Influência dos programas coletivos na condição física de mulheres idosas

Introducción: los países más desarrollados del mundo están asistiendo a una regresión poblacional, lo que les supone un enorme costo en la atención sociosanitaria. Existe mucha evidencia sobre el envejecimiento y estudios sobre la in uencia de la actividad física en la salud de las personas, cuyo resultado dependerá de la forma de implementarla. Objetivo: comparar los efectos en la salud física de dos programas de ejercicio físico supervisado para personas mayores. Materiales y método: se realizó un estudio de tipo cuasiexperimental, comparándose dos programas de ejercicio físico colectivo supervisado realizados por sendos grupos de mujeres mayores independientes entre 55 y 65 años. Se utilizó como control un programa sociomotriz existente, y se implementó un programa experimental, con contenidos complementarios, y más sesiones y actividades en el exterior. Se examinó la condición física, calculándose media y distribución de varianza. Resultados: los datos muestran que las mujeres mejoraron en el 90% de los indicadores de salud y percibieron mejor su aptitud física. El programa experimental, con mayor número de sesiones y actividades en el medio natural, se mostró signi cativamente efectivo en relación con el equilibrio y la fuerza de los miembros inferiores. Discusión y conclusiones: los programas de ejercicio físico colectivo supervisado son positivos para la salud física de las personas mayores, pero particularmente aquellos que alcanzan una práctica semanal de tres días, que incluya un 30% de sesiones en el exterior.Introduction: The more developed countries of the world are suffering a population regression, which supposes a high cost of socio-health care. There is a lot of evidence on ageing, however, studies on the influence of physical activity on the health of people are insufficient, as it largely depends on its implementation. Objective: To compare the effects in physical health of two supervised physical exercise programs for seniors. Materials and methods: A quasi-experimental study was carried out, comparing two supervised collective physical exercise programs performed by groups of independent older women aged 55-65 years. An existing sociomotor program was used as a control, and an experimental program was implemented, with additional contents, and more sessions and activities abroad. The physical condition was examined, and averaging and variance distribution was calculated. Results: The results showed that older women improved in 90% of physical fitness indicators and perceived their physical health better. In fact, the experimental program, with more sessions and activities in the natural environment was more effective in relation to balance and strength of the lower limbs. Discussion and conclusions: Supervised collective physical exercise programs are positive for the physical health of older people, but especially those who achieved three-day weekly practice, which includes 30% outdoor sessions.Introdução: os países mais desenvolvidos do mundo estão assistindo a uma regressão populacional, o que lhes supõe um enorme custo na atenção sociossanitária. Existe muita evidência sobre o envelhecimento e estudos sobre a in uência da atividade física na saúde das pessoas, cujo resultado dependerá da forma de implementá-la. Objetivo: comparar os efeitos na saúde física de dois programas de exercício físico supervisado para idosos. Materiais e métodos: se realizou um estudo de tipo quase-experimental, comparando-se dois programas de exercício físico coletivo supervisado, realizados pelos seus respetivos grupos de mulheres idosas independentes entre cinquenta e cinco e sessenta e cinco anos. Utilizou-se como controle um programa socio-motriz existente, e se implementou um programa experimental, com conteúdos complementários, e mais sessões e atividades no exterior. Se examinou a condição física, calculando-se média e distribuição de variância. Resultados: os dados mostram que as mulheres melhoraram no 90% dos indicadores de saúde e perceberam melhor a sua aptidão física. O programa experimental, com maior número de sessões e atividades no meio natural, se mostrou signi cativamente efetivo em relação com o equilíbrio e a força dos membros inferiores. Discussão e conclusões: os programas de exercícios físico coletivo supervisado sçao positivos para a saúde física dos idosos, mas particularmente aqueles que alcançam uma prática semanal de três dias, que inclua um 30% de sessões no exterior

