Sociodemographic factors associated with Kyasanur forest disease in India - a retrospective study.

Objectives: Kyasanur forest disease (KFD) is a tick-borne disease in India affecting humans and two local non-human primate species. A critical knowledge gap in the scientific literature is the lack of information on how people's sociodemographic factors influence KFD occurrence. Methods: We analyzed available data on KFD from three data sources: (a) 104 peer-reviewed articles using keyword searches on PubMed Central and Google Scholar, (b) 116 Program for Monitoring Emerging Diseases reports, and (c) an acute febrile illness surveillance data set on KFD from a report by the government of India. We performed statistical analyses to calculate the prevalence of KFD by state and differences in KFD cases by sex and age group. Results: All three data sets used indicate that KFD cases and deaths have occurred predominantly in the 15-64 years age group (literature: 87% cases and 95% deaths, Program for Monitoring Emerging Diseases: 78% cases and 78% deaths, acute febrile illness: 96% cases [no breakdown for acute febrile illness death data]). Data reporting varies across states and is non-standardized. Conclusions: The inconsistent reporting of sociodemographic data on KFD in India has created a gap in our understanding of its impact on different social groups. Collecting and reporting data on sociodemographic factors is critical to understanding the epidemiology of KFD and designing effective public health interventions.

Awareness of the diagnosis, treatment, and control of diabetes mellitus in Brazil.

OBJECTIVE: To estimate the proportions of awareness, treatment, and control of diabetes mellitus (DM) in the Brazilian adult population. METHOD: This is a cross-sectional study, with data from a representative sample of the Brazilian population, taken from the National Health Survey(PNS 2014/2015). Outcomes were defined based on glycated hemoglobin (HbA1c) measurements, self-reported DM diagnosis, and use of hypoglycemic agents or insulin. The proportion of DM awareness, treatment, and control was estimated according to sociodemographic characteristics, health conditions, and access to health services, and their respective 95% confidence intervals. RESULTS: DM prevalence in the Brazilian population was of 8.6% (95%CI: 7.8-9.3): 68.2% (95%CI: 63.9-72.3) were aware of their diagnosis, 92.2% (95%CI: 88.6-94.7) of those who were aware were undergoing drug treatments, and, of these, 35.8% (95%CI: 30.5-41.6) had controlled HbA1c levels. The proportions of DM awareness, control, and treatment were lower in men aged 18 to 39 years, individuals with low education, without health insurance, and beneficiaries of the Bolsa Família program. CONCLUSION: Approximately one in ten Brazilians has DM. A little more than half of this population is aware of their diagnosis, a condition measured by HbA1c dosage and clinical diagnosis. Among those who know, the vast majority are undergoing drug treatments. However, less than half of these have their HbA1c levels controlled. Worse scenarios were found in subgroups with high social vulnerability.

Doctors' recommendations and healthy lifestyle behaviors among individuals with hypertension in Brazil.

Little is known about whether doctors' recommendations encourage healthy behaviors among individuals with hypertension in Brazil. This study examined the biological, social, and health factors related to doctor's recommendations and the associations between doctor's recommendations and healthy behaviors. The sample consisted of individuals with hypertension (N = 18,260) from Brazil's 2019 National Health Survey. The outcomes examined included smoking, drinking, diet, salt intake, physical activity, and doctor visits. Study findings indicated that more than 80% of people with hypertension in Brazil received doctors' recommendations to adhere to medical care and engage in healthy behaviors. Those who received recommendations were more likely to practice healthy eating and exercise regularly but also to be obese/overweight, smoke, and drink excessively. Nonetheless, the findings concerning diet and exercise suggest the value of doctors' recommendations for individuals with hypertension in Brazil.

Randomized control trial of a childhood obesity prevention family-based program: "Abriendo Caminos" and effects on BMI.

