Family history of hypertension: Impact on blood pressure, anthropometric measurements and physical activity level in schoolchildren

Background: A family history of arterial hypertension (AH), combined with environmental risk factors, is directly related to the development of AH. Objective: To evaluate the frequency of AH, anthropometric indicators and level of physical activity and their association with a family history (FH) of AH in school children. Methods: Cross-sectional study with 118 students, aged between 11 and 17 years, of both sexes. Waist circumference (WC), weight, height, level of physical activity and FH of HA were collected. Body mass index z score (BMI-z) and waist-to-height ratio (WHtR) were calculated. Binary logistic regression model was used to verify the chance risk, with significance p <0.05. Results: Of the 118 parents who answered the questionnaire, 34.7% had a positive FH of AH. Girls with a positive FH had higher means of WC (p= 0,004), BMI (p=0,020), and systolic blood pressure (SBP) (p=0,006) than boys, and a higher risk of being overweight (OR=4,48; 95%CI:1,55–12,94), and having elevated WHtR (OR=5.98; 95%CI:1.66–21.47) and SBP (OR=3,07; 95%CI:1,03–9,13) than girls without a FH, but they practice more vigorours moderate physical activity (MVPA) (p=0,039). On the other hand, no differences in these parameters were observed between boys with and without a FM of AH. Conclusions: Overweight and a FH of hypertension were associated with an increased risk for AH in girls. This was not observed among boys, perhaps due to more active lifestyle.FCT -Fundação para a Ciência e a Tecnologia(UIDB/00317/2020

Comparação do perfil de estilo de vida e a prática de atividade física entre meninas e meninos

The aim of this study was to compare lifestyle profile and physical activity between girls and boys. A total of 336 students 11 to 17 years old participated in the study (51.5% female). Height, body mass, sexual maturation and z-score body mass index (BMI-z) were assessed. The level of physical activity (PA) was determined through the International Physical Activity Questionnaire (IPAQ). Lifestyle was assessed using the Individual Lifestyle Profile questionnaire (PEVI), computing the total scores from five components and considering the following cutoff points: >30 points = favorable PEVI; and ≤30 points = unfavorable PEVI. Results showed 35.1% of the students were considered overweight, 74.78% did not comply with the recommendations for physical activity and 31.5% presented unfa-vorable PEVI. There was a difference between boys and girls in moderate to vigorous physical activity (MVPA) (p = 0.048). Boys presented better lifestyle (p = 0.06) and had, on average, more light PA (p < 0.01), moderate PA (p < 0.01), vigorous PA (p < 0.01) and MVPA (p < 0.01) than girls. Girls with favorable PEVI had higher average levels of light PA than those with unfavorable PEVI (p < 0.001). It was concluded that boys are more active during the week when compared to girls. However, they also present fewer concerns with preventive behaviors and relationships. Light PA was higher in girls with a favorable lifestyle profile.O objetivo deste estudo foi comparar o perfil de estilo de vida e a prática de atividade física entre meninas e meninos. Participaram do estudo 336 escolares, de 11 a 17 anos de de idade (51,5% sexo feminino). Foram avaliados a estatura, massa corporal, maturação sexual e índice de massa corporal escore z (IMC-z). O nível de atividade física (AF) foi analisado pelo International Physical Activity Questionnaire (IPAQ). O estilo de vida foi avaliado por meio do questionário Perfil do Estilo de Vida Individual (PEVI), analisando o total de escores dos cinco componentes, considerando-se como pontos de corte: >30 pontos = PEVI favorável e ≤30 pontos = PEVI desfavorável. Observou-se que 35,1% dos escolares foram considerados acima do peso, 74,78% não cumprem as recomendações de atividade física e 31,5% apresentaram PEVI desfavorável. Exis tiu diferença entre meninos e meninas para a prática de atividade física moderada e vigorosa (AFMV) (p = 0,048). Os meninos apresentaram melhor estilo de vida (p = 0,06) e praticam em média mais AF leve (p < 0,01), AF moderada (p < 0,01), AF vigorosa (p < 0,01) e AFMV (p < 0,01) do que meninas. Enquanto as meninas com PEVI favorável praticam em média mais AF leve do que aquelas com PEVI desfavorável (p < 0,001). Concluiu-se que meninos praticam mais AF na semana em relação às meninas, entretanto possuem menor preocupação com comportamentos preventivos e relacionamentos. A prática de AF leve foi maior em meninas com perfil de estilo de vida favorável.Portuguese national funds through the FCT (Foundation for Science and Technology) within the framework of the CIEC (Research Center for Child Studies of the University of Minho) project under the reference UIDB/00317/202

