Individual characteristics, perceived neighborhood, and walking for transportation among older Brazilian people residing in a large urban area

This study aimed to investigate the association of individual and environmental characteristics with walking for transportation among older Brazilian people living in a large urban area. Data from 825 participants (≥ 60 years) from a multistage household survey in Belo Horizonte, Brazil, were used. Walking for transportation was evaluated using the International Physical Activity Questionnaire. The environmental variables included six perceived neighborhood scales (walkability, quality of services, physical disorder, safety, social disorder, and social cohesion). A Poisson regression analysis with robust variance was performed. The walking for transportation was significantly associated with walkability scale, lower family income (up to four minimum wages), very good/good self-rated health, and high social participation. Our results suggest that promoting adequate conditions for walkability in urban areas, expanding the opportunities for social participation, and improving general health is essential to increase walking levels for transportation among this older Brazilian population.

Perceived neighborhood and fall history among community-dwelling older adults living in a large Brazilian urban area: a multilevel approach

Few studies have examined the neighborhood features related to falls in the older population in low-and-middle-income countries, including Brazil. This study aimed to evaluate if perceived neighborhood features are related to falls among older Brazilian adults living in a large urban area. This cross-sectional study was conducted using data from 834 participants (≥60 years) from a multistage household survey in Belo Horizonte, Brazil. The association between fall history in the previous year and perceived neighborhood features (quality of services, physical and social disorder, and safety) was examined using multilevel logistic regression. The fall prevalence was 13.6%. Older adults living in neighborhoods with a higher physical disorder were more likely to report fall in the previous year, even after controlling for demographic, clinical and social variables (OR = 2.59; 95% CI = 1.14-5.87). The other neighborhood features investigated were not associated with a fall history. Our findings suggest that improving the physical environment represents an important strategy to prevent falls in the Brazilian urban older population.

Associations of the perceived neighborhood environment and screen time in adolescents living in a medium-sized city in Brazil: a cross-sectional study

Individual attributes have been investigated to explain sedentary behavior. However, few studies have evaluated this association at the neighborhood level. This study aimed to determine the association between screen time (ST) among adolescents and perceived neighborhood characteristics. This cross-sectional study was conducted using a multistage household survey in Vespasiano, Brazil, in 2015-2016. Logistic regression analyses were performed to assess the associations between the adolescent self-reported ST (television, computer, and video game > 2 h/day) and neighborhood characteristics (green space, sidewalk maintenance, street lighting, social disorder, safety during the day, and risk of violence) reported by an adult. Four hundred and twenty-three adolescents aged 11-17 participated in the study. ST was reported by 74.0% of the adolescents. After adjustment for confounder variables, neighborhood characteristics did not remain associated with ST. The results evidence no associations between ST among adolescents and perceived neighborhood environment and indicate the need for future studies of this relation.

Noise annoyance, sociodemographic and health patterns, and neighborhood perceptions in a Brazilian metropolis: BH Health Study

OBJECTIVE

The present study aims to analyze the association of noise annoyance with individual and sociodemographic factors and self-perception of the neighborhood in an urban center.

METHODS

Data were collected through a population-based cross-sectional study held in two of the nine health districts in the city of Belo Horizonte, Minas Gerais, Brazil, from 2008 to 2009. The study included 3,934 individuals of both genders, aged 18 years and older. The response variable was the self-perception of noise, investigated by the question: "In your neighborhood, does the noise bother you?" The explanatory variables were grouped into the following domains: sociodemographic, social determinants, self-rated health, and self-reported diseases.

RESULTS

The prevalence of noise annoyance was 47% for women and 39.8% for men. For both genders, noise annoyance was independently associated with bad traffic and the presence of loud music, discussions, and late-night parties.

CONCLUSION

Gender differences were identified in the association of noise annoyance with sociodemographic characteristics and self-reported morbidity. Traffic and social customs were the main sources of noise in the regions under study.

Exploring neighborhood socioeconomic disparity in self-rated health: a multiple mediation analysis

There is still a need for more empirical investigations to better understand the causal pathways by which neighborhood socioeconomic contexts translate into states of health. This study explored the relationship between neighborhood socioeconomic position and health, as well as the role of social cohesion, violence, places to buy healthy food, and sports and leisure spaces in mediating this relationship in a diverse set of neighborhoods in Brazil. We applied a general multiple mediation approach to analyze a cross-sectional survey of 4.046 adults living in 149 neighborhoods in 2008 and 2009. The property value was chosen as an indicator of neighborhood socioeconomic position and self-rated health as the outcome. The four mediators were constructed from the self-perception of the participants. Results: We found that people living in economically advantaged neighborhoods were less likely to report their health as being fair/poor/very poor (OR = 0.71; 95% CI = 0.63, 0.76) than people living in disadvantaged neighborhoods, and this effect was mediated by the perception of violence in the neighborhoods. On average, 8.4% of the neighborhood socioeconomic disparity in self-rated health may be explained by violence. We did not ascertain as mediators social cohesion, places to buy healthy food, and sports and leisure spaces. Violence perception mediates the relationship between neighborhood socioeconomic position and self-rated health. Targeted interventions designed to improve the health status of the population could usefully focus on reducing the level of violence in which people live.

Densidade de estabelecimentos que comercializam bebidas alcoólicas na área residencial está associada ao consumo de álcool em adolescentes?