Background: Hispanic individuals are at increased risk for obesity and other chronic health conditions. This article evaluates the effect of a family-based, childhood obesity primary prevention intervention in a community setting. Methods: A multi-site, randomized controlled trial community program with assessments at pre (T0), post-program (T1), and 6-months post-program (T2). Participating families were recruited from five sites. Only families of Mexican or Puerto Rican heritage with a least one child between 6 and 18 years were included in the study, without weight restrictions. Families were randomized to the intervention and control arms. Intervention families received six-2 h weekly workshops. Control families received printed generic nutrition and wellness information. Heights and weights were measured at the 3-time points to calculate BMI z-scores, BMI-percentiles, and weight status using age- and sex-specific growth charts, according to the CDC guidelines. Results: There were no differences in BMI-z scores between children in the intervention (n = 239) and control groups (n = 187) at T0. BMI z-scores decreased in the intervention group (-0.03, 95% CI, -0.066, -0.003, p = 0.032) at T1, but not in the control group at T1. Changes in BMI z-scores were not statistically significant at T2. Conclusion: The Abriendo Caminos intervention effectively prevented unhealthy weight gain in Hispanic children in the short-term, but not at 6-months post-intervention. Younger children and girls benefited more from the program at 6-months post-intervention. Additional efforts are needed to sustain long-term changes. Culturally-tailored programs can provide families with the knowledge to produce short-term changes and a potential pathway for sustainable changes in implementing healthy behaviors.

Setting references for daily intake of micronutrients: A study on magnesium.

OBJECTIVES: The Institute of Medicine stratifies the references for daily nutrient intake into age and sex groups, considering that the basal metabolic rate varies according to these aspects, and in most cases, it extrapolates the values calculated for adults to children, because their body weights are different. In this context, this study aimed to evaluate the recommendation for magnesium in children according to energy expenditure. METHODS: This was an observational study using the database of the Social Changes, Asthma and Allergy in Latin America (SCAALA) cohort, which randomly collected information from 1445 children ages 4 to 11 y. Of these, 480 (33%) were part of the present study (children between 7 and 11 y old with eutrophic body mass index and adequate growth). Information on food intake was obtained from the child's parents or legal guardians through a 24-h recall. The population was characterized using static analyses such as the Student t test, Pearson correlation coefficient, and linear regression. RESULTS: The mean age of the sample was 8.5 ± 0.96 y, and 54% were males. The mean magnesium intake was 149 ± 70 mg, with a high correlation observed between energy expenditure and magnesium intake (boys: R, 0.716; P <0.001; girls: R, 0.641; P < 0.001). CONCLUSIONS: The metabolic rate can be considered a reference variable for recommending the daily intake of the studied nutrient, aiming to avoid deficiencies and food poisoning because of poor intake.

Awareness of the diagnosis, treatment, and control of diabetes mellitus in Brazil / Conhecimento do diagnóstico, tratamento e controle do diabetes mellitus no Brasil

ABSTRACT OBJECTIVE To estimate the proportions of awareness, treatment, and control of diabetes mellitus (DM) in the Brazilian adult population. METHOD This is a cross-sectional study, with data from a representative sample of the Brazilian population, taken from the National Health Survey(PNS 2014/2015). Outcomes were defined based on glycated hemoglobin (HbA1c) measurements, self-reported DM diagnosis, and use of hypoglycemic agents or insulin. The proportion of DM awareness, treatment, and control was estimated according to sociodemographic characteristics, health conditions, and access to health services, and their respective 95% confidence intervals. RESULTS DM prevalence in the Brazilian population was of 8.6% (95%CI: 7.8-9.3): 68.2% (95%CI: 63.9-72.3) were aware of their diagnosis, 92.2% (95%CI: 88.6-94.7) of those who were aware were undergoing drug treatments, and, of these, 35.8% (95%CI: 30.5-41.6) had controlled HbA1c levels. The proportions of DM awareness, control, and treatment were lower in men aged 18 to 39 years, individuals with low education, without health insurance, and beneficiaries of the Bolsa Família program. CONCLUSION Approximately one in ten Brazilians has DM. A little more than half of this population is aware of their diagnosis, a condition measured by HbA1c dosage and clinical diagnosis. Among those who know, the vast majority are undergoing drug treatments. However, less than half of these have their HbA1c levels controlled. Worse scenarios were found in subgroups with high social vulnerability.