Objectively Measured Physical Activity and Body Mass Index in Preschool Children

Aim. To examine the association between objectively measured physical activity (PA) and body mass index (BMI) in preschool children. Methods. The study comprised 281 children (55.9% boys) aged from 4 to 6 years. PA was measured by accelerometer. Children were categorized as non-overweight (NOW) and overweight/obese (OW) according to the sex-adjusted BMI z-score (<1 and ≥1, resp.). Results. Total and moderate intensity PA were not associated with BMI. We observed that a higher proportion of OW children were classified as low-vigorous PA compared to their NOW peers (43.9 versus 32.1%, resp., P > .05). Logistic regression analysis showed that children with low-vigorous PA had higher odds ratio (OR) to be classified as OW compared to those with high-vigorous PA (OR = 4.4; 95% CI: 1.4–13.4; P = .008) after adjusting for BMI at first and second years of life and other potential confounders. Conclusion. The data suggests that vigorous PA may play a key role in the obesity development already at pre-school age

Low back pain and physical activity during pregnancy: a longitudinal prospective study

Low back pain (LBP) is an increasingly reported condition, and physical activity (PA) may play an important role. The aim of the present study was to evaluate the proportion of pregnancy-related LBP and its association with type and intensity level of PA during pregnancy. A longitudinal prospective study was carried out with a cohort of 118 pregnant women. Participants were evaluated in all trimesters. LBP was assessed with a self-reported questionnaire and participants were categorized according to its occurrence. The type and intensity of PA were evaluated using the Pregnancy Physical Activity Questionnaire and categorized into tertiles. Binary logistic regression models were constructed to verify the relationship between LBP and type, the intensity of PA in all trimesters, and LPB pre-pregnancy. LBP was reported by 40.7%, 52.2% and 66.7% of the subjects in the first, second, and third trimesters, respectively. No significant associations were found between LBP and type and intensity of PA. However ,women who had LBP before pregnancy, compared to those who did not, had higher odds of expressing LBP during pregnancy (OR= 3.85, 95% CI: 1.344-11.025). LBP is a common condition and increased during pregnancy. Results of this study suggest that type and intensity of PA are not associated with emerging of LBP during pregnancy.info:eu-repo/semantics/publishedVersio

Hypertensive measures In schoolchildren: risk of central obesity and protective effect of moderate-to-vigorous physical activity

