Functional limitation on elderly people in the northeast and the feminization of eld in urban and rural areas of Brazil

Population aging in Brazil increases on a large scale due to declining fertility and mortality. This phenomenon can be influenced by several factors (demographic, biological and social), making them determinants for the health conditions of the elderly populations residing in different geographic areas. The present study aims to identify the functional limitation in elderlyresidents of urban and rural areas of Brazil. This is a descriptive epidemiological study with a quantitative approach. It was evidenced that the functional limitation for activities of daily living and instrumental activities of daily living are concentrated in the northeast region, mainly in the urban area. The following states presented the highest proportions of daily life activity limitation in urban areas: Alagoas (11.60%), Rio Grande do Norte (10.95%), Pernambuco (10.36%) and Paraíba (9.62%). For activities of daily living in the rural area were found in the states of Paraíba (12.19%), Maranhão (8.93%), Piauí (8.85%) and then Pernambuco (7.24%). Data from the functional limitation for instrumental activities of daily living again highlighted the Northeast region, with the states of Rio Grande do Norte (26.01%), Paraíba (25.96%), Maranhão (25.72%) and Alagoas (24.57%). Lastly, it was verified that the elderly woman exhibits greater proportions of functional limitation in relation to the elderly of the masculine sex, standing out again the northeastern region of the country.

Puberty in a sample of brazilian schoolboys: onset and anthropometric characteristics / Puberdade em uma amostra de meninos escolares brasileiros: início e características antropométricas

ABSTRACT Objective: To determine the age of puberty onset in boys and collect anthropometric data of participants at different puberty stages. Methods: This is a cross-sectional study that assessed 430 boys in a random sample representing 48,390 students from public and private schools from the city of Uberaba, Southeast Brazil. The inclusion criteria were males, aged between 5 and 18 years, and absence of previous diseases. Participants and their guardians filled a semistructured questionnaire with questions relevant to their and their parents' puberty. We set the significance at p<0.05 and calculated the 95% confidence intervals. Results: The mean age found in the puberty stage G2 was 11.2±1.8 (95% of participants in stage G2 were 9.2-13.4 years old). Pubarche data showed a mean of age of 11.0±1.6 years (95% of the participants experienced pubarche when they were 8.0-14.0 years old). When compared to the confidence intervals of two classical studies on the subject, our results showed a trend toward earlier pubarche. In addition, the mean age of this event in the children's parents was of 12.1±1.4 years, which was significantly higher than the age of the children's pubarche (p<0.001). Conclusions: These results indicate a secular decreasing trend in pubarche age and an earlier puberty onset. Considering these parameters, is important to design public policies aimed at preventing these early events.

RESUMO Objetivo: Determinar a idade em que a puberdade começa em meninos e coletar dados antropométricos de participantes em diferentes fases da puberdade. Métodos: Trata-se de um estudo transversal no qual foram avaliados 430 meninos, uma amostra aleatória representativa da população total de 48.390 estudantes de escolas públicas e particulares de Uberaba, Minas Gerais. Os critérios de inclusão foram: ser do sexo masculino, ter idade de 5 a 18 anos e ausência de doenças prévias. Os participantes e seus responsáveis preencheram um questionário semiestruturado com perguntas pertinentes à sua puberdade e à de seus pais. Os dados foram considerados significantes para p<0,05, e os intervalos de confiança calculados foram de 95%. Resultados: A média de idade encontrada no estágio G2 foi de 11,2±1,8 anos, sendo que 95% dos participantes em G2 tinham entre 9,2 a 13,4 anos. Quanto à pubarca, a média de idade foi de 11,0±1,6 anos, e 95% dos participantes apresentaram pubarca entre 8,0 e 14,0 anos. Quando tais resultados foram comparados aos intervalos de confiança de dois estudos clássicos sobre o tema, houve tendência à pubarca mais precoce. Além disso, a média de idade da pubarca nos pais das crianças foi de 12,1±1,4 anos, significantemente maior em relação à dos filhos (p<0,001). Conclusões: Os resultados indicam uma tendência secular em direção à diminuição da idade da pubarca e um possível início mais precoce da puberdade. É muito importante considerar esses parâmetros para estabelecer políticas públicas destinadas a prevenir esses eventos iniciais.

Availability and storage of hazardous products in households in the metropolitan region of manaus: a population-based survey, 2015 / Disponibilidade e armazenamento de produtos perigosos em domicílios da região metropolitana de manaus: estudo de base populacional, 2015

ABSTRACT Objective: The availability of hazardous products in households increases the risks of poisoning. The present study aimed to assess the frequency and associated factors of the availability and storage of hazardous products in residences in the metropolitan region of Manaus. Methods: Population-based and cross-sectional study conducted in 2015 with adults selected with three-stage probabilistic sampling. Participants were interviewed face-to-face. Prevalence ratio (PR) of the presence of hazardous products (presence of chumbinho [illegal anti-cholinesterase rodenticide], artisanal cleaning products, and unsafe storage of these products and medications) and 95% confidence intervals (95%CI) were calculated with Poisson regression with robust variance, weighted by the complex sampling method adopted. Results: A total of 4,001 participants was included, of which 53.0% (95%CI 51.5-54.6) reported presence of hazardous products in their households, 36.3% (95%CI 34.8-37.8) had unsafe storage, 16.2% (95%CI 15.1-17.4) had artisanal cleaning products, and 8.2% (95%CI 7.4-9.1) had chumbinho. Households with children ≤5 years old had safer storage (PR=0.78; 95%CI 0.71-0.86) and more artisanal products (PR=1.30; 95%CI 1.11-1.51). Presence of artisanal products was higher in lower educational levels (PR=2.20; 95%CI 1.36-3.57) and lower economic classifications (PR=1.63; 95%CI 1.25-2.13). Conclusions: Over half of the households in the metropolitan region of Manaus kept hazardous products; one-third stored them unsafely. Artisanal cleaning products and chumbinho were frequently present. Households with children had safer storage of products, and socioeconomic factors affected the availability of such hazardous products.

