Padrão de Atividade Física "Guerreiros de Fim de Semana": Risco ou Benefício para a Saúde? / "Weekend Warriors" Physical Activity Pattern: Health Risk or Benefit?

A vida frenética, principalmente nos grandes centros urbanos, dificulta, para algumas pessoas, a realização de atividade física de forma regular (3-5 vezes por semana). Todavia, a possibilidade de realizar essas atividades em um ou dois dias da semana pode ser uma alternativa bastante interessante, uma vez que este padrão de atividade física tem sido associado a menor mortalidade por todas as causas, cardiovasculares e câncer. Nesta breve revisão narrativa, abordaremos os principais estudos científicos sobre os "Guerreiros de Fim de Semana" e sua relação com os benefícios e riscos à saúde. Certamente, a incorporação desse padrão de atividade física nas recomendações e orientações futuras promoverá melhora das condições de saúde e auxiliará o poder público a adequar as estratégias de combate ao sedentarismo.

Leisure time physical activity among older adults in Brazil: a time series analysis of a population-based survey (2009-2020).

The practice of leisure time physical activity brings several health benefits, such as the prevention of noncommunicable diseases. Investigating the temporal trend of physical activity practice in older adults by sociodemographic characteristics and geographical regions could be important to plan public health policies and effective interventions. This is a time series study that analyzes the temporal trend of leisure time physical activity among Brazilian older adults with data from 2009 to 2020. For this, we used a sample of 186,097 older adults (≥ 60 years old) obtained from the Risk and Protective Factors Surveillance System for Chronic Noncomunicable Diseases Through Telephone Interview (Vigitel) (2009-2020). Information on leisure time physical activity and sociodemographic and health characteristics were collected. Prais-Winsten regression was used to identify significant trends in the annual variation of the leisure time physical activity indicators. Practice of ≥ 150 minutes/week of moderate intensity leisure time physical activity varied from 23.3% to 27.5% (0.41p.p./year) (2009-2020), with a higher increase during 2015-2020 (0.59p.p./year). The increase in the most recent period occurred among men, aged from 60 to 69 years, with lower educational level, residing in the Northeast Region, and without self-reported chronic diseases. These results may contribute to the evaluation of Brazilian health policies targeting the leisure time physical activity practice in older adults.

Panorama of Intimate Partner Violence Against Women in Brazil and its Association With Self-Perception of Health: Findings From a National Representative Survey.

Intimate partner violence (IPV) is a challenge in Brazil. The country holds one of the highest rates of femicide in the world, most of which are preceded by IPV. We conducted a cross-sectional study with 34,334 women, aged 18 to 59 years, from the 2019 Brazilian National Health Survey to analyze the prevalence of IPV and its subtypes among the Brazilian adult women in the last 12 months, encompassing their health consequences and the use of health services resulting from IPV. We also used logistic regression models to estimate the association of sociodemographic characteristics and self-perceived health status with IPV. The prevalence of IPV among Brazilian adult women in the last 12 months was 7.6% (95% confidence interval [CI] [7.0, 8.2]). Women aged 18 to 39 years, not married, and with income of up to 1 minimum wage (MW), had higher odds of suffering IPV. Among those who reported health consequences due to IPV, 69% reported psychological consequences, and 13.9% sought health care, mostly in primary or secondary health care services in the Brazilian Unified Health System (41.9%). Regarding the self-perceived health variables, women who reported eating problems (odds ratio [OR] = 1.29; [1.01, 1.65]), lack of interest/absence of pleasure (OR = 1.41; [1.11, 1.79]), depressive feelings (OR = 1.39; [1.03, 1.88]), feeling of failure (OR = 1.75; [1.36, 2.24]), and suicidal thoughts (OR = 1.73; [1.25, 2.41]) had greater odds of reporting IPV compared to those who did not report these same perceptions. The results show that younger, divorced or single, low-income women with eating problems and mental health disorders were more likely to suffer IPV. IPV often led to health problems, and many abused women sought support from public health services. Health professionals must be trained to identify and care for these women, thereby acting as allies in preventing and reducing IPV.

