Spatio-Temporal Cluster Detection of Dengue, Chikungunya, and Zika Viruses' Infection in Rio de Janeiro State from 2010 to 2019.

Dengue (DENV), chikungunya (CHIKV), and Zika (ZIKV) virus infections are widespread throughout the Rio de Janeiro state. The co-circulation of these emergent arboviruses constitutes a serious public health problem, resulting in outbreaks that can spatially and temporally overlap. Environmental conditions favor the presence, maintenance, and expansion of Aedes aegypti, the primary vector of these urban arboviruses. This study assessed the detection of clusters of urban arboviruses in the Rio de Janeiro state from 2010 to 2019. Notified cases of dengue, chikungunya, and Zika were grouped by year according to the onset of symptoms and their municipality of residence. The study period recorded the highest number of dengue epidemics in the state along with the simultaneous circulation of chikungunya and Zika viruses. The analyzes showed that the central municipalities of the metropolitan regions were associated with higher risk areas. Central municipalities in metropolitan regions were the first most likely clusters for dengue and Zika, and the second most likely cluster for chikungunya. Furthermore, the northwest and north regions were comprised clusters with the highest relative risk for the three arboviruses, underscoring the impact of these arboviruses in less densely populated regions of Brazil. The identification of high-risk areas over time highlights the need for effective control measures, targeted prevention and control interventions for these urban arboviral diseases.

Corrigendum to "How, what, and why: housing, water & sanitation and wealth patterns in a cross-sectional study of the Guarani Birth Cohort, the first indigenous birth cohort in Brazil" [The Lancet Regional Health - Americas 2023;21: 100496].

[This corrects the article DOI: 10.1016/j.lana.2023.100496.].

Central adiposity as a predictor of mortality in older adults: Identification of cutoffs using generalized additive models.

Background: Obesity is associated with premature mortality in adults; however, this association has been inconsistent in the older adult population. In addition, there is a lack of specific cutoff points for indicators of negative health outcomes in older adults. Methods: This is a prospective study with 796 non-institutionalized older adults. Data on sociodemographic characteristics, lifestyle, food consumption, and nutritional status were obtained at baseline. Generalized additive models were used to identify cutoff points for the waist circumference (WC) and waist-to-height ratio (WHtR) and Cox proportional hazards models to assess the independent association between adiposity and mortality. Results: Over the 9 years of follow-up, 197 deaths (24.7%) occurred, of which 51.8% were men, with a mean age of 76.1 ± 9.0 years. Older adults at higher risk of death had WHtR of <0.52 or ≥0.63 and WC of <83 cm or ≥101 cm. An increased risk of death was observed in older adults with high WC (HR: 2.03 95% CI: 1.20-3.41) and high WHtR (HR: 1.51 95% CI: 1.01-2.26) in the adjusted models, and an increase in WC was a risk factor for higher CVD mortality (HR: 2.09, 95% CI: 1.12-3.88) in the adjusted models. Conclusion: Adiposity was associated with an increased risk of death in older adults. In view of these results and considering the lack of cutoff points for anthropometric indices in Brazilian older adults, further studies are needed to confirm the WC and WHtR cutoff values found in this study.

How, what, and why: housing, water & sanitation and wealth patterns in a cross-sectional study of the Guarani Birth Cohort, the first Indigenous birth cohort in Brazil.

Background: Despite the importance of social determinants of health, studies on the effects of socioeconomic, sanitary, and housing conditions on Indigenous child health are scarce worldwide. This study aims to identify patterns in housing, water & sanitation, and wealth (HSW) in the first Indigenous birth cohort in Brazil-The Guarani Birth Cohort. Methods: Cross-sectional study using baseline data from The Guarani Birth Cohort. We used Multiple Correspondence Analysis and Cluster Analysis. The clusters identified were ordered in increasing degrees of access to public policies and wealth, defining the patterns of HSW. Finally, we explored the association between the patterns and one of the health outcomes, hospitalization, in the birth cohort. Findings: Three patterns were identified for housing and water & sanitation, and four for wealth status, resulting in 36 combinations of patterns (3 × 3 × 4). More than 62% of children in the cohort were found with the lowest wealth patterns. The distribution of children across patterns in one dimension was not fully determined by the other two dimensions. Statistically significant associations were found between precarious households and extreme poverty, and hospitalization. Interpretation: We observed substantial heterogeneity in the distribution of children across the 36 combinations. These findings highlight that, should the dimensions of HSW be associated with health outcomes, as seen for hospitalization, they should be considered separately in multivariable models, in order to improve the estimation of their independent effects. Funding: National Council for Scientific and Technological Development, Brazil (CNPq); Oswaldo Cruz Foundation, Brazil (Fiocruz); Research Foundation of the State of Rio de Janeiro, Brazil (FAPERJ).

