECTIVE: The objective was to determine the proportion of patients with difficult-to-treat or difficult-to-prevent acute gout attacks eligible for IL-1 inhibition. METHODS: Participants included in the French cross-sectional GOSPEL cohort (n = 1003 gout patients) were examined for contraindications and intolerance to standard of care (SoC) drugs of gout flares (colchicine, non-steroidal anti-inflammatory drugs and systemic glucocorticoids). Patients were classified as definitely eligible for first-line IL-1 inhibition (canakinumab) according to European summary of product characteristics (contraindications/intolerance to SoC and at least three flares per year) without any other anti-inflammatory options (contraindications/intolerance only), or potentially eligible (precaution of use). Eligibility to receive IL-1 during an on-going flare related to insufficient efficacy was assessed (second-line eligibility). RESULTS: Definite first-line eligibility for IL-1 therapy was found in 10 patients (1%) and contraindication to all SoC therapies in nine patients who had presented <3 flares in the past 12 months. At least precaution of use for SoC therapies was noted for 218/1003 patients (21.7%). Of 487 patients experiencing flares at baseline, 114 (23.4%) were still experiencing pain scored ⩾4/10 numeric scale on day 3, one of whom could not receive further SoC drugs. Only nine of them had three or more flares in the past year and were eligible for second-line IL-1 inhibition. CONCLUSION: Despite significant numbers of patients without any SoC anti-inflammatory therapeutic options for gout flares, eligibility for IL-1 inhibition therapy according to current European approval is rare.

Identifying patterns of unhealthy diet and physical activity in four countries of the Americas: a latent class analysis

[ABSTRACT]. Objectives. To determine clusters of individuals who present similar health behaviors in terms of diet, physical activity, and sedentarism, in four countries of the Americas: Brazil (2013), Chile (2009), Mexico (2012), and the United States of America (2013). This makes it possible to determine which of these behaviors occur simultaneously, as well as the demographic and sociodemographic characteristics associated with each cluster. Methods. The individual-level data analyzed were drawn from national health interviews and health examination surveys in Brazil, Chile, Mexico, and the United States, for different time periods. Using international physical activity guidelines and national dietary guidelines, the health behaviors of each individual were assessed. A latent class analysis was conducted to classify individuals into clusters based on these behaviors, and was followed by multinomial regressions to determine the characteristics of those in each class. Results. Overall, most individuals belonged to the classes characterized by average or unhealthy diets but sufficient amounts of physical activity. However, large differences exist across countries and population groups. Men with higher socioeconomic characteristics were globally more likely to belong to the least healthy class in each country. Conclusions. Findings from this analysis support the implementation of more refined policy actions to target specific unhealthy behaviors in different population groups, defined by gender, age group, socioeconomic status, and, to some extent, place of residence. The at-risk populations identified through this paper are those that should be targeted by upcoming interventions.

[RESUMEN]. Objetivos. Determinar conglomerados de personas que presentan comportamientos similares con respecto a la salud en materia de alimentación, actividad física y vida sedentaria en cuatro países de la Región de las Américas: Brasil (2013), Chile (2009), Estados Unidos de América (2013) y México (2012). Esto permite determinar cuáles de estos comportamientos se presentan simultáneamente, así como las características demográficas y sociodemográficas propias de cada conglomerado. Métodos. Los datos a nivel individual que se analizaron se obtuvieron de entrevistas nacionales de salud y encuestas sobre exámenes de salud en Brasil, Chile, Estados Unidos y México para diferentes períodos. Se evaluaron los comportamientos de cada persona con respecto a la salud a partir de directrices de actividad física internacionales y directrices alimentarias nacionales. Se realizó un análisis de clases latentes para clasificar a los personas en conglomerados basados en dichos comportamientos, seguido de regresiones polinómicas para determinar las características de los integrantes de cada clase. Resultados. En términos generales, la mayor parte de las personas pertenecían a las clases caracterizadas por una alimentación promedio o insalubre, pero con niveles suficientes de actividad física. Sin embargo, hay grandes diferencias entre los distintos países y grupos poblacionales. Los hombres con las características socioeconómicas más altas tenían más probabilidades en general de pertenecer a la clase menos saludable de cada país. Conclusiones. Los resultados de este análisis apoyan la ejecución de acciones de políticas públicas más refinadas, dirigidas a determinados comportamientos nocivos en diferentes grupos poblacionales, definidos por género, grupo etario, nivel socioeconómico y, hasta cierto punto, lugar de residencia. Las próximas intervenciones deben dirigirse a los grupos poblacionales en riesgo establecidos en este artículo.

