Cut down on the prevalence of cesarean sections in Brazil: a time-series from 2000 to 2017

Cesarean section was developed to reduce maternal-fetal morbidity and mortality, however when performed without scientific evidence it is associated with complications. This study analyses the temporal trend and factors associated with cesarean section in Brazil, its regions and Federation Units between 2000 and 2017. Ecological study. The prevalence of cesarean sections and maternal variables were identified from the Information System on Live Births. The Prais-Winsten method was used for time series analysis. In the whole period there were 53.497.303 births in Brazil, 48.4% by cesarean section. Between 2000 and 2009, the mean cesarean section in Brazil increased from 39.7% (SD 9.8) to 53% (SD 9.4) between 2010 and 2017 with an annual variation of 1.7 p.p (95%CI 1.6; 1.8). There is stability between 2010 and 2017, with a slight decline from 2015 in the Southeast region with an annual variation of -0.9 (95%CI -1.5; 0.0). It is observed that the caesarean section has remained stable in most macro-regions and even decreasing in the southeast and in the group of women with higher education, not adolescents and better prenatal coverage. It is believed that Brazil has reached the plateau in the prevalence of cesarean section (60%) in most states and in the next years there is a decrease in these prevalences

Evolution of the epidemiological research on physical activity in Brazil: a systematic review

OBJECTIVE: To describe the evolution of the epidemiological research on physical activity in Brazil. METHODS: A systematic review of the literature was carried out in electronic databases (Medline/PubMed, Lilacs, Ovid, Science Direct, BioMed Central and High Wire), non-indexed Brazilian journals, query by specific authors, and contact with other researchers. The inclusion criteria were: the sample should be representative of a defined population; sample size equal to or greater than 500 individuals; data collection in Brazil; measurement of physical activity; and report of data on this variable. RESULTS: A total of 42 studies were reviewed. The first study was published in 1990, and there has been a clear growth in the number of publications since 2000. Great regional disparities were seen and most studies were carried out in the Southeast and South regions. Almost all studies (93%) used questionnaires but operational definitions of sedentary lifestyle and questionnaires used varied markedly across studies preventing result comparisons. CONCLUSIONS: Although the literature on physical activity in Brazil has quantitatively increased, methodological limitations make it difficult to compare study results. Therefore, standardization of instruments and definitions is essential for the improvement of scientific knowledge in the area.OBJETIVO: Descrever a evolução da pesquisa epidemiológica em atividade física no Brasil. MÉTODOS: Revisão sistemática da literatura, realizada em bases de dados eletrônicas (Medline/PubMed, Lilacs, Ovid, Science Direct, BioMed Central e High Wire), em periódicos nacionais não indexados, por busca específica por autores e contato com pesquisadores. A seleção dos artigos teve como critérios de inclusão: amostra representativa de alguma população definida; tamanho da amostra de pelo menos 500 indivíduos; coleta de dados realizada no Brasil; mensuração de atividade física e relato dos resultados com base nessa variável. RESULTADOS: Foram incluídos 42 estudos. O primeiro artigo foi publicado em 1990, observando-se tendência de aumento de publicações a partir de 2000. Foi detectada disparidade regional nas publicações, com concentração de estudos nas regiões Sudeste e Sul. A maioria dos estudos (93%) utilizou questionários como instrumentos de pesquisa, cujos conteúdos variaram, assim como as definições operacionais de sedentarismo, dificultando a comparação dos resultados. CONCLUSÕES: Embora a literatura em epidemiologia da atividade física venha crescendo quantitativamente no Brasil, limitações metodológicas dificultam a comparação entre os estudos, tornando a padronização de instrumentos e definições essenciais para o avanço científico da área

