Consumption of carbonated soft drinks, fruits and vegetables and association with macroeconomic indicators: the analysis of students from seventy-four countries (2003-2015).

This study aimed to compare fruits and vegetables (FV), and carbonated soft drink (CSD) consumption among adolescents from seventy-four countries, according to macroeconomic indicators. This is an ecological study, developed with countries evaluated through the Global School-based Student Health Survey (2003-2014) and the National School Health Survey (PeNSE-Brazil, 2015). The percentages of students in each country who consumed CSD and FV daily and their association with the Human Development Index (HDI) and the Gross National Income per capita (GNIpc) were assessed. Scatter plots were constructed for each marker, and a multilevel model was tested to consider the effects of region in the associations. The overall prevalence of daily CSD consumption was 54·1 %. CSD consumption was positively associated with HDI and GNIpc through multilevel models, and Central and South America showed a considerable higher consumption compared with other regions. Overall, FV daily consumption was 67·9 % and 74·6 %, respectively, and no associations with macroeconomic indicators were found. The study shows concerning rates of CSD consumption among adolescents, and a trend of increased consumption with the improvement of the country's development and GNIpc. This points for the importance of public policies that regulate food and beverage industries to reduce CSD consumption and related co-morbidities among adolescents.

Influência dos indicadores econômicos na distribuição espacial de internações relacionadas as doenças crônicas não transmissíveis / Influence of economic indicators on the spatial distribution of hospitalizations related to chronic noncommunicable diseases / Influencia de los indicadores económicos en la distribución espacial de las hospitalizaciones relacionadas con enfermedades crónicas no transmisibles

Objetivo: analisar a distribuição das Internações por Condições Sensíveis à Atenção Primária relacionadas às Doenças Crônicas Não Transmissíveis em São Carlos, SP, Brasil, e verificar a correlação com as variáveis econômicas. Método: Trata-se de um estudo ecológico, utilizando dados secundários coletados por meio do levantamento nas fichas de Autorização de Internação Hospitalar no período de 2015 a 2018 e analisados por meio da estatística descritiva e correlação de Pearson. A geocodificação e geoprocessamento foram realizadas nos softwares ArcGis e Google Earth Pro. A pesquisa foi aprovada pelo comitê de ética em pesquisa da instituição. Resultados: Foram encontradas correlações (21% e 25%), referente, respectivamente, às variáveis renda do setor censitário e renda per capita, sugerem que quanto maior a renda, menor será o número de internação. Conclusão: O aumento do coeficiente de ICSAP em regiões de baixa renda, indica que a renda consiste em um fator determinante no processo saúde-doença.

Objective: to analyze the distribution of hospitalizations for conditions relating to chronic noncommunicable diseases and amenable to primary care in São Carlos, São Paulo and to ascertain correlations with economic variables. Method: this ecological study used secondary data collected from the survey of hospitalization authorization (AIH) forms in the period from 2015 to 2018, which were analyzed using descriptive statistics and Pearson's correlation. Geocoding and geoprocessing were performed using ArcGis and Google Earth Pro software. The study was approved by the research ethics committee. Results: 21% and 25% correlations were found with, respectively, census tract income and per capita income, suggesting that the higher the income, the lower the number of hospitalizations. Conclusion: the increase in the coefficient for such hospitalizations in low-income regions indicates that income is a determining factor in the health-disease process.

Objetivo: analizar la distribución de Hospitalizaciones por Condiciones Sensibles a la Atención Primaria relacionadas con Enfermedades Crónicas No Transmisibles en São Carlos-SP y verificar la correlación con variables económicas. Método: se trata de un estudio ecológico, utilizando datos secundarios recolectados a través de la encuesta en formularios de Autorización de Hospitalización (AIH) en el período de 2015 a 2018 y analizados mediante estadística descriptiva y correlación de Pearson. La geocodificación y el geoprocesamiento se realizaron utilizando el software ArcGis y Google Earth Pro. La investigación fue aprobada por el comité de ética. Resultados: se encontraron correlaciones (21% y 25%), referidas, respectivamente, a las variables 'ingresos del sector censal' e 'ingresos per cápita', sugiriendo que cuanto más altos sean los ingresos, menor será el número de hospitalizaciones. Conclusión: el aumento del coeficiente ICSAP en las regiones de bajos ingresos indica que los ingresos son un factor determinante en el proceso salud-enfermedad.

Increasing anaphylaxis events in Western Australia identified using four linked administrative datasets.

BACKGROUND: Anaphylaxis events are increasing worldwide, based on studies of single administrative datasets including hospital admissions, emergency room presentations, and prescription and medical claims data. Linking multiple administrative datasets may provide better epidemiological estimates, by capturing a greater number of anaphylaxis events occurring at the individual level. In this linked data study in Western Australia, we combined 4 population-based datasets to identify anaphylaxis events, factors influencing occurrence, and change in event rates from 2002 to 2013. METHODS: Four linked administrative datasets from the Western Australian Data Linkage System were used, representing ambulance attendances, emergency department presentations, hospital inpatient admissions and death registrations. An anaphylaxis cohort was identified using ICD-9-CM, ICD-10-AM and additional anaphylaxis diagnosis codes, with event rates calculated. We explored the impact of age, gender, cause, Indigenous status and socioeconomic index on event rates. Standard Poisson regression models were used to examine the significance of the change in anaphylaxis event rates over time. RESULTS: A total 12,637 individuals (mean age 31.8 years, 49.6% female) experienced 15,462 anaphylaxis events between 2002 and 2013 (97.5% in non-Indigenous patients and 59.5% residing in the area of greatest socioeconomic advantage). Anaphylaxis event rates increased from 15.4 to 82.5/105 population between 2002 and 2013. The greatest increase in anaphylaxis events was seen in those coded as unspecified anaphylaxis (all ages, males and females combined, p < 0.001), with the highest rates of unspecified anaphylaxis in males 0-4 years (171.9/105 population in 2013), and females 15-19 years (104.0/105 in 2013). The average annual percent increase (95% CI) for food-related anaphylaxis was 9.2% (6.6-12.0); for medication-related anaphylaxis was 5.8% (4.5-7.1); and for unspecified anaphylaxis was 10.4% (9.8-11.0); all p < 0.001. There was a significant increase in ambulance attendance, emergency presentations and inpatient admissions for anaphylaxis between 2002 and 2013, with emergency presentations (56.0/105 population), inpatient admissions (43.2/105), and ambulance attendance (21.6/105) highest in 2013. Only 25 anaphylaxis-related deaths were recorded in the mortality register with no significant change in rates over time. CONCLUSION: Using multiple linked administrative datasets, we identified significantly higher rates of total anaphylaxis than previously reported, with more than 5-fold increases in anaphylaxis events between 2002 and 2013. While the combination of 4 population-level datasets provides a more comprehensive capture of cases, even at the individual dataset level, admission rates for anaphylaxis in Western Australia are substantially higher than those previously reported for similar time periods, both in Australia and worldwide.