RESUMO: Objetivos: Investigar a associação entre a densidade de estabelecimentos de venda de bebidas alcoólicas no entorno da residência dos adolescentes e a prevalência de consumo de álcool na vida e atual, ajustado por fatores individuais e familiares. Métodos: As informações provêm da pesquisa domiciliar por amostragem probabilística estratificada e por conglomerados em três estágios (setor censitário, domicílio, adulto e adolescente), realizada em Belo Horizonte, Brasil (Saúde em Beagá, 2008-9) e de fontes oficiais de estabelecimentos que comercializam bebidas alcoólicas, devidamente georreferenciados. O desfecho foi o autorrelato de consumo de álcool na vida e atual pelos adolescentes. A variável de exposição foi a densidade de estabelecimentos definida como número de locais de venda de bebida dentro do buffer de 200 metros da residência dos adolescentes. A associação foi estimada pela regressão de Poisson ajustada por fatores individuais e familiares. Resultados: Participaram 601 adolescentes de 14-17 anos; 53,3% eram homens e 71% tinham renda familiar até cinco salários mínimos. A prevalência de consumo de álcool na vida foi de 57,0% (intervalo de confiança de 95% - IC95% 51,5 - 62,6) e o atual de 11,9% (IC95% 8,7 - 15,0). Na análise multivariada, verificou-se associação significativa entre o consumo atual de bebidas alcoólicas e a densidade de lanchonetes (razão de prevalência - RP = 1,13; IC95% 1,03 - 1,24), bares (RP = 1,21; IC95% 1,05 - 1,38) e restaurantes (RP = 1,11; IC95% 1,02 - 1,21). Interações significativas entre densidade de estabelecimentos com sexo e idade foram encontradas. Conclusão: O consumo atual de álcool pode ser potencializado pela presença de alguns tipos de estabelecimentos localizados no buffer de 200 metros da residência dos adolescentes.

Built and Social Environment by Systematic Social Observation and Leisure-Time Physical Activity Report among Brazilian Adults: a Population-Based Study

The aim of this study was to investigate the relationship between built and social environment and leisure-time physical activity (LTPA) among adults living in an urban center. The individual data was from the household survey and the environmental data was assessed through systematic social observation by trained observers on street segments of respondents' residences. The relationship between environmental factors and LTPA was examined using multilevel logistic regression. The prevalence of LTPA was 30.2% (95% CI 27.4-32.9%). Individuals living in census tracts with higher walking environment indicators (OR = 1.20; 95% CI 1.02 to 1.40) and safety (OR = 1.18; 95% CI 1.01 to 1.38) were more likely to be active during leisure time, even after adjusting for individual variables. Improving the built and social environment is an important step for achieving higher levels of LTPA in the population in a middle-income country.

A multilevel model of life satisfaction among old people: individual characteristics and neighborhood physical disorder

Background

Considering the lack of studies that examine built environmental factors associated with life satisfaction among old people in developing countries, particularly those focused on Brazil, the aim of this study was to estimate the prevalence of life satisfaction among old adults residents in a Brazilian urban center and to investigate its association with individual characteristics and objective measures of the built environment.

Methods

A household survey (N = 832) in Belo Horizonte, Minas Gerais, Brazil (2008–2009) and a Systematic Social Observation (SSO) was used in this study. Life satisfaction was assessed through Self-Anchoring Ladder Scale, developed by Cantril, in 1965. Participants’ answers were categorized as satisfied (rungs 6–10) and dissatisfied (rungs 0–5). A Multilevel Poisson regression analysis with robust variance was performed.

Results

The prevalence of satisfaction with life was approximately 82%. Higher prevalence of life satisfaction was significantly associated with old people who reported higher incomes, higher religious participation, who practice physical activity and who perceive their health as good and very good. In contextual level, results showed that when the contextual features were adjusted separately by the individual characteristics they were no longer significant. The results also showed a lower prevalence of life satisfaction among those living in neighborhoods with higher physical disorder, even after adjusting for individual and other contextual characteristics.

Conclusions

The present findings suggest that life satisfaction should be assessed whenever evaluating urban redevelopment programs designed to improve neighborhood characteristics, reducing physical disorder, especially among old adults.

The Influence of Neighborhood Social Capital on Leisure-Time Physical Activity: a Population-Based Study in Brazil

Environmentally targeted approaches to promote physical activity are emerging in recent years as a complementary strategy to the traditional individual approaches. This study explored the relation between community social capital and leisure-time physical activity in an adult population-based sample in Brazil. We applied a generalized estimating equation approach to analyze a cross-sectional survey of 3667 adults living in 149 neighborhoods. Social capital was assessed by scales that measured collective efficacy and social cohesion in the neighborhood. We find that individuals living in areas with higher level of social cohesion were more likely to be physically active even after controlling for potentially confounding individual and area-level covariates (PR = 1.56; 95% CI = 1.13, 2.16). Collective efficacy was not significantly associated with leisure-time physical activity. Interventions to strengthen social cohesion in the community may be an avenue for promoting physical activity.

Socioeconomic position and disability: "The Belo Horizonte, Brazil Health Study"

This study aims to investigate the association of socioeconomic status and comorbidities of self-reported disability. Data were obtained from a population survey in Belo Horizonte from 2008 to 2009. The sample was probabilistic and stratified by conglomerates in three stages: census tracts, households and individuals. The outcome variable was disability, defined by the self-reported problems in bodily functions or structures. The explanatory variables were gender, age, self-reported morbidity and socioeconomic status index that included variables mother and respondent schooling and household income. The factorial analysis was used to evaluate the socioeconomic status index and logistic regression. The prevalence of disability was 10.43% (95% CI: 9.1-11.7%). Self-reported disability was associated with age (OR = 1.02; 95% CI: 1.01-1.03) and reporting of two or more diseases (OR = 3.24; CI 95%; 2.16-4.86) and socioeconomic status index (OR = 0.96; 95% CI: 0.95-0.97). The worse socioeconomic status and occurrence of diseases appear to contribute to the occurrence of disability. These results show health inequities among people with disabilities, and BPC relevance supporting vulnerable populations.

