Effectiveness of the 5A Counseling Model-Based Interventions on Physical Activity Indicators in Adults: A Systematic Review.

BACKGROUND: To identify and appraise the effectiveness of the 5A-counseling-model-based interventions on indicators of physical activity in adults. METHODS: A systematic review was conducted from systematic searches in Embase, Lilacs, Pubmed, Scielo, Scopus, Sportdiscus and Web of Science, involving studies published from its inception until May 2022. To avoid potential losses, searches also were made in Google Scholar and in reference lists. The assessment of studies, data extraction, and synthesis were carried out independently by two researchers. RESULTS: Four studies composed the synthesis, which involved people with an average age between 40 and 55 years, most of the samples being women. It was observed that counseling was carried out in conjunction with other strategies, such as drawing up an action plan, sending text messages, and offering educational material. Only one study showed a statistically significant difference between the intervention and control groups in the "daily number of steps" indicator. CONCLUSIONS: Based on available studies, 5A-counseling-model-based interventions did not reflect significant findings in relation to physical activity. However, given the potential of the model, future studies are recommended with a better description of the strategies, as well as a more robust methodology, to strengthen the evidence.

Factors associated with Physical Activity Counseling by Health Workers Questionnaire: construction, validation and reliability / Questionário sobre fatores associados para o Aconselhamento para Atividade Física por Trabalhadores da Saúde: construção, validação e reprodutibilidade

The main purpose of this study is to describe the development, validation and reliability of a ques-tionnaire to measure the associated factors of physical activity counseling by health workers. The development of the questionnaire was carried out in four steps: construction of the analytical matrix; face validation; pilot study; and reliability assessment. The analytical matrix consisted of ten modules with a total of 47 questions. In the second step, 21 Brazilian experts of different knowledge back-grounds gave their opinion on the presentation, clarity and adequacy of each item. In the third step, a pilot study was carried out with 20 professionals (doctors, nurses and community health agents) from the Joao Pessoa, Paraíba Family Health Strategy. In the last step, reliability index was assessed among a sample of 53 health workers from five health units. The final version of the questionnaire was composed of 53 questions distributed in ten modules. Results showed a total validity index of 0.90 ranging from 0.83 to 0.95 in the modules. The clarity and adequacy of the scale showed mean values of 0.93 (ranging from 0.87 to 0.96) and 0.95 (ranging from 0.91 to 0.98), respectively. Eight out of ten modules showed all items with reliability greater than 0.60 (kappa). The questionnaire showed a satisfactory validity and reliability and it is recommended for studies to measure physical activity counseling and other practices in health promotion by health workers in the primary health care

O objetivo deste estudo é descrever o desenvolvimento, validação e reprodutibilidade de um questionário para mensurar fatores associados à prática do aconselhamento para atividade física por trabalhadores de saúde. O desenvolvimento do questionário foi realizado em quatro etapas: construção da matriz analítica; validação de face; estudo piloto; estudo de reprodutibilidade. A primeira etapa resultou numa matriz analítica com dez módulos com um total de 47 questões. Na segunda etapa, 21 brasileiros especialistas em diferentes áreas opinaram sobre a apresentação, clareza e adequação de cada item. Na terceira etapa, foi realizado o estudo piloto com 20 profissionais (médicos, enfermeiros e agentes comunitários de saúde) da Estratégia de Saúde da Família de João Pessoa-PB. Por fim, uma amostra de 53 trabalhadores participou do estudo de reprodutibili-dade. A versão final do questionário foi composta de 53 questões distribuídas em dez módulos. Foi encontrado um índice de validade geral de 0,90, variando de 0,81 a 0,95 nos módulos. A clareza e adequação da escala demonstraram valores médios de 0,93 (variando entre 0,87 e 0,96) e 0,95 (variando entre 0,91 e 0,98), respectivamente. Oito dos dez módulos apresentaram todos os itens com valores de reprodutibilidade acima de 0,60 (kappa). O questionário apresentou validade satisfatória e reprodutibilidade adequada, recomendando a sua utilização em estudos que visam avaliar a prática de aconselhamento de atividade física e outras prá-ticas de promoção da saúde por trabalhadores de saúde da atenção primaria à saúde

Effects of community health worker-based interventions on physical activity levels in children: a systematic review / Efeitos de intervenções conduzidas por agentes comunitários de saúde nos níveis de atividade física em crianças: revisão sistemática