Influência dos programas coletivos na condição física de mulheres idosas

Introducción: los países más desarrollados del mundo están asistiendo a una regresión poblacional, lo que les supone un enorme costo en la atención sociosanitaria. Diversas investigaciones ponen en evidencia el envejecimiento, y muchos estudios demuestran la influencia de la actividad física en la salud de las personas, cuyo resultado dependerá de la forma de implementarla. Objetivo: El objetivo de este artículo es comparar los efectos en la salud física de dos programas de ejercicio físico supervisado para personas mayores. Materiales y métodos: se realizó un estudio de tipo cuasiexperimental, comparándose dos programas de ejercicio físico colectivo supervisado realizados por sendos grupos de mujeres mayores independientes entre 55 y 65 años. Se utilizó como control un programa sociomotriz existente, y se implementó un programa experimental, con contenidos complementarios, y más sesiones y actividades en el exterior. Se examinó la condición física, calculándose media y distribución de varianza. Resultados: los datos muestran que las mujeres mejoraron en el 90% de los indicadores de salud y percibieron mejor su aptitud física. El programa experimental, con mayor número de sesiones y actividades en el medio natural, se mostró significativamente efectivo en relación con el equilibrio y la fuerza de los miembros inferiores. Conclusiones: los programas de ejercicio físico colectivo supervisado son positivos para la salud física de las personas mayores, pero en especial aquellos que alcanzan una práctica semanal de tres días, que incluya un 30% de sesiones en el exterior.Introduction: The more developed countries of the world are suffering a population regression, which suppose a high cost on socio-health care. There is a lot of evidence on aging, however, studies on the influence of physical activity on the health of people are insufficient, as it largely depends on its implementation. Objective: The objective is to compare the effects in physical health of two supervised physical exercise programs for seniors. Materials and methods: A quasi-experimental study was carried out, comparing two supervised collective physical exercise programs performed by groups of independent older women aged 55-65 years. An existing sociomotor program was used as control, and an experimental program was implemented, with additional contents, and more sessions and activities abroad. The physical condition was examined, and averaging and variance distribution was calculated. Results: The results showed that older women improved in 90% of physical fitness indicators and perceived their physical health better. In fact, the experimental program, with more sessions and activities in the natural environment was more effective in relation to balance and strength of the lower limbs. Conclusions: Supervised collective physical exercise programs are positive for the physical health of older people, but especially those who achieved three-day weekly practice, which includes 30% outdoor sessions.Introdução: os países mais desenvolvidos do mundo estão assistindo a uma regressão populacional, o que lhes supõe um enorme custo na atenção sociossanitária. Existe muita evidência sobre o envelhecimento e estudos sobre a in uência da atividade física na saúde das pessoas, cujo resultado dependerá da forma de implementá-la. Objetivo: comparar os efeitos na saúde física de dois programas de exercício físico supervisado para idosos. Materiais e métodos: se realizou um estudo de tipo quase-experimental, comparando-se dois programas de exercício físico coletivo supervisado, realizados pelos seus respetivos grupos de mulheres idosas independentes entre cinquenta e cinco e sessenta e cinco anos. Utilizou-se como controle um programa socio-motriz existente, e se implementou um programa experimental, com conteúdos complementários, e mais sessões e atividades no exterior. Se examinou a condição física, calculando-se média e distribuição de variância. Resultados: os dados mostram que as mulheres melhoraram no 90% dos indicadores de saúde e perceberam melhor a sua aptidão física. O programa experimental, com maior número de sessões e atividades no meio natural, se mostrou signicativamente efetivo em relação com o equilíbrio e a força dos membros inferiores. Discussão e conclusões: os programas de exercícios físico coletivo supervisado sçao positivos para a saúde física dos idosos, mas particularmente aqueles que alcançam uma prática semanal de três dias, que inclua um 30% de sessões no exterior

Global variation in diabetes diagnosis and prevalence based on fasting glucose and hemoglobin A1c

Fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) are both used to diagnose diabetes, but these measurements can identify different people as having diabetes. We used data from 117 population-based studies and quantified, in different world regions, the prevalence of diagnosed diabetes, and whether those who were previously undiagnosed and detected as having diabetes in survey screening, had elevated FPG, HbA1c or both. We developed prediction equations for estimating the probability that a person without previously diagnosed diabetes, and at a specific level of FPG, had elevated HbA1c, and vice versa. The age-standardized proportion of diabetes that was previously undiagnosed and detected in survey screening ranged from 30% in the high-income western region to 66% in south Asia. Among those with screen-detected diabetes with either test, the age-standardized proportion who had elevated levels of both FPG and HbA1c was 29-39% across regions; the remainder had discordant elevation of FPG or HbA1c. In most low- and middle-income regions, isolated elevated HbA1c was more common than isolated elevated FPG. In these regions, the use of FPG alone may delay diabetes diagnosis and underestimate diabetes prevalence. Our prediction equations help allocate finite resources for measuring HbA1c to reduce the global shortfall in diabetes diagnosis and surveillance

Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults

Background Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5–19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI <18·5 kg/m2) and obesity (BMI ≥30 kg/m2). For schoolaged children and adolescents, we report thinness (BMI <2 SD below the median of the WHO growth reference) and obesity (BMI >2 SD above the median). Findings From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness. Interpretation The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesit

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Minimal information for studies of extracellular vesicles (MISEV2023): From basic to advanced approaches

Extracellular vesicles (EVs), through their complex cargo, can reflect the state of their cell of origin and change the functions and phenotypes of other cells. These features indicate strong biomarker and therapeutic potential and have generated broad interest, as evidenced by the steady year-on-year increase in the numbers of scientific publications about EVs. Important advances have been made in EV metrology and in understanding and applying EV biology. However, hurdles remain to realising the potential of EVs in domains ranging from basic biology to clinical applications due to challenges in EV nomenclature, separation from non-vesicular extracellular particles, characterisation and functional studies. To address the challenges and opportunities in this rapidly evolving field, the International Society for Extracellular Vesicles (ISEV) updates its 'Minimal Information for Studies of Extracellular Vesicles', which was first published in 2014 and then in 2018 as MISEV2014 and MISEV2018, respectively. The goal of the current document, MISEV2023, is to provide researchers with an updated snapshot of available approaches and their advantages and limitations for production, separation and characterisation of EVs from multiple sources, including cell culture, body fluids and solid tissues. In addition to presenting the latest state of the art in basic principles of EV research, this document also covers advanced techniques and approaches that are currently expanding the boundaries of the field. MISEV2023 also includes new sections on EV release and uptake and a brief discussion of in vivo approaches to study EVs. Compiling feedback from ISEV expert task forces and more than 1000 researchers, this document conveys the current state of EV research to facilitate robust scientific discoveries and move the field forward even more rapidly

Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950–2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021