Neighborhood-based physical activity differences: Evaluation of the effect of health promotion program

Introduction

The practice of physical activity is an important factor in the prevention of health problems. However, a small portion of the population is physically active. Recent reviews show that physical activity classes in community settings have the potential to increase population levels of physical activity and reduce health inequalities.

Objective

To evaluate the effect of the Academias da Cidade Program in Belo Horizonte on the practice of physical activity in leisure time (PALT) by non-users living near the program centers.

Methods

We conducted a home-based health survey in Belo Horizonte (2008–2009) with 1,581 adults who were non-users of the program and who lived within a 1,500-meter radius of one active program center (exposed group) and two nonoperational centers with sites reserved for their construction (unexposed group). We collected data on PALT levels (≥150 minutes/week), which was measured with the Physical Activity International Questionnaire and analyzed with binary logistic regression using the Generalized Estimating Equations method. The propensity score was used as an adjustment variable to control the potential confusion in the measures of effect of exposure studied.

Results

The overall prevalence of the PALT was 26.5% in the exposed group and 22.7% in the unexposed group. The exposed group was more likely to be active in leisure time (OR = 1.05; CI 95%: 1.01–1.10). When considering the interaction between exposed group and distance, individuals in the exposed group who lived less than 500 meters from the program center were more likely to be active in leisure time (OR = 1.18, CI 95%: 1.03–1.35) compared to their counterparts.

Conclusion

Promoting physical activity in the community can favorably affect PALT levels among residents, especially those living closest to intervention centers. We believe the Academias da Cidade Program is a promising strategy to facilitate the access to appropriate spaces for the practice of physical activity and contribute to increase the levels physical activity within populations.

Self-rated health and perceived violence in the neighborhood is heterogeneous between young women and men

Background

Self-rated health (SRH) is the general perception of an individual’s own health and a key indicator to measure health in population-based studies. Few studies have examined the association between perceived urban violence and SRH among young adults. There were an estimated 475,000 deaths in 2012 as a result of homicide on the world. Sixty percent of these deaths occurred among males aged 15–44 years, making homicide the third leading cause of death for this population group. This study aimed to determine and quantify the association between sex-specific perception of violence in the neighborhood and SRH among young adults.

Methods

Participants included 955 young adults (18–29 years) residing in Belo Horizonte, Minas Gerais, Brazil between 2008 and 2009. Logistic regression analysis was used to estimate the strength of the associations. The perceived urban violence score was constructed from variables that assessed the respondents’ insecurity and perception of fear and danger of suffering some form of violence in the neighborhood using exploratory factor analysis.

Results

18,3% of respondents rated their health as fair/ poor/very poor. Among women, fair/ poor/very poor SRH was associated with age between 25 and 29 years, low socioeconomic status score, being dissatisfied with weight, not exercising regularly, not having a healthy diet, and having some chronic disease. Men who rated their health as fair/poor/very poor more frequently smoked, were dissatisfied with their weight, did not exercise regularly, consumed fewer fruits and vegetables, and had some chronic disease compared to men who rated their health as very good/good. In the final model, after adjusting for confounding variables, perceived violence in the neighborhood was associated with poor SRH in young women only (OR = 1.52; 95% CI: 1.04–2.21).

Conclusion

The results indicate that public and health policies should implement interventions on the neighborhood physical and social environment to improve the perception of safety and have a positive impact on people’s health, especially women.

Family context and the physical activity of adolescents: comparing differences

INTRODUCTION

Family context plays an important role with regard to the physical activity (PA) of adolescents. Intense changes in family composition, including an increase of single-parent structures can affect behavior.

OBJECTIVE

To estimate the prevalence of PA, between boys and girls of 11-17 years old, and investigate its association with family context variables.

METHODS

A cross-sectional population-based study "The BH Health Study" was conducted in two health districts of Belo Horizonte. The outcome was PA (≥ 300 minutes/week), which was created from a score that combined time and frequency of cycling and walking to school and leisure time. The independent variables were family context, sociodemographic characteristics and nutritional status. Poisson regression was used with a robust variance and was stratified by gender.

RESULTS

1,015 adolescents participated, 52.8% of whom were male, with a mean age of 14 (± 1.9) years old. The prevalence of PA was 38.8% for girls and 54.5% for boys. Among girls, the family context variables were not significantly associated with PA. Boys were more active when there was an adult in the household reported who did PA (PR = 1.26; 95%CI 1.02 - 1.55) and when living with a single mother (PR = 1.63; 95%CI 1.01 - 2.63). It was also observed that boys that live with their mother and father (PR=1.90; 95%CI 1.06 - 3.41) or only with their mother (PR = 1.82; 95%CI 1.01 - 3.27) reported did PA more frequently in their free time.

CONCLUSION

The presence of an active adult in the household, mainly the mother, appears to be an important factor associated with boys' PA.

[Indicators of physical and social neighborhood attributes measured by the Systematic Social Observation method]

Place of residence is heavily shaped by social position, indicating that neighborhood characteristics can be important contributing factors to health iniquities. The objectives were to construct indicators of the physical and social environment in an urban context based on variables obtained with the Systematic Social Observation method (SSO) and to analyze them according to the Health Vulnerability Index (HVI). The instrument was developed to determine the characteristics of the physical and social neighborhood in two health districts in Belo Horizonte, Minas Gerais State, Brazil. Data were collected from April to June 2011. To develop the simple indicators, ratios were calculated for the number of observed items per residence in each segment. Composite indicators were built using principal components analysis via covariance matrix. The final sample consisted of 1,295 street segments nested in 147 neighborhoods. Indicators referring to street conditions and transit items, mobility, appearance, housing and property, physical disorder, safety/security, and services showed a dose-response behavior in relation to HVI (p < 0.05). Indicators pertaining to place to practice physical activity and leisure did not show significant differences. The indicators displayed coherent behavior towards different HVI strata and proved adequate within each respective domain and subdomain.

