Physical activity during early life and the risk of all-cause mortality in midlife: findings from a birth cohort study.

BACKGROUND: The objective of this study was to examine the association between physical activity during childhood and adolescence and the risk of all-cause mortality in midlife. We analyzed data from a birth cohort (The 1958 National Child Development Survey), including births in England, Wales and Scotland. METHODS: Physical activity was assessed using questionnaires at ages 7, 11 and 16. Death certificates defined all-cause mortality. Cumulative exposure, sensitive and critical periods, and physical activity trajectory from childhood to adolescence were tested using multivariate Cox proportional hazard models. The sweep the death was confirmed was defined as the time event. RESULTS: From age 23 to 55, 8.9% of participants (n = 9398) died. Physical activity in childhood and adolescence affected the risk of all-cause mortality in midlife. In men, physical activity at ages 11 [hazard ratio (HR): 0.77; 95% confidence interval (CI): 0.60-0.98] and 16 (HR: 0.60; 95% CI: 0.46-0.78) was associated with reduced risk of all-cause mortality. In women, physical activity at age 16 (HR: 0.68; 95% CI: 0.48-0.95) was associated with reduced risk of all-cause mortality. Physical activity in adolescence eliminated the risk of all-cause mortality associated with physical inactivity in adulthood in women. CONCLUSIONS: Physical activity during childhood and adolescence was associated with reduced risk of all-cause mortality with different effects by sex.

[The experience of forced sexual intercourse among undergraduate students: associated factors and possible consequences]. / Experiência de relação sexual forçada entre estudantes de graduação: fatores associados e possíveis consequências.

The scope of this article is to investigate the prevalence of the experience of forced sexual intercourse on life and its possible consequences on mental and sexual health among undergraduate students at a public university in Brazil. It is a quantitative cross-sectional study with 996 undergraduate students. Sampling was carried out systematically by single-stage clusters. Descriptive, bivariate and multivariate analyses were performed using the Poisson Regression model, and the etiological fractions of the consequences of forced sexual intercourse were calculated. The lifetime prevalence of forced sexual intercourse was 12.1%. Female sex, non-heterosexual sexual orientation, first sexual intercourse before the age of 14, child food insecurity and domestic violence were associated with a higher prevalence of the outcome. Individuals who experienced forced sexual intercourse were more likely to be diagnosed with sexually transmitted infections and to represent a potential suicide risk. The study revealed the problems of sexual violence in the university context.

O objetivo deste artigo é investigar a prevalência de relação sexual forçada na vida e suas possíveis consequências na saúde mental e sexual em acadêmicos de cursos de graduação de uma universidade pública no Brasil. Estudo transversal quantitativo com 996 estudantes de graduação. A amostragem realizada de forma sistemática por conglomerados. Foi usado o modelo de Regressão de Poisson, e foram calculadas as frações etiológicas das consequências de relação sexual forçada. A prevalência de relação sexual forçada ao longo da vida foi de 12,1%. Sexo feminino, orientação sexual não heterossexual, primeira relação sexual antes de 14 anos de idade, insegurança alimentar e violência no contexto doméstico na infância foram associados à maior prevalência do desfecho. Indivíduos que sofreram relação sexual forçada foram mais propensos a apresentar diagnóstico de infecções sexualmente transmissíveis e de ter risco de suicídio. O estudo evidenciou a problemática da violência sexual no contexto universitário.

Experiência de relação sexual forçada entre estudantes de graduação: fatores associados e possíveis consequências / The experience of forced sexual intercourse among undergraduate students: associated factors and possible consequences

Resumo O objetivo deste artigo é investigar a prevalência de relação sexual forçada na vida e suas possíveis consequências na saúde mental e sexual em acadêmicos de cursos de graduação de uma universidade pública no Brasil. Estudo transversal quantitativo com 996 estudantes de graduação. A amostragem realizada de forma sistemática por conglomerados. Foi usado o modelo de Regressão de Poisson, e foram calculadas as frações etiológicas das consequências de relação sexual forçada. A prevalência de relação sexual forçada ao longo da vida foi de 12,1%. Sexo feminino, orientação sexual não heterossexual, primeira relação sexual antes de 14 anos de idade, insegurança alimentar e violência no contexto doméstico na infância foram associados à maior prevalência do desfecho. Indivíduos que sofreram relação sexual forçada foram mais propensos a apresentar diagnóstico de infecções sexualmente transmissíveis e de ter risco de suicídio. O estudo evidenciou a problemática da violência sexual no contexto universitário.