Leisure time physical activity among older adults in Brazil: a time series analysis of a population-based survey (2009-2020) / Atividade física no lazer entre idosos no Brasil: análise de séries temporais de um inquérito de base populacional (2009-2020) / Actividad física por ocio entre adultos mayores en Brasil: análisis de series temporales de una encuesta basada en la población (2009-2020)

The practice of leisure time physical activity brings several health benefits, such as the prevention of noncommunicable diseases. Investigating the temporal trend of physical activity practice in older adults by sociodemographic characteristics and geographical regions could be important to plan public health policies and effective interventions. This is a time series study that analyzes the temporal trend of leisure time physical activity among Brazilian older adults with data from 2009 to 2020. For this, we used a sample of 186,097 older adults (≥ 60 years old) obtained from the Risk and Protective Factors Surveillance System for Chronic Noncomunicable Diseases Through Telephone Interview (Vigitel) (2009-2020). Information on leisure time physical activity and sociodemographic and health characteristics were collected. Prais-Winsten regression was used to identify significant trends in the annual variation of the leisure time physical activity indicators. Practice of ≥ 150 minutes/week of moderate intensity leisure time physical activity varied from 23.3% to 27.5% (0.41p.p./year) (2009-2020), with a higher increase during 2015-2020 (0.59p.p./year). The increase in the most recent period occurred among men, aged from 60 to 69 years, with lower educational level, residing in the Northeast Region, and without self-reported chronic diseases. These results may contribute to the evaluation of Brazilian health policies targeting the leisure time physical activity practice in older adults.

A prática de atividade física no lazer traz diversos benefícios à saúde, como a prevenção de doenças não transmissíveis. Investigar a tendência temporal da prática de atividade física em idosos de acordo com características sociodemográficas e regiões geográficas pode ser importante para formular políticas públicas de saúde e intervenções efetivas. Este é um estudo de série temporal para analisar a tendência temporal de idosos brasileiros à prática de atividade física no lazer entre 2009 e 2020. Uma amostra de 186.097 idosos (≥ 60 anos) foi obtida do Sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (Vigitel) (2009-2020). Foram coletadas informações sobre prática de atividade física no lazer e características sociodemográficas e de saúde. A regressão de Prais-Winsten foi utilizada para identificar tendências significativas na variação anual dos indicadores de prática de atividade física no lazer. A prática de atividades físicas moderadas por ≥ 150 minutos/semana variou de 23,3% a 27,5% (0,41p.p./ano) (2009-2020) com maior aumento em 2015-2020 (0,59p.p./ano). O aumento mais recente ocorreu entre homens, indivíduos entre 60 e 69 anos de idade, aqueles com menor escolaridade, residentes na Região Nordeste e sem doença crônica autorreferida. Esses resultados podem contribuir para a avaliação das políticas de saúde brasileiras voltadas à prática de atividade física no lazer em idosos.

La práctica de actividad física por ocio trae diversos beneficios a la salud, como la prevención de enfermedades no transmisibles. Investigar la tendencia temporal de la práctica de actividad física en adultos mayores según las características sociodemográficas y las regiones geográficas puede ser importante para formular políticas de salud pública e intervenciones efectivas. Este es un estudio de serie temporal para analizar la tendencia temporal de adultos mayores brasileños a la práctica de actividad física por ocio entre 2009 y 2020. Se obtuvo una muestra de 186,097 adultos mayores (≥ 60 años) del Vigilancia de Factores de Riesgo y Protección para Enfermedades Crónicas No Transmisibles por Entrevista Telefónica (Vigitel) (2009-2020). Se recopiló información sobre práctica de actividad física por ocio y las características sociodemográficas y de salud. Se utilizó la regresión de Prais-Winsten para identificar tendencias significativas en la variación anual de los indicadores de práctica de actividad física por ocio. La práctica de actividades físicas moderada por ≥ 150 minutos/semana varió de 23,3% a 27,5% (0,41p.p./año) (2009-2020) con el mayor aumento en 2015-2020 (0,59p.p./año). El aumento más reciente ocurrió entre hombres, las personas entre 60 y 69 años de edad, aquellos con menor educación, residentes en la Región Nordeste y sin enfermedad crónica autoinformada. Estos resultados pueden contribuir a la evaluación de las políticas de salud brasileñas dirigidas a la práctica de actividad física por ocio en adultos mayores.

