A saúde de adolescentes na volta às atividades escolares presenciais após dois anos de pandemia do Covid-19 ­ estudo transversal de base escolar em Pelotas/RS / The health of adolescents returning to face-to-face school activities after two years of the Covid-19 pandemic - school-based cross-sectional study in Pelotas/RS / La salud de los adolescentes que retornan a las actividades escolares presenciales después de dos años de la pandemia de Covid-19 - estudio transversal escolar en Pelotas/RS

O objetivo do estudo foi comparar a percepção sobre a massa corporal, comportamentos relacionados à saúde, e a saúde mental de escolares adolescentes durante o período de retorno às atividades escolares presenciais com o período anterior à pandemia de COVID-19. O estudo foi realizado com 425 escolares (16,96±1,39 anos; 60,2% do sexo feminino) selecionados aleatoriamente de escolas das redes pública e privada de Pelotas/RS. Para a coleta dos dados foi utilizado um questionário de autopreenchimento contendo perguntas retrospectivas e atuais sobre as variáveis analisadas. Os resultados indicaram que a percepção sobre a massa corporal, o nível de atividade física, o tempo de sono, e a saúde mental (apenas para as meninas) estão piores (p<0,05) no momento atual quando comparados ao período anterior à pandemia. Por outro lado, hábitos alimentares e tempo de tela recreativo apresentaram melhores resultados (p<0,05) no momento atual do que no período anterior à pandemia. Estes resultados mostram um complexo panorama em relação à saúde de adolescentes no período de retomada das atividades presencias, tornando o retorno às atividades escolares presenciais um desafio para os próprios adolescentes, seus familiares, para professores, e para as escolas.

The aim of this study was to compare the perception of body mass, health- related behaviors and mental health of adolescent schoolchildren during the period of return to face to face school activities with the period before COVID-19 pandemic. The study was carried out with 425 students (16.96±1.39 years; 60.2% female) randomly selected from public and private schools in Pelotas/RS. For data collection, a self-completion questionnaire was used, containing retrospective and current questions about analyzed outcomes. The results indicated that the perception of body mass, level of physical activity, sleep time, and mental health (only for girls) are worse (p<0.05) at present when compared to the period before the pandemic. On the other hand, eating habits and recreational screen time showed better results (p<0.05) at present than in the period before the pandemic. These results show a complex panorama concerning the health of adolescents in the period of resumption of face to face activities, making this return a challenge for the adolescents themselves, their families, teachers and for schools.

El objetivo de este estudio fue comparar la percepción de masa corporal, comportamientos relacionados a la salud y salud mental de escolares adolescentes durante el período de retorno a las actividades escolares presenciales con el período anterior a la pandemia de COVID-19. El estudio fue realizado con 425 alumnos (16,96±1,39 años; 60,2% del sexo femenino) seleccionados aleatoriamente de escuelas públicas y privadas de Pelotas/RS. Para la recolección de datos, se utilizó un cuestionario auto-completado, conteniendo preguntas retrospectivas y actuales sobre los resultados analizados. Los resultados indicaron que la percepción de la masa corporal, el nivel de actividad física, el tiempo de sueño y la salud mental (sólo para las niñas) son peores (p<0,05) en la actualidad en comparación con el período anterior a la pandemia. Por otro lado, los hábitos alimentarios y el tiempo de pantalla recreativo mostraron mejores resultados (p<0,05) en la actualidad que en el periodo anterior a la pandemia. Estos resultados muestran un panorama complejo en relación a la salud de los adolescentes en el período de reanudación de las actividades presenciales, haciendo de este retorno un desafío para los propios adolescentes, sus familias, profesores y para las escuelas.

Physical activity in birth cohorts of three Brazilian cities (Ribeirão Preto, Pelotas, and São Luís): A cross-sectional study.

OBJECTIVE: To describe the prevalence of physical activity among subjects from birth cohorts of three cities located in different regions of Brazil according to sociodemographic characteristics and sex, comparing the relationships within and between cohorts. METHODS: Cross-sectional study involving 12,724 adolescents and young adults who participated in five birth cohorts: Ribeirão Preto [1978/79 (37/39 years old in 2016) and 1994 (22 years in 2016)]; Pelotas [1982 (30 years in 2012) and 1993 (22 years in 2015)], and São Luís [1997/98 (18/19 years in 2016)]. Leisure-time physical activity was evaluated with questionnaires (insufficiently active: <150 min/week and active: ≥150 min/week) and moderate and vigorous physical activity (MVPA) was objectively measured by accelerometry. Those, in each city, were evaluated accordingly to skin color, socioeconomic classification, and study/work activities. RESULTS: The prevalence of leisure-time physical activity ranged from 29.2% at 30 years old in Pelotas to 54.6% among adolescents from São Luís. The prevalence of leisure-time physical activity was higher among younger people (54.6% in São Luís 1997), while the same was not observed for total physical activity. MVPA (3rd tercile) was higher in the cohorts from Pelotas and São Luís. The prevalence of leisure-time physical activity and MVPA was higher in men. The data showed that the variation in physical activity was associated with sex and sociodemographic conditions in all cohorts. CONCLUSION: Sociodemographic characteristics should be considered when promoting leisure-time physical activity and actions aimed at young people, and adults who are more socioeconomically vulnerable should be encouraged.