Associations between in-school-hours physical activity and child health-related quality of life: A cross-sectional study in a sample of Australian primary school children.

The aim of the current study was to examine the association between Australian primary school children's objectively measured in-school-hours weekly physical activity (PA) and their health-related quality of life (HRQoL). A cross-sectional study of 1128 Grade 2 and 3 children, aged 7-9 years, from 62 primary schools was conducted in New South Wales, Australia between October 2017 and April 2018. Children's PA was assessed via an accelerometer worn for five days during school hours. Their parents completed a telephone interview, answering demographic, child HRQoL and out-of-school-hours PA questions. Children's in-school-hours PA was classified as total PA and moderate-to-vigorous PA (MVPA). HRQoL scores were aggregated and reported at the high construct level domains (Total Quality of Life (Total HRQoL), Physical and Psychosocial Health Summary Scores). Multiple linear mixed regression analyses accounting for clustering were conducted to evaluate the association between children's in-school-hours weekly PA and their HRQoL. After adjusting for potential confounders, significant positive associations were found between children's in-school-hours weekly total PA and Total HRQoL (0.62 units, 95% CI: 0.29; 0.94, p < 0.001), Physical (0.71 units, 95% CI: 0.38; 1.04, p ≤ 0.001) and Psychosocial (0.58 units, 95% CI: 0.19; 0.97, p = 0.004) scores, with a stronger association observed between average weekly MVPA than average weekly total PA. There were also positive associations between PA and HRQoL for each sex when analysed separately. Our findings demonstrate a positive association between children's objectively-measured in-school-hours PA and parent-reported child HRQoL, strengthening evidence supporting the continued implementation of school-based PA programs for broader health outcomes.

Potencial impacto financeiro às famílias na adoção das recomendações do Guia Alimentar para a População Brasileira / Potential financial impact on families in adopting the Brazilian Dietary Guidelines

Introdução: A adesão de um padrão alimentar não saudável pela população depende não só das características individuais (como psicológicas e sociais), mas também de características ambientais, que envolvem desde a acessibilidade ao local de compra e a disponibilidade do alimento, ate a exposição desse alimento nas mídias, e principalmente, suas políticas de preço. Considerando esse padrão não saudável como o principal determinante da epidemia de obesidade e de doenças crônicas não transmissíveis, o atual Guia Alimentar para a População Brasileira recomenda priorizar o consumo de alimentos frescos (não processados ou minimamente processados) e evitar alimentos ultraprocessados do cotidiano da população. Entretanto, ainda não está claro se o cenário econômico brasileiro favorece essas recomendações e a adoção de uma dieta saudável. Objetivo: Analisar os aspectos econômicos relacionados à adoção das recomendações do Guia Alimentar para a População Brasileira. Metodologia: Trata-se de um trabalho ecológico com delineamento misto, envolvendo estudo de série temporal e estudos transversais. Dados da Pesquisa de Orçamentos Familiares (POF 2008/09) e do Sistema Nacional de Índices de Preços ao Consumidor (SNIPC), além do sistema de classificação de alimentos NOVA utilizado no Guia Alimentar para a População Brasileira, foram utilizados. No manuscrito 01, dietas isoenergéticas (2.000 kcal) foram otimizadas por modelos de programação linear no intuito de analisar o impacto econômico das recomendações do Guia no custo atual da dieta. Os modelos foram identificados não só ao atender as recomendações do Guia Alimentar (considerando a participação dos grupos alimentares) e preservar ao máximo a composição alimentar atual, mas também ao respeitar as restrições nutricionais (baseadas em recomendações internacionais) e os limites de aceitação alimentar na população. O impacto do Guia Alimentar foi analisado comparando-se o custo das dietas otimizadas com o da dieta atual, para a população total e de acordo com o nível de renda. No manuscrito 02, um índice de inadequação da composição dietética (IICD) foi calculado no intuito de analisar a influência do preço dos alimentos sobre a composição alimentar da dieta dos brasileiros. O IACD foi calculado a partir da participação (%) dos grupos de alimentos classificados no Guia, indicando a diferença na composição alimentar da dieta atual e da dieta recomendada (esta identificada no manuscrito 01). A influência do preço dos alimentos no IICD foi analisada por meio do modelo de regressão log-log. O modelo final foi ajustado por renda (R$) e características sociodemográficas. Todos os modelos foram desenvolvidos para a população total e de acordo com o nível de renda. No manuscrito 03, a série de preço real (R$/kg) dos alimentos mais consumidos no país (n=102) foi calculada no intuito de analisar a mudança do preço de grupos alimentares ao longo do tempo no Brasil. Dados sobre preço de alimentos e bebidas da POF 2008/09 foram utilizados para calcular o preço real ao longo do tempo (de janeiro de 1995 até dezembro de 2017), usando a variação mensal dos preços do SNIPC. O preço mensal médio de cada grupo e subgrupo alimentar foram calculados considerando a quantidade adquirida de cada produto. Modelos polinomiais fracionários foram empregados para sintetizar as mudanças dos preços, e para estimar o preço de cada grupo e subgrupo até dezembro de 2030. Resultados: No manuscrito 01, o custo atual da dieta foi de R$3,37, menor entre as famílias de baixa renda (R$2,62) e maior entre as famílias de alta renda (R$4,17). Independentemente do nível de renda familiar, o custo da dieta e a parcela do orçamento alimentar foram diminuindo de forma gradativa ao atender as recomendações do Guia. Ainda assim, as famílias de baixa renda comprometem o orçamento duas vezes mais que as famílias de alta renda (20,20% vs 7,96%). No manuscrito 02, alimentos ultraprocessados responderam por 18,3% da dieta atual, enquanto alimentos não processados e minimamente processados responderam por pouco menos da metade das calorias. A otimização sugere valores para esses grupos de 9,1% e 69,4%, respectivamente, na dieta recomendada. Um aumento de 1,00% no preço de alimentos não processados ou minimamente processados aumentou o IICD em 0,76% (dieta menos saudável), enquanto um aumento de 1,00% no preço de alimentos ultraprocessados diminuiu o IICD em 0,70% (dieta saudável). A associação inversa entre preço de alimentos ultraprocessados e IICD permaneceu significativa apenas entre os estratos de baixa renda (-1,11%; p <0,05). No manuscrito 03, o grupo de alimentos ultraprocessados foi o mais caro (R$6,51/Kg), seguido pelos grupos de alimentos processados (R$6,44/Kg), e de alimentos não processados ou minimamente processados e ingredientes culinários processados (R$3,45/Kg) em 1995. Desde o início dos anos 2000, o preço dos alimentos ultraprocessados passou por sucessivas reduções, ficando mais baratos que os alimentos processados e reduzindo a distância entre eles e o preço do outro grupo. As previsões indicaram que alimentos não saudáveis se tornarão mais baratos que alimentos saudáveis em 2026. Conclusão: A adoção de práticas alimentares mais saudáveis ainda pode ser realizada com o mesmo ou menor orçamento da dieta atual. Entretanto, se nada for feito, o preço dos alimentos no Brasil mudarão desfavoravelmente considerando as recomendações do Guia Alimentar para a População Brasileira. A tributação de alimentos ultraprocessados e subsídios para alimentos não processados ou minimamente processados são alternativas para favorecer a adoção das recomendações do Guia Alimentar e melhorar a composição da dieta dos brasileiros.