RESUMO OBJETIVO Estimar as proporções dos indivíduos que têm conhecimento do diagnóstico, tratamento e controle do diabetes mellitus (DM) na população adulta brasileira. MÉTODO Este é um estudo transversal, com dados de amostra representativa da população brasileira, provenientes da Pesquisa Nacional de Saúde (PNS 2014/2015). Os desfechos foram definidos com base na medida de hemoglobina glicada (HbA1c), no diagnóstico autorreferido de DM e no uso de hipoglicemiantes ou de insulina. Estimou-se a proporção do conhecimento, tratamento e controle do DM de acordo com as características sociodemográficas, condição de saúde e de acesso aos serviços de saúde, e seus respectivos intervalos de 95% de confiança (IC95%). RESULTADOS A prevalência de DM na população brasileira foi 8,6% (IC95% 7,8-9,3), 68,2% (IC95% 63,9-72,3) tinham conhecimento do seu diagnóstico, 92,2% (IC95% 88,6-94,7) dos que tinham conhecimento realizam tratamento medicamentoso, e desses, 35,8% (IC95% 30,5-41,6) tinham os níveis de HbA1c controlados. As proporções de conhecimento, controle e tratamento foram menores nos homens, com idade de 18 a 39 anos, indivíduos que possuem baixa escolaridade, sem plano de saúde e beneficiários do Programa Bolsa Família. CONCLUSÃO Aproximadamente um em cada dez brasileiros apresenta DM. Um pouco mais da metade desta população tem conhecimento do seu diagnóstico, condição aferida por dosagem de HbA1c e diagnóstico clínico. Entre os que sabem, a grande maioria está sob tratamento medicamentoso. Porém, menos da metade destes tem seus níveis de HbA1c controlados. Cenários piores foram encontrados em subgrupos com alta vulnerabilidade social.

Availability of Drinking Water Source and the Prevalence of Diarrhea among Nigerian Households.

Diarrhea is highly prevalent in Nigeria and accounts for 16% of deaths among Nigerian children. The WHO classifies water source into two categories: improved and unimproved. This study aimed to examine the association between type of water source and the prevalence of diarrhea among members of a nationally representative sample of Nigerian households while controlling for key sociodemographic and household factors. This study used cross-sectional data from 22,571 households participating in the 2018 Water, Sanitation and Hygiene-National Outcome Routine Mapping survey. Data collectors visited and interviewed household members across all 36 states in the country. Logistic regression was used to assess associations between water source type and the odds of a family member reporting diarrhea, after controlling for financial status, availability of soap/detergent for handwashing, availability of a refrigerator in the home, toilet type, and urban/rural status. After controlling for explanatory variables in the adjusted model, having an unimproved water source was associated with greater odds of diarrhea among a family member (odds ratio, 1.59; 95% CI, 1.44-1.77). Not having a refrigerator and not having soap/detergent for handwashing were also associated with greater odds of diarrhea. In summary, this study found an association between water-source type and diarrhea prevalence among Nigerian households. This study is in line with prior studies in Nigeria and elsewhere, and the results call for greater commitment and action by stakeholders to improve water sources and, ultimately, reduce the prevalence of diarrhea in Nigeria.

A biopsychosocial examination of chronic back pain, limitations on usual activities, and treatment in Brazil, 2019.

BACKGROUND: Chronic back pain is prevalent in Brazil, leading to enormous healthcare costs and social burdens. It also disproportionately affects low-income and less-healthy people. OBJECTIVES: This study examines the associations of chronic back pain with biological, psychological, and social factors; how it limits usual activities; and how chronic back pain influences the use of treatment services. METHODS: Using Brazil's National Health Survey (PNS-2019), multivariate logistic regressions were conducted to examine how biological, psychological, and social factors correlate with chronic back pain, limitations on usual activities, and pain treatment. RESULTS: PNS-2019 data showed that 23.4% (95% CI 22.8-24.0) of Brazilian adults aged over 20 reported back pain. A higher prevalence of chronic back pain was associated with biological factors (older age, being female, overweight or obese, current smoking, and having more chronic conditions), lower social conditions (low education, low per capita household income, non-married, and living in rural areas), and poor psychological health (more depressive symptoms). Chronic back pain is more likely to limit usual activities among those with low social conditions (lower education, lower income), poor physical and behavioral health (obese, current smokers, and those with a greater number of chronic conditions), and worse psychological health (more depressive symptoms). However, married people and those who do not consume alcohol were also more likely to report limited activities. Among those with back pain, 68% received at least one form of treatment. Those with intense limitations on their usual activities were 2.2 times as likely to report treatment. People with higher social conditions (higher income, college education, and private health insurance) were more likely to receive treatment. CONCLUSION: The results show significant biological, psychological, and social disparities in the prevalence of chronic back pain in Brazil. The findings point to the need for tailored policies and prevention programs with attention to vulnerable groups. Even though Brazil has universal health care, those with better socioeconomic conditions are more likely to receive treatment.