Abstract The scope of this article is to investigate the prevalence of the experience of forced sexual intercourse on life and its possible consequences on mental and sexual health among undergraduate students at a public university in Brazil. It is a quantitative cross-sectional study with 996 undergraduate students. Sampling was carried out systematically by single-stage clusters. Descriptive, bivariate and multivariate analyses were performed using the Poisson Regression model, and the etiological fractions of the consequences of forced sexual intercourse were calculated. The lifetime prevalence of forced sexual intercourse was 12.1%. Female sex, non-heterosexual sexual orientation, first sexual intercourse before the age of 14, child food insecurity and domestic violence were associated with a higher prevalence of the outcome. Individuals who experienced forced sexual intercourse were more likely to be diagnosed with sexually transmitted infections and to represent a potential suicide risk. The study revealed the problems of sexual violence in the university context.

Estresse percebido entre estudantes de graduação: fatores associados, a influência do modelo ENEM/SiSU e possíveis consequências sobre a saúde / Perceived stress among undergraduate students: associated factors, influence of the ENEM/SiSU model, and its possible consequences on health

RESUMO Objetivo: Medir os níveis de estresse percebido, os fatores associados, em especial o impacto da escolha e satisfação com o curso, bem como as possíveis consequências desse desfecho entre graduandos. Métodos: Estudo transversal conduzido em 2019 com 996 estudantes de graduação de uma universidade pública no Sul do Brasil. A amostragem foi realizada de forma sistemática por conglomerados em único estágio. O desfecho foi avaliado por meio da Escala de Estresse Percebido. As análises de fatores associados e possíveis consequências foram realizadas por meio de regressão linear múltipla e regressão de Poisson, respectivamente. Resultados: O escore médio de estresse percebido foi de 31,1 (DP = 9). Indivíduos do sexo feminino, de orientação sexual não heterossexual, mais pobres, com insegurança alimentar, com medo de violência no bairro, com percepção de difícil acesso a serviço psicológico e com menor suporte social foram os mais estressados. Participantes mais velhos e com algum nível de atividade física foram menos estressados. A insatisfação com o curso atual, e não o fato de ser o curso desejado no ingresso, foi associada ao estresse. Uso não médico de remédio prescrito, ansiedade generalizada, sintomas depressivos e pior qualidade de sono e de vida foram identificados como possíveis consequências do estresse. Conclusões: O modelo ENEM/SiSU parece não exercer efeito no estresse. Além disso, esse desfecho foi mais elevado entre indivíduos mais vulneráveis, tendo contribuído para diversos desfechos negativos em saúde mental. Recomenda-se o fortalecimento de serviços de assistência estudantil para que esses casos sejam identificados e manejados.

ABSTRACT Objective: To measure levels of perceived stress, associated factors, especially the impact of choice and satisfaction with the course, as well as the possible consequences of this outcome among undergraduates. Methods: Cross-sectional study conducted in 2019 with 996 undergraduate students from a public university in southern Brazil. Sampling was carried out systematically by single-stage clusters. The outcome was assessed using the Perceived Stress Scale. Analysis of associated factors and possible consequences were performed using multiple linear regression and Poisson regression, respectively. Results: Mean perceived stress score was 31.1 (SD = 9). Female individuals, with non-heterosexual orientation, poorer, with food insecurity, with fear of violence in the neighborhood, with perception of difficult access to psychological services and with less social support were the most stressed. Older participants with some level of physical activity were less stressed. Dissatisfaction with the current course, rather than the fact that it was the desired course prior admission, was associated with high levels of stress. Non-medical use of prescribed medication, generalized anxiety, depressive symptoms, and poorer quality of sleep and life were identified as possible consequences of stress. Conclusions: The ENEM/SiSU model seems to have no effect on stress. Furthermore, this outcome was higher among more vulnerable individuals, having contributed to several negative outcomes in mental health. It is recommended to strengthen student assistance services so that these cases can be identified and managed.

A Study on the Health and Wellness of Undergraduate Students (SABES-Grad): methodological aspects of a nationwide multicenter and multilevel study overlapping with the Covid-19 pandemic.