Introduction: Adherence to an unhealthy dietary pattern by the population depends not only on individual characteristics (such as psychological and social), but also on environmental characteristics, which range from accessibility to the place of purchase and availability of food, to the exposure of this food in the media, and mainly, its price policies. Considering this unhealthy pattern as the main determinant of the obesity epidemic and non-communicable diseases, the current Brazilian Dietary Guidelines recommends prioritizing the consumption of fresh foods (unprocessed or minimally processed) and avoiding ultra-processed foods from the population's daily life. However, it is still unclear whether the Brazilian economic scenario favors these recommendations and the adoption of a healthy diet. Objective: To analyze the economic aspect related to the adoption of the Brazilian Dietary Guidelines. Methodology: It is an ecological work with a mixed design, involving a time series study and cross-sectional studies. Data from the Household Budget Survey (2008/09 HBS) and from the National System of Consumer Price Indexes (NSCPI), besides that NOVA food classification system used in the Brazilian Dietary Guidelines, were used. In manuscript 01, isoenergetic diets (2,000 kcal) were optimized by linear programming models in order to analyze the economic impact of the Brazilian Dietary Guidelines on current diet cost. The models were identified according to Brazilian Dietary Guidelines (considering the share (%) of food groups) and in order to preserve current diet, beside that to respect nutritional constrains (based on international recommendations) and food acceptance limits (obtained direct in the studied population). The impact of the Brazilian Dietary Guidelines was analyzed by comparing the cost of optimized diets with that of the current diet, for the total population and according to income level. In manuscript 02, a Dietary Composition Inadequacy Index (DCII) was calculated in order to analyze the influence of food prices on the dietary composition from Brazilians. The DCII was calculated from the share (%) of the food groups according to NOVA, indicating the difference in the food composition of the current diet and the recommended diet (this identified in manuscript 01). The influence of food prices on the DCII was analyzed using the log-log regression model. The final model was adjusted by income (R$) and sociodemographic characteristics. All models were developed for the total population and according to income level. In manuscript 03, the series of real prices (R$/kg) of the most consumed foods in the country (n = 102) was calculated in order to measure change in price of food groups over time in Brazil. Data on price of foods and beverages from 2008/09 HBS were used to calculate real price over time (from January 1995 to December 2017), using the monthly variation in prices from NSCPI. The average monthly price of each group and subgroup were calculated considering the quantity purchased of each product. Fractional polynomial models were used to synthesize price changes, and to estimate the price of each group and subgroup by December 2030. Results: In manuscript 01, current diet cost was R$3.37, lower among low-income families (R$2.62) and higher among high-income families (R$4.17). Regardless of income, diet cost and budget compromise decreased when approaching the Guidelines. Even so, the low-income families compromised the budget twice as much as high-income families (20.20% vs 7.96%). In manuscript 02, ultra-processed foods responded for 18.3% of the current diet, while unprocessed and minimally processed foods responded for slightly less than half of the calories. The optimization suggests values for these groups of 9.1% and 69.4%, respectively, in the recommended diet. A 1.00% increase in the price of unprocessed or minimally processed food increased the DCII by 0.76% (less healthy diet), while a 1.00% increase in the price of ultra-processed food decreased the DCII by 0.70 % (healthy diet). The inverse association between the price of ultra-processed foods and DCII remained significant only among the low-income strata (-1.11%; p <0.05). In manuscript 03, the group of ultra-processed foods was the most expensive (R$6.51/Kg), followed by the groups of processed foods (R$6.44/Kg), and of unprocessed or minimally processed foods and processed culinary ingredients (R$3.45/kg) in 1995. Since the early 2000s, the price of ultra-processed foods underwent successive reductions, becoming cheaper than processed foods and reducing the distance between it and the price of the other group. Predictions indicated that unhealthy foods will become cheaper than healthy foods in 2026. Conclusion: The adoption of healthier eating practices can still be performed with the same or lower budget than the current diet. However, if nothing is done, the food prices in Brazil will change unfavorably considering the Brazilian Dietary Guidelines recommendations. Taxation of ultra-processed foods and subsidies for unprocessed or minimally processed foods are alternatives to favor the adoption of the Brazilian Dietary Guideline and to improve the dietary composition of the Brazilians.

