Association between sleep problems and functional disability in community-dwelling older adults.

BACKGROUND: Sleep problems are frequently observed in older adults. They can lead to changes in the individual's physical, occupational, cognitive, and social functioning, compromising the performance of activities of daily living and contributing to the occurrence of functional disability. This study evaluated the association between sleep problems and functional disability in community-dwelling older adults. METHODS: This was a cross-sectional study with data from 10,507 Brazilian community-dwelling older adults participating in the 2013 National Health Survey. The exposure variable was self-reported sleep problems in the last two weeks. The outcome measure was functional disability assessed from self-reported questionnaires, categorized into basic activities of daily living (BADL) and instrumental activities of daily living (IADL), and defined as not being able to perform or having little or a lot of difficulty in at least one of the activities investigated in the domain of interest. RESULTS: Older adults who reported sleep problems had 1.53 (95%CI: 1.34; 1.75) and 1.42 (95%CI: 1.26; 1.59) greater odds of having a disability in BADL and IADL when compared to individuals who reported having no sleep problems. CONCLUSIONS: Older adults with sleep problems were more likely to have a functional disability, both in BADL and IADL. Thus, it is important to implement strategies to screen for sleep problems in older adults in primary health care as a preventive strategy for functional disability.

Association between sleep problems and multimorbidity patterns in older adults.

BACKGROUND: Sleep problems are frequent in older adults and are associated with chronic diseases. However, the association with multimorbidity patterns is still unknown. Considering the negative impacts that multimorbidity patterns can have on older adults' life, knowledge of this association can help in the screening and early identification of older adults with sleep problems. The objective was to verify the association between sleep problems and multimorbidity patterns in older Brazilian adults. METHODS: This was a cross-sectional study conducted with data from 22,728 community-dwelling older adults from the 2019 National Health Survey. The exposure variable was self-reported sleep problems (yes/no). The study outcomes were: multimorbidity patterns, analyzed by self-report of the coexistence of two or more chronic diseases with similar clinical characteristics: (1) cardiopulmonary; (2) vascular-metabolic; (3) musculoskeletal; (4) coexisting patterns. RESULTS: Older adults with sleep problems had 1.34 (95%CI: 1.21; 1.48), 1.62 (95%CI: 1.15; 2.28), 1.64 (95%CI: 1.39; 1.93), and 1.88 (95%CI: 1.52; 2.33) greater odds of presenting vascular-metabolic, cardiopulmonary, musculoskeletal, and coexisting patterns, respectively. CONCLUSIONS: These results suggest that public health programs aimed at preventing sleep problems in older adults are essential to reduce possible adverse health outcomes, including multimorbidity patterns and their negative consequences for older adults' health.

Time trends in the prevalence of breastfeeding among schoolchildren from public and private schools in Florianópolis, Southern Brazil: From 2002 to 2013.

OBJECTIVE: To describe breastfeeding trends from 2002 to 2012/2013, and to investigate whether breastfeeding practices differ between mothers of children in public and private schools. METHODS: Data were obtained from three school-based cross-sectional studies conducted with 7 to 10 years old children. The total sample was 7264 individuals. Data related to breastfeeding were analyzed descriptively and compared using the chi-square test for heterogeneity or trend. RESULTS: In the 10-year period was observed a decrease in the total percentage of schoolchildren who were not breastfed (12.9%-10.5%) and an increase in the percentage of schoolchildren breastfed for >12 months (23.9%-36.7%). In public schools, the increase of breastfeeding for >12 months was independent of maternal age and years of schooling. In private schools, the increase was observed for schoolchildren born to older mothers and to more educated mothers, although the highest percentage was observed for schoolchildren born to less educated mothers. CONCLUSIONS: The results confirm the complexity of determining breastfeeding behaviors, and understanding these dynamics is fundamental to develop and improve programs and actions aimed at encouraging, supporting, and protecting breastfeeding. However, strategies developed in Brazil during the first decade of the 21st century should explain the increase of proportion of breastfed children for more than 12 months, and the concomitant decrease of never breastfeed children in the city of Florianopolis (Southern Brazil).

Education and Income Levels are Associated With Energy and Micronutrient Intake.

Introduction: According to the literature, education and income are determinants factors of diet quality and consequently of micronutrient intake. However, this association is still little known among adults who live in middle-income countries. Objective: To estimate energy and micronutrients intake by men and women living in a capital city in southern Brazil, according to education and income levels, and to identify prevalence of inadequate micronutrient intake according also to education and income levels. Method: This is a second wave cross-sectional analysis of a population-based longitudinal study, the EpiFloripa Adultos, including 1,222 individuals of 22-63 years. Data on food consumption were obtained through applying two 24-hour dietary recalls, and the prevalence of inadequate micronutrient intake, following the recommendations of the Institute of Medicine and from the National Research Council. Results: A tendency of increased intake with an increase in income (calcium, vitamins C, E) and education levels (calcium, vitamins A, C, D) was observed for most of the micronutrients analyzed (p<0.05 in all cases); still, a prevalence of inadequacy according to Estimated Average Requirement (EAR) between 85.5-100% in intake of vitamins A, D and E were found for the whole sample. Iron inadequate intake was associated with education level and among women less than 50 years of age (p=0.018). Conclusion: The results showed an influence of the education and income levels on micronutrient intake, point to the need of daily food consumption, of minimally processed and in natura foods (as fruits, vegetables, whole grains, milk and its derivatives) as a means to reduce the encountered inadequacies.

[Screen time, obesity and cardiovascular disease among elderly Brazilians: 2013 and 2019 National Health Surveys]. / Tempo de televisão, obesidade e doenças cardiovasculares em idosos brasileiros: Pesquisas Nacionais de Saúde 2013 e 2019.