Prevalência e fatores associados ao autorrelato de deficiência: uma comparação por sexo

RESUMO: Objetivo: Estimar a prevalência de deficiência e sua associação com características sociodemográficas e de saúde, estratificadas por sexo. Métodos: Estudo transversal com amostra probabilística de 4.048 residentes com idade ≥ 18 anos em dois distritos sanitários de Belo Horizonte (MG) durante o período 2008-2009. A variável resposta “deficiência” foi definida com base no autorrelato de problema nas funções ou nas estruturas do corpo. As variáveis explicativas foram sociodemográficas (“sexo”, “idade”, “cor de pele”, “estado civil”, “anos de estudos” e “renda familiar”) e de saúde (“morbidade referida”, “autoavaliação de saúde”, “qualidade de vida” e “satisfação com a vida”). Empregou-se a análise multivariada pela árvore de decisão, utilizando-se o algoritmo Chi-square Automatic Interaction Detector. Resultados: A prevalência global de deficiência foi de 10,4%, maior no sexo feminino (11,9%; intervalo de confiança - IC95% 10,2-13,6) do que no masculino (8,7%; IC95% 6,8-10,5). Na análise multivariada, as variáveis que melhor discriminaram a deficiência foram “idade” e “morbidade” no sexo feminino, “baixa escolaridade” e “pior autoavaliação de saúde” no sexo masculino. O autorrelato de deficiência foi mais frequente entre mulheres em idade produtiva (40 a 59 anos) e de menor renda, e entre homens de menor escolaridade e renda. Com relação às condições de saúde, os maiores percentuais de deficiência foram observados, para ambos os sexos, entre aqueles que relataram três ou mais doenças e pior percepção de saúde. Conclusão: Os resultados reforçam a necessidade de atenção diferenciada, uma vez que mulheres em idade produtiva e homens com menor escolaridade são mais vulneráveis à ocorrência de deficiência.

The place where you live and self-rated health in a large urban area

The aim of this study was to determine and quantify the association between one's perception of the place of residence and self-rated health. 4,048 adult residents of Belo Horizonte, Minas Gerais State, Brazil, participated in the study in 2008 and 2009. Ordinal logistic regression was used to estimate the magnitude of the association. Health was rated as good or very good, fair, or poor or very poor by 65.7%, 27.8%, and 6.5% of the subjects, respectively. Better self-rated health was associated with the following neighborhood characteristics: positive evaluation of aesthetics and mobility, better quality of public services, less physical and social disorder. The perception of violence had a borderline statistically significant association with worse self-rated health. These associations persisted after controlling for potential confounding demographic, socioeconomic, health, and health behavior variables. The results indicate that public and health policies should incorporate interventions that address the physical and social environment in addition to policies focused on individuals.

Social context of neighborhood and socioeconomic status on leisure-time physical activity in a Brazilian urban center: The BH Health Study

This study aimed to estimate the prevalence of leisure-time physical activity and investigate its association with contextual characteristics of the social and physical environment in different socioeconomic statuses, using a household survey in Belo Horizonte, Minas Gerais State, Brazil (2008-2009). Leisure-time physical activity was measured by the International Physical Activity Questionnaire; and the social and physical environment by scales arising from perception of neighborhood attributes. Multilevel logistic regression analysis was performed separately for each socioeconomic status stratum. The overall prevalence of leisure-time physical activity was 30.2%, being 20.2% amongst participants of low socioeconomic status, 25.4% in the medium and 40.6% in the high socioeconomic status group. A greater perception of social cohesion was associated with increased leisure-time physical activity only amongst participants of the lowest socioeconomic status even after adjusting for individual characteristics. The results demonstrate the importance of social cohesion for the promotion of leisure-time physical activity in economically disadvantaged groups, supporting the need to stimulate interventions for enhancing social relationships in this population.

Self-rated health in urban adults, perceptions of the physical and social environment, and reported comorbidities: The BH Health Study

This study assesses the prevalence of poor self-rated health and investigates its association with individual and environmental characteristics in adults with and without reported morbidity. A household survey assessed 4,048 adults in two districts of Belo Horizonte, Minas Gerais State, Brazil. We used Poisson regression with robust variance stratified by the presence of reported morbidity. Prevalence of poor self-rated health was 29.9% (42.6% in those with morbidity and 13.1% in the group without morbidity). All assessed domains were associated with self-rated health in subjects with reported morbidity. In the group without reported morbidity, the following were associated with self-rated health: social environment, socio-demographic factors, lifestyle, and psychological health. Perceived problems in the environment were associated with poor self-rated health in both groups, even after hierarchical adjustment. The results suggest the importance of investigating self-rated health stratified by reported morbidity and reinforce the need to include variables that characterize the physical and social environment.

Association of socioeconomic factors with body mass index, obesity, physical activity, and dietary factors in Belo Horizonte, Minas Gerais State, Brazil: The BH Health Study

Obesity prevalence is rapidly increasing in developing countries. Existing research investigating social patterning of obesity and its risk factors in Latin American urban contexts has inconsistent findings. This study analyzed a multistage household survey in adults in Belo Horizonte, Minas Gerais State, Brazil. Marginal models were used to examine the association of education and household and neighborhood income with body mass index (BMI), obesity, physical inactivity, and low fruit and vegetable intake after adjusting for age and ethnicity and stratifying by sex. BMI and obesity were inversely associated with education in women. BMI was positively associated with household and neighborhood income in men. Additionally, physical inactivity and low fruit and vegetable intake were inversely associated with education and household income in both men and women, and physical inactivity was inversely associated with neighborhood income in men. Understanding the drivers of these patterns will allow for development of appropriate policy and interventions to reduce cardiovascular disease risk in large cities in Latin America.