Higher hemoglobin levels are associated with better physical performance among older adults without anemia: a longitudinal analysis.

BACKGROUND: Anemia is the most common hematological abnormality among older adults, and it is associated with decreased physical performance. But the role of hemoglobin in the absence of anemia remains unclear. Thus, this study aimed to assess the impact of hemoglobin levels on physical performance in Brazilian older adults without anemia. METHODS: The study is longitudinal in that it relies on two waves of the Saúde, Bem-Estar e Envelhecimento (SABE; Health, Well-being, and Aging) study: 2010 and 2015-2016. Mixed-effects linear regression was used to determine the effects of the hemoglobin concentrations on the Short Physical Performance Battery-SPPB over time among the 1,023 who had complete data and did not have anemia in 2010. In the follow-up, there were 567 without anemia. RESULTS: In analyses adjusted for age, education, comorbidities, body mass index, and physical inactivity, we found a differential association between hemoglobin concentration and SBBP by sex, with a positive interaction (ß Hb*female= 0.20, 95% CI 0.04,0.37). At lower levels of hemoglobin, women have lower levels of SPPB than men, but at higher levels of hemoglobin concentration, there are no sex differences in physical performance. In addition, higher age was negatively associated with SPPB levels and cardiometabolic diseases, other diseases, and physical inactivity. Education was positively associated with physical performance. CONCLUSION: Our study demonstrates that higher hemoglobin levels were associated with better physical performance among older adults without anemia in Brazil. However, there were sex differences in this association. This finding is important because, in clinical practice, most health professionals focus on the World Health Organization definition of anemia. Our study suggests the importance of hemoglobin levels among older adults, even those without anemia, and highlights sex differences.

Coresidence increases the risk of testing positive for COVID-19 among older Brazilians.

BACKGROUND: Brazil is among the countries hit hardest by COVID-19, and older adults are among the vulnerable groups. Intergenerational coresidence and interdependence among family members, both prevalent in Brazil, likely increase social and physical contact and thus potential infection. METHODS: Using nationally representative data from the COVID-19 module of the Brazilian National Household Sample Survey (Pesquisa Nacional por Amostra de Domicílios), collected between July and November of 2020, we examined the association between living arrangements and exposure to and testing for COVID-19 among 63,816 Brazilians aged 60 years and older. We examine whether living arrangements influence self-reported COVID-19 symptoms as an indicator of subjective health assessment, testing as an indicator of health care service use, and a positive COVID-19 test result as an objective indicator of exposure to the disease. RESULTS: Living arrangements shape older adults' vulnerabilities to COVID-19 exposure and testing. Specifically, those living alone were more likely to report having symptoms and having had a test for COVID-19. However, older adults in multigenerational and skipped generation households were more likely than solo-dwellers to test positive for COVID-19. Those with symptoms were more likely to test, regardless of their living arrangement. Among older adults without symptoms, those living alone had a higher probability of testing than those living in multigenerational or skipped-generation households. CONCLUSIONS: Overall, our findings suggest that coresidence with younger family members puts older adults' health at risk in the context of COVID-19. As younger Brazilians are increasingly vulnerable to COVID-19 and experiencing severe outcomes, policy makers need to be more attentive to the health needs of households that comprise older and younger cohorts, which are also more prevalent in poor and marginalized segments of the population.

Optimizing Dementia Care for Mexicans and for Mexican-Origin U.S. Residents.

In this article, we report on the recommendations of a binational conference that examined the institutional capacities and future ability of Mexico and the United States to address the need for affordable and sustainable dementia care that results from growing older adult populations. These recommendations reflect the large difference in resources between the two nations and each country's political and institutional capacity. Progress in both countries will require an expansion of programs or the generation of new ones, to meet the needs of older adults, including improving access to services and actively managing the dementia care burden. A comprehensive federal health care safety net will be required in both nations, but economic realities will constrain its implementation. Both nations suffer from a persistent shortage of geriatric primary care physicians and geriatricians, especially in rural areas. Advances in diagnosis, treatment, and care management require additional knowledge and skills of general and specialized staff in the health care workforce to deliver evidence-based, culturally and linguistically appropriate long-term care, and human rights-oriented services. We conclude with a discussion of recommendations for binational dementia care policy and practice.