ABSTRACT Objective: To identify the strategies and effects of interventions carried out by community health workers (CHW) on physical activity (PA) levels in children and adolescents. Data source: In August 2020, a systematic review, designed according to the PRISMA checklist items, was conducted by searches in seven electronic databases and in reference lists. Original studies were searched without restriction with regard to year of publication; they were written in Spanish, English or Portuguese and examined interventions implemented by CHW, involving theoretical and/or practical contents of PA, with a focus on children and/or adolescents between three and 19 years of age. Data synthesis: Of the 2,321 studies initially retrieved, eight were included, targeting samples with more specific characteristics (e.g., clinical, ethnic and/or socioeconomic). In all studies, CHW were trained to lead educational activities. In three non-controlled trials, positive results were observed, involving indicators such as moderate and vigorous PA and physical inactivity reduction. Also, two positive results were found in reducing sedentary behavior. Conclusions: Even though most of the interventions included did not have a significant effect on increasing PA levels, the available findings reinforce the role of CHW as an important strategy for dialogue between health services and the most vulnerable communities, and they suggest a greater articulation of these professionals in the actions developed in the school context.

RESUMO Objetivo: Identificar as estratégias e os efeitos de intervenções conduzidas por agentes comunitários de saúde (ACS) nos níveis de atividade física (AF) em crianças e adolescentes. Fontes de dados: Em agosto de 2020, uma revisão sistemática, delineada de acordo com os itens da lista de verificação PRISMA, foi desenvolvida por meio de buscas em sete bases de dados eletrônicas e em listas de referências. Foram procurados estudos originais, sem restrição quanto ao ano de sua publicação, escritos em espanhol, inglês e português, que desenvolveram intervenções implementadas por ACS envolvendo conteúdos teóricos e/ou práticas de AF com foco em crianças e/ou adolescentes na faixa entre os 3 e os 19 anos de idade. Síntese dos dados: Dos 2.321 estudos inicialmente avaliados, foram incluídos oito, direcionados a amostras com características mais específicas (clínicas, étnicas e/ou socioeconômicas). Em todos os estudos, ACS receberam treinamento prévio para a condução de atividades educativas. Em três ensaios não controlados foram observados resultados positivos envolvendo indicadores de AF moderadas, vigorosas e redução da inatividade física. Complementarmente, dois resultados positivos foram encontrados na redução do comportamento sedentário. Conclusões: Mesmo que a maior parte das intervenções incluídas não tenha apresentado efeitos significativos no aumento dos níveis de AF, a evidência disponível reforça o papel dos ACS como uma importante estratégia de diálogo entre os serviços de saúde e as comunidades mais vulneráveis e sugere maior articulação desses profissionais nas ações desenvolvidas no contexto escolar.

Effects of community health worker-based interventions on physical activity levels in children: a systematic review.

OBJECTIVE: To identify the strategies and effects of interventions carried out by community health workers (CHW) on physical activity (PA) levels in children and adolescents. DATA SOURCE: In August 2020, a systematic review, designed according to the PRISMA checklist items, was conducted by searches in seven electronic databases and in reference lists. Original studies were searched without restriction with regard to year of publication; they were written in Spanish, English or Portuguese and examined interventions implemented by CHW, involving theoretical and/or practical contents of PA, with a focus on children and/or adolescents between three and 19 years of age. DATA SYNTHESIS: Of the 2,321 studies initially retrieved, eight were included, targeting samples with more specific characteristics (e.g., clinical, ethnic and/or socioeconomic). In all studies, CHW were trained to lead educational activities. In three non-controlled trials, positive results were observed, involving indicators such as moderate and vigorous PA and physical inactivity reduction. Also, two positive results were found in reducing sedentary behavior. CONCLUSIONS: Even though most of the interventions included did not have a significant effect on increasing PA levels, the available findings reinforce the role of CHW as an important strategy for dialogue between health services and the most vulnerable communities, and they suggest a greater articulation of these professionals in the actions developed in the school context.

Associated factors with physical activity counseling among Brazilian Family Health Strategy workers.