Overweight in men and women among urban area residents: individual factors and socioeconomic context

The present study aimed to evaluate factors associated with overweight among adults living in urban areas, with the income of the census tract as a context variable. The survey assessed individuals from two health districts of Belo Horizonte, Minas Gerais State, Brazil. Excess weight was determined by body mass index > 25kg/m2. Multilevel logistic regression was used. The sample comprised 2,935 individuals aged 20 to 60 years. The prevalence of overweight was 52.3% (95%CI: 49.9-54.8), similar between men and women. Higher schooling proved to be protective against overweight in women and a risk for men. Living in census tracts with higher income was associated with excess weight only in males. Report of the consumption of diet soft drinks was positively associated with overweight in both sexes. The occurrence of this event seems to be influenced by different factors or to interrelate differently in men and women.

Nutritional status of urban adolescents: individual, household and neighborhood factors based on data from The BH Health Study

Abstract The increasing prevalence of overweight in young people suggests that adolescent nutritional status is influenced by environmental factors. Using hierarchical modelling, this study aimed to analyse the association between individual, household and neighborhood factors and adolescent nutritional status and well-being. The study used data from a population-based household survey conducted in Belo Horizonte, the capital of the State of Minas Gerais, Brazil, between 2008 and 2009. Data was obtained from an adult and adolescent in each household using a confidential questionnaire and anthropometric measurements. Adolescent nutritional status was evaluated using multinomial regression analysis considering distal and proximal influences. The prevalence of overweight and thinness among the sample of 1,030 adolescents was 21.9% and 4.6%, respectively. Although variables from all blocks remained in the final model, head of household education level, family habits and family nutritional status were shown to strongly influence adolescent nutritional status. New approaches to public health are needed which focus on raising awareness and promoting health education targeting teenagers and their social context.

Leisure-time physical activity in the vicinity of Academias da Cidade Program in Belo Horizonte, Minas Gerais State, Brazil: the impact of a health promotion program on the community

Abstract This study analyzed leisure-time physical activity among 1,621 adults who were non-users of the Academias da Cidade Program in Belo Horizonte, Minas Gerais State, Brazil, but who lived in the vicinity of a fitness center in operation (exposed Group I) or in the vicinity of two sites reserved for future installation of centers (control Groups II and III). The dependent variable was leisure-time physical activity, and linear distance from the households to the fitness centers was the exposure variable, categorized in radial buffers: < 500m; 500-1,000m; and 1,000-1,500m. Binary logistic regression was performed with the Generalized Estimation Equations method. Residents living within < 500m of the fitness center gave better ratings to the physical environment when compared to those living in the 1,000 and 1,500m buffers and showed higher odds of leisure-time physical activity (OR = 1.16; 95%CI: 1.03-1.30), independently of socio-demographic factors; the same was not observed in the control groups (II and III). The findings suggests the program’s potential for influencing physical activity in the population living closer to the fitness center and thus provide a strategic alternative for mitigating inequalities in leisure-time physical activity.

Influence of individual and socio-environmental factors on self-rated health in adolescents

OBJECTIVE

This study aimed to determine if individual and socio-environmental characteristics can influence the self-rated health among Brazilian adolescents.

METHODS

It included 1,042 adolescents from 11 to 17 years old who participated in the Beagá Health Study (Estudo Saúde em Beagá), a multistage household survey in an urban setting. Logistic regression analyses were performed to determine the association between the self-rated health and the following explanatory variables: sociodemographic factors, social support, lifestyle, physical and psychological health.

RESULTS

Good/very good and reasonable/poor/very poor self-rated health were reported by 88.5 and 11.5% of adolescents, respectively. The data on sociodemographic factors (SES), social support, lifestyle, psychological and physical health were associated with poor self-rated health (p ≤ 0.05). The associated variables were: age 14 - 17 years (OR =1.71; 95%CI 1.06 - 2.74), low SES (OR =1.68; 95%CI 1.05 - 2.69), few (OR = 2.53; 95%CI 1.44 - 4.46) and many quarrels in family (OR = 9.13; 95%CI 4.53 - 18.39), report of unkind and unhelpful peers (OR = 2.21; 95%CI 1.11 - 4.43), consumption of fruits < 5 times a week (OR = 1.78; 95CI% 1.07 - 2.95), physical inactivity (OR = 2.31; 95%CI 1.15 - 4.69), overweight (OR = 2.42; 95%CI 1.54 - 3.79) and low level of life satisfaction (OR = 2.31; 95%CI 1.34 - 3.98).

CONCLUSIONS

Poor self-rated health among adolescents was associated with individual and socio-environmental characteristics related to family, school and neighborhood issues. Quantifying the self-rated health according to the theoretical framework of the child's well-being should help in arguing that self-rated health might be a strong indicator of social inequities for the studied population.

Bullying among adolescents in a Brazilian urban center - "Health in Beagá" Study

OBJECTIVE

To analyze the prevalence of bullying and its associated factors in Brazilian adolescents.

METHODS

Data were used from a population-based household survey conducted by the Urban Health Observatory (OSUBH) utilizing probability sampling in three stages: census tracts, residences, and individuals. The survey included 598 adolescents (14-17 years old) who responded questions on bullying, sociodemographic characteristics, health-risk behaviors, educational well-being, family structure, physical activity, markers of nutritional habits, and subjective well-being (body image, personal satisfaction, and satisfaction with their present and future life). Univariate and multivariate analysis was done using robust Poisson regression.

RESULTS

The prevalence of bullying was 26.2% (28.0% among males, 24.0% among females). The location of most bullying cases was at or on route to school (70.5%), followed by on the streets (28.5%), at home (9.8%), while practicing sports (7.3%), at parties (4.6%), at work (1.7%), and at other locations (1.6%). Reports of bullying were associated with life dissatisfaction, difficulty relating to parents, involvement in fights with peers and insecurity in the neighborhood.