The scope of this paper was to analyze the association between the time spent watching television (TV) and the presence of obsessive-compulsive disorder (OCD) obesity and obesity associated with cardiovascular diseases (CVD) among elderly Brazilians, according to gender, comparing data from the 2013 and 2019 National Health Surveys (NHS). It involved a cross-sectional study, with data from 23,815 and 43,554 elderly people, respectively, from the 2013 and 2019 NHS. Self-reported TV screen time was categorized into: <3, 3-6, and ≥6 per day. Obesity was assessed by body mass index ≥27 kg/m² and CVD by self-reported medical diagnosis. In 2013, elderly women who watched TV ≥6 hours/day were more likely to have OCD obesity (OR=1.87; 95%CI=1.32;2.64) and obesity associated with CVD (OR=6.30; 95%CI=3.38;11.74). In 2019, elderly women who watched TV between 3-6 hours/day (OR=1.44; 95%CI=1.25;1.65) and ≥6 hours/day (OR=1.55; 95%CI=1.28;1.88) were more likely to have OCD obesity, while the incidence of obesity associated with CVD was higher for ≥6 hours/day (OR=2.13; 95%CI=1.48;3.06). In 2019, men were more likely to have obesity associated with CVD watching TV between 3-6 hours/day (OR=1.76; 95%CI=1.20;2.56) and ≥6 hours/day (OR=2.13; 95%CI=1.27;3.57). The importance of reducing screen time by the elderly is clearly evident.

Objetivou-se analisar a associação entre tempo assistindo televisão (TV) e a presença de obesidade isolada e associada às doenças cardiovasculares (DCV) de idosos brasileiros, conforme o sexo, comparando-se os dados das Pesquisas Nacionais de Saúde 2013 e 2019. Estudo transversal, com dados de 23.815 e 43.554 idosos das PNS 2013 e 2019, respectivamente. O autorrelato do tempo assistindo à TV foi categorizado em: <3, 3-6 e ≥6 horas diárias. A obesidade isolada foi avaliada pelo índice de massa corporal ≥27 kg/m² e a DCV pelo autorrelato de diagnóstico médico. Em 2013, as idosas que assistiam à TV ≥6 horas/dia apresentaram maiores chances de obesidade isolada (OR=1,87; IC95%=1,32;2,64) e associada à DCV (OR=6,30; IC95%=3,38;11,74). Em 2019, as idosas que assistiam à TV entre 3-6 horas/dia (OR=1,44; IC95%=1,25;1,65) e ≥6 horas/dia (OR=1,55; IC95%=1,28;1,88) tiveram maiores chances de obesidade isolada, já as chances de obesidade associada à DCV, foram maiores para ≥6 horas/dia (OR=2,13; IC95%=1,48;3,06). Em 2019, os homens tiveram maiores chances de obesidade associada às DCV assistindo à TV entre 3-6 horas/dia (OR=1,76; IC95%=1,20;2,56) e ≥6 horas/dia (OR=2,13; IC95%=1,27;3,57). Evidencia-se a importância em diminuir o tempo assistindo à TV dos idosos.

[Are different typologies of sedentary behavior associated with history of sleep problems in community-dwelling elderly?] / As diferentes tipologias do comportamento sedentário estão associadas ao histórico de problemas no sono em idosos comunitários?

Alterations in sleep are common in older persons, and some risk factors may aggravate this condition. Understanding the association between sedentary behavior and history of sleep problems can assist the elaboration of intervention programs. The study aimed to verify the association between typologies of sedentary behavior and history of sleep problems in community-dwelling older Brazilians. A cross-sectional study was performed with data from 43,554 older persons participating in the Brazilian National Health Survey (2019). Typologies of sedentary behavior were assessed by: (1) time watching television; (2) leisure-time inactivity; and (3) total inactivity (TV + leisure-time inactivity). Sedentary behavior was categorized as < 3, 3-6, and > 6 hours/day. The outcome was history of sleep problems (difficulty falling asleep, waking up frequently at night, or sleeping more than usual) assessed by self-report in the last 15 days. Associations were verified with multivariate logistic regression. Older persons that spent more 6 hours/day watching TV had 13% higher odds (OR = 1.13, 95%CI: 1.02; 1.26) of reporting sleep problems. For total sedentary behavior, older persons that were inactive 3-6 hours and more than 6 hours/day showed 13% (OR = 1.13; 95%CI: 1.04; 1.22) and 11% (OR = 1.11; 95%CI: 1.01; 1.23) higher odds of sleep problems, respectively. Older persons in the sample that reported more than 6 hours a day watching TV and > 3 hours in total sedentary behavior had higher odds of sleep problems. The findings call attention to the need to reduce sedentary behavior in the elderly.

Alterações no sono são comuns em idosos e alguns fatores de risco podem agravar essa condição. Entender a associação do comportamento sedentário com o histórico de problemas de sono poderá auxiliar na elaboração de programas de intervenção. Verificar a associação entre tipologias do comportamento sedentário e histórico de problemas no sono em idosos comunitários brasileiros. Estudo transversal, com dados de 43.554 idosos participantes da Pesquisa Nacional de Saúde (PNS), de 2019. As tipologias do comportamento sedentário foram avaliadas por: (1) tempo assistindo televisão; (2) atividades de lazer; e (3) tempo despendido total (televisão + lazer). O comportamento sedentário foi categorizado em < 3; 3-6 e > 6 horas/dia. O desfecho foi histórico de problemas de sono (dificuldade para adormecer, acordar frequentemente à noite ou dormir mais do que de costume) avaliados por meio do autorrelato nos últimos 15 dias. As associações foram verificadas pela regressão logística multivariável. Idosos que permaneceram tempo > 6 horas/dia em comportamento sedentário assistindo televisão tiveram 13% (OR = 1,13; IC95%: 1,02; 1,26) maiores probabilidades de relatarem problemas de sono. Referente ao comportamento sedentário total, idosos que permaneceram entre 3-6 horas e mais do que 6 horas/dia apresentaram 13% (OR = 1,13; IC95%: 1,04; 1,22) e 11% (OR = 1,11; IC95%: 1,01; 1,23) maiores probabilidades de problemas de sono, respectivamente. Os idosos amostrados que relataram permanecer por períodos superiores a 6 horas por dia em comportamento sedentário assistindo à televisão e > 3 horas em comportamento sedentário total tiveram maiores chances de terem problemas no sono. Estes achados podem contribuir nas orientações sobre a necessidade de redução no comportamento sedentário em idosos.

