Avaliação da prática de atividade física em escolares brasileiros e associação dessa prática com características individuais e contextuais / Avaliação da prática de atividade física em escolares brasileiros e associação dessa prática com características individuais e contextuais

Introdução: A atividade física (AF) é um dos principais fatores de proteção contra doenças crônicas não transmissíveis, devendo sua prática ser estimulada durante todo o ciclo de vida. No Brasil, menos de 50% dos adolescentes praticam AF regularmente (300+ minutos/semana) e são escassos os estudos que avaliam a prática de AF ao longo do tempo nesse grupo, bem como a associação dessa prática com características individuais e contextuais. Objetivos: Avaliar a prática de atividade física em adolescentes comparando os inquéritos da Pesquisa Nacional de Saúde do Escolar (PeNSE) de 2012 e 2015 (artigo 1) e investigar a associação dessa prática com características individuais (artigo 2) e contextuais (artigo 3). Métodos: No primeiro artigo, o indicador atividade física globalmente estimada com o ponto de corte de 300+ minutos/semana foi utilizado para determinar, nas capitais, a prevalência de adolescentes fisicamente ativos nos inquéritos da PeNSE/2012 e PeNSE/2015. Foi observada estabilização da prevalência de adolescentes fisicamente ativos entre 2012 (21,0%; IC95% 20,3 ­ 21,7) e 2015 (20,7%; IC95%: 20,1 ­ 21,3), independente do sexo, idade, escolaridade da mãe e cor da pele. Essa estabilização também foi observada em todas as capitais, exceto em Belém, onde houve redução na prevalência de adolescentes fisicamente ativos. No segundo artigo, que utilizou dados da PeNSE/2012, representativos de todo o Brasil, a variável resposta foi a prática regular de atividade física determinada pelo indicador atividade física globalmente estimada com o ponto de corte de 300+ minutos/semana utilizado para classificar os adolescentes em ativos e insuficientemente ativos. As variáveis explicativas foram agrupadas em quatro domínios: 1) Demográfico; 2) Psicossocial; 3) Comportamental; 4) Sociocultural. Para verificar os fatores associados à pratica regular de AF foi realizada regressão de Poisson, estratificada por sexo. A prevalência de adolescentes fisicamente ativos foi maior em meninos quando comparado as meninas, 27,9% e 13,1%, respectivamente. Constatou-se maior prática de AF em meninos de menor faixa etária, filhos de mães com maior escolaridade, que consumiam alimentos saudáveis como feijão, frutas, verduras, legumes e leite, assim como entre aqueles com supervisão familiar. Ao mesmo tempo, hábitos não saudáveis como insônia e consumo de álcool também se associaram positivamente à prática de AF. Em meninas foi observada maior prática de AF dentre aquelas que viviam com as mães e cujas mães apresentavam maior escolaridade. Além da supervisão familiar, a prática da AF nas meninas também esteve associada positivamente com a frequência de refeição com os pais. Entretanto, assim como nos meninos, a insônia e consumo de álcool se associaram com o aumento da prática da AF. No terceiro artigo, a variável resposta foi a prevalência de adolescentes ativos (300+ minutos/semana) nas capitais brasileiras, obtida pelo indicador atividade física acumulada, relatado na PeNSE/2012. As variáveis explicativas foram obtidas em diversas fontes e representam uma média agregada de cada capital. Essas variáveis foram divididas em cinco domínios: Ambiente natural (temperatura); Indicadores socioeconômicos e educacionais (renda per capita); Infraestrutura (percentual de domicílios com rampa para cadeirantes); Violência urbana (taxa de mortalidade por homicídio); Influência sociocultural para prática de atividade física (percentual de adultos ativos no lazer). Para a identificação dos fatores associados foi utilizada regressão linear múltipla. O modelo final mostrou que menor temperatura (ß: - 0,46; IC: - 0,88; - 0,04), maior IDEB (ß: 3,02; IC: 0,36; 5,67), maior percentual de rampa para cadeirantes (ß: 0,25; IC: 0,04; 0,47) e maior percentual de adultos ativos (ß: 0,35; IC: 0,13; 0,57) nas cidades, estão associados com o aumento da prevalência dos adolescentes fisicamente ativos. Conclusões: Verificou-se estabilização da prevalência de adolescentes fisicamente ativos residentes nas capitais brasileiras entre os anos de 2012 e 2015 mostrando a necessidade de reavaliar/expandir as políticas públicas de promoção da AF. Em nível do indivíduo, escolaridade materna, hábitos alimentares saudáveis e supervisão familiar foram associados à pratica regular de AF dos adolescentes, evidenciando a importância da família para aquisição de hábitos saudáveis nessa faixa etária. Ao analisar características contextuais, verificou-se se que temperaturas amenas, maior qualidade educacional, melhor infraestrutura e maior apoio sociocultural para prática de AF estão associados ao aumento da proporção de jovens ativos. Tais resultados podem contribuir para avaliação e/ou implantação de políticas públicas mais assertivas que visem o aumento da AF de adolescentes brasileiros