This study aimed to determine the prevalence and associated factors with physical activity counseling among Brazilian Family Health Strategy workers. This is a cross-sectional study conducted with a random sample of 591 health workers who work in the Family Health Teams of João Pessoa-PB, Brazil. Counseling for physical activity was defined as any advising targeted for increasing patients' physical activity levels conducted for at least six months. The following factors were considered: time working in health care units, amount of daily attendance, continuing education, perceived barriers, self-efficacy, attitude, self-rated health, physical activity level and nutritional status. Prevalence of counseling was 46.3%, being higher among physicians (74.5%; 95%CI: 59.6-85.2) and nurses (60.3%; 95%CI: 48.0-71.4) compared to community health workers (42.9%; 95%CI: 38.2-47.7) and nurses assistants (31.5%; 95%CI: 20.2-45.4). The results showed health professionals with positive self-rated health, without perception of barriers, having a positive attitude and high self-efficacy were more likely to perform physical activity counseling. Knowledge and actions on factors associated with physical activity counseling can help broaden the involvement of primary health care providers in health education.

Associated factors with physical activity counseling among Brazilian Family Health Strategy workers / Fatores associados ao aconselhamento em atividade física entre trabalhadores da Estratégia Brasileira de Saúde da Família

Abstract This study aimed to determine the prevalence and associated factors with physical activity counseling among Brazilian Family Health Strategy workers. This is a cross-sectional study conducted with a random sample of 591 health workers who work in the Family Health Teams of João Pessoa-PB, Brazil. Counseling for physical activity was defined as any advising targeted for increasing patients' physical activity levels conducted for at least six months. The following factors were considered: time working in health care units, amount of daily attendance, continuing education, perceived barriers, self-efficacy, attitude, self-rated health, physical activity level and nutritional status. Prevalence of counseling was 46.3%, being higher among physicians (74.5%; 95%CI: 59.6-85.2) and nurses (60.3%; 95%CI: 48.0-71.4) compared to community health workers (42.9%; 95%CI: 38.2-47.7) and nurses assistants (31.5%; 95%CI: 20.2-45.4). The results showed health professionals with positive self-rated health, without perception of barriers, having a positive attitude and high self-efficacy were more likely to perform physical activity counseling. Knowledge and actions on factors associated with physical activity counseling can help broaden the involvement of primary health care providers in health education.

Resumo O estudo objetivou determinar a prevalência e os fatores associados ao aconselhamento para atividade física entre trabalhadores da Estratégia de Saúde da Família. Trata-se de estudo transversal com amostra de 591 trabalhadores de Equipes de Saúde da Família de João Pessoa-PB, Brasil. Aconselhamento para atividade física foi definido como qualquer recomendação direcionada a aumentar os níveis de atividade física dos usuários conduzida por pelo menos seis meses. Foram considerados os seguintes fatores: tempo de trabalho, quantidade de atendimentos, educação permanente, barreiras percebidas, autoeficácia, atitude, autoavaliação de saúde, nível de atividade física e estado nutricional. A prevalência de aconselhamento foi de 46,3%, sendo maior entre médicos (74,5%; IC95%: 59,6-85,2) e enfermeiros (60,3%; IC95%: 48,0-71,4) em relação aos agentes comunitários de saúde (42,9%; IC95%: 38,2-47,7) e técnicos de enfermagem (31,5%; IC95%: 20,2-45,4). Profissionais com autoavaliação positiva de saúde, sem percepção de barreiras, com atitude positiva e alta autoeficácia, apresentaram maior chance de realizar aconselhamento. Conhecimentos e ações sobre os fatores associados ao aconselhamento podem ajudar a ampliar o envolvimento dos profissionais em iniciativas de educação em saúde.

PHYSICAL ACTIVITY, SCREEN TIME, NUTRITIONAL STATUS AND SLEEP IN ADOLESCENTS IN NORTHEAST BRAZIL.

OBJECTIVE: To verify the prevalence of sleep quality and duration and its association with the level of physical activity, screen time and nutritional status in adolescents. METHODS: This is a cross-sectional study with 1,432 adolescents (53.1%, female), ten to 14 years old (12.0±1.0 year) from public schools in Joao Pessoa, Northeast Brazil. Physical activity (≥300 vs. <300 minutes/week), screen time (≤2 vs. >2 h/day) and duration (<8 vs. ≥8 h/day) and perception of sleep quality (negative vs. positive perception) were measured by questionnaire. Nutritional status was assessed by body mass index (low weight / normal weight vs. overweight / obesity). Binary logistic regression was used to analyze association between variables, considering different aggregation of negative factors. RESULTS: The prevalence of insufficient duration and negative perception of sleep quality was 12.6% (95%CI 10.9-14.4) and 21.0% (95%CI 18.9-23.1), respectively. There was a linear trend in the chance of the adolescents to present insufficient duration of sleep as a result of simultaneous negative factors (physical inactivity, excessive screen time, being overweight) (OR=4.31; 95%CI 1.50-12.48). CONCLUSIONS: Adolescents exposed simultaneously to low levels of physical activity, excessive screen time and overweight had a lower sleep duration.