Fundamento: Aumento da prevalência de hipertensão arterial (HA) em crianças e adolescentes e sua associação com diversas comorbidades. Objetivo: Verificar a associação de HA, obesidade central e obesidade geral, e nível de atividade física em escolares.Métodos: Participaram do estudo 336 crianças e adolescentes, de 11 a 17 anos de idade. Aferiram-se estatura, peso corporal, circunferência da cintura (CC) e pressão arterial (PA). Foi calculado o índice de massa corporal escore z (IMC-z). O nível de atividade física foi avaliado pela versão curta do International Physical Activity Questionnaire (IPAQ), conforme a prática em atividades físicas moderadas-vigorosas (AF-mv). Consideraram-se hipertensos os escolares que apresentaram pressão arterial sistólica (PAS) e/ou diastólica (PAD) superiores ao percentil 95, de acordo com sexo, faixa etária e estatura, ou ≥120×80mmHg. Utilizaram-se os testes estatísticos de t-Student, Qui-quadrado, Mann-Whitney e modelo de regressão logistica binária, considerando-se o nível de significância de p<0,05. Resultados: Foram observados que 40,5% dos escolares apresentaram HA, 35,11% excesso de peso (12,5% obesos), 13,39% CC elevada e 40,2% foram considerados insuficientemente ativos em AF-mv. As chances de HA foram relacionadas à CC elevada (OR=6,11; IC95%:2,59 a 14,42) e ao excesso de peso (OR=2,91; IC95%:1,76 a 4,79). Além disso, os adolescentes que praticavam AF-mv apresentaram menor risco de PAD elevada (OR=0,33; IC95%:0,15 a 0,72). Conclusão: Concluiu-se que a obesidade central, a obesidade geral e o sexo masculino foram os melhores preditores de HA em crianças e adolescentes. A prática de AF-mv demonstrou efeito protetor na PAD elevada em escolares.O presente estudo foi financiado pela Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Centro de Investigação em Estudos da Criança (CIEC), pelo Projeto Estratégico UID/CED/00317/2013, por meio dos Fundos Nacionais da Fundação para a Ciência e a Tecnologia (FCT), cofinanciado pelo Fundo Europeu de Desenvolvimento Regional (FEDER) por meio do COMPETE 2020 – Programa Operacional Competitividade e Internacionalização (POCI) com a referência POCI-01-0145-FEDER-007562

Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods: GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings: Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation: As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and developm nt investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

Family history of arterial hypertension and central adiposity: impact on blood pressure in schoolchildren

Background: A family history of arterial hypertension is an important risk factor for arterial hypertension. This study aimed to verify the mediating role of high central adiposity in the relationship between family history of arterial hypertension and blood pressure in schoolchildren. Methods: Cross-sectional study with 118 schoolchildren of both sexes aged between 11 and 17 years. Weight, height, waist circumference and body mass index z score were verified. Somatic maturation was predicted by age for peak growth velocity. The family history of arterial hypertension was verified and defined as hypertensive schoolchildren with systolic blood pressure or diastolic blood pressure. Mediation analysis was used with linear regression models applied by PROCESS macro for SPSS (version 22.0), with significance p < 0.05. Results: It was observed that 34.7% of the students have family history of arterial hypertension, 36% of the girls and 44.2% of the boys have arterial hypertension. In girls, the relationship between waist circumference and systolic blood pressure was direct (β = 0.535 p = 0.005), and those with a family history of arterial hypertension and who had a waist circumference greater than those without a family history of arterial hypertension was significant (β = -5,437 p = 0.009). Likewise, the relationship between family history of arterial hypertension and systolic blood pressure was attenuated when waist circumference was included in the model (β = -5.544; p = 0.103), indicating waist circumference as a mediator with an influence percentage of 19%. For boys, waist circumference is not a mediator of the relationship between family history of arterial hypertension and blood pressure. Conclusions: Elevated central adiposity was a mediator of the relationship between family history of arterial hypertension and high blood pressure in girls, indicating the importance of family health strategies in the prevention and management of arterial hypertension in children and adolescents.Este trabalho foi financiado por Fundos Nacionais através da FCT – Fundação para a Ciência e a Tecnologia no âmbito dos projetos do CIEC (Centro de Investigação em Estudos da Criança da Universidade do Minho) com as referências UIDB/00317/2020 e UIDP/00317/2020.This study was funded by Coordination for the Improvement of Higher Education Personnel (CAPES), the National Council for Scientific and Technological Development (CNPq by National Funds through FCT – Foundation for Science and Technology within the scope of the CIEC project (Research Center for Child Studies at the University of Minho) with reference UIDB/00317/2020 and the Research Group: Educational Policies: Conceptions and Practices – PPECP of the Graduate Program in Education at the Pontifical Catholic University of Paraná—PUCPR