Physical activity in birth cohorts of three Brazilian cities (Ribeirão Preto, Pelotas, and São Luís): A cross-sectional study / Atividade física em coortes de nascimento de três cidades brasileiras (Ribeirão Preto, Pelotas e São Luís): estudo transversal

ABSTRACT Objective: To describe the prevalence of physical activity among subjects from birth cohorts of three cities located in different regions of Brazil according to sociodemographic characteristics and sex, comparing the relationships within and between cohorts. Methods: Cross-sectional study involving 12,724 adolescents and young adults who participated in five birth cohorts: Ribeirão Preto [1978/79 (37/39 years old in 2016) and 1994 (22 years in 2016)]; Pelotas [1982 (30 years in 2012) and 1993 (22 years in 2015)], and São Luís [1997/98 (18/19 years in 2016)]. Leisure-time physical activity was evaluated with questionnaires (insufficiently active: <150 min/week and active: ≥150 min/week) and moderate and vigorous physical activity (MVPA) was objectively measured by accelerometry. Those, in each city, were evaluated accordingly to skin color, socioeconomic classification, and study/work activities. Results: The prevalence of leisure-time physical activity ranged from 29.2% at 30 years old in Pelotas to 54.6% among adolescents from São Luís. The prevalence of leisure-time physical activity was higher among younger people (54.6% in São Luís 1997), while the same was not observed for total physical activity. MVPA (3rd tercile) was higher in the cohorts from Pelotas and São Luís. The prevalence of leisure-time physical activity and MVPA was higher in men. The data showed that the variation in physical activity was associated with sex and sociodemographic conditions in all cohorts. Conclusion: Sociodemographic characteristics should be considered when promoting leisure-time physical activity and actions aimed at young people, and adults who are more socioeconomically vulnerable should be encouraged.

RESUMO Objetivo: Descrever a prevalência de atividade física entre sujeitos de coortes de nascimento de três cidades localizadas em diferentes regiões do Brasil segundo características sociodemográficas e sexo, comparando relações intra e intercoortes. Métodos: Estudo transversal com 12.724 adolescentes e adultos jovens que participaram de cinco coortes de nascimento: Ribeirão Preto [1978/79 (37/39 anos em 2016) e 1994 (22 anos em 2016)]; Pelotas [1982 (30 anos em 2012) e 1993 (22 anos em 2015)] e São Luís [1997/98 (18/19 anos em 2016)]. A atividade física no lazer foi avaliada com questionários (insuficientemente ativo: <150 min/semana; ativo: ≥150 min/semana) e a atividade física moderada e vigorosa (AFMV) foi medida objetivamente por acelerometria. Foram avaliadas a cor da pele, a classificação socioeconômica e as atividades de estudo/trabalho. Resultados: A prevalência de ativos no lazer variou de 29,2% aos 30 anos em Pelotas a 54,6% entre os adolescentes de São Luís. A prevalência de ativos no lazer foi maior entre os mais jovens (54,6% em São Luís/1997), o que não foi observado para a atividade física total. A AFMV (3o tercil) foi maior nas coortes de Pelotas e São Luís. A prevalência de ativos no lazer e a AFMV foi maior nos homens. Os dados mostraram que a variação da atividade física foi associada ao sexo e às condições sociodemográficas em todas as coortes. Conclusão: As características sociodemográficas devem ser consideradas na promoção da atividade física no lazer e as ações voltadas para jovens e adultos mais vulneráveis socioeconomicamente devem ser incentivadas.

[Trends and inequalities in food insecurity during the COVID-19 pandemic: results of four serial epidemiological surveys]. / Tendências e desigualdades na insegurança alimentar durante a pandemia de COVID-19: resultados de quatro inquéritos epidemiológicos seriados.

The objective was to analyze trends and inequalities in the prevalence of food insecurity during the COVID-19 pandemic according to sociodemographic factors and social distancing measures. We analyzed data from four serial epidemiological surveys on COVID-19 in May and June 2020, with adults and elderly living in Bagé, Rio Grande do Sul State, Brazil. Food insecurity was assessed with the short version of the Brazilian Food Insecurity Scale (EBIA), with the recall period adapted to the beginning of the social distancing period in the city. Sociodemographic characteristics and the adoption of social distancing measures were analyzed, and their associations with food insecurity were assessed with chi-square test. The temporal trend in food insecurity according to these characteristics was assessed via linear regression. Inequalities in food insecurity were assessed with the angular inequality index and concentration index. Of the 1,550 individuals studied, 29.4% (95%CI: 25.0; 34.4) presented food insecurity. Analysis of inequality showed higher concentration of food insecurity among the younger and less educated and those living with five or more residents in the same household. Over the course of the four surveys, prevalence of food insecurity decreased most sharply among the younger, those living in households with up to two residents, and those with two or more workers. There was a strong association between food insecurity and sociodemographic factors, which may indicate the pandemic´s potential economic impact on households' food situation.

O objetivo foi analisar tendências e desigualdades na prevalência de insegurança alimentar na pandemia de COVID-19, de acordo com fatores sociodemográficos e com medidas de distanciamento social. Dados de quatro inquéritos epidemiológicos seriados sobre a COVID-19 desenvolvidos entre maio e junho de 2020, com adultos e idosos residentes na cidade de Bagé, Rio Grande do Sul, Brasil. Insegurança alimentar foi avaliada por meio da versão curta da Escala Brasileira de Insegurança Alimentar (EBIA), com o período recordatório adaptado ao início das medidas de distanciamento social no município. As características sociodemográficas e a adoção de medidas de distanciamento social foram analisadas, e suas associações com a insegurança alimentar foram avaliadas utilizando-se o teste de qui-quadrado. A tendência temporal da insegurança alimentar de acordo com tais características foi avaliada usando-se regressão linear. As desigualdades na insegurança alimentar foram avaliadas utilizando-se o índice angular de desigualdade e o índice de concentração. Dos 1.550 indivíduos estudados, 29,4% (IC95%: 25,0; 34,4) apresentaram insegurança alimentar. A análise de desigualdade mostrou maior concentração da insegurança alimentar entre os mais jovens, os menos escolarizados e os que residiam em domicílios com cinco moradores ou mais. Ao longo dos quatro inquéritos, a prevalência de insegurança alimentar reduziu mais acentuadamente entre os mais jovens, naqueles que residiam em domicílios com até dois moradores e com dois ou mais trabalhadores. Evidenciou-se forte associação da insegurança alimentar com os aspectos sociodemográficos dos entrevistados, o que pode indicar o potencial impacto econômico da pandemia na situação alimentar dos domicílios.