INTRODUCTION: The academic environment can negatively impact the mental health of undergraduate students, particularly in the context of the coronavirus disease 2019 (Covid-19) pandemic. This study aimed to describe the methodological and operational aspects of a study of the health and well-being of undergraduate students: the Study on the Health and Wellness of Undergraduate Students (SABES-Grad) project. METHOD: This was a nationwide cross-sectional study divided across two data collection strategies: a single-center, on-site data collection carried out in 2019 at the Universidade Federal do Rio Grande (FURG) and a multicenter, multilevel, online data collection carried out in 2020/2021 at FURG, the Universidade Federal Fluminense (UFF), the Universidade Federal do Mato Grosso (UFMT), the Universidade do Estado do Amazonas (UEA), and the Universidade Federal Rural de Pernambuco (UFRPE). The main outcomes of interest were depressive symptoms, generalized anxiety, and suicide risk. RESULTS: A total of 996 students participated in the 2019 data collection (63.8% female; median age of 22 years; response rate of 85.2%) and 5,720 students participated in the 2020/2021 collection (66.7% female; median age of 22 years; response rate of 84.3%). Significant variations in socioeconomic and demographic profiles were observed between the different universities. Approximately one-third of the sample had been tested for Covid-19 in 2020/2021, 7.8% of whom had tested positive. CONCLUSION: The SABES-Grad project was the result of collaborative work between several actors from public universities in Brazil. Several aspects of the preparation and execution of this research are discussed in terms of its originality and relevance. Barriers and limitations and strategies adopted to overcome them are also presented.

Suicide risk among undergraduate students in Brazil in the periods before and during the COVID-19 pandemic: results of the SABES-Grad national survey.

BACKGROUND: Undergraduate students present high rates of psychological distress, including suicide risk. Due to the coronavirus disease 2019 (COVID-19) pandemic, this scenario may have been aggravated. Thus, the objective of the current study was to evaluate changes in the suicide risk rate from the period before to during the COVID-19 pandemic, as well as the factors associated with this outcome among Brazilian undergraduate students. METHODS: This was a nationwide survey carried out in Brazil with a cross-sectional design, including two data collection periods: a single-center in-person collection in 2019 and another multicenter online collection in 2020/2021. Data were collected using self-administered instruments. The outcome was a high risk of suicide, measured through the Mini International Neuropsychiatric Interview. Analyses were carried out on data from two periods, i.e. before and during the pandemic (bivariate analysis and interaction tests), and a model of associated factors (multivariate analysis using Poisson regression) was developed including all participating universities distributed in the five regions of Brazil. RESULTS: In total, 6716 Brazilian undergraduate students participated (996 in 2019 and 5720 in 2020/2021). The prevalence of a high suicide risk rose from 11.3% to 17.0%, especially among women and poorer individuals. The prevalence of a high risk of suicide among Brazilian undergraduates was 19.6% and was associated with several socioeconomic, academic, pandemic, and mental health factors. CONCLUSIONS: The prevalence of a high suicide risk increased from prepandemic to during the pandemic, appearing to be largely influenced by social determinants, in conjunction with the implications of the COVID-19 pandemic.

A Study on the Health and Wellness of Undergraduate Students (SABES-Grad): methodological aspects of a nationwide multicenter and multilevel study overlapping with the Covid-19 pandemic

Abstract Introduction The academic environment can negatively impact the mental health of undergraduate students, particularly in the context of the coronavirus disease 2019 (Covid-19) pandemic. This study aimed to describe the methodological and operational aspects of a study of the health and well-being of undergraduate students: the Study on the Health and Wellness of Undergraduate Students (SABES-Grad) project. Method This was a nationwide cross-sectional study divided across two data collection strategies: a single-center, on-site data collection carried out in 2019 at the Universidade Federal do Rio Grande (FURG) and a multicenter, multilevel, online data collection carried out in 2020/2021 at FURG, the Universidade Federal Fluminense (UFF), the Universidade Federal do Mato Grosso (UFMT), the Universidade do Estado do Amazonas (UEA), and the Universidade Federal Rural de Pernambuco (UFRPE). The main outcomes of interest were depressive symptoms, generalized anxiety, and suicide risk. Results A total of 996 students participated in the 2019 data collection (63.8% female; median age of 22 years; response rate of 85.2%) and 5,720 students participated in the 2020/2021 collection (66.7% female; median age of 22 years; response rate of 84.3%). Significant variations in socioeconomic and demographic profiles were observed between the different universities. Approximately one-third of the sample had been tested for Covid-19 in 2020/2021, 7.8% of whom had tested positive. Conclusion The SABES-Grad project was the result of collaborative work between several actors from public universities in Brazil. Several aspects of the preparation and execution of this research are discussed in terms of its originality and relevance. Barriers and limitations and strategies adopted to overcome them are also presented.

