Use of health services and adherence to social distancing by adults with Noncommunicable Diseases during the COVID-19 pandemic, Brazil, 2020. / Uso dos serviços de saúde e adesão ao distanciamento social por adultos com doenças crônicas na pandemia de COVID-19, Brasil, 2020.

The present study investigates the association between the self-reported diagnosis of noncommunicable disease (NCD) and the adherence to social distancing and the use of health services during the COVID-19 pandemic. This was a cross-sectional study with Brazilian adults who participated in the ConVid- Behavior Survey, conducted online between April 24 and May 24, 2020(n = 45.161). This studyconsidered the following NCDs: diabetes, hypertension, respiratory disease, heart disease, and cancer, and evaluated the use of health services and the adherence to social distancing, as well as estimated the prevalences and adjusted prevalence ratio (aPR); 33,9% (95% CI: 32,5-35,3) referred to one or more NCD. Individuals with NCDsshowed a greater adherence to intense social distancing (aPR: 1,07;95% CI: 1,03-1,11), sought out health services more often (aPR:1,24; 95% CI:1,11-1,38), and found greater difficultyin scheduling doctor's appointments (aPR:1.52; 95% CI 1,35-1,71), receiving healthcare treatment (APR:1,50;95% CI:1,22-1,84) and medication (APR:2,17;95% CI:1,77-2,67), and performing examinations (APR:1,78;95% CI:1,50-2,10) and scheduled interventions (APR:1,65;95% CI:1,16-2,34). The presence of NCDs was associated with social distancing, seeking out health care, and difficulty in using health services.

Este estudo investiga a associação entre diagnóstico autorreferido de Doença Crônica Não Transmissível (DCNT) e adesão ao distanciamento social e utilização dos serviços de saúde durante a pandemia de COVID-19. Estudo transversal com adultos brasileiros que participaram da ConVid Pesquisa de Comportamentos, realizada de 24 de abril a 24 de maio de 2020, via web (n = 45.161). Considerou as DCNT: diabetes, hipertensão, doença respiratória, doença do coração e câncer. Avaliou a utilização de serviços de saúde e a adesão ao distanciamento social. Estimou as prevalências e razões de prevalências ajustadas (RPa). 33,9% (IC95%: 32,5-35,3) referiu uma ou mais DCNT. Indivíduos com DCNT tiveram maior adesão ao distanciamento social intenso (RPa:1,07; IC95%:1,03-1,11), procuraram mais o serviço de saúde (RPa:1,24; IC95%:1,11-1,38) e tiveram mais dificuldades para marcar consulta (RPa:1,52; IC95%:1,35-1,71), conseguir atendimento de saúde (RPa:1,50; IC95%:1,22-1,84) e medicamentos (RPa:2,17; IC95%:1,77-2,67), realizar exames (RPa:1,78; IC95%:1,50-2,10) e intervenções programadas (RPa:1,65; IC95%:1,16-2,34). A presença de DCNT associou-se à maior adesão ao distanciamento social, procura por atendimento de saúde e dificuldade na utilização dos serviços de saúde.

Smoking among Brazilian adolescents during the COVID-19 pandemic: a cross-sectional study.

BACKGROUND: The social distancing measures during the coronavirus disease 2019 (COVID-19) pandemic resulted in mental suffering among adolescents, leading to risky consumption of psychoactive substances such as tobacco. OBJECTIVE: To analyze the factors associated with tobacco use among adolescents during the COVID-19 social distancing period in Brazil. DESIGN AND SETTING: Cross-sectional study used data from ConVid Adolescentes survey in Brazil. METHODS: Tobacco use was assessed before and during social distancing. The explanatory variables investigated were sex, age, race/skin color, type of school, maternal education, region of residence, adherence to social restriction measures, number of close friends, sleep quality during the pandemic, mood, passive smoking, use of alcoholic beverages during the pandemic, sedentary behavior, and physical activity. A logistic regression model was used for the data analysis. RESULTS: Tobacco use by adolescents did not change during the pandemic (from 2.58% to 2.41%). There was a higher chance of tobacco use among adolescents aged between 16 and 17 years, self-reported black ones, residing in the South and Southeast regions, reported feeling sad and loneliness, had sleeping problems that worsened, were using alcoholic beverages during the pandemic, and were passive smokers at home. Adolescents whose mothers had completed high school or higher, had strict social restrictions, and increased their physical activity during the pandemic had a lower chance of tobacco use. CONCLUSION: Tobacco uses during the COVID-19 pandemic was higher in vulnerable groups, such as black adolescents and those with mental suffering.

Alcohol consumption among adolescents during the COVID-19 pandemic, ConVid Adolescents – Behavior Research O consumo de bebidas alcoólicas entre adolescentes durante a pandemia de COVID-19, ConVid Adolescentes — Pesquisa de Comportamentos

Objective: To describe the prevalence of alcohol consumption before and during the COVID-19 pandemic and to analyze the factors associated with this behavior during the period of social distancing among Brazilian adolescents. Methods: Cross-sectional study using data from the ConVid Adolescents survey, carried out via the Internet between June and September 2020. The prevalence of alcohol consumption before and during the pandemic, as well as association with sociodemographic variables, mental health, and lifestyle were estimated. A logistic regression model was used to assess associated factors. Results: 9,470 adolescents were evaluated. Alcohol consumption decreased from 17.70% (95%CI 16.64–18.85) before the pandemic to 12.80% (95%CI 11.85–13.76) during the pandemic. Alcohol consumption was associated with the age group of 16 and 17 years (OR=2.9;95%CI 1.08–1.53), place of residence in the South (OR=1.82;95%CI 1.46–2.27) and Southeast regions (OR=1.33;95%CI 1.05–1.69), having three or more close friends (OR=1.78;95%CI 1.25–2.53), reporting worsening sleep problems during the pandemic (OR=1.59;95%CI 1.20–2.11), feeling sad sometimes (OR=1,83;95%CI 1,40–2,38) and always (OR=2.27;95%CI 1.70–3.05), feeling always irritated (OR=1,60;95%CI 1,14–2,25), being a smoker (OR=13,74;95%CI 8.63–21.87) and a passive smoker (OR=1.76;95%CI 1.42–2.19). Strict adherence to social distancing was associated with lower alcohol consumption (OR=0.40;95%CI 0.32–0.49). Conclusions: The COVID-19 pandemic led to a decrease in consumption of alcoholic beverages by Brazilian adolescents, which was influenced by sociodemographic and mental health factors, adherence to social restriction measures and lifestyle in this period. Managers, educators, family and the society must be involved in the articulation of Public Policies to prevent alcohol consumption.