Background: Estimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020–21 COVID-19 pandemic period. Methods: 22 223 data sources from vital registration, sample registration, surveys, censuses, and other sources were used to estimate mortality, with a subset of these sources used exclusively to estimate excess mortality due to the COVID-19 pandemic. 2026 data sources were used for population estimation. Additional sources were used to estimate migration; the effects of the HIV epidemic; and demographic discontinuities due to conflicts, famines, natural disasters, and pandemics, which are used as inputs for estimating mortality and population. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate under-5 mortality rates, which synthesised 30 763 location-years of vital registration and sample registration data, 1365 surveys and censuses, and 80 other sources. ST-GPR was also used to estimate adult mortality (between ages 15 and 59 years) based on information from 31 642 location-years of vital registration and sample registration data, 355 surveys and censuses, and 24 other sources. Estimates of child and adult mortality rates were then used to generate life tables with a relational model life table system. For countries with large HIV epidemics, life tables were adjusted using independent estimates of HIV-specific mortality generated via an epidemiological analysis of HIV prevalence surveys, antenatal clinic serosurveillance, and other data sources. Excess mortality due to the COVID-19 pandemic in 2020 and 2021 was determined by subtracting observed all-cause mortality (adjusted for late registration and mortality anomalies) from the mortality expected in the absence of the pandemic. Expected mortality was calculated based on historical trends using an ensemble of models. In location-years where all-cause mortality data were unavailable, we estimated excess mortality rates using a regression model with covariates pertaining to the pandemic. Population size was computed using a Bayesian hierarchical cohort component model. Life expectancy was calculated using age-specific mortality rates and standard demographic methods. Uncertainty intervals (UIs) were calculated for every metric using the 25th and 975th ordered values from a 1000-draw posterior distribution. Findings: Global all-cause mortality followed two distinct patterns over the study period: age-standardised mortality rates declined between 1950 and 2019 (a 62·8% [95% UI 60·5–65·1] decline), and increased during the COVID-19 pandemic period (2020–21; 5·1% [0·9–9·6] increase). In contrast with the overall reverse in mortality trends during the pandemic period, child mortality continued to decline, with 4·66 million (3·98–5·50) global deaths in children younger than 5 years in 2021 compared with 5·21 million (4·50–6·01) in 2019. An estimated 131 million (126–137) people died globally from all causes in 2020 and 2021 combined, of which 15·9 million (14·7–17·2) were due to the COVID-19 pandemic (measured by excess mortality, which includes deaths directly due to SARS-CoV-2 infection and those indirectly due to other social, economic, or behavioural changes associated with the pandemic). Excess mortality rates exceeded 150 deaths per 100 000 population during at least one year of the pandemic in 80 countries and territories, whereas 20 nations had a negative excess mortality rate in 2020 or 2021, indicating that all-cause mortality in these countries was lower during the pandemic than expected based on historical trends. Between 1950 and 2021, global life expectancy at birth increased by 22·7 years (20·8–24·8), from 49·0 years (46·7–51·3) to 71·7 years (70·9–72·5). Global life expectancy at birth declined by 1·6 years (1·0–2·2) between 2019 and 2021, reversing historical trends. An increase in life expectancy was only observed in 32 (15·7%) of 204 countries and territories between 2019 and 2021. The global population reached 7·89 billion (7·67–8·13) people in 2021, by which time 56 of 204 countries and territories had peaked and subsequently populations have declined. The largest proportion of population growth between 2020 and 2021 was in sub-Saharan Africa (39·5% [28·4–52·7]) and south Asia (26·3% [9·0–44·7]). From 2000 to 2021, the ratio of the population aged 65 years and older to the population aged younger than 15 years increased in 188 (92·2%) of 204 nations. Interpretation: Global adult mortality rates markedly increased during the COVID-19 pandemic in 2020 and 2021, reversing past decreasing trends, while child mortality rates continued to decline, albeit more slowly than in earlier years. Although COVID-19 had a substantial impact on many demographic indicators during the first 2 years of the pandemic, overall global health progress over the 72 years evaluated has been profound, with considerable improvements in mortality and life expectancy. Additionally, we observed a deceleration of global population growth since 2017, despite steady or increasing growth in lower-income countries, combined with a continued global shift of population age structures towards older ages. These demographic changes will likely present future challenges to health systems, economies, and societies. The comprehensive demographic estimates reported here will enable researchers, policy makers, health practitioners, and other key stakeholders to better understand and address the profound changes that have occurred in the global health landscape following the first 2 years of the COVID-19 pandemic, and longer-term trends beyond the pandemic

Burden of disease scenarios for 204 countries and territories, 2022–2050: a forecasting analysis for the Global Burden of Disease Study 2021

