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Correction to Lancet Gastroenterol Hepatol 2022; 7: 627-47. Lancet Gastroenterol Hepatol. 2022 Aug;7(8):704. doi: 10.1016/S2468-1253(22)00210-2. PMID: 35809605. Background: Colorectal cancer is the third leading cause of cancer deaths worldwide. Given the recent increasing trends in colorectal cancer incidence globally, up-to-date information on the colorectal cancer burden could guide screening, early detection, and treatment strategies, and help effectively allocate resources. We examined the temporal patterns of the global, regional, and national burden of colorectal cancer and its risk factors in 204 countries and territories across the past three decades. Methods: Estimates of incidence, mortality, and disability-adjusted life years (DALYs) for colorectal cancer were generated as a part of the Global Burden of Diseases, Injuries and Risk Factors Study (GBD) 2019 by age, sex, and geographical location for the period 1990-2019. Mortality estimates were produced using the cause of death ensemble model. We also calculated DALYs attributable to risk factors that had evidence of causation with colorectal cancer. Findings: Globally, between 1990 and 2019, colorectal cancer incident cases more than doubled, from 842 098 (95% uncertainty interval [UI] 810 408-868 574) to 2·17 million (2·00-2·34), and deaths increased from 518 126 (493 682-537 877) to 1·09 million (1·02-1·15). The global age-standardised incidence rate increased from 22·2 (95% UI 21·3-23·0) per 100 000 to 26·7 (24·6-28·9) per 100 000, whereas the age-standardised mortality rate decreased from 14·3 (13·5-14·9) per 100 000 to 13·7 (12·6-14·5) per 100 000 and the age-standardised DALY rate decreased from 308·5 (294·7-320·7) per 100 000 to 295·5 (275·2-313·0) per 100 000 from 1990 through 2019. Taiwan (province of China; 62·0 [48·9-80·0] per 100 000), Monaco (60·7 [48·5-73·6] per 100 000), and Andorra (56·6 [42·8-71·9] per 100 000) had the highest age-standardised incidence rates, while Greenland (31·4 [26·0-37·1] per 100 000), Brunei (30·3 [26·6-34·1] per 100 000), and Hungary (28·6 [23·6-34·0] per 100 000) had the highest age-standardised mortality rates. From 1990 through 2019, a substantial rise in incidence rates was observed in younger adults (age

Introduction: Functional disabilities are more prevalent in older adults with multimorbidity and depression. However, few studies have investigated the combination of multimorbidity and depression with functional disability. This study aims to verify whether symptoms of depression and multimorbidity combined increase the prevalence of functional disability in Brazilian older adults.Material and methods: This is a cross-sectional study conducted with data from the Brazilian Longitudinal Study of Aging (ELSI-Brazil) baseline examination in 2015–2016 in adults aged 50 years and older. The variables included were basic (BADL) and instrumental activities of daily living (IADL), depressive symptoms, multimorbidity (≥2 chronic diseases), sociodemographic variables, and lifestyle. Logistic regression was performed to estimate crude and adjusted odds ratios.Results: A total of 7,842 participants over 50 years of age were included. Of these, 53.5% were women and 50.5% were between 50 and 59 years old, 33.5% reported ≥4 depressive symptoms, 51.4% had multimorbidity, 13.5% reported difficulty in performing at least one BADL, and 45.1% reported difficulty in performing the IADL. In the adjusted analysis, the prevalence of difficulty on BADL was 6.52 (95% CI: 5.14; 8.27) and on IADL was 2.34 (95% CI: 2.15; 2.55), higher for those with depression and multimorbidity combined when compared with those without these conditions.Conclusion: The combination of symptoms of depression and multimorbidity may increase functional impairments in the BADL and IADL of Brazilian older adults, impairing self-efficacy, independence, and autonomy. Early detection of these factors benefits the person, their family, and the healthcare system for health promotion and disease prevention.

Background Understanding the impact of national public expenditure and its allocation on child mortality may help governments move towards target 3.2 proposed in the 2030 Agenda. The objective of this study was to estimate the impacts of governmental expenditures, total, on health, and on other sectors, on neonatal mortality and mortality of children aged between 28 days and five years. Methods This study has an ecological design with a population of 147 countries, with data between 2012 and 2019. Two steps were used: first, the Generalized Propensity Score of public spending was calculated; afterward, the Generalized Propensity Score was used to estimate the expenditures’ association with mortality rates. The primary outcomes were neonatal mortality rates (NeoRt) and mortality rates in children between 28 days and 5 years (NeoU5Rt). Results The 1% variation in Int$ Purchasing Power Parity (Int$ PPP) per capita in total public expenditures, expenditure in health, and in other sectors were associated with a variation of -0.635 (95% CI -1.176, -0.095), -2.17 (95% CI -3.051, -1.289) -0.632 (95% CI -1.169, -0.095) in NeoRt, respectively The same variation in public expenditures in sectors other than health, was associates with a variation of -1.772 (95% CI -6.219, -1.459) on NeoU5Rt. The results regarding the impact of total and health public spending on NeoU5Rt were not consistent. Conclusion Public investments impact mortality in children under 5 years of age. Likely, the allocation of expenditures between the health sector and the other social sectors will have different impacts on mortality between the NeoRt and the NeoU5Rt.

Objetivo: O objetivo deste estudo é revisar subsídios sobre o perfil neuropsicológico de mulheres com câncer de mama em tratamento quimioterápico. Metodologia: Tratou-se de uma revisão de escopo a partir do levantamento dos últimos cinco anos nas bases de dados PubMed, Scielo e Lilacs. Foram seguidos os parâmetros propostos pelo PRISMA e utilizados os seguintes descritores: “câncer de mama/ breast neoplasms” e “avaliação neuropsicológica/ neuropsychological evaluation”. Resultados: Foram encontrados 8 artigos. Os autorrelatos de comprometimento cognitivo ainda são maiores em comparação com resultados obtidos através de instrumentos neuropsicológicos, no entanto, os déficits cognitivos apresentados com maior intensidade se referem a funções executivas, memória, atenção e velocidade de processamento. Conclusões: Não existe consenso quanto ao impacto do tratamento oncológico (quimioterapia) na cognição, devendo haver padronização dos instrumentos para avaliação, bem como, implementação de novas tecnologias de neuroimagem.