Pulmonary rehabilitation programs for patients with COPD

Pulmonary rehabilitation programs are aimed at providing benefits to COPD patients, in various aspects. Our objective was to review the literature on COPD patient rehabilitation. This systematic review involved articles written in English, Spanish, or Portuguese; published between 2005 and 2009; and indexed in national and international databases. Articles were classified in accordance with the Global Initiative for Chronic Obstructive Lung Disease criteria for the determination of the level of scientific evidence (grade of recommendation A, B, or C). The outcome measures were exercise, quality of life, symptoms, exacerbations, mortality, and pulmonary function. Treatments were classified as standard rehabilitation, partial rehabilitation, strength exercises, and resistance exercises. Of the 40 articles selected, 4, 18, and 18 were classified as grades A, B, and C, respectively. Of the 181 analyses made in these articles, 61, 50, 23, 23, 20, and 4, respectively, were related to the outcome measures quality of life, exercise, symptoms, exacerbations, pulmonary function, and mortality. The standard rehabilitation programs showed positive effects on all of the outcomes evaluated, except for mortality (because of the small number of analyses). However, we found no differences among the various rehabilitation programs regarding their effects on the outcomes studied. Rehabilitation programs can be considered important tools for the treatment of COPD. Therefore, health administrators should implement public policies including such programs in the routine of health care facilities.Programas de reabilitação pulmonar visam à melhora do paciente com DPOC em vários aspectos. Esta revisão teve como objetivo avaliar a literatura sobre reabilitação em pacientes com DPOC. Foi realizada uma revisão sistemática incluindo artigos publicados entre 2005 e 2009, indexados em bases de dados nacionais e internacionais e escritos em inglês, espanhol ou português. Os artigos foram classificados segundo o critério da Global Initiative for Chronic Obstructive Lung Disease para nível de evidência científica (grau de recomendação A, B e C). Os desfechos exercício, qualidade de vida, sintomas, exacerbações, mortalidade e função pulmonar foram pesquisados. Os tratamentos foram classificados como reabilitação padrão, reabilitação parcial, exercícios de força e exercícios de resistência. Dos 40 artigos selecionados, 4, 18 e 18 foram classificados com graus A, B e C, respectivamente. Das 181 análises oriundas desses artigos, 61, 50, 23, 23, 20 e 4, respectivamente, foram relacionadas aos desfechos qualidade de vida, exercício, sintomas, exacerbação, função pulmonar e mortalidade. Em todos os desfechos avaliados, os programas de reabilitação padrão tiveram efeitos positivos sobre os desfechos estudados, exceto para mortalidade pelo reduzido número de análises. Entretanto, não foram verificadas diferenças nos efeitos sobre os desfechos estudados quando os diferentes programas de reabilitação foram comparados. Programas de reabilitação pulmonar podem ser considerados importantes ferramentas no arsenal do tratamento da DPOC, merecendo atenção dos gestores em saúde para a implementação de políticas públicas que os incluam como rotina nos serviços de saúde.Universidade Federal de Pelotas Faculdade de Medicina Departamento de Clínica MédicaUniversidade Federal do Rio Grande do Sul Faculdade de Medicina Departamento de Medicina InternaUniversidade Federal de São Paulo (UNIFESP)Universidade Federal de Santa Catarina Departamento de NutriçãoFundação Universidade Federal do Rio Grande Instituto de Ciências Humanas e da InformaçãoUniversidade Federal de Pelotas Escola Superior de Educação FísicaUNIFESPSciEL

Planejamento e execução de um inquérito populacional de saúde por meio de consórcio de pesquisa multidisciplinar = Planning and execution of a population health survey by means of a multidisciplinary research consortium