El objetivo fue analizar tendencias y desigualdades en la prevalencia de inseguridad alimentaria durante la pandemia de COVID-19, de acuerdo con factores sociodemográficos, así como con las medidas de distanciamiento social. Se analizaron datos de cuatro encuestas epidemiológicas seriadas sobre la COVID-19, desarrolladas entre mayo y junio de 2020, con adultos y ancianos residentes en la ciudad de Bagé, Rio Grande do Sul, Brasil. La inseguridad alimentaria se evaluó a través de la versión corta de la Escala Brasileña de Inseguridad Alimentaria (EBIA), con un período recordatorio, adaptado al inicio de las medidas de distanciamiento social en el municipio. Fueron analizadas características sociodemográficas y la adopción de medidas de distanciamiento social, así como sus asociaciones con la inseguridad alimentaria, utilizándose un test de chi-cuadrado. Se evaluó la tendencia temporal de la inseguridad alimentaria de acuerdo con tales características, utilizándose la regresión lineal. Se evaluaron desigualdades en la inseguridad alimentaria, mediante el índice angular de desigualdad y el índice de concentración. De los 1.550 individuos estudiados, un 29,4% (IC95%: 25,0; 34,4) presentaron inseguridad alimentaria. El análisis de desigualdad mostró una mayor concentración de inseguridad alimentaria entre los más jóvenes, los menos escolarizados, y quienes residían en domicilios con cinco residentes o más. A lo largo de las cuatro encuestas, la prevalencia de inseguridad alimentaria se redujo más acentuadamente entre los más jóvenes, en quienes residían en domicilios con hasta dos residentes y con dos o más trabajadores. Se evidenció una fuerte asociación de la inseguridad alimentaria con aspectos sociodemográficos de los entrevistados, lo que puede indicar el potencial impacto económico de la pandemia en la situación alimentaria de los domicilios.

Tendências e desigualdades na insegurança alimentar durante a pandemia de COVID-19: resultados de quatro inquéritos epidemiológicos seriados / Trends and inequalities in food insecurity during the COVID-19 pandemic: results of four serial epidemiological surveys / Tendencias y desigualdades en la inseguridad alimentaria durante la pandemia de COVID-19: resultados de cuatro encuestas epidemiológicas seriadas

O objetivo foi analisar tendências e desigualdades na prevalência de insegurança alimentar na pandemia de COVID-19, de acordo com fatores sociodemográficos e com medidas de distanciamento social. Dados de quatro inquéritos epidemiológicos seriados sobre a COVID-19 desenvolvidos entre maio e junho de 2020, com adultos e idosos residentes na cidade de Bagé, Rio Grande do Sul, Brasil. Insegurança alimentar foi avaliada por meio da versão curta da Escala Brasileira de Insegurança Alimentar (EBIA), com o período recordatório adaptado ao início das medidas de distanciamento social no município. As características sociodemográficas e a adoção de medidas de distanciamento social foram analisadas, e suas associações com a insegurança alimentar foram avaliadas utilizando-se o teste de qui-quadrado. A tendência temporal da insegurança alimentar de acordo com tais características foi avaliada usando-se regressão linear. As desigualdades na insegurança alimentar foram avaliadas utilizando-se o índice angular de desigualdade e o índice de concentração. Dos 1.550 indivíduos estudados, 29,4% (IC95%: 25,0; 34,4) apresentaram insegurança alimentar. A análise de desigualdade mostrou maior concentração da insegurança alimentar entre os mais jovens, os menos escolarizados e os que residiam em domicílios com cinco moradores ou mais. Ao longo dos quatro inquéritos, a prevalência de insegurança alimentar reduziu mais acentuadamente entre os mais jovens, naqueles que residiam em domicílios com até dois moradores e com dois ou mais trabalhadores. Evidenciou-se forte associação da insegurança alimentar com os aspectos sociodemográficos dos entrevistados, o que pode indicar o potencial impacto econômico da pandemia na situação alimentar dos domicílios.

The objective was to analyze trends and inequalities in the prevalence of food insecurity during the COVID-19 pandemic according to sociodemographic factors and social distancing measures. We analyzed data from four serial epidemiological surveys on COVID-19 in May and June 2020, with adults and elderly living in Bagé, Rio Grande do Sul State, Brazil. Food insecurity was assessed with the short version of the Brazilian Food Insecurity Scale (EBIA), with the recall period adapted to the beginning of the social distancing period in the city. Sociodemographic characteristics and the adoption of social distancing measures were analyzed, and their associations with food insecurity were assessed with chi-square test. The temporal trend in food insecurity according to these characteristics was assessed via linear regression. Inequalities in food insecurity were assessed with the angular inequality index and concentration index. Of the 1,550 individuals studied, 29.4% (95%CI: 25.0; 34.4) presented food insecurity. Analysis of inequality showed higher concentration of food insecurity among the younger and less educated and those living with five or more residents in the same household. Over the course of the four surveys, prevalence of food insecurity decreased most sharply among the younger, those living in households with up to two residents, and those with two or more workers. There was a strong association between food insecurity and sociodemographic factors, which may indicate the pandemic´s potential economic impact on households' food situation.