Impact of an Australian state-wide active travel campaign targeting primary schools.

Active travel can have health and environmental benefits. This study evaluated the impact of a month-long (October 2015) campaign encouraging primary school children in Victoria, Australia to engage in active school travel. With support from local councils, schools participated in the campaign by monitoring active school travel and delivering promotional activities. A longitudinal study evaluated campaign impact. Carers (n = 715) of Victorian primary school children were recruited via social media and completed online surveys at baseline (T1; 0 wk) and during (T2; +2 wks) and after the campaign (T3; +6 wks). Carers reported their child's travel behaviour over the last five school days, and whether their child and/or their child's school participated in the campaign. Separate generalised linear models were used for T2 and T3 outcomes adjusting for T1 values and potential confounders. A greater proportion of children who participated in the campaign engaged in any active school travel at T2 (OR = 2.49, 95% CI = 1.63, 3.79) and T3 (1.62, 95% CI = 1.06, 2.46) compared with non-participating children. Similarly, these children had a higher frequency of active school travel at T2 (IRR = 1.60, 95% CI = 1.29, 1.97) and T3 (IRR = 1.45, 95% CI = 1.16, 1.80). Campaign participation resulted in small, short-term increases in active school travel.

Bariatric Surgery Offer in Brazil: a Macroeconomic Analysis of the Health system's Inequalities.

BACKGROUND: Brazil currently holds the second place in the worldwide ranking of the largest number of bariatric surgical procedures performed. The offer of bariatric surgery in the public health system is not sufficient for its demand; it remains to be determined whether the recent economic downturn affected this offer. OBJECTIVE: To analyze the proportion of bariatric surgeries performed by the public system in Brazil and assess the influence of macroeconomic variables over time. METHODS: This is a nationwide analysis which correlated the estimated number of bariatric surgeries in Brazil in both public and private health-providing systems from 2003 through 2017 with the main macroeconomic variables of Brazil during the evaluated period (gross domestic product [GDP], inflation rate, and unemployment rate), and both overall and public healthcare expenditures. RESULTS: The proportion of surgeries performed in the public system varied from 7.1% in 2014 to 10.4% in 2004. There was a significant positive correlation between the public proportion of surgeries with the unemployment rate (R = 0.55666; P = 0.03868). There were significant negative correlations between the proportion of public surgeries with the public health expenditure per capita (R = - 0.88811; P = 0.00011) and with the public percentage of healthcare expenditure per capita (R = - 0.67133; P = 0.01683). CONCLUSION: There were direct correlations between the number of public bariatric procedures and the unemployment rate, as well as with the public healthcare expenditure per capita. Despite the increase in the number of public procedures, its proportion reveals an insufficiency of the current offer of bariatric surgery provided by the public system.

Hypertension bearers with high risk/big risk of cardiovascular diseases and socioeconomic and health indicators

SUMMARY OBJECTIVE To correlate the number of hypertensive patients with high and very high risk for cardiovascular diseases with socioeconomic and health indicators. METHODS An ecological study carried out from the National Registry of Hypertension and Diabetes (SisHiperDia). The variable "hypertensive patients with high and very high risk" was correlated with the Human Development Index, health care costs and services, average household income per capita, per capita municipal income, number of hospital admissions in SUS, number of medical consultations in the SUS and specific mortality due to diseases of the circulatory system, considering the 27 federative units of Brazil. The data was processed in software IBM Statistical Package for the Social Sciences (SPSS) Statistics, version 22.00. The statistical analysis considered the level of significance p<0.05. RESULTS Brazilian states with more hypertensive registries in high/very high risk spend more on public health, fewer people reach the elderly age group and more deaths from diseases of the circulatory system (p<0.05). The very high risk stratum correlated with more physicians per population (p<0.05). CONCLUSION: Systemic arterial hypertension has a direct impact on life expectancy and also on the economic context, since when it evolves to high and very high risk for cardiovascular diseases, it generates more expenses in health and demand more professionals, burdening the public health system. Monitoring is necessary in order to consolidate public policies to promote the health of hypertensive individuals.