Consumption of Fish and ω-3 Fatty Acids and Cancer Risk: An Umbrella Review of Meta-Analyses of Observational Studies.

Multiple studies have suggested that ω-3 fatty acid intake may have a protective effect on cancer risk; however, its true association with cancer risk remains controversial. We performed an umbrella review of meta-analyses to summarize and evaluate the evidence for the association between ω-3 fatty acid intake and cancer outcomes. We searched PubMed, Embase, and the Cochrane Database of Systematic Reviews from inception to December 1, 2018. We included meta-analyses of observational studies that examined associations between intake of fish or ω-3 fatty acid and cancer risk (gastrointestinal, liver, breast, gynecologic, prostate, brain, lung, and skin) and determined the level of evidence of associations. In addition, we appraised the quality of the evidence of significant meta-analyses by using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. We initially screened 598 articles, and 15 articles, including 57 meta-analyses, were eligible. Among 57 meta-analyses, 15 reported statistically significant results. We found that 12 meta-analyses showed weak evidence of an association between ω-3 fatty acid intake and risk of the following types of cancer: liver cancer (n = 4 of 6), breast cancer (n = 3 of 14), prostate cancer (n = 3 of 11), and brain tumor (n = 2 of 2). In the other 3 meta-analyses, studies of endometrial cancer and skin cancer, there were no assessable data for determining the evidence levels. No meta-analysis showed convincing, highly suggestive, or suggestive evidence of an association. In the sensitivity analysis of meta-analyses by study design, we found weak associations between ω-3 fatty acid intake and breast cancer risk in cohort studies, but no statistically significant association in case-control studies. However, the opposite results were found in case of brain tumor risk. Although ω-3 fatty acids have been studied in several meta-analyses with regard to a wide range of cancer outcomes, only weak associations were identified in some cancer types, with several limitations. Considering the nonsignificant or weak evidence level, clinicians and researchers should cautiously interpret reported associations between ω-3 fatty acid consumption and cancer risks.

Hyperprogressive Disease during Anti-PD-1 (PDCD1) / PD-L1 (CD274) Therapy: A Systematic Review and Meta-Analysis.

Hyperprogressive disease (HPD) is a recently acknowledged pattern of rapid tumor progression after the initiation of immune checkpoint inhibitors. HPD has been observed across various types of tumors and has been associated with poor survival. We performed a meta-analysis to identify baseline (i.e., prior to programmed cell death 1 [PD-1, PDCD1] / programmed cell death 1 ligand 1 [PD-L1, CD274] inhibitor therapy) patient factors associated with risks of developing HPD during PD-1/PD-L1 inhibitor therapy. We searched eight databases until 6 June 2019. We calculated the summary odds ratio (OR) and its 95% confidence interval (CI) using the random-effects model and explored between-study heterogeneity and small-study effects. A total of nine articles was eligible (217 HPD cases, 1519 cancer patients) for meta-analysis. There was no standard definition of HPD, and the incidence of HPD ranged from 1 to 30%. We identified twenty-three baseline patient factors, of which five factors were statistically significantly associated with HPD. These were serum lactate dehydrogenase (LDH) above the upper normal limit (OR = 1.89, 95% CI = 1.02-3.49, p = 0.043), more than two metastatic sites (OR = 1.86, 1.34-2.57, p < 0.001), liver metastases (OR = 3.33, 2.07-5.34, p < 0.001), Royal Marsden Hospital prognostic score of 2 or above (OR = 3.33, 1.96-5.66, p < 0.001), and positive PD-L1 expression status that was inversely correlated with HPD (OR = 0.60, 0.36-0.99, p = 0.044). Between-study heterogeneity was low. Evidence of small-study effect was found in one association (PD-L1 expression). Subset analyses of patients with non-small cell lung cancer showed similar results. Future studies are warranted to identify underlying molecular mechanisms and to test their roles as predictive biomarkers of HPD.

Physical activity during adolescence and risk of colorectal adenoma later in life: results from the Nurses' Health Study II.