Physical activity, screen time, nutritional status and sleep in adolescents in northeast brazil / Prática de atividade física, tempo de tela, estado nutricional e sono em adolescentes no nordeste do brasil

ABSTRACT Objective: To verify the prevalence of sleep quality and duration and its association with the level of physical activity, screen time and nutritional status in adolescents. Methods: This is a cross-sectional study with 1,432 adolescents (53.1%, female), ten to 14 years old (12.0±1.0 year) from public schools in Joao Pessoa, Northeast Brazil. Physical activity (≥300 vs. <300 minutes/week), screen time (≤2 vs. >2 h/day) and duration (<8 vs. ≥8 h/day) and perception of sleep quality (negative vs. positive perception) were measured by questionnaire. Nutritional status was assessed by body mass index (low weight / normal weight vs. overweight / obesity). Binary logistic regression was used to analyze association between variables, considering different aggregation of negative factors. Results: The prevalence of insufficient duration and negative perception of sleep quality was 12.6% (95%CI 10.9-14.4) and 21.0% (95%CI 18.9-23.1), respectively. There was a linear trend in the chance of the adolescents to present insufficient duration of sleep as a result of simultaneous negative factors (physical inactivity, excessive screen time, being overweight) (OR=4.31; 95%CI 1.50-12.48). Conclusions: Adolescents exposed simultaneously to low levels of physical activity, excessive screen time and overweight had a lower sleep duration.

RESUMO Objetivo: Verificar a prevalência da percepção da qualidade e duração do sono e sua associação com o nível de atividade física, tempo de tela e estado nutricional em adolescentes. Métodos: Trata-se de um estudo transversal com 1.432 adolescentes (53,1% do sexo feminino), de dez a 14 anos de idade (12,0±1,0 ano) e de escolas públicas de João Pessoa (PB). A atividade física (≥300 vs. <300 min/semana), o tempo de tela (≤2 vs. >2 h/dia) e a duração (<8 vs. ≥8 h/dia) e percepção da qualidade do sono (percepção negativa vs. percepção positiva) foram mensuradas por questionário. O estado nutricional foi avaliado pelo índice de massa corporal (baixo peso/peso normal vs. sobrepeso/obesidade). A regressão logística binária foi utilizada para analisar a associação entre as variáveis. Resultados: A prevalência de duração insuficiente e a percepção negativa da qualidade do sono foram de 12,6% (intervalo de confiança de 95% [IC95%] 10,9-14,4) e 21,0% (IC95% 18,9-23,1), respectivamente. Identificou-se tendência linear de aumento na chance de os adolescentes apresentarem duração insuficiente de sono com o aumento do número de fatores negativos (inatividade física, tempo excessivo de tela, excesso de peso corporal) a que eles estavam expostos (Odds Ratio [OR]=4,31; IC95% 1,50-12,48). Conclusões: Adolescentes expostos simultaneamente a baixos níveis de atividade física, tempo excessivo de tela e excesso de peso tiveram menor duração de sono.

[The urgency of Public Health in Physical Education training: lessons from COVID-19]. / A urgência da Saúde Coletiva na formação em Educação Física: lições com o COVID-19.

The COVID-19 pandemic has generated several controversies in the health area, particularly regarding social isolation measures, widely perceived as being one of the most effective strategies to reduce the spread of the virus. The Physical Education (PE) area became involved in these discussions, through contradictory positions of professionals, scientific societies and class entities regarding the reopening of fitness centers during the pandemic. We understand that some of these discussions revealed important weaknesses in relation to the approach to basic health knowledge, such as those related to epidemiology and public health measures. We seek in this essay, without the intention of exhausting the subject or performing an academic prescription, to support our position regarding the urgency of the approach of PE training within the field of Public Health, as well as presenting some proposals for this approach to effectively occur. We advocate training that favors a broader view of health, that enables professionals in the field to understand the potential relationship between PE and health, but at the same time recognize that physical activity is not a panacea and that human health has many others determinants and conditions.