El objetivo fue analizar tendencias y desigualdades en la prevalencia de inseguridad alimentaria durante la pandemia de COVID-19, de acuerdo con factores sociodemográficos, así como con las medidas de distanciamiento social. Se analizaron datos de cuatro encuestas epidemiológicas seriadas sobre la COVID-19, desarrolladas entre mayo y junio de 2020, con adultos y ancianos residentes en la ciudad de Bagé, Rio Grande do Sul, Brasil. La inseguridad alimentaria se evaluó a través de la versión corta de la Escala Brasileña de Inseguridad Alimentaria (EBIA), con un período recordatorio, adaptado al inicio de las medidas de distanciamiento social en el municipio. Fueron analizadas características sociodemográficas y la adopción de medidas de distanciamiento social, así como sus asociaciones con la inseguridad alimentaria, utilizándose un test de chi-cuadrado. Se evaluó la tendencia temporal de la inseguridad alimentaria de acuerdo con tales características, utilizándose la regresión lineal. Se evaluaron desigualdades en la inseguridad alimentaria, mediante el índice angular de desigualdad y el índice de concentración. De los 1.550 individuos estudiados, un 29,4% (IC95%: 25,0; 34,4) presentaron inseguridad alimentaria. El análisis de desigualdad mostró una mayor concentración de inseguridad alimentaria entre los más jóvenes, los menos escolarizados, y quienes residían en domicilios con cinco residentes o más. A lo largo de las cuatro encuestas, la prevalencia de inseguridad alimentaria se redujo más acentuadamente entre los más jóvenes, en quienes residían en domicilios con hasta dos residentes y con dos o más trabajadores. Se evidenció una fuerte asociación de la inseguridad alimentaria con aspectos sociodemográficos de los entrevistados, lo que puede indicar el potencial impacto económico de la pandemia en la situación alimentaria de los domicilios.

Objectively measured physical activity according to the periods of the day in the Pelotas Cohort / Medida objetiva de atividade física de acordo com períodos do dia em uma coorte de Pelotas

This study aims to describe objectively measured physical activity (PA) in different periods of the day in young adults according to sex, socioeconomic position and during weekdays and weekends. This is a cross-sectional analysis carried out with the participants of the 1993 Pelotas Birth Cohort at 22 years. PA was assessed by triaxial accelerometer. Descriptive analyses were performed presenting the time spent on light PA (LPA) and bouted moderate to vigorous PA (MVPA) in different periods of the day (morning - 6am to 11:59 am, afternoon ­ 12pm to 7:59 pm and night ­ 8pm to 11:59pm). The present study included 2,766 individuals (48.2% male and 51.8% female). LPA was higher among women, while bouted MVPA levels were higher among men. The median of PA was higher on weekdays compared to weekends for all intensities. The bouted MVPA medians in the morning and at night were zero minutes for all days and both sexes. The richest group presented a higher percentage of individuals with zero minutes. PA may vary according to different periods of the day and intensity. The absence of PA practice was markedly influenced by sex and socioeconomic position

Este estudo teve o objetivo de mensurar atividade física (AF) objetivamente em diferentes períodos do dia em adultos jovens de acordo com sexo, posição socioeconômica e dia de semana e final de semana. Esta é uma análise transversal conduzida com participantes da Coorte de Nascimentos de 1993 de Pelotas aos 22 anos. AF foi avaliada por um acelerômetro triaxial. Foram realizadas análises descritivas apresentando o tempo em AF leve (AFL) e moderada a vigorosa (AFMV ) em diferentes períodos do dia (manhã ­ 6h às 11:59h, tarde ­ 12h às 19:59h e noite ­ 20h às 0h). O presente estudo incluiu 2.766 individuos (48.2% homens e 51.8% mulheres). AFL foi maior entre as mulheres enquanto AFMV foi maior entre os homens. A mediana de AF foi maior nos dias de semana comparado aos dias de final de semana para qualquer intensidade. As medianas de AFMV pela manhã e noite foram zero minutos para todos os dias nos dois sexos. O grupo econômico mais alto apresentou maior percentual de individuos com zero minutos de AFMV. AF pode variar de acordo com diferentes períodos do dia e intensidades. A ausência de prática de AF foi marcadamente influenciada por sexo e posição socioeconômica

Effect of physical training periodization on physical activity level in adults with obesity / Efeito da periodização do treinamento físico no nível de atividade física em adultos com obesidade

The study aimed to compare the effect of physical training with and without periodization on daily physical activity levels and on time spent in sedentary behavior in adults with obesity. In a randomized controlled trial, 69 obese adults of both sexes (BMI ≥ 30 kg/m²) were randomized to three groups: periodized group (PG), non-periodized group (NPG) and control group (CG). The periodized and non-periodized groups underwent 16 weeks of supervised and combined physical training (aerobic and resistance) in 60-minute sessions three times a week. Physical activity and sedentary behavior levels were measured by accelerometry (ActiGraph - GT3x). The time spent in sedentary behavior after the intervention increased 6.5% in the PG and 1.2% in the CG and decreased 0.5% in the NPG. Changes in the levels of light physical activity were -4.6% in the PG, +0.5% in the NPG and -2.3% in the CG, while moderate to vigorous physical activity levels showed a reduction of 3.0% in the PG and increases of 0.5% in the NPG and 12.2% in the CG. It is worth mentioning, however, that no isolated time and group effects or time x group interaction were identified for any of the analyzed variables (p > 0.05). A combined and supervised physical training program, with or without load progression, was not able to promote changes in the sedentary behavior and physical activity levels of obese adults, which shows that specific actions targeted at these behaviors are necessary

O estudo teve por objetivo comparar o efeito do treinamento físico, com e sem periodização, nos níveis de atividade física diária e no tempo em comportamento sedentário de adultos com obesidade. Em um estudo randomizado controlado,69 adultos de ambos os sexos com obesidade (IMC ≥ 30 kg/m²) foram randomizados em três grupos: grupo periodizado (GP), grupo não periodizado (GNP) e grupo controle (GC). Os grupos periodizado e não periodizado foram submetidos a 16 semanas de treinamento físico combinado (aeróbio e resistido) e supervisionado, três vezes na semana, em sessões de 60 minutos. Os níveis de atividade física e comportamento sedentário foram mensurados por meio de acelerometria (ActiGraph - GT3x). O tempo despendido em comportamento sedentário após a intervenção aumentou 6,5% no GP e 1,2% no GC e reduziu 0,5% no GNP. As mudanças nos níveis de atividade física leve foram de -4,6% no GP, +0,5% no GNP e -2,3% no GC, ao passo que os níveis de atividade física moderada a vigorosa apresentaram reduções de 3,0% no GP e aumentos de 0,5% no GNP e 12,2% no GC. Vale destacar, porém, que não foram identificados efeitos isolados do tempo e do grupo e nem interação tempo e grupo para nenhuma das variáveis analisadas (p > 0,05). Um programa de treinamento físico combinado e supervisionado, com ou sem progressão de carga, não foi capaz de promover mudanças no comportamento sedentário e nos níveis de atividade física de adultos com obesidade, sendo necessárias ações específicas voltadas a estes comportamentos

Women, children and adolescents in conflict countries: an assessment of inequalities in intervention coverage and survival.