RESUMO Objetivo: A disponibilidade de produtos perigosos em domicílios aumenta os riscos de intoxicações. Este estudo objetivou avaliar a frequência e os fatores associados à disponibilidade e armazenamento de produtos perigosos em residências da Região Metropolitana de Manaus. Métodos: Estudo transversal de base populacional realizado em 2015 com adultos selecionados por amostragem probabilística em três estágios. Os participantes foram entrevistados pessoalmente. A razão de prevalência (RP) da presença de produtos perigosos (presença de chumbinho [rodenticida anticolinesterase ilegal], produtos de limpeza artesanais e armazenamento inseguro desses produtos e de medicamentos) e intervalos de confiança de 95% (IC95%) foram calculados por regressão de Poisson com variância robusta, ponderada pela amostragem complexa adotada. Resultados: 4.001 participantes foram incluídos, dos quais 53,0% (IC95% 51,5-54,6) reportaram a presença de produtos perigosos em seus domicílios, 36,3% (IC95% 34,8-37,8) apresentaram armazenamento inseguro, 16,2% (IC95% 15,1-17,4) possuíam produtos de limpeza artesanais e 8,2% (IC95% 7,4-9,1) possuíam chumbinho. Os domicílios com crianças menores de 5 anos apresentaram armazenamento mais seguro (RP=0,78; IC95% 0,71-0,86) e mais produtos artesanais (RP=1,30; IC95% 1,11-1,51). Presença de produtos artesanais foi maior em menores níveis de escolaridade (RP=2,20; IC95% 1,36-3,57) e menores classificações econômicas (RP=1,63; IC95% 1,25-2,13). Conclusões: Mais da metade dos domicílios da Região Metropolitana de Manaus possuía produtos perigosos; um terço os armazenava sem segurança. Produtos de limpeza artesanais e chumbinho estavam frequentemente presentes. Os domicílios com crianças apresentaram armazenamento mais seguro de produtos e fatores socioeconômicos afetaram a disponibilidade de tais produtos perigosos.

Movilidad urbana y bienestar subjetivo: reflexiones desde la ética / Urban mobility and subjective well-being: reflections from ethics

Los planes urbanísticos de las agencias gubernamentales se sustentan en el discurso de la ONU-Hábitat. El cual dicta los lineamientos del hacer ciudad. Donde la movilidad urbana, es un tema prioritario en las agendas de los gobiernos, buscando alternativas centradas en promover el uso del transporte colectivo, como principal forma de movilidad cotidiana. Pero en su movilidad cotidiana, los sujetos en su día a día se encuentran con problemas, amenazas y conflictos que son factores de estrés. De ahí que sea necesaria una reflexión ética sobre los planes urbanísticos para buscar el bienestar colectivo y subjetivo.

The urban plans of the government agencies are based on the discourse promoted by the UN-Habitat. That dictates the guidelines of making a city. Where urban mobility is a priority issue on government agendas, seeking alternatives focused on promoting the use of collective transport, as the main form of daily mobility.Subjects in their daily mobility encounter problems, threats and conflicts that are stressors. Therefore, an ethical reflection on urban planning is necessary to seek collective and subjective well-being.

Factores sociodemográficos y eventos de vida tempranos asociados con la felicidad en adultos de Lima Metropolitana / Socio-demographic factors and early life events associated with happiness in adults of Metropolitan Lima

RESUMEN Objetivos: Estimar los factores sociodemográficos y eventos de vida tempranos asociados con la feli cidad en adultos de Lima Metropolitana. Materiales y métodos: Se realizó un análisis secundario del Estudio Epidemiológico de Salud Mental de Lima Metropolitana 2012, el cual utilizó los instrumentos de índice de calidad de vida, la versión breve y modificada del EMBU, un cuestionario de eventos adver sos tempranos, un índice de felicidad construido a partir del ítem único sobre felicidad de Andrews y la escala de satisfacción con la vida. Se realizaron análisis multivariados ajustados. Resultados: La felicidad se asoció con el sexo, estado civil, pobreza y nivel de instrucción. Los estilos de crianza asociados con menor felicidad fueron: las conductas de rechazo y las actitudes machistas, y con mayor felicidad: el calor emocional. No se encontró asociación con prácticas de crianza de sobreprotección o favoritismo. Como eventos adversos tempranos se asociaron significativamente: discusiones dentro de la familia, padre con problemas de alcohol, ausencia paterna, conductas de amenazas o chantaje emocional. Conclusiones: Los hallazgos resaltan la importancia de desarrollar programas intensivos en los primeros años de vida que estimulen estilos de crianza y ambientes de desarrollo saludables.

ABSTRACT Objectives: To estimate socio-demographic factors and early life events associated with happiness in adults in metropolitan Lima. Materials and methods: A secondary analysis was carried out on the Epi demiological Study of Mental Health of Metropolitan Lima 2012. The instruments used were the Quality of Life Index; a brief and modified version of the EMBU; a questionnaire of early adverse events; a Hap piness Index built from Andrews' single item of Happiness and the Life Satisfaction Scale. Adjusted mul tivariate analyses were performed. Results: Happiness was significantly associated with gender, marital status, poverty, and level of education. Parenting styles associated significantly with less happiness were: behaviors of rejection and sexist attitudes; and with higher happiness: emotional warmth. No associa tion was found with overprotection or favoritism breeding practices. Early adverse events significantly associated with lower happiness were discussions within the family, father with problems of alcohol, parental absence, behaviors of emotional blackmail or threats. Conclusions: This study highlights the importance of developing intensive programs in the first years of life that promote parenting styles and healthy development environments.

Condiciones de trabajo, seguridad y salud en la población económicamente activa y ocupada en áreas urbanas del Perú / Working, safety and health conditions in the economically active and employed population in urban areas of Peru

RESUMEN Objetivos: La presente investigación tiene como objetivo conocer las condiciones de trabajo, seguridad y sa lud en el trabajo de la población urbana económicamente activa ocupada del Perú. Materiales y métodos: Se realizó un estudio transversal basado en una muestra probabilística de áreas y multietápica en la que partici paron 3122 personas mayores de 14 años distribuidas en todo el país. Resultados : La mayoría fueron hombres (53,6%) entre 30 y 59 años (50%). En cuanto a las condiciones de trabajo, la mayoría labora más de 48 horas semanales (39,8%) y de lunes a sábado (44,7%). Respecto a las condiciones de seguridad, higiene, ergonómicas y psicosociales, los resultados mostraron una menor exposición de riesgo. Sobre las condiciones de salud, la mayoría refiere que no se identifican ni se evalúan los riesgos laborales en su puesto de trabajo (35,9%); que no tienen servicios de salud ocupacional (40,7%) ni un delegado o un comité de seguridad y salud (39,4%); y que no se le realizan evaluaciones médico ocupacionales (39,3%). Conclusiones: La población económica mente activa urbana ocupada del Perú se expone con más frecuencia al ruido, la radiación solar, las posturas incómodas y los movimientos repetitivos; trabaja rápido con poco control y esconde sus emociones; además, en los lugares de trabajo no se gestiona la salud ocupacional. Estas condiciones pueden afectar la salud de los trabajadores y la calidad del trabajo.