RESUMO OBJETIVO Correlacionar o número de cadastros de hipertensos com risco alto e muito alto para doenças cardiovasculares com os indicadores socioeconômicos e de saúde. MÉTODOS Estudo ecológico realizado a partir do Sistema Nacional de Cadastro de Hipertensão e Diabetes (SisHiperDia). A variável "hipertensos com risco alto e muito alto" foi correlacionada ao Índice de Desenvolvimento Humano, gastos com ações e serviços de saúde, renda média domiciliar per capita, renda municipal per capita, número de internações hospitalares no SUS, número de consultas médicas no SUS e mortalidade específica por doenças do aparelho circulatório, considerando as 27 unidades federativas do Brasil. Os dados foram processados no software IBM Statistical Package for the Social Sciences (SPSS) Statistics, versão 22.00. A análise estatística considerou o nível de significância p < 0,05. RESULTADOS Estados brasileiros com mais cadastros de hipertensos em riscos alto/muito alto gastam mais na saúde pública, menos pessoas alcançam a faixa etária idosa e há mais mortes por doenças do aparelho circulatório (p < 0,05). O estrato de risco muito alto correlacionou com mais médicos por habitantes (p < 0,05). CONCLUSÃO A hipertensão arterial sistêmica impacta diretamente a expectativa de vida e também o contexto económico, pois, quando evolui para risco alto e muito alto, para as doenças cardiovasculares, gera mais gastos em saúde e demanda mais profissionais, onerando o sistema público de saúde. É necessário monitoramento, em busca da consolidação das políticas públicas de promoção da saúde dos hipertensos.

Nationwide Macroeconomic Variables and the Growth Rate of Bariatric Surgeries in Brazil.

BACKGROUND: The effect of nationwide economic issues on the necessary expansion in the number of bariatric procedures remains unclear. OBJECTIVE: This study aims to determine whether there are correlations between the growth rate in the number of bariatric surgeries and the major macroeconomic variables over time in Brazil. METHODS: It is a nationwide analysis regarding the number of bariatric surgeries in Brazil and the main national macroeconomic variables from 2003 through 2016: gross domestic product (GDP), inflation rate, and the unemployment rate, as well as the evolution in the number of registered bariatric surgeons. RESULTS: There were significant positive correlations of the growth rate of surgeries with the early variations of the GDP (R = 0.5558; p = 0.04863) and of the overall health expenditure per capita (R = 0.78322; p = 0.00259). The growth rate of the number of bariatric surgeries was not correlated with the unemployment and inflation rates, as well as with the growth rate of available bariatric surgeons. CONCLUSION: There were direct relationships between the growth rate of bariatric surgeries and the evolutions of the GDP and health care expenditure per capita. These variables appear to influence the nationwide offer of bariatric surgery.

Predictors and correlates of serum 25-hydroxyvitamin D concentrations in young women: results from the Safe-D study.

Vitamin D deficiency is a global public health concern. Studies of serum 25-hydroxyvitamin D (25(OH)D) determinants in young women are limited and few include objective covariates. Our aims were to define the prevalence of vitamin D deficiency and examine serum 25(OH)D correlates in an exploratory study of women aged 16-25 years. We studied 348 healthy females living in Victoria, Australia, recruited through Facebook. Data collected included serum 25(OH)D assayed by liquid chromatography-tandem MS, relevant serum biochemistry, soft tissue composition by dual-energy X-ray absorptiometry, skin melanin density, Fitzpatrick skin type, sun exposure using UV dosimeters and lifestyle factors. Mean serum 25(OH)D was 68 (sd 27) nmol/l and 26 % were vitamin D deficient (25(OH)D 2 h in the sun in summer daily, holidaying in the most recent summer period, serum Fe levels, height and multivitamin use were positively associated with 25(OH)D. Fat mass and a blood draw in any season except summer was inversely associated with 25(OH)D. Vitamin D deficiency is common in young women. Factors such as hormonal contraception, sun exposure and sun-related attitudes, as well as dietary supplement use are essential to consider when assessing vitamin D status. Further investigation into methods to safely optimise vitamin D status and to improve understanding of the impact of vitamin D status on long-term health outcomes is required.

[Relevance of the socioeconomic and health context in patient satisfaction]. / Relevancia del contexto socioeconómico y sanitario en la satisfacción del paciente.

OBJECTIVE: To determine which factors of the socioeconomic and health contexts influence the perception of the satisfaction of the population with the health services. METHODS: The data come from the European Health Survey of 2009. In the 22,188 subjects surveyed, the relationship between the perception of satisfaction with the health services received and the individual and contextual variables was studied, applying a multilevel analysis. RESULTS: The factors of the socioeconomic and health contexts that influence satisfaction are: higher rates of low level of studies where the perception of excellence is less likely (odds ratio [OR]: 0.48-0.82) and dissatisfaction is more prevalent (OR: 1.46-1.63). Likewise, the proportion of unsatisfied citizens is lower when per capita expenditure on health services is very high (>1400 €) (OR: 0.49-0.87) and the ratio "primary health care physicians/inhabitants" is high (>60) (OR: 0.500.85). In addition, the prevalence of dissatisfaction describes a positive linear trend with the unemployment rate (OR: 1.12; p=0.0001) and the relative magnitude of the services sector (OR: 1.03; p=0.001). By contrast, this linear trend is negative as the Health Care Coverage Ratio increases (OR: 0.88; p=0.04). CONCLUSIONS: The individual factors that determine patient satisfaction are: sex, age, mental health and country of birth. In addition, there are differences in patient satisfaction among the autonomous communities according to socio-economic determinants such as GDP per capita, low-level study rates, unemployment rates or number of inhabitants/doctor's ratio. User satisfaction studies as well as being adjusted for individual variables such as sex, age or health level should also take into account characteristics of the socioeconomic environment of the geographic area where they reside.

