Overweight in Older Adults: A Follow-Up of Fifteen Years of the SABE Survey.

Despite extensive research on overweight and obesity, there are few studies that present longitudinal statistical analyses among non-institutionalized older adults, particularly in low- and middle-income countries. This study aimed to assess the prevalence and factors associated with excess weight in older adults from the same cohort over a period of fifteen years. A total of 264 subjects aged (≥60 years) from the SABE survey (Health, Wellbeing and Aging) in the years 2000, 2006, 2010, and 2015 in the city of São Paulo, Brazil, were evaluated. Overweight was assessed by a BMI of ≥28 kg/m2. Multinomial logistic regression models adjusted for sociodemographic and health data were used to assess factors associated with excess weight. After normal weight, overweight was the most prevalent nutritional status in all evaluated periods: 34.02% in 2000 (95%CI: 28.29-40.26); 34.86% in 2006 (95%CI: 28.77-41.49%); 41.38% in 2010 (95%CI: 35.25-47.79); 33.75% in 2015 (95%CI: 28.02-40.01). Being male was negatively associated with being overweight in all years (OR: 0.34 in 2000; OR: 0.36 in 2006; OR: 0.27 in 2010; and OR: 0.43 in 2015). A greater number of chronic diseases and worse functionality were the main factors associated with overweight, regardless of gender, age, marital status, education, physical activity, and alcohol or tobacco consumption. Older adults with overweight and obesity, a greater number of chronic diseases, and difficulties in carrying out daily tasks required a greater commitment to healthcare. Health services must be prepared to accommodate this rapidly growing population in low- and middle-income countries.

[Factors associated with undiagnosed hypertension among elderly adults in Brazil - ELSI-Brazil]. / Fatores associados à hipertensão não diagnosticada entre adultos mais velhos no Brasil - ELSI-Brasil.

This article aims to identify factors associated with undiagnosed systemic arterial hypertension (SAH) among elderly adults in Brazil. A total of 5,416 hypertensive participants in the Longitudinal Study of the Health of Elderly Brazilians (ELSI-BRAZIL) were evaluated. Undiagnosed SAH was identified by mean blood pressure (BP) ≥140/90 mmHg without previous SAH diagnosis. Logistic regression was used to verify factors associated with undiagnosed SAH. In this study, 19.8% of the hypertensive patients evaluated did not report a previous diagnosis of SAH. Age between 60 to 69 (OR: 0.68, 95%CI 0.55-0.85) and 70 to79 (OR: 0.67, 95%CI 0.51-0.89), being black (OR: 0.67, 95%CI 0.49-0.91), obese (OR: 0.51, 95%CI 0.40-0.65), having one chronic disease (OR: 0.54, 95%CI 0.44-0.66) or more (OR: 0.32, 95%CI 0.25-0.42) and medical consultations in the last year (OR: 0.47, 95%CI 0.38-0.58) were factors associated with lower chances of undiagnosed SAH, while being male (OR: 1.27, 95%CI 1,05-1,54), presenting low body weight (OR: 1.33, 95%CI 1,00-1,78) and alcohol consumption (OR: 1.36, 95%CI 1,09-1,68) increased the chances of having the undiagnosed condition. The characteristics identified in this study needs to be observed in health services, expanding early diagnosis and preventing the progression of BP and its future consequences.

O objetivo deste artigo é identificar fatores associados à hipertensão arterial sistêmica (HAS) não diagnosticada entre adultos mais velhos no Brasil. Foram avaliados 5.416 participantes hipertensos do Estudo Longitudinal da Saúde dos Idosos Brasileiros (ELSI-Brasil). HAS não diagnosticada foi definida como a presença de pressão arterial (PA) ≥140/90 mmHg sem diagnóstico prévio. Regressão logística foi utilizada para verificar fatores associados à HAS não diagnosticada. No estudo, 19,8% dos hipertensos avaliados não relataram diagnóstico prévio de HAS. Ter entre 60 e 69 anos (OR: 0,68, IC95% 0,55-0,85) e 70 e 79 (OR: 0,67, IC95% 0,51-0,89), cor preta (OR: 0,67, IC95% 0,49-0,91), ser obeso (OR: 0,51, IC95% 0,40-0,65), ter uma doença crônica (OR: 0,54, IC95% 0,44-0,66) ou mais (OR: 0,32, IC95% 0,25-0,42) e consultas no último ano (OR: 0,47, IC95% 0,38-0,58) foram fatores associados a menores chances de HAS não diagnosticada, enquanto sexo masculino (OR: 1,27, IC95% 1,05-1,54), baixo peso (OR: 1,33, IC95% 1,00-1,78) e consumo de álcool (OR: 1,36, IC95% 1,09-1,68) elevaram as chances para apresentar a doença não diagnosticada. As características identificadas nesse estudo devem ser observadas em serviços de saúde, ampliando o diagnóstico precoce e prevenindo a progressão da PA e suas futuras consequências.