ABSTRACT Objetives: The present study aims to know the work, safety and health conditions at the jobs of the economically active urban population in Peru. Materials and Methods: A cross-sectional study was carried out based on a probabilistic sample of multistage areas in which 3122 people over 14 years of age distributed nationwide partici pated. Results: The majority were men (53.6%) between 30 and 59 years (50%). As for working conditions, most people work more than 48 hours per week (39.8%), and Monday through Saturday (44.7%). Regarding the safety, hygiene, ergonomic and psychosocial conditions, the results showed a lower risk exposure. Regarding health conditions, the majority report that the identification and evaluation of occupational hazards is not carried out in their workplace (35.9%), they do not have occupational health services (40.7%) or a delegate or a Health and sa fety committee (39.4%) and no occupational medical evaluations (39.3%). Conclusions: The economically active urban population of Peru is more frequently exposed to noise, solar radiation, awkward postures and repetitive movements, work at a fast pace with little control and hide their emotions; In addition, occupational health is not managed adequately in workplaces. These conditions may affect the health of workers and the quality of work.

Consumo de frutas e verduras por adolescentes catarinenses ao longo de uma década / Fruit and vegetable consumption over a decade among adolescents in the State of Santa Catarina, Brazil

Resumo Compreender mudanças no consumo de frutas e verduras por adolescentes é importante para criação de ações de saúde pública. O objetivo deste artigo é investigar mudanças, em dez anos, no consumo diário de frutas e verduras por adolescentes, de acordo com sexo, idade e área de moradia. Estudo de painel (análise secundária) da pesquisa "Estilo de vida e comportamentos de risco de jovens catarinenses". Adolescentes (15-19 anos) de escolas estaduais, em 2001 (n = 5.028) e 2011 (n = 6.529), responderam questionário sobre consumo de frutas e verduras e aspectos sociodemográficos. Estatística descritiva e regressão logística (2001 vs 2011), estratificada para sexo, idade e área de moradia. Houve diminuição no consumo diário de frutas (39,1% e 16,6%) e de verduras (40,1% e 20,6%). Diferentes prevalências são observadas de acordo com subgrupos, principalmente entre moças. A chance para consumo diário de verduras entre rapazes e adolescentes de área rural continuou a mesma. A diminuição na prevalência do consumo diário de frutas e verduras por adolescentes catarinenses de 15 a 19 anos aponta necessidade de criação de estratégias para reversão deste cenário.

Abstract Understanding the changes in the trends of fruit and vegetable consumption among adolescents is important in order to implement public health actions. The scope of this article is to investigate the changes over a ten-year period in the daily fruit and vegetable consumption among adolescents from Santa Catarina, according to sex, age and housing area. It is a secondary analysis of a panel survey entitled "Lifestyle and Risk Behavior of Adolescents in the State of Santa Catarina, Brazil (ComPAC)." Adolescents (15-19 years of age) of state schools in 2001 (n=5.028) and 2011 (n=6.529) answered a questionnaire about fruit and vegetable consumption as well as about sociodemographic aspects. Descriptive statistics and logistic regression were applied, according to sex, age and housing area. There was a decrease in daily fruit (39.1% and 16.6%) and vegetable (40.1% and 20.6%) consumption. Different prevalence levels were observed when analyzing subgroups, mainly among girls. From 2001 to 2011, daily vegetable consumption among boys and adolescents in rural areas remained the same. The decrease in daily consumption of fruit and vegetables among adolescents aged 15 to 19 in Santa Catarina highlights the need for the development of strategies to reverse this scenario.

Cambios en el calendario de uso de condón masculino en la primera y última relación sexual en distintas cohortes de mujeres / Changes in male condom use at first and last sexual intercourse in different birth cohorts

Resumen: Objetivo: Caracterizar el uso de condón en la primera y última relación sexual en diferentes cohortes para observar posibles diferencias entre grupos generacionales. Material y métodos: Mediante la Encuesta Nacional de Niños, Niñas y Mujeres 2015, representativa a nivel nacional, se ajustaron modelos de regresión Poisson para buscar asociación de variables de interés con el uso del condón en la primera y última relación sexual. Resultados: Las cohortes más jóvenes, con mayor educación y riqueza tienen mayores posibilidades de usar condón en su primera y última relación sexual; hablar lengua indígena se asocia con menores posibilidades de uso en ambos eventos. El uso de condón en el debut sexual incrementa la posibilidad de uso en la última relación sexual. Conclusiones: Existe un cambio generacional en el uso del condón en la primera y última relación sexual entre las más jóvenes. La utilización del condón en el debut sexual favorece su uso posterior.

Abstract: Objective: Characterize the use of condoms in the first and last sexual intercourse in different birth cohorts, to observe possible differences among generations. Materials and methods: Using the National Survey of Boys, Girls and Women, 2015, representative at the national level, we adjust Poisson regression models to find associations between variables of interest and the use of condoms in first and last intercourse. Results: Women from younger cohorts, with higher education and wealth are more likely to use a condom in their first and last sexual intercourse; speaking an indigenous language is associated with a lower likelihood of condom use at both events. Using condom in sexual debut increases the likelihood of using in last intercourse. Conclusions: There is a generational change in condom use at first and last sex among younger cohorts. The use of the condom in sexual debut favors its later use.

Autocorrelación espacial de mortalidad por cáncer de mama en la Región Metropolitana, Chile: estudio ecológico / Spatial autocorrelation of breast cancer mortality in the Metropolitan Region, Chile: an ecological study

INTRODUCCIÓN El cáncer de mama es la neoplasia maligna más común en las mujeres en todo el mundo y en Chile, siendo la primera causa de muerte oncológica femenina. Se ha reportado amplia variación en la mortalidad, con focos geográficos de mayor riesgo. OBJETIVO Analizar espacialmente la mortalidad por cáncer de mama en mujeres de la Región Metropolitana en 2015. MÉTODOS Estudio ecológico. Se utilizaron los datos de los registros de defunciones del año 2015 (C50 según CIE10), y las proyecciones poblacionales del Instituto Nacional de Estadísticas. Se calcularon tasas de mortalidad por cáncer de mama brutas y razones de mortalidad estandarizadas. Se realizó un análisis epidemiológico espacial estimando el índice I de Moran Global y Local para evaluar autocorrelación espacial. Los resultados se presentan en mapas (cartografía precenso 2016). RESULTADOS Se registraron 622 defunciones por cáncer de mama en la Región Metropolitana en 2015. La edad promedio de las mujeres fallecidas fue de 66 años (desviación estándar: 15,5). El 92,4% de las muertes se registró en zonas centrales o urbanas. Sin embargo, las mayores tasas de mortalidad se observaron en comunas periféricas. No se observó autocorrelación espacial global en la región (I de Moran de 0,007; p = 0,134). A nivel local, cuatro comunas se diferencian de forma significativa de sus vecinas. CONCLUSIONES El riesgo de morir por cáncer de mama en la Región Metropolitana de Chile se concentra en comunas periféricas. Cuatro comunas de la región presentan riesgos diferentes de sus comunas vecinas, por lo que es necesario explorar factores que explican la desigual distribución de las muertes.