Introduction: Physical activity (PA) is one of the main protection factors against chronic non-communicable diseases, and its practice should be stimulated throughout the life cycle. In Brazil, fewer than 50% of adolescents practice PA regularly (300+ minutes/week), and few studies are evaluating PA practice over time in this age group, as well as the association of this practice with individual and contextual characteristics. Objectives: To evaluate the practice of PA in adolescents by comparing the surveys of the National Adolescent Schoolbased Health Survey (PeNSE) of 2012 and 2015 (article 1), to investigate the association of this practice with individual characteristics (article 2) and with contextual characteristics (article 3). Methods: In the first article, the overall PA indicator (with cut-off point of 300+ minutes/week) was used to determine the prevalence of physically active adolescents in the PeNSE/2012 and PeNSE/2015 surveys. A stabilization was observed in the prevalence of physically active adolescents between 2012 (21.0%, 95% CI 20.3 - 21.7) and 2015 (20.7%, CI 95%: 20.1 - 21.3), regardless of sex, age, mother's schooling or skin color. This stabilization was also observed in all capitals, except for Belém, where a reduction was observed in the prevalence of physically active adolescents. In the second article, which used PeNSE/2012 data, the response variable was the regular practice of PA (determined by the overall PA indicator with the cut-off point of 300+ minutes/week) used to classify adolescents as active or insufficiently active. The explanatory variables were grouped into four domains: 1) Demographic; 2) Psychosocial; 3) Behavioral; 4) Sociocultural. In order to verify the factors associated with regular practice of PA, a Poisson regression stratified by sex was performed. The prevalence of physically active adolescents was higher in boys when compared to girls, 27.9% and 13.1%, respectively. A higher practice of PA was observed in boys who were younger in age, whose mothers had higher education levels, who consumed healthy foods such as beans, fruits, vegetables, and milk, as well as in boys who benefited from family supervision. At the same time, unhealthy habits such as insomnia and alcohol consumption were also positively associated with PA practice. In girls, a higher practice of PA was observed among those who lived with their mothers and whose mothers had higher education levels. In addition to family supervision, the practice of PA in girls was also positively associated with the frequency of meals had in company of their parents. However, just as with boys, insomnia and alcohol consumption were associated with increased PA practice. In the third article, the response variable was the prevalence of active adolescents (300+ minutes/week) in the Brazilian capitals, obtained by the accumulated physical activity indicator reported in PeNSE/2012. The explanatory variables were obtained from several sources and represent an aggregate average of each capital. These variables were divided into five domains: Natural environment (temperature); socioeconomic and educational indicators (per capita income); infrastructure (percentage of households with a wheelchair ramp); urban violence (death rate by homicide); socio-cultural encouragement for PA practice (percentage of active adults in leisure). Multiple linear regression was used to identify the associated factors. The final model showed that lower temperature (ß: - 0.46, CI: - 0.88, - 0.04), higher IDEB (ß: 3.02, IC: 0.36, 5.67) (ß: 0.25, CI: 0.04; 0.47) and higher percentage of active adults (ß: 0.35; CI: 0.13; 0.57) in the cities, are associated with the increase in prevalence of physically active adolescents. Conclusions: There was a stabilization of the prevalence of physically active adolescents living in Brazilian capitals between the years of 2012 and 2015, which shows the need to reassess and expand the public policies that promote PA. At the individual level, maternal schooling, healthy eating habits and family supervision have been associated with regular PA practice among adolescents, which evinces the importance of family in the acquirement of healthy habits by this age group. When analyzing contextual characteristics, it was verified that mild temperatures, higher quality of education, better infrastructure and greater socio-cultural support for PA are associated with increased proportions of active youths. Such results may contribute to the evaluation and implementation of more assertive public policies aiming at the increase of physical activity in Brazilian adolescents.