Factors associated with body mass index changes among older adults: a ten-year follow-up.

To examine changes in body mass index (BMI) among older Brazilian adults and associated factors. Longitudinal, population-based study, conducted in São Paulo, Brazil. Adults aged 60 years or over (n = 1,796) from the first wave of data collection from the Health, Well-Being, and Aging Study (SABE Project) conducted from 2000 to 2010. Repeated mixed-effects linear regression was used to analyze longitudinal changes in BMI and to examine whether sociodemographic characteristics, health conditions, and social behaviors were associated with these changes. Mean BMI decreased after 70 years. Men had lower BMI than women (ß = -1.86, 95%CI: -2.35; -1.37). Older adults who consumed alcohol (ß = 0.30, 95%CI: 0.06; 0.54), had more than one chronic disease (ß = 0.19, 95%CI: 0.26; 0.72) and who did not perform physical activity (ß = 0.56, 95%CI: 0.38; 0.74) had higher BMI. Subjects who smoked (ß = -0.40, 95%CI: -0.76; -0.04) and who reported having eaten less food in recent months (ß = -0.48, 95%CI: -0.71; -0.24) had lower BMI. In older Brazilians, several sociodemographic characteristics, health conditions, and behaviors predict BMI. Increasing prevalence of chronic diseases and growing sedentary behaviors in Brazil may have detrimental effects on BMI at older ages.

Simpson's paradox: a demographic case study of population dynamics, poverty, and inequality. / O paradoxo de Simpson: um estudo de caso demográfico sobre dinâmica da população, pobreza e desigualdade.

Brazil is undergoing a demographic transition characterized by regional inequalities. It is reasonable to assume that aspects related to poverty, development and inequality might reverse the sign of the association of indicators of demographic transition, exemplifying a phenomenon known as Simpson's Paradox. The aim of this study was to analyze the effect of inequality, poverty and social development on population dynamics in Brazil, verifying the occurrence of Simpson's paradox in demographic transition. We used population data from the 1991, 2000 and 2010 national censuses, broken down by age and federative unit (FU). The correlation between demographic indicators was assessed by stratifying the FUs into groups according to their median social indicators. The findings show that all FUs have progressed against social indicators and are undergoing demographic transition; however, despite reductions in disparities over the study period, persistent gaps exist between regions. Simpson's paradox was present when the analysis was carried out by census year and social indicators, and was particularly pronounced in 1991. The main challenge is to define how to analyze demographic dynamics in Brazil and understand how contextual factors alter the pace, quantum, and pattern of demographic transition.

O Brasil experimenta uma transição demográfica marcada por desigualdades regionais. É possível supor que aspectos relacionados à pobreza, desenvolvimento e desigualdade possam reverter os efeitos de associação dos indicadores da transição demográfica, tipificando um fenômeno conhecido como Paradoxo de Simpson. O objetivo foi analisar o efeito da desigualdade, pobreza e desenvolvimento social na dinâmica populacional brasileira, verificando a ocorrência do paradoxo de Simpson na transição demográfica. Foram utilizados dados populacionais oriundos dos Censos Demográficos brasileiros de 1991 a 2010, segundo idade e unidades da federação. Foi avaliada a correlação entre os indicadores demográficos, estratificando das unidades da federação em grupos de acordo com os indicadores sociais. Há um avanço das unidades federativas (UF) com relação aos indicadores sociais. A transição vem ocorrendo em todas as UF, com persistência da distância entre elas, mesmo que com redução ao longo dos anos. Observou-se o paradoxo de Simpson quando a análise foi realizada segundo ano censitário e indicador social, principalmente para o ano de 1991. O principal desafio é compreender como a dinâmica demográfica brasileira pode ser analisada e compreender de que forma os fatores contextuais alteram seu ritmo, quantum e padrão.