Mental health of Brazilian adolescents during the COVID-19 pandemic.

We aimed to assess the factors associated with frequent sadness and nervousness in Brazilian adolescents, during the Covid-19 pandemic, in 9470 adolescents (aged 12-17 years), interviewed from June 27 to September 17, 2020. Prevalences and prevalence ratios were estimated according to socio-demographic variables and factors related to family, school, friends, and health. Brazilian adolescents often felt sad (32.4%) and nervous (48.7%). Higher prevalences of these feelings were related to: being female; aged 15-17 year; from families with financial difficulties; having learned little or nothing with remote education; missing friends; having few friends; family disagreements; having regular/bad health before the pandemic; and worsened health and sleep during the pandemic. Higher prevalence of nervousness was also found in adolescents who worked before the pandemic and those who reported lack of concentration and not knowing if they had COVID-19. Sadness and nervousness in Brazilian adolescents is high and the need for action by the government, schools, health services, and parents to mitigate the impact of the pandemic on the physical and mental health of adolescents. Special attention must be paid to adolescents with previous health problems and those belonging to the most socially vulnerable population.

The COVID-19 pandemic and changes in eating habits of Brazilian adolescents.

Introduction: The social distancing imposed by the COVID-19 pandemic influenced lifestyle and modified dietary patterns. Our objective was to evaluate the consumption of fruits and vegetables (FV), and ultra-processed foods (UPF), before and after the COVID-19 pandemic, as well as to identify the sociodemographic factors associated. Methods: This study used data from the "Convid Adolescents", a survey on health behaviors that were collected through an online questionnaire self-completed by 9.470 adolescents between 12 and 17 years of age during the pandemic in Brazil in 2020. Individuals were invited to participate through a chain-sampling procedure called "virtual snowballing". Information about FV, and UPF consumption before and during the pandemic period were reported. The independent variables used were sex, age group, race/color of skin, kind of school, education level of the mother, region of Brazil, financial difficulties during the pandemic, food insecurity, and social restrictions. Logistic regression models were used. Results: There was a reduction in the low consumption of FV (83.5% to 80.3%) and there was no significant difference in the high consumption of UPF (38.9% to 38.1%) before and during the pandemic. The incidence of low consumption of FV and high consumption of UPF during the pandemic was 20% and 13.8%, respectively. Girls, private school adolescents, who reported having food insecurity and financial difficulties during the pandemic were the most affected subgroups. Conclusions: Despite little change in the prevalence of FV and UPF consumption before and during the pandemic, the incidence of high consumption of UPF and low FV consumption was high, and it identified in specific population subgroups.

COVID-19 mortality in Brazil, 2020-21: consequences of the pandemic inadequate management.

BACKGROUND: The COVID-19 pandemic brought countless challenges to public health and highlighted the Brazilian health system vulnerabilities in facing the emergency. In this article, we analyze data on COVID-19-related deaths in 2020-21 to show the epidemic consequences in Brazil. METHODS: The Mortality Information System and the Live Birth Information System were the primary information sources. We used population estimates in 2020-21 to calculate COVID-19 specific mortality rates by age, sex, and educational level. Considering the total number of COVID-19 deaths in 2020-21, the COVID-19 proportional mortality (%) was estimated for each age group and sex. A graph of the daily number of deaths from January 2020 to December 2021 by sex was elaborated to show the temporal evolution of COVID-19 deaths in Brazil. In addition, four indicators related to COVID-19 mortality were estimated: infant mortality rate (IMR); maternal mortality ratio (MMR); number and rate of orphans due to mother's COVID-19 death; the average number of years lost. RESULTS: The overall COVID-19 mortality rate was 14.8 (/10,000). The mortality rates increase with age and show a decreasing gradient with higher schooling. The rate among illiterate people was 38.8/10,000, three times higher than a college education. Male mortality was 31% higher than female mortality. COVID-19 deaths represented 19.1% of all deaths, with the highest proportions in the age group of 40-59 years. The average number of years lost due to COVID-19 was 19 years. The MMR due to COVID-19 was 35.7 per 100,000 live births (LB), representing 37.4% of the overall MMR. Regarding the number of orphans due to COVID-19, we estimated that 40,830 children under 18 lost their mothers during the epidemic, with an orphans' rate of 7.5/10,000 children aged 0-17 years. The IMR was 11.7 per 1000 LB, with 0.2 caused by COVID-19. The peak of COVID-19 deaths occurred in March 2021, reaching almost 4000 COVID-19 deaths per day, higher than the average number of deaths per day from all causes in 2019. CONCLUSIONS: The delay in adopting public health measures necessary to control the epidemic has exacerbated the spread of the disease, resulting in several avoidable deaths.

Risk of SARS-CoV-2 infection among front-line healthcare workers in Northeast Brazil: a respondent-driven sampling approach.