Fatores associados à hipertensão não diagnosticada entre adultos mais velhos no Brasil - ELSI-Brasil / Factors associated with undiagnosed hypertension among elderly adults in Brazil - ELSI-Brazil

Resumo O objetivo deste artigo é identificar fatores associados à hipertensão arterial sistêmica (HAS) não diagnosticada entre adultos mais velhos no Brasil. Foram avaliados 5.416 participantes hipertensos do Estudo Longitudinal da Saúde dos Idosos Brasileiros (ELSI-Brasil). HAS não diagnosticada foi definida como a presença de pressão arterial (PA) ≥140/90 mmHg sem diagnóstico prévio. Regressão logística foi utilizada para verificar fatores associados à HAS não diagnosticada. No estudo, 19,8% dos hipertensos avaliados não relataram diagnóstico prévio de HAS. Ter entre 60 e 69 anos (OR: 0,68, IC95% 0,55-0,85) e 70 e 79 (OR: 0,67, IC95% 0,51-0,89), cor preta (OR: 0,67, IC95% 0,49-0,91), ser obeso (OR: 0,51, IC95% 0,40-0,65), ter uma doença crônica (OR: 0,54, IC95% 0,44-0,66) ou mais (OR: 0,32, IC95% 0,25-0,42) e consultas no último ano (OR: 0,47, IC95% 0,38-0,58) foram fatores associados a menores chances de HAS não diagnosticada, enquanto sexo masculino (OR: 1,27, IC95% 1,05-1,54), baixo peso (OR: 1,33, IC95% 1,00-1,78) e consumo de álcool (OR: 1,36, IC95% 1,09-1,68) elevaram as chances para apresentar a doença não diagnosticada. As características identificadas nesse estudo devem ser observadas em serviços de saúde, ampliando o diagnóstico precoce e prevenindo a progressão da PA e suas futuras consequências.

Abstract This article aims to identify factors associated with undiagnosed systemic arterial hypertension (SAH) among elderly adults in Brazil. A total of 5,416 hypertensive participants in the Longitudinal Study of the Health of Elderly Brazilians (ELSI-BRAZIL) were evaluated. Undiagnosed SAH was identified by mean blood pressure (BP) ≥140/90 mmHg without previous SAH diagnosis. Logistic regression was used to verify factors associated with undiagnosed SAH. In this study, 19.8% of the hypertensive patients evaluated did not report a previous diagnosis of SAH. Age between 60 to 69 (OR: 0.68, 95%CI 0.55-0.85) and 70 to79 (OR: 0.67, 95%CI 0.51-0.89), being black (OR: 0.67, 95%CI 0.49-0.91), obese (OR: 0.51, 95%CI 0.40-0.65), having one chronic disease (OR: 0.54, 95%CI 0.44-0.66) or more (OR: 0.32, 95%CI 0.25-0.42) and medical consultations in the last year (OR: 0.47, 95%CI 0.38-0.58) were factors associated with lower chances of undiagnosed SAH, while being male (OR: 1.27, 95%CI 1,05-1,54), presenting low body weight (OR: 1.33, 95%CI 1,00-1,78) and alcohol consumption (OR: 1.36, 95%CI 1,09-1,68) increased the chances of having the undiagnosed condition. The characteristics identified in this study needs to be observed in health services, expanding early diagnosis and preventing the progression of BP and its future consequences.

Incidência, fatores associados e desfechos relacionados à hipertensão arterial em idosos de São Paulo: Estudo SABE / Incidence, associated factors and outcomes related with arterial hypertension in older adults of São Paulo: SABE Survey