Alimentação de estudantes: associação com fatores individuais, familiares, comportamentais e indicadores socioeconômicos / Food consumption of students: association with individual, family, behavioral and socioeconomic indicators

A alimentação na adolescência possui múltiplos determinantes individuais e contextuais, cujo monitoramento em sistemas de vigilância pode subsidiar políticas públicas mais efetivas. Deste modo, esta tese objetivou investigar a alimentação de estudantes e sua relação com fatores individuais, familiares, comportamentais e indicadores macroeconômicos. Para isto, apresenta três artigos: 1) “Consumption of sugar-rich food products among Brazilian students: National School Health Survey (PeNSE 2012)”; 2) “Coexistence of risk behaviors for being overweight among Brazilian adolescents”; e 3) “Marcadores do consumo alimentar saudável e não saudável e indicadores macroeconômicos: Análise de estudantes de 74 países”. Os dois primeiros artigos possuem delineamento transversal e utilizaram dados de amostra representativa de estudantes brasileiros, de escolas públicas e privadas, de áreas urbanas e rurais, avaliados na Pesquisa Nacional de Saúde do Escolar (PeNSE 2012). No Artigo 1, analisou-se o consumo de alimentos ricos em açúcar (guloseimas e refrigerantes) entre estudantes brasileiros e foram identificados os fatores associados a esse consumo. No segundo artigo, avaliou-se a magnitude e os aspectos relacionados à coexistência de comportamentos de risco para o excesso de peso (comportamento sedentário, consumo regular de alimentos ricos em açúcar e frituras, e irregular de frutas, verduras e legumes). O Artigo 3, de delineamento ecológico, foi realizado a partir de amostras representativas de estudantes brasileiros (Amostra 2 - PeNSE 2015) e de outros 73 países avaliados pela Global School-Based Student Health Survey (GSHS). O seu objetivo foi comparar as prevalências de consumo diário de marcadores de alimentação saudável (frutas, verduras e legumes) e não saudável (refrigerantes) entre estudantes destes 74 países, segundo indicadores macroeconômicos. O consumo regular de alimentos rico...

Adolescent food consumption has multiple individual and contextual determinants, whose monitoring in surveillance systems can support public policies that are more effective. Therefore, this thesis aimed to investigate the food consumption of students and its relation with individual, family, behavioral, and macroeconomic indicators. For this, it presents three articles: 1) "Consumption of sugar-rich food products among Brazilian students: National School Health Survey (PeNSE 2012)"; 2) "Coexistence of risk behaviors for being overweight among Brazilian adolescents"; and 3) "Markers of healthy and unhealthy food consumption and macroeconomic indicators: Analysis of students from 74 countries". The first two articles present a cross-sectional design and used from a representative sample of Brazilian students from public and private schools in urban and rural areas, evaluated in the National School Health Survey (PeNSE 2012). In article 1, the objective was to analyze the consumption of sugary foods (sweets and soft drinks) among Brazilian students and to identify the associated factors. The second article evaluated the magnitude and the aspects associated with the coexistence of risk behaviors for being overweight (sedentary behavior, regular consumption of sugary and fried foods, and irregular fruits and vegetables). Article 3 has an ecological design and was based on representative samples of Brazilian students (Sample 2 - PeNSE 2015) and from 73 other countries evaluated in the Global School-Based Student Health Survey (GSHS). The objective of this study was to compare the prevalence of daily consumption of healthy (fruits and vegetables) and unhealthy (soft drinks) food markers among students from these 74 countries, according to macroeconomic indicators. The regular consumption of sugary foods (sweets or soft drinks) was verified among 36.1% of Brazilian adolescents, and was higher among girls, 14-15 years old students, with higher maternal education...

Relationship between suicide rate and economic growth and stock market in the People's Republic of China: 2004-2013.

OBJECTIVES: The objective of this study was to estimate the features of suicide rate and its association with economic development and stock market during the past decade in the People's Republic of China. METHODS: Official data were gathered and analyzed in the People's Republic of China during the period 2004-2013. Nationwide suicide rate was stratified by four year age-groups, sex, urban/rural areas, and regions (East, Central, and West). Annual economic indexes including gross domestic product (GDP) per capita and rural and urban income per capita were all adjusted for inflation. Variation coefficient of market index (VCMI) was also included as an economic index to measure the fluctuation of the stock market. Negative binomial regression was performed to examine the time trend of region-level suicide rates and effects of sex, age, urban/rural area, region, and economic index on the suicide rates. RESULTS: Suicide rates of each age-group, sex, urban/rural area, and region were generally decreased from 2004 to 2013, while annual GDP per capita and rural and urban income per capita were generally increased by year. VCMI fluctuated largely, which peaked around 2009 and decreased after that time. Negative binomial regression showed that the decreased suicide rate in East and Central rural areas was the main cause of the decrease in suicide rate in the People's Republic of China. Suicide rate in the People's Republic of China for the study period increased with age and was higher in rural than in urban area, higher in males than in females, and the highest in the Central region. When GDP per capita increased by 2,787 RMB, the suicide rate decreased by 0.498 times. VCMI showed no significant relationship with suicide rate in the negative binomial regression. CONCLUSION: Suicide rate decreased in 2004-2013; varied among different age-groups, sex, urban/rural areas, and regions; and was negatively associated with the economic growth in the People's Republic of China. Stock market showed no relationship with suicide rate, but this finding needs to be verified in a future study.

Progression of Mortality due to Diseases of the Circulatory System and Human Development Index in Rio de Janeiro Municipalities / Evolução da Mortalidade por Doenças do Aparelho Circulatório e do Índice de Desenvolvimento Humano nos Municípios do Estado do Rio de Janeiro

Abstract Background: Diseases of the circulatory system (DCS) are the major cause of death in Brazil and worldwide. Objective: To correlate the compensated and adjusted mortality rates due to DCS in the Rio de Janeiro State municipalities between 1979 and 2010 with the Human Development Index (HDI) from 1970 onwards. Methods: Population and death data were obtained in DATASUS/MS database. Mortality rates due to ischemic heart diseases (IHD), cerebrovascular diseases (CBVD) and DCS adjusted by using the direct method and compensated for ill-defined causes. The HDI data were obtained at the Brazilian Institute of Applied Research in Economics. The mortality rates and HDI values were correlated by estimating Pearson linear coefficients. The correlation coefficients between the mortality rates of census years 1991, 2000 and 2010 and HDI data of census years 1970, 1980 and 1991 were calculated with discrepancy of two demographic censuses. The linear regression coefficients were estimated with disease as the dependent variable and HDI as the independent variable. Results: In recent decades, there was a reduction in mortality due to DCS in all Rio de Janeiro State municipalities, mainly because of the decline in mortality due to CBVD, which was preceded by an elevation in HDI. There was a strong correlation between the socioeconomic indicator and mortality rates. Conclusion: The HDI progression showed a strong correlation with the decline in mortality due to DCS, signaling to the relevance of improvements in life conditions.

