Decline in Stroke Mortality Between 1997 and 2012 by Sex: Ecological Study in Brazilians Aged 15 to 49 Years.

This study aimed to analyse the time trends of stroke mortality between 1997 and 2012 according to sex in Brazilians aged 15 to 49 years. This ecological study used data obtained from the Mortality Information System, which is available from the National Health System Department of Informatics - DATASUS and maintained by the Brazilian Ministry of Health. Stroke definition included International Classification of Disease version 10 (ICD-10) codes I60, I61, I63, and I64. Crude and age-standardized mortality rates and respective 95% confidence intervals were estimated per 100,000 inhabitants and stratified by age, region, year, and sex. Linear regression models were used to analyse the time trends with a confidence level of 95%. The statistical program used was Stata 11.0. Between 1997 and 2012, there were 124,866 deaths due to stroke in Brazilians aged 15 to 49 years. There was a decreasing linear trend in stroke mortality among men (ß = -0.46, p < 0.001, R2 = 0.95) and women (ß = -0.40, p < 0.001, R2 = 0.98) during this period. Overall there was no significant difference in stroke mortality trends by sex, except with respect to the age group of 40 to 49 years where there was a difference in the decrease of stroke mortality between men and women (interaction sex * year: ß = 0.238, p = 0.012, R² = 0.96). Mortality rates decrease significantly over time in men and women in the age group 15 to 49 years old, but there is only significant difference in the decrease of rates by sex only in the age group from 40 to 49 years old.

Reporting bias in the literature on the associations of health-related behaviors and statins with cardiovascular disease and all-cause mortality.

Reporting bias in the literature occurs when there is selective revealing or suppression of results, influenced by the direction of findings. We assessed the risk of reporting bias in the epidemiological literature on health-related behavior (tobacco, alcohol, diet, physical activity, and sedentary behavior) and cardiovascular disease mortality and all-cause mortality and provided a comparative assessment of reporting bias between health-related behavior and statin (in primary prevention) meta-analyses. We searched Medline, Embase, Cochrane Methodology Register Database, and Web of Science for systematic reviews synthesizing the associations of health-related behavior and statins with cardiovascular disease mortality and all-cause mortality published between 2010 and 2016. Risk of bias in systematic reviews was assessed using the ROBIS tool. Reporting bias in the literature was evaluated via small-study effect and excess significance tests. We included 49 systematic reviews in our study. The majority of these reviews exhibited a high overall risk of bias, with a higher extent in health-related behavior reviews, relative to statins. We reperformed 111 meta-analyses conducted across these reviews, of which 65% had statistically significant results (P < 0.05). Around 22% of health-related behavior meta-analyses showed small-study effect, as compared to none of statin meta-analyses. Physical activity and the smoking research areas had more than 40% of meta-analyses with small-study effect. We found evidence of excess significance in 26% of health-related behavior meta-analyses, as compared to none of statin meta-analyses. Half of the meta-analyses from physical activity, 26% from diet, 18% from sedentary behavior, 14% for smoking, and 12% from alcohol showed evidence of excess significance bias. These biases may be distorting the body of evidence available by providing inaccurate estimates of preventive effects on cardiovascular and all-cause mortality.

Prevalence of active transportation among adults in Latin America and the Caribbean: a systematic review of population-based studies / Prevalência do deslocamento ativo em adultos na América Latina e Caribe: revisão sistemática de estudos populacionais

Objective. To describe the prevalence of “active” (self-propelled, human-powered) transportation in the Latin America and Caribbean (LAC) region over the past decade. Methods. MEDLINE, Excerpta Medica (Embase), SportDiscus, Lilacs, MediCarib, Web of Science, OVID, CINAHL, Scopus, Google Scholar, National Transportation Library, and TRIS/TRID were searched for articles on active transportation published between January 2003 and December 2014 with (at least) a title and abstract in English, Portuguese, or Spanish. Research was included in the study if the two reviewing authors agreed it 1) was conducted in an adult sample (≥ 18 years old), 2) was designed to be representative of any LAC area, and 3) reported at least one measure of active transportation. Reference lists of included papers and retrieved reviews were also checked. A total of 129 key informants (87 scientific experts and 42 government authorities) were contacted to identify additional candidate publications. Two other authors extracted the data independently. Results. A total of 10 459 unique records were found; the full texts of 143 were reviewed; and a total of 45 studies were included in the study, yielding estimates for 72 LAC settings, most of which were in Argentina, Brazil, and Colombia. No eligible studies were found for the years 2003–2004, resulting in a 10-year study time frame. Estimates were available for walking, cycling, or the combination of both, with a high degree of heterogeneity (heterogeneity index (I2) ≥ 99%). The median prevalence of active transportation (combining walking and cycling) was 12.0%, ranging from 5.1% (in Palmas, Brazil) to 58.9% (in Rio Claro, Brazil). Men cycled more than women in all regions for which information was available. The opposite was true for walking. Conclusions. Prevalence of active transportation in LAC varied widely, with great heterogeneity and uneven distribution of studies across countries, indicating the need for efforts to build comprehensive surveillance systems with standardized, timely, and detailed estimates of active transportation in order to support policy planning and evaluation.