BACKGROUND: Physical activity during adulthood has been consistently associated with lower risk of colorectal cancers, but whether physical activity during adolescence may also play a role in colorectal carcinogenesis is unclear. METHODS: We included 28,250 women in the Nurses' Health Study II who provided data on physical activity during adolescence (ages 12-22 years) in 1997 and underwent lower bowel endoscopy (1998-2011). We used logistic regression models for clustered data to examine the association between physical activity during adolescence and risk of adenoma later in life. RESULTS: Physical activity during adolescence was inversely associated with risk of colorectal adenoma (2373 cases), independent of physical activity during adulthood. The multivariable-adjusted odds ratio (OR) of adenoma was 0.89 (95% CI 0.77-1.02; Ptrend = 0.03) comparing women with ≥ 72 metabolic equivalent of tasks-hours/week (MET-h/week) to < 21 MET-h/week. Women with high physical activity during both adolescence (≥53.3 MET-h/week) and adulthood (≥23.1 MET-h/week) had significantly lower risk of adenoma (all adenomas: OR 0.76; 95% CI 0.66-0.88; advanced adenoma: OR 0.61; 95% CI 0.45-0.82) compared to women with low physical activity during both stages of life. CONCLUSIONS: Our findings suggest that physical activity during adolescence may lower the risk of colorectal adenoma later in life.

Mortality on the first day of life: trends, causes of death and avoidability in eight Brazilian Federative Units, between 2010 and 2015. / Mortalidade no primeiro dia de vida: tendências, causas de óbito e evitabilidade em oito Unidades da Federação brasileira, entre 2010 e 2015.

OBJECTIVE: to calculate mortality rates on the first day of life from 2010 to 2015 in eight Brazilian Federative Units providing better quality information, to assess associated factors and to classify deaths by underlying causes and avoidability. METHODS: this was a descriptive study; mortality rates were compared according to maternal and child characteristics; avoidability analysis used the 'Brazilian list of avoidable causes of death'. RESULTS: 21.6% (n=20,791) of all infant deaths occurred on the first day of life; the mortality rate reduced from 2.7 to 2.3 deaths/1,000 live births; rates were higher in live births with low birthweight and preterm births, and among babies born to mothers with no schooling; main causes of death were respiratory distress syndrome (8.9%) and extreme immaturity (5.2%); 66.3% of causes of death were avoidable. CONCLUSION: 2/3 of deaths on the first day of life could have been avoided with adequate care for women during pregnancy and delivery and adequate care for live births.

Proportion of cancer cases and deaths attributable to lifestyle risk factors in Brazil.

BACKGROUND: Lifestyle risk factors (tobacco smoking, alcohol consumption, overweight and obesity, unhealthy diet, and lack of physical activity) have been associated with increased risk of at least 20 types of cancer. We estimated the proportion of cancer cases and deaths that could be potentially avoided by eliminating or reducing lifestyle risk factors in Brazil. METHODS: We obtained the distribution of lifestyle risk factors by sex and age groups from recent representative health surveys in Brazil; relative risks from pooled analyses of prospective studies and meta-analyses; and cancer cases and deaths in 2012 from GLOBOCAN. RESULTS: We found that 26.5% (114,497 cases) of all cancer cases and 33.6% (63,371 deaths) of all cancer deaths could be potentially avoided by eliminating lifestyle risk factors in Brazil. Plausible reductions in these exposures based on policy targets and cancer prevention recommendations could have potentially avoided 4.5% (19,731 cases) and 6.1% (11,480 deaths) of all cancer cases and deaths, respectively. Tobacco smoking accounted for most of the preventable cancer cases and deaths, followed by high body mass index and alcohol consumption. Larynx, lung, oropharynx, esophagus and colorectum cancer cases and deaths could be at least halved by eliminating these lifestyle risk factors. CONCLUSION: Findings from this study may be useful to inform strategies for cancer prevention and control across Brazil.

Association of type and intensity of physical activity with plasma biomarkers of inflammation and insulin response.