Introduction: Conflict adversely impacts health and health systems, yet its effect on health inequalities, particularly for women and children, has not been systematically studied. We examined wealth, education and urban/rural residence inequalities for child mortality and essential reproductive, maternal, newborn and child health interventions between conflict and non-conflict low-income and middle-income countries (LMICs). Methods: We carried out a time-series multicountry ecological study using data for 137 LMICs between 1990 and 2017, as defined by the 2019 World Bank classification. The data set covers approximately 3.8 million surveyed mothers (15-49 years) and 1.1 million children under 5 years including newborns (<1 month), young children (1-59 months) and school-aged children and adolescents (5-14 years). Outcomes include annual maternal and child mortality rates and coverage (%) of family planning services, 1+antenatal care visit, skilled attendant at birth (SBA), exclusive breast feeding (0-5 months), early initiation of breast feeding (within 1 hour), neonatal protection against tetanus, newborn postnatal care within 2 days, 3 doses of diphtheria, pertussis and tetanus vaccine, measles vaccination, and careseeking for pneumonia and diarrhoea. Results: Conflict countries had consistently higher maternal and child mortality rates than non-conflict countries since 1990 and these gaps persist despite rates continually declining for both groups. Access to essential reproductive and maternal health services for poorer, less educated and rural-based families was several folds worse in conflict versus non-conflict countries. Conclusions: Inequalities in coverage of reproductive/maternal health and child vaccine interventions are significantly worse in conflict-affected countries. Efforts to protect maternal and child health interventions in conflict settings should target the most disadvantaged families including the poorest, least educated and those living in rural areas.

Closing the inequality gaps in reproductive, maternal, newborn and child health coverage: slow and fast progressors.

Introduction: Universal Health Coverage (UHC) is a critical goal under the Sustainable Development Goals (SDGs) for health. Achieving this goal for reproductive, maternal, newborn and child health (RMNCH) service coverage will require an understanding of national progress and how socioeconomic and demographic subgroups of women and children are being reached by health interventions. Methods: We accessed coverage databases produced by the International Centre for Equity in Health, which were based on reanalysis of Demographic and Health Surveys, Multiple Indicator Cluster Surveys and Reproductive and Health Surveys. We limited the data to 58 countries with at least two surveys since 2008. We fitted multilevel linear regressions of coverage of RMNCH, divided into four main components-reproductive health, maternal health, child immunisation and child illness treatment-to estimate the average annual percentage point change (AAPPC) in coverage for the period 2008-2017 across these countries and for subgroups defined by maternal age, education, place of residence and wealth quintiles. We also assessed change in the pace of coverage progress between the periods 2000-2008 and 2008-2017. Results: Progress in RMNCH coverage has been modest over the past decade, with statistically significant AAPPC observed only for maternal health (1.25, 95% CI 0.90 to 1.61) and reproductive health (0.83, 95% CI 0.47 to 1.19). AAPPC was not statistically significant for child immunisation and illness treatment. Progress, however, varied largely across countries, with fast or slow progressors spread throughout the low-income and middle-income groups. For reproductive and maternal health, low-income and lower middle-income countries appear to have progressed faster than upper middle-income countries. For these two components, faster progress was also observed in older women and in traditionally less well-off groups such as non-educated women, those living in rural areas or belonging to the poorest or middle wealth quintiles than among groups that are well off. The latter groups however continue to maintain substantially higher coverage levels over the former. No acceleration in RMNCH coverage was observed when the periods 2000-2008 and 2008-2017 were compared. Conclusion: At the dawn of the SDGs, progress in coverage in RMNCH remains insufficient at the national level and across equity dimensions to accelerate towards UHC by 2030. Greater attention must be paid to child immunisation to sustain the past gains and to child illness treatment to substantially raise its coverage across all groups.

Large and persistent subnational inequalities in reproductive, maternal, newborn and child health intervention coverage in sub-Saharan Africa.

Subnational inequalities have received limited attention in the monitoring of progress towards national and global health targets during the past two decades. Yet, such data are often a critical basis for health planning and monitoring in countries, in support of efforts to reach all with essential interventions. Household surveys provide a rich basis for interventions coverage indicators on reproductive, maternal, newborn and child health (RMNCH) at the country first administrative level (regions or provinces). In this paper, we show the large subnational inequalities that exist in RMNCH coverage within 39 countries in sub-Saharan Africa, using a composite coverage index which has been used extensively by Countdown to 2030 for Women's, Children's and Adolescent's Health. The analyses show the wide range of subnational inequality patterns such as low overall national coverage with very large top inequality involving the capital city, intermediate national coverage with bottom inequality in disadvantaged regions, and high coverage in all regions with little inequality. Even though nearly half of the 34 countries with surveys around 2004 and again around 2015 appear to have been successful in reducing subnational inequalities in RMNCH coverage, the general picture shows persistence of large inequalities between subnational units within many countries. Poor governance and conflict settings were identified as potential contributing factors. Major efforts to reduce within-country inequalities are required to reach all women and children with essential interventions.