Resumo Fundamentos: As doenças do aparelho circulatório (DAC) são a principal causa de morte no Brasil e no Mundo. Objetivo: Correlacionar taxas de mortalidade compensadas e ajustadas por DAC nos Municípios do Estado do Rio de Janeiro (ERJ) entre 1979 e 2010 com o Índice de Desenvolvimento Humano (IDH) a partir de 1970. Métodos: Populações e óbitos obtidos no DATASUS/MS. Calcularam-se taxas de mortalidade por Doenças Isquêmicas do Coração (DIC), Doenças Cerebrovasculares (DCBV) e DAC ajustadas pelo método direto e compensadas por causas mal definidas. Dados de IDH foram obtidos no Instituto de Pesquisas Econômicas Aplicadas. As taxas de mortalidade e o IDH foram correlacionados pela estimação de coeficientes lineares de Pearson. Os coeficientes de correlação entre as taxas de mortalidade dos anos censitários de 1991, 2000 e 2010 e IDH nos anos censitários de 1970, 1980 e 1991 foram calculados com a defasagem de dois censos demográficos. Foram estimados os coeficientes de inclinação da regressão entre a variável dependente doença e a variável independente IDH. Resultados: Nas últimas décadas, houve redução da mortalidade por DAC em todos os municípios do ERJ principalmente por queda da mortalidade por DCBV e foi precedida por elevação do IDH, havendo forte correlação entre o indicador socioeconômico e as taxas de mortalidade. Conclusão: A variação evolutiva do IDH demonstrou elevada correlação com a redução da mortalidade por DAC. Essas relações sinalizam a importância na melhoria das condições de vida da população para reduzir a mortalidade cardiovascular.

Spatial regression with covariate measurement error: A semiparametric approach.

Spatial data have become increasingly common in epidemiology and public health research thanks to advances in GIS (Geographic Information Systems) technology. In health research, for example, it is common for epidemiologists to incorporate geographically indexed data into their studies. In practice, however, the spatially defined covariates are often measured with error. Naive estimators of regression coefficients are attenuated if measurement error is ignored. Moreover, the classical measurement error theory is inapplicable in the context of spatial modeling because of the presence of spatial correlation among the observations. We propose a semiparametric regression approach to obtain bias-corrected estimates of regression parameters and derive their large sample properties. We evaluate the performance of the proposed method through simulation studies and illustrate using data on Ischemic Heart Disease (IHD). Both simulation and practical application demonstrate that the proposed method can be effective in practice.

Long-term weight gain and economic impact in pigs castrated under local anaesthesia.

Castration is a controversial practice in swine production because in some countries is still performed without anaesthesia, and therefore causes intense suffering and stress to animals. This study investigated the effect of pre-surgical administration of local anaesthesia (LA) on the growth performance of piglets until the end of the growth phase (102 days). Piglets aged 3 to 5 days were selected in pairs of similar weights and same age. They were originated from 22 litters. The groups were randomly assigned to one of two treatments. Castration was performed with (LA; n = 45) or without (NLA; n = 45) intra-testicular administration of 0.5 mL of 2% lidocaine plus adrenaline per testicle, administered by an automatic repeating vaccinator. Castration was performed 10 min later. Average daily weight gain and economic impact were evaluated between the intervals before castration until 21 (weaning phase), before castration until 60 (end of the initial nursery phase) and before castration until 102 (growth phase) days of age. Average daily weight gain data were analyzed by comparing the average daily weight gain between the weaning phase, 60 and 102 days of age versus the initial weight (pre-castration). At the end of the growing phase, animals treated with LA showed greater weight gain than animals castrated without anaesthesia. LA also showed improved cost:benefit ratio and theore might provide greater economic benefit under the conditions used in this study. Our findings have proved that castration with LA improves long-term weight gain of piglets.

Medición simplificada del nivel socioeconómico en encuestas breves: propuesta a partir de acceso a bienes y servicios / Simplified indicator of socioeconomic status in short surveys: a proposal based on assets and services

Objetivo. Desarrollar un indicador socioeconómico para encuestas breves que permita una clasificación en relación con un criterio poblacional y que resulte parsimonioso. Material y métodos. Se generó un indicador socioeconómico a partir de variables dicotómicas de bienes y servicios. Se obtuvo la correlación de los resultados obtenidos de la Encuesta Nacional de Ingresos y Gastos en los Hogares ENIGH con los de una encuesta breve y se les comparó con los de un indicador construido a partir de un conjunto mayor de variables. Resultados. La concordancia para los quintiles 1, 2, 3, 4 y 5 del indicador amplio y el parsimonioso son 94, 94, 82, 83 y 89%, respectivamente. El coeficiente de correlación por rangos de Spearman fue de 0.85. Conclusiones. El indicador parsimonioso propuesto captura la heterogeneidad del nivel socioeconómico en la encuesta probada. Se sugiere su uso para encuestas breves debido a sus ventajas: a) se elabora con variables dicotómicas; b) las variables base no implican el cumplimiento de algún supuesto estadístico; c) es fácilmente calculado, y d) se puede utilizar para comparar grupos.