Sintomas de ansiedade generalizada entre estudantes de graduação: prevalência, fatores associados e possíveis consequências / Symptoms of generalized anxiety among undergraduate students: prevalence, associated factors and possible consequences

RESUMO Objetivo Medir a prevalência de sintomatologia ansiosa entre estudantes de graduação de uma universidade pública no Sul do Brasil, seus fatores associados e possíveis consequências. Métodos Trata-se de um estudo transversal com uma amostra aleatória de graduandos, realizado em 2019. Foi utilizado um questionário com questões sociodemográficas, acadêmicas e de saúde mental e física. Sintomas de ansiedade generalizada foram avaliados por meio do Generalized Anxiety Disorder - 7 (GAD-7). Fatores associados e possíveis consequências foram analisados por meio da regressão de Poisson com ajuste robusto da variância. Resultados Entre os 994 participantes, a prevalência de sintomas de ansiedade generalizada severa foi de 30,9% (IC 95%: 27,9%-33,9%). As variáveis independentemente associadas a sintomas de ansiedade generalizada foram: sexo feminino, orientação não heterossexual, sentir muito/muitíssimo medo de violência no bairro e perceber como difícil o acesso a serviço psicológico. Possuir alto nível de suporte social e apresentar algum nível de atividade física foi considerado fator de proteção para o desfecho. Possíveis consequências dos sintomas de ansiedade generalizada foram: pior qualidade de sono, utilizar algum medicamento sem prescrição nos últimos 30 dias e ser classificado como risco de suicídio moderado/severo. Conclusões Esses resultados demonstram a necessidade de um olhar mais atento para alguns subgrupos populacionais. Recomenda-se a implementação de intervenções psicológicas que incluam um número maior de indivíduos simultaneamente (como a criação de grupos terapêuticos), com o intuito de reduzir a carga de ansiedade no contexto universitário. O fortalecimento do setor de assistência estudantil da universidade também se torna uma importante possibilidade de melhora para esse cenário.

ABSTRACT Objective To measure the anxious symptoms of undergraduate students at a public university in southern Brazil, the factors associated with it and the possible consequences. Methods This was a cross-sectional study with a random sample of undergraduate students in 2019. A questionnaire that evaluated sociodemographic, academic, mental and physical health aspects was used. Symptoms of generalized anxiety were evaluated through the Generalized Anxiety Disorder - 7 (GAD-7). Associated factors and possible consequences were analyzed using the Poisson regression, with robust variance adjustment. Results Among the 994 participants, the prevalence of symptoms of severe generalized anxiety was 30.9% (95% CI: 27,9%-33,9%). The variables independently associated with symptoms of generalized anxiety were: female gender, non-heterosexual orientation, feeling very afraid of violence in the neighborhood, perceiving access to psychological service as difficult. Having a high level of social support, and with any level of physical activity were considered protective factors for the outcome. Possible consequences of symptoms of generalized anxiety were: worse sleep quality, non-medical use of prescription drugs in the last 30 days, and being classified with moderate or severe suicide risk. Conclusions These results indicate the need to a closer attention to subgroups within this population. Implementation of psychological interventions that includes a broader range of individuals simultaneously are recommended (such as therapeutic groups) to reduce the burden of anxiety in the university context. The strengthening of the university's student assistance sector is also important to improve this situation.

Does Money Buy Happiness? Disentangling the Association Between Income, Happiness and Stress.

Although there is evidence of an inverse relationship between stress and happiness, less is known about the interrelationship between income, happiness and stress. The purpose of this research brief was to investigate whether and how income and stress shape the distribution of happiness. A population-based cross-sectional study was conducted in the city of Rio Grande, Southern Brazil, with 1,168 individuals aged 18 years or older. The data were collected in 2016 and analyzed in 2019. Wealthiest people tended to be happier and less stressed. Less-stressed people had higher levels of happiness, which remain stable regardless of their income. Most-stressed individuals had lower prevalence of happiness throughout all income subgroups. Happiness levels among both rich and poor respondents decreased as stress levels increased. Nonetheless, this reduction was more pronounced among the poorest respondents. Concluding, stress plays an important role in the relationship between income and happiness. Although there is some evidence that money can exert influence on happiness, it seems that this association is highly dependent of individuals' stress levels.

Fear of Covid-19 and health-related outcomes: results from two Brazilian population-based studies.