O desequilíbrio esforço-recompensa está associado à hipertensão arterial entre servidores públicos brasileiros? Resultados do ELSA-Brasil / Is the effort-reward imbalance associated with hypertension among Brazilian civil servants? Results from the ELSA-Brasil study

Resumo Objetivos: analisar a associação entre o estresse no trabalho, segundo o modelo de desequilíbrio esforço-recompensa (DER), e a hipertensão arterial (HA), assim como investigar o papel modificador de efeito do excesso de comprometimento (EC) e do sexo. Métodos: análise seccional de dados de trabalhadores(as) ativos que participaram da segunda onda de coleta de dados (2012-2014) do Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil). O estresse no trabalho foi mensurado pela versão brasileira da escala de DER, composta por três dimensões: esforço, recompensa e EC. A HA foi definida como níveis de pressão arterial sistólica/diastólica ≥ 140/90 mmHg ou uso de medicamento anti-hipertensivo. Empregou-se regressão logística, bruta e ajustada por potenciais fatores de confusão. As interações multiplicativas foram investigadas. Resultados: participaram 9.465 servidores, 51,9% do sexo feminino. A prevalência de HA foi de 34,9%. No modelo ajustado, associações limítrofes foram identificadas entre o DER (razão>1) e maior EC com maiores chances de HA (OR: 1,11; IC95%: 1,00; 1,24; e OR: 1,13; IC95%: 1,01; 1,26, respectivamente). A análise de interação indicou que sexo e EC não são modificadores de efeito. Conclusão: DER e EC associaram-se a maiores chances de HA, após ajuste. Sexo e EC não foram modificadores de efeito.

Abstract Objectives: to evaluate the association between job stress, according to the effort-reward imbalance (ERI) model, and hypertension (HTN), as well as to investigate the effect modifier role of overcommitment (OC) and sex. Methods: cross-sectional analysis of data from active workers who participated in the second data collection wave (2012-2014) of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Job stress was measured by the ERI scale - Brazilian version, comprising three dimensions: effort, reward, and OC. HTN was defined as systolic or diastolic blood pressure levels ≥ 140/90 mmHg or antihypertensive medication use. Associations were estimated by logistic regression, crude and adjusted for potential confounding factors. Multiplicative interactions were investigated. Results: a total of 9,465 civil servants participated in the study, 51.9% females. HTN prevalence was 34.9%. The adjusted model identified borderline associations between ERI (ratio > 1) and higher OC with higher odds of HTN (OR = 1.11, 95%CI = 1.00; 1.24; and OR = 1.13; 95%CI = 1.01; 1.26, respectively). Interaction analysis indicated no differences in associations according to sex and OC. Conclusion: results show that ERI and OC are associated with higher odds of HTN after adjustment. Sex and OC were not effect modifiers.

Entomological Surveillance of Aedes Mosquitoes: Comparison of Different Collection Methods in an Endemic Area in RIO de Janeiro, Brazil.

Using collection methods for Aedes adults as surveillance tools provides reliable indices and arbovirus detection possibilities. This study compared the effectiveness of different methods for collecting Ae. aegypti and Ae. albopictus and detecting arboviruses circulating in field-caught female specimens. Collection sites were defined in urban, peri-urban, and rural landscapes in two Brazilian cities. Collections were performed using Adultraps (ADT), BG-Sentinel (BGS), CDC-like traps (CDC), and indoor (ASP-I) and outdoor (ASP-O) aspiration during the rainy and dry seasons of 2015 and 2016. Generalized linear mixed models were used to model the effectiveness of each collection method. A total of 434 Ae. aegypti and 393 Ae. albopictus were collected. In total, 64 Ae. aegypti and sixteen Ae. albopictus female pools were tested for DENV, CHIKV, ZIKV, or YFV; none were positive. Positivity and density were linear at low densities (<1 specimen); thereafter, the relationship became non-linear. For Ae. aegypti, ADT and CDC were less effective, and ASP-I and ASP-O were as effective as BGS. For Ae. albopictus, all collection methods were less effective than BGS. This study highlights the need for an integrated surveillance method as an effective tool for monitoring Aedes vectors.

Dengue, Chikungunya, and Zika: Spatial and Temporal Distribution in Rio de Janeiro State, 2015-2019.

Simultaneous spatial circulation of urban arboviral diseases, such as dengue, chikungunya, and Zika, is a major challenge. In this ecological study of urban arboviruses performed from 2015 to 2019, we analyzed the spatial and temporal dynamics of these arboviruses in all 92 municipalities and nine health regions of Rio de Janeiro state. Annual cumulative incidences are presented for all three arboviruses throughout the study period. Spatial analyses of the three studied arboviruses showed distinct behaviors among municipalities and health regions. Co-circulation of the three arboviruses in the state and a heterogeneous spatiotemporal pattern was observed for each disease and region, with dengue having a higher annual incidence during the five years of the study, as well as two consecutive epidemic years in the state. The increase in transmission in different regions of the state in one year culminated in an epidemic in the state in the following year. A high annual cumulative incidence of chikungunya occurred in municipalities from 2017 to 2019 and of Zika only in 2016. Some municipalities with higher population densities showed higher incidences for some arboviruses and appeared to contribute to the dissemination to cities of lower demographic density and maintenance of these urban arboviruses. Thus, regions recording increased incidences of the three diseases in their territories for long periods should be considered municipal poles, as they initiated and sustained high transmission within their region.

