Impacto da inatividade física e custos de hospitalização por doenças crônicas

OBJECTIVE To evaluate the physical inactivity-related inpatient costs of chronic non-communicable diseases. METHODS This study used data from 2013, from Brazilian Unified Health System, regarding inpatient numbers and costs due to malignant colon and breast neoplasms, cerebrovascular diseases, ischemic heart diseases, hypertension, diabetes, and osteoporosis. In order to calculate the share physical inactivity represents in that, the physical inactivity-related risks, which apply to each disease, were considered, and physical inactivity prevalence during leisure activities was obtained from Pesquisa Nacional por Amostra de Domicílio (Brazil's National Household Sample Survey). The analysis was stratified by genders and residing country regions of subjects who were 40 years or older. The physical inactivity-related hospitalization cost regarding each cause was multiplied by the respective share it regarded to. RESULTS In 2013, 974,641 patients were admitted due to seven different causes in Brazil, which represented a high cost. South region was found to have the highest patient admission rate in most studied causes. The highest prevalences for physical inactivity were observed in North and Northeast regions. The highest inactivity-related share in men was found for osteoporosis in all regions (≈ 35.0%), whereas diabetes was found to have a higher share regarding inactivity in women (33.0% to 37.0% variation in the regions). Ischemic heart diseases accounted for the highest total costs that could be linked to physical inactivity in all regions and for both genders, being followed by cerebrovascular diseases. Approximately 15.0% of inpatient costs from Brazilian Unified Health System were connected to physical inactivity. CONCLUSIONS Physical inactivity significantly impacts the number of patient admissions due to the evaluated causes and through their resulting costs, with different genders and country regions representing different shares.OBJETIVO Avaliar o custo de internações por doenças crônicas não transmissíveis atribuível à inatividade física. MÉTODOS Este estudo utilizou dados de 2013, do Sistema Único de Saúde, referentes ao número e respectivo custo das internações por neoplasia maligna de cólon e mama, doenças cerebrovasculares, doenças isquêmicas do coração, hipertensão, diabetes e osteoporose. Para o cálculo da fração atribuível à inatividade física foram considerados os riscos relativos da inatividade física a cada doença e a prevalência de inatividade física no lazer foi obtida da Pesquisa Nacional por Amostra de Domicílio. A análise foi estratificada por sexo e região do País de indivíduos com idade igual ou superior a 40 anos. O custo das internações de cada causa atribuível à inatividade física foi multiplicado pela respectiva fração a ela atribuível. RESULTADOS Foram realizadas 974.641 internações hospitalares por sete causas de internações no Brasil, em 2013, o que representou custo alto. A região Sul apresentou a maior taxa de internação na maioria das causas estudadas. A maior prevalência de inatividade física ocorreu nas regiões Norte e Nordeste. A maior fração atribuível à inatividade em homens foi encontrada para a osteoporose em todas as regiões (≈ 35,0%), enquanto o diabetes apresentou maior fração atribuível à inatividade em mulheres (variação de 33,0% a 37,0% nas regiões). As doenças isquêmicas do coração foram responsáveis pelos mais altos custos totais e atribuíveis à inatividade física em todas as regiões e em ambos os sexos, seguidas das doenças cerebrovasculares. Aproximadamente 15,0% dos custos ao Sistema Único de Saúde das internações foi atribuível à inatividade física. CONCLUSÕES A inatividade física impacta significativamente o número de internações hospitalares pelas causas avaliadas e nos custos resultantes, com diferenças na ocorrência dependendo do sexo e região do País

Comparação da prática de atividade física em adolescentes de Pelotas-RS em um período de seis anos e meio

Comparação da prática de atividade física em adolescentes de Pelotas-RS em um período de seis anos e mei

Physical activity during pregnancy: barriers, trends and effects on postpartum depressive symptoms