Las alteraciones en el sueño son comunes en ancianos y algunos factores de riesgo pueden agravar esa condición. Entender la asociación del comportamiento sedentario con el historial de problemas de sueño podrá ayudar en la elaboración de programas de intervención. El objetivo fue verificar la asociación entre tipologías del comportamiento sedentario y el historial de problemas en el sueño en ancianos de comunidades con pocos recursos brasileños. Estudio transversal, con datos de 43.554 ancianos participantes en la Encuesta Nacional de Salud (2019). Las tipologías del comportamiento sedentario se evaluaron por el: (1) Tiempo viendo televisión; (2) Actividades de ocio y (3) Tiempo invertido en total (televisión + ocio). El comportamiento sedentario se categorizó en < 3; 3-6 y > 6 horas/día. El resultado fue el historial de problemas de sueño (dificultad para dormirse, despertarse frecuentemente por la noche o dormir más que de costumbre), evaluados a través del autoinforme en los últimos 15 días. Las asociaciones se verificaron a través de una regresión logística multivariable. Los ancianos que permanecieron tiempo > 6 horas/día en comportamiento sedentario viendo televisión tuvieron un 13% (OR = 1,13; IC95%: 1,02; 1,26) de mayores probabilidades de que informaran problemas de sueño. En lo referente al comportamiento sedentario total, los ancianos que permanecieron entre 3-6 horas y más de 6 horas/día presentaron un 13% (OR = 1,13; IC95%: 1,04; 1,22) y un 11% (OR = 1,11; IC95%: 1,01; 1,23) mayores probabilidades de problemas de sueño, respectivamente. Los ancianos de la muestra que informaron permanecer por períodos superiores a 6 horas al día en comportamiento sedentario viendo televisión y > 3 horas en comportamiento sedentario total tuvieron mayores probabilidades de tener problemas de sueño. Estos resultados pueden contribuir al fortalecimiento en la necesidad de reducción en el comportamiento sedentario en ancianos.

[Sedentary behavior and association with multimorbidity and patterns of multimorbidity in elderly Brazilians: data from the Brazilian National Health Survey, 2019]. / Comportamento sedentário e associação com multimorbidade e padrões de multimorbidade em idosos brasileiros: dados da Pesquisa Nacional de Saúde de 2019.

Sedentary behavior emerges as an important determinant of health in elderly persons, but its relationship to multimorbidity and its patterns in the Brazilian population have received little attention in epidemiological studies. Such associations can assist the elaboration of public policies aimed at modification of this behavior. This study thus aimed to assess the association between sedentary behavior and multimorbidity and its patterns in elderly Brazilians. This was a cross-sectional study of 43,554 elderly Brazilians in the Brazilian National Health Survey, 2019. Self-reported SB was categorized as < 3; 3-6; and > 6 hours a day. The presence of multimorbidity and its patterns were analyzed by self-report of two or more chronic diseases, where the three established patterns considered the diseases with similar clinical characteristics: (1) cardiopulmonary; (2) vascular-metabolic; and (3) mental-musculoskeletal. The associations were measured by binary logistic regression. Elderly persons that spent 3-6 hours/day in sedentary behavior had lower odds (OR = 1.39; 95%CI: 1.29; 1.50) of presenting multimorbidity, vascular-metabolic pattern (OR = 1.39; 95%CI: 1.29; 1.50), and mental-musculoskeletal pattern (OR = 1.11; 95%CI: 1.00; 1.24). Sedentary behavior > 6 hours/day was associated with higher odds of multimorbidity (OR = 1.58; 95%CI: 1.43; 1.74) and the cardiopulmonary (OR = 1.73; 95%CI: 1.33; 2.27), vascular-metabolic (OR = 1.49; 95%CI: 1.35; 1.64), and mental-musculoskeletal (OR = 1.15; 95%CI: 1.01; 1.31) patterns when compared to elders with 3 hours/day of sedentary behavior. This showed that extensive time in sedentary behavior is a relevant risk factor for multimorbidity and its patterns in the elderly.

O comportamento sedentário emerge como um importante determinante da saúde da pessoa idosa, no entanto, sua relação com a multimorbidade e seus padrões de acometimento em estudos epidemiológicos têm sido pouco explorados na população brasileira. Tais associações poderão auxiliar na elaboração de políticas públicas visando à modificação desse comportamento. Assim, o objetivo deste estudo foi avaliar a associação entre comportamento sedentário com multimorbidade e seus padrões em idosos brasileiros. Estudo transversal, com 43.554 idosos da Pesquisa Nacional de Saúde de 2019. O comportamento sedentário autorreferido foi categorizado em < 3; 3-6; e > 6 horas por dia. A presença de multimorbidade e seus padrões foram analisados pelo autorrelato da coexistência de duas ou mais doenças crônicas, sendo que os três padrões estabelecidos consideraram as doenças com características clínicas similares: (1) cardiopulmonar; (2) vascular-metabólico; e (3) mental-musculoesquelético. As associações foram realizadas pela regressão logística binária. Os idosos que despendiam 3-6 horas/dia em comportamento sedentário tiveram maiores chances (OR = 1,39; IC95%: 1,29; 1,50) de apresentar multimorbidade, padrão vascular-metabólico (OR = 1,39; IC95%: 1,29; 1,50) e mental-musculoesquelético (OR = 1,11; IC95%: 1,00; 1,24). Quando o comportamento sedentário foi > 6 horas/dia, houve maiores chances de multimorbidade (OR = 1,58; IC95%: 1,43; 1,74) e dos padrões cardiopulmonar (OR = 1,73; IC95%: 1,33; 2,27), vascular-metabólico (OR = 1,49; IC95%: 1,35; 1,64) e mental-musculoesquelético (OR = 1,15; IC95%: 1,01; 1,31), quando comparados àqueles que ficavam até 3 horas/dia. Dessa forma, evidenciou-se que tempos elevados em comportamento sedentário são fatores de risco relevantes para a ocorrência de multimorbidade e seus padrões em idosos.