ArboAlvo: stratification method for territorial receptivity to urban arboviruses.

OBJECTIVE: To present the urban arboviruses (dengue, zika and chikungunya) stratification methodology by the territorial receptivity Index, an instrument for the surveillance and control of these diseases, which considers the heterogeneity of an intra-municipal territory. METHODS: Ecological study that uses as unit of analysis the areas covered by health centers in Belo Horizonte. For the development of a territorial receptivity index, indicators of socio-environmental determination of urban arboviruses were selected in order to integrate the analysis of main components. The resulting components were weighted by the analytic hierarchy process and combined via map algebra. RESULTS: The territorial receptivity index showed great heterogeneity of urban infrastructure conditions. The areas classified with high and very high receptivity correspond to approximately 33% of the occupied area and are mainly concentrated in the administrative planning regions of East, Northeast, North, West, and Barreiro, especially in areas surrounding the municipality. When the density of dengue cases and Aedes eggs, from 2016, were superimposed with the stratification by the index of territorial receptivity to urban arboviruses, areas of very high receptivity had a high density of cases and Aedes eggs - higher than that observed in other areas of the city, which corresponds to a very small percentage of the municipal territory (13.5%). CONCLUSION: The analyses indicate the need for the development of adequate surveillance and control actions for each context, overcoming the logic of homogeneous allocation throughout the territory.

ArboAlvo: stratification method for territorial receptivity to urban arboviruses / ArboAlvo: método de estratificação da receptividade territorial às arboviroses urbanas

ABSTRACT OBJECTIVE To present the urban arboviruses (dengue, zika and chikungunya) stratification methodology by the territorial receptivity Index, an instrument for the surveillance and control of these diseases, which considers the heterogeneity of an intra-municipal territory. METHODS Ecological study that uses as unit of analysis the areas covered by health centers in Belo Horizonte. For the development of a territorial receptivity index, indicators of socio-environmental determination of urban arboviruses were selected in order to integrate the analysis of main components. The resulting components were weighted by the analytic hierarchy process and combined via map algebra. RESULTS The territorial receptivity index showed great heterogeneity of urban infrastructure conditions. The areas classified with high and very high receptivity correspond to approximately 33% of the occupied area and are mainly concentrated in the administrative planning regions of East, Northeast, North, West, and Barreiro, especially in areas surrounding the municipality. When the density of dengue cases and Aedes eggs, from 2016, were superimposed with the stratification by the index of territorial receptivity to urban arboviruses, areas of very high receptivity had a high density of cases and Aedes eggs - higher than that observed in other areas of the city, which corresponds to a very small percentage of the municipal territory (13.5%). CONCLUSION The analyses indicate the need for the development of adequate surveillance and control actions for each context, overcoming the logic of homogeneous allocation throughout the territory.

RESUMO OBJETIVO Apresentar a metodologia de estratificação das arboviroses urbanas (dengue, zika e chikungunya) pelo índice de receptividade territorial, instrumento de vigilância e controle dessas doenças que considera a heterogeneidade territorial intramunicipal. MÉTODOS Estudo ecológico que utiliza como unidade de análise as áreas de abrangência dos centros de saúde de Belo Horizonte (MG). Para a construção do índice de receptividade territorial foram selecionados indicadores de determinação socioambiental das arboviroses urbanas a fim de integrar à análise de componentes principais. As componentes resultantes foram ponderadas por análise de processos hierárquicos e agregadas por meio de álgebra de mapas. RESULTADOS O índice de receptividade territorial evidenciou grande heterogeneidade das condições de infraestrutura urbana. As áreas classificadas como alta e muito alta receptividade correspondem a aproximadamente 33% da área ocupada e se concentram sobretudo nas regiões de planejamento administrativo Leste, Nordeste, Norte, Oeste e Barreiro, principalmente em áreas limítrofes do município. Quando sobrepostas à densidade de casos de dengue e de ovos de Aedes em 2016, a estratificação pelo índice de receptividade territorial às arboviroses urbanas demonstra que áreas de muito alta receptividade apresentam uma densidade de casos, bem como de ovos de Aedes superior àquela observada nas demais áreas da cidade, o que corresponde a um percentual bastante reduzido do território municipal (13,5%). CONCLUSÕES As análises indicam a necessidade do desenvolvimento de ações de vigilância e controle adequadas para cada contexto, superando, assim, a lógica de alocação homogênea em todo o território.

A Perspective on Inhabited Urban Space: Land Use and Occupation, Heat Islands, and Precarious Urbanization as Determinants of Territorial Receptivity to Dengue in the City of Rio De Janeiro.