Several biological mechanisms linking physical activity with cancer have been proposed. However, the influence of specific components of physical activity (volume, type and intensity), and their interaction with adiposity and diet, on cancer-related biomarkers remain unclear. We used cross-sectional data on 7,219 men in the Health Professionals Follow-up Study (1992-1994) with C-reactive protein (CRP), interleukin-6 (IL6), tumor necrosis factor alpha receptor 2 (TNFαR2), adiponectin, C-peptide and triglycerides/high-density lipoprotein cholesterol ratio (TG/HDL). Details on physical activity, diet and adiposity were assessed by questionnaires. We used multivariable-adjusted linear regression analyses to estimate relative concentrations of biomarkers by physical activity. Total physical activity was favorably associated with all biomarkers in a fairly linear manner. Comparing the highest (63+ metabolic equivalent (MET)-hr/week) to the lowest (0-8.9 MET-hr/week) physical activity groups, the percent relative difference in concentration of biomarkers was -31% for CRP, -22% for IL6, -8% for TNFαR2, +9% for adiponectin, -22% for C-peptide, and -20% for TG/HDL. These differences were modestly attenuated after adjustment for adiposity. For the same total MET-hours of physical activity, the association was stronger for men engaging in both aerobic and resistance exercises compared to those engaging in aerobic only. However, no difference was found between those engaging in vigorous activities (≥20% of total MET-hours) compared to those who did smaller amount of vigorous activities. Physical activity showed similar associations for these biomarkers regardless of adiposity and dietary pattern. In conclusion, high physical activity, preferably aerobic plus resistance training, was associated with favorable cancer-related biomarkers.

Resting heart rate and risk of type 2 diabetes: A prospective cohort study and meta-analysis.

BACKGROUND: Positive association between resting heart rate (RHR) and risk of type 2 diabetes (T2D) has been documented in several studies. However, whether RHR is an independent predictor of T2D and its potential interaction with other risk factors of T2D remain unclear. METHODS: We conducted a prospective cohort study of 31 156 men from the Health Professionals Follow-up Study (1992-2012). Cox proportional hazard model was used to examine the association between RHR and T2D risk. We further examined whether this association is modified by known risk factors. Lastly, we conducted a meta-analysis of prospective cohort studies. RESULTS: During 505 380 person-years of follow-up, we identified 2338 incident T2D cases. The multivariable-adjusted hazard ratio (HR) comparing the highest vs lowest categories of RHR was 1.69 (95% confidence interval [CI], 1.43-2.01). Increase in 10 bpm of RHR was associated with 19% increased risk of T2D in the fully adjusted model (HR, 1.19; 95% CI, 1.14-1.24). The HRs of T2D associated with RHR were stronger among those with normal weight or without hypertension (P interaction < 0.001). Moreover, RHR with other known risk factors cumulatively increased T2D risk. A meta-analysis consistently showed a positive association between RHR and T2D risk (the summary relative risk [RR] for highest vs lowest RHR, 1.53; 95% CI, 1.26-1.86, n = 12, the summary RR per 10 bpm increase, 1.17; 95% CI, 1.09-1.26, n = 13). CONCLUSIONS: High RHR was independently associated with increased risk of T2D. Our findings suggest that RHR, with other known risk factors, could be a useful tool to predict T2D risk.

Physical activity and preventable premature deaths from non-communicable diseases in Brazil.

BACKGROUND: Studies on the impact of counterfactual scenarios of physical activity on premature deaths from non-communicable diseases (NCDs) are sparse in the literature. We estimated preventable premature deaths from NCDs (diabetes, ischemic heart disease, stroke, and breast and colon cancers) in Brazil by increasing population-wide physical activity (i) to theoretical minimum risk exposure levels; (ii) reaching the physical activity recommendation; (iii) reducing insufficient physical activity by 10%; and (iv) eliminating the gender differences in physical activity. METHODS: Preventable fractions were estimated using data from a nationally representative survey, relative risks from a meta-analysis and number of premature deaths (30-69 years) from the Brazilian Mortality Information System. RESULTS: Physical activity could potentially avoid up to 16 700 premature deaths from NCDs in Brazil, corresponding to 5.75 and 3.23% of premature deaths from major NCDs and of all-causes, respectively. Other scenarios suggested the following impact on premature deaths: reaching physical activity recommendation (5000 or 1.74% of major NCDs); 10% reduction in insufficient physical activity (500 or 0.17% of major NCDs); eliminating gender differences in physical activity (1000 or 0.33% of major NCDs). CONCLUSIONS: Physical activity may play an important role to reduce premature deaths from NCD in Brazil.