Objetivo. Descrever a prevalência do “deslocamento ativo” (uso de modais de transporte autopropulsados e de propulsão humana) na região da América Latina e Caribe (ALC) na última década. Métodos. Foi realizada uma busca nos bancos de dados MEDLINE, Excerpta Medica (Embase), SportDiscus, Lilacs, MediCarib, Web of Science, OVID, CINAHL, Scopus, Google Scholar, National Transportation Library e TRIS/TRID por artigos sobre deslocamento ativo publicados entre janeiro de 2003 e dezembro de 2014 com (pelo menos) título e resumo em inglês, espanhol ou português. Pesquisas foram incluídas no estudo se os dois autores da revisão concordaram que a pesquisa 1) havia sido realizada em uma amostra de adultos (≥ 18 anos de idade), 2) tinha o intuito de ser representativa de uma área da ALC e 3) relatava pelo menos uma medida de deslocamento ativo. As referências bibliográficas dos artigos e revisões incluídos também foram analisadas. Foram contatados 129 informantes-chave (87 peritos científicos e 42 autoridades de governo) para identificar possíveis publicações adicionais de interesse. Outros dois autores extraíram os dados de maneira independente. Resultados. Foram encontrados 10 459 registros não duplicados; os textos completos de 143 foram examinados; e 45 foram incluídos na revisão, gerando estimativas para 72 regiões da ALC, a maioria na Argentina, Brasil e Colômbia. Não foi encontrado nenhum estudo dos anos 2003-2004 que atendesse os critérios de inclusão; portanto, o período de análise foi de 10 anos. Foram obtidas estimativas para caminhada, deslocamento com bicicleta ou a combinação de ambos os modais; con alto grau de heterogeneidade (índice de heterogeneidade (I2) ≥ 99%). A prevalência mediana de deslocamento ativo (combinação de caminhada e deslocamento com bicicleta) foi de 12,0%, variando de 5,1% (em Palmas, Brasil) a 58,9% (em Rio Claro, Brasil). Homens andaram de bicicleta mais do que as mulheres em todas as regiões para as quais havia informações disponíveis. Constatou-se o oposto em relação à caminhada. Conclusões. A prevalência de deslocamento ativo variou muito na ALC, com grande heterogeneidade e distribuição desigual de estudos entre países. Isso indica necessidade de esforços para construir sistemas de vigilância integrais que proporcionem estimativas padronizadas, oportunas e detalhadas do deslocamento ativo para subsidiar a formulação e avaliação de políticas.

Artificially Sweetened Beverages and the Response to the Global Obesity Crisis.

Christopher Millett and colleagues argue that artificially sweetened beverages should not be promoted as part of a healthy diet.

Prevalence of active transportation among adults in Latin America and the Caribbean: a systematic review of population-based studies.

OBJECTIVE: To describe the prevalence of "active" (self-propelled, human-powered) transportation in the Latin America and Caribbean (LAC) region over the past decade. METHODS: MEDLINE, Excerpta Medica (Embase), SportDiscus, Lilacs, MediCarib, Web of Science, OVID, CINAHL, Scopus, Google Scholar, National Transportation Library, and TRIS/TRID were searched for articles on active transportation published between January 2003 and December 2014 with (at least) a title and abstract in English, Portuguese, or Spanish. Research was included in the study if the two reviewing authors agreed it 1) was conducted in an adult sample (≥ 18 years old), 2) was designed to be representative of any LAC area, and 3) reported at least one measure of active transportation. Reference lists of included papers and retrieved reviews were also checked. A total of 129 key informants (87 scientific experts and 42 government authorities) were contacted to identify additional candidate publications. Two other authors extracted the data independently. RESULTS: A total of 10 459 unique records were found; the full texts of 143 were reviewed; and a total of 45 studies were included in the study, yielding estimates for 72 LAC settings, most of which were in Argentina, Brazil, and Colombia. No eligible studies were found for the years 2003-2004, resulting in a 10-year study time frame. Estimates were available for walking, cycling, or the combination of both, with a high degree of heterogeneity (heterogeneity index (I2) ≥ 99%). The median prevalence of active transportation (combining walking and cycling) was 12.0%, ranging from 5.1% (in Palmas, Brazil) to 58.9% (in Rio Claro, Brazil). Men cycled more than women in all regions for which information was available. The opposite was true for walking. CONCLUSIONS: Prevalence of active transportation in LAC varied widely, with great heterogeneity and uneven distribution of studies across countries, indicating the need for efforts to build comprehensive surveillance systems with standardized, timely, and detailed estimates of active transportation in order to support policy planning and evaluation.