INTRODUCTION: Rio de Janeiro is the second-largest city in Brazil, with strong socio-spatial segregation, and diverse and heterogeneous land use, occupation, and landscapes. The complexity of dengue requires the construction of surveillance and control tools that take into account the historical, social, economic, and environmental processes mediated in the territory as a central axis of public policy. In this context, this study aimed to stratify the city into areas of receptivity to dengue, using innovative "territorial indicators" because they are built based on the actual occupation of the territory. METHODS: We designed and constructed 17 indicators that sought to characterize the transformed and inhabited space according to receptivity to dengue. We used data on land use and occupation, connectivity, climate, and landscape. We developed the dengue receptivity through principal component analysis (PCA), using multiple criteria analysis and map algebra integrated in a GIS platform. RESULTS: The most receptive areas were concentrated in the transition between the north and west zones of the city, a region of unconsolidated urban sprawl. The areas of greatest receptivity had the highest incidence and density of Aedes eggs during the study period. The correlation between receptivity index and incidence rate was positive in the epidemic years. CONCLUSION: The proposed set of indicators was able to identify areas of greater receptivity, such as regions of disorderly urban sprawl, with a concentration of social and environmental processes that are related to the occurrence of dengue outbreaks and high vector density. On the other hand, population immunity plays an important role in the spatial distribution of dengue during non-epidemic years.

Factores asociados al consumo de frutas y verduras en Argentina: un estudio multinivel / Factors associated with the consumption of fruits and vegetables in Argentina: A multilevel study

RESUMEN INTRODUCCIÓN Algunos estudios apuntan a una asociación entre la evolución de la prevalencia de enfermedades crónicas no transmisibles con los patrones alimentarios y la situación nutricional de la población. El objetivo de este estudio fue describir el consumo de frutas y verduras en Argentina y su asociación con factores socioeconómicos, demográficos y de actividad física, a nivel individual, provincial y regional. MÉTODOS Se utilizó un modelo multinivel, con información de la Encuesta Nacional de Factores de Riesgo (2013) y del Censo Nacional (2001 y 2010). RESULTADOS El modelo demostró que ser del sexo femenino, tener más años de edad, ingreso a partir de 4.501 pesos y nivel de instrucción secundario completo o más se asocia de manera positiva al consumo de estos alimentos. En contraste, estar separado/a, divorciado/a, viudo/a o soltero/a y practicar actividad física moderada o baja se asocia negativamente a la ingesta de frutas y verduras. El efecto de la variabilidad explicada a nivel provincial y regional resultó ser mínimo. CONCLUSIONES El trabajo se enmarca en una línea de estudios que señalan que los factores relacionados con la alimentación saludable están vinculados a los entornos sociales y físicos, principalmente a características socioeconómicas del grupo de pertenencia y al contexto en que se vive. En este sentido, sería importante contar con información con mayores niveles de desagregación.

ABSTRACT INTRODUCTION Some studies show an association between the evolution of the prevalence of non-communicable chronic diseases with eating patterns and nutritional situation of the population. The purpose of this research was to describe fruit and vegetable consumption in Argentina and its association with socio-economic, demographic and physical activity factors at individual, provincial and regional levels. METHODS A multilevel model approach was used, with information provided in the Argentina National Survey of Risk Factors (2013) and National Census of Population (200! and 2010). RESULTS The model showed a positive association between fruit and vegetable consumption and being female, being older, having a monthly income over the ARS $450! threshold and having finished secondary school. In contrast, being separated, divorced, widowed or single, and practicing moderate or low physical activity were negatively associated with the intake of fruits and vegetables. The effect of the variability at provincial and regional level turned out to be minimal. CONCLUSIONS This work is part of a series of studies that link factors related to healthy eating with social and physical environments, mainly with socioeconomic characteristics of the peer group and its context. In this sense, it would be important to provide more disaggregated information.

Definition of persistent areas with increased dengue risk by detecting clusters in populations with differing mobility and immunity in Rio de Janeiro, Brazil.

Dengue is a re-emerging arbovirus infection of major epidemiological importance. The detection of dengue clusters is an important epidemiological surveillance strategy, contributing to better allocation of control measures and prioritizing areas that are subject to increased risk of transmission. Studies involving human populations with low mobility are scarce, and the current study thus aims to investigate the presence of persistent dengue clusters in the city of Rio de Janeiro, Brazil, in populations with different mobility and immunity. Epidemiological data on dengue were obtained from the Brazilian Ministry of Health. Areas of increased risk were defined by the space-time scan statistical method and analysis of persistence with use of map algebra. For both study populations, the clusters that were identified did not show spatial concordance, except in years when both presented the same immunological profile. Their persistent clusters were located mostly in the West Zone of city. The clusters of the two study populations only displayed spatial concordance in years with similar immune profiles, which confirms the confounding role of immunity and supports the use of populations with high percentages of susceptible individuals when designing territory-based dengue studies. The space-time similarity between the areas of persistent risk in both populations suggests that the West Zone, a region with disorderly urban growth and low mean income, shows the highest risk of dengue transmission. The definition of persistent dengue clusters contributes to the improvement of dengue control strategies and territorial planning.