OBJECTIVES: We assessed the prevalence of SARS-CoV-2 infection, personal protective equipment (PPE) shortages and occurrence of biological accidents among front-line healthcare workers (HCW). DESIGN, SETTING AND PARTICIPANTS: Using respondent-driven sampling, the study recruited distinct categories of HCW attending suspected or confirmed patients with COVID-19 from May 2020 to February 2021, in the Recife metropolitan area, Northeast Brazil. OUTCOME MEASURES: The criterion to assess SARS-CoV-2 infection among HCW was a positive self-reported PCR test. RESULTS: We analysed 1525 HCW: 527 physicians, 471 registered nurses, 263 nursing assistants and 264 physical therapists. Women predominated in all categories (81.1%; 95% CI: 77.8% to 84.1%). Nurses were older with more comorbidities (hypertension and overweight/obesity) than the other staff. The overall prevalence of SARS-CoV-2 infection was 61.8% (95% CI: 55.7% to 67.5%) after adjustment for the cluster random effect, weighted by network, and the reference population size. Risk factors for a positive RT-PCR test were being a nursing assistant (OR adjusted: 2.56; 95% CI: 1.42 to 4.61), not always using all recommended PPE while assisting patients with COVID-19 (OR adj: 2.15; 95% CI: 1.02 to 4.53) and reporting a splash of biological fluid/respiratory secretion in the eyes (OR adj: 3.37; 95% CI: 1.10 to 10.34). CONCLUSIONS: This study shows the high frequency of SARS-CoV2 infection among HCW presumably due to workplace exposures. In our setting, nursing assistant comprised the most vulnerable category. Our findings highlight the need for improving healthcare facility environments, specific training and supervision to cope with public health emergencies.

[Homecare of elderly Brazilians with functional dependency: inequalities and challenges during the first wave of the COVID-19 pandemic]. / O cuidado domiciliar de idosos com dependência funcional no Brasil: desigualdades e desafios no contexto da primeira onda da pandemia de COVID-19.

The article aims to analyze the pandemic's effect on the burden of care for elderly persons with functional dependency according to the presence of hired caregivers and socioeconomic conditions in the year 2020. Data were obtained from the ConVid - Behavior Survey of 2020. We calculated the percentage distribution and prevalence of the population living with elderly persons with functional dependency during the COVID-19 pandemic according to sex, race/color, and income. We estimated the Pearson chi-square test and prevalence ratio for the increase in household work, fitting Poisson regression models with robust variance and using 95% confidence intervals (95%CI). Among adults living with elderly individuals, 8.1% (95%CI: 7.1-9.4) had at least one elderly person with functional dependency. During the pandemic, 11.7% (95%CI: 8.5-16.0) stopped hiring third-party caregivers, which can be explained by social distancing to reduce risk of transmission and/or by the decline in families' purchasing power. Those who lost hired caregivers during the pandemic were more likely to experience an increase in the burden of care, regardless of their socioeconomic status. There was an unequal distribution of caregiving work in the population, intensified by the arrival of the COVID-19 pandemic. The heavier load of care for elderly persons with functional dependency was sharper in more socioeconomically privileged groups such as whites and those with higher income. One hypothesis is that more vulnerable groups already bore a high burden of care before the pandemic. The crisis in care has been aggravated by the dismantling of primary healthcare in Brazil, a reduction in social support for Brazilian families during the pandemic, and rising unemployment, decreasing families' capacity to hire caregivers.

O artigo tem o objetivo de analisar o efeito da pandemia na carga de cuidado da pessoa idosa com dependência funcional, segundo a presença de cuidador contratado e condições socioeconômicas no ano de 2020. Utilizou-se a ConVid - Pesquisa de Comportamentos de 2020 como fonte de dados. Calculou-se a distribuição percentual e a prevalência da população que mora com idoso com dependência funcional durante a pandemia da COVID-19, segundo sexo, raça/cor da pele e renda. Estimou-se o teste de qui-quadrado de Pearson e a razão da prevalência de aumento do trabalho doméstico, ajustando-se modelos de regressão de Poisson com a variância robusta. Utilizou-se o intervalo de 95% de confiança (IC95%). Entre adultos que moravam com idoso, 8,1% (IC95%: 7,1-9,4) tinham pelo menos um idoso com dependência funcional. Durante a pandemia, 11,7% (IC95%: 8,5-16,0) deixaram de ter cuidador, o que se explica pelo distanciamento social para redução de risco de contágio e/ou pela diminuição da capacidade aquisitiva das famílias. Aqueles que perderam cuidador remunerado durante a pandemia tiveram maior probabilidade de aumento da carga do cuidado, independentemente da condição socioeconômica. Verificou-se a distribuição desigual do trabalho de cuidar na população, que se intensificou com a chegada da pandemia da COVID-19. A piora da carga de cuidado de idoso com dependência funcional foi mais acentuada entre os grupos mais privilegiados, como brancos e de maior renda. Uma hipótese é a de que os grupos mais vulneráveis já tivessem uma alta carga de cuidado antes da pandemia. A crise no cuidado se agrava diante do desmonte da atenção básica, redução do suporte social às famílias brasileiras no contexto de pandemia e aumento do desemprego, diminuindo a capacidade de contratação de cuidador.