The sequelae of coronavirus disease-2019 (COVID-19) are another socio-economic problem of the pandemic. Fatigue and dyspnea are the most prevalent symptoms. It is not known whether exercise can be used to treat long COVID-19. This study aimed to investigate the effects of an 8-week face-to-face rehabilitation program on COVID-19 compared to a remote monitoring group. A total of 37 participants (24.3% hospitalized) were assessed before and after rehabilitation (n = 22; 40.8 ± 10.0 years) or remote monitoring (n = 15; 45.4 ± 10.5 years). The participants were allocated according to their preferences. Both groups showed improved fatigue and exercise capacity (Incremental Shuttle Walk Test). Participants in the face-to-face rehabilitation group showed improved dyspnea (Pulmonary Functional Status and Dyspnea Questionnaire), anxiety (Hospital Anxiety and Depression Scale), attention, and short-term memory (d2-R and Rey's Auditory-Verbal Learning Test). Of the main sequelae, fatigue improves naturally, whereas dyspnea requires rehabilitation. Our results demonstrated the benefits of exercise for COVID-19 sequelae.

Summary Background Prevention, control, and treatment of respiratory tract cancers are important steps towards achieving target 3.4 of the UN Sustainable Development Goals (SDGs)—a one-third reduction in premature mortality due to non-communicable diseases by 2030. We aimed to provide global, regional, and national estimates of the burden of tracheal, bronchus, and lung cancer and larynx cancer and their attributable risks from 1990 to 2019. Methods Based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 methodology, we evaluated the incidence, mortality, years lived with disability, years of life lost, and disability-adjusted life-years (DALYs) of respiratory tract cancers (ie, tracheal, bronchus, and lung cancer and larynx cancer). Deaths from tracheal, bronchus, and lung cancer and larynx cancer attributable to each risk factor were estimated on the basis of risk exposure, relative risks, and the theoretical minimum risk exposure level input from 204 countries and territories, stratified by sex and Socio-demographic Index (SDI). Trends were estimated from 1990 to 2019, with an emphasis on the 2010–19 period. Findings Globally, there were 2·26 million (95% uncertainty interval 2·07 to 2·45) new cases of tracheal, bronchus, and lung cancer, and 2·04 million (1·88 to 2·19) deaths and 45·9 million (42·3 to 49·3) DALYs due to tracheal, bronchus, and lung cancer in 2019. There were 209 000 (194 000 to 225 000) new cases of larynx cancer, and 123 000 (115 000 to 133 000) deaths and 3·26 million (3·03 to 3·51) DALYs due to larynx cancer globally in 2019. From 2010 to 2019, the number of new tracheal, bronchus, and lung cancer cases increased by 23·3% (12·9 to 33·6) globally and the number of larynx cancer cases increased by 24·7% (16·0 to 34·1) globally. Global age-standardised incidence rates of tracheal, bronchus, and lung cancer decreased by 7·4% (−16·8 to 1·6) and age-standardised incidence rates of larynx cancer decreased by 3·0% (−10·5 to 5·0) in males over the past decade; however, during the same period, age-standardised incidence rates in females increased by 0·9% (−8·2 to 10·2) for tracheal, bronchus, and lung cancer and decreased by 0·5% (−8·4 to 8·1) for larynx cancer. Furthermore, although age-standardised incidence and death rates declined in both sexes combined from 2010 to 2019 at the global level for tracheal, bronchus, lung and larynx cancers, some locations had rising rates, particularly those on the lower end of the SDI range. Smoking contributed to an estimated 64·2% (61·9–66·4) of all deaths from tracheal, bronchus, and lung cancer and 63·4% (56·3–69·3) of all deaths from larynx cancer in 2019. For males and for both sexes combined, smoking was the leading specific risk factor for age-standardised deaths from tracheal, bronchus, and lung cancer per 100 000 in all SDI quintiles and GBD regions in 2019. However, among females, household air pollution from solid fuels was the leading specific risk factor in the low SDI quintile and in three GBD regions (central, eastern, and western sub-Saharan Africa) in 2019. Interpretation The numbers of incident cases and deaths from tracheal, bronchus, and lung cancer and larynx cancer increased globally during the past decade. Even more concerning, age-standardised incidence and death rates due to tracheal, bronchus, lung cancer and larynx cancer increased in some populations—namely, in the lower SDI quintiles and among females. Preventive measures such as smoking control interventions, air quality management programmes focused on major air pollution sources, and widespread access to clean energy should be prioritised in these settings. Funding Bill & Melinda Gates Foundation.

A depressão é uma doença que causa grande incapacidade e possui alta prevalência entre idosos. Também de expressiva distribuição se encontra a deficiência de vitamina D, que favorece o desenvolvimento de sintomas depressivos. Tanto a depressão quanto baixos níveis de vitamina D isoladamente são preditores de maior mortalidade. Esta revisão integrativa teve o objetivo de levantar informações acerca da combinação de deficiência de vitamina D e presença de depressão, e a influência na mortalidade em idosos. Foi realizada pesquisa nas bases de dados eletrônicas BVS, Embase, Cochrane e PubMed, sem restrição do tipo de estudo, linguística ou de tempo, com os descritores “depressão”, “deficiência de vitamina D”, “idosos”, “mortalidade”, e suas variações. A busca inicial identificou 302 artigos. Após exclusão dos duplicados e dos trabalhos que não englobaram todos os descritores de interesse, foram incluídos dois artigos para a presente revisão integrativa. Identificou-se que a população estudada tinha baixos níveis de 25(OH)D, e que isto se associou à ocorrência de sintomas depressivos. A análise conjunta de depressão e deficiência de 25(OH)D, e o impacto na mortalidade foi realizada em apenas um dos artigos. Neste, os indivíduos deprimidos com maior risco de óbito apresentavam deficiência de 25(OH)D. Em conclusão, observou-se associação entre depressão e baixos níveis de vitamina D, relacionando-se à maior mortalidade. Estas variáveis são modificáveis, porém, a literatura apresenta poucos dados neste contexto para permitir uma tomada de decisão. Mais pesquisas na área poderão esclarecer a relação que existe entre depressão, deficiência de vitamina D e mortalidade, e possibilitar modificação no curso deste desfecho.