Fear is a reaction that can influence multiple aspects of health and life. During the Covid-19 pandemic, there have been serious pathophysiological, social, behavioral and mental consequences that can be related to fear. This study aimed to assess the fear of Covid-19 and its association with sociodemographic, behavioral and health variables. Data were gathered from two cross-sectional population-based studies conducted in 2020 with adults from two cities from Southern Brazil. The Fear of Covid-19 scale was used to evaluate fear of Covid. Exposure variables were socioeconomic, demographic, health and pandemic-related factors. Adjusted Poisson regression was performed to assess the association between fear of Covid-19 and the exposure variables. A total of 2,152 subjects were assessed. Higher fear of Covid-19 was found among women and in individuals with symptoms of Covid-19. Living alone, being richer, and testing positive for Covid-19 were associated with lower prevalence of fear. Higher prevalence of fear of Covid-19 was related to worse sleep quality, worse health perception, sadness, higher stress, depressive symptoms, and suicidal ideation. There was a linear association between fear of Covid-19 and health outcomes. The results provide evidence that fear of Covid-19 seems to be associated with socioeconomic, demographic, health and pandemic-related factors.

Alcohol Consumption and Smoking During Covid-19 Pandemic: Association with Sociodemographic, Behavioral, and Mental Health Characteristics.

The Covid-19 pandemic is related to increased alcohol consumption and smoking. These behaviors may be related to several sociodemographic, behavioral and mental health factors. Thus, the aim of this study was to assess the association between alcohol consumption and cigarette smoking with sociodemographic, behavioral and mental health characteristics. This study used data from two population-based studies conducted in two cities from Southern Brazil amid the Covid-19 pandemic. Individuals aged 18 years or older were included and selected using a multistage sampling procedure. Alcohol consumption and smoking and changes in such consumption during the Covid-19 pandemic were evaluated. Sociodemographic, behavioral, pandemic-related, and mental health variables were also included. A hierarchical model was used to conduct the adjusted analyses, and Poisson regression with robust adjustment was used for variance. A total of 2170 individuals were studied. The prevalence of alcohol consumption and smoking were 9.3% and 14.2%, respectively. The rates of increase in alcohol consumption and smoking during the Covid-pandemic were about 20% and 30%, respectively. They were higher among those with depressive symptoms, feeling of sadness and self-reported stress. Those with poor diet quality had higher prevalence of alcohol consumption (PR: 1.82) and were 1.58 times more likely to smoke. The findings may help stakeholders in health and political systems to better understand the consequences of the Covid-19 pandemic and develop strategies to mitigate these consequences in Brazil and elsewhere.

Socioeconomic inequalities in the access to health services: a population-based study in Southern Brazil.

This article aims to measure socioeconomic inequalities regarding access to health services, contact with health professionals, and specific health interventions. This was a cross-sectional population-based study with individuals aged 18 years or older, living in the city of Rio Grande. The outcomes were the following: Family Health Strategy (FHS) coverage; having a health insurance plan; receiving a visit of a community health worker; medical consultation; dental consultation; dietary counseling; having a class with a physical education professional; flu vaccination; mammography, cytopathological and prostate exams. Relative and absolute measures were used to assess inequalities in the distribution of the outcomes. There was a response rate of 91% (1,300 adults were interviewed). Coverage indicators ranged from 16.1%, for having a class with a physical education professional, to 80.0% for medical consultation. FHS coverage and visit of a community health agent presented higher proportions among the poorest while outcomes regarding contact with health professionals, screening exams and flu vaccine were more prevalent among richest group. We observed low coverage levels of access to health services and professionals in addition to marked socioeconomic inequalities.

Physical Inactivity From Childhood to Adolescence and Incident Depression.

INTRODUCTION: The long-term impact of physical activity during early life on the risk of depression in later stages of adulthood remains unclear. This study examines the association between physical activity during childhood and adolescence and the incidence of depressive symptoms in early, middle, and late adulthood. METHODS: Data from a birth cohort (the 1958 National Child Development Survey), including births (N=17,415) in England, Wales, and Scotland, were used. After birth, 11 more follow-ups were carried out between ages 7 and 62 years (2020). Leisure-time physical activity was assessed through a self-reported questionnaire. Psychological measures were assessed with the teacher-rated Bristol Social Adjustment Guide, the teacher-rated Rutter scale, and the self-rated Malaise Inventory. Leisure-time physical activity and psychological symptoms were examined in all the 11 follow-up assessments included in this study. Best-fit model was used to obtain hazard ratios and 95% CIs of depression symptoms by physical activity status in different ages, including demographic, behavioral, and health-related variables as potential confounders. RESULTS: After multivariate analysis, being physically active at age 16 years reduced the risk of incident elevated depressive symptoms (hazard ratio=0.73, 95% CI=0.62, 0.85) throughout adulthood. The long-term impacts of physical activity practiced at age 16 years persisted throughout adulthood up to age 62 years. CONCLUSIONS: Adolescence is a critical early-life period to promote physical activity for reducing the incidence of elevated depressive symptoms throughout adulthood. Public health policies should promote healthy lifestyles during the lifespan to reduce both the burden of physical inactivity and depressive symptoms at the population level.