El artículo tiene como objetivo analizar el efecto de la pandemia en la carga de cuidado de la persona anciana con dependencia funcional, según la presencia del cuidador contratado y condiciones socioeconómicas, durante el año 2020. Se utilizó la ConVid - Encuesta de Comportamientos de 2020 como fuente de datos. Se calculó la distribución porcentual y la prevalencia de la población que vive con anciano con dependencia funcional durante la pandemia de COVID-19, según sexo, raza/color de piel y renta. Se estimó el test de chi-cuadrado de Pearson y la razón de la prevalencia de aumento del trabajo doméstico, ajustándose a modelos de regresión de Poisson con variancia robusta. Se utilizó el intervalo de 95% de confianza (IC95%). Entre adultos que vivían con ancianos, un 8,1% (IC95%: 7,1-9,4) tenían por lo menos un anciano con dependencia funcional. Durante la pandemia, un 11,7% (IC95%: 8,5-16,0) dejaron de tener cuidador, lo que se explica por el distanciamiento social para la reducción del riesgo de contagio y/o por la disminución de la capacidad adquisitiva de las familias. Aquellos que perdieron un cuidador remunerado durante la pandemia tuvieron una mayor probabilidad de aumento de la carga del cuidado, independientemente de la condición socioeconómica. Se verificó la distribución desigual del trabajo de cuidar en la población, que se intensificó con la llegada de la pandemia de COVID-19. El empeoramiento de la carga de cuidado de anciano con dependencia funcional fue más acentuada entre los grupos más privilegiados, como blancos y de mayor renta. Una hipótesis es la de que los grupos más vulnerables ya tuvieran una alta carga de cuidado antes de la pandemia. La crisis en el cuidado se agrava ante el desmantelamiento de la Atención Básica, reducción del apoyo social a las familias brasileñas en el contexto de pandemia y aumento del desempleo, disminuyendo la capacidad de contratación de cuidadores.

Factors affecting Brazilians' self-rated health during the COVID-19 pandemic.

This is a cross-sectional study investigating the factors affecting brazilians' self-rated health during the COVID-19 pandemic, based on data from the web-based behavior survey. Carried out from April 24 to May 24, 2020, the survey recruited participants by a chain sampling procedure. Its outcome was the worsening of self-rated health during the pandemic. Statistical analysis was based on a hierarchical model of determination. Logistic regression models were used to test the associations between sociodemographic characteristics, pre-existing health conditions, lifestyle indicators and intensity of social restraint measures, and biological and psychological issues during the pandemic. From the total sample of 45,161 participants, 29.4% reported worsening of health state during this period. After adjusting for hierarchical distal factors, the health problems mostly associated with worsening health state were: bad self-rated health (adjusted OR = 4.35, p < 0.001), health care seeking for mental health problem (adjusted OR = 3.95, p < 0.001), and for COVID-19 (adjusted OR = 3.60, p < 0.001). People who experienced sleep problems, worsening of back pain, depression and at least one flu symptom during the pandemic were twice as likely to report worsening of health status. Sedentary and eating behaviors and adherence to social distancing measures showed significant correlation with the outcome. There exists a relation between social, biological, and psychological factors, mediated by lifestyles and variables pertaining to confinement. Altogether, these factors have negatively affected self-rated health during the COVID-19 pandemic in Brazil.

Seroprevalence of IgG and IgM anti-SARS-CoV-2 among voluntary blood donors in Rio de Janeiro, Brazil

Background: In Brazil, mathematical models for derivingestimates and projections of COVID-19 cases have been developed without data on asymptomatic SARS-CoV-2 infection. We estimated the seroprevalence of antibodies to SARS-CoV-2 among blood donors in the State of Rio de Janeiro. Methods: Data were collected on 2,857 blood donors from April 14 to 27, 2020. We report the crude prevalence of antibodies to SARS-CoV-2, the weighted prevalence by the total state population, and adjusted prevalence estimates for test sensitivity and specificity. To establish the correlates of SARS-CoV-2 prevalence, we used logistic regression models. The analysis included period and site of blood collection, sociodemographic characteristics, and place of residence. Results: The proportion of SARS-Cov-2 positive tests without any adjustment was 4.0% (95% CI 3.3-4.7%), and the weighted prevalence was 3.8% (95% CI 3.1-4.5%). Further adjustment by test sensitivity and specificity produced lower estimates, 3.6% (95% CI 2.7-4.4%) and 3.3% (95% CI 2.6-4.1%), respectively. The variable most significantly associated with the crude prevalence was the period of blood collection: the later the period, the higher the prevalence. Regarding socio-demographic characteristics, the younger the blood donors, the higher the prevalence, and the lower the educational level, the higher the odds of a positive SARS-Cov-2 antibody. Similar results were found for the weighted prevalence. Discussion: Although our findings resulted from a convenience sample, they match some basic premises: the increasing trend over time, since the epidemic curve in the state is still on the rise;the higher prevalence among the youngest who are more likely to circulate;and the higher prevalence among the less educated as they have more difficulties in following the social distancing recommendations. Despite the study limitations, it is possible to infer that protective levels of natural herd immunity to SARS-CoV-2 are far from being reached in Rio de Janeiro. (AU)

Seroprevalence of anti-SARS-CoV-2 among blood donors in Rio de Janeiro, Brazil.

OBJECTIVE To estimate the seroprevalence of antibodies to SARS-CoV-2 among blood donors in the state of Rio de Janeiro, Brazil. METHODS Data were collected on 2,857 blood donors from April 14 to 27, 2020. This study reports crude prevalence of antibodies to SARS-CoV-2, population weighted prevalence for the state, and prevalence adjusted for test sensitivity and specificity. Logistic regression models were used to establish the correlates of SARS-CoV-2 prevalence. For the analysis, we considered collection period and site, sociodemographic characteristics, and place of residence. RESULTS The proportion of positive tests for SARS-Cov-2, without any adjustment, was 4.0% (95%CI 3.3-4.7%), and the weighted prevalence was 3.8% (95%CI 3.1-4.5%). We found lower estimates after adjusting for test sensitivity and specificity: 3.6% (95%CI 2.7-4.4%) for the non-weighted prevalence, and 3.3% (95%CI 2.6-4.1%) for the weighted prevalence. Collection period was the variable most significantly associated with crude prevalence: the later the period, the higher the prevalence. Regarding sociodemographic characteristics, the younger the blood donor, the higher the prevalence, and the lower the education level, the higher the odds of testing positive for SARS-Cov-2 antibody. We found similar results for weighted prevalence. CONCLUSIONS Our findings comply with some basic premises: the increasing trend over time, as the epidemic curve in the state is still on the rise; and the higher prevalence among both the youngest, for moving around more than older age groups, and the less educated, for encountering more difficulties in following social distancing recommendations. Despite the study limitations, we may infer that Rio de Janeiro is far from reaching the required levels of herd immunity against SARS-CoV-2.