Objetivo: Estimar o efeito da participação em grupos de estimulação e reabilitação cognitiva mediados pelo uso de computadores e Internet sobre a função cognitiva de idosos. Métodos: Estudo prospectivo de intervenção controlada e randomizado por sorteio realizado de 2010 a 2011 com pacientes voluntários atendidos em uma Clínica de Memória do Sul de Santa Catarina, Brasil. O grupo de intervenção (n=56) recebeu um programa de estimulação cognitiva de 20 sessões quinzenais de 1,5 horas cada. O grupo controle (n=53) recebeu acompanhamento médico de rotina. Ambos os grupos receberam orientações de saúde, atividade física e não faziam uso prévio de computadores e Internet. O desfecho foi o ganho de 4 pontos ou mais no Mini Exame de Estado Mental, entre as avaliações. Foi realizada análise de regressão logística com resultados expressos em Odds Ratio (OR) e seus respectivos intervalos de confiança de 95% (IC95%), com nível de significância de p≤0,05. Resultados: O grupo de intervenção obteve uma probabilidade 4,63 vezes maior do desfecho (OR= 4,63; IC 95%: 1,43-14,94) em relação ao grupo controle. Conclui-se que a participação em grupos de estimulação cognitiva mediado pelo uso de computadores e Internet está associado a melhora significativa na função cognitiva de idosos com comprometimento cognitivo leve.

Background Increased circulating endocannabinoids levels are typically associated with aerobic exercise. This phenomenon is associated with a “runner’s high,” a state of euphoria and well-being experienced after a long exercise. We will provide in this review a transparent and standardized methodology following the PRISMA-P and Cochrane Handbook for Systematic Reviews of Interventions for conducting a systematic review and meta-analysis for synthesizing the available evidence about the effects of physical activity on the circulating levels of AEA and 2-AG endocannabinoids in healthy subjects. Methods A multi-disciplinary team with basic and clinical expertise in exercise science developed this protocol. PubMed, EMBASE, Web of Science, CINAHL, SPORTDiscus, and Scopus will be the databases. A health sciences librarian was consulted in the development of the research. Search strategies will combine MeSH terms and free text words, including “exercise,” “exercise, physical,” “exercise training,” “physical activity,” “endocannabinoids,” “2-arachidonoyl-glycerol,” “glyceryl 2-arachidonate,” “2-AG,” “anandamide,” “AEA,” “n-arachidonoylethanolamide,” “adult,” “young adult,” and “middle-aged.” We will select experimental or quasi-experimental studies published through December 2021. The selection of studies, data extraction, assessment of the risk of bias, and the quality of evidence will be carried out in a paired and independent manner, and the consistency will be assessed using the statistics of Cohen Kappa. Methodological quality will be assessed using the Revised Cochrane risk of bias tool for randomized trials (RoB 2) and the Risk Of Bias In Nonrandomized Studies of Interventions (ROBINS-I) risk tool. We will use the Grading of Recommendations Assessment, Development, and Evaluation to assess the quality of the evidence, χ2 and I2 tests for heterogeneity, funnel plots, and the Egger test for publication bias. A meta-analysis for each data comparison will be performed whenever possible to determine the effect of physical activity on endocannabinoids’ circulating levels. Discussion This systematic review and meta-analysis will provide an overview of the evidence about physical activity over AEA and 2-AG endocannabinoids, including comparability of variables between studies, critical interpretation of results, and use of accurate statistical techniques. The endocannabinoid is molecules by which muscles communicate with other tissues and organs, mediating the beneficial effects of exercise on health and performance, including increased glucose uptake, improved insulin action, and mitochondrial biogenesis. They are essential to exercise. Thus, this study will review the acute effect of physical exercise on circulating levels of endocannabinoids in healthy individuals. The results of this study will potentially be transferred to doctors, health professionals, and legislators to guide their decision making, as well as will improve future research. Systematic review registration PROSPERO CRD42020202886.

Objective: The high potential of digital technologies to reduce medication errors in patients hospitalized or under hospital care was explored in this investigation. The study identifies common types of medication errors and their probable causes. Furthermore, examines the technological innovation solutions available that have not yet been applied in this context, specifically the Internet of Things usage to reduce medication errors through a practical example. Methods: A rapid review was applied, exploring the papers from two databases. The analysis was limited to the period from 2017 to 2021, resulting in 147 articles from the VHL Regional Portal – Virtual Health Library and 257 articles from the PubMed database. Results: There were analyzed 40 studies. An error mapping related to the theme was made. Also, the technology application and their effectiveness were identified in the studies. According to the research, inattention or distraction due to the excessive journey of work was pointed out as the main reason that leads to medication errors with the systems employed. Conclusion: There are several opportunities to improve hospital procedures with new technological approaches. By implementing innovative technologies, hospital medication errors can be managed more efficiently and reduce costs and waste with errors medication.

Anemia and dynapenia can occur simultaneously. Separately, both conditions increase the mortality risk with advancing age. However, there is no epidemiological evidence on the combined effect of these conditions on mortality in older adults. We investigated whether combined anemia and dynapenia increase the mortality risk, and whether there are gender differences.A 10-year follow-up study was conducted involving 5,310 older adults from the English Longitudinal Study of Ageing (ELSA). According to the diagnosis of anemia (hemoglobin concentration13.0 g/dL in men and12.0 g/dL in women) and dynapenia (grip strength26 kg for men and16 kg for women), individuals at baseline were categorized as "non-anemic/non-dynapenic", "dynapenic", "anemic" and "anemic/dynapenic". The outcome was all-cause mortality during the follow-up period.A total of 984 deaths were computed during the follow-up (63.7% in non-anemic/non-dynapenic, 22.8% in dynapenic, 7.5% in anemic and 6.0% in anemic/dynapenic). Adjusted Cox proportional hazard models stratified by sex showed that anemia and dynapenia combined was associated with an increased mortality risk in men (HR: 1.64; 95% IC 1.08 - 2.50) and women (HR: 2.17; 95% CI 1.44 - 3.26). Anemia in men (HR: 1.68; 95% CI 1.22 - 2.32) and dynapenia in women (HR: 1.37; 95% CI 1.09 - 1.72) were also risk factors for mortality.The coexistence of anemia and dynapenia increases the mortality risk, highlighting the need for early identification, prevention, and treatment of these conditions to reduce their complications and the mortality risk.