Background: Future trends in disease burden and drivers of health are of great interest to policy makers and the public at large. This information can be used for policy and long-term health investment, planning, and prioritisation. We have expanded and improved upon previous forecasts produced as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) and provide a reference forecast (the most likely future), and alternative scenarios assessing disease burden trajectories if selected sets of risk factors were eliminated from current levels by 2050. Methods: Using forecasts of major drivers of health such as the Socio-demographic Index (SDI; a composite measure of lag-distributed income per capita, mean years of education, and total fertility under 25 years of age) and the full set of risk factor exposures captured by GBD, we provide cause-specific forecasts of mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) by age and sex from 2022 to 2050 for 204 countries and territories, 21 GBD regions, seven super-regions, and the world. All analyses were done at the cause-specific level so that only risk factors deemed causal by the GBD comparative risk assessment influenced future trajectories of mortality for each disease. Cause-specific mortality was modelled using mixed-effects models with SDI and time as the main covariates, and the combined impact of causal risk factors as an offset in the model. At the all-cause mortality level, we captured unexplained variation by modelling residuals with an autoregressive integrated moving average model with drift attenuation. These all-cause forecasts constrained the cause-specific forecasts at successively deeper levels of the GBD cause hierarchy using cascading mortality models, thus ensuring a robust estimate of cause-specific mortality. For non-fatal measures (eg, low back pain), incidence and prevalence were forecasted from mixed-effects models with SDI as the main covariate, and YLDs were computed from the resulting prevalence forecasts and average disability weights from GBD. Alternative future scenarios were constructed by replacing appropriate reference trajectories for risk factors with hypothetical trajectories of gradual elimination of risk factor exposure from current levels to 2050. The scenarios were constructed from various sets of risk factors: environmental risks (Safer Environment scenario), risks associated with communicable, maternal, neonatal, and nutritional diseases (CMNNs; Improved Childhood Nutrition and Vaccination scenario), risks associated with major non-communicable diseases (NCDs; Improved Behavioural and Metabolic Risks scenario), and the combined effects of these three scenarios. Using the Shared Socioeconomic Pathways climate scenarios SSP2-4.5 as reference and SSP1-1.9 as an optimistic alternative in the Safer Environment scenario, we accounted for climate change impact on health by using the most recent Intergovernmental Panel on Climate Change temperature forecasts and published trajectories of ambient air pollution for the same two scenarios. Life expectancy and healthy life expectancy were computed using standard methods. The forecasting framework includes computing the age-sex-specific future population for each location and separately for each scenario. 95% uncertainty intervals (UIs) for each individual future estimate were derived from the 2·5th and 97·5th percentiles of distributions generated from propagating 500 draws through the multistage computational pipeline. Findings: In the reference scenario forecast, global and super-regional life expectancy increased from 2022 to 2050, but improvement was at a slower pace than in the three decades preceding the COVID-19 pandemic (beginning in 2020). Gains in future life expectancy were forecasted to be greatest in super-regions with comparatively low life expectancies (such as sub-Saharan Africa) compared with super-regions with higher life expectancies (such as the high-income super-region), leading to a trend towards convergence in life expectancy across locations between now and 2050. At the super-region level, forecasted healthy life expectancy patterns were similar to those of life expectancies. Forecasts for the reference scenario found that health will improve in the coming decades, with all-cause age-standardised DALY rates decreasing in every GBD super-region. The total DALY burden measured in counts, however, will increase in every super-region, largely a function of population ageing and growth. We also forecasted that both DALY counts and age-standardised DALY rates will continue to shift from CMNNs to NCDs, with the most pronounced shifts occurring in sub-Saharan Africa (60·1% [95% UI 56·8–63·1] of DALYs were from CMNNs in 2022 compared with 35·8% [31·0–45·0] in 2050) and south Asia (31·7% [29·2–34·1] to 15·5% [13·7–17·5]). This shift is reflected in the leading global causes of DALYs, with the top four causes in 2050 being ischaemic heart disease, stroke, diabetes, and chronic obstructive pulmonary disease, compared with 2022, with ischaemic heart disease, neonatal disorders, stroke, and lower respiratory infections at the top. The global proportion of DALYs due to YLDs likewise increased from 33·8% (27·4–40·3) to 41·1% (33·9–48·1) from 2022 to 2050, demonstrating an important shift in overall disease burden towards morbidity and away from premature death. The largest shift of this kind was forecasted for sub-Saharan Africa, from 20·1% (15·6–25·3) of DALYs due to YLDs in 2022 to 35·6% (26·5–43·0) in 2050. In the assessment of alternative future scenarios, the combined effects of the scenarios (Safer Environment, Improved Childhood Nutrition and Vaccination, and Improved Behavioural and Metabolic Risks scenarios) demonstrated an important decrease in the global burden of DALYs in 2050 of 15·4% (13·5–17·5) compared with the reference scenario, with decreases across super-regions ranging from 10·4% (9·7–11·3) in the high-income super-region to 23·9% (20·7–27·3) in north Africa and the Middle East. The Safer Environment scenario had its largest decrease in sub-Saharan Africa (5·2% [3·5–6·8]), the Improved Behavioural and Metabolic Risks scenario in north Africa and the Middle East (23·2% [20·2–26·5]), and the Improved Nutrition and Vaccination scenario in sub-Saharan Africa (2·0% [–0·6 to 3·6]). Interpretation: Globally, life expectancy and age-standardised disease burden were forecasted to improve between 2022 and 2050, with the majority of the burden continuing to shift from CMNNs to NCDs. That said, continued progress on reducing the CMNN disease burden will be dependent on maintaining investment in and policy emphasis on CMNN disease prevention and treatment. Mostly due to growth and ageing of populations, the number of deaths and DALYs due to all causes combined will generally increase. By constructing alternative future scenarios wherein certain risk exposures are eliminated by 2050, we have shown that opportunities exist to substantially improve health outcomes in the future through concerted efforts to prevent exposure to well established risk factors and to expand access to key health interventions