A hipertensão arterial (HA) é a doença mais prevalente na população e o planejamento do cuidado ao idoso hipertenso deve ser pensado de forma a evitar, retardar ou reduzir desfechos indesejáveis. Os objetivos deste trabalho foram: 1) Estimar a incidência de HA em idosos em 6 anos e seus fatores de risco; 2) Avaliar a associação entre diferentes níveis de HA e desfechos relacionados em idosos após 6 anos; 3) Avaliar a associação entre HA e a mortalidade em idosos entre 2000 e 2016. Este é um estudo longitudinal com dados do estudo SABE - Saúde, Bem-estar e Envelhecimento, que possui uma amostra probabilística representativa de idosos residentes na cidade de São Paulo. Para os objetivos 1 e 2 foram utilizados os dados coletados nas duas últimas ondas do estudo até o momento (2010 e 2016), e para o objetivo 3 foram utilizados os dados de todas as ondas do estudo (2000, 2006, 2010 e 2016). Modelos de regressão de Poisson foram utilizados para avaliar os fatores de risco para incidência de HA em 2016 e para a análise entre diferentes categorias de HA e ocorrência de desfechos em 2016. Para análise de associação entre HA e mortalidade foram utilizados modelos de regressão de Cox e Cox com variável tempo dependente. As análises estatísticas foram realizadas nos softwares estatísticos Stata versão 14.0 em modo survey e no R versão 4.1.1 utilizando o pacote survey. Toda a análise estatística foi realizada incorporando os pesos amostrais, para manter a representatividade da população na amostra estudada. Em 2010, 19,6% não tinham hipertensão, 33,8% apresentavam HA controlada, 38,7% apresentavam HA não controlada e 7,9% apresentavam HA resistente. A incidência acumulada de HA em 2016 foi de 36,1%. Foram fatores associados à incidência de HA: idade a partir de 75 anos, pré-hipertensão, hipercolesterolemia isolada, diabetes, consultas no último ano e doença coronariana em 2010. Incidência de baixa filtração glomerular (FG) foi o desfecho mais observado em 2016 entre os idosos hipertensos. Foi encontrada associação entre HA não controlada e incidência de sintomas depressivos (RR: 2,1 - IC995% 1,0-4,4) e entre HA resistente e a incidência de baixa FG (RR: 2,1 - IC95% 1,1-4,0 em comparação aos normotensos e RR: 1,8 - IC 95% 1,0-3,2 em comparação aos hipertensos controlados). Pressão de pulso (PP)≥66 mmHg foi associada a mortalidade por doenças coronarianas entre 2010 e 2016 (HR: 4,2 - IC95% 1,1-15,9). A mortalidade por doenças cerebrovasculares manteve-se associada de maneira significativa à presença de HA entre 2000 e 2016 (HR: 2,6 IC95% 1,3-5,5). Mais de um terço dos idosos sem hipertensão se tornou hipertenso em 6 anos, sendo essa progressão mais comum entre aqueles que já possuíam um pior estado geral de saúde. Ter HA, principalmente não controlada ou resistente, foi associado à incidência de piores desfechos de saúde ao longo do tempo. A avaliação da associação entre HA e seus desfechos fatais e não fatais em um estudo populacional evidencia a importância da prevenção e controle da HA e, consequentemente, a diminuição de suas diversas consequências.

Arterial hypertension (AH) is the most prevalent disease in the population and the planning of care to the hypertensive older adults should aim to avoid, delay or reduce health outcomes related to AH. The aims of this study were: 1) to estimate the incidence of AH in 6 years and its risk factors; 2) to evaluate the association between different levels of AH and health outcomes after 6 years; 3) to evaluate the association between AH and mortality in older adults between 2000 and 2016. This is a longitudinal study with data from the SABE Survey - Health, Well-being and Aging, witha probabilistic sample representative of the elderly residents in the city of São Paulo. For objectives 1 and 2 the data collected in the last two waves of the study were used (2010 and 2016), and for objective 3 data from all waves of the study were used (2000, 2006, 2010 and 2016). Poisson regression models were used to evaluate the risk factors for the incidence of AH in 2016 and to analyze the association between different categories of AH and occurrence of health outcomes in 2016. Cox regression models and cox regression models with time varying variables were used to analyze the association between AH and mortality. Statistical analyzes were performed using Stata version 14.0 and R Version 4.1.1 using the Survey package. All statistical analysis was performed incorporating sample weights to maintain the population's representativeness in the sample studied. In 2010, 19.6% of the older adults were normotensive, 33.8% had controlled AH, 38.7% had uncontrolled AH and 7.9% had resistant AH. The incidence of AH in 2016 was 36.1%. Age of 75 years and more, prehypertension, hypercholesterolemia, diabetes, consultations in the last year and coronary disease in 2010 were associated with the incidence of AH in 2016. The incidence of low glomerular filtration was the most observed health outcome in 2016 among hypertensive older adults. Association was found between uncontrolled AH and incidence of depressive symptoms (RR: 2,1 - CI95% 1.0-4.4) and between resistant AH and the incidence of low GF (RR: 2,1 - CI95% 1,1-4.0 compared to normotensive elderly and RR: 1.8 - CI 95% 1.0-3.2 compared to controlled hypertensive). Pulse pressure (PP)≥66 mmHg was associated with coronary disease mortality between 2010 and 2016 (HR: 4.2 - CI95% 1.1-15.9). Cerebrovascular disease mortality was significantly associated with the presence of AH between 2000 and 2016 (HR: 2.6 CI95% 1.3-5.5). More than one third of the older adults without hypertension became hypertensive in 6 years. This progression was more common among those who already had worse health conditions in 2010. Hypertension, especially uncontrolled or resistant, was associated with the incidence of worst health outcomes over time. The evaluation of the association between AH and its fatal and non-fatal outcomes in population studies highlights the importance of AH prevention and control and, consequently, the reduction of its various consequences.