El comportamiento sedentario emerge como un importante determinante de salud en personas ancianas, no obstante, su relación con la multimorbilidad y los patrones de enfrentamiento a la misma en estudios epidemiológicos se han investigado poco en la población brasileña. Tales asociaciones podrán apoyar en la elaboración de políticas públicas, con vistas a la modificación de ese comportamiento. Por ello, el objetivo de este estudio fue evaluar la asociación entre comportamiento sedentario con multimorbilidad y sus patrones en ancianos brasileños. Es un estudio transversal, con 43.554 ancianos de la Encuesta Nacional de Salud de 2019. El comportamiento sedentario autoinformado se categorizó en < 3; 3-6; y > 6 horas por día. La presencia de multimorbilidad y sus patrones se analizaron mediante el autoinforme de la coexistencia de dos o más enfermedades crónicas, siendo que los tres patrones establecidos consideraron las enfermedades con características clínicas similares: (1) cardiopulmonar; (2) vascular-metabólica y (3) mental-musculoesquelética. Las asociaciones fueron realizadas mediante regresión logística binaria. Los ancianos que pasaban 3-6h/día en comportamiento sedentario tuvieron mayores oportunidades (OR = 1,39; IC95%: 1,29; 1,50) de presentar multimorbilidad, patrón vascular-metabólico (OR = 1,39; IC95%: 1,29; 1,50) y mental-musculoesquelético (OR = 1,11; IC95%: 1,00; 1,24). Cuando el comportamiento sedentario fue > 6 horas/día hubo mayores oportunidades de multimorbilidad (OR = 1,58; IC95%: 1,43; 1,74), y de los patrones cardiopulmonar (OR = 1,73; IC95%: 1,33; 2,27), vascular-metabólico (OR = 1,49; IC95%: 1,35; 1,64) y mental-musculoesquelético (OR = 1,15; IC95%: 1,01; 1,31), cuando se compara con aquellos que estaban hasta 3 horas/día. De esa forma, se evidenció que tiempos elevados en comportamiento sedentario se mostraron factores de riesgo relevantes para la ocurrencia de multimorbilidad y sus patrones en ancianos.

Prevalence of dental visits and its associated factors during prenatal care: a cross-sectional study with puerperal women in hospitals covered by the Brazilian National Health System, Santa Catarina State, Brazil, 2019. / Prevalência de consulta odontológica e fatores associados à sua realização durante o pré-natal: estudo transversal com puérperas em hospitais do Sistema Único de Saúde, Santa Catarina, 2019.

OBJECTIVE: To assess the prevalence of dental visits and its associated factors during prenatal care. METHODS: This was a cross-sectional study based on interviews conducted with puerperal women in 31 hospitals covered by the Brazilian National Health System (SUS) in Santa Catarina, Brazil, 2019. Sociodemographic, economic and prenatal-related data were collected. Multivariate analyses were performed using logistic regression to calculate odds ratios (OR). RESULTS: 3,580 puerperal women and 41.4% (95% confidence interval [95%CI] 39.7;43%) underwent dental visits during prenatal care. Higher chance of dental visits was associated with higher education level (OR=1.35 - 95%CI 1.06;1.71) and a higher number of medical/nursing consultations (OR= 1.97 - 95%CI 1.47;2.65); this chance decreased when the puerperal women did not have paid work (OR=0.82 - 95%CI 0.70;0.96) and did not take part in education activities offered by the SUS (OR=0.63 - 95%CI 0.52;0.77). CONCLUSION: Factors related to schooling, employment, prenatal care and education activities increased the chance of dental visits during pregnancy in Santa Catarina State.

Individual and contextual variables associated with smoking and alcohol consumption during pregnancy.

OBJECTIVE: to analyze the association between individual characteristics and housing context with smoking and alcohol consumption during pregnancy. METHODS: a cross-sectional study with a probabilistic sample of 3,580 pregnant women who underwent prenatal care in the Unified Health System in 2019. The outcomes were firsthand, secondhand smoke and alcohol consumption during pregnancy. Individual characteristics and the living environment were used as exploratory variables. RESULTS: living in a neighborhood with episodes of violence, without social cohesion and without urban elements that encourage physical activity was associated with smoking. Alcohol consumption during pregnancy was associated with living in environments that do not encourage physical activity. Smoking was also associated with lower income and education. CONCLUSIONS: individual characteristics and the living environment are associated with smoking, secondhand smoke and alcohol consumption during pregnancy.

From prenatal care to childbirth: a cross-sectional study on the influence of a companion on good obstetric practices in the Brazilian National Health System in Santa Catarina State, 2019. / Do pré-natal ao parto: um estudo transversal sobre a influência do acompanhante nas boas práticas obstétricas no Sistema Único de Saúde em Santa Catarina, 2019.

OBJECTIVE: To analyze association between presence of a companion during prenatal consultations and childbirth and quality of care received by puerperal women using the Brazilian National Health System (SUS). METHODS: This was a cross-sectional study with puerperal women who underwent prenatal care and delivery on the SUS in Santa Catarina State, Brazil, in 2019, and who were interviewed within 48 hours postpartum. Prevalence ratios were estimated using Poisson regression. RESULTS: 3,580 puerperal women were interviewed. In prenatal care, presence of a companion was positively associated with receiving guidance from health professionals (PR=1.27 - 95%CI 1.08;1.50) and building a birth plan (PR=1.51 - 95%CI 1.15;1.97). At delivery, presence of a companion was associated with greater receipt of analgesics (PR=2.89 - 95%CI 1.40;5.97), non-pharmacological pain relief management (PR=1.96 - 95%CI 1.44;2.65), choice of position for delivery (PR=1.63 - 95%CI 1.24;2.16) and less likelihood of being strapped down (PR=0.47 - 95%CI 0.35;0.63). CONCLUSION: Presence of a companion during prenatal care and delivery was associated with better quality of care.