Current guidelines recommends that pregnant women should engage in moderate-intensity physical activity for at least 30 minutes on the majority of the days of the week to obtain mother-child health-related benefits. However, the gestational period has been associated to declines in physical activity levels among women of reproductive age and the literature has shown that inactivity is very common during pregnancy. Although the benefits of regular physical activity during pregnancy are being increasingly documented in the literature, the effects of physical activity during pregnancy on some health outcomes requires a broader understand. This PhD thesis aimed to summarize the perceived barriers to physical activity practice during pregnancy; evaluate time changes in leisure-time physical activity during pregnancy in the period from 2004 to 2015 and, to evaluate the effects of an exercise intervention during pregnancy on the incidence of postpartum depressive symptoms. In the first article perceived barriers to leisure-time physical activity during pregnancy were identified by performing a literature review of quantitative and qualitative evidence. Pregnancy-related symptoms and limitations barriers were the most reported in the studies. Mother-child safety concerns, lack of advice and, lack of social support were also important emphasized pregnancy-related barriers. In the second article, we evaluated time changes in leisure-time physical activity during pregnancy in an 11-year period by comparing data from the 2004 and 2015 Pelotas birth cohort studies. Findings showed that the prevalence of physical activity during pregnancy declined over time. In the third article, the effects of an exercise intervention during pregnancy on postpartum depressive symptoms were evaluated by conducting a randomized control trial nested to the 2015 Pelotas Birth Cohort Study (PAMELA Trial). Findings showed that the incidence of probable major depression was lower among pregnant women from the intervention group when compared to the control group (no exercise intervention).Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPESAs diretrizes atuais recomendam que mulheres grávidas pratiquem atividade física de intensidade moderada com duração de 30 minutos, na maior parte, se não todos os dias da semana, visando inúmeros benefícios para a saúde materna e infantil. Entretanto, o período gestacional tem sido identificado como contribuinte para o declínio da prática de atividade física entre as mulheres em idade reprodutiva e a literatura tem demonstrado que a inatividade física é frequente entre gestantes. Embora o acúmulo de evidências que suportam os benefícios da prática de atividade física durante a gestação seja crescente, seu efeito sobre alguns desfechos de saúde ainda necessita de uma compreensão mais ampla. Essa tese teve como objetivo identificar as barreiras percebidas à prática de atividade física no período gestacional; avaliar a variação temporal na prevalência de atividade física na gestação no tempo de lazer no período de 2004-2015 e, avaliar os efeitos de uma intervenção com exercício físico na gestação sobre a incidência de sintomas depressivos no período pós-parto. No primeiro artigo avaliou-se as barreiras percebidas à prática de atividade física no período gestacional por meio de uma revisão sistemática da literatura quantitativa e qualitativa acerca do tema. As barreiras mais reportadas pelas mulheres foram os sintomas e limitações do período gestacional. Além disso, a incerteza quanto aos riscos da prática de atividade física na gestação, a falta de recomendação médica e de suporte social foram frequentemente mencionadas. No segundo artigo, avaliou-se as tendências temporais da prática de atividade física na gestação nos últimos onze anos comparando-se dados das Coortes de Nascimento de 2004 e 2015 da cidade de Pelotas-RS, Brasil. Os resultados desse artigo mostram que a prática de atividade física na gestação declinou ao longo do período estudado. No terceiro artigo avaliou-se os efeitos de uma intervenção com exercício físico na gestação (PAMELA Trial) sobre a incidência de sintomas depressivos no período pós parto. Esse estudo foi conduzido de maneira aninhada à Coorte de Nascimentos de 2015. Os resultados do estudo mostraram que a incidência de sintomas depressivos no período pós-parto (≥ 12 pontos no teste de Edimburgo) foi significativamente menor entre as participantes do grupo intervenção quando comparadas ao grupo controle (que não praticou atividade física)

Contraception in adolescence: the influence of parity and marital status on contraceptive use in 73 low-and middle-income countries

Abstract Background There is still a large gap in relation to effectively meet the contraceptive needs and family planning goals of adolescents. Our aim was to describe how having a partner and children impact on contraceptive behavior of sexually active female adolescents from low and middle-income countries (LMICs). Methods Analyses were based on the most recent Demographic and Health Surveys and Multiple Indicator Surveys carried out since 2005 in 73 LMICs with available data for sexually active women aged 15–19 years. Modern contraceptive prevalence and demand for family planning satisfied with modern methods of contraception (mDFPS) were estimated among three subgroups of adolescents considering their parity and marital status- not married, married without children, and married with children – at national and regional levels. Results Female adolescents who were married with no children presented the lowest median modern contraceptive prevalence in all world regions, ranging from 2.9% in West & Central Africa to 29.0% in Latin America & Caribbean. Regarding mDFPS, the lowest coverage for married adolescents without children was found in West & Central Africa (12.6%), whereas Latin America & Caribbean presented the highest (50.4%). In East Asia & Pacific, not married adolescents were the group with the lowest mDFPS (17.1%). In 12 countries, mDFPS was below 10% among married adolescents without children: Angola, Chad, Congo, Congo DR, Guinea, Mozambique, Niger, Nigeria, and Senegal in Africa, Philippines and Timor-Leste in Asia and Guyana in Latin America & Caribbean. Conclusions In most countries, modern contraceptive prevalence and mDFPS were particularly low among married female adolescents without children, which should be considered a priority group for intervention. The findings suggest that social norms regarding marriage and fertility expectations and other cultural barriers have a role at least as relevant as contraceptive availability. All these aspects need to be considered in the design of family planning strategies to effectively increase modern contraceptive use among adolescents everywhere, particularly in conservative contexts