ObjectiveThis study aimed to evaluate the effects of physical rehabilitation for adults with sequelae after COVID-19.MethodsThis clinical, nonrandomized, controlled, and open study will examine 82 participants who have met the inclusion criteria and who will be divided into treatment and control groups according to participant preference. The intervention group will receive face-to-face care; the control group will receive remote educational guidance for 8 weeks, with pre-post evaluations. The primary outcomes are dyspnea, fatigue, and exercise capacity; the secondary outcomes are lung function, heart rate variability, handgrip strength, knee extensor strength and electrical activity, physical activity, functional limitation, cognitive function, depression and anxiety, and biochemical measures of hypoxia, inflammation, oxidative stress, blood glucose, and lactate blood tests. The survey will follow theStandard Protocol Items for Randomized Trialsguidelines, and the results will be reported according to theConsolidated Standards of Reporting Trialsguidelines. Effects will be assessed based on the intent-to-treat data collected. Analysis of covariance will be used for the initial and final evaluations, with a significance level of 5%.Results and ConclusionsThe results will show the effectiveness of rehabilitation in adults with post-COVID-19 sequelae.ImpactFatigue, dyspnea, cough, and muscle and joint pain are common sequelae of post-COVID-19 syndrome. Physical rehabilitation is one modality for treating these sequelae. This protocol can provide a treatment model for patients with post-COVID-19 sequelae.

Objetivo: Analisar a probabilidade de sobrevida e fatores prognósticos após cinco anos do diagnóstico de câncer de próstata em Florianópolis (SC). Métodos: Trata-se de um estudo de coorte com dados do Registro de Câncer de Base Populacional (2008-2012), e do Sistema de Informação sobre Mortalidade (2008-2017). O tempo de sobrevida foi o intervalo entre a data do diagnóstico e a data do óbito ou final do acompanhamento. As variáveis independentes foram idade, etnia, grau de instrução, estado civil e extensão da doença. As análises foram estratificadas por faixa etária. Resultados: Foram incluídos 836 homens e 103 foram a óbito por câncer durante o acompanhamento. A probabilidade de sobrevida encontrada foi de 87,7%. O aumento da idade reduziu a sobrevida, enquanto a extensão metastática foi o fator independente para o óbito. Conclusão: A idade e o estadiamento avançado são determinantes para o prognóstico do paciente com essa neoplasia. Ressalta-se a importância em reduzir o tempo entre manifestação de sintomas e diagnóstico do câncer.

Introdução: Os anos de vida perdidos ajustados por incapacidade (DALY), conhecido como carga de doença, mensuram o impacto de uma doença na população. O câncer de pulmão está entre as principais causas de carga de doença no mundo. Objetivo: Analisar a tendência dos anos de vida perdidos ajustados por incapacidade em pessoas com diagnóstico de câncer de pulmão em Florianópolis, no período de 2008 a 2012. Métodos: Foi realizado um estudo ecológico com dados do Sistema de Informações sobre Mortalidade para estimar os Anos de Vida Perdidos (YLL) e do Registro de Câncer de Base Populacional de Florianópolis para os Anos Vividos com Incapacidade (YLD), e a soma destes, gerou o DALY. Foram calculadas as taxas ajustadas geral, por sexo e faixas etárias. As tendências foram estimadas pelo programa Joinpoint. Resultados: Estimou-se 8.791,17 DALYs, 98,2% relacionados ao YLL. Os indicadores apresentaram estabilidade durante o período. O sexo masculino representou 58,1% da carga. Conclusão: A tendência da carga do câncer de pulmão apresentou estabilidade. Entretanto as faixas etárias de 50 a 69 anos tiveram maiores taxas. Isto reforça a importância da redução do tabagismo na população de Florianópolis, para redução da carga estimada.

OBJETIVO Estimar a probabilidade de sobrevivência e os fatores prognósticos das neoplasias relacionados ao tabagismo em uma coorte de base populacional. MÉTODOS Trata-se de uma coorte com dados do Registro de Câncer de Base Populacional de Florianópolis, região Sul do Brasil, de 2008 a 2012. Utilizou-se o software Stata 16.0 para estimar as probabilidades de sobrevivência em cinco anos após o diagnóstico, pelo método de Kaplan Meier, e os riscos de óbito, pela regressão de Cox. RESULTADOS Foram incluídos 2.829 registros de câncer relacionados ao tabagismo, mais prevalentes entre pessoas do sexo masculino, com mais de 70 anos, nove anos ou mais de escolaridade, cor branca, com companheiro e diagnóstico metastático. Os agrupamentos mais frequentes foram cólon e reto (28,7%), traqueia, brônquios e pulmões (18,6%) e estômago (11,8%). No acompanhamento, 1.450 foram a óbito. O câncer de pâncreas foi o que apresentou pior probabilidade de sobrevivência (14,3%), seguido pelo câncer de fígado (19,4%). CONCLUSÃO Os fatores de risco para o óbito e as taxas de sobrevivência diferem entre os 13 tipos de câncer relacionados ao tabaco. O diagnóstico precoce e a prevenção primária são estratégias que devem ser aprimoradas para melhorar a sobrevivência e diminuir a carga relacionada a esses tipos de câncer.

To estimate the probability of survival and prognostic factors for tobacco-related neoplasms in a population-based cohort.This is a cohort with data from the Population-Based Cancer Registry of Florianópolis, southern Brazil, from 2008 to 2012. The Stata 16.0 software was used to estimate the probabilities of survival in five years after diagnosis, by the Kaplan Meier method, and the risk of death, by the Cox regression.A total of 2,829 cancer records related to smoking were included, more prevalent among males, over 70 years of age, nine years or more of schooling, white, with a partner and metastatic diagnosis. The most frequent groupings were colon and rectum (28.7%), trachea, bronchi and lungs (18.6%) and stomach (11.8%). At follow-up, 1,450 died. Pancreatic cancer had the worst probability of survival (14.3%), followed by liver cancer (19.4%).Risk factors for death and survival rates differ across the 13 types of tobacco-related cancers. Early diagnosis and primary prevention are strategies that must be improved to improve survival and decrease the burden related to these types of cancer.