Mortalidade no primeiro dia de vida: tendências, causas de óbito e evitabilidade em oito Unidades da Federação brasileira, entre 2010 e 2015 / Mortalidad en el primer día de vida: tendencias, causas de muerte y evitabilidad en ocho Unidades de la Federación brasileña, entre 2010 y 2015 / Mortality on the first day of life: trends, causes of death and avoidability in eight Brazilian Federative Units, between 2010 and 2015

Objetivo: calcular taxas de mortalidade no primeiro dia de vida entre 2010 e 2015 em oito Unidades da Federação brasileira com melhor qualidade de informação, avaliar fatores associados e classificar os óbitos segundo causa básica e evitabilidade. Métodos: estudo descritivo; as taxas foram comparadas conforme características maternas e da criança; a análise de evitabilidade usou a 'Lista brasileira de causas de mortes evitáveis'. Resultados: 21,6% (n=20.791) dos óbitos infantis ocorreram no primeiro dia de vida; a taxa de mortalidade reduziu-se de 2,7 para 2,3 óbitos/1.000 nascidos vivos; observaram-se maiores taxas em NV com baixo peso, nascidos pré-termo e filhos de mães sem escolaridade; as principais causas dos óbitos foram síndrome da angústia respiratória (8,9%) e imaturidade extrema (5,2%); 66,3% das causas de óbito foram consideradas evitáveis. Conclusão: dois terços dos óbitos no primeiro dia de vida poderiam ser evitados por atenção adequada à mulher na gestação e no parto, e ao NV.

Objetivo: calcular la mortalidad en el primer día de vida entre 2010 y 2015 en ocho Unidades de la Federación brasileña con mejor calidad de información, analizar factores asociados y clasificar las causas básicas y la evitabilidad de los óbitos. Métodos: estudio descriptivo; las tasas de mortalidad fueron comparadas según las características maternas y del recién nacido (RN); el análisis de evitabilidad utilizó la 'Lista brasileña de causas de muertes evitables'. Resultados: un 21,6% (n=20.791) de los óbitos infantiles ocurrió en el primer día de vida; la tasa de mortalidad se redujo de 2,7 a 2,3 óbitos/1.000 nacidos vivos (NV); las tasas fueron mayores en NV de bajo peso, prematuros e hijos de madres sin escolaridad; las principales causas de óbito fueron síndrome de angustia respiratoria (8,9%) e inmadurez extrema (5,2%); un 66,3% de las causas de óbito fueron consideradas evitables. Conclusión: 2/3 de los óbitos en el primer día de vida podrían haber sido evitados con una atención adecuada a la mujer embarazada, al parto y al NV.

Objective: to calculate mortality rates on the first day of life from 2010 to 2015 in eight Brazilian Federative Units providing better quality information, to assess associated factors and to classify deaths by underlying causes and avoidability. Methods: this was a descriptive study; mortality rates were compared according to maternal and child characteristics; avoidability analysis used the 'Brazilian list of avoidable causes of death'. Results: 21.6% (n=20,791) of all infant deaths occurred on the first day of life; the mortality rate reduced from 2.7 to 2.3 deaths/1,000 live births; rates were higher in live births with low birthweight and preterm births, and among babies born to mothers with no schooling; main causes of death were respiratory distress syndrome (8.9%) and extreme immaturity (5.2%); 66.3% of causes of death were avoidable. Conclusion: 2/3 of deaths on the first day of life could have been avoided with adequate care for women during pregnancy and delivery and adequate care for live births.

Correction to: Personal, relational and school factors associated with involvement in fights with weapons among school-age youth in Brazil: a multilevel ecological approach.

The authors would like to include the funding note here which was found missing in the original publication.

Preventable fractions of colon and breast cancers by increasing physical activity in Brazil: perspectives from plausible counterfactual scenarios.