INTRODUCTION Breast cancer is the most common malignancy in women worldwide and Chile, being the leading cause of female cancer death. A wide variation in mortality has been reported, with geographic clusters of higher risk. OBJECTIVE To spatially analyze mortality from breast cancer in women in the Metropolitan Region in 2015. METHODS Ecological study of location. We used death records in 2015 (C50 according to ICD10) and population projections of the Statistics Institute to estimate mortality rates. We calculated crude breast cancer mortality rates and standardized mortality ratios and performed a spatial epidemiological analysis of breast cancer mortality in women, estimating the global and local Moran I index to assess spatial autocorrelation. We present the results in maps according to the 2016 pre-census cartography. RESULTS There were 622 deaths from breast cancer in the Metropolitan Region in 2015. The mean age was 66 years (SD: 15.5). 92.4% of deaths were registered in urban or central areas. However, the highest mortality rates were observed in peripherical districts. No global spatial autocorrelation was observed in the region (Moran's I 0.007 p = 0.134). However, at the local level, four districts differ significantly from their neighbors. CONCLUSIONS The risk of dying from breast cancer in the Metropolitan Region of Chile is concentrated in women from peripherical communes. Four districts in the region present different risks from their neighboring districts. It is necessary to investigate local realities to prevent deaths from this pathology.

Prevalência e fatores associados de cefaleia entre adolescentes: resultados de um estudo de base populacional / Prevalence of headache and associated factors among adolescents: results of a population-based study

RESUMO: Introdução: A cefaleia é uma das queixas somáticas relacionadas a problemas de saúde mais comuns entre crianças e adolescentes. Objetivo: Estimar a prevalência de cefaleia em adolescentes da cidade de São Paulo, Brasil, e fatores associados. Métodos: Trata-se de estudo transversal de base populacional, realizado em 2015, com 539 adolescentes de ambos os sexos, entre 15 e 19 anos de idade. Coletaram-se as informações por inquérito domiciliar, e selecionaram-se os participantes com base em amostragem probabilística. Utilizaram-se na análise frequências, teste χ2 e análise de regressão logística. Adotou-se nível de significância de 5%. Resultados: A prevalência estimada de cefaleia é de 38,2% (intervalo de confiança - IC95% 33,8 - 42,7), de dor de cabeça simples 32,8% (IC95% 28,8 - 37,2) e de enxaqueca 7,8% (IC95% 5,6 - 10,7). Os fatores associados encontrados com cefaleia foram: ser do sexo feminino (razão de chances/odds ratio - OR = 2,2; IC95% 1,4 - 3,4), transtorno mental comum (TMC) (OR = 2,8; IC95% 1,7 - 4,9), problema de visão (OR = 2,6; IC95% 1,6 - 4,2), dor nas costas (OR = 2,2; IC95% 1,3 - 3,5), sinusite (OR = 2,0; IC95% 1,2 - 3,4) e ter escolaridade com ensino fundamental II incompleto (OR = 3,0; IC95% 1,6 - 5,6). Conclusão: A prevalência de cefaleia em adolescentes da cidade de São Paulo em 2015 representou mais de 1/3 (um terço) dessa população. Os principais fatores associados foram sexo, baixa escolaridade e as comorbidades TMC e problema de visão.

ABSTRACT: Introduction: Cephalalgia is one of the most common somatic complaints related to health problems in childhood and adolescence. Objective: To measure the cephalalgia prevalence in adolescents from the city of São Paulo, Brazil, and associated factors. Methods: This is a cross-sectional population-based study, carried out in 2015, with 539 adolescents of both sexes, aged between 15 and 19 years. The information was collected in a household survey, and the participants were selected from probabilistic sampling. Frequencies, χ2 test and logistic regression analysis were used in the study, and significance level was 5%. Results: the estimated prevalence of cephalalgia was 38.2% (95%CI 33.8 - 42.7), and 7.8% (95%CI 5.6 - 10.7), migraine. The associated factors for cephalalgia were: female sex (OR = 2.2; 95%CI 1.4 - 3.4), Common Mental Disorder (OR = 2.8; 95%CI 1.7 - 4.9), vision impairment (OR = 2.6; 95%CI 1.6 - 4.2), besides back pain (OR = 2.2; 95%CI 1.3 - 3.5), sinusitis (OR = 2.0; 95%CI 1.2 - 3.4) and incomplete elementary education (OR = 3.0; 95%CI 1.6 - 5.6). Conclusion: The prevalence of headache among adolescents in the city of São Paulo represented more than 1/3 (one third) of this population. The main associated factors were sex, low schooling and the following comorbidities: common mental disorder and vision impairment.

Simultaneidade de doenças crônicas não transmissíveis em 2013 nas capitais brasileiras: prevalência e perfil sociodemográfico / Simultaneidad de enfermedades crónicas no transmisibles en 2013 en las capitales brasileñas: prevalencia y perfil demográfico / Simultaneity of chronic noncommunicable diseases in 2013 in Brazilian state capital cities: prevalence and demographic profile

Objetivo: descrever a prevalência e o perfil sociodemográfico da simultaneidade de doenças crônicas não transmissíveis (DCNTs) em adultos e idosos das capitais brasileiras. Métodos: Sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas não Transmissíveis (Vigitel), realizado em 2013; a simultaneidade considerou duas ou mais DCNTs (diabetes mellitus, dislipidemia, hipertensão e obesidade). Resultados: dos 52.929 participantes, 13,7% dos adultos e 42,9% dos idosos tiveram simultaneidade de DCNT; houve maior agrupamento da hipertensão com diabetes mellitus em adultos, e hipertensão com obesidade em idosos; a simultaneidade foi mais prevalente em mulheres, na idade entre 50 e 59 anos, com companheiro, e de escolaridade até oito anos de estudo; as cidades com menor e maior prevalência em adultos, respectivamente, foram São Luís e Cuiabá, e em idosos, Belém e Manaus. Conclusão: a simultaneidade foi identificada no contexto nacional; medidas de prevenção devem ser direcionadas especialmente ao tratamento da hipertensão.

Objetivo: describir la prevalencia y el perfil sociodemográfico de la simultaneidad de enfermedades crónicas no transmisibles (ECNT) en adultos y ancianos de las capitales brasileñas. Métodos: Sistema de Vigilancia de Factores de Riesgo y Protección para Enfermedades Crónicas no Transmisibles (Vigitel), realizado en 2013; la simultaneidad consideró dos o más ECNT (diabetes mellitus, dislipidemia, hipertensión y obesidad). Resultados: en 52.929 participantes, 13,7% de los adultos y el 42,9% de los ancianos presentaron simultaneidad de ECNT; hubo mayor agrupamiento de hipertensión con diabetes mellitus en adultos e hipertensión con obesidad en ancianos; la mayor prevalencia fue en mujeres, con edad entre 50 y 59 años, con compañero y escolaridad de hasta ocho años; las ciudades con menor y mayor prevalencia, respectivamente, en adultos fueron São Luís y Cuiabá, y en los ancianos, Belém y Manaus. Conclusión: la simultaneidad se identificó en el contexto nacional, y medidas de prevención deben ser dirigidas especialmente al tratamiento de la hipertensión.