Health conditions and weight change among the older adults over ten years of the SABE Survey. / Condições de saúde e mudança de peso de idosos em dez anos do Estudo SABE.

OBJECTIVE: To analyze the relationship between health conditions and weight changes among elderly people monitored by the SABE Survey over a ten-year period in São Paulo/SP. METHODS: This was a longitudinal study that followed (2000-baseline, 2006 and 2010) change in body weight (outcome variable) and associated health conditions (exposure variables) in the elderly (n=571); multinomial logistic regression analyses were employed. RESULTS: Average weight increase in the evaluated period was 29.0%. 34.0% (2006) and 12.5% (2010) lost weight and 18.2% (2006) and 39.9% (2010) gained weight. Prevalence of chronic diseases increased from 34.1% (2000) to 51.9% (2006) and 60.1% (2010). Older people with weight gain also rated their overall health as poorer in 2006 (RR:3.15; 95%CI 1.21;8.17) and 2010 (RR:2.46; 95%CI 1.02;5.94). The higher numbers of diseases (RR:2.12; 95%CI 1.00;4.46) and hospitalizations (RR:3.50; 95%CI 1.40;8.72) were associated with a decrease in weight in 2010. CONCLUSION: Weight changes are related to poorer health status among the elderly.

Health conditions and change weight of older adults in ten years of the SABE Survey / Condiciones de salud y cambio de peso de personas mayores en diez años del Estudio SABE / Condições de saúde e mudança de peso de idosos em dez anos do Estudo SABE

Objective. To analyze the relationship between health conditions and weight changes among the elderly, SABE Survey, over a period of ten years. Methods. Longitudinal study that followed (2000-baseline, 2006 and 2010) the change in body weight (outcome variable) and associated health conditions (exposure variables) in the elderly (n=571); multinomial logistic regression analyzes were employed. Results. The average weight increase in the evaluated period was 29.0%. 34.0% (2006) and 12.5% (2010) lost weight and 18.2% (2006) and 39.9% (2010) gained weight. The prevalence of chronic diseases increased from 34.1% (2000) to 51.9% (2006) and 60.1% (2010). Older people with weight gain also rated their overall health worse in 2006 (RR:3.15; 95%CI 1.21;8.17) and 2010 (RR:2.46; 95%CI 1.02;5.94). The highest number of diseases (RR:2.12; 95%CI 1.00;4.46) and hospitalizations (RR:3.50; 95%CI 1.40;8.72) were associated with a decrease in weight in 2010. Conclusion. Weight changes are related to worse health status among the elderly.

Objetivo. Analisar a relação das condições de saúde com a mudança de peso entre idosos, do Estudo SABE, em um período de dez anos. Métodos. Estudo longitudinal que acompanhou (2000-baseline, 2006 e 2010) a mudança do peso corporal (variável desfecho) e condições de saúde associadas (variáveis de exposição) em idosos (n=571); análises de regressão logística multinomial foram empregadas. Resultados. O aumento médio de peso no período foi de 29,0%. Perderam peso 34,0% (2006) e 12,5% (2010); e ganharam peso 18,2% (2006) e 39,9% (2010). A prevalência de doenças crônicas aumentou de 34,1% (2000) para 51,9% (2006) e 60,1% (2010). Idosos com aumento de peso avaliaram pior sua saúde geral em 2006 (RR:3,15; IC95%1,21;8,17) e 2010 (RR:2,46; IC95%1,02;5,94). Maior número de doenças (RR:2,12; IC95%1,00;4,46) e internações (RR:3,50; IC95%1,40;8,72) associaram-se a diminuição de peso em 2010. Conclusão. Mudanças de peso estão relacionadas a um pior estado de saúde entre idosos.