Definition of persistent areas with increased dengue risk by detecting clusters in populations with differing mobility and immunity in Rio de Janeiro, Brazil / Definição de áreas persistentes com risco aumentado de dengue através da detecção de clusters em populações com diferentes padrões de mobilidade e imunidade no Rio de Janeiro, Brasil / Definición de áreas persistentes con riesgo elevado de dengue, mediante la detección de clústeres en poblaciones con diferente movilidad e inmunidad, en Río de Janeiro, Brasil

Dengue is a re-emerging arbovirus infection of major epidemiological importance. The detection of dengue clusters is an important epidemiological surveillance strategy, contributing to better allocation of control measures and prioritizing areas that are subject to increased risk of transmission. Studies involving human populations with low mobility are scarce, and the current study thus aims to investigate the presence of persistent dengue clusters in the city of Rio de Janeiro, Brazil, in populations with different mobility and immunity. Epidemiological data on dengue were obtained from the Brazilian Ministry of Health. Areas of increased risk were defined by the space-time scan statistical method and analysis of persistence with use of map algebra. For both study populations, the clusters that were identified did not show spatial concordance, except in years when both presented the same immunological profile. Their persistent clusters were located mostly in the West Zone of city. The clusters of the two study populations only displayed spatial concordance in years with similar immune profiles, which confirms the confounding role of immunity and supports the use of populations with high percentages of susceptible individuals when designing territory-based dengue studies. The space-time similarity between the areas of persistent risk in both populations suggests that the West Zone, a region with disorderly urban growth and low mean income, shows the highest risk of dengue transmission. The definition of persistent dengue clusters contributes to the improvement of dengue control strategies and territorial planning.

A dengue é uma arbovirose reemergente de grande importância epidemiológica. A detecção de clusters de dengue representa uma importante estratégia de vigilância epidemiológica, que contribui para melhor alocação de medidas de controle no território e priorização de áreas sujeitas a risco aumentado de transmissão. São raros os estudos que envolvem populações humanas com mobilidade baixa; portanto, este estudo tem como objetivo investigar a presença de clusters persistentes de dengue no Município do Rio de Janeiro, Brasil, entre populações com diferentes padrões de mobilidade e imunidade. Os dados epidemiológicos sobre dengue foram obtidos do Ministério da Saúde. As áreas de risco aumentado foram definidas pelo método estatístico de varredura espaço-tempo, e a análise de persistência usou a álgebra cartográfica. Para as duas populações do estudo, os clusters identificados não mostraram concordância espacial, exceto nos anos em que ambas apresentaram o mesmo perfil imunológico. Para ambas as populações, os clusters persistentes estavam localizados principalmente na Zona Oeste da cidade. Os clusters nas duas populações do estudo mostraram concordância especial apenas nos anos em que ambas apresentavam perfis imunológicos semelhantes, o que confirma o papel de confounding da imunidade e sustenta o uso de populações com percentuais altos de indivíduos suscetíveis no desenho de estudos sobre dengue com base territorial. A semelhança espaço-temporal entre as áreas de risco persistente em ambas as populações sugere que a Zona Oeste, uma região com crescimento urbano desordenado e média de renda baixa, apresenta o maior risco de transmissão de dengue. A definição de clusters de dengue persistentes contribui para o aprimoramento das estratégias de controle da dengue e de planejamento territorial.

El dengue es una infección por arbovirus reemergente de mucha importancia epidemiológica. La detección de clústeres de dengue es una importante estrategia de vigilancia epidemiológica, que contribuye a mejorar la asignación de medidas de control en el territorio, priorizando áreas que están sujetas a un riesgo de transmisión más elevado. Los estudios que implican poblaciones humanas con baja movilidad son escasos y, por tanto, el presente estudio tiene como fin investigar la presencia de clústeres persistentes de dengue en la ciudad de Río de Janeiro, Brasil, en poblaciones con diferente movilidad e inmunidad. Los datos epidemiológicos sobre dengue se obtuvieron del Ministerio de Salud brasileño. Las áreas de riesgo elevado se definieron mediante un método de análisis espacio-tiempo estadístico, además, el análisis de persistencia utilizó álgebra de mapas. Para las dos poblaciones en estudio, los clústeres que fueron identificados no mostraron concordancia espacial, excepto durante los años en que ambos presentaron el mismo perfil inmunológico. Para ambas poblaciones, los clústeres persistentes se localizaron en su mayoría en la zona oeste de la ciudad. Los clústeres de las dos poblaciones en estudio solo mostraron concordancia espacial durante los años en que ambas contaban con perfiles inmunes similares, lo que confirma el rol confusor de la inmunidad y respalda el uso de poblaciones con altos porcentajes de individuos susceptibles, cuando se diseñan estudios sobre el dengue basados en territorios. La similitud espacio-tiempo entre áreas de riesgo persistente en ambas poblaciones sugiere que la zona oeste, la región con un crecimiento urbano desordenado y una media de ingresos bajos, muestra el riesgo más alto de transmisión de dengue. La definición de los clústeres dengue persistente contribuye a la mejora de las estrategias para el control del dengue y su planificación territorial.