ASSOCIATION BETWEEN BREASTFEEDING AND OVERWEIGHT/OBESITY IN SCHOOLCHILDREN AGED 7-14 YEARS.

OBJECTIVE: To evaluate the prevalence of breastfeeding (BF) and the association between occurrence/duration of BF and overweight/obesity in schoolchildren aged 7-14 years. METHODS: This is a cross-sectional study, conducted in 2012-2013, on schoolchildren aged 7-14 years from Florianópolis, Santa Catarina, Southern Brazil. Weight and height were measured according to procedures of the World Health Organization. Breastfeeding and sociodemographic data were obtained from a questionnaire responded by parents/guardians. BF was categorized as a dichotomous variable (yes/no) and according to duration (months). Nutritional status was evaluated according to the Z score of the body mass index per age for sex and it was categorized into two groups: normal weight (

[Multimorbidity patterns and functional disability in elderly Brazilians: a cross-sectional study with data from the Brazilian National Health Survey]. / Padrões de multimorbidade e incapacidade funcional em idosos brasileiros: estudo transversal com dados da Pesquisa Nacional de Saúde.

The presence of multimorbidity patterns has been related to functional disability in basic activities (BADLs) and instrumental activities of daily living (IADLs), which are essential for elder individuals' self-care and autonomy. The study thus aimed to estimate the association between multimorbidity patterns and presence of functional disability in elderly Brazilians. This was a cross-sectional study using data from the Brazilian National Health Survey (PNS 2013) in a sample of elderly Brazilians (≥ 60 years). The measures of functional disability were from self-completed questionnaires, categorized in basic activities of daily living (BADLs) and instrumental activities of daily living (IADLs). The multimorbidity patterns analyzed here were: (1) cardiorespiratory; (2) vascular-metabolic; and (3) mental-musculoskeletal. The adjustment variables included age, sex, schooling, and region of Brazil. Multivariate logistic regression analyses were performed, estimating crude and adjusted odds ratios (OR) with Stata 16.0. Elderly individuals classified in the mental-musculoskeletal patterns showed the highest odds of disability in BADLs (OR = 2.72; 95%CI: 2.33; 3.18), while those with the cardiopulmonary pattern showed the highest odds of disability in IADLs (OR = 2.65; 95%CI: 1.95; 3.60), compared to those without the same patterns. All the multimorbidity patterns analyzed here were associated with disability in BADLs and IADLs and should thus be considered when planning measures to prevent disabilities in elderly individuals with multimorbidity.

A presença de padrões de multimorbidade tem sido relacionada à incapacidade funcional nas atividades básicas (ABVD) e instrumentais (AIVD) de vida diária, que são essenciais ao autocuidado e autonomia do idoso. Assim, o objetivo do estudo foi estimar a associação dos padrões de multimorbidade com a presença de incapacidade funcional em idosos brasileiros. Tratou-se de um estudo transversal, utilizando dados da Pesquisa Nacional de Saúde (PNS 2013), realizada com idosos brasileiros (≥ 60 anos). As medidas de incapacidade funcional foram provenientes de questionários autorreferidos, categorizadas em atividades básicas de vida diária (ABVD) e atividades instrumentais de vida diária (AIVD). Os padrões de multimorbidade analisados foram: (1) cardiorespiratório; (2) vascular-metabólico; e (3) mental-musculoesquelético. As variáveis de ajuste incluíram idade, sexo, anos de estudo e região do país. Foram realizadas análises de regressão logística multivariável, estimando-se as odds ratio (OR) brutas e ajustadas, pelo software Stata 16.0. Os idosos classificados nos padrões mental-musculoesquelético tiveram maiores chances de ter incapacidade nas ABVD (OR = 2,72; IC95%: 2,33; 3,18), enquanto aqueles com padrão cardiopulmonar mostraram maiores chances de incapacidade nas AIVD (OR = 2,65; IC95%: 1,95; 3,60), quando comparados aos que não tinham os mesmos padrões de acometimento. Concluiu-se que todos os padrões de multimorbidade analisados foram associados à presença de incapacidade nas ABVD e AIVD e, assim, devem ser considerados no planejamento das ações para prevenção de incapacidades em idosos com multimorbidades.

La presencia de patrones de multimorbilidad ha sido relacionada con la incapacidad funcional en actividades básicas (ABVDs) e instrumentales (AIVDs) de la vida diaria, las cuales son esenciales para el autocuidado y autonomía del anciano. De esta forma, el objetivo del estudio fue estimar la asociación de los patrones de multimorbilidad con la presencia de incapacidad funcional en ancianos brasileños. Se trató de un estudio transversal, utilizando datos de la Encuesta Nacional de Salud (PNS 2013), realizada con ancianos brasileños (≥ 60 años). Las medidas de incapacidad funcional provinieron de cuestionarios autoinformados, categorizadas en actividades básicas de vida diaria (ABVDS) y actividades instrumentales de vida diaria (AIVDS). Los patrones de multimorbilidad analizados fueron: (1) Cardiorrespiratorio; (2) Vascular-metabólico; y (3) Mental-musculoesquelético. Las variables de ajuste incluyeron edad, sexo, años de estudio y región del país. Se realizaron análisis de regresión logística multivariada, estimándose las odds ratio (OR) brutas y ajustadas, mediante el software Stata 16.0. Los ancianos clasificados en los patrones mental-musculoesquelético tuvieron mayores oportunidades de tener incapacidad en las ABVDs (OR = 2,72; IC95%: 2,33; 3,18), mientras que aquellos con patrón cardiopulmonar mostraron mayores oportunidades de incapacidad en las AIVDs (OR = 2,65; IC95%: 1,95; 3,60), cuando se comparan a los que no tenían los mismos patrones de alteraciones. Se concluyó que todos los patrones de multimorbilidad analizados estuvieron asociados con la presencia de incapacidad en las ABVDs y AIVDs, y de este modo deben ser considerados en la planificación de las acciones para la prevención de incapacidades en ancianos con multimorbilidades.