Condições de saúde e mudança de peso de idosos em dez anos do Estudo SABE / Condiciones de salud y cambio de peso de personas mayores en diez años del Estudio SABE / Health conditions and weight change among the older adults over ten years of the SABE Survey

Objetivo: Analisar a relação das condições de saúde com a mudança de peso entre idosos em um período de dez anos em São Paulo/SP. Métodos: Estudo longitudinal que acompanhou (2000-baseline, 2006 e 2010) a mudança do peso corporal (variável desfecho) e condições de saúde associadas (variáveis de exposição) em idosos (n=571); análises de regressão logística multinomial foram empregadas. Resultados: O aumento médio de peso no período foi de 29,0%. Perderam peso 34,0% (2006) e 12,5% (2010); e ganharam peso 18,2% (2006) e 39,9% (2010). A prevalência de doenças crônicas aumentou de 34,1% (2000) para 51,9% (2006) e 60,1% (2010). Idosos com aumento de peso avaliaram pior sua saúde geral em 2006 (RR:3,15; IC95% 1,21;8,17) e 2010 (RR:2,46; IC95% 1,02;5,94). Maior número de doenças (RR:2,12; IC95% 1,00;4,46) e internações (RR:3,50; IC95% 1,40;8,72) associaram-se a diminuição de peso em 2010. Conclusão: Mudanças de peso estão relacionadas a um pior estado de saúde entre idosos.

Objetivo: Analizar la relación entre las condiciones de salud y el cambio de peso entre adultos mayores durante un período de diez años en São Paulo/SP. Métodos: Estudio longitudinal (2000-baseline, 2006 y 2010) que siguió el cambio en el peso corporal (variable de resultado) y las condiciones de salud asociadas (variables de exposición) en adultos mayores (n=571); se emplearon análisis de regresión logística multinomial. Resultado: El aumento de peso promedio en el período evaluado fue del 29,0%. Un 34,0% (2006) y 12,5% (2010) perdieron peso; 18,2% (2006) y 39,9% (2010) ganaron peso. La prevalencia de enfermedades crónicas aumentó del 34,1% (2000) para 51,9% (2006) y 60,1% (2010). Las personas mayores con aumento de peso calificaron su salud general peor en 2006 (RR:3,15; IC95% 1,21;8,17) y 2010 (RR:2,46; IC95% 1,02;5,94). El mayor número de enfermedades (RR:2,12; IC95% 1,00;4,46) y hospitalizaciones (RR:3.50; IC95% 1,40;8,72) se asociaron con una disminución del peso en 2010. Conclusión: Los cambios de peso están relacionados con un peor estado de salud entre los adultos mayores.

Objective: To analyze the relationship between health conditions and weight changes among elderly people monitored by the SABE Survey over a ten-year period in São Paulo/SP. Methods: This was a longitudinal study that followed (2000-baseline, 2006 and 2010) change in body weight (outcome variable) and associated health conditions (exposure variables) in the elderly (n=571); multinomial logistic regression analyses were employed. Results: Average weight increase in the evaluated period was 29.0%. 34.0% (2006) and 12.5% (2010) lost weight and 18.2% (2006) and 39.9% (2010) gained weight. Prevalence of chronic diseases increased from 34.1% (2000) to 51.9% (2006) and 60.1% (2010). Older people with weight gain also rated their overall health as poorer in 2006 (RR:3.15; 95%CI 1.21;8.17) and 2010 (RR:2.46; 95%CI 1.02;5.94). The higher numbers of diseases (RR:2.12; 95%CI 1.00;4.46) and hospitalizations (RR:3.50; 95%CI 1.40;8.72) were associated with a decrease in weight in 2010. Conclusion: Weight changes are related to poorer health status among the elderly.

Prevalence of Systemic Arterial Hypertension Diagnosed, Undiagnosed, and Uncontrolled in Elderly Population: SABE Study.