Spatiotemporal diffusion of influenza A (H1N1): Starting point and risk factors.

Influenza constitutes a major challenge to world health authorities due to high transmissibility and the capacity to generate large epidemics. This study aimed to characterize the diffusion process of influenza A (H1N1) by identifying the starting point of the epidemic as well as climatic and sociodemographic factors associated with the occurrence and intensity of transmission of the disease. The study was carried out in the Brazilian state of Paraná, where H1N1 caused the largest impact. The units of spatial and temporal analysis were the municipality of residence of the cases and the epidemiological weeks of the year 2009, respectively. Under the Bayesian paradigm, parametric inference was performed through a two-part spatiotemporal model and the integrated nested Laplace approximation (INLA) algorithm. We identified the most likely starting points through the effective distance measure based on mobility networks. The proposed estimation methodology allowed for rapid and efficient implementation of the spatiotemporal model, and provided evidence of different patterns for chance of occurrence and risk of influenza throughout the epidemiological weeks. The results indicate the capital city of Curitiba as the probable starting point, and showed that the interventions that focus on municipalities with greater migration and density of people, especially those with higher Human Development Indexes (HDIs) and the presence of municipal air and road transport, could play an important role in mitigation of effects of future influenza pandemics on public health. These results provide important information on the process of introduction and spread of influenza, and could contribute to the identification of priority areas for surveillance as well as establishment of strategic measures for disease prevention and control. The proposed model also allows identification of epidemiological weeks with high chance of influenza occurrence, which can be used as a reference criterion for creating an immunization campaign schedule.

Association between perceived racial discrimination and hypertension: findings from the ELSA-Brasil study.

"Pardos" and blacks in Brazil and blacks in the USA are at greater risk of developing arterial hypertension than whites, and the causes of this inequality are still little understood. Psychosocial and contextual factors, including racial discrimination, are indicated as conditions associated with this inequality. The aim of this study was to identify the association between perceived racial discrimination and hypertension. The study evaluated 14,012 workers from the ELSA-Brazil baseline population. Perceived discrimination was measured by the Lifetime Major Events Scale, adapted to Portuguese. Classification by race/color followed the categories proposed by Brazilian Institute of Geography and Statistics (IBGE). Hypertension was defined by standard criteria. The association between the compound variable - race/racial discrimination - and hypertension was estimated by Poisson regression with robust variance and stratified by the categories of body mass index (BMI) and sex. Choosing white women as the reference group, in the BMI < 25kg/m2 stratum, "pardo" women showed adjusted OR for arterial hypertension of 1.98 (95%CI: 1.17-3.36) and 1.3 (95%CI: 1.13-1.65), respectively, whether or not they experienced racial discrimination. For black women, ORs were 1.9 (95%CI: 1.42-2.62) and 1.72 (95%CI: 1.36-2.18), respectively, for the same categories. Among women with BMI > 25kg/m2 and men in any BMI category, no effect of racial discrimination was identified. Despite the differences in point estimates of prevalence of hypertension between "pardo" women who reported and those who did not report discrimination, our results are insufficient to assert that an association exists between racial discrimination and hypertension.

Association between perceived racial discrimination and hypertension: findings from the ELSA-Brasil study / A associação entre discriminação racial percebida e hipertensão: achados do estudo ELSA-Brasil / Asociación entre la discriminación racial percibida y la hipertensión: hallazgos del estudio ELSA-Brasil

"Pardos" and blacks in Brazil and blacks in the USA are at greater risk of developing arterial hypertension than whites, and the causes of this inequality are still little understood. Psychosocial and contextual factors, including racial discrimination, are indicated as conditions associated with this inequality. The aim of this study was to identify the association between perceived racial discrimination and hypertension. The study evaluated 14,012 workers from the ELSA-Brazil baseline population. Perceived discrimination was measured by the Lifetime Major Events Scale, adapted to Portuguese. Classification by race/color followed the categories proposed by Brazilian Institute of Geography and Statistics (IBGE). Hypertension was defined by standard criteria. The association between the compound variable - race/racial discrimination - and hypertension was estimated by Poisson regression with robust variance and stratified by the categories of body mass index (BMI) and sex. Choosing white women as the reference group, in the BMI < 25kg/m2 stratum, "pardo" women showed adjusted OR for arterial hypertension of 1.98 (95%CI: 1.17-3.36) and 1.3 (95%CI: 1.13-1.65), respectively, whether or not they experienced racial discrimination. For black women, ORs were 1.9 (95%CI: 1.42-2.62) and 1.72 (95%CI: 1.36-2.18), respectively, for the same categories. Among women with BMI > 25kg/m2 and men in any BMI category, no effect of racial discrimination was identified. Despite the differences in point estimates of prevalence of hypertension between "pardo" women who reported and those who did not report discrimination, our results are insufficient to assert that an association exists between racial discrimination and hypertension.