BACKGROUND: Physical activity is associated with lower risk of colon and breast cancers. Herein we estimated preventable fractions of colon and breast cancers in Brazil by increasing population-wide physical activity to different counterfactual scenarios. METHODS: We used data from a representative national survey in Brazil and corresponding relative risks of colon and postmenopausal breast cancers from a meta-analysis. Estimated cancer incidence was retrieved from GLOBOCAN and Brazilian National Cancer Institute. Five counterfactual scenarios for physical activity were considered: (i) theoretical minimum risk exposure level (≥8,000 metabolic equivalent of tasks-minute/week - MET-min/week); (ii) physical activity recommendation (≥600 MET-min/week); (iii) a 10% reduction in prevalence of insufficient physical inactivity (<600 MET-min/week); (iv) physical activity level in each state equals the most active state in Brazil; (v) closing the gender differences in physical activity. RESULTS: About 19% (3,630 cases) of colon cancers and 12% (6,712 cases) of postmenopausal breast cancers could be prevented by increasing physical activity to ≥8,000 MET-min/week. Plausible counterfactual scenarios suggested the following impact on cancer prevention: reaching physical activity recommendation: 1.7% (1,113 cases) of breast and 6% (1,137 cases) of colon; 10% reduction in physical inactivity prevalence: 0.2% (111 cases) of breast and 0.6% (114 cases) of colon; most active state scenario: 0.3% (168 cases) of breast and 1% (189 cases) of colon; reducing gender differences in physical activity: 1.1% (384 cases) of breast and 0.6% (122 cases) of colon. CONCLUSIONS: High levels of physical activity are required to achieve a sizable impact on breast and colon cancer prevention in Brazil.

Personal, relational and school factors associated with involvement in fights with weapons among school-age youth in Brazil: a multilevel ecological approach.

OBJECTIVES: To investigate the association between personal, relational and school factors with involvement in fights with weapon among Brazilian school-age youth. METHODS: Using data from the Adolescent School-Based Health Survey 2015 (n = 102.072), we conducted multilevel logistic regression models. RESULTS: IFW was associated with female sex (OR = 0.45), and with older age (OR = 1.15), previous involvement in physical violence (OR = 2.05), history of peer verbal (OR = 1.14) and domestic victimization (OR = 2.11), alcohol use (OR = 2.42) and drug use (OR = 3.23). The relational variables (e.g., parent's supervision) were mostly negatively associated with IFW. At the school level, attending public school and attending schools in violent surroundings were both positively associated with IFW. The intraclass correlation coefficient estimated in the empty model showed that 5.77% of the variance of IFW was at school level. When all individual- and school-level variables were included in the model, the proportional changes in variance were 61.7 and 71.55%, respectively. CONCLUSIONS: IFW is associated with personal, relational and school factors. Part of the variance in IFW by school is explained by characteristics of the school context.

Reporting bias in the literature on the associations of health-related behaviors and statins with cardiovascular disease and all-cause mortality.

Reporting bias in the literature occurs when there is selective revealing or suppression of results, influenced by the direction of findings. We assessed the risk of reporting bias in the epidemiological literature on health-related behavior (tobacco, alcohol, diet, physical activity, and sedentary behavior) and cardiovascular disease mortality and all-cause mortality and provided a comparative assessment of reporting bias between health-related behavior and statin (in primary prevention) meta-analyses. We searched Medline, Embase, Cochrane Methodology Register Database, and Web of Science for systematic reviews synthesizing the associations of health-related behavior and statins with cardiovascular disease mortality and all-cause mortality published between 2010 and 2016. Risk of bias in systematic reviews was assessed using the ROBIS tool. Reporting bias in the literature was evaluated via small-study effect and excess significance tests. We included 49 systematic reviews in our study. The majority of these reviews exhibited a high overall risk of bias, with a higher extent in health-related behavior reviews, relative to statins. We reperformed 111 meta-analyses conducted across these reviews, of which 65% had statistically significant results (P < 0.05). Around 22% of health-related behavior meta-analyses showed small-study effect, as compared to none of statin meta-analyses. Physical activity and the smoking research areas had more than 40% of meta-analyses with small-study effect. We found evidence of excess significance in 26% of health-related behavior meta-analyses, as compared to none of statin meta-analyses. Half of the meta-analyses from physical activity, 26% from diet, 18% from sedentary behavior, 14% for smoking, and 12% from alcohol showed evidence of excess significance bias. These biases may be distorting the body of evidence available by providing inaccurate estimates of preventive effects on cardiovascular and all-cause mortality.