"Burnout in Medical Oncology Fellows: a Prospective Multicenter Cohort Study in Brazilian Institutions".

Burnout syndrome is a common occurrence among oncologists. Doctors enrolled in residency programs in clinical oncology are exposed to similar risk factors; however, few data are available in this population. This study assessed the occurrence of burnout and associated factors among first-year residents at Brazilian institutions. The present prospective, multicenter, cohort study was conducted with doctors enrolled in residency programs in clinical oncology at Brazilian institutions affiliated with the public health system. The participants answered a sociodemographic questionnaire, the Maslach Burnout Inventory (MBI), Lipp's Stress Inventory, and the Beck Depression Inventory (BDI), upon admission to the program and 6 and 12 months later. Of 37 eligible residency programs in 2009, 11 (30.6 %) agreed to participate in the study. Fifty-four residents, representing 100 % of new admissions to the participating institutions, were included. Most of the participants met the criteria for severe burnout upon admission to the residency programs (emotional exhaustion in 49.0 % and depersonalization in 64.7 %). The scores on MBI domains emotional exhaustion and depersonalization increased significantly (p < 0.01) during the first year of residency, and the prevalence of burnout increased to 88 % at the end of that first year. The present study found a high prevalence of burnout among doctors enrolled in residency programs in clinical oncology at Brazilian institutions. A large fraction of the participants met the criteria for burnout syndrome upon admission to the program, which suggests that the problem began during the course of the previous residency program in internal medicine.

Impact of travel mode shift and trip distance on active and non-active transportation in the São Paulo Metropolitan Area in Brazil.

BACKGROUND: Changes in urban mobility play a major role in transforming metropolitan areas into healthier places. This study quantified the impact of changes in travel mode shift and trip distance on active and non-active transportation of working age adult population of São Paulo. METHODS AND FINDINGS: Through different scenarios, we estimated the daily time spent in transportation per inhabitant (divided in active and non-active transportation time) and the proportion of inhabitants accumulating 30 min or more of daily active transportation. The replacement of individual for collective motorized modes in long distance trips (> 1000 m) in combination with the substitution of long for short trips positively impacted all outcomes. Compared to the current situation, there was an increase in the active transportation time (from 19.4 to 26.7 min/inhabitant), which also increased the proportion of adults active for transportation (from 27.6% to 35.4%). Additionally, the non-active transportation time decreased (from 67.0 to 26.2 min/inhabitant), which helped to reduce the total time spent in transportation (from 86.4 to 52.9 min/inhabitant). CONCLUSION: Transport and urban planning policies to reduce individual motorized trips and the number of long trips might produce important health benefits, both by increasing population levels of active transportation and reducing the non-active and the total time of daily trips.

Frequency, distribution and time trends of types of leisure-time physical activity in Brazil, 2006-2012.

OBJECTIVES: To describe the frequency and the distribution of the main types of leisure time physical activity (LTPA) practiced by Brazilian adults in 2012 and to observe their time trends from 2006 to 2012. METHODS: Cross-sectional data from the Brazilian surveillance system of risk and protective factors for non-transmissible chronic diseases from 2006 to 2012 (around 54,000 adults aged 18 years or older in all Brazilian State capitals interviewed yearly). Participants were asked whether they had practiced any type of exercise or sport in the last 3 months, and if so which type. Linear regression was used to identify trends of the five most cited LTPA. RESULTS: In 2012, walking was reported as the main LTPA (18.1 %), followed by strength training/gymnastics (11.2 %) and football (7.2 %). Time-trend analysis showed reduction in football (9.1-7.2 %; p = 0.004, ß = -0.25, R(2) = 0.79) and increase in strength training/gymnastics (7.9-11.2 %; p = 0.02, ß = 0.50, R(2) = 0.62) and running (1.7-3.1 %; p < 0.001, ß = 0.22, R(2) = 0.93). CONCLUSIONS: Walking was the main type of LTPA. Patterns of LTPA types remained relatively stable over the last 7 years.