Impact of cutoff points on adolescent sedentary behavior measured by accelerometer / Impacto dos pontos de corte para comportamento sedentário mensurado por acelerômetro em adolescentes

The aim of this study was to analyze the impact of cutoff points in defining sedentary behavior (SB) time and prevalence, measured by accelerometers in adolescents from Northeastern Brazil. This is a cross-sectional study with adolescents aged between 10 and 14 years from public schools in João Pessoa, Paraíba state, conducted in 2014. SB was measured by an accelerometer (ActiGraph GT3X+) and the following cutoff points were applied: Evenson (≤ 25 counts/15sec), Puyau (< 800 counts/60sec), Vanhelst (≤ 400 counts/60sec), Hänggi (< 3 counts/1sec) and Romanzini (≤ 180 counts/15sec), along with the 20 and 60-minute accelerometer nonwear time. To compare the av-erage and prevalence of excessive SB time (≥ 8 hours/day) between cutoff points, one-way ANOVA for repeated measures (Bonferroni post hoc) and the Cochran test, respectively, were used. There were significant differences in average SB between the cutoff points analyzed (p > 0.05), ranging from 37.44 min/day (Romanzini: 547.37 min/day vs. Vanhelst: 584.81 min/day) to 370.44 min/day (Hänggi: 310.51 min/day vs. Puyau: 680.95 min/day) for the 20-minute nonwear criterion; and from 81.52 min/day (Evenson: 502.41 min/day vs. Romanzini: 583.93 min/day) to 361.94 min/day (Hänggi: 354.58 min/day vs. Puyau: 716.52 min/day) for the 60-minute criterion. The prevalence of excessive SB varied from 3.3% (Hänggi) to 99.3% (Puyau). Average daily SB and the prevalence of excessive SB in the adolescents showed marked differences between the cutoff points assessed

O objetivo deste estudo foi analisar o impacto dos pontos de corte para definir comportamento sedentário (CS) no tempo e prevalência desse comportamento, mensurado por acelerômetros, em adolescentes no Nordeste do Brasil. Estudo transversal, com adolescentes de 10 a 14 anos de idade de escolas públicas de João Pessoa, Paraíba, em 2014. O CS foi mensurado por acelerômetro (ActiGraph GT3X+) e foram aplicados os seguintes pontos de corte: Evenson (≤ 25 counts/15seg), Puyau (< 800 counts/60seg), Vanhelst (≤ 400 counts/60seg), Hänggi (< 3 counts/1seg) e Romanzini (≤ 180 counts/15seg), combinados às definições de 20 e 60 minutos de não uso do acelerômetro. Para comparar o tempo médio e a prevalência de tempo excessivo de CS (≥ 8 horas/dia), entre os pontos de corte, utilizou-se a ANOVA ONE-WAY para medidas repetidas (post hoc de Bonferroni) e o teste de Cochran, respectivamente. Houve diferenças significativas na média de CS entre todos os pontos de corte analisados (p < 0,05), variando de 37,44 min/dia (Romanzini: 547,37 min/dia vs. Vanhelst: 584,81 min/dia) a 370,44 min/dia (Hänggi: 310,51 min/dia vs. Puyau: 680,95 min/dia) para o critério de 20 minutos de não uso; e de 81,52 min/dia (Evenson: 502,41 min/dia vs. Romanzini: 583,93 min/dia) a 361,94 min/dia (Hänggi: 354,58 min/dia vs. Puyau: 716,52 min/dia) para o de 60 minutos. A prevalência de exposição excessiva de CS variou de 3,3% (Hänggi) a 99,3% (Puyau). O tempo médio diário e a prevalência de exposição excessiva de CS de adolescentes apresentaram diferenças acentuadas entre os pontos de corte analisado

Preferências de atividade física em adultos brasileiros: resultados da Pesquisa Nacional de Saúde / Physical activity preferences in Brazilian adults: results from National Health Survey

O objetivo do estudo foi verificar a distribuição dos diferentes tipos de práticas entre os praticantes de atividade física de uma amostra de adultos de acordo com características sociodemográficas. Estudo transversal utilizando dados da Pesquisa Nacional de Saúde (PNS) de 2013, com adultos de 18 anos ou mais, praticantes de atividade física (n = 17.350). As variáveis independentes foram sexo, faixa etária, escolaridade e regiões geográficas. As variáveis dependentes foram os tipos de atividade física mais praticadas na população. Para apresentar as frequências de prática de prática segundo região, escolaridade e idade as atividades as atividades foram divididas em três grupos: caminhada, exercício e esportes. Os dados foram analisados no STATA 12.1. Nos homens, as atividades mais comuns foram futebol (39,1%), caminhada (22,9%) e musculação (15,3%). Nas mulheres, foram a caminhada (48,9%), ginástica (19,2%) e musculação (14,2%). Nos homens, a prática de caminhada foi maior nos mais velhos, sem instrução e da região Centro Oeste (p < 0,001). Quanto a prática de exercícios, nos homens, este hábito foi mais comum entre os mais jovens, com maior escolaridade, e da região Sudeste (p < 0,001). Em relação aos esportes, a prática foi mais comum nos mais jovens, nos com maior escolaridade e da região Norte (p < 0,001), tanto nos homens quanto nas mulheres. A prática esportiva foi menos frequente nas mulheres. Os tipos de atividade têm grande influência da idade, escolaridade dos indivíduos e região do país. Estes aspectos devem ser levados em conta do planejamento de intervenções

This study aims to verify the distribution of different types of practices in Brazilian adults according to sociodemographic variables. Cross-sectional study using data from the National Health Survey (PNS) of 2013 including individuals with 18 years or more practitioners of physical activity (n = 17,350). Independent variables were sex, age, education and geographic regions. The dependent variables were the types of physical activity more frequent in the population. To present frequencies according to region, education and age types of physical activity were classified in three groups: walking, exercise and sports. The data were analyzed in STATA 12.1 using the svy command. Among men, the most common activities were soccer (39.1%), walking (22.9%) and bodybuilding (15.3%). Among women, were walking (48.9%), gymnastics (19.2%) and bodybuilding (14.2%). Among men, walking was higher in older individuals, with no education and in the Midwest region (p < 0.001). For exercise, among men, the habit was more common among younger, with higher education and the Southeast (p < 0.001). Regarding sports, the practice was more common among the younger ones, with higher schooling and the Northern region (p < 0.001). The associations for women were similar to associations for men. The types of physical activity have influence of age, education and region of country. These aspects should be considered in interventions planning. More studies are necessary to under-stand the motivators to choose each practice