An invisible villain: high perceived stress, its associated factors, and possible consequences in a population-based survey in southern Brazil.

INTRODUCTION: Much of the evidence on the relationship between stress, lifestyle, and other physical and mental health outcomes comes from studies conducted in high-income countries. There is therefore a need for research among populations in low and middle-income settings. OBJECTIVES: To measure stress levels and identify factors associated with a high stress level and its consequences for health. METHODS: This was a population-based cross-sectional study carried out in 2016 with adults aged 18 years or older in a municipality in southern Brazil. A two-stage sampling strategy based on census tracts was used. Stress levels were measured with the Perceived Stress Scale (PSS-14) and classified into quartiles. The impact of the highest stress levelon each outcome was assessed with etiologic fractions (EF). RESULTS: The most stressed groups were: females (PR = 1.51, 95%CI 1.25-1.81), younger people (PR = 1.76, 95%CI 1.26-2.46), middle-aged individuals (PR = 1.60, 95%CI 1.17-2.19), those with lower schooling (PR = 1.56, 95%CI 1.20-2.02), the physically inactive (PR = 1.51, 95%CI 1.20-1.91), people who spent three or more hours watching television per day (PR = 1.29, 95%CI 1.12-1.50), and those with food insecurity (PR = 1.44, 95%CI 1.19-175). Possible consequences of high stress level were regular or poor self-perception of health (EF = 29.6%), poor or very poor sleep quality (EF = 17.3%), lower quality of life (EF = 45.6%), sadness (EF = 24.2%), and depressive symptoms (EF = 35.8%). CONCLUSIONS: Stress plays an important role in several domains of health. Both public policies that target reduction of inequalities and specific stress-management interventions can reduce stress levels in populations, thereby decreasing the burden of other negative physical and mental health outcomes related to stress.

An invisible villain: high perceived stress, its associated factors, and possible consequences in a population-based survey in southern Brazil

Abstract Introduction Much of the evidence on the relationship between stress, lifestyle, and other physical and mental health outcomes comes from studies conducted in high-income countries. There is therefore a need for research among populations in low and middle-income settings. Objectives To measure stress levels and identify factors associated with a high stress level and its consequences for health. Methods This was a population-based cross-sectional study carried out in 2016 with adults aged 18 years or older in a municipality in southern Brazil. A two-stage sampling strategy based on census tracts was used. Stress levels were measured with the Perceived Stress Scale (PSS-14) and classified into quartiles. The impact of the highest stress levelon each outcome was assessed with etiologic fractions (EF). Results The most stressed groups were: females (PR = 1.51, 95%CI 1.25-1.81), younger people (PR = 1.76, 95%CI 1.26-2.46), middle-aged individuals (PR = 1.60, 95%CI 1.17-2.19), those with lower schooling (PR = 1.56, 95%CI 1.20-2.02), the physically inactive (PR = 1.51, 95%CI 1.20-1.91), people who spent three or more hours watching television per day (PR = 1.29, 95%CI 1.12-1.50), and those with food insecurity (PR = 1.44, 95%CI 1.19-175). Possible consequences of high stress level were regular or poor self-perception of health (EF = 29.6%), poor or very poor sleep quality (EF = 17.3%), lower quality of life (EF = 45.6%), sadness (EF = 24.2%), and depressive symptoms (EF = 35.8%). Conclusions Stress plays an important role in several domains of health. Both public policies that target reduction of inequalities and specific stress-management interventions can reduce stress levels in populations, thereby decreasing the burden of other negative physical and mental health outcomes related to stress.

Socioeconomic inequalities in the access to health services: a population-based study in Southern Brazil / Desigualdades socioeconômicas no acesso aos serviços de saúde: um estudo de base populacional no sul do Brasil

Abstract This article aims to measure socioeconomic inequalities regarding access to health services, contact with health professionals, and specific health interventions. This was a cross-sectional population-based study with individuals aged 18 years or older, living in the city of Rio Grande. The outcomes were the following: Family Health Strategy (FHS) coverage; having a health insurance plan; receiving a visit of a community health worker; medical consultation; dental consultation; dietary counseling; having a class with a physical education professional; flu vaccination; mammography, cytopathological and prostate exams. Relative and absolute measures were used to assess inequalities in the distribution of the outcomes. There was a response rate of 91% (1,300 adults were interviewed). Coverage indicators ranged from 16.1%, for having a class with a physical education professional, to 80.0% for medical consultation. FHS coverage and visit of a community health agent presented higher proportions among the poorest while outcomes regarding contact with health professionals, screening exams and flu vaccine were more prevalent among richest group. We observed low coverage levels of access to health services and professionals in addition to marked socioeconomic inequalities.