CONCLUSIONS

A high prevalence of bullying among participating adolescents was found, and the school serves as the main bullying location, although other sites such as home, parties and workplace were also reported. Characteristics regarding self-perception and adolescent perceptions of their environment were also associated with bullying, thus advancing the knowledge of this type of violence, especially in urban centers of developing countries.

Self-Rated Health among Urban Adolescents: The Roles of Age, Gender, and Their Associated Factors

Health status is often analyzed in population surveys. Self-rated health (SRH) is a single-item summary measure of the perception of one’s health. In Brazil, studies on the SRH of adolescents remain scarce, especially those aiming to understand the domains that compose this construct. Therefore, the aim of this study is to determine the prevalence of poor SRH and its associated factors among 11- to 13-year-olds and 14- to 17-year-olds living in a large urban center in Brazil. This cross-sectional study was conducted using a household survey across Belo Horizonte that included 1,042 adolescents. Stratified logistic regression models were used for each age group to assess the associations between worse SRH and the following variables: socio-demographic, social and family support, lifestyles, psychological health, and anthropometry. Approximately 11% (95% CIs = 8.7–13.6) of the studied adolescents rated their health as poor, and SHR decreased with age among males and females. This trend was more pronounced among girls (from 6.9% among 11- to 13-year-old girls to 16.9% among 14- to 17-year-old girls) than boys (from 8.3% among 11- to 13-year-old boys to 11% among 14- to 17-year-old boys). Worse SRH was associated with family support (as assessed by the absence of parent-adolescent conversations; odds ratio [OR] = 3.5 among 11- to 13-year-olds), family structure (OR = 2.8 among 14- to 17-year-olds), and argument reporting (OR = 8.2 among 14- to 17-year-olds). Among older adolescents, the consumption of fruit fewer than five times per week (OR = 2.4), life dissatisfaction (OR = 2.8), underweight status (OR = 6.7), and overweight status (OR = 2.7) were associated with poor SRH. As adolescents age, their universe expands from their relationship with their parents to include more complex issues, such as their lifestyles and life satisfaction. Therefore, these results suggest the importance of evaluating SRH across adolescent age groups and demonstrate the influence of the family environment (in addition to other factors) on negative health assessments, particularly among 14- to 17-year-olds.

Instrumento para condução de observação social sistemática: métodos e resultados da concordância interobservadores

A observação social sistemática tem sido utilizada para a coleta de informações do entorno físico e social da vizinhança. Os objetivos deste artigo foram descrever a operacionalização da observação social sistemática do entorno físico e social de vizinhanças urbanas e avaliar a concordância do instrumento utilizado. O instrumento foi elaborado para coleta de informações em diferentes domínios. No total, 1.306 segmentos de rua, pertencentes a 149 diferentes vizinhanças de Belo Horizonte, Minas Gerais, Brasil, foram observados. Para o estudo de concordância, 149 segmentos foram reauditados. Para se estabelecer a concordância, foi utilizado o kappa Fleiss interobservador. A concordância média dos itens foi 0,57 (DP = 0,24); 53% tiveram concordância substancial ou quase perfeita; 20,4%, moderada. O instrumento se mostrou adequado para observação de características com maior estabilidade temporal, principalmente quanto a serviços, caracterização dos imóveis, ambiente para pedestres e segurança.

Assessing the psychometric and ecometric properties of neighborhood scales in developing countries: Saúde em Beagá Study, Belo Horizonte, Brazil, 2008-2009

Although specific measurement instruments are necessary to better understand the relationship between features of neighborhoods and health, very few studies have developed instruments to measure neighborhood features in developing countries. The objective of the study was to develop valid and reliable measures of neighborhood context useful in a Latin American urban context, assess their psychometric and ecometric properties, and examine individual and neighborhood-level predictors of these measures. We analyzed data from a multistage household survey (2008-2009) conducted in Belo Horizonte City by the Observatory for Urban Health. One adult in each household was selected to answer a questionnaire that included scales to measure neighborhood domains. Census tracts were used to proxy neighborhoods. Internal consistency was evaluated by Cronbach's alpha, and multilevel models were used to estimate ecometric properties and to estimate associations of neighborhood measures with socioeconomic indicators. The final sample comprised 4048 survey respondents representing 149 census tracts. We assessed ten neighborhood environment dimensions: public services, aesthetic quality, walking environment, safety, violence, social cohesion, neighborhood participation, neighborhood physical disorder, neighborhood social disorder, and neighborhood problems. Cronbach's alpha coefficients ranged from 0.53 to 0.83; intraneighborhood correlations ranged from 0.02 to 0.53, and neighborhood reliability varied from 0.76 to 0.99. Most scales were associated with individual and neighborhood socioeconomic predictors. Questionnaires can be used to reliably measure neighborhood contexts in developing countries.

[Silhouette scales and body satisfaction in adolescents: a systematic literature review]

The purpose of this study was to summarize studies on adolescents' body satisfaction, focusing on the use of silhouette scales. A systematic review was carried out on MEDLINE, LILACS, SciELO, and in unpublished papers. The final analysis included 36 studies. The majority adopted the scale proposed by Stunkard et al., self-administered, presented in ascending order and on a single sheet of paper. Most studies compared characteristics on satisfaction and dissatisfaction, used the chi-square test, and did not test for confounding. Among 18 studies included in the meta-analysis, prevalence of body dissatisfaction ranged from 32.2% to 83%. The review showed wide heterogeneity between studies (p-value = 0.000; I(2) = 87.39) even after sub-group analysis and the absence of relevant information for proper comparison of studies. The article concludes by recommending greater rigor in application of the scales and presentation of study methods on body satisfaction assessed by silhouette scales, in addition to new methodological studies and those that elucidate factors related to body satisfaction.