Apoio social e prática de atividade física no lazer em adolescentes: um estudo de base populacional / Social support and physical activity during leisure in adolescents: a population-based study

O objetivo do estudo foi avaliar a associação entre a prática de atividade física (AF) no lazer e o apoio social em adolescentes de 10 a 19 anos. O estudo transversal, de base populacional, foi realizado em Pelotas, Rio Grande do Sul, Brasil. Foram considerados ativos os adolescentes que realizavam no mínimo 300 minutos semanais de AF no lazer. O apoio social foi estudado através da Escala de Apoio Social para a AF. Foram entrevistados 743 adolescentes. A proporção de ativos no lazer foi de 28,2% (IC 95%: 24,6-31,3). Meninos com maior apoio social de amigos apresentaram uma probabilidade 112% (IC 95%: 41,0-183,0) maior de serem ativos em comparação a seus pares com menor apoio social. Meninas com apoio social elevado de familiares tiveram uma probabilidade de 102% (IC 95%: 12,0-193,0) maior de serem ativas. O percentual equivalente entre os meninos foi de 44% (IC 95%: 8,0-103,0). O incentivo de familiares e amigos exerce influência na prática de AF e apresenta questões culturais, como a indução de meninas para caminhadas e meninos para outras AF, especialmente dos amigos

The aim of the study was to evaluate the association between leisure-time physical activity (PA) and social support among adolescents aged 10 to 19 years. This was a population-based cross-sectional study carried out in the city of Pelotas, Rio Grande do Sul, Brazil. Adolescents were considered as active in leisure-time if reporting to practice 300 min/wk or more of PA. Social support was assessed through the PA Social Support Scale. The study included 743 adolescents. The proportion of active adolescents was 28.2% (95%CI: 24.6-31.3). Boys who report to have higher social support from friends were 112% (95%CI: 41.0-214.0) more likely to achieve PA recommendations as compared to their peers reporting no such social support. Girls with high scores of social support from the family were 102% (95%CI: 12.0-193.0) more likely to be active than those without such a support. The equivalent proportion for boys was 44% (95%CI: 8.0-103.0). The encouragement of family and friends influences the practice of PA and presents cultural issues, such as inducing girls to walk and boys to other PAs, especially friends

Temporal trends in the nutritional status of women and children under five years of age in sub-Saharan African countries: ecological study.

BACKGROUND: While the global prevalence of obesity is rapidly increasing, this pandemic has received less attention in sub-Saharan Africa, particularly in the light of the persistent undernutrition that exists in the context of maternal and child health. We aimed to describe obesity trends among women of childbearing age over recent decades, along with trends in over and undernutrition among children under five years of age, in sub-Saharan African countries. DESIGN AND SETTING: Ecological study with temporal trend analysis in 13 sub-Saharan African countries. METHODS: This was a description of temporal trends in nutritional status: adult obesity, childhood overweight, low height-for-age (stunting), low weight-for-height (wasting), low weight-for-age (underweight) and low birth weight. Publicly available data from repeated cross-sectional national surveys (demographic and health surveys and multiple-indicator cluster surveys) were used. We chose 13 sub-Saharan African countries from which at least four surveys conducted since 1993 were available. We investigated women aged 15-49 years and children under five years of age. RESULTS: In multilevel linear models, the prevalence of obesity increased by an estimated 6 percentage points over 20 years among women of childbearing age, while the prevalence of overweight among children under 5 years old was stable. A major decrease in stunting and, to a lesser extent, wasting accompanied these findings. CONCLUSIONS: The upward trend in obesity among women of childbearing age in the context of highly prevalent childhood undernutrition suggests that the focus of maternal and child health in sub-Saharan Africa needs to be expanded to consider not only nutritional deficiencies but also nutritional excess.

Socioeconomic inequalities in access to skilled birth attendance among urban and rural women in low-income and middle-income countries.

INTRODUCTION: Rapid urbanisation is one of the greatest challenges for Sustainable Development Goals. We compared socioeconomic inequalities in urban and rural women's access to skilled birth attendance (SBA) and to assess whether the poorest urban women have an advantage over the poorest rural women. METHODS: The latest available surveys (DemographicHealth Survey, Multiple Indicators Cluster Surveys) of 88 countries since 2010 were analysed. SBA coverage was calculated for 10 subgroups of women according to wealth quintile and urban-rural residence. Poisson regression was used to test interactions between wealth quintile index and urban-rural residence on coverage. The slope index of inequality (SII) and concentration index were calculated for urban and rural women. RESULTS: 37 countries had surveys with at least 25 women in each of the 10 cells. Average rural average coverage was 72.8 % (ranging from 17.2% % in South Sudan to 99.9 % in Jordan) and average urban coverage was 80.0% (from 23.6% in South Sudan to 99.7% in Guyana. In 33 countries, rural coverage was lower than urban coverage; the difference was significant (p<0.05) in 15 countries. The widest urban/rural coverage gap was in the Central African Republic (32.8% points; p<0.001). Most countries showed narrower socioeconomic inequalities in urban than in rural areas. The largest difference was observed in Panama, where the rural SII was 77.1% points larger than the urban SII (p<0.001). In 31 countries, the poorest rural women had lower coverage than the poorest urban women; in 20 countries, these differences were statistically significant (p<0.05). CONCLUSION: In most countries studied, urban areas present a double advantage of higher SBA coverage and narrower wealth-related inequalities when compared with rural areas. Studies of the intersectionality of wealth and residence can support policy decisions about which subgroups require special efforts to reach universal coverage.