Evaluation of preoperative chlorhexidine bath for reducing the incidence of surgical site infection in patients undergoing spinal surgery / 中国感染控制杂志

Objective To investigate the effect of preoperative chlorhexidine bath for reducing the incidence of sur-gical site infection(SSI)in patients undergoing spinal surgery.Methods All patients who undergoing spinal surgery (with no implants)in the department of neurosurgery of a hospital between January 2013 and December 2014 were monitored,the selected patients were divided into control group (January-December of 2013,no intervention meas-ures were taken)and trial group(January-December of 2014,1 .8%-2.2% chlorhexidine bath for two nights before operation),incidence of SSI between two groups of patients before and after intervention was compared,interven-tions effect was evaluated.Results A total of 1 043 patients undergoing spinal surgery were enrolled,41 (3.93%) had SSI,incidence of SSI rates in control group and trial group were 6.47% and 2.34% respectively,the difference was statistically significant (P=0.001).According to the incidence of SSI in control group,actual infected patients in trial group were 27 less than the anticipated patients with infection.The average hospitalization expense in SSI group and non-SSI group were ￥33 641 .00 and ￥23 072.50 respectively,each patient could save ￥10 568.50 on average.Therefore,through the intervention measures,￥285 349.50 of hospitalization expense could be saved. Except ￥2 100 of trial material cost and ￥12 820 of manual labour cost,￥270 429.50 of social cost was ultimately saved.The mean length of hospital stay in control group and trial group were 10 (8-12)days and 9 (8-12)days respectively,rank test showed that the difference was not statistically significant (Z = - 0.68,P = 0.50 ). Conclusion Chlorhexidine bath intervention can not only reduce SSI rate,but also save the expense of hospitaliza-tion,whether it can shorten the length of hospital stay needs to be further studied.

How can we teach them about neurotrauma prevention? Prospective and randomized "Pense Bem-Caxias do Sul" study with multiple interventions in preteens and adolescents.

UNLABELLED: OBJECT.: A previous study published by the authors showed that a single intervention could not change the baseline attitudes toward neurotrauma prevention. The present study was designed to evaluate the effectiveness of multiple interventions in modifying knowledge and attitudes for the prevention of neurotrauma in Brazilian preteens and adolescents. METHODS: In a randomized controlled trial, fifth-year primary school (PS) and second-year high school (HS) students were divided into a control and 2 intervention (single/multiple) groups. The study was conducted in the following 8 stages: T1, questionnaire to measure baseline characteristics; T2, lecture on trauma prevention; T3, reapplying the questionnaire used in T1; T4, Traffic Department intervention; T5, a play about trauma and its consequences; T6, Fire Department intervention; T7, Emergency Medical Service intervention; and T8, reapplying the questionnaire used in T1 and T3. Positive answers were considered those affirming the use of safety devices "always or sometimes" and negative as "never" using safety devices. RESULTS: The sample consisted of 535 students. Regarding attitudes, students in all groups at any stage of measurement showed protective behavior more than 95% of the time about seat belt use. There were only differences between attitudes in PS and HS students on T8 assessment concerning the use of safety equipment on bikes in the multiple-intervention group and concerning the use of safety equipment on skateboards and rollerblades in single- and multiple-intervention groups. These differences were caused mainly by the reduction in positive answers by the HS group, rather than by the increase in positive or protective answers by the PS group. However, there was no difference when the control and intervention groups were compared, independent of the attitudes or the student groups studied. The most important reason for not using protective devices was the belief that they would not get hurt. CONCLUSIONS: Multiple and different types of educational interventions, such as lectures, scenes from plays about trauma and its consequences, traffic and fire department intervention, and medical emergency intervention directed to preteens and adolescents from public and private schools did not modify most students' attitudes toward injury prevention. Clinical trial registration no: U1111-1121-0192 (National System of Ethics and Research in Brazil).