O paradoxo de Simpson: um estudo de caso demográfico sobre dinâmica da população, pobreza e desigualdade / Simpson's paradox: a demographic case study of population dynamics, poverty, and inequality

Resumo O Brasil experimenta uma transição demográfica marcada por desigualdades regionais. É possível supor que aspectos relacionados à pobreza, desenvolvimento e desigualdade possam reverter os efeitos de associação dos indicadores da transição demográfica, tipificando um fenômeno conhecido como Paradoxo de Simpson. O objetivo foi analisar o efeito da desigualdade, pobreza e desenvolvimento social na dinâmica populacional brasileira, verificando a ocorrência do paradoxo de Simpson na transição demográfica. Foram utilizados dados populacionais oriundos dos Censos Demográficos brasileiros de 1991 a 2010, segundo idade e unidades da federação. Foi avaliada a correlação entre os indicadores demográficos, estratificando das unidades da federação em grupos de acordo com os indicadores sociais. Há um avanço das unidades federativas (UF) com relação aos indicadores sociais. A transição vem ocorrendo em todas as UF, com persistência da distância entre elas, mesmo que com redução ao longo dos anos. Observou-se o paradoxo de Simpson quando a análise foi realizada segundo ano censitário e indicador social, principalmente para o ano de 1991. O principal desafio é compreender como a dinâmica demográfica brasileira pode ser analisada e compreender de que forma os fatores contextuais alteram seu ritmo, quantum e padrão.

Abstract Brazil is undergoing a demographic transition characterized by regional inequalities. It is reasonable to assume that aspects related to poverty, development and inequality might reverse the sign of the association of indicators of demographic transition, exemplifying a phenomenon known as Simpson's Paradox. The aim of this study was to analyze the effect of inequality, poverty and social development on population dynamics in Brazil, verifying the occurrence of Simpson's paradox in demographic transition. We used population data from the 1991, 2000 and 2010 national censuses, broken down by age and federative unit (FU). The correlation between demographic indicators was assessed by stratifying the FUs into groups according to their median social indicators. The findings show that all FUs have progressed against social indicators and are undergoing demographic transition; however, despite reductions in disparities over the study period, persistent gaps exist between regions. Simpson's paradox was present when the analysis was carried out by census year and social indicators, and was particularly pronounced in 1991. The main challenge is to define how to analyze demographic dynamics in Brazil and understand how contextual factors alter the pace, quantum, and pattern of demographic transition.

Socioeconomic inequalities related to dental care needs among adolescents and adults living in the state of Minas Gerais, Brazil / Desigualdades socioeconômicas relacionadas à necessidade de tratamento odontológico entre adolescentes e adultos residentes em Minas Gerais, Brasil

Abstract Background There is significant evidence of inequalities in the need for dental treatment, and their monitoring is essential for public health planning. Objective To measure the extent of the association between socioeconomic inequality and need for dental care. Method This study used data from the 2011 Survey of Oral Health Conditions, including a representative sample of adolescents (n=2,310) and adults (n=1,188) from the state of Minas Gerais, Brazil. Need for dental treatment was evaluated according to criteria of the World Health Organization (WHO). Family income was used as a measure of socioeconomic status. The magnitude of socioeconomic inequalities related to the need for treatment was assessed using the slope index of inequality (SII) and the relative index of inequality (RII). Results Among adolescents, the SII was -22.9% (95% CI -34.8; -11.0) and the estimated RII was 0.61 (95% CI 0.47; 0.79). Among adults, the SII was -28.0% (95% CI -39.8; -16.3) and the RII was 0.58 (95% CI 0.45; 0.74). Conclusion There are socioeconomic inequalities regarding the need for dental treatment, and individuals with lower family income present a higher prevalence of need.