Objective: to describe the prevalence and sociodemographic profile of chronic noncommunicable disease (CNCDs) simultaneity in adults and elderly people resident in Brazilian state capital cities. Methods: Chronic Noncommunicable Disease Risk and Protection Factor Surveillance System Survey 2013; simultaneity was considered to be two or more CNCDs (diabetes mellitus, dyslipidemia, hypertension, and obesity). Results: of the total 52,929 participants, 13.7% of adult participants and 42.9% of elderly participants had CNCD simultaneity; hypertension and diabetes mellitus simultaneity was greater in adults, while hypertension and obesity simultaneity was greater in the elderly; simultaneity was more prevalent in women, in those between 50 and 59 years old, with partners and up to eight years of schooling; the cities with the lowest and highest prevalence in adults were São Luís and Cuiabá, respectively, while in the elderly, the cities were Belém and Manaus, respectively. Conclusion: simultaneity was identified nationwide; prevention measures should be directed especially toward treatment of hypertension.

Sobrepeso, obesidade e fatores associados aos adultos em uma área urbana carente do Nordeste Brasileiro / Overweight and obesity and associated factors in adults in a poor urban area of Northeastern Brazil

RESUMO: Introdução: As mudanças produzidas no processo saúde/doença, sobretudo no campo da nutrição, corroboram a substituição das carências nutricionais com emergência do excesso de peso (sobrepeso/obesidade). Objetivo: Analisar a prevalência e fatores associados ao excesso de peso em adultos residentes em uma área urbana carente do Recife, Nordeste do Brasil. Métodos: Trata-se de um estudo transversal analítico, com uma amostra de 644 adultos de 20 a 59 anos. Analisaram possíveis associações do excesso de peso aos fatores demográficos, socioeconômicos, comportamentais e morbidades por meio de regressão de Poisson, considerando como estatisticamente significantes aquelas com valor de p < 0,05. Resultados: A prevalência do excesso de peso foi de 70,3%, sendo menor na faixa de 20-29 anos e maior na faixa etária de 30-39 anos, e estabilizando-se nas demais. No modelo de regressão multivariado, foi observado que a faixa etária, classe econômica, diabetes mellitus (DM) e hipertensão arterial sistêmica (HAS) mostraram-se diretamente associada ao excesso de peso, enquanto a variável consumo semanal de feijão mostrou-se inversamente associada. A alta prevalência do excesso de peso encontrado pressupõe que as comunidades carentes das quais os indivíduos fazem parte já se incluem no processo de transição nutricional que está em curso no país. Conclusão: Os resultados significativos de sobrepeso/obesidade detectados na área urbana carente estudada, impõe a necessidade de incluir esse problema como prioridade de saúde pública nessas comunidades.

ABSTRACT: Introduction: The changes that occurred in the health/disease process, especially in the field of nutrition, corroborate the replacement of nutritional deficiencies with the pandemic emergency of overweight (overweight/obesity). Objective: To analyze the prevalence and factors associated with overweight in adults living in a poor urban area in Recife, Northeast Brazil. Methods: This is a cross-sectional study with a sample of 644 adults aged 20-59 years. Possible associations of overweight with demographic, socioeconomic, behavioral and morbidity factors were analyzed through Poisson Regression, considering as statistically significant those with p < 0.05. Results: The prevalence of overweight was 70.3%, being lower in the age range of 20-29 years, greater in the range of 30-39 years and stabilizing in the others. In the final multivariate model, it was observed that the age group, economic class, diabetes mellitus and high blood pressure were directly associated with overweight, while bean consumption showed an inverse association. The high prevalence of overweight found indicates that poor communities are already included in the nutritional transition process that is in course in country. Conclusion: The significant result of overweight found at this poor urban area imposes the need to include this problem as a public health priority in these communities.

Nationwide use of psychotropic drugs for treatment of self-reported depression in the Brazilian urban adult population / Uso nacional de drogas psicotrópicas no tratamento da depressão autorreferida na população adulta urbana brasileira

ABSTRACT: Objective: Antidepressant use is increasing worldwide, but national data on psychotropic drug use by depressed patients in Brazil is lacking. Methodology: Between 2013 and 2014, a representative sample of urban adult individuals were asked if they had a diagnosis of chronic disease, had a medical indication for drug treatment, and were taking chronic medications at the time for each reported diagnosis. We analyzed the frequencies of reported depression and the medications related to this disease. Results: Overall, 6.1% of respondents reported depression. The prevalence increased with age - 9.5% among the elders - was higher among women (8.9%) and in the south of the country (8.9%). As a single disease, the prevalence of depression was higher among young people (17.6%). Among those with multimorbidity, the prevalence of depression rose to 25.7%. Of those who reported depression, 81.3% had medical indication for treatment and 90.3% were under treatment - this proportion was lower among young people (84.5%) and those living in the poorest region (78.6%). Antidepressants accounted for 47.2% of psychotropic drugs taken by respondents with depression, with regional differences - only 30% used antidepressants in the North. Polypharmacy was reported by 22% of those with depression and other chronic diseases. Conclusion: Depression in Brazil, is common among young adults as a single chronic disease and highly prevalent among people with chronic multimorbidity, especially the young. The treatment gap was larger among young people and in the less developed regions of the country.

RESUMO: Objetivo: O uso de antidepressivos está aumentando em todo o mundo, mas faltam dados nacionais sobre o uso de drogas psicotrópicas por pacientes deprimidos no Brasil. Metodologia: Entre 2013 e 2014, uma amostra representativa de indivíduos adultos urbanos foi questionada sobre a presença diagnóstica de doença crônica, a indicação médica para tratamento medicamentoso e o uso de medicamentos crônicos à época de cada diagnóstico relatado. Foram analisadas as frequências de depressão relatada e os medicamentos relacionados a essa doença. Resultados: No geral, 6,1% dos entrevistados relataram depressão. A prevalência aumentou com a idade (9,5% entre os idosos) foi maior entre as mulheres (8,9%) e no sul do país (8,9%). Como doença única, a prevalência de depressão foi maior entre os jovens (17,6%). Entre aqueles com multimorbidade, a prevalência de depressão subiu para 25,7%. Dos que relataram depressão, 81,3% tinham indicação médica para tratamento e 90,3% estavam em tratamento - essa proporção foi menor entre os jovens (84,5%) e os que moram na região mais pobre (78,6%). Os antidepressivos representaram 47,2% dos medicamentos psicotrópicos tomados pelos entrevistados com depressão, com diferenças regionais - apenas 30% usavam antidepressivos no Norte. Polifarmácia foi relatada por 22% das pessoas com depressão e outras doenças crônicas. Conclusão: A depressão no Brasil é comum entre adultos jovens como doença crônica única e altamente prevalente entre as pessoas com multimorbidade crônica, principalmente os jovens. A lacuna de tratamento foi maior entre os jovens e nas regiões menos desenvolvidas do país.