Avaliação da implantação do Método Canguru por gestores, profissionais e mães de recém-nascidos

Trata-se de estudo de avaliação qualitativa que buscou compreender dificuldades e facilidades da implantação do Método Canguru em maternidades brasileiras capacitadas pelo Ministério da Saúde sob a ótica de profissionais de saúde, gestores e mães de recém-nascidos de baixo peso atendidos nesses serviços. Realizaram-se entrevistas semiestruturadas durante visita in loco as maternidades. Utilizou-se a análise estrutural de narração como método de análise dos dados. Os principais núcleos avaliativos centrais identificados foram: importância do método para a assistência ao recém nascido; importância do apoio institucional para a sustentabilidade do método. Para o aprofundamento da reflexão sobre os resultados encontrados, o referencial teórico da análise institucional foi fundamental. Apesar das resistências, a institucionalização do método está sendo realizada nas maternidades, porém, há necessidade de se manter capacitações periódicas e de se alocar maiores recursos que permitam melhorar a infraestrutura dos serviços, refletindo na humanização do cuidado de forma mais efetiva.

Safety of Kangaroo Mother Care in intubated neonates under 1500 g

Kangaroo Mother Care (KMC) has been used as a technique to promote mother-child bonding. It has been discussed of its use for preterm under mechanical ventilation. The objective of this study is to assess the vital signs of preterm infants with a birth weight lower than 1500 g who are under intubation and hemodynamically stable in KMC. Forty-three preterm infants with a mean gestational age at birth of 29.1 ± 1.6 weeks and a mean birth weight of 1.1334 ± 2318 g. The preterm infants were longitudinally assessed for 90 min (15 min before, 60 min in KMC and 15 min after). These periods were compared, and the dependent variables heart rate, oxygen saturation (SpO(2)), axilary temperature and mean arterial blood pressure were statistically significant (p < 0.05). Clinically, however, the results were not significantly different. The results show that KMC is a safe method under the study conditions presented here.

Cuidado mãe canguru em recém-nascidos pré-termo sob suporte ventilatório: avaliação dos estados comportamentais

OBJETIVOS: descrever os estados comportamentais dos recém-nascidos com peso inferior a 1500 g, em ventilação mecânica, antes, durante e após o cuidado mãe canguru (CMC). MÉTODOS: estudo do tipo quase experimental em que os estados comportamentais definidos como sono profundo, ativo, sonolência, alerta inativo, alerta ativo e choro de acordo com a Escala Neonatal de Brazelton foram avaliados em três momentos: 15 minutos antes do CMC, 30 minutos após o início da exposição e 15 minutos após o CMC num total de uma hora de exposição. Quarenta e quatro recém-nascidos pré-termo (poder estatístico >0,9), com idade gestacional média de 29 semanas e peso médio de 1096 g, intubados e estáveis do ponto de vista hemo-dinâmico, foram selecionados por amostra de entrada contínua. RESULTADOS: evidenciou-se o favorecimento do sono, principalmente o sono profundo (52,3%), comparado aos períodos antes (6,8%) e após (13,6%) (p<0,001) o CMC. Além disso, os recém-nascidos apresentaram sinais de dor após o CMC com diferença significativa (p=0,002). CONCLUSÕES: o cuidado mãe canguru, nas condições deste estudo, pode ser considerado como uma estratégia favorecedora para o desenvolvimento neurocomportamental.

Processo de trabalho na Unidade de Terapia Intensiva Neonatal: construção de uma atenção orientada pela integralidade

Trata-se de um estudo qualitativo, que teve como objetivo analisar a ação dos profissionais e sua contribuição na construção da integralidade do cuidado ao recém-nascido internado na Unidade de Terapia Intensiva Neonatal (UTIN). O estudo foi realizado no Hospital Sofia Feldman, em Belo Horizonte (Minas Gerais), e teve como sujeitos 10 profissionais que assistem o recém-nascido na UTIN, e 7 pais de recém-nascidos ali internados. Para coleta de dados utilizaram-se a Oficina de Trabalho e a Observação Participante. O tratamento e a análise dos dados coletados foram feitos por meio de Análise de Discurso. A partir dos dados, evidenciaram-se as potencialidades da prática dos profissionais orientada pelo sentido da integralidade, os atos de saúde que materializam ou não a integralidade, as diferentes percepções dos participantes acerca do trabalho realizado pela equipe, e de que forma a lógica da organização do processo de trabalho inscreve o fazer do coletivo de trabalhadores.

A perspectiva das mães sobre o óbito infantil: uma investigação além dos números

Estudo qualitativo realizado em Belo Horizonte, Minas Gerais, Brasil, com objetivo de investigar a morte infantil sob a perspectiva das mães. Foram entrevistadas 16 mães que haviam perdido seus bebês, a maioria no período neonatal. As entrevistas foram analisadas tomando-se como principais categorias a percepção do processo saúde-doença-morte, a relação médico-paciente e a qualidade da assistência. A descontinuidade entre o pré-natal e o parto, as dificuldades enfrentadas para a realização do parto, a peregrinação das gestantes, a falta de comunicação com os profissionais de saúde, a dissociação entre as condições hospitalares oferecidas e as necessidades percebidas, foram algumas das situações evidenciadas. Medo, solidão, abandono, insegurança, impotência foram sentimentos que acompanharam as mães por ocasião do parto e durante o curto período de vida da criança. A iniqüidade de direitos, como categoria mais abrangente, permeou os diversos depoimentos, revelando um processo de exclusão das mães e de suas crianças enquanto usuárias do sistema público de saúde.