Education across the life-course and hypertension in adults from Southern Brazil.

The present study examines the association between life-course socioeconomic position (SEP) and hypertension (SAH), focusing on the health impacts of childhood SEP (SEPc), adult SEP (SEPa), as well as SEP mobility. Data from the Brazilian EpiFloripa Cohort Study (n = 1,720; 56% women; 55% <= 30 years) were analyzed. SAH was determined by the average of two measures of systolic and diastolic blood pressure, previous medical diagnosis or use of anti-hypertensive medication (43% of the sample was hypertensive). The main independent variables were: SEPa - participants' level of education; SEPc - parental educational attainment; and SEP mobility - the socio-economic trajectories from SEPc to SEPa. Five logistic regressions models were adjusted for sex, age or income, and were compared among each other. High SEPa was associated with a 37% reduction in the odds of SAH compared to low SEPa. High SEP over the life course was associated with 34-37% lower odds of SAH compared to persistent low SEP. Mobility models explained more of the outcome variance than the sensitive period model. The results reinforce the importance of education in the risk of SAH and the relevance of a socioeconomic mobility approach for the analysis of social inequalities in health.

Change in the distribution of body mass index in Brazil: analysing the interindividual inequality between 1974 and 2013.

BACKGROUND: Brazil is among the 10 countries with the highest prevalence of overweight in the world. The aim was to analyse the changes in the dispersion of body mass index (BMI) in the Brazilian population from the 1970s to 2013 in specific population groups. METHODS: Data were extracted from five national household surveys between 1974-1975 and 2013, including adults aged 20 to 64. We calculated SD, median, fifth and 95th percentiles of BMI for each sociodemographic category (sex, age, schooling) and survey year in order to explore whether changes in mean BMI are followed by changes in dispersion. RESULTS: During the period the mean BMI ranged from 22.7 kg/m2 to 26.6 kg/m2, with a much higher variation in the 95th percentile (+6.1 kg/m2) when compared with the fifth percentile (+1.8 kg/m2). The within-group differences increased over time. The SD increased in all categories analysed and was higher among women, lower schooling groups and the oldest group. An increase of 1.0 kg/m2 in the BMI mean was associated with an increase of 0.32 kg/m2 in the SD, 0.45 kg/m2 in the fifth percentile and 1.50 kg/m2 in the 95th percentile of BMI. CONCLUSIONS: Population changes occurred in BMI are more complex than the simple increase of its average. Concomitant to the increase in BMI, there was an increase in the within-group differences, showing that growing inequalities are not driven solely by sociodemographic factors.

Socio-economic life course and obesity among adults in Florianopolis, southern Brazil.

OBJECTIVE: To estimate the association between socio-economic life course and body mass index (BMI), waist circumference (WC) and general and abdominal obesity in adults. METHODS: A cross-sectional analysis of a population-based cohort study of 1,222 adults (aged 22-63) from Florianopolis, southern Brazil. The socio-economic life course was analysed using the educational level of participants and their parents. Height, weight and WC were measured by specially trained staff. Linear and logistic regressions were used with adjustment for confounding factors, and data were stratified according to sex. RESULTS: Mean BMI and WC were about 2kg/m2 (95% CI: -3.3 to -0.7) and 6cm (95% CI: -9.7 to -2.9) lower in women with a high socio-economic position, while the association was reversed in men with a high socio-economic position, with WC being about 4cm higher (95% CI: 0.1 to 7.5). In addition, women who had always been in a high socio-economic position were less likely to have abdominal obesity (OR: 0.38; 95% CI: 0.20 to 0.76) while no such association was found in men. CONCLUSION: Socio-economic life course influences BMI, WC and obesity, with differences between males and females, thereby indicating that public policies that contemplate a socio-economic life course approach can be effective for controlling obesity.

Associação entre fatores socioeconômicos e demográficos e vacinação antirrábica de cães e gatos domésticos / Association between socioeconomic and demographic factors and rabies vaccination of dogs and cats

Resumo Introdução A raiva é uma doença endêmica no Brasil, cuja forma de combate em humanos é a vacinação de animais. Objetivo Buscou-se analisar associação entre fatores sociodemográficos e econômicos de adultos com vacinação antirrábica de animais domésticos com amostra da Pesquisa Nacional de Saúde realizada em 2013. Método Estudo transversal tendo como desfecho vacinação antirrábica de cães e gatos e exposições: sexo, idade, escolaridade, renda per capita e cor da pele autodeclarada do chefe de domicílio. Foram realizadas análises bi e multivariadas por meio de regressão logística. Resultados No Brasil, 59,3% (IC95%59,1-59,5) dos domicílios tinham animal de estimação. Em relação à vacinação antirrábica, a região Sudeste possui a maior prevalência, em que 84,8% (IC95%83,3-86,2) dos domicílios vacinaram todos os cães e gatos, contra 63,7% (IC95%60,9-66,3) na região Sul. Indivíduos com ≥50 anos têm 64% mais chances de vacinar cães e gatos, comparados àqueles na faixa etária mais jovem (18-29 anos). Quanto à escolaridade, indivíduos com ≥12 anos de estudo têm 2,4 vezes mais chances de vacinar todos os animais do domicílio, em relação àqueles com 0-8 anos de estudo. Conclusão Os resultados deste estudo apontam para a necessidade de políticas públicas que orientem a população sobre guarda responsável e que ofertem serviços de imunização.