Resumo Introdução As desigualdades na necessidade de tratamento odontológico têm sido consistentemente relatadas, sendo o monitoramento delas essencial para o planejamento da saúde pública. Objetivo Avaliar a magnitude da desigualdade socioeconômica relacionada à necessidade de atendimento odontológico. Método Utilizaram-se dados da Última Pesquisa de Condições de Saúde Bucal de Minas Gerais, realizada em 2011, com amostra representativa de adolescentes (n = 2.310) e adultos (n = 1.188). A necessidade de tratamento odontológico foi avaliada de acordo com os critérios da Organização Mundial de Saúde (OMS). A renda familiar foi utilizada como medida de posição socioeconômica. A magnitude das desigualdades socioeconômicas relacionadas à necessidade de tratamento foi avaliada por meio do Índice Absoluto de Desigualdades (IAD) e Índice Relativo de Desigualdades (IRD). Resultados Entre adolescentes, o IAD foi de -22,9% (IC95% -34,8; -11,0) e o IRD estimado em 0,61 (IC95% 0,47; 0,79). Entre adultos, o IAD foi de -28,0% (IC95% -39,8; -16,3) e IRD 0,58 (IC 95% 0,45; 0,74). Conclusão Existem desigualdades socioeconômicas relacionadas à necessidade de tratamento odontológico, sendo que indivíduos com menor renda familiar apresentam maior prevalência de necessidades.

Simpson's paradox: a demographic case study about population dynamics, poverty and inequality / O Paradoxo de Simpson: um estudo de caso demográfico sobre dinâmica da população, pobreza e desigualdade

Brazil is experiencing a demographic transition marked by regional inequalities. It is possible to assume that aspects related to poverty, development and inequality can reverse the association effects of the demographic transition indicators, typifying a phenomenon known as Simpson's Paradox. The aim of this study was to analyze the effect of inequality, poverty, and social development on the Brazilian population dynamics, verifying the occurrence of Simpson's paradox in the demographic transition. Population data from the Brazilian Demographic Censuses from 1991 to 2010 were used, according to age in Brazil and federation units. The correlation between demographic indicators was evaluated, stratifying the units of the federation into groups according to social indicators. There is an advance of UFs in relation to social indicators, although heterogeneity persists. The transition has been occurring in all FUs, with the distance between them persisting, even though it has been decreasing over the years. Simpson's paradox was observed when the analysis was carried out according to the census year, and according to the social indicator, mainly for the year 1991. The main challenge is to understand how the Brazilian demographic dynamics can be analyzed and to understand how the contextual factors change its rhythm, quantum, and pattern.

O Brasil experimenta uma transição demográfica marcada por desigualdades regionais. É possível supor que aspectos relacionados à pobreza, desenvolvimento e desigualdade possam reverter os efeitos de associação dos indicadores da transição demográfica, tipificando um fenômeno conhecido como Paradoxo de Simpson. O objetivo deste estudo foi analisar o efeito da desigualdade, pobreza e desenvolvimento social na dinâmica populacional brasileira, verificando a ocorrência do paradoxo de Simpson na transição demográfica. Foram utilizados dados populacionais oriundos dos Censos Demográficos brasileiros de 1991 a 2010, segundo idade no Brasil e unidades da federação. Foi avaliada a correlação entre os indicadores demográficos, estratificando das unidades da federação em grupos de acordo com os indicadores sociais. Há um avanço das UF com relação aos indicadores sociais, ainda que persista a heterogeneidade. A transição vem ocorrendo em todas as UF, com persistência da distância entre elas, mesmo que com redução ao longo dos anos. Observou-se o paradoxo de Simpson quando a análise foi realizada segundo ano censitário, e segundo indicador social, principalmente para o ano de 1991. O principal desafio é compreender como a dinâmica demográfica brasileira pode ser analisada e compreender de que forma os fatores contextuais alteram seu ritmo, quantum e padrão.

Association of self-reported sleep disturbances with ideal cardiovascular health in Brazilian adults: A cross-sectional population-based study.

OBJECTIVE: To examine the association between sleep disturbances and cardiovascular health in Brazilian adults. METHODS: We analyzed cross-sectional data from a nationally representative sample of 36,480 Brazilian adults ages 18 and over. Multivariate Poisson regression models were used to assess the association between sleep disturbances (difficulty falling asleep, frequent interruptions in sleep, or sleeping more than usual) and Life's Simple 7 (LS7) cardiovascular health (CVH) scores through consideration of four behaviors (smoking, physical activity, body mass index, and diet) and three biological factors (hypercholesterolemia, hypertension, and diabetes). RESULTS: Adults with no sleep disturbances had better CVH, with higher mean LS7 CVH scores (4.2, 95% confidence interval [CI]: 4.1; 4.2) when compared to those experiencing some level of sleep disturbance within a 2-week timespan (3.8, 95% CI: 3.7; 3.8). Specifically, compared to those with no sleep disturbance, adults reporting sleep disturbances for half of the weekdays had significantly lower LS7 CVH mean scores (ß = -0.02, 95% CI: -0.04; 0.01). Adults who had disturbances more than half of the weekdays had even lower scores (ß = -0.06, 95% CI: -0.09; -0.02), followed by those who reported disturbances almost every day (ß = -0.08, 95% CI: -0.11; -0.04), even after adjusting for age, sex, education status, depressive symptoms, and night shift work. CONCLUSION: Brazilian adults with sleep disturbances are less likely to achieve ideal CVH. Given that sleep disturbances seem to be increasingly common in Brazil, recent gains in CVH mortality may be affected.