Avaliação dos recursos hospitalares para assistência perinatal em Belo Horizonte, Minas Gerais

OBJETIVO: Verificar a adequação de recursos hospitalares no atendimento às gestantes/neonatos, no ano de 1996. MÉTODOS: Trata-se de um estudo transversal abrangendo 28 hospitais-maternidade em funcionamento no município de Belo Horizonte, MG. Utilizou-se um modelo de avaliação denominado "níveis de complexidade e segurança em potencial de unidades perinatais de hospitais-maternidade", elaborado a partir da avaliação de três grandes áreas hospitalares: infra-estrutura geral, infra-estrutura clínica-perinatal e recursos das unidades perinatais. Foram desenvolvidos dois escores de pontos envolvendo essas áreas hospitalares, totalizando 1.000 pontos quando considerada a assistência perinatal de risco habitual e 2.000 pontos para assistência perinatal de médio/alto risco. A partir de 500 pontos, os hospitais foram classificados em dois níveis: I-A e I-B (para risco habitual) e seis níveis de I-A a III-B (para médio/alto risco). RESULTADOS: Na avaliação com o escore proposto para risco habitual, cinco hospitais foram considerados inadequados para realizarem atendimento a qualquer tipo de parto, classificados como nível zero; esse número aumentou para sete, quando se utilizou o escore para parto de médio/alto risco. CONCLUSÃO: O modelo de avaliação utilizado mostrou-se adequado para classificar os hospitais de acordo com a infra-estrutura disponível para assistência perinatal.

Weight of preterm newborns during the first twelve weeks of life

A longitudinal and prospective study was carried out at two state-operated maternity hospitals in Belo Horizonte during 1996 in order to assess the weight of preterm appropriate-for-gestational-age newborns during the first twelve weeks of life. Two hundred and sixty appropriate-for-gestational-age preterm infants with birth weight <2500 g were evaluated weekly. The infants were divided into groups based on birth weight at 250-g intervals. Using weight means, somatic growth curves were constructed and adjusted to Count's model. Absolute (g/day) and relative (g kg-1 day-1) velocity curves were obtained from a derivative of this model. The growth curve was characterized by weight loss during the 1st week (4-6 days) ranging from 5.9 to 13.3% (the greater the percentage, the lower the birth weight), recovery of birth weight within 17 and 21 days, and increasingly higher rates of weight gain after the 3rd week. These rates were proportional to birth weight when expressed as g/day (the lowest and the highest birth weight neonates gained 15.9 and 30.1 g/day, respectively). However, if expressed as g kg-1 day-1, the rates were inversely proportional to birth weight (during the 3rd week, the lowest and the highest weight newborns gained 18.0 and 11.5 g kg-1 day-1, respectively). During the 12th week the rates were similar for all groups (7.5 to 10.2 g kg-1 day-1). The relative velocity accurately reflects weight gain of preterm infants who are appropriate for gestational age and, in the present study, it was inversely proportional to birth weight, with a peak during the 3rd week of life, and a homogeneous behavior during the 12th week for all weight groups.

Arterial blood pressure of term newborns during the first week of life

The progressive behavior of the blood pressure of term newborns during the first week of life was assessed by the simultaneous use of oscillometric and Doppler methods. A total of 174 term neonates born at the Municipal Hospital Odilon Behrens in Belo Horizonte, from March 1996 to February 1997, were prospectively assessed. The oscillometric and Doppler ultrasonic methods were simultaneously used for four consecutive recordings obtained at 12 +/- 6, 24 +/- 6 and 72 +/- 24 h and on the 7th +/- 1 day of life. The combined use of the two methods simplified the procedure, with automatic cuff inflation and deflation, and speed was properly controlled with an automatic pressure monitor. The procedure was performed using a Y-connection to the mercury sphygmomanometer, with blood pressure being recorded with an automatic device and systolic blood pressure being measured simultaneously by Doppler ultrasound. The newborns were awake, not crying and in the supine position. A statistically significant increase in systolic and diastolic blood pressure was observed between the first and second, and the third and fourth measurements by Doppler and oscillometric methods. No significant correlation between birth weight, length, ponderal index and blood pressure was observed. The technique used represents a simpler and more accurate procedure for blood pressure measurement.

[Growth of preterm infants]

A hundred-forty-one infants born from 26 to 36 weeks, appropriate-for-gestational-age, were followed from birth until the corrected postmenstrual age of 42 weeks. Weight, height and cephalic perimeter were measured on a weekly basis. Based on the average values and percentiles of these measurements it was adjusted a third degree polynomial function. The growth curves obtained, when compared with the so-called intra-uterine growth curves, showed that during the 40th and 42nd postmenstrual weeks the averages and medians are similar. It was observed that the growth dynamics of the preterm infants showed a catch-up pattern in the immediate postnatal period.

[Prevalence of breast feeding in low birth weight infants]

The present situation regarding the breast feeding of children born with a weight of 2,500 grammes or less (LWB) at the Hospital das Clínicas of the Medical School of the Universidade de S. Paulo in Ribeirão Preto (Brazil) was studied. The study was descriptive and the data were obtained through a longitudinal follow-up carried over the period from October 1985 to September 1986 inclusive. Of the 222 children included in the study, 30 (13.5%) infants were not breastfed. Thus the incidence of breast feeding among this population was of 86.5%. At 3 months 62.5% of these infants were still being breastfed. At 6 months this figure fell to 38.5% and only 25.0% were still being breast-fed at the end of 12 months. The average duration of breast feeding for the 192 children that had started it was of 4 months. An association was found between the level of literacy of the mothers and the duration of breast feeding. Birthweight was found to be associated with the incidence and duration of breast feeding in general, as well as with the incidence of exclusive breast feeding. These data are considerably lower than recent figures obtained from the populations of well-developed countries, especially than those of Finnish infants born with a weight of less than 1.500 g. Action programmes involving the community and/or the Institution must be implemented in order to improve these figures.