Supplemental digital content is available in the text., Objective There is little evidence of the association between complete tooth loss and allostatic load (AL). We investigated, firstly, the association between complete tooth loss and changes in AL for 12 years among older English adults. A second aim was to explore the role of fruit and vegetable consumption in explaining the aforementioned association. Methods AL was calculated for 2430 English Longitudinal Study of Ageing cohort (2004/5–2016/17) participants 50 years and older based on nine biomarkers: systolic and diastolic blood pressures, glycated hemoglobin, high- and low-density lipoprotein cholesterol, triglycerides, fibrinogen, C-reactive protein, and waist circumference. The exposure was complete tooth loss. Participants were classified as dentate or edentulous. A linear mixed-effects model was fitted to model the 12-year change in AL score and its association with complete tooth loss after adjustments for confounders (demographic factors, socioeconomic position, and health behaviors). Results Around 11% of the participants were edentulous. Complete tooth loss was positively associated with baseline AL scores but not with its rate of change over time. The predicted mean AL scores were 3.60 (95% confidence interval [CI] = 3.53–3.68) and 3.98 (95% CI = 3.76–4.21) as well as 4·28 (95% CI = 4·18, 4·39) and 4·66 (95% CI = 4·42, 4·90) for dentate and edentulous participants, at baseline and end of follow-up, respectively. Fruit and vegetable consumption was not associated with baseline AL or its rate of change. Conclusions Complete tooth loss was associated with baseline AL score but not with its development over time, whereas the consumption of fruit and vegetables did not help to explain this association. Both conditions may share common determinants earlier in life.

The present work raises an investigation about the feature importance to estimate the COVID-19 infection, using Machine Learning approach. Our work analyzed 175 features, using the Permutation Importance method, to assess the importance and list the twenty most relevant ones that represent the probability of infection of the disease. Among all features, the most important were: i) the period comprised between the date of notification and symptom onset stand out, ii) the rate of confirmed in the territory of health units in the last 14 days, iii) the rate of discarded and removed from the health territory, iv) the age, v) variables of the traffic flow and vi) symptoms features as fever, cough and sore throat. The model was validated and reached an accuracy average of 78.19%, whereas the sensitivity and specificity achieved 83.05% and the 75.50% respectively in the infection estimate. Therefore, the proposed investigation represents an alternative to guide authorities in understanding aspects related to the disease.

BackgroundErgogenic evidence for caffeine is robust in sports and isolated limb tasks. Our objective was to evaluate a possible ergogenic effect on postural muscles, still unknown, through the Biering-Sørensen’s lumbar extension test.MethodsA double-blind, controlled placebo, crossover study. Fifty-one healthy, physically inactive male subjects (18-25 years) with average body mass (BMI 18.5 – 24.9 kg/m2) were recruited. The subjects received oral caffeine (6 mg/kg) and saline (0.3%) in two cross-evaluations separated by one week. The primary outcome was the time in the Biering-Sørensen test after 1 hour of treatment. The secondary outcomes were peak lumbar extension force, rating of perceived exertion, EMG’s median frequency and muscle recruitment of multifidus spinae and transversalis/interne oblique muscles, and cardiovascular variables (heart rate and blood pressure).Results27 subjects were blindly treated with caffeine and saline. Caffeine was ergogenic during the Biering-Sørensen test. It increased lumbar extension time (d = 0.34, Pd = 0.37, Pη2 = 0.49, Pmultifidus spinae. In the transversalis/interne oblique muscles, caffeine increased the median frequency η2 = 0.13, Pη2 = 0.13, PConclusionsOur results show that caffeine is ergogenic for postural muscles. Decreased RPE and improved muscle activity suggest central mechanisms of caffeine.Trial registrationUTN U1111-1234-2079.BULLET POINTSCaffeine increases the extension time of the lumbar spine in the Biering-Sørensen test.Caffeine decreases perceived exertion during the Biering-Sørensen test.Caffeine increases muscle stimulation and recruitment of the multifidus spinae during the Biering-Sørensen test.Caffeine increases muscle stimulation of the transversalis/interne oblique muscles during the Biering-Sørensen test.

This paper aims to identify sociodemographic and care characteristics of dependent older adults, formal and family caregivers in municipalities from different Brazilian regions. A cross-sectional study was carried out with a sample of 175 people, of whom 64 were older adults, 27 formal caregivers, and 84 family caregivers. Semi-structured interviews were conducted with specific questions for each group on the theme of care and dependence. Most older adults were female, aged 80 years or older, with low education and have been dependent for four years or more. Older adults reported feelings of loneliness, pointed out difficulties in medical care, and 29% had only access to Primary Health Care actions. Inequalities, burden, illnesses, and social problems were found among family caregivers. Black females with no formal employment, little or no training for the function, and low remuneration predominated among formal caregivers, and care was associated with domestic chores. We can conclude that gender and race inequalities persist in the care of dependent older adults, and we observed that the rigid social roles assigned to men and women in Brazil persist in the family and work dynamics in caring for the dependent older adults.O artigo tem como objetivo identificar características sociodemográficas e assistenciais de idosos dependentes, cuidadores formais e familiares em municípios de diferentes regiões brasileiras. Realizou-se um estudo transversal com amostra de 175 pessoas, sendo 64 idosos, 27 cuidadores formais e 84 cuidadores familiares. Foram realizadas entrevistas semiestruturadas, com questões específicas para cada grupo sobre a temática do cuidado e dependência. A maioria dos idosos era do sexo feminino, com idade igual ou maior a 80 anos, com baixa escolaridade e dependente há quatro anos ou mais. Os idosos relataram sentimentos de solidão, apontaram dificuldades na assistência médica e 29% tinham acesso apenas a ações da Atenção Primária à Saúde. Entre os cuidadores familiares, encontrou-se desigualdades, sobrecargas, adoecimentos e problemas sociais. Entre os formais predominou o sexo feminino, a raça negra, sem vínculo legal de trabalho, pouca ou nenhuma formação para a função e baixa remuneração; o cuidado associou-se aos afazeres domésticos. Conclui-se que perduram as desigualdades de gênero e raça no cuidado às pessoas idosas em situação de dependência. Observou-se também que a rigidez dos papeis sociais atribuídos a homens e mulheres no Brasil persistem nas dinâmicas familiares e laborais no cuidado ao idoso dependente.

Este ensaio de cunho reflexivo tem o objetivo de discutir a importância das tecnologias leves e da educação em saúde no enfrentamento à pandemia da COVID-19. O texto aborda o contexto epidemiológico e as medidas de prevenção ao Coronavírus, especialmente a quarentena e o isolamento social. Além do mais, propõe um conjunto de estratégias micropolíticas que contribuem para o enfrentamento à pandemia, especialmente as tecnologias leves e a educação em saúde. Defendemos que, em tempos de pandemia, é fundamental a humanização do cuidado, o diálogo e as relações de confiança entre profissionais e usuários. As reflexões suscitadas constituem-se como práxis transversais ao trabalho e caracterizam-se como compromissos éticos, estéticos e políticos no enfrentamento à pandemia, necessárias para a produção de sentido e sensibilização das ações impostas por autoridades sanitárias.