Health access to immigrants: identifying gaps for social protection in health / Acceso a salud en inmigrantes: identificando brechas para la protección social en salud

ABSTRACT OBJECTIVE To compare the access to and effective use of health services available among international migrants and Chileans. METHODS Secondary analysis of the National Socioeconomic Characterization Survey (CASEN - Caracterización Socioeconómica Nacional ), version 2017. Indicators of access to the health system (having health insurance) and effective use of health services (perceived need, appointment or coverage, barriers and need satisfaction) were described in immigrants and local population, self-reported. Gaps by immigrant status were estimated using logistic regressions, with complex samples. RESULTS Immigrants were 7.5 times more likely to have no health insurance than local residents. Immigrants presented less perceived need than local residents, together with a greater lack of appointments (OR: 1.7 95%CI: 1.2-2.5), coverage (OR: 2.7 95%CI: 2.0-3.7) and unsatisfied need. The difference between immigrants and locals was not statistically significant in barriers to health care access (α = 0.005). CONCLUSIONS Disadvantages persist regarding the access to and use of health services by immigrants as opposed to Chileans compared with information from previous years. It is necessary to reduce the gaps between immigrants and people born in Chile, especially in terms of health system access. This is the first barrier to effective use of services. The generation of concrete strategies and health policies that consider an approach of social participation of the immigrant community is suggested to bring the health system closer to this population.

RESUMEN OBJETIVO Comparar el acceso y uso efectivo de servicios de salud disponibles entre migrantes internacionales y chilenos. MÉTODOS Análisis secundario de la encuesta poblacional de Caracterización Socioeconómica Nacional (CASEN), versión 2017. Se describieron indicadores de acceso al sistema de salud (tener previsión de salud) y uso efectivo de servicios de salud (necesidad sentida, consulta o cobertura, barreras y satisfacción de la necesidad) en inmigrantes y locales, autorreportados. Las brechas por condición de inmigrante se estimaron utilizando regresiones logísticas, con muestras complejas. RESULTADOS Los inmigrantes presentaron 7,5 veces más chances de no tener previsión de salud que los locales. Los inmigrantes presentaron una menor necesidad sentida que los locales, en conjunto con una mayor falta de consulta (OR: 1,7 IC95%: 1,2-2,5), cobertura (OR: 2,7 IC95%: 2,0-3,7) e insatisfacción de necesidades. La diferencia entre inmigrantes y locales no fue estadísticamente significativa en barreras de acceso a atención en salud (α = 0,005). CONCLUSIONES Persisten las desventajas en acceso y uso a servicios de salud en inmigrantes en comparación con los nacidos en Chile en contraste con información de años anteriores. Es necesario reducir las brechas entre inmigrantes y nacidos en Chile, sobre todo en cuanto a pertenencia a un sistema de salud. Esta es la primera barrera para un uso efectivo de servicios. Se sugiere generar estrategias concretas y políticas en salud que consideren un enfoque de participación social de la comunidad inmigrante y, adicionalmente, acerquen al sistema de salud a esta población.

Asentamientos precarios en la Ciudad Autónoma de Buenos Aires: Apuntes para una revisión de los conceptos de villa, asentamiento y núcleo habitacional transitorio en el marco de la producción estadística / Precarious settlements in Buenos Aires City: Notes for a review of the concepts of villa, settlement and transient housing nucleus in the framework of statistical production

El presente informe documenta las tareas realizadas por la Dirección General de Estadística y Censos del Gobierno de la Ciudad de Buenos Aires (DGEyC-GCBA), en el marco del Programa de Estudios de Pobreza del Instituto Nacional de Estadística y Censos (INDEC), para contribuir a la definición conceptual y operativa de los asentamientos irregulares o precarios (y su tipología) en la Ciudad de Buenos Aires. Las definiciones son el paso necesario que permite identificar estas áreas de la Cuidad, por lo tanto, resultan esenciales tanto para las tareas pre-censales (en perspectiva del próximo Censo de Población, Hogares y Viviendas de 2020) como para la explotación de los datos. En la primera parte se presenta una reseña histórica, en la que se describe el proceso de conformación y evolución de los asentamientos precarios (villas, asentamientos y Núcleos Habitacionales Transitorios) en la Ciudad de Buenos Aires, haciendo eje en los aspectos demográficos y sociopolíticos que lo marcaron, y se presenta una imagen de la situación actual de dichas áreas, detallando los cambios en marcha. En un segundo apartado, se analizan las definiciones vigentes, tanto conceptuales como operativas, utilizadas tanto por la DGEyC, como por organismos públicos del GCBA, y por organismos nacionales, provinciales y la academia. A la vez, se presentan los criterios operativos empleados por la DGEyC en las tareas pre-censales y en el procesamiento de la información del Censo 2010 en las áreas con asentamientos precarios. Finalmente, a partir de la información disponible (con datos del Censo 2010), se analizan los indicadores sociodemográficos que intervienen en las definiciones relevadas con el propósito de encontrar regularidades en cada uno de los tipos de asentamientos precarios analizados. (AU)

Tendencia y factores asociados a la frecuencia de cepillado dental en menores de doce años, Perú 2013-2018 / Trend and factors associated with the frequency of tooth brushing in children under twelve years old, Peru 2013-2018

RESUMEN Objetivos. Determinar la tendencia y factores asociados al cepillado de dos o más veces por día en niños menores de doce años entre el 2013 y 2018 en Perú. Materiales y métodos. Se realizó un estudio transversal mediante análisis secundario de datos reportados por la Encuesta Demográfica y de Salud Familiar. Se consideró la información de niños con al menos un cepillado al día, considerando como «Adecuada Frecuencia de Cepillado Dental¼ (AFC) para quienes reportaban de dos a más; se generaron medidas porcentuales por ámbito geográfico, características sanitarias, de vivienda y hogar. Se determinaron los factores asociados a la AFC mediante regresión logística binaria para encuestas complejas, la variabilidad de la tendencia se identificó mediante regresión joinpoint con un 95% de confianza. Resultados. En el 2013, la AFC fue del 79,0% con un aumento a 83,9% para el 2018; se identificó que cuatro de 25 espacios geográficos se mantuvieron sin variación de AFC, y otros cuatro disminuyeron. Todas las características sanitarias mostraron favorecer el cepillado, destacándose que el no compartir el cepillo generó un OR de 2,30, IC 95%: 1,46 a 3,60. La región natural, el tipo de lugar de residencia y el quintil de riqueza afectaron la AFC; la AFC fue mayor según se incrementa el grupo etario. Conclusiones . El porcentaje de AFC ha aumentado en los últimos años, siendo influenciado favorablemente por los aspectos sanitarios; a nivel rural este porcentaje es significativamente menor, algo que también se evidencia en la región sierra.