Systemic arterial hypertension is the most prevalent chronic noncommunicable disease among older people. This study aimed to estimate the prevalence of hypertension in the elderly and to analyze factors associated with diagnosed, undiagnosed, and uncontrolled hypertension. This is a cross-sectional study of data from the SABE study-Health, Well-Being, and Aging Survey-a multiple-cohort study, obtained in 2010, composed of a probabilistic sample representative of the population of the São Paulo city aged ≥60 years. Hypertension was self-reported or defined by increased blood pressure. Multinomial regression assessed factors associated with diagnosis and lack of diagnosis of hypertension (reference: no hypertension), and logistic regression assessed factors associated with uncontrolled hypertension (reference: controlled). The prevalence of hypertension was 79.5%, and in 51% of individuals with the condition, hypertension was uncontrolled. Undiagnosed hypertension was associated with nonwhite skin color (OR: 1.89, CI: 1.11-3.19), being uninsured (OR: 1.77, CI: 1.04-3.03), overweight (OR: 2.38, CI: 1.09-5.19), higher education (OR: 0.46, CI: 0.22-1.94), and ≥1 chronic disease (OR: 0.28; CI: 0.13-0.58). Diagnosed hypertension was associated with age between 70 and 79 years (OR: 2.02, CI: 1.34-3.05), age ≥80 (OR: 2.73, CI: 1.72-4.31), nonwhite skin color (OR: 1.48, CI: 1.01-2.18), being uninsured (OR: 1.70, CI: 1.18-2.47), at least one medical consultation in the last year (OR: 1.86, CI: 1.06-3.25), obesity (OR: 2.50, CI: 1.61-3.88), and ≥1 chronic disease (OR: 2.81, CI: 1.94-4.08). Among those with hypertension, being uncontrolled was associated with widowhood (OR: 1.73, CI: 1.23-2.43), being uninsured (OR: 1.38, CI: 1.02-1.87), and female gender (OR: 0.61, CI: 0.43-0.87). The prevalence of hypertension was high in this population, and its diagnosis and control were associated with socioeconomic, demographic, and healthcare access factors.

Adherence, Adhesion, and Dropout Reasons of a Physical Activity Program in a High Social Vulnerability Context.

BACKGROUND: One of the most important health determinants is social vulnerability, which can interfere in the practice of physical activity (PA). This study aimed at analyzing adherence to a PA program in a high social vulnerability context. METHODS: A longitudinal study with a 6-month intervention period was conducted. The program offered monitored walks associated with behavioral change educational campaigns. Sociodemographic characteristics, occupation, PA level, noncommunicable chronic diseases, participants' frequency of participation in the program, and intervention dropout reasons were evaluated. Descriptive and survival analyses were accomplished. RESULTS: Among the 106 participants, 88.0% were female and 21.7% were older adults. The most mentioned participation reasons were health improvement (23.0%), weight loss (19.0%), disease control (17.0%), and social living (12%). The mean frequency of participation in the program was 27.4%. Dropout rate was 52.7%. The main reported reasons for dropping out were work hours (27.8%), health problems (25.9%), personal reasons (22.2%), and lack of time (11.1%). Factors associated with remaining in the program were being older adults and presenting body mass index <25 kg/m2. CONCLUSIONS: Results showed that in a high social vulnerability context, adherence to PA programs is low, and adult-life-related commitments and high levels of obesity are factors associated with lower adherence.

Hipertensão arterial sistêmica em idosos de São Paulo e fatores associados ao diagnóstico, não diagnóstico e controle: Estudo SABE / Systemic arterial hypertension in elderly of São Paulo and associated fators of diagnostic, nondiagnostic and control the SABE study