Resumo O objetivo deste artigo é mensurar desigualdades socioeconômicas no acesso a serviços de saúde, no contato com profissionais e em intervenções específicas. Estudo transversal de base populacional com indivíduos (18 anos ou mais) vivendo em Rio Grande. Os desfechos mensurados foram: cobertura da Estratégia de Saúde da Família (ESF), plano de saúde, visita do agente comunitário de saúde, consulta médica, consulta com dentista, aconselhamento nutricional, aula com professor de educação física, vacina da gripe, mamografia, exames citopatológico e de próstata. Medidas de desigualdade absolutas e relativas foram utilizadas para avaliar a distribuição dos desfechos. A taxa de resposta foi de 91% (1.300 adultos entrevistados). A cobertura dos indicadores variou de 16,1%, para ter aula com professor de educação física, a 80,0%, para consulta médica. Cobertura de ESF e visita do agente comunitário de saúde apresentaram maior proporções entre os mais pobres, enquanto desfechos de contato com profissionais de saúde, exames de rastreamento e vacina da gripe foram mais prevalentes entre os mais ricos. Foram observadas baixas coberturas de acesso aos serviços e contato com profissionais, bem como desigualdades sociodemográficas importantes.

Cobertura do exame citopatológico de colo uterino em mulheres em um município do Sul do Brasil: prevalência e fatores associados / Coverage of cervical cytopathological examination among women from Southern Brazil: prevalence rates and associated factors

RESUMO : Objetivo: Investigou-se a cobertura de exame citopatológico de colo uterino e fatores associados em mulheres entre 25 e 64 anos em município do sul do Brasil. Métodos: Estudo transversal, de base populacional, realizado na cidade de Rio Grande, RS. O desfecho, cobertura de exame citopatológico de colo uterino, foi definido como reali-zação do exame nos últimos três anos para mulheres de 25 a 64 anos, de acordo com a recomendação do Instituto Nacional do Câncer. A coleta de dados ocorreu em 2016. As variáveis independentes incluídas foram: faixa etária, cor da pele, estado civil, escolaridade, nível econômico, histórico gestacional, tabagismo, obesidade, posse de pla-no de saúde, consulta ao médico no último ano, cadastrado do domicílio em Unidade Básica de Saúde da Família e se havia recebido visita de agente de saúde no último ano. Resultados: Participaram 521 mulheres, com média de idade de 44,3 anos. A cobertura foi de 78,1% (IC95% 73,5 a 82,7). Após ajustes, evidenciou-se como fatores as-sociados ao desfecho: ser casada/viúva/separada/divorciada, não ser fumante, ter plano de saúde, ter consultado um médico no último ano e possuir domicílio cadastrado na Unidade Básica de Saúde da Família. Conclusãov: A cobertura de exame citopatológico de colo uterino mostrou-se próxima à meta do Ministério da Saúde, abrangendo oito em cada dez mulheres. Mulheres solteiras, fumantes, sem plano de saúde, que não costumam ir ao médico e cujo domicílio não está cadastrado em UBSF constituíram os grupos de risco para não realizarem o exame. (AU)

ABSTRACT: Objective: To determine the coverage of cervical cancer screening and its associated factors among women from southern Brazil aged 25 to 64 years. Methods: This was a cross-sectional population-based study conducted in the city of Rio Grande, RS. The outcome of interest consisted of a cytopathological examination of the uterine cer-vix in the previous three years in women aged 25 to 64 years, according to the criteria of the Brazilian National Cancer Institute. The data were collected in 2016, and the following independent variables were considered: age, skin color, marital status, schooling, socioeconomic status, gestational history, smoking habits, overweight, health insurance, having visited a physician or having been visited by a community health agent in the previous year, and household registered in a primary care facility (PCF) of the healthcare system. Results: This study included a total of 521 women, with a mean age of 44.3 years. The coverage of cervical cancer screening was 78.1% (95% CI: 73.5 to 82.7). The following characteristics were associated with the outcome: marital status, non-smoking habits, health insurance, having visited a physician in the previous year, and household registered in a PCF. Conclusion:The coverage of cervical cancer screening observed in our study (8 out of ten women) was close to the Brazilian Ministry of Health goals. Single women, smoking habits, no health insurance, having not visited a physician in the previous year, and not having their household registered in a PCF were considered risk factors. (AU)

Physical activity attenuates the risk for dementia associated with aging in older adults with mild cognitive impairment. Findings from a population-based cohort study.