[RESUMO]. Objetivos. Determinar aglomerados de indivíduos com comportamentos de saúde semelhantes quanto à alimentação, atividade física e sedentarismo em quatro países das Américas: Brasil (2013), Chile (2009), México (2012) e Estados Unidos (2013) a fim de determinar os comportamentos que ocorrem simultaneamente e as características demográficas e sociodemográficas associadas a cada aglomerado. Métodos. Os dados ao nível do indivíduo analisados no estudo foram obtidos em entrevistas de saúde nacionais e pesquisas de saúde realizadas no Brasil, Chile, México e Estados Unidos em diferentes períodos. Os comportamentos de saúde de cada indivíduo foram avaliados segundo as diretrizes internacionais de atividade física e as diretrizes nacionais de alimentação. Foi realizada uma análise de classes latentes para classificar os indivíduos em aglomerados de acordo com os comportamentos, seguida da análise por regressão polinômica para determinar as características destes comportamentos em cada classe. Resultados. A maioria dos indivíduos pertencia a classes caracterizadas por alimentação média ou pouco saudável, porém com nível suficiente de atividade física. No entanto, existem grandes diferenças entre os países e os grupos populacionais. Verificou-se maior probabilidade de os indivíduos do sexo masculino de nível socioeconômico mais alto pertencerem à classe menos saudável em cada país. Conclusões. Os achados desta análise apoiam a implementação de ações de política mais apuradas dirigidas a determinados comportamentos pouco saudáveis em diferentes grupos populacionais, definidos por gênero, faixa etária, condição socioeconômica e, em certa medida, local de residência. As populações em risco identificadas no estudo devem ser o principal alvo de intervenções imediatas.

Identifying patterns of unhealthy diet and physical activity in four countries of the Americas: a latent class analysis.

OBJECTIVES: To determine clusters of individuals who present similar health behaviors in terms of diet, physical activity, and sedentarism, in four countries of the Americas: Brazil (2013), Chile (2009), Mexico (2012), and the United States of America (2013). This makes it possible to determine which of these behaviors occur simultaneously, as well as the demographic and sociodemographic characteristics associated with each cluster. METHODS: The individual-level data analyzed were drawn from national health interviews and health examination surveys in Brazil, Chile, Mexico, and the United States, for different time periods. Using international physical activity guidelines and national dietary guidelines, the health behaviors of each individual were assessed. A latent class analysis was conducted to classify individuals into clusters based on these behaviors, and was followed by multinomial regressions to determine the characteristics of those in each class. RESULTS: Overall, most individuals belonged to the classes characterized by average or unhealthy diets but sufficient amounts of physical activity. However, large differences exist across countries and population groups. Men with higher socioeconomic characteristics were globally more likely to belong to the least healthy class in each country. CONCLUSIONS: Findings from this analysis support the implementation of more refined policy actions to target specific unhealthy behaviors in different population groups, defined by gender, age group, socioeconomic status, and, to some extent, place of residence. The at-risk populations identified through this paper are those that should be targeted by upcoming interventions.

Identifying patterns of unhealthy diet and physical activity in four countries of the Americas: a latent class analysis / Identificación de pautas poco saludables de alimentación y actividad física en cuatro países de la Región de las Américas: un análisis de clases latentes / Identificar padrões de alimentação pouco saudável e atividade física em quatro países das Américas: análise de classes latentes