Abstract Background In Brazil, rabies is an endemic disease and the vaccination of animals is a form of combat for humans. Objective The study aimed to analyze the association between sociodemographic and economic factors of adults and rabies vaccination of domestic animals, using samples from the National Health Survey conducted in 2013. Method This is a cross-sectional study with the outcome of rabies vaccination of dogs and cats and exposures: sex, age, education, per capita income, and skin color of the head of household. Bi and multivariate analyses were performed by logistic regression. Results In Brazil, 59.3% (95% CI 59.1-59.5) of households have pets. Regarding rabies vaccination, the southeast region has the highest prevalence, with 84.8% (95% CI 83.3-86.2) of households vaccinating all dogs and cats against 63.7% (95% CI 60.9-66.3) in the south region. Individuals in the age group ≥50 years are 64% more likely to vaccinate dogs and cats compared to those in the younger age group (18-29 years old). Regarding education, individuals with ≥12 school years are 2.4 times more likely to vaccinate all animals in the household compared to those with 0-8 school years. Conclusion The results of this study point to the fact that there's a demand for public policies to guide the population on responsible custody and to provide immunization services.

Socioeconomic status in childhood and obesity in adults: a population-based study.

OBJECTIVE To test whether there is an association between socioeconomic status in childhood and measures of body mass index, waist circumference and the presence of overall and abdominal obesity in adult life. METHODS A cross-sectional analysis of a population-based cohort study, including a sample of adults (22-63 years old) living in Florianópolis, Southern Brazil. The socioeconomic status in childhood was analyzed through the education level of the participant's parents. Height, weight and waist circumference were measured by previously trained interviewers. Linear and logistic regressions with adjustment for confounding factors and stratification of data according to gender were used. RESULTS Of the 1,222 adults evaluated, 20.4% (95%CI 18.1-22.8) presented overall obesity and 24.8% (95%CI 22.4-27.4), abdominal obesity. The body mass index and waist circumference averages among women were, respectively, 1.2 kg/m2 (95%CI -2.3- -0.04) and 2.8 cm (95%CI -5.3- -0.2) lower among those with higher socioeconomic status in childhood. Among men, waist circumference was 3.9 cm (95%CI 1.0-6.8) higher in individuals with higher socioeconomic status in childhood. Regarding obesity, women of higher socioeconomic status in childhood had lower odds of abdominal obesity (OR = 0.56, 95%CI 0.34-0.90), and no such association was observed among men. CONCLUSIONS The socioeconomic status in childhood influences body mass index, waist circumference and obesity in adults, with a difference in the direction of association according to gender. The higher socioeconomic status among men and the lower socioeconomic status among women were associated with higher adiposity indicators.

Influence of alcohol and tobacco consumption on maternal and perinatal outcomes of puerperal women attended at the Brazilian National Health System / Influência do consumo de álcool e tabaco em desfechos maternos e perinatais de puérperas atendidas no Sistema Único de Saúde

Abstract Objectives: to evaluate the association between alcohol and tobacco consumption during pregnancy with maternal and child health conditions. Methods: cross-sectional study with a probabilistic sample of pregnant women living in Santa Catarina who conducted prenatal care and childbirth in the public national health service in 2019. A face-to-face survey questionnaire was applied to 3,580 pregnant women including maternal health issues during pregnancy and perinatal health of the newborn. Crude logistic regression analyzes were performed and adjusted for socio-demographic and maternal health conditions. Results: the prevalence of alcohol and tobacco consumption during pregnancy was 7.2% and 9.3%, respectively. Alcohol consumption during pregnancy increased the chance of maternal anemia by 45% (CI95%=1.09-1.91), increased the chance of gestational diabetes by 73% (CI95%=1.14-2.63) and reduced the chance of hypertension (OR=0.59; CI95%=0.37-0.94). Tobacco consumption doubled the chance of low birth weight (OR=2.16; CI95%=1.33-3.51). Conclusion: the consumption of alcoholic beverages during pregnancy increased the chance of maternal health complications, such as anemia and gestational diabetes, while tobacco increased the chance of low birth weight.

Resumo Objetivos: avaliar a associação entre o consumo de álcool e de tabaco durante a gravidez com condições de saúde maternas e da criança. Métodos: estudo transversal com amostra probabilística de gestantes residentes em Santa Catarina que realizaram o pré-natal e o parto na rede pública do estado em 2019. Foi aplicado questionário face-a-face com 3.580 gestantes incluindo questões de saúde maternas durante a gestação e saúde perinatal do recém-nascido. Foram realizadas análises de regressão logística brutas e ajustadas para condições sócio-demográficas e de saúde maternas. Resultados: as prevalências de consumo de bebidas alcoólicas e de tabaco durante a gestação foram de 7,2% e 9,3%, respectivamente. O consumo de álcool durante a gestação aumentou em 45% a chance de anemia materna (IC95%=1,09-1,91) e em 73% a de diabetes gestacional (IC95%=1,14-2,63) e reduziu a chance de hipertensão (OR=0,59; IC95%=0,37-0,94). O consumo de tabaco dobrou a chance de baixo peso gestacional ao nascer (OR=2,16; IC95%=1,33-3,51). Conclusão: o consumo de bebidas alcoólicas durante a gestação aumentou a chance de intercorrências de saúde maternas, como anemia e diabetes gestacional, enquanto o tabaco aumentou a chance de baixo peso ao nascer.