Introdução: A hipertensão arterial sistêmica (HAS), destaca-se entre as doenças crônicas não transmissíveis (DCNT) por ser a mais prevalente entre idosos. Objetivos: Estimar a prevalência de pré-hipertensão, HAS não diagnosticada, controlada e não controlada de idosos na cidade de São Paulo; descrever suas condições de vida e saúde; motivos de não realização de tratamento, verificar a associação entre tipos de tratamento e controle; analisar fatores associados ao diagnóstico e controle da HAS. Métodos: Estudo transversal de base populacional utilizando dados do Estudo SABE Saúde, Bem Estar e Envelhecimento, coletados em 2010. Foram avaliados 1233 idosos, classificados em cinco grupos de acordo com a medida de pressão arterial e realização ou não de tratamento: 1) normotensos, 2) pré-hipertensos, 3) hipertensos sem diagnóstico, 4) controlados e 5) não controlados. Foram realizadas análises descritivas por meio de proporções e médias ponderadas, e regressão logística para avaliar os fatores associados à presença de hipertensão não diagnosticada, diagnosticada, e não controlada. As análises foram realizadas no software estatístico Stata 13.0 em modo survey. Resultados: Na população de idosos da cidade de São Paulo, a prevalência de hipertensão foi de 79,4 por cento (sendo 43,2 por cento hipertensos controlados e 56,7 por cento não controlados). 11,4 por cento dos hipertensos não referiram ter a doença no momento da avaliação. A prevalência de pré-hipertensão foi de 12 por cento. Idosos de até 69 anos foram observados com mais frequência entre os normotensos e pré-hipertensos, enquanto os mais velhos foram frequentemente observados entre os hipertensos com diagnóstico. As mulheres apresentaram maiores frequências de hipertensão controlada, enquanto os homens apresentaram maiores frequências de não diagnóstico e não controle. Os fatores associados a hipertensão não controlada foram: sexo feminino (OR:0,67; IC:0,46;0,97), utilizar o SUS (OR:1,37; IC:0,99;1,89) e ser viúvo (OR:1,74; 1,20;2,52) e consultas no último ano (OR:0,52; IC:0,28;0,94). Os fatores associados a hipertensão não diagnosticada foram: ser moreno, mulato e pardo (OR:2,21; IC:1,21; 3,96), consultas no último ano (OR: 0,52; IC:0,27;0,99), ser ex-fumante (OR: 2,34; IC:1,28; 4,26), ter sobrepeso (OR: 2,45; IC:1,09;5,51), ser usuário do SUS (OR:1,75; IC:1,01; 3,03), e ter pelo menos uma DCNT (OR: 0,28; IC:0,13;0,59). Foram associados com a HAS diagnosticada: faixa etária (OR: 2,03; IC:1,34;3,08 para pessoas de 70 a 79 anos e OR: 2,59; IC: 1,61;4,17 para pessoas de 80 anos ou mais), utilizar o SUS (OR: 1,67; IC:1,15;2,43), consultas no último ano (OR: 1,78; IC:1,62;3,13), ser ex-fumante (OR: 1,79; IC:1,17;2,76), ser obeso (OR: 2,49; IC:1,61;3,86) e ter pelo menos uma DCNT (OR: 2,70; IC:1,85;3,94). Conclusão: Os resultados obtidos fornecem informações representativas sobre as condições de vida e saúde dos idosos da cidade. A prevalência da doença nos idosos de São Paulo foi mais alta que em outras partes do país, e uma parte da população idosa com pressão arterial elevada não possui diagnóstico médico de HAS. Idosos com excesso de peso e outras doenças crônicas frequentam mais serviços de saúde e apresentam maiores chances de ter a doença diagnosticada, enquanto homens entre 60 e 69 anos são observados com mais frequência entre os não diagnosticados. Usuários do SUS e viúvos apresentaram chances elevadas para a doença não controlada

Background: Systemic arterial hypertension (SAH) stands out among chronic noncommunicable diseases (CNCD) for being the most prevalent among the elderly population. Objectives: To estimate the prevalence of prehypertension, undiagnosed, controlled and uncontrolled SAH in the elderly living in São Paulo; to describe their life and health conditions; to describe the reasons for not having treatment, to evaluate the association between types of treatment and control; to analyze the associated factors with diagnosis and control of SAH. Methods: A cross-sectional, population-based study using data from the SABE Study - Health, Well-Being and Aging, collected in 2010. A total of 1233 elderly subjects were classified into five groups according to blood pressure measurement and treatment or non-treatment: 1) normotensive, 2) prehypertensive, 3) hypertensive without previous diagnosis, 4) controlled hypertension and 5) uncontrolled hypertension. Descriptive analyzes were performed by means of weighted proportions, and logistic regressions were performed to evaluate the factors associated with the presence of undiagnosed, diagnosed, and uncontrolled hypertension. All analyzes were performed in statistical software Stata 13.0 in survey mode. Results: In the elderly population of São Paulo, the prevalence of hypertension was 79.4 per cent (43.2 per cent were controlled and 56.7 per cent were uncontrolled). 11.4 per cent of the hypertensive elderly did not report having the disease at the time of the evaluation. In addition, the prevalence of prehypertension was 12 per cent. Elderly patients up to age 69 were observed more frequently among normotensive and prehypertensive subjects, while older subjects were frequently observed among hypertensive with diagnosis. Women had higher frequencies of controlled hypertension, while the men presented higher frequencies of non-diagnosis and non-control. The factors associated with uncontrolled hypertension were: being female (OR:0,67; CI:0,46;0,97), being uninsured (OR: 1,37; CI:0,99;1,89), widowhood (OR:1,74; CI:1,20;2,52) and medical consultations in the last year (OR:0,52; CI:0,28;0,94). The factors associated with undiagnosed hypertension were: being brown or mulatto (OR: 2,21; CI:1,23;3,96), medical consultation in the last year (OR: 0,52; CI:0,27;0,99), being a former -smoker (OR: 2,34; CI:1,28;4,26), being overweight (OR: 2,45; CI:1,09;5,51), uninsured (OR:1,75; CI:1,01;3,03) and having at least one CNCD (OR: 0,28; CI:013;0,59). Age (OR: 2,03; CI:1,34;3,08 for people aged 70 to 79 years and OR: 2,59; CI:1,61;3,86 for people aged 80 years or over), being uninsured (OR: 1,67; CI:1,15;2,43), (OR: 1,78; CI:1,62;3,13), former smoker (OR: 1,79; CI:1,17; 2,76), being obese (OR: 2,49; CI:1,61;3,86) and having at least one CNCD (OR: 2,70; CI:1,85;3,94). Conclusion: The results provide representative information on the life and health conditions of the elderly in the city of Sao Paulo. The prevalence of the disease in the elderly of São Paulo was higher than in other parts of the country, and a portion of this population had high blood pressure without medical diagnosis of SAH. People with chronic diseases and overweight are more likely to be diagnosed due the frequency of medical services, while men between the ages of 60 and 69 are more likely to be undiagnosed. Uninsured elderlies and widows presented higher odds for the uncontrolled disease