ABSTRACT Objectives To determine clusters of individuals who present similar health behaviors in terms of diet, physical activity, and sedentarism, in four countries of the Americas: Brazil (2013), Chile (2009), Mexico (2012), and the United States of America (2013). This makes it possible to determine which of these behaviors occur simultaneously, as well as the demographic and sociodemographic characteristics associated with each cluster. Methods The individual-level data analyzed were drawn from national health interviews and health examination surveys in Brazil, Chile, Mexico, and the United States, for different time periods. Using international physical activity guidelines and national dietary guidelines, the health behaviors of each individual were assessed. A latent class analysis was conducted to classify individuals into clusters based on these behaviors, and was followed by multinomial regressions to determine the characteristics of those in each class. Results Overall, most individuals belonged to the classes characterized by average or unhealthy diets but sufficient amounts of physical activity. However, large differences exist across countries and population groups. Men with higher socioeconomic characteristics were globally more likely to belong to the least healthy class in each country. Conclusions Findings from this analysis support the implementation of more refined policy actions to target specific unhealthy behaviors in different population groups, defined by gender, age group, socioeconomic status, and, to some extent, place of residence. The at-risk populations identified through this paper are those that should be targeted by upcoming interventions.

RESUMEN Objetivos Determinar conglomerados de personas que presentan comportamientos similares con respecto a la salud en materia de alimentación, actividad física y vida sedentaria en cuatro países de la Región de las Américas: Brasil (2013), Chile (2009), Estados Unidos de América (2013) y México (2012). Esto permite determinar cuáles de estos comportamientos se presentan simultáneamente, así como las características demográficas y sociodemográficas propias de cada conglomerado. Métodos Los datos a nivel individual que se analizaron se obtuvieron de entrevistas nacionales de salud y encuestas sobre exámenes de salud en Brasil, Chile, Estados Unidos y México para diferentes períodos. Se evaluaron los comportamientos de cada persona con respecto a la salud a partir de directrices de actividad física internacionales y directrices alimentarias nacionales. Se realizó un análisis de clases latentes para clasificar a los personas en conglomerados basados en dichos comportamientos, seguido de regresiones polinómicas para determinar las características de los integrantes de cada clase. Resultados En términos generales, la mayor parte de las personas pertenecían a las clases caracterizadas por una alimentación promedio o insalubre, pero con niveles suficientes de actividad física. Sin embargo, hay grandes diferencias entre los distintos países y grupos poblacionales. Los hombres con las características socioeconómicas más altas tenían más probabilidades en general de pertenecer a la clase menos saludable de cada país. Conclusiones Los resultados de este análisis apoyan la ejecución de acciones de políticas públicas más refinadas, dirigidas a determinados comportamientos nocivos en diferentes grupos poblacionales, definidos por género, grupo etario, nivel socioeconómico y, hasta cierto punto, lugar de residencia. Las próximas intervenciones deben dirigirse a los grupos poblacionales en riesgo establecidos en este artículo.

RESUMO Objetivos Determinar aglomerados de indivíduos com comportamentos de saúde semelhantes quanto à alimentação, atividade física e sedentarismo em quatro países das Américas: Brasil (2013), Chile (2009), México (2012) e Estados Unidos (2013) a fim de determinar os comportamentos que ocorrem simultaneamente e as características demográficas e sociodemográficas associadas a cada aglomerado. Métodos Os dados ao nível do indivíduo analisados no estudo foram obtidos em entrevistas de saúde nacionais e pesquisas de saúde realizadas no Brasil, Chile, México e Estados Unidos em diferentes períodos. Os comportamentos de saúde de cada indivíduo foram avaliados segundo as diretrizes internacionais de atividade física e as diretrizes nacionais de alimentação. Foi realizada uma análise de classes latentes para classificar os indivíduos em aglomerados de acordo com os comportamentos, seguida da análise por regressão polinômica para determinar as características destes comportamentos em cada classe. Resultados A maioria dos indivíduos pertencia a classes caracterizadas por alimentação média ou pouco saudável, porém com nível suficiente de atividade física. No entanto, existem grandes diferenças entre os países e os grupos populacionais. Verificou-se maior probabilidade de os indivíduos do sexo masculino de nível socioeconômico mais alto pertencerem à classe menos saudável em cada país. Conclusões Os achados desta análise apoiam a implementação de ações de política mais apuradas dirigidas a determinados comportamentos pouco saudáveis em diferentes grupos populacionais, definidos por gênero, faixa etária, condição socioeconômica e, em certa medida, local de residência. As populações em risco identificadas no estudo devem ser o principal alvo de intervenções imediatas.