The increasing burden of cancer attributable to high body mass index in Brazil.

BACKGROUND: Body mass index (BMI) has been constantly increasing over the last decades in most parts of the world, most notably in transitioning nations such as Brazil. High BMI (>22 kg/m2) is associated with an increased risk of 14 types of cancer. We estimated the extent to which reducing high BMI could lower cancer incidence in Brazil, nationally as well as at regional and state levels. METHODS: We calculated fractions of cancer incidence in 2012 attributable to high BMI as well as projections for attributable cases in 2025 using BMI data from representative national surveys and relative risks published in meta-analyses. Estimates of cancer incidence were retrieved from GLOBOCAN and the Brazilian National Cancer Institute. RESULTS: We found that 15,465 (3.8%) of all new cancer cases diagnosed in Brazil in 2012 were attributable to high BMI, with a higher burden in women (5.2%) than in men (2.6%). The cancer sites contributing most to the number of attributable cases were breast (n = 4777), corpus uteri (n = 1729), and colon (n = 681) in women, and colon (n = 1062), prostate (n = 926), and liver (n = 651) in men. The highest population attributable fractions (PAFs) for all cancers were found in the richer states of the country, located in the south (1.5% men/3.4% women) and the southeast (1.5% men/3.3% women). CONCLUSIONS: Cancer cases attributable to high BMI will reach 29,490, which will be 4.6% of all cancers in Brazil in 2025; the extent will be greater in women (6.2% or 18,837) than in men (3.2% or 10,653). This information is a tool to support policy makers for future cancer prevention strategies in Brazil.

Why precision medicine is not the best route to a healthier world.

Precision medicine has been announced as a new health revolution. The term precision implies more accuracy in healthcare and prevention of diseases, which could yield substantial cost savings. However, scientific debate about precision medicine is needed to avoid wasting economic resources and hype. In this commentary, we express the reasons why precision medicine cannot be a health revolution for population health. Advocates of precision medicine neglect the limitations of individual-centred, high-risk strategies (reduced population health impact) and the current crisis of evidence-based medicine. Overrated "precision medicine" promises may be serving vested interests, by dictating priorities in the research agenda and justifying the exorbitant healthcare expenditure in our finance-based medicine. If societies aspire to address strong risk factors for non-communicable diseases (such as air pollution, smoking, poor diets, or physical inactivity), they need less medicine and more investment in population prevention strategies.

Physical activity and cancer: an umbrella review of the literature including 22 major anatomical sites and 770 000 cancer cases.

OBJECTIVE: To provide an overview of the breadth and validity of claimed associations between physical activity and risk of developing or dying from cancer. DESIGN: Umbrella review. DATA SOURCES: We searched Medline, Embase, Cochrane Database and Web of Science. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Systematic reviews about physical activity and cancer incidence and cancer mortality in different body sites among general population. RESULTS: We included 19 reviews covering 22 cancer sites, 26 exposure-outcome pairs meta-analyses and 541 original studies. Physical activity was associated with lower risk of seven cancer sites (colon, breast, endometrial, lung, oesophageal, pancreas and meningioma). Only colon (a protective association with recreational physical activity) and breast cancer (a protective association with overall physical activity) were supported by strong evidence and highly suggestive evidence, respectively. Evidence from endometrial, lung, oesophageal, pancreas and meningioma presented hints of uncertainty and bias in the literature (eg, not reaching P values<10-6) showing large between-study heterogeneity and/or not demonstrating a definite direction for the effect when 95% prediction intervals were considered. Four of the 26 meta-analyses showed small study effects and 4 showed excess significance. CONCLUSION: Physical activity is associated with a lower risk of several cancers, but only colon and breast cancer associations were supported by strong or highly suggestive evidence, respectively. Evidence from other cancer sites was less consistent, presenting hints of uncertainty and/or bias.