Associations of Sociodemographic Factors and Health Behaviors with the Emotional Well-Being of Adolescents during the COVID-19 Pandemic in Brazil.

This cross-sectional study utilizes data from a nationwide web-based survey aimed to identify the factors affecting the emotional well-being of Brazilian adolescents aged 12-17 during the period of school closures and confinement. Data collection took place from 27 June to 17 September 2020. We used the "virtual snowball" sampling method, and students from private and public schools were included. A total of 9470 adolescents were analyzed. A hierarchical logistic regression model was used to find the factors associated with reporting at least two of three self-reported problems-sadness, irritability, and sleep problems. The main proximal factor was loneliness (AdjOR = 8.12 p < 0.001). Problems related to school closures also played an important role. Regular intake of fruits and vegetables, as well as physical activity, demonstrated a positive influence on emotional well-being, while excessive screen time (AdjOR = 2.05, p < 0.001) and alcohol consumption negatively affected outcomes (AdjOR = 1.73, p < 0.001). As for distal variables, less affluent adolescents were the most affected, and males reported fewer emotional problems than females. Uncertainty regarding the disease in a context of socioeconomic vulnerability, together with rises in unhealthy behaviors and isolation from their immediate social circles, have negatively affected adolescents' emotional status throughout the COVID-19 pandemic.

Noncommunicable diseases and changes in lifestyles during the COVID-19 pandemic in Brazil. / Doenças crônicas não transmissíveis e mudanças nos estilos de vida durante a pandemia de COVID-19 no Brasil.

OBJECTIVE: To compare lifestyle changes during the COVID-19 pandemic according to the presence or absence of noncommunicable diseases (NCDs) in Brazilian adults. METHODS: Cross-sectional study, using data from the ConVid survey, between April and May 2020. The following variables were evaluated: lifestyle and presence of one or more NCDs (diabetes, hypertension, respiratory disease, heart disease, and cancer). Sociodemographic characteristics were used as adjustment. Relative frequencies and confidence intervals (CI) of 95% of the explanatory variables were calculated before and during the pandemic. For the comparison of groups, with or without NCDs, crude and adjusted (PRadj) prevalence ratios were estimated by Poisson regression. RESULTS: There was a reduction in physical activity (60% in those without NCDs and 58% in those with NCDs) and in vegetable consumption (10.8% in those without NCDs and 12.7% in those with NCDs). On the other hand, there was an increase in the time spent watching television and on screens of computer/tablet (302% and 43.5% in those without NCDs and 196.5% and 30.6% with NCDs, respectively); consumption of frozen meals (43.6% in those without NCDs and 53.7% with NCDs), snacks (42.3% without NCDs and 31.2% with NCDs), and chocolate (14.8% without NCDs). During the pandemic, patients with NCDs were less active (PRadj = 0.77; 95%CI 0.65 - 0.92), had greater habit of watching TV (PRadj = 1.16; 95%CI 1.08 - 1.26), and consumed less vegetables (PRadj = 0.88; 95%CI 0.81 - 0.96). CONCLUSION: It was evident that adults with NCDs had their lifestyles more altered during the COVID-19 pandemic.

OBJETIVO: Comparar as mudanças de estilos de vida durante a pandemia COVID-19, segundo a presença ou não de doenças crônicas não transmissíveis (DCNT) em adultos brasileiros. MÉTODOS: Estudo transversal, com dados da pesquisa ConVid - Pesquisa de Comportamentos, realizada entre abril e maio de 2020. Avaliaram-se as variáveis estilo de vida e presença de uma ou mais DCNT (diabetes, hipertensão, doença respiratória, doença do coração e câncer). As características sociodemográficas foram usadas como ajuste. Calcularam-se as frequências relativas e os intervalos de confiança (IC) de 95% das variáveis antes da e durante a pandemia. Para a comparação de grupos, sem ou com DCNT, estimaram-se as prevalências e razões de prevalência bruta e ajustada (RPa) utilizando a regressão de Poisson. RESULTADOS: Houve redução da prática de atividade física (60% nos sem DCNT e 58% nos com DCNT) e do consumo de hortaliças (10,8% nos sem DCNT e 12,7% nos com DCNT). Verificou-se aumento no tempo de uso de televisão e computador/tablet (302 e 43,5% nos sem DCNT e 196,5 e 30,6% nos com DCNT, respectivamente); consumo de congelados (43,6% nos sem DCNT e 53,7% com DCNT), salgadinhos (42,3% sem DCNT e 31,2% com DCNT) e chocolate (14,8% sem DCNT). Durante a pandemia, portadores de DCNT apresentaram menor prática de atividade física suficiente (RPa = 0,77; IC95% 0,65 - 0,92), maior hábito de assistir à televisão (RPa = 1,16; IC95% 1,08 - 1,26) e menor consumo de hortaliças (RPa = 0,88; IC95% 0,81 - 0,96). CONCLUSÃO: Evidenciou-se que adultos com DCNT tiveram seus estilos de vida mais alterados durante a pandemia de COVID-19.

Effect of chronic non-communicable diseases (CNCDs) on the sleep of Brazilians during the COVID-19 pandemic.