Reliability and concurrent validity of the Global Physical Activity Questionnaire in adults from a Brazilian rural area / Teste-reteste e validade concorrente do Questionário Global de Atividade Física em adultos de uma população rural no Brasil

The aim of this study was to test reliability of the Global Physical Activity Questionnaire (GPAQ), and its concurrent validity using accelerometers, in a Brazilian rural population. Fifty-five adults (18+ years) living in a rural Brazilian city were selected to wear an accelerometer for one week and to an-swer the GPAQ twice in a week period interval. Reliability was verified using Intraclass Correlation Coefficients and the concurrent validity was analyzed based on Bland and Altman's diagrams. We found relatively high reliability for the total physical activity (ICC = 0.78; 95%CI: 0.63; 0.87). The average difference between both GPAQ measures was 192 minutes (95%CI: -69.63; 453.75). Wider differences were found when participants reported > 400 minutes of physical activity per week. There was limited agreement between the GPAQ and accelerometer measures (total average difference = -1043 minutes; 95%CI: -1452.23; -634.09). Thus, the questionnaire presented limited concurrent validity and acceptable reliability, being able to be used in rural populations. However, there is still a need of new physical activity instruments focused on rural populations

O objetivo deste estudo foi realizar um teste-reteste do Questionário Global de Atividade Física (GPAQ) e sua validade concorrente com acelerômetros em uma população rural brasileira. Cinquenta e cinco adultos (18 anos ou mais) moradores da área rural da cidade de Arroio do Padre foram selecionados para responder o GPAQ em duas semanas subsequentes e usar um acelerômetro por uma semana. Para realizar o teste-reteste foi usado o coeficiente de correlação intraclasse (CCI) e a validade concorrente foi analisada usando gráficos Bland and Altman. O resultado do teste-reteste de atividade física total foi alto (CCI = 0,78; IC95%: 0,63; 0,87). A diferença média entre as duas medidas do GPAQ foi 192 minutos (IC95%: -69.63; 453.75). Maiores diferenças foram encontradas quando os participantes reportaram praticar mais de 400 minutos de atividade física por semana. A concordância foi limitada entre as medidas do GPAQ e do acelerômetro (diferença média total = -1043 minutos; IC95%: -1452.23; -634.09). Logo, o GPAQ apresentou limitada validade concorrente e aceitável teste-reteste, podendo ser usado em populações rurais. Contudo, a criação de um novo instrumento de atividade física focado na população rural é necessária

Promoção da saúde: um convite à releitura de imprecisões teóricas na área de Atividade Física e Saúde / Health Promotion: an Invitation to Addressing Theoretical Imprecisions in the Field of Physical Activity and Health

A noção de "Promoção da Saúde" recebe enorme atenção por parte do núcleo profissional de Educação Física. Entretanto, ela tem sido utilizada de forma indiscriminada. O ensaio pretende visibilizar a relevância de maior demarcação conceitual em torno da Promoção da Saúde e apontar as diferenças teóricas existentes. Dois aspectos são analisados: a simbiose prevenção/promoção da saúde e a abordagem dura em direção aos indivíduos e pouco crítica aos contextos e às condições de vida. À medida que os estudos se situarem teoricamente, caminhos poderão se abrir para embates e amadurecimento teórico-prático da Promoção da Saúde com repercussões nas intervenções, na formação profissional e na pesquisa na área. Estranhar o que temos feito é uma premissa nem sempre simpática, contudo é justamente este desprendimento que sinalizará amadurecimento, posicionamento, e, com divergências possíveis, proporcionará densidade conceitual e evolução ao tema Promoção da Saúde na Atividade Física e Saúde

The concept of 'Health Promotion' receives widespread attention from the field of Physical Education. Nevertheless, this concept has been indistinctly used. This essay aims to highlight the need for stricter conceptual delimitation regarding the concept of health promotion, particularly by pointing out differences in existing theories. We give particular attention to two issues: symbiosis prevention/health promotion and the limited view that behaviors are defined by individual choices ignoring the context and living conditions. We ad-vocate that these theoretical pathways need to be addressed in order to enrich discussions around the concept of Health Promotion for intervention, health education and research purposes. Challenging our current practice is not a pleasant action, however this is exactly the sign of maturation needed for dealing with existing conceptual discrepancies aimed at pushing the fields of health promotion and physical activity forward

Sociodemographic inequalities in leisure-time physical activity and active commuting to school in Brazilian adolescents: National School Health Survey (PeNSE 2009, 2012, and 2015). / Desigualdades sociodemográficas na prática de atividade física de lazer e deslocamento ativo para a escola em adolescentes: Pesquisa Nacional de Saúde do Escolar (PeNSE 2009, 2012 e 2015).

The objective of this study was to identify inequalities in leisure-time physical activity and active commuting to school in Brazilian adolescents, as well as trends according to gender, type of school, maternal schooling, and geographic region, from 2009 to 2015. This was a descriptive study based on data from the Brazilian National School Health Survey (PeNSE) in 2009, 2012, and 2015. Students were defined as active in their leisure time when they practiced at least 60 minutes of physical activity a day on five or more of the seven days prior to the interview. Active commuting to school was defined as walking or biking to school on the week prior to the interview. The outcomes were stratified by gender, type of school, maternal schooling, and geographic region. Inequalities were assessed by differences and ratios between the estimates, as well as summary inequality indices. The 2009, 2012, and 2015 surveys included 61,301, 61,145, and 51,192 schoolchildren, respectively. Prevalence of leisure-time physical activity was 13.8% in 2009, 15.9% in 2012, and 14.7% in 2015; the rates for active commuting to school were 70.6%, 61.7%, and 66.7%, respectively. Boys showed 10 percentage points higher prevalence of leisure-time physical activity and 5 points higher active commuting to school than girls. Children of mothers with more schooling showed a mean of 10 percentage points higher prevalence of leisure-time physical activity than children of mothers with the lowest schooling and some 30 percentage points lower in relation to active commuting to school. The observed inequalities remained constant over the course of the period. The study identified socioeconomic and gender inequalities that remained constant throughout the period and which were specific to each domain of physical activity.