ABSTRACT Objetivos. To determine the trend and factors associated with brushing two or more times per day in children under twelve years of age between 2013 and 2018 in Peru. Materials and Methods. A cross-sectional study was conducted by secondary analysis of data reported by the Demographic and Family Health Survey (ENDES). Information on children with at least one brushing per day was taken into account, considering as an "Adequate Toothbrushing Frequency" (ATF) for those who reported brushing two to more times per day. Percentage measures were generated by geographical area, health, housing, and household characteristics. Factors associated with an ATF were determined by using binary logistic regression for complex surveys, trend variability was identified by joinpoint regression with a 95% confidence. Results. In 2013, the ATF was 79.0%, increasing to 83.9% by 2018. Four out of 25 geographic areas were identified as having no variation on the ATF, and four others decreased. All sanitary characteristics showed favoring brushing, emphasizing that not sharing the toothbrush generated a 2.30 OR, 95% CI: 1.46 to 3.60. The natural region, type of place of residence, and wealth index quintile affected the ATF. The ATF was higher as the age group increased. Conclusions. The percentage of ATF has increased in recent years, being favorably influenced by health aspects; in rural areas, this percentage is significantly lower, something that is also evident in the Highland region.

Factores asociados al uso de servicios de salud oral en adultos mayores peruanos: análisis secundario de encuesta poblacional, 2018 / Factors associated with the use of oral health services in older peruvian adults: secondary analysis of population survey, 2018

RESUMEN Objetivos: Identificar la prevalencia y factores asociados al uso de servicios de salud oral en adultos mayores (AM) peruanos durante el 2018. Materiales y métodos: Análisis secundario de los datos de 4874 AM peruanos de la Encuesta Demográfica y de Salud Familiar (ENDES) 2018. Se consideró el uso de servicio de salud oral (sí/no) en razón de los seis meses previos a la aplicación de la encuesta como variable dependiente, las variables independientes fueron: sexo, edad, área de residencia, nivel educativo, estado civil, dominio geográfico, limitación física, afiliación a un seguro de salud, lengua hablada y quintil de bienestar. Se realizó un análisis descriptivo usando frecuencias absolutas y proporciones ponderadas, y un análisis multivariado empleando modelos lineales generalizados (familia Poisson). Resultados: Del total de AM, 52,6% fueron mujeres, 52,9% pertenecían al grupo de 60 a 69 años de edad, 77% pertenecían al área urbana y 81,1% estuvieron afiliados a un seguro de salud. La prevalencia del uso de servicios odontológicos durante los últimos seis meses fue 24,9%. El análisis multivariado encontró asociación con el área de residencia (p<0,001), el nivel educativo superior (p=0,001), la afiliación a un seguro de salud (p<0,001), el dominio geográfico (p=0,019) y todos los quintiles de bienestar (p<0,001). Conclusiones : La prevalencia de uso de servicios de salud oral en AM fue baja, y sus factores asociados fueron el área de residencia, el nivel educativo, la afiliación a un seguro de salud, el dominio geográfico y los quintiles de bienestar.

ABSTRACT Objectives : To identify the prevalence and factors associated with the use of oral health services in Peruvian older adults (OA) during 2018. Materials and Methods . Secondary analysis of data on 4,874 Peruvian OAs from the Demographic and Family Health Survey (ENDES) carried out in 2018. The use of oral health services was considered (yes/no) based on the six months prior to the application of the survey as a dependent variable. The independent variables were sex, age, area of residence, educational level, marital status, geographical domain, physical limitation, health insurance, spoken language, and welfare index quintile. A descriptive analysis was performed using absolute frequencies and weighted proportions, and a multivariate analysis using generalized linear models (Poisson regression). Results . From the total of OAs, 52.6% were women, 52.9% belonged to the 60-69 age group, 77% belonged to the urban area, and 81.1% had a health insurance. The prevalence of the use of dental care services in the last six months was 24.9%. Multivariate analysis found association with area of residence (p<0.001), higher educational level (p=0.001), health insurance affiliation (p<0.001), geographic domain (p=0.019), and all welfare index quintiles (p<0.001). Conclusions . The prevalence of the use of dental care services in OAs was low, and its associated factors were the area of residence, educational level, health insurance, geographic domain, and welfare index quintiles.

The use of analgesics and risk of self-medication in an urban population sample: cross-sectional study / Uso de analgésicos e o risco da automedicação em amostra de população urbana: estudo transversal

Abstract Background and objectives: There are few data in the literature characterizing the pattern of analgesic use in Latin American countries, including Brazil. Little is known about the undertreatment of pain and its influence on the habit of self-medication with analgesics. The aim of this study is to define the pattern of analgesic use among chronic pain patients and its potential association with self-medication with analgesics. Method: Cross-sectional observational study with an urban population sample. Chronic pain was defined as a pain lasting for at least 90 days. The study was approved by the Research Ethics Committee of the institution. Results: 416 subjects were included; 45.7 % (n = 190) had chronic pain, with females (72.3 %; p = 0.04) being the most affected. Self-medication with analgesics is practiced by 78.4% of patients with chronic pain. The most common current analgesic treatment consists of non-steroidal anti-inflammatory drugs (dipyrone and acetaminophen). Weak opioids are rarely used and only 2.6% of subjects with chronic pain were taking these analgesics. None of the subjects were taking potent opioids. Conclusions: The practice of self-medication with analgesics is frequent among patients with chronic pain, which may be due to the underprescription of more potent analgesics, such as opioids. It can also be said that, given the data presented, there is no crisis of recreational opioid use in the studied population.