This study aimed to investigate the effect of Chronic Noncommunicable Diseases (CNCDs) on the onset or increase in sleep problems during the COVID-19 pandemic period. The role of the report of sadness or nervousness during the pandemic was also evaluated as a mediator of this association. Data from a behavior survey during COVID-19, conducted in Brazil with 45,161 people (18 years old or older), from April 24 to May 24, 2020, were used. The outcome variable was the onset or increase in sleep problems, and the exposure variable was the presence of CNCDs. The adjusted Odds Ratio of the association between CNCDs and sleep was estimated, and a mediation analysis was performed to test the effect of the report of sadness or nervousness on this association, using the Karlson Holm Breen method. The increase in sleep problems was reported by 44.9% of the population, and 33.9% reported at least one CNCD. The chance of sleep problems was higher among people with diabetes (1.34; 1.05-1.71), hypertension (1.26; 1.06-1.50), and with coronary heart diseases (1.36; 1.13-1.65) or respiratory diseases (1.42; 1.04-1.93). Compared to people without CNCDs, individuals with at least one CNCD had a 36% greater chance of impaired sleep (1.36; 1.19-1.55). The report of sadness or nervousness explained 45.1% of the association between CNCD and sleep. Our findings alert us to care for the emotional state and sleep of chronic patients during the waves of the COVID-19 pandemic, and indicate the need for sleep monitoring in this population.

Changes in Brazilians' socioeconomic and health conditions during the COVID-19 pandemic. / Mudanças nas condições socioeconômicas e de saúde dos brasileiros durante a pandemia de COVID-19.

OBJECTIVE: To describe changes in socioeconomic and health conditions of Brazilians during the COVID-19 pandemic. METHODOLOGY: Cross-sectional study with data from a web-based behavioral survey carried out from April 24 to May 24, 2020, with 45,161 participants recruited by the chain sampling method. A descriptive analysis of the survey topics was performed: adherence to social restriction measures, diagnosis of the new coronavirus, work situation and income, difficulties in routine activities, presence of comorbidities, psychological issues, and access to health services. Prevalence and respective 95% confidence intervals were estimated. RESULTS: Approximately 74% of Brazilians adhered to social restrictions. As for flu symptoms, 28.1% reported having at least one flu symptom, but only 5.9% underwent testing for COVID-19. Regarding the socioeconomic impact, 55.1% reported a decrease in family income, and 7.0% were left without any income; 25.8% of the people lost their jobs, with the group of informal workers being the most affected (50.6%). As for health conditions, 29.4% reported worsening of health status; 45%, having sleep problems; 40% frequently presented feelings of sadness, and 52.5%, of anxiety; 21.7% sought health care, and, among them, 13.9% did not get care. CONCLUSION: The findings show the importance of controlling the COVID-19 pandemic in Brazil, to mitigate the adverse effects on the socioeconomic and health conditions related to social restriction measures.

OBJETIVO: Descrever as mudanças nas condições socioeconômicas e de saúde dos brasileiros durante a pandemia de COVID-19. MÉTODOS: Estudo transversal com dados de pesquisa de comportamentos realizada pela internet de 24 de abril a 24 de maio de 2020 com 45.161 participantes recrutados por amostragem em cadeia. Foi feita uma análise descritiva de temas abordados na pesquisa: adesão às medidas de restrição social, diagnóstico do novo coronavírus, situação de trabalho e rendimentos, dificuldades nas atividades de rotina, presença de comorbidades, estado de ânimo e acesso aos serviços de saúde. Foram estimados as prevalências e os intervalos de 95% de confiança. RESULTADOS: Aproximadamente 75% dos brasileiros aderiram à restrição social. Quanto aos sintomas de gripe, 28,1% relatou ter apresentado algum sintoma, mas apenas 5,9% realizou teste para COVID-19. Em relação à situação socioeconômica, 55,1% relatou diminuição do rendimento familiar, e 7% ficou sem rendimento; 25,8% dos indivíduos ficaram sem trabalhar, sendo o grupo de trabalhadores informais o mais afetado (50,6%). Quanto às condições de saúde, 29,4% avaliou que a sua saúde piorou; 45% teve problemas no sono, 40% apresentou, frequentemente, sentimento de tristeza e 52,5% de ansiedade/nervosismo; 21,7% procurou serviço de saúde e, entre estes, 13,9% não conseguiu atendimento. CONCLUSÃO: Os achados mostram a importância do controle da pandemia de COVID-19 no Brasil, para mitigar os efeitos adversos na situação socioeconômica e nas condições de saúde relacionados às medidas de restrição social.

Adherence to physical contact restriction measures and the spread of COVID-19 in Brazil. / Adesão às medidas de restrição de contato físico e disseminação da COVID-19 no Brasil.

OBJECTIVE: To analyze the adherence of the population to physical contact restriction measures and the spread of COVID-19 in Brazil. METHODS: This was a web-based health survey carried out from April 24 to May 24 2020 using a chain sampling procedure. Intensity of adherence to physical contact restriction measures was analyzed according to sociodemographic characteristics, using logistic regression models to investigate associations with 'No/little adherence'. RESULTS: Of the 45,161 participants, 74.2% (73.8;74.6%) reported intense adherence to the measures. The group that did not adhere to the measures was characterized by men (31.7%), those aged 30 to 49 (36.4%), those with low education levels (33.0%), those who worked during the pandemic (81.3%), those resident in the North (28.1%) and Midwest (28.5%) regions of the country. In Brazil as a whole, there was a decrease in COVID-19 daily growth rates, from 45.4% to 5.0%. CONCLUSION: A large part of the Brazilian population adhered to physical contact restriction measures, which possibly contributed to decreasing the spread of COVID-19.