Objective. To develop a socioeconomic index for brief surveys that allows a classification in relation to a reference population with a parsimonious approach. Materials and methods. A socioeconomic index was created using assets and use of services indicators to predict income level within a national representative survey of income (ENIGH, National Survey of Households Income and Expenditures) and then tested with data from a survey among key populations (men who have sex with men/transvestite, transgender, transsexual/female sex workers) and compared to an already published indicator. Results. The concordance for quintiles 1, 2, 3, 4, and 5 between the two indexes were 94, 94, 82, 83, and 89%, respectively. The Spearman's rank correlation coefficient was 0.85. Conclusions. The proposed parsimonious index captures the socioeconomic level heterogeneity in the MSM/TTT/FSW survey. The use of this index is suggested for short surveys because of the next advantages: a) it uses dichotomic variables; b) the variables used do not imply the fulfillment of any statistical assumption; c) it is easily calculated; d) it can be used for comparing groups.

Rationale and study protocol for the 'active teen leaders avoiding screen-time' (ATLAS) group randomized controlled trial: an obesity prevention intervention for adolescent boys from schools in low-income communities.

INTRODUCTION: The negative consequences of unhealthy weight gain and the high likelihood of pediatric obesity tracking into adulthood highlight the importance of targeting youth who are 'at risk' of obesity. The aim of this paper is to report the rationale and study protocol for the 'Active Teen Leaders Avoiding Screen-time' (ATLAS) obesity prevention intervention for adolescent boys living in low-income communities. METHODS/DESIGN: The ATLAS intervention will be evaluated using a cluster randomized controlled trial in 14 secondary schools in the state of New South Wales (NSW), Australia (2012 to 2014). ATLAS is an 8-month multi-component, school-based program informed by self-determination theory and social cognitive theory. The intervention consists of teacher professional development, enhanced school-sport sessions, researcher-led seminars, lunch-time physical activity mentoring sessions, pedometers for self-monitoring, provision of equipment to schools, parental newsletters, and a smartphone application and website. Assessments were conducted at baseline and will be completed again at 9- and 18-months from baseline. Primary outcomes are body mass index (BMI) and waist circumference. Secondary outcomes include BMI z-scores, body fat (bioelectrical impedance analysis), physical activity (accelerometers), muscular fitness (grip strength and push-ups), screen-time, sugar-sweetened beverage consumption, resistance training skill competency, daytime sleepiness, subjective well-being, physical self-perception, pathological video gaming, and aggression. Hypothesized mediators of behavior change will also be explored. DISCUSSION: ATLAS is an innovative school-based intervention designed to improve the health behaviors and related outcomes of adolescent males in low-income communities.

Impacto económico de la variación del precio de leche: Caso: Un caso en la finca lechera de Santa Bárbara de Barinas, Venezuela / Economic impact in milk price changes case: A case of a dairy farm in Santa Bárbara de Barinas, Venezuela

El objetivo de esta investigación fue determinar el impacto económico de la variación del precio de leche en una finca lechera de Santa Bárbara de Barinas, estado Barinas, Venezuela. La metodología se basó en entrevistas, verificación de datos y revisión de informes. El período de estudio comprendió desde el 01 de enero al 31 de diciembre de 2011. El resultado económico consideró el valor y la estructura de costos de la producción y los indicadores de rentabilidad. Los resultados arrojaron que los costos de producción fueron distribuidos así: costos fijos (44%); costos variables (56%). Los insumos de mayor impacto económico fueron: alimento concentrado (47,29%) y mano de obra (26,60%). El costo de producción unitario de 1 litro de leche en bolívares (Bs./L) pasó de 2,62 a 2,43 Bs./L, desde el período enero-septiembre a octubre-diciembre 2011, respectivamente, variando el precio de venta unitario de 2,50 a 3,60 Bs./L en los períodos señalados. En consecuencia, hubo pérdidas económicas en el primer período, las cuales fueron compensadas con los ingresos procedentes de la venta de leche durante el segundo período, alcanzando ingresos netos (IN) de 80,98 miles de Bs./año. Con la venta de becerros y algunos animales de descarte, el IN total alcanzó los 88,69 miles de Bs./año. Se concluye, que bajo este esquema de regulación de precios del sector lechero, el sistema de producción de ganadería no es sostenible, pues sólo permite generar una relación beneficio/costo de 1,10; con una rentabilidad en la inversión del 3,03%. Se recomienda que el Estado venezolano establezca las medidas correctivas en el sector ganadero, para recuperarse de la crisis económica actual. Finalmente, el productor debe mantener un registro actualizado de costos, que podría ser utilizado como información de base, para la toma de decisiones sobre el negocio ganadero.

The purpose of this research was to determine the economic impact of the variations in the price of milk in a dairy farm, located in Santa Bárbara de Barinas, the State of Barinas, in Venezuela. The methodology used was interviews, data verification and reports review. The study period comprised from January 1 to December 31, 2011. The financial analysis considered both the value and structure of production costs, and the profitability indicators. The results showed that the production costs were distributed, as follows: fixed costs (44%) and variable costs (56%); the inputs with the greatest economic impact were concentrated food (47.29%) and labor cost (26.60%). The unit cost of production of 1 L of milk (Bs/L) decreased from 2.62 Bs./L to 2.43 Bs./L from the periods January-September to October-December 2011, respectively, with an increase in the unit selling price from 2.50 to 3.60 Bs./L in the periods indicated. Consequently, there were economic losses in the first period, which were set off with the incomes from the milk sales in the second period, reaching a net income (NI) of up to 80.98 thousand Bs./year. Adding the revenue from the sale of calves and some discarded animals, the total NI was 88.69 thousand Bs./year. It is concluded that, under the current scheme of price regulation in the dairy sector, the livestock production system is not sustainable, as it only generates a benefit/cost ratio of 1.10, with a return on investment of 3.03%. It is recommended that the Venezuelan Government establish corrective measures in the livestock sector to recover from the current economic crisis. Finally, the producer must keep an updated cost structure that can be used as a baseline information for the decision-making of the cattle business.