Pretos e pardos no Brasil e negros nos Estados Unidos têm risco aumentado de desenvolver hipertensão arterial, quando comparados com brancos, mas as causas dessa desigualdade ainda são pouco compreendidas. Fatores psicossociais e contextuais, inclusive discriminação racial, têm sido apontados como condições associadas a essa desigualdade. O estudo teve como objetivo identificar a associação entre discriminação racial percebida e hipertensão. O estudo avaliou 14.012 participantes da linha de base do estudo ELSA-Brasil. A discriminação foi medida com a Lifetime Major Events Scale, adaptada para português. A classificação de raça/cor seguiu as categorias propostas pelo Instituto Brasileiro de Geografia e Estatística (IBGE). Hipertensão arterial foi definida de acordo com as diretrizes atuais. A associação entre a variável composta - raça/discriminação racial - e hipertensão foi estimada através de regressão de Poisson com variância robusta, e estratificada pelas categorias de índice de massa corporal (IMC) e gênero. Tendo como categoria de referência as mulheres brancas, no estrato de IMC < 25kg/m2, as mulheres pardas mostraram OR ajustada para hipertensão arterial de 1,98 (IC95%: 1,17-3,36) e 1,3 (IC95%: 1,13-1,65), respectivamente, conforme relatavam ou não a exposição à discriminação racial. Para as mulheres pretas, as ORs foram 1,9 (IC95%: 1,42-2,62) e 1,72 (IC95%: 1,36-2,18), respectivamente, para as mesmas categorias. Entre mulheres com IMC > 25kg/m2 e homens em qualquer categoria de IMC, não foi identificado nenhum efeito de discriminação racial. Apesar das diferenças nas estimativas pontuais da prevalência de hipertensão entre mulheres pardas que relataram (vs. não relataram) discriminação racial, nossos resultados são insuficientes para afirmar que existe uma associação entre discriminação racial percebida e hipertensão.

Los "mestizos" y negros in Brasil y los negros en los EE.UU. tienen un riesgo mayor de desarrollar hipertensión que los blancos, y las causas de esta inequidad se han estudiado poco. Factores psicosociales y contextuales, incluyendo la discriminación racial, han sido identificados como las condiciones asociadas a esta inequidad. El objetivo de este estudio fue identificar la asociación entre la discriminación racial percibida y la hipertensión. El estudio evaluó a 14.012 trabajadores procedentes de la base de referencia poblacional del ELSA-Brasil. La discriminación percibida se midió mediante la Lifetime Major Events Scale, adaptada al portugués. La clasificación por raza/color siguió las categorías propuestas por el Instituto Brasileño de Geografía y Estadística. La hipertensión fue definida por criterios estándar. La asociación entre la variable compuesta -raza/discriminación racial- e hipertensión se estimó por regresión de Poisson con varianza robusta y estratificada por las categorías: índice de masa corporal (IMC) y sexo. Se eligieron mujeres blancas como grupo de referencia, en el IMC < 25kg/m2 estrato, las mujeres "mestizas" mostraron una proporción de probabilidades ajustadas para hipertensión arterial de 1,98 (IC95%: 1,17-3,36) y 1,3 (IC95%: 1,13-1,65), respectivamente, hayan o no sufrido discriminación racial. Para las mujeres negras, la proporción de probabilidades ajustadas fueron 1,9 (IC95%: 1,42-2,62) y 1,72 (IC95%: 1,36-2,18), respectivamente, en las mismas categorías. Entre las mujeres con IMC > 25kg/m2 y hombres en cualquier categoría IMC, no se identificaron efectos de discriminación racial. A pesar de las diferencias en las estimaciones puntuales sobre la prevalencia de la hipertensión entre las mujeres "mestizas", que informaron y no informaron discriminación racial, nuestros resultados son insuficientes para afirmar que existe una asociación entre la discriminación racial e hipertensión.

Using Gamma and Quantile Regressions to Explore the Association between Job Strain and Adiposity in the ELSA-Brasil Study: Does Gender Matter?

This paper explores the association between job strain and adiposity, using two statistical analysis approaches and considering the role of gender. The research evaluated 11,960 active baseline participants (2008-2010) in the ELSA-Brasil study. Job strain was evaluated through a demand-control questionnaire, while body mass index (BMI) and waist circumference (WC) were evaluated in continuous form. The associations were estimated using gamma regression models with an identity link function. Quantile regression models were also estimated from the final set of co-variables established by gamma regression. The relationship that was found varied by analytical approach and gender. Among the women, no association was observed between job strain and adiposity in the fitted gamma models. In the quantile models, a pattern of increasing effects of high strain was observed at higher BMI and WC distribution quantiles. Among the men, high strain was associated with adiposity in the gamma regression models. However, when quantile regression was used, that association was found not to be homogeneous across outcome distributions. In addition, in the quantile models an association was observed between active jobs and BMI. Our results point to an association between job strain and adiposity, which follows a heterogeneous pattern. Modelling strategies can produce different results and should, accordingly, be used to complement one another.