Influência dos programas coletivos na condição física de mulheres idosas

Introducción: los países más desarrollados del mundo están asistiendo a una regresión poblacional, lo que les supone un enorme costo en la atención sociosanitaria. Existe mucha evidencia sobre el envejecimiento y estudios sobre la in uencia de la actividad física en la salud de las personas, cuyo resultado dependerá de la forma de implementarla. Objetivo: comparar los efectos en la salud física de dos programas de ejercicio físico supervisado para personas mayores. Materiales y método: se realizó un estudio de tipo cuasiexperimental, comparándose dos programas de ejercicio físico colectivo supervisado realizados por sendos grupos de mujeres mayores independientes entre 55 y 65 años. Se utilizó como control un programa sociomotriz existente, y se implementó un programa experimental, con contenidos complementarios, y más sesiones y actividades en el exterior. Se examinó la condición física, calculándose media y distribución de varianza. Resultados: los datos muestran que las mujeres mejoraron en el 90% de los indicadores de salud y percibieron mejor su aptitud física. El programa experimental, con mayor número de sesiones y actividades en el medio natural, se mostró signi cativamente efectivo en relación con el equilibrio y la fuerza de los miembros inferiores. Discusión y conclusiones: los programas de ejercicio físico colectivo supervisado son positivos para la salud física de las personas mayores, pero particularmente aquellos que alcanzan una práctica semanal de tres días, que incluya un 30% de sesiones en el exterior.Introdução: os países mais desenvolvidos do mundo estão assistindo a uma regressão populacional, o que lhes supõe um enorme custo na atenção sociossanitária. Existe muita evidência sobre o envelhecimento e estudos sobre a in uência da atividade física na saúde das pessoas, cujo resultado dependerá da forma de implementá-la. Objetivo: comparar os efeitos na saúde física de dois programas de exercício físico supervisado para idosos. Materiais e métodos: se realizou um estudo de tipo quase-experimental, comparando-se dois programas de exercício físico coletivo supervisado, realizados pelos seus respetivos grupos de mulheres idosas independentes entre cinquenta e cinco e sessenta e cinco anos. Utilizou-se como controle um programa socio-motriz existente, e se implementou um programa experimental, com conteúdos complementários, e mais sessões e atividades no exterior. Se examinou a condição física, calculando-se média e distribuição de variância. Resultados: os dados mostram que as mulheres melhoraram no 90% dos indicadores de saúde e perceberam melhor a sua aptidão física. O programa experimental, com maior número de sessões e atividades no meio natural, se mostrou signi cativamente efetivo em relação com o equilíbrio e a força dos membros inferiores. Discussão e conclusões: os programas de exercícios físico coletivo supervisado sçao positivos para a saúde física dos idosos, mas particularmente aqueles que alcançam uma prática semanal de três dias, que inclua um 30% de sessões no exterior.Introduction: The more developed countries of the world are suffering a population regression, which supposes a high cost of socio-health care. There is a lot of evidence on ageing, however, studies on the influence of physical activity on the health of people are insufficient, as it largely depends on its implementation. Objective: To compare the effects in physical health of two supervised physical exercise programs for seniors. Materials and methods: A quasi-experimental study was carried out, comparing two supervised collective physical exercise programs performed by groups of independent older women aged 55-65 years. An existing sociomotor program was used as a control, and an experimental program was implemented, with additional contents, and more sessions and activities abroad. The physical condition was examined, and averaging and variance distribution was calculated. Results: The results showed that older women improved in 90% of physical fitness indicators and perceived their physical health better. In fact, the experimental program, with more sessions and activities in the natural environment was more effective in relation to balance and strength of the lower limbs. Discussion and conclusions: Supervised collective physical exercise programs are positive for the physical health of older people, but especially those who achieved three-day weekly practice, which includes 30% outdoor sessions