A urgência da Saúde Coletiva na formação em Educação Física: lições com o COVID-19 / The urgency of Public Health in Physical Education training: lessons from COVID-19

Resumo A pandemia de COVID-19 gerou diversas polêmicas na área da saúde, particularmente sobre as medidas de isolamento social, entendida como uma das estratégias mais eficazes para reduzir a propagação do vírus. A área da Educação Física (EF) se envolveu nessas discussões, por meio de posicionamentos contraditórios de profissionais, sociedades científicas e entidades de classe a respeito da reabertura das academias de ginástica em plena pandemia. Entendemos que alguns destes discursos revelaram importantes fragilidades com relação à aproximação aos conhecimentos básicos de saúde, como aqueles relativos à epidemiologia e medidas sanitárias. Buscamos neste ensaio, sem a intenção de esgotar o assunto ou realizar receituário acadêmico, sustentar nossa posição a respeito da urgência da aproximação da formação em EF com o campo da Saúde Coletiva, bem como apresentar algumas proposições para que ela, de fato, aconteça. Defendemos assim uma formação que favoreça uma visão mais ampliada da saúde, que possibilite que profissionais e professores compreendam a relação potencial entre a EF e a saúde, mas que ao mesmo tempo reconheçam que a atividade física não é uma panaceia e que a saúde humana tem muitos outros determinantes e condicionantes.

Abstract The COVID-19 pandemic has generated several controversies in the health area, particularly regarding social isolation measures, widely perceived as being one of the most effective strategies to reduce the spread of the virus. The Physical Education (PE) area became involved in these discussions, through contradictory positions of professionals, scientific societies and class entities regarding the reopening of fitness centers during the pandemic. We understand that some of these discussions revealed important weaknesses in relation to the approach to basic health knowledge, such as those related to epidemiology and public health measures. We seek in this essay, without the intention of exhausting the subject or performing an academic prescription, to support our position regarding the urgency of the approach of PE training within the field of Public Health, as well as presenting some proposals for this approach to effectively occur. We advocate training that favors a broader view of health, that enables professionals in the field to understand the potential relationship between PE and health, but at the same time recognize that physical activity is not a panacea and that human health has many others determinants and conditions.

Aconselhamento para atividade física na atenção primária à saúde: uma revisão integrativa / Counseling for physical activity in primary health care: an integrative review / Asesoría para la actividad física en la atención primaria de salud: una revisión integrativa

O objetivo foi sintetizar a produção acadêmica sobre a temática do aconselhamento para atividade física na atenção primária à saúde do Sistema Único de Saúde (SUS). Trata-se de revisão integrativa da literatura, realizada nas bases LILACS, MEDLINE, PubMed e SciELO, publicada até dezembro de 2018. Foram analisados 22 estudos, dos quais 13 foram observacionais, sete intervenções e dois qualitativos. A prevalência de aconselhamento para usuários variou de 20% a 59,4% entre os estudos e observou-se o perfil de usuários que mais recebem aconselhamento (mulheres, pessoas mais velhas e com diagnóstico de doenças crônicas). Os profissionais mais aconselhadores são: médicos, aqueles fisicamente ativos, que se sentem capazes de aconselhar e que não identificam a falta de tempo como barreira. As intervenções apresentaram efeitos modestos nos níveis de atividade física dos usuários e nas práticas de aconselhamento dos profissionais.

This study analyzes academic literature on counseling for physical activity in primary health care under Brazil's Unified Health System (SUS). This is an integrative literature review conducted on content from the LILACS, MEDLINE, PubMed and SciELO databases published until December 2018. Twenty-two studies were analyzed, of which 13 were observational, seven were experimental and two were qualitative. The prevalence of counseling varied from 20% to 59,4% between studies and the profiles of counseled patients were observed (women, elderly people, patients diagnosed with chronic diseases). Counseling is most often provided by doctors, physically active people, those who feel able to counsel, and people who do not see lack of time as a barrier. Interventions had modest effects on patients' physical activity levels and professionals' counseling practices.

El objetivo fue sintetizar la producción académica sobre el tema de la asesoría para la actividad física en la atención primaria de salud del Sistema Único de Salud (SUS). Se trata de una revisión integrativa de la literatura, realizada en las bases de datos LILACS, MEDLINE, PubMed y SciELO, publicada hasta diciembre de 2018. Se analizaron 22 estudios, de los cuales 13 fueron observacionales, siete intervenciones y dos cualitativos. La prevalencia de asesoría a usuarios varió del 20% al 59,4% entre los estudios y se observó el perfil de usuarios que más recibieron asesoría (mujeres, personas mayores y personas diagnosticadas con enfermedades crónicas). Los profesionales que más asesoran son: médicos, aquellos que son físicamente activos, que se sienten capaces de aconsejar y que no identifican la falta de tiempo como una barrera. Las intervenciones tuvieron efectos modestos en los niveles de actividad física de los usuarios y en las prácticas de asesoría de los profesionales.