Resumo Justificativa e objetivos: Há poucos dados na literatura que caracterizam o padrão de uso de analgésicos na América Latina e no Brasil. Também se sabe pouco sobre o subtratamento da dor e sua influência no hábito de automedicação analgésica. O objetivo desta pesquisa é definir o padrão de uso de analgésicos entre os portadores de dor crônica (DC) e a sua potencial associação à automedicação analgésica. Método: Estudo observacional transversal com amostra de população urbana. A dor crônica foi definida como aquela presente por pelo menos 90 dias. A pesquisa foi aprovada pelo Comitê de Ética em Pesquisa institucional. Resultados: Foram incluídos 416 indivíduos; 45,7% (n = 190) portadores de dor crônica, sendo os do sexo feminino (72,3%; p = 0,04) os mais acometidos. A automedicação analgésica é praticada por 78,4% dos portadores de dor crônica. O tratamento analgésico vigente mais frequente é composto pelos anti-inflamatórios não esteroides (AINES), dipirona e paracetamol. Os opioides fracos são pouco usados e apenas 2,6% dos indivíduos com dor crônica fazem uso desses analgésicos. Nenhum dos indivíduos estava em uso de opioides potentes. Conclusões: A prática de automedicação analgésica é frequente entre os portadores de dor crônica, o que pode ser consequência da pouca prescrição de analgésicos mais potentes, como os opioides. Pode-se também dizer que, pelos dados apresentados, não ocorre uma crise de uso recreativo de opioides na população estudada.

Face validity of the general development assessment test (EVADE) in children and adolescents aged 6-14 years / Validación de apariencia de la prueba general para la evaluación del desarrollo (EVADE) en niños, niñas y adolescentes entre los 6 y 14 años

Abstract Background: The general development assessment test (EVADE) for children and adolescents aged 6-14 years is the only national screening tool for development assessment of school-age children and adolescents. This article presents the results obtained after applying the face validity process to the test, the handbook, and the standardized materials. Methods: An exploratory, descriptive study was conducted with a quantitative-qualitative methodology. The EVADE test was applied to a sample of 730 children and adolescents between 6 and 14 years of age, for which the expert judgment technique was used. Data analysis was carried out through a psychometric analysis of the items and by the triangulation method. Results: From the 730 participants included, 44.5% were from rural areas (n = 325) and 55.4% from urban areas (n = 405), of which 51.7% (n = 378) of females and 48.2% (n = 352) of males were assessed by the test. The difficulty level and discriminative effectiveness quotient of the items were calculated, which, together with the experts' findings, resulted in 22-item modifications and the creation of four new items in the cognitive and language areas. The qualification by areas also changed, improving the handbook and creating new materials. Conclusions: This research provides a validated screening test for the child and adolescent population, which was included in the Costa Rican comprehensive childcare public policy. However, subsequent validation processes are recommended to improve specific areas, such as motor skills and social-affective development.

Resumen Introducción: La prueba general para la evaluación del desarrollo (EVADE) para niñas, niños y adolescentes entre 6 y 14 años es la única prueba a nivel nacional que valora el desarrollo en población escolar y adolescente. Este artículo presenta los resultados tras someter la prueba, el instructivo y los materiales estandarizados al proceso de validación de apariencia. Métodos: Se llevó a cabo un estudio descriptivo exploratorio, con metodología cuantitativa-cualitativa. La prueba EVADE se aplicó a una muestra de 730 niñas, niños y adolescentes entre 6 y 14 años; asimismo, se utilizó la técnica de juicio de expertos. El análisis de los datos se efectuó a través de un análisis psicométrico de los enunciados y triangulación. Resultados: De los 730 participantes, el 44.5% correspondió a zonas rurales (n = 325) y el 55.4% a zonas urbanas (n = 405). El 51.7% de ellos eran de sexo femenino (n = 378) y el 48.2%, de sexo masculino (n = 352). Se calculó el nivel de dificultad y el coeficiente de efectividad discriminativa para los enunciados. A la par de los hallazgos referidos por los expertos, resultó en la modificación de 22 enunciados, la creación de cuatro nuevos artículos en las áreas cognitiva y de lenguaje. También se cambió la calificación por áreas, se mejoró el instructivo y se crearon nuevos materiales. Conclusiones: La presente investigación aporta una prueba validada para la población infantil escolar y adolescente, que fue incluida en la política pública de atención integral de la población infantil costarricense. Se recomiendan procesos de validación subsecuentes con el fin de mejorar áreas específicas, como motricidad y socioafectiva.

Factores sociodemográficos asociados con los modos de transporte en escolares y adolescentes mexicanos / Commuting to school among Mexican schoolchildren and adolescents

Resumen Introducción: Los modos activos de transporte (caminar o andar en bicicleta) tienen efectos benéficos para la salud, por lo cual deben identificarse factores que los promuevan. El objetivo de este estudio fue analizar la relación de los modos de transporte utilizados por la población pediátrica mexicana para acudir a la escuela con las características sociodemográficas, socioeconómicas y de inseguridad pública a nivel estatal. Métodos: Se estimó la frecuencia de los modos de transporte utilizados por los escolares y adolescentes para trasladarse a la escuela (con la base de la Encuesta Intercensal 2015). En un análisis ecológico (i.e., entidades federativas como unidades de observación) se obtuvieron correlaciones con estadísticas a nivel estatal con inseguridad alimentaria, nivel de urbanización y mortalidad por muertes violentas. Resultados: El modo de transporte más frecuente fue caminar (66.2%), seguido por el automóvil (16.2%) y el transporte público (15.3%). El transporte activo fue más frecuente en individuos del sexo masculino, escolares, personas de nivel socioeconómico bajo, zonas rurales, la región sur y aquellos cuyo traslado requería menos de 15 minutos. El transporte pasivo fue más frecuente en individuos del sexo femenino, adolescentes, personas de nivel socioeconómico alto y en zonas urbanas. En los estados más urbanizados fue menos frecuente el transporte activo y más prevalente el trasporte motorizado. La inseguridad pública se relacionó negativamente con el uso de bicicleta. Conclusiones: Se requiere mantener o incrementar el uso de modos de transporte activos en la población pediátrica mexicana mediante políticas públicas que mejoren el entorno y garanticen ambientes seguros.

Abstract Background: Active commuting (walking or cycling) is associated with benefits to health; thus, it is required to identify factors that promote it. The objective of this study was to analyze the relationship between the transport modes used by Mexican pediatric population to commute to school with sociodemographic and socioeconomic individual characteristics and public insecurity at the state level. Methods: The frequency of transport modes used by schoolchildren and adolescents to commute to school (walking, cycling, private car and public transport) were estimated using the database of the Encuesta Intercensal 2015. In an ecological analysis (i.e., states as observation units) correlations with food insecurity, urbanization level, and violent deaths statistics at state-level were obtained. Results: The most frequent transportation mode was walking (66.2%), followed by car (16.2%) and public transportation (15.3%). Active commuting (walking or cycling) was more frequent in males, schoolchildren, low socioeconomic status, living in rural or southern areas and those who spent <15 min to commute. Passive commute was more frequent among females, adolescents, high socioeconomic status, and living in urban areas. In the more urbanized states, active transportation was less frequent, but motorized transportation was more prevalent. Public insecurity was negatively related to cycling. Conclusions: Maintaining or increasing active commuting among Mexican pediatric population is necessary through public policies aimed to improve physical and social environment.