Burden of physical inactivity and hospitalization costs due to chronic diseases

<div><p> OBJECTIVE To evaluate the physical inactivity-related inpatient costs of chronic non-communicable diseases. METHODS This study used data from 2013, from Brazilian Unified Health System, regarding inpatient numbers and costs due to malignant colon and breast neoplasms, cerebrovascular diseases, ischemic heart diseases, hypertension, diabetes, and osteoporosis. In order to calculate the share physical inactivity represents in that, the physical inactivity-related risks, which apply to each disease, were considered, and physical inactivity prevalence during leisure activities was obtained from Pesquisa Nacional por Amostra de Domicílio (Brazil's National Household Sample Survey). The analysis was stratified by genders and residing country regions of subjects who were 40 years or older. The physical inactivity-related hospitalization cost regarding each cause was multiplied by the respective share it regarded to. RESULTS In 2013, 974,641 patients were admitted due to seven different causes in Brazil, which represented a high cost. South region was found to have the highest patient admission rate in most studied causes. The highest prevalences for physical inactivity were observed in North and Northeast regions. The highest inactivity-related share in men was found for osteoporosis in all regions (≈ 35.0%), whereas diabetes was found to have a higher share regarding inactivity in women (33.0% to 37.0% variation in the regions). Ischemic heart diseases accounted for the highest total costs that could be linked to physical inactivity in all regions and for both genders, being followed by cerebrovascular diseases. Approximately 15.0% of inpatient costs from Brazilian Unified Health System were connected to physical inactivity. CONCLUSIONS Physical inactivity significantly impacts the number of patient admissions due to the evaluated causes and through their resulting costs, with different genders and country regions representing different shares.</p></div

Temporal Trends of Physical Activity and Sedentary Behavior Simultaneity in Brazilian Students.

OBJECTIVE: To evaluate trends in physical activity and sedentary behavior simultaneity among Brazilian students from 2009 to 2015 and its association with independent variables. METHODS: This study presents a panel of 3 cross-sectional studies carried out in 2009, 2012, and 2015 (Pesquisa Nacional de Saúde do Escolar-PeNSE). The population was comprised of ninth-grade public and private schools students from Brazilian capitals. Physical activity and sedentary behavior variables were combined to create the outcome of simultaneity of these risk factors. RESULTS: A large proportion of students were simultaneously inactive and sedentary in the 3 surveys. However, it was possible to observe a downward trend (2009: 56.4%; 95% confidence interval, 55.7-57.1; 2012: 53.7%; 95% confidence interval, 53.0-54.4; 2015: 51.9%; 95% confidence interval, 51.2-52.7). In 2015, estimates of physical inactivity and sedentary behavior simultaneity were greater than 48% for 20 out of 27 of the Brazilian states. Significant declining trends were observed among mideast residents, females, nonwhite, and those attending private schools. Only around 5%-7% of the adolescents were both active and nonsedentary in the 3 surveys. CONCLUSION: Despite of a slight decreasing trend in the proportion of Brazilian students simultaneously inactive and sedentary throughout the period, the prevalence remained elevated across the surveys

Why are pregnant women physically inactive?:A qualitative study on the beliefs and perceptions about physical activity during pregnancy

This study aimed to describe the beliefs and perceptions of pregnant women and healthcare providers about physical activity during pregnancy. Using a qualitative approach, 30 pregnant women and the 14 healthcare providers caring for them were interviewed in the second trimester of pregnancy. We included women who maintained, decreased, or stopped physical activity since becoming pregnant. They were divided into low (≤ 8 years) and high schooling (&gt; 8 years). Semi-structured, in-depth interviews were conducted and guided by three key questions: (1) When does physical activity during pregnancy start to be considered a wrong behavior?; (2) What are the main barriers (biological or others) to physical activity?; and (3) Do the actions of healthcare providers and people close to pregnant women reinforce barriers? Interviews were audio recorded, transcribed, and analyzed based on recurring themes. All women changed their physical activity behavior (decreased or stopped) when they discovered their pregnancy. Fear of miscarriage, contractions, bleeding, and of causing malformations in the baby were the most reported reasons for decreasing or stopping physical activity. Participants also lacked access to consistent information and healthcare providers' support on the benefits of physical activity. Despite the current international recommendations to regular physical activity during pregnancy, uncertainty regarding its benefits remains. Interventions to promote physical activity during this period should include the training of healthcare providers so they can advise and discard ideas contrary to mother-child health benefits.</p