Isolated and simultaneous perceived barriers to physical activity counseling / Barreiras percebidas isoladas e simultâneas para o aconselhamento para atividade física

The aim of this study was to determine the prevalence of perceived barriers and their isolated and simultaneous association with the practice of counseling for physical activity by primary health care workers. This is a cross-sectional study with 591 health workers, who work in the Family Health Teams. Counseling for physical activity was defined as the accomplishment of such a practice for more than six months. The barriers investigated were lack of time, lack of knowledge, lack of professionals to guide, lack of available instructional material, lack of environmental resources and lack of financial resources of the user. Binary logistic regression was used to evaluate the possible relation-ships between perceived barriers and the practice of counseling for physical activity. Non-counselors reported a lack of time (68.8%), knowledge (68.5%) and orientation (63.2%) compared to their peer counselors (p ≤ 0.001). Professionals with three or more barriers were more likely not to advise (OR = 3.91; 95%CI: 2.10 - 7.29) when compared to those who reported no concurrent barriers. These results indicate that the simultaneity of perceived barriers is negatively associated to the practice of counseling for physical activity of health workers

O objetivo deste estudo foi determinar a prevalência das barreiras percebidas e sua associação isolada e simultânea com a prática de aconselhamento para atividade física por profissionais da atenção primária à saúde. Foi conduzido um estudo transversal com 591 profissionais da Estratégia de Saúde da Família. O aconselhamento para a atividade física foi definido como a realização de tal prática há mais de seis meses. As barreiras investigadas foram a falta de tempo, falta de conhecimento, falta de profissionais para orientar, falta de material instrucional disponível, falta de recursos ambientais e falta de recurso financeiro do usuário. Utilizou-se a regressão logística binária para avaliar as associações entre barreiras percebidas e a prática de aconselhamento. Profissionais não aconselhadores relataram em maior proporção a falta de tempo (68,8%), de conhecimento (68,5%) e de orientação (63,2%) comparados aos seus pares aconselhadores (p ≤ 0,001). Profissionais com três ou mais barreiras apresentaram maior chance de não aconselhar (OR = 3,91; IC95%: 2,10 - 7,29) quando comparados com aqueles que não relataram barreiras simultâneas. Os resultados sugerem que a simultaneidade de barreiras percebidas contribui negativamente na prática do aconselhamento para atividade física

[Socio-demographic factors associated with three sedentary behaviors in Brazilian workers]. / Aspectos sociodemográficos associados a três comportamentos sedentários em trabalhadores brasileiros.

This study focused on the association between socio-demographic characteristics and three sedentary behaviors among industrial workers in Brazil. Data were analyzed on 47,477 workers from 24 Brazilian states, collected by questionnaires from 2006 to 2008. Individual and simultaneous presence of ≥ 4 hours of TV time per day, commuting by car or motorcycle, and sitting most of the time at work were investigated, as well as associations between these behaviors and gender, age, schooling, and family income. Simple and multiple binary logistic regression were used. Older workers and those with more schooling and higher income had increased odds of presenting two or all of the three target behaviors. Associations between gender and sedentary behaviors depend on the specific behavior. Such information can be useful for planning interventions to reduce sedentary behavior, with better targeting and more effectiveness in reaching different population subgroups.

Aspectos sociodemográficos associados a três comportamentos sedentários em trabalhadores brasileiros / Socio-demographic factors associated with three sedentary behaviors in Brazilian workers / Aspectos sociodemográficos asociados a tres comportamientos sedentarios en trabajadores brasileños

O objetivo foi investigar a associação entre aspectos sociodemográficos e três comportamentos sedentários em trabalhadores da indústria no Brasil. Analisaram-se dados de 47.477 trabalhadores das indústrias de 24 Unidades Federativas, coletados por questionário de 2006 a 2008. Analisou-se a presença individual e simultânea de assistência à televisão ≥ 4 horas/dia, deslocamento de carro ou moto para o trabalho e passar a maior parte do tempo sentado no trabalho, assim como a associação desses comportamentos sedentários com sexo, idade, renda familiar mensal e nível de escolarização. Para tanto, utilizou-se a regressão logística binária simples e múltipla. Trabalhadores com mais idade, escolarização e renda tiveram maiores odds de apresentar dois dos três comportamentos sedentários investigados, assim como a presença simultânea deles. As associações entre sexo e comportamentos sedentários dependem do comportamento investigado. Tais informações podem ajudar no planejamento de ações de redução de comportamentos sedentários mais bem direcionadas e mais eficientes no alcance de diferentes subgrupos da população.