Lifestyle behaviors changes during the COVID-19 pandemic quarantine among 6,881 Brazilian adults with depression and 35,143 without depression

Our aim was to analyze the association between previously diagnosed lifetime depression and changes in physical activity (PA), TV-viewing, consumption of fruits and vegetables as well as frequency of ultra-processed food (UPF) consumption. Data of 41,923 Brazilian adults (6,881 with depression and 35,042 without depression) were used. Participants reported PA (&#8805;150 min/week), TV-viewing (&#8805;4 h/day), frequency of eating fruits or vegetables (&#8804;4 days/week) and UPF (&#8805;5 days/week). For incidence indicators, we only considered participants without the risk behavior before the quarantine. People without and with depression presented, respectively, incidence of physical inactivity [70.1% (95%CI: 67.4-72.8) vs 76.3 (70.3-81.5)], high TV-viewing [31.2 (29.6-32.8) vs 33.9 (30.5-37.4)], low frequency of fruit or vegetable consumption [28.3 (25.8-31.0) vs 31.5 (26.1-37.5)] and elevated frequency of UPF consumption [9.7 (8.9-10.7) vs 15.2 (13.0-17.7)]. Participants with depression were more likely to present elevated frequency of UPF consumption incidence [OR:1.49 (95%CI:1.21-1.83)]. Thus, participants with previous diagnosis of depression were at risk for incidence of unhealthy diet behaviors. Resumo Nosso objetivo foi analisar a associação entre depressão previamente diagnosticada e alterações na atividade física (AF), tempo assistindo TV, consumo de frutas e vegetais, bem como na frequência do consumo de alimentos ultraprocessados (AUP). Foram utilizados dados de 41.923 adultos brasileiros (6.881 com depressão e 35.042 sem depressão) de uma pesquisa de comportamentos em âmbito nacional. Os participantes relataram a prática de AF (&#8805;150 min / semana), tempo de TV (&#8805;4 h/dia), frequência de consumo de frutas ou vegetais (&#8804;4 dias/semana) e AUP (&#8805;5 dias/semana). Para indicadores de incidência, consideramos apenas participantes sem o comportamento de risco antes da quarentena. Pessoas sem e com depressão apresentaram, respectivamente, incidência de inatividade física [70,1% (IC95%: 67,4-72,8) vs 76,3 (70,3-81,5)], elevado tempo assistindo TV [31,2 (29,6-32,8) vs 33,9 (30,5- 37,4)], baixa frequência de consumo de frutas ou vegetais [28,3 (25,8-31,0) vs 31.5 (26.1-37.5)] e frequência elevada de AUP [9,7 (8,9-10,7) vs 15,2 (13,0-17,7)]. Pessoas com diagnóstico prévio de depressão apresentaram maior probabilidade de incidência de elevado consumo de AUP [OR:1,49 (IC95%:1,21-1,83)]. Portanto, participantes com diagnóstico prévio de depressão apresentam maior risco de incidência de comportamentos alimentares não saudáveis.

Adherence to physical contact restriction measures and the spread of COVID-19 in Brazil

Resumo Objetivo: Analisar a adesão da população às medidas de restrição de contato físico e disseminação da COVID-19 no Brasil. Métodos: Inquérito de saúde, realizado pela internet, com amostragem em cadeia, no período de 24 de abril a 24 de maio de 2020. A intensidade da adesão à restrição de contato físico foi analisada segundo características sociodemográficas, utilizando-se modelos de regressão logística para investigar associações com 'Nenhuma/pouca adesão'. Resultados: Dos 45.161 participantes, 74,2% (73,8-74,6%) relataram intensa adesão às medidas. O grupo que não aderiu às medidas foi composto homens (31,7%), com idade de 30 a 49 anos (36,4%), baixa escolaridade (33,0%), trabalhando durante a pandemia (81,3%), residentes nas regiões Norte (28,1%) e Centro-Oeste (28,5%) do país. Houve importante redução das taxas de crescimento diário, de 45,4 para 5,0%. Conclusão: Grande parte da população brasileira aderiu às medidas de restrição de contato físico, o que, possivelmente, contribuiu para reduzir a disseminação da COVID-19. Resumen Objetivo: Analizar la adhesión de los brasileños a las medidas de restricción de contacto físico y diseminación del COVID-19. Métodos: Encuesta de salud realizada por internet con muesteo em cadena entre 24 de abril y 24 de mayo de 2020. La intensidad de la adhesión a la restricción de contacto físico se analizó de acuerdo con características sociodemográficas, utilizando modelos de regresión logística para investigar asociaciones con 'Ninguna/poca adhesión'. Resultados: Participaron 45.161, de los cuales un 74,2% (73,8;74,6%) informó intensa adhesión. El grupo con poca adhesión se caracterizó por hombres (31,7%), 30-49 años (36,4%), baja educación (33,0%), que trabajaron durante la pandemia (81,3%), residiendo em las regiones Norte (28,1%) y Centro-Oeste (28,5%) del país. En Brasil hubo una reducción relevante em las tasas de crecimiento diario, del 45,4% al 5,0%. Conclusión: Gran parte de la población adhirió a las medidas de restricción de contacto físico, lo que posiblemente contribuyó a la disminución de la diseminación del COVID-19. Objective: To analyze the adherence of the population to physical contact restriction measures and the spread of COVID-19 in Brazil. Methods: This was a web-based health survey carried out from April 24 to May 24 2020 using a chain sampling procedure. Intensity of adherence to physical contact restriction measures was analyzed according to sociodemographic characteristics, using logistic regression models to investigate associations with 'No/little adherence'. Results: Of the 45,161 participants, 74.2% (73.8;74.6%) reported intense adherence to the measures. The group that did not adhere to the measures was characterized by men (31.7%), those aged 30 to 49 (36.4%), those with low education levels (33.0%), those who worked during the pandemic (81.3%), those resident in the North (28.1%) and Midwest (28.5%) regions of the country. In Brazil as a whole, there was a decrease in COVID-19 daily growth rates, from 45.4% to 5.0%. Conclusion: A large part of the Brazilian population adhered to physical contact restriction measures, which possibly contributed to decreasing the spread of COVID-19.