Objective To determine the extent to which racial inequities in tooth loss and functional dentition are explained by individual socioeconomic status, smoking status and frequency/reason for the use of dental services. Methods Data came from the Brazilian Longitudinal Study of Ageing, a nationally representative sample of community-dwelling people aged 50 years and over. Tooth loss and functional dentition (ie 20+ natural teeth) were the outcomes. The main explanatory variable was self-classified race. Covariates included dental visits in the past 12 months, dental visits for check-ups only, smoking status, self-reported chronic conditions, depression and cognitive function. Logistic regression and Blinder-Oaxaca decomposition analysis were used to estimate the share of each factor in race-related tooth loss inequities. Results The analytical sample comprised of 7126 respondents. While the prevalence of functional dentition in White Brazilians was 37% (95% CI: 33.5;40.9), it was 29% (95% CI: 26.4;31.6) among Browns and 30% (95% CI: 25.1;35.4) among Blacks. The average number of lost teeth among Whites, Browns and Blacks were 18.7 (95% CI: 17.8;19.6), 20.4 (95% CI: 19.7;21.1) and 20.8 (95% CI: 19.5;22.0), respectively. Decomposition analysis showed that the selected covariates explained 71% of the racial inequalities in tooth loss. Dental visits in the previous year and smoking status explained nearly half of race-related gaps. Other factors, such as per capita income, education and cognitive status, also had an important contribution to the examined inequalities. The proportion of racial inequities in tooth loss that was explained by dental visits (frequency and reason) and smoking status decreased from 40% for those 50-59 years of age to 22% among participants aged 70-79 years. Conclusions Frequency and reason for dental visits and smoking status explained nearly half of the racial inequity in tooth loss among Brazilian older adults. The Brazilian Family Health Strategy Program should target older adults from racial groups living in deprived areas.

Incluye: Correction: Burden of injury along the development spectrum: associations between the Socio-demographic Index and disability-adjusted life year estimates from the Global Burden of Disease Study 2017. Inj Prev. 2020 Oct;26(Supp 1):i164. doi: 10.1136/injuryprev-2019-043296corr1. Epub 2020 Sep 28. PMID: 32989004 Background: The epidemiological transition of non-communicable diseases replacing infectious diseases as the main contributors to disease burden has been well documented in global health literature. Less focus, however, has been given to the relationship between sociodemographic changes and injury. The aim of this study was to examine the association between disability-adjusted life years (DALYs) from injury for 195 countries and territories at different levels along the development spectrum between 1990 and 2017 based on the Global Burden of Disease (GBD) 2017 estimates. Methods: Injury mortality was estimated using the GBD mortality database, corrections for garbage coding and CODEm-the cause of death ensemble modelling tool. Morbidity estimation was based on surveys and inpatient and outpatient data sets for 30 cause-of-injury with 47 nature-of-injury categories each. The Socio-demographic Index (SDI) is a composite indicator that includes lagged income per capita, average educational attainment over age 15 years and total fertility rate. Results: For many causes of injury, age-standardised DALY rates declined with increasing SDI, although road injury, interpersonal violence and self-harm did not follow this pattern. Particularly for self-harm opposing patterns were observed in regions with similar SDI levels. For road injuries, this effect was less pronounced. Conclusions: The overall global pattern is that of declining injury burden with increasing SDI. However, not all injuries follow this pattern, which suggests multiple underlying mechanisms influencing injury DALYs. There is a need for a detailed understanding of these patterns to help to inform national and global efforts to address injury-related health outcomes across the development spectrum. Funding for GBD 2017 was provided by the Bill and Melinda Gates Foundation. Sí

Resumo: Introdução: Os desafios impostos pela pandemia da Covid-19 à educação médica exigem novas estratégias pedagógicas para a formação de profissionais éticos, humanistas, críticos e reflexivos. Objetivo: Identificar as estratégias pedagógicas para a educação médica implementadas durante a pandemia da Covid-19 em diferentes países do mundo. Método: Realizou-se uma revisão da literatura acadêmica indexada em bases de dados internacionais, de acordo com a metodologia scoping review. As informações foram coletadas nas bases de dados PubMed, Lilacs, SciELO, Biblioteca Virtual em Saúde e Web of Science e Scopus. Utilizaram-se as palavras-chave “Education, Medical” AND “Pandemics” OR “Coronavirus Infections”. Encontraram-se 1.350 artigos, dos quais 27 atenderam aos critérios de inclusão e foram analisados. Resultados: Identificou-se que as estratégias pedagógicas para a educação médica durante a pandemia da Covid-19 são centradas no ensino remoto, com a utilização de plataformas digitais de educação a distância por meio da internet e da tecnologia. A literatura reconheceu a necessidade de envolvimento dos professores com o processo pedagógico, o planejamento das atividades e a identificação das plataformas digitais apropriadas. Não há consenso sobre a inserção dos estudantes nas atividades práticas. Os estudos evidenciaram a existência da educação a distância mesmo antes da pandemia e vinculação com a prática da telemedicina. A necessidade de os currículos de Medicina incluírem disciplinas de gerenciamento de pandemia com foco na saúde pública também foi identificado. Conclusão: As experiências encontradas estão concentradas em países de alta renda e desenvolvidos e são dependentes da internet e das tecnologias de informação e comunicação. Identificaram-se omissões acerca das limitações e fragilidades dessa nova estratégia pedagógica, especialmente a falta de acesso universal e igualitário aos meios digitais, a desconsideração de realidades minoritárias e subdesenvolvidas e a desvalorização das relações interpessoais essenciais à formação médica.