This study focused on the association between socio-demographic characteristics and three sedentary behaviors among industrial workers in Brazil. Data were analyzed on 47,477 workers from 24 Brazilian states, collected by questionnaires from 2006 to 2008. Individual and simultaneous presence of ≥ 4 hours of TV time per day, commuting by car or motorcycle, and sitting most of the time at work were investigated, as well as associations between these behaviors and gender, age, schooling, and family income. Simple and multiple binary logistic regression were used. Older workers and those with more schooling and higher income had increased odds of presenting two or all of the three target behaviors. Associations between gender and sedentary behaviors depend on the specific behavior. Such information can be useful for planning interventions to reduce sedentary behavior, with better targeting and more effectiveness in reaching different population subgroups.

El objetivo fue investigar la asociación entre aspectos sociodemográficos y tres comportamientos sedentarios en trabajadores de la industria en Brasil. Se analizaron datos de 47.477 trabajadores de industrias de 24 Unidades Federativas de Brasil, obtenidas por cuestionario de 2006 a 2008. Se investigó la presencia individual y simultánea de ver televisión ≥ 4 horas/día, desplazamiento en coche o moto para el trabajo y pasar la mayor parte del tiempo sentado en el trabajo, así como la asociación de esos comportamientos sedentarios con sexo, edad, renta familiar mensual y nivel de escolaridad. Para eso, se utilizó la regresión logística binaria simple y múltiple. Trabajadores con más edad, escolaridad y renta tuvieron mayor razón de oportunidades de presentar dos de los tres comportamientos sedentarios investigados, así como la presencia simultánea de ellos. Las asociaciones entre sexo y comportamientos sedentarios dependen del comportamiento investigado. Tales informaciones pueden ser útiles para planear acciones de reducción de comportamientos sedentarios mejor dirigidas y más eficientes en el alcance a diferentes subgrupos de la población.

Changes in total and central adiposity and body fat distribution among 7-10-year-old schoolchildren in Brazil.

OBJECTIVE: To describe changes in total and central adiposity and body fat distribution in children over a 5-year period by investigating variations in BMI, waist circumference (WC), waist-to-height ratio (WHtR) and skinfold thicknesses (SFT). DESIGN: A school-based sample of children from 2nd to 5th grades of elementary schools participated in two cross-sectional studies in 2002 (n 2936) and 2007 (n 1232). SETTING: Public and private schools of Florianopolis, Brazil. SUBJECTS: Schoolchildren aged 7-10 years had their weight, height, WC and SFT measured according to standard procedures. Body fat distribution was assessed by triceps, subscapular, suprailiac and medial calf skinfold measurements. Changes in BMI, WC, WHtR and SFT were analysed, adjusting for type of school and monthly family income. RESULTS: Adjusted mean differences between 2002 and 2007 for BMI and WC were always positive and of similar magnitude between boys and girls. However, a statistically significant increase was observed only for BMI (raw and Z-score values) in boys. WHtR remained stable in both sexes. Adjusted median values for SFT also increased in boys and girls, except for triceps skinfold. BMI, WC and SFT tended to increase across age classes in both sexes. The relative change observed for the median central skinfolds (subscapular and suprailiac) was greater than that of peripheral skinfolds (triceps and medial calf). CONCLUSIONS: The subcutaneous adipose tissue (SFT) appeared to increase at a faster rate than total adiposity (BMI). The increase in central SFT indicates that the relative change is due primarily to a rise in central adiposity.

Time spent by Brazilian students in different modes of transport going to school: changes over a decade (2001-2011).

To examine changes in the time spent in each mode of transportation used for going to school by gender and age among adolescents from Santa Catarina State, Brazil. Two school-based surveys were performed in 2001 (N = 5,028) and 2011 (N = 6,529) in high school students (15-19 years old). The mode of transportation (on foot; by bicycle; by bus; car/motorcycle) and the time spent for commuting to school were assessed. Active commuting increased for short trips in both genders (male: 25.1% to 36.7%; female: 18.8% to 29.2%) and in all ages (15-16 years: 21% to 32.7%; 17-19 years: 21.9% to 32.4%), and declined for longer trips in males (30.5% to 21.9%) and in 15-16 years old students (25.7% to 34.7%). Car/motorcycle use has doubled for short trips in males (38.1% to 65.9%) and in 17-19 years old students (37.7% to 62.7%), while the use of buses remained stable in both genders. Our findings contribute to discussions on public policy focusing on the design of safe environments to promote active commuting to schools, particularly to decrease the use of motorized transport for short trips.