Evaluating the impact of a walking program in a disadvantaged area: using the RE-AIM framework by mixed methods.

BACKGROUND: The positive health impact of physical activity (PA) is well known, yet a large proportion of the world's population remains sedentary. General PA programs are common as health promotion initiatives. However, effectiveness evaluations of such PA programs on individual and organizational aspects, which could inform the decision-making process of public health bodies are still lacking, particularly in the most socially disadvantaged areas, where health promotion schemes are particularly needed. The aim of this study was to assess the effectiveness of a Guided Walking Program in a high social vulnerability context. METHODS: A quasi-experimental, mixed methods study was conducted. The program had a duration of 6 months and a 6-month follow-up period after the intervention. Session frequency was five times a week, where sessions consisted of supervised PA combined with educational sessions. The Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework was followed to assess the program. The International Physical Activity Questionnaire (IPAQ) and accelerometers were used to measure levels of PA. Focus groups were conducted to gain a comprehensive insight on the implementation domain. RESULTS: Most subjects in the intervention (IG) (n = 74) and control (CG) (n = 74) groups were female (IG:90.5%; CG:95.9%), aged 18-49 years (IG:44.6%; CG:43.2%), received less than 1 minimum wage (IG:74.3%; CG:83.7%) and had 0-4 years of formal education (IG:52.1%; CG:46.1%). The reach of the intervention was 0.3%. The IG showed increased levels of PA at post-intervention and 6-month follow-up. However, the difference between groups was not statistically significant. Adoption data revealed that 89.5% of the professionals in the Primary Health Care Center (health center) team perceived the benefits of the program for the population. The program was independently promoted by the health center team for a further 4 months post-intervention. The qualitative data revealed that the program was discontinued due to participants' low adherence and human resource limitations in the unit's operational dynamics. CONCLUSIONS: A health promotion intervention in a socially deprived setting faces challenges but can be effective and feasible to implement. The present study informs the development of future health promotion initiatives in this context. TRIAL REGISTRATION: NCT02857127 . Registered: 30 July 2016 (retrospectively registered).

Programa de caminhada em Unidades de Saúde da Família em um contexto de alta vulnerabilidade social / Walking program in Family Health Units from high level of poverty context

O programa Caminhada Orientada em Unidades de Saúde da Família (USF) ocorre em quatro USFs em um contexto de alta vulnerabilidade social do município de São Carlos, SP, em parceria com a Universidade Federal de São Carlos (UFSCar). O programa visa a promoção de saúde através da prática de exercícios físicos em conjunto com ações educativas de promoção de saúde. A equipe de trabalho é formada por profissionais das USFs, bem como docentes, graduandos e egressos dos cursos de Gerontologia e Educação Física. Resultados gerais mostram que houve um aumento de 87,6 (±10,1) para 204,1 (±23,7) minutos semanais nos domínios de deslocamento e lazer somados. Além disso, 78,5% da equipe de profissionais das USFs relataram se sentir envolvido na aplicação da intervenção. Programas desse modelo podem ser aplicados na Atenção Básica (AB) de Saúde, de modo a garantir a equidade das ações do Sistema Único de Saúde.

The Walking program in Family Health Units (USF) occurs in four Units Health in a context of high social vulnerability of São Carlos, SP, in partnership with the Federal University of São Carlos. The program is aimed at health promotion through physical exercise added with educational activities for health promotion. The team consists of professionals from USF, teachers, undergraduates and graduates of Gerontology and Physical Education. Overall results show that there was an increase of 87.6 (±10.1) to 204.1 (±23.7) minutes per week in transportation and leisure time combined. In addition, 78.5 % of health professional reported feeling involved in applying the intervention. Programs of this model can be applied in the Primary Health Care to ensure the fairness of the actions of the National Health System.