From 2016 to 2040 the number of people with dementia in the United Kingdom is expected to increase by 57%, while 70% percent of it is due to a higher life expectancy. Thus, we analyzed the overall and age-stratified effect of physical activity on risk of dementia in participants with mild cognitive impairment (MCI) of the English Longitudinal Study of Ageing (ELSA). Participants of the ELSA, aged over 50 with MCI, were followed-up nine times between 2002 and 2019. Physical activity was assessed using a self-reported, validated questionnaire and participants were classified as inactive, low, or moderate-to-high active. Medical diagnosis of dementia was self-reported or determined using the Informant Questionnaire on Cognitive Decline in the Elderly. Data from 521 participants with MCI were analyzed (56% women; mean [SD] age, 68.7 [10.6]). Over 17-year follow-up, 20.5 (95%CI: 17.3 to 24.2)% were diagnosed with dementia. The risk of incident dementia was reduced in participants engaging in low (HR: 0.34; 95%CI: 0.22 to 0.54) or moderate-to-high (HR: 0.16; 95%CI: 0.08 to 0.33) levels of physical activity. Risk of dementia in adults aged 80 or more engaging in low or moderate-to-high levels of physical activity was not different from inactive adults aged between 50 and 69 years. Results were sustained after competing risk regression model and sensitivity analyses to reduce the impact of reverse causality. Physical activity appears to minimize the risk associated with aging in older adults with MCI.

Uso de club drugs entre estudantes de graduação: prevalência, características associadas e a influência dos pares / Club drugs use among undergraduate students: prevalence, associated characteristics and peer influence

OBJETIVO: Medir a prevalência do uso na vida, no último ano e no último mês de duas club drugs ­ o ecstasy e o LSD ­, bem como as características associadas ao uso dessas substâncias, no último mês, entre estudantes de graduação de uma universidade no Sul do Brasil. MÉTODOS: Trata-se de um estudo transversal conduzido no ano de 2015 com amostragem aleatória sistemática por conglomerados. Participaram 1.423 estudantes de graduação. Foi utilizado um modelo de análise multivariável em três níveis hierárquicos por meio da regressão de Poisson com ajuste robusto da variância. RESULTADOS: As prevalências de uso na vida, no último ano e no último mês de club drugs foram de 12,7%, 7,8% e 3,8%, respectivamente. Indivíduos do sexo masculino, com orientação sexual homossexual ou bissexual, mais jovens, que moravam com seus pares, solteiros, e que relataram uso no último mês de tabaco e maconha apresentaram maior probabilidade de ter feito uso no último mês de alguma club drug. Entretanto, a variável mais fortemente associada a esse desfecho foi ter algum amigo que já fez uso de alguma droga ilícita na vida (RP = 19,54). CONCLUSÕES: O ambiente universitário parece ser um terreno fértil para a difusão do uso de club drugs. O fortalecimento de uma rede de apoio institucional da universidade, capaz de propor atividades de prevenção, bem como de identificar, acolher e encaminhar casos em que haja abuso e dependência dessas substâncias, pode ser uma estratégia importante para lidar com essa problemática.

OBJECTIVE: To measure the prevalence of lifetime, last-year, and last-month use of two club drugs ­ ecstasy and LSD ­, as well as the characteristics associated with the last-month use of these substances among undergraduate students at a university in southern Brazil. METHODS: This was a cross-sectional study conducted in 2015 with a clustered systematic sampling strategy. Overall, 1,423 undergraduate students participated. A three-level hierarchical multivariate analysis model was used through Poisson regression with robust adjustment of variance. RESULTS: Prevalence of lifetime, last-year, and lastmonth use of club drugs were 12.7%, 7.8% and 3.8%, respectively. Male participants, with homosexual or bisexual sexual orientation, younger, who lived with their peers, who were single, and who reported last-month use of tobacco and marijuana had higher probability of last-month use club drugs. However, the variable most strongly associated with this outcome was having a friend with lifetime use of illicit drugs (PR = 19.54). CONCLUSIONS: University environment seems to be a fertile ground for the spread of the use of club drugs. The strengthening of the university's institutional assistance network, capable of proposing prevention activities, as well as identifying, supporting and referring cases where there is abuse and dependence on these substances can be an important strategy to deal with this problem.