The Influence of Evidence-Based Exercise and Age Reattribution on Physical Function in Hispanic Older Adults: Results From the ¡Caminemos! Randomized Controlled Trial.

Older Hispanics routinely exhibit unhealthy beliefs about "normal" aging trajectories, particularly related to exercise and physical function. We evaluated the prospective effects of age reattribution on physical function in older Hispanics. Participants (n = 565, ≥60 years) were randomly assigned into (a) treatment group-attribution-retraining, or (b) control group-health education. Each group separately engaged in four weekly 1-hr group discussions and 1-hr exercise classes, followed by monthly maintenance sessions. The Short Physical Performance Battery (SPPB) measured physical function throughout the 24-month intervention. No significant difference in physical function between intervention arms was evident over time. However, both groups experienced significant improvements in physical function at 24 months (ß = 0.43, 95% confidence interval [CI] = [0.16, 0.70]). Participating in the exercise intervention was associated with improvements in physical function, although no additional gains were apparent for age attribution-retraining. Future research should consider strengthening or modifying intervention content for age reattribution or dosage received.

Factors associated with use of assistive walking devices among older adults in Brazil / Fatores associados ao uso de tecnologia assistiva para auxiliar na mobilidade entre idosos no Brasil

Abstract Background Walking devices and other forms of assistive technology (AT) can benefit older adults by supporting mobility and social interactions, but usage outside of high-income countries is generally low. Objective To examine the factors associated with AT use and whether AT use is associated with higher levels of social participation among older adults in Brazil. Method The 2013 Brazilian National Health Survey interviewed 23,815 individuals 60 years or older. Descriptive and logistic regression analyses were used to examine AT use, including canes and walkers, to assist with walking and social participation. Results Among older adults with mobility difficulty, 34.0% (95% CI 31.2- 36.9) reported using AT. Prevalence of the use of AT for walking increases with age: 21.4% of those 60-69 years reported using AT while 58.5% of those 90 years or older did. AT was negatively associated with participation in social activities. Conclusion Our analyses focused on older adults with mobility limitations who need appropriate transportation and environment adaptations to engage socially. Contrary to studies in more developed countries, among Brazilians, AT use is negatively associated with social interactions. The resulting confinement seems to lead to social isolation.

Resumo Introdução Os dispositivos de tecnologia assistiva (TA) podem ajudar idosos na mobilidade e nas interações sociais, mas o uso fora de países de alta renda é geralmente baixo. Objetivo Analisar os fatores associados ao uso de TA e se o uso de TA está associado a níveis mais elevados de participação social entre idosos no Brasil. Método A Pesquisa Nacional de Saúde - PNS 2013 no Brasil entrevistou 23.815 indivíduos com 60 anos ou mais. Análises descritivas e de regressão logística foram utilizadas para examinar a utilização de TA para auxiliar na mobilidade e participação social. Resultados Entre idosos com dificuldade de locomoção, 34,0% (95% IC 31,2-36,9) relataram uso de TA. A prevalência do uso de TA para se locomover aumenta com a idade: 21,4% dos 60-69 anos relataram usar TA enquanto a proporção aumenta para 58,5% entre os de 90 anos ou mais. Uso de TA está negativamente associado à participação em atividades sociais. Conclusão Entre idosos no Brasil com limitações de mobilidade que necessitam de adaptações adequadas de transporte e meio ambiente para engajar socialmente, o uso de TA foi associado negativamente às interações sociais. Esse resultado difere de estudos em países mais desenvolvidos.