Effect of school-based intervention on diet in high school students / Efetividade de uma intervenção de base escolar sobre as práticas alimentares em estudantes do ensino médio

Interventions during adolescence are important for modifying risk eating behavior that contribute to the early development of obesity and other non-transmissible chronic diseases, such as the consumption of high energy-dense and low nutrient-dense foods. The aim of this study was to assess the effect of a school-based intervention on the diet of high school students who study at night. Randomized controlled study conducted in 2006 in two Brazilian state capitals (Florianopolis and Recife). The intervention included multiple strategies for improving healthy eating and physical activity. Weekly frequency consumption of fruits, vegetables, dairy products, salty snacks, sweets and soft drinks, daily frequency consumption of fruits and vegetables and stages of change in fruit and vegetable consumption behavior were investigated using questionnaires. A total of 2155 students were included (mean age ± SD = 18.4 years ± 2.4) at baseline, 989 of whom remained in post-intervention. Bivariate analyses indicated greater frequency of vegetable consumption (p=0.008) and lower frequency of sweets (p=0.032) and soft drinks (p=0.003) in the intervention group compared to controls. The change in behavior was also favorable for the intervention group (p=0.016). Analysis regression showed positive effects of complying with vegetable intake recommendations (OR = 1.54 CI95% 1.19-1.97) and favorable changes in lower sweet consumption (OR = 1.21 CI95% 1.02-1.43) in the intervention group, compared to controls. We found positive effects on the eating habits of the students as a result of The Saude na Boa Project.

Intervenções durante a adolescência são importantes para modificar a exposição a condutas alimentares de risco que contribuem para o desenvolvimento precoce da obesidade e de outras doenças crônicas não transmissíveis, como o excessivo consumo de alimentos de alta densidade energética e baixa quantidade de micronutrientes. O objetivo desse estudo foi avaliar a efetividade de uma intervenção de base escolar nas práticas alimentares de estudantes do ensino médio noturno. Intervenção randomizada e controlada, realizada em 2006, em duas capitais brasileiras (Florianópolis e Recife). A intervenção envolveu estratégias múltiplas para melhorar a alimentação e promover a atividade física. A frequência de consumo semanal de frutas, hortaliças, laticínios, salgadinhos, doces e refrigerantes, a frequência de consumo diário de frutas e hortaliças e os estágios de mudança de comportamento para consumo de frutas e hortaliças foram investigados mediante aplicação de questionários. Foram incluídos 2155 estudantes (idade média ± DP = 18,4 anos ± 2,4) na linha de base, dos quais 989 completaram o estudo. Após a intervenção houve maior frequência de consumo de verduras (p=0,008) e menor frequência de consumo de doces (p=0,032) e refrigerantes (p=0,003) no grupo intervenção, comparado ao controle. A mudança nos estágios de comportamento foi também favorável ao grupo intervenção (p=0,016). As análises de regressão mostraram efeitos positivos no atendimento às recomendações de consumo de verduras (RO = 1,54 IC95% 1,19-1,97) e mudanças favoráveis na diminuição do consumo de doces (RO = 1,21 IC95% 1,02-1,43) no grupo intervenção, comparado ao controle. Foram verificados efeitos positivos nas práticas alimentares dos estudantes como resultado do Projeto Saúde na Boa.

Evaluation of the family health strategy implementation in Santa Catarina in 2004 and 2008.

This study aimed to evaluate the implementation of the Family Health Program in municipalities of the State of Santa Catarina, Brazil at two different periods (2004 and 2008). Two hundred forty-four (83%) municipalities with complete health information data comprised the sample. Indicators of coverage, evidence of change in the healthcare model, and impact were calculated based on health system database. Official documents and observed distribution of measures at the country level were used in order to classify municipalities within each indicator. A high coverage level increased from 73 to 83% of the cities between 2004 and 2008. Most of them showed poor evidence of change in the healthcare model at both time points. Increased proportion of cities showed low levels of morbidity by diseases sensible to the primary health care from 2004 to 2008. Despite the fact that was improvement in coverage and impact indicators over four years, most of the cities studied showed poor evidence of change in the healthcare model, warning to the review of the health care practices and organization by health professionals and managers.