The presence of multimorbidity patterns has been related to functional disability in basic activities (BADLs) and instrumental activities of daily living (IADLs), which are essential for elder individuals' self-care and autonomy. The study thus aimed to estimate the association between multimorbidity patterns and presence of functional disability in elderly Brazilians. This was a cross-sectional study using data from the Brazilian National Health Survey (PNS 2013) in a sample of elderly Brazilians (≥ 60 years). The measures of functional disability were from self-completed questionnaires, categorized in basic activities of daily living (BADLs) and instrumental activities of daily living (IADLs). The multimorbidity patterns analyzed here were: (1) cardiorespiratory; (2) vascular-metabolic; and (3) mental-musculoskeletal. The adjustment variables included age, sex, schooling, and region of Brazil. Multivariate logistic regression analyses were performed, estimating crude and adjusted odds ratios (OR) with Stata 16.0. Elderly individuals classified in the mental-musculoskeletal patterns showed the highest odds of disability in BADLs (OR = 2.72; 95%CI: 2.33; 3.18), while those with the cardiopulmonary pattern showed the highest odds of disability in IADLs (OR = 2.65; 95%CI: 1.95; 3.60), compared to those without the same patterns. All the multimorbidity patterns analyzed here were associated with disability in BADLs and IADLs and should thus be considered when planning measures to prevent disabilities in elderly individuals with multimorbidity.A presença de padrões de multimorbidade tem sido relacionada à incapacidade funcional nas atividades básicas (ABVD) e instrumentais (AIVD) de vida diária, que são essenciais ao autocuidado e autonomia do idoso. Assim, o objetivo do estudo foi estimar a associação dos padrões de multimorbidade com a presença de incapacidade funcional em idosos brasileiros. Tratou-se de um estudo transversal, utilizando dados da Pesquisa Nacional de Saúde (PNS 2013), realizada com idosos brasileiros (≥ 60 anos). As medidas de incapacidade funcional foram provenientes de questionários autorreferidos, categorizadas em atividades básicas de vida diária (ABVD) e atividades instrumentais de vida diária (AIVD). Os padrões de multimorbidade analisados foram: (1) cardiorespiratório; (2) vascular-metabólico; e (3) mental-musculoesquelético. As variáveis de ajuste incluíram idade, sexo, anos de estudo e região do país. Foram realizadas análises de regressão logística multivariável, estimando-se as odds ratio (OR) brutas e ajustadas, pelo software Stata 16.0. Os idosos classificados nos padrões mental-musculoesquelético tiveram maiores chances de ter incapacidade nas ABVD (OR = 2,72; IC95%: 2,33; 3,18), enquanto aqueles com padrão cardiopulmonar mostraram maiores chances de incapacidade nas AIVD (OR = 2,65; IC95%: 1,95; 3,60), quando comparados aos que não tinham os mesmos padrões de acometimento. Concluiu-se que todos os padrões de multimorbidade analisados foram associados à presença de incapacidade nas ABVD e AIVD e, assim, devem ser considerados no planejamento das ações para prevenção de incapacidades em idosos com multimorbidades.La presencia de patrones de multimorbilidad ha sido relacionada con la incapacidad funcional en actividades básicas (ABVDs) e instrumentales (AIVDs) de la vida diaria, las cuales son esenciales para el autocuidado y autonomía del anciano. De esta forma, el objetivo del estudio fue estimar la asociación de los patrones de multimorbilidad con la presencia de incapacidad funcional en ancianos brasileños. Se trató de un estudio transversal, utilizando datos de la Encuesta Nacional de Salud (PNS 2013), realizada con ancianos brasileños (≥ 60 años). Las medidas de incapacidad funcional provinieron de cuestionarios autoinformados, categorizadas en actividades básicas de vida diaria (ABVDS) y actividades instrumentales de vida diaria (AIVDS). Los patrones de multimorbilidad analizados fueron: (1) Cardiorrespiratorio; (2) Vascular-metabólico; y (3) Mental-musculoesquelético. Las variables de ajuste incluyeron edad, sexo, años de estudio y región del país. Se realizaron análisis de regresión logística multivariada, estimándose las odds ratio (OR) brutas y ajustadas, mediante el software Stata 16.0. Los ancianos clasificados en los patrones mental-musculoesquelético tuvieron mayores oportunidades de tener incapacidad en las ABVDs (OR = 2,72; IC95%: 2,33; 3,18), mientras que aquellos con patrón cardiopulmonar mostraron mayores oportunidades de incapacidad en las AIVDs (OR = 2,65; IC95%: 1,95; 3,60), cuando se comparan a los que no tenían los mismos patrones de alteraciones. Se concluyó que todos los patrones de multimorbilidad analizados estuvieron asociados con la presencia de incapacidad en las ABVDs y AIVDs, y de este modo deben ser considerados en la planificación de las acciones para la prevención de incapacidades en ancianos con multimorbilidades.

Objetivo: analisar o perfil dos tabagistas em tratamento e os fatores associados ao abandono do tratamento e cessação do tabagismo em um programa municipal. Método: estudo transversal realizado em Araranguá, Santa Catarina com 109 pessoas do Programa Controle do Tabagismo, entre março e dezembro de 2018. Foram coletadas informações sociodemográficas e de saúde, incluindo sintomas depressivos, impulsividade e capacidade de enfrentamento. Realizou-se análises descritivas e inferenciais. Resultados: 40,4% dos participantes abandonaram o tratamento, grupo que obteve maior média para impulsividade. Os principais motivos relatados para o abandono do tratamento foram: “estar bem sem fumar”, situações relacionadas ao trabalho e sintomas de abstinência. Observou-se que 7,64% cessaram o tabagismo e 93,8% apresentavam dependência leve à nicotina. Conclusão: apesar do abandono ser alto, alguns permaneceram em cessação. Os com 49 anos ou menos foram tiveram abandono significativamente maior e a dependência à nicotina apresenta-se como dificultador significativo da cessação.

Objective This cross-sectional population-based study aimed to determine the cutoff points of anthropometric indicators to screen for sarcopenia and the association between sarcopenia and these indicators. Methods The sample consisted of 601 older adults. Sarcopenia was detected by appendicular skeletal muscle index. The receiver operating characteristic curve identified the cutoff points for body mass index, waist-to-height ratio, waist circumference, and handgrip strength to screen for sarcopenia. Based on the cut-off points, principal component analysis determined which indicators had a better fit as discriminants to compose an indicator. Finally, logistic regression analysis was performed with this indicator as the main independent variable. Results The results showed that all anthropometric indicators and handgrip strength were capable of discriminating sarcopenia; however, body mass index, waist circumference, and waist-to-height ratio were the best discriminants in principal components analysis, composing the new indicator. Adjusted logistic regression analysis showed that sarcopenia was associated with the indicator in both sexes. Conclusion The concomitant presence of low body mass index, low waist circumference, and low waist-to-height ratio may help to discriminate sarcopenia. RESUMO Objetivo Este estudo transversal, populacional, teve como objetivo determinar pontos de corte de indicadores antro-pométricos e força de preensão manual para triagem de sarcopenia e verificar a associação entre sarcopenia e estes indicadores. Métodos A amostra foi composta por 601 idosos e a sarcopenia foi identificada pelo índice de massa muscular apendicular. A curva Receiver Operating Characteristic identificou os valores de pontos de corte para: índice de massa corporal, razão cintura-estatura, perímetro de cintura e força de preensão manual para triagem da sarcopenia. A partir dos pontos de corte foi realizada análise de componentes principais para definir os que mais se adequaram como discriminantes, compondo um indicador, e realizado análise de regressão logística com este indicador como variável independente principal. Resultados Os resultados mostraram que todos os indicadores antropométricos e a força de preensão manual foram considerados discriminadores de sarcopenia, entretanto o índice de massa corporal, o perímetro da cintura e a razão cintura estatura mostram-se como os melhores discriminantes na análise de componentes principais, compondo o novo indicador. A análise de regressão logística (ajustada) mostrou que a sarcopenia foi associada com o indicador em ambos os sexos. Conclusão A presença de índice de massa corporal baixo, baixa relação cintura estatura e baixo perímetro da cintura concomitantemente podem auxiliar na discriminação da sarcopenia.