Lifestyle behaviors changes during the COVID-19 pandemic quarantine among 6,881 Brazilian adults with depression and 35,143 without depression

Our aim was to analyze the association between previously diagnosed lifetime depression and changes in physical activity (PA), TV-viewing, consumption of fruits and vegetables as well as frequency of ultra-processed food (UPF) consumption. Data of 41,923 Brazilian adults (6,881 with depression and 35,042 without depression) were used. Participants reported PA (&#8805;150 min/week), TV-viewing (&#8805;4 h/day), frequency of eating fruits or vegetables (&#8804;4 days/week) and UPF (&#8805;5 days/week). For incidence indicators, we only considered participants without the risk behavior before the quarantine. People without and with depression presented, respectively, incidence of physical inactivity [70.1% (95%CI: 67.4-72.8) vs 76.3 (70.3-81.5)], high TV-viewing [31.2 (29.6-32.8) vs 33.9 (30.5-37.4)], low frequency of fruit or vegetable consumption [28.3 (25.8-31.0) vs 31.5 (26.1-37.5)] and elevated frequency of UPF consumption [9.7 (8.9-10.7) vs 15.2 (13.0-17.7)]. Participants with depression were more likely to present elevated frequency of UPF consumption incidence [OR:1.49 (95%CI:1.21-1.83)]. Thus, participants with previous diagnosis of depression were at risk for incidence of unhealthy diet behaviors. Resumo Nosso objetivo foi analisar a associação entre depressão previamente diagnosticada e alterações na atividade física (AF), tempo assistindo TV, consumo de frutas e vegetais, bem como na frequência do consumo de alimentos ultraprocessados (AUP). Foram utilizados dados de 41.923 adultos brasileiros (6.881 com depressão e 35.042 sem depressão) de uma pesquisa de comportamentos em âmbito nacional. Os participantes relataram a prática de AF (&#8805;150 min / semana), tempo de TV (&#8805;4 h/dia), frequência de consumo de frutas ou vegetais (&#8804;4 dias/semana) e AUP (&#8805;5 dias/semana). Para indicadores de incidência, consideramos apenas participantes sem o comportamento de risco antes da quarentena. Pessoas sem e com depressão apresentaram, respectivamente, incidência de inatividade física [70,1% (IC95%: 67,4-72,8) vs 76,3 (70,3-81,5)], elevado tempo assistindo TV [31,2 (29,6-32,8) vs 33,9 (30,5- 37,4)], baixa frequência de consumo de frutas ou vegetais [28,3 (25,8-31,0) vs 31.5 (26.1-37.5)] e frequência elevada de AUP [9,7 (8,9-10,7) vs 15,2 (13,0-17,7)]. Pessoas com diagnóstico prévio de depressão apresentaram maior probabilidade de incidência de elevado consumo de AUP [OR:1,49 (IC95%:1,21-1,83)]. Portanto, participantes com diagnóstico prévio de depressão apresentam maior risco de incidência de comportamentos alimentares não saudáveis.

La pandemia de COVID-19 y los cambios en el estilo de vida de los adultos brasileños: un estudio transversal, 2020 The COVID-19 Pandemic and changes in adult Brazilian lifestyles: a cross-sectional study, 2020

Resumo Objetivo Descrever as mudanças nos estilos de vida, quanto ao consumo de tabaco, bebidas alcoólicas, alimentação e atividade física, no período de restrição social consequente à pandemia da COVID-19. Métodos Estudo transversal realizado com dados do inquérito ConVid sobre comportamentos em saúde. Os dados foram coletados por meio de questionário on-line autopreenchido pelos participantes. Procedimentos de pós-estratificação foram empregados para o cálculo das prevalências e intervalos de confiança de 95%. Resultados Participaram 45.161 indivíduos com 18 ou mais anos de idade. Durante o período de restrição social, foi relatada diminuição da prática de atividade física e aumento do tempo em frente a telas, da ingestão de alimentos ultraprocessados, do número de cigarros fumados e do consumo de bebidas alcóolicas. Foram observadas diferenças segundo sexo e faixa etária. Conclusão Os resultados apontam uma piora dos estilos de vida e aumento de comportamentos de risco à saúde. Resumen Objetivo Describir los cambios en los estilos de vida, en relación al consumo de tabaco y alcohol, alimentación y actividad física, en el período de restricción social resultante de la pandemia de COVID-19. Métodos Este es un estudio transversal realizado en Brasil con datos de la encuesta de salud virtual del ConVid sobre comportamiento en salud. Los datos se recolectaron en cuestionario online autocompletado por los participantes. Se emplearon procedimientos de post-estratificación para el cálculo de las prevalencias y el intervalo de confianza del 95%. Resultados Participaron 45.161 personas de 18 años o más. Durante el tiempo de restricción social se redujo la práctica de actividad física y hubo un aumento del tiempo frente a pantallas, a la ingestión de alimentos ultraprocesados, a la cantidad de cigarrillos y al consumo de bebidas alcohólicas. Se observaron diferencias según el sexo y el grupo de edad. Conclusión Los resultados indican un empeoramiento en el estilo de vida y un aumento de los comportamientos de riesgo para la salud. Objective To describe lifestyle changes with regard to consumption of tobacco and alcohol, food intake and physical activity, in the period of social restriction resulting from the COVID-19 pandemic. Methods This is a cross-sectional study conducted in Brazil with data from the ConVid online health behavior survey. The data were collected via an online questionnaire answered by the survey participants. Post-stratification procedures were used to calculate prevalence rates and 95% confidence intervals. Results 45,161 individuals aged 18 years or more participated. During the period of social restriction participants reported a decrease in practicing physical activity and an increase in time spent using computers or tablets or watching TV, intake of ultra-processed foods, number of cigarettes smoked and alcoholic beverage consumption. Differences were observed according to sex and age group. Conclusion The results indicate a worsening of lifestyles and an increase in health risk behaviors.