ESUMO OBJETIVOS: Descrever os aspectos metodológicos e operacionais de um inquérito de pesquisa sobre saúde, realizado por meio de um consórcio de pesquisa multidisciplinar. MÉTODOS: Um estudo transversal de base populacional foi realizado com indivíduos de 18 anos ou mais, residentes na zona urbana do município de Rio Grande, RS, Brasil. A amostragem foi probabilística, tendo como unidade primária amostral os setores censitários. O instrumento de pesquisa consistiu num questionário padronizado, com questões fechadas e previamente testado, aplicado face a face no domicílio. Um questionário resumido foi aplicado a 10,5% dos indivíduos para fins de controle de qualidade. O trabalho de campo se estendeu de abril a julho de 2016 e a pesquisa foi previamente aprovada por comitê de ética em pesquisa. RESULTADOS: Dos 70 setores censitários amostrados, foram selecionados 711 domicílios e 1. 429 indivíduos. Responderam o questionário 1. 300 indivíduos (91,0%) de 676 domicílios (95,1%). As perdas e recusas foram mais prevalentes para os indivíduos do sexo masculino e dos setores do centro da cidade. A reprodutibilidade do questionário foi satisfatória (kappa médio = 0,80). CONCLUSÕES: Apontaram-se os principais aspectos metodológicos de um consórcio de pesquisa multidisciplinar, que poderão ser de interesse para outros pesquisadores. Destaca-se a relevância deste tipo de estudo para a produção de informações sobre diversas condições de saúde da populaçã

Congresso “Atividade física e saúde pública em tempos de pandemia: desafios e perspectivas futuras”: relato de experiência

Understanding the impact of the pandemic on the population's physical activity and sedentary behavior is essential for the implementation of public health policies and future interventions. We report the planning and holding of a free and virtual scientific congress, with the aim of promoting discussion about physical activity and public health in times of a pandemic, addressing its challenges and future perspectives. The Research Group on Physical Activity and Public Health, GPASP-FURG used a platform for registration, submission of papers and issuance of certificates was Even3®. For dissemination to the community, Instagram®, Facebook® and WhatsApp® were systematically used, and formal emails were used for academic institutions. For the transmission, StreamYard® was used with sharing and storage on YouTube® through the GPASP channel. The congress was held between September and October 2021, on 6 Fridays at night. It had the participation of 21 researcher-speakers from Brazilian and international universities and 06 researcher-mediators. There were 1,431 entries, 79 works submitted in 03 thematic áreas (Physical monitoring and health during the pandemic; Interventions in physical activity and during the pandemic; Diseases and diseases sponsored during the pandemic), 48 of which were approved and published in the special scientific edition of Vittalle Magazine. The scientific sessions had so far 1,387 views and the roundtables 4,487 views. During the broadcasts, the Pix keys were released to benefit 03 charities in Rio Grande do Sul. The planning, evaluation of works, mediation of scientific sessions and post-event task list were carried out by postgraduate and scientific initiation students aiming at academic development.A compreensão do impacto da pandemia na atividade física e no comportamento sedentário da população é essencial para a implementação de políticas de saúde pública e de futuras intervenções. Relatamos o planejamento e realização de um congresso científico virtual e gratuito, que objetivou fomentar a discussão sobre a atividade física e saúde pública em tempos de pandemia, abordando desafios e perspectivas futuras. O Grupo de Pesquisa em Atividade Física e Saúde Pública, GPASP-FURG utilizou a plataforma de inscrições, submissão de trabalhos e emissão de certificados Even3®. Para divulgação utilizou-se sistematicamente o Instagram®, Facebook® e WhatsApp® e para as instituições acadêmicas e-mails formais. Para a transmissão utilizou-se o StreamYard® com compartilhamento e armazenamento no YouTube® por meio do canal do GPASP. O congresso foi realizado entre setembro e outubro de 2021, em 06 sextas-feiras no período noturno. Contou com a participação de 21 pesquisadores-palestrantes de universidades brasileiras e internacionais e 06 pesquisadores-mediadores. Houve 1.431 inscritos, 79 trabalhos submetidos em 03 áreas temáticas (Monitoramento de atividade física e saúde durante a pandemia; Intervenções em atividade física e saúde durante a pandemia; Agravos e doenças crônicas durante a pandemia), sendo 48 deles aprovados e publicados na edição especial da Revista Vittalle. As sessões científicas tiveram 1.387 visualizações e as mesas-redondas 4.487 visualizações. Nas transmissões foram divulgadas as chaves Pix para beneficiar 03 instituições de caridade rio-grandinas. O planejamento, avaliação de trabalhos, mediação das sessões científicas e lista de tarefas pós-evento foram realizadas por alunos de pós-graduação e iniciação científica visando o desenvolvimento acadêmico

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