Multinomial model and zero-inflated gamma model to study time spent on leisure time physical activity: an example of ELSA-Brasil.

OBJECTIVE: To compare two methodological approaches: the multinomial model and the zero-inflated gamma model, evaluating the factors associated with the practice and amount of time spent on leisure time physical activity. METHODS: Data collected from 14,823 baseline participants in the Longitudinal Study of Adult Health (ELSA-Brasil - Estudo Longitudinal de Saúde do Adulto ) have been analysed. Regular leisure time physical activity has been measured using the leisure time physical activity module of the International Physical Activity Questionnaire. The explanatory variables considered were gender, age, education level, and annual per capita family income. RESULTS: The main advantage of the zero-inflated gamma model over the multinomial model is that it estimates mean time (minutes per week) spent on leisure time physical activity. For example, on average, men spent 28 minutes/week longer on leisure time physical activity than women did. The most sedentary groups were young women with low education level and income. CONCLUSIONS: The zero-inflated gamma model, which is rarely used in epidemiological studies, can give more appropriate answers in several situations. In our case, we have obtained important information on the main determinants of the duration of leisure time physical activity. This information can help guide efforts towards the most vulnerable groups since physical inactivity is associated with different diseases and even premature death.

Multinomial model and zero-inflated gamma model to study time spent on leisure time physical activity: an example of ELSA-Brasil

ABSTRACT OBJECTIVE To compare two methodological approaches: the multinomial model and the zero-inflated gamma model, evaluating the factors associated with the practice and amount of time spent on leisure time physical activity. METHODS Data collected from 14,823 baseline participants in the Longitudinal Study of Adult Health (ELSA-Brasil - Estudo Longitudinal de Saúde do Adulto ) have been analysed. Regular leisure time physical activity has been measured using the leisure time physical activity module of the International Physical Activity Questionnaire. The explanatory variables considered were gender, age, education level, and annual per capita family income. RESULTS The main advantage of the zero-inflated gamma model over the multinomial model is that it estimates mean time (minutes per week) spent on leisure time physical activity. For example, on average, men spent 28 minutes/week longer on leisure time physical activity than women did. The most sedentary groups were young women with low education level and income CONCLUSIONS The zero-inflated gamma model, which is rarely used in epidemiological studies, can give more appropriate answers in several situations. In our case, we have obtained important information on the main determinants of the duration of leisure time physical activity. This information can help guide efforts towards the most vulnerable groups since physical inactivity is associated with different diseases and even premature death.

Association between perceived neighbourhood characteristics, physical activity and diet quality: results of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

BACKGROUND: The study explores associations between perceived neighbourhood characteristics, physical activity and diet quality, which in Latin America and Brazil have been scarcely studied and with inconsistent results. METHODS: We conducted a cross-sectional analysis of 14,749 individuals who participated in the Brazilian Longitudinal Study of Adult Health (Estudo Longitudinal de Saúde do Adulto, ELSA-Brasil) baseline. The study included current and retired civil servants, aged between 35 and 74 years, from universities and research institutes in six Brazilian states. The International Physical Activity Questionnaire (IPAQ) long form was used to characterize physical activity during leisure time and commuting; additional questions assessed how often fruit and vegetables were consumed, as a proxy for diet quality. Neighbourhood characteristics were evaluated by the "Walking Environment" and "Availability of Healthy Foods" scales originally used in the Multi-Ethnic Study of Atherosclerosis (MESA). Associations were examined using multinomial logistic regression. RESULTS: Perceiving a more walkable neighbourhood was positively associated with engaging in leisure time physical activity and doing so for longer weekly. Compared with those who saw their neighbourhood as less walkable, those who perceived it as more walkable had 1.69 (95 % CI 1.57-1.83) and 1.39 (1.28-1.52) greater odds of engaging in leisure time physical activity for more than 150 min/week or up to 150 min/week (vs. none), respectively. Perceiving a more walkable neighbourhood was also positively associated with transport-related physical activity. The same pattern was observed for diet: compared with participants who perceived healthy foods as less available in their neighbourhood, those who saw them as more available had odds 1.48 greater (1.31-1.66) of eating fruits, and 1.47 greater (1.30-1.66) of eating vegetables, more than once per day. CONCLUSIONS: Perceived walkability and neighbourhood availability of healthy food were independently associated with the practice of physical activity and diet quality, respectively, underlining the importance of neighbourhood-level public policies to changing and maintaining health-related habits.