Tempo de televisão, obesidade e doenças cardiovasculares em idosos brasileiros: Pesquisas Nacionais de Saúde 2013 e 2019 / Screen time, obesity and cardiovascular disease among elderly Brazilians: 2013 and 2019 National Health Surveys

Resumo Objetivou-se analisar a associação entre tempo assistindo televisão (TV) e a presença de obesidade isolada e associada às doenças cardiovasculares (DCV) de idosos brasileiros, conforme o sexo, comparando-se os dados das Pesquisas Nacionais de Saúde 2013 e 2019. Estudo transversal, com dados de 23.815 e 43.554 idosos das PNS 2013 e 2019, respectivamente. O autorrelato do tempo assistindo à TV foi categorizado em: <3, 3-6 e ≥6 horas diárias. A obesidade isolada foi avaliada pelo índice de massa corporal ≥27 kg/m² e a DCV pelo autorrelato de diagnóstico médico. Em 2013, as idosas que assistiam à TV ≥6 horas/dia apresentaram maiores chances de obesidade isolada (OR=1,87; IC95%=1,32;2,64) e associada à DCV (OR=6,30; IC95%=3,38;11,74). Em 2019, as idosas que assistiam à TV entre 3-6 horas/dia (OR=1,44; IC95%=1,25;1,65) e ≥6 horas/dia (OR=1,55; IC95%=1,28;1,88) tiveram maiores chances de obesidade isolada, já as chances de obesidade associada à DCV, foram maiores para ≥6 horas/dia (OR=2,13; IC95%=1,48;3,06). Em 2019, os homens tiveram maiores chances de obesidade associada às DCV assistindo à TV entre 3-6 horas/dia (OR=1,76; IC95%=1,20;2,56) e ≥6 horas/dia (OR=2,13; IC95%=1,27;3,57). Evidencia-se a importância em diminuir o tempo assistindo à TV dos idosos.

Abstract The scope of this paper was to analyze the association between the time spent watching television (TV) and the presence of obsessive-compulsive disorder (OCD) obesity and obesity associated with cardiovascular diseases (CVD) among elderly Brazilians, according to gender, comparing data from the 2013 and 2019 National Health Surveys (NHS). It involved a cross-sectional study, with data from 23,815 and 43,554 elderly people, respectively, from the 2013 and 2019 NHS. Self-reported TV screen time was categorized into: <3, 3-6, and ≥6 per day. Obesity was assessed by body mass index ≥27 kg/m² and CVD by self-reported medical diagnosis. In 2013, elderly women who watched TV ≥6 hours/day were more likely to have OCD obesity (OR=1.87; 95%CI=1.32;2.64) and obesity associated with CVD (OR=6.30; 95%CI=3.38;11.74). In 2019, elderly women who watched TV between 3-6 hours/day (OR=1.44; 95%CI=1.25;1.65) and ≥6 hours/day (OR=1.55; 95%CI=1.28;1.88) were more likely to have OCD obesity, while the incidence of obesity associated with CVD was higher for ≥6 hours/day (OR=2.13; 95%CI=1.48;3.06). In 2019, men were more likely to have obesity associated with CVD watching TV between 3-6 hours/day (OR=1.76; 95%CI=1.20;2.56) and ≥6 hours/day (OR=2.13; 95%CI=1.27;3.57). The importance of reducing screen time by the elderly is clearly evident.

Metodologias ativas de ensino-aprendizagem: uso, dificuldades e capacitação entre docentes de curso de Medicina / Active teaching and learning methodologies: use, difficulties and training among medical course teachers

Resumo: Introdução: No Brasil, as Diretrizes Curriculares Nacionais para o curso de Medicina apontam que a formação médica deverá usar metodologias que privilegiem a participação ativa do aluno na construção do conhecimento, além de preverem a existência de programas de desenvolvimento e aperfeiçoamento docente no interior dos cursos de Medicina. Objetivo: Este estudo teve como objetivo avaliar o uso, a dificuldade e a capacitação referentes às metodologias ativas de ensino-aprendizagem (MAP) em docentes do curso de Medicina em dois campi da Universidade Federal de Santa Catarina. Método: Trata-se de estudo transversal com coleta de dados por meio de questionário em formato on-line, em que se pesquisaram variáveis demográficas, de formação acadêmica, de atuação docente e de MAP, incluindo seu uso na prática pedagógica, dificuldades e realização de capacitação no tema. Foram feitas análises estatísticas com o intuito de verificar diferenças entre as variáveis analisadas. Resultado: Participaram 63 docentes, com média de idade de 48,2 anos, maioria do gênero feminino (57,1%), com regime de trabalho de dedicação exclusiva (61,9%) e metade da amostra composta por médicos. Apenas um a cada dez professores referiu que não utiliza e/ou nunca utilizou MAP na sua atuação como docente, e metade mencionou ter dificuldade na sua utilização. Quanto à capacitação pedagógica, 54% referiram ter realizado, dos quais 67,7% mencionaram que ela não foi suficiente para dar densidade teórica ao processo de ensino-aprendizagem com MAP. Estudo de caso e aprendizagem baseada em problemas foram as MAP mais conhecidas e utilizadas dentro da universidade. Conclusão: O uso das MAP foi alto, e pouco mais da metade dos docentes tem alguma capacitação no tema. Considerando que a maioria dos docentes apontou dificuldades no seu uso com os discentes, faz-se necessário planejar a metodologia, a carga horária ou os temas das capacitações que são oferecidas.

Abstract: Introduction: In Brazil, the National Curriculum Guidelines for Medicine courses state that medical training should use methodologies that favor the active participation of the student in the construction of knowledge, in addition to providing for the existence of teacher development and improvement programs within Medical courses. Objective: To evaluate the use, difficulty and training related to Active Teaching and Learning Methodologies (MAP) in teachers of the Medicine course in two campuses of the Federal University of Santa Catarina. Method: Cross-sectional study with data collection through a questionnaire in an online format, researching demographic, academic education, teaching and MAP variables, including its use in pedagogical practice, difficulties and training on the subject. Statistical analyses were performed in order to verify differences among the analyzed variables. Results: 63 teachers participated, with a mean age of 48.2 years, mostly female (57.1%), who worked exclusively for the university (61.9%) and half of the sample population was composed of physicians. Only one in ten teachers reported that they do not use and/or never used MAP in their work as a teacher, and half reported having difficulty in using it. As for the pedagogical training, 54% reported having performed it, and among these, 67.7% reported that it was not enough to give theoretical density to the teaching-learning process with MAP. Case study and problem-based learning were the best-known MAPs and used within the university. Conclusion: The use of MAP was high and just over half of the teachers reported some training in the subject. Considering that most teachers pointed out difficulties in its use with students, it is necessary to plan the methodology, workload or themes of the training that are offered.