Resumo OBJETIVO: propor e apresentar aplicação de estratificação dos municípios brasileiros em grupos homogêneos para estudos de avaliação de desempenho da gestão em saúde. MÉTODOS: estudo metodológico com classificação dos municípios segundo as condições que influenciam a gestão em saúde e porte populacional; dados referentes ao ano de 2010 foram compilados de bases demográficas e de saúde; testes de correlação e análise fatorial foram utilizados. RESULTADOS: identificaram-se sete estratos - Grande porte; Médio porte com influentes favoráveis, regulares ou desfavoráveis; e Pequeno porte com influentes favoráveis, regulares ou desfavoráveis -; houve concentração de municípios com influentes favoráveis nas faixas de melhor poder aquisitivo e de financiamento, e concentração de municípios com influentes desfavoráveis nas regiões Norte e Nordeste. CONCLUSÃO: a classificação proposta agrupou municípios semelhantes quanto aos fatores influentes da gestão em saúde, permitindo a identificação de grupos comparáveis de municípios e configurando uma alternativa consistente para estudos de avaliação de desempenho. Abstract OBJECTIVE: to propose and present a stratification of Brazilian municipalities into homogeneous groups for evaluation studies of health management performance. METHODS: this was a methodological study, with selected indicators which classify municipalities according to conditions that influence the health management and population size; data for the year 2010 were collected from demographic and health databases; correlation tests and factor analysis were used. RESULTS: seven strata were identified - Large-sized; Medium-sized with favorable, regular or unfavorable influences; and Small-sized with favorable, regular or unfavorable influences -; there was a concentration of municipalities with favorable influences in strata with better purchasing power and funding, as well as a concentration of municipalities with unfavorable influences in the North and Northeast regions. CONCLUSION: the proposed classification grouped similar municipalities regarding influential factors in health management, which allowed the identification of comparable groups of municipalities, setting up a consistent alternative to performance evaluation studies. Resumen OBJETIVO: proponer y presentar la estratificación de municipios brasileños en grupos homogéneos para estudios de evaluación del desempeño de la gestión en salud. MÉTODOS: estudio metodológico, con la clasificación de municipios en función de las condiciones que influyen en la gestión de la salud y tamaño de población; los datos para el año 2010 fueran compilados en las bases demográficas y de salud; se utilizaron pruebas de correlación y análisis factorial. RESULTADOS: se identificaron siete estratos según el tamaño - grande; medio con condiciones favorables, regular o desfavorables; y pequeño con condiciones favorables, regular o desfavorables -; los municipios con condiciones favorables se centran en las mejores condiciones de poder adquisitivo y financiamiento, así como la condición desfavorable en el Norte y Nordeste. CONCLUSIÓN: la clasificación propuesta agrupa municipios similares, lo que permitió la identificación de grupos comparables entre municipios, constituyendo una alternativa coherente con estudios de evaluación de desempeño.

Objective: To analyze Covid-19 incidence and mortality and its relationship with social indicators of the municipalities of Santa Catarina. Methods: An ecological study with data from the 1st to 14th epidemiological weeks in the year 2020. The independent variables were sociodemographic indicators. The outcomes were the incidence and mortality rates for Covid-19 for each municipality. Negative inflated zero binomial regression was used, considering 95% confidence intervals and thematic maps were created. Results: In the period, 17,368 cases and 253 deaths were recorded. The incidence of Covid-19 was associated with greater population size, demographic density, and Gini index, and decreased with increasing aging rates. Mortality, on the other hand, was associated with an increase in population size and demographic density. Conclusion: Although Covid-19 has potential for dissemination to all municipalities in Santa Catarina, social and demographic characteristics are related to pandemic behavior. Objetivo: analizar la relación entre incidencia y mortalidad por Covid-19 con indicadores sociodemográficos en los municipios de Santa Catarina. Métodos: estudio ecológico con datos de la 1ª a la 14ª semana epidemiológica del año 2020. Las variables independientes fueron indicadores sociodemográficos y los resultados fueron las tasas de incidencia y mortalidad debidas a Covid-19. Se utilizó una regresión binomial negativa inflada de ceros, con los respectivos intervalos de confianza del 95% y se elaboraron mapas temáticos. Resultados: en el período, se registraron 17.368 casos y 253 muertes. La incidencia de Covid-19 se asoció con un mayor tamaño de la población y la densidad demográfica y el índice Gini y disminuyó con el aumento de las tasas de envejecimiento. La mortalidad se asoció con un aumento en el tamaño de la población y la densidad demográfica. Conclusión: Aunque Covid-19 tiene potencial de difusión a todos los municipios del estado de Santa Catarina, las características sociales y demográficas están relacionadas con el comportamiento de la pandemia. Objetivo: Analisar a relação entre incidência e mortalidade por Covid-19 com os indicadores sociodemográficos nos municípios de Santa Catarina. Métodos: estudo ecológico com dados da 1ª a 14ª semana epidemiológica do ano de 2020. As variáveis independentes foram indicadores sociodemográficos e os desfechos foram as taxas de incidência e de mortalidade por Covid-19. Foi utilizada a regressão binomial negativa inflada de zeros, com os respectivos intervalos de confiança de 95% e elaborados mapas temáticos. Resultados: No período foram registrados 17.368 casos e 253 óbitos. A incidência da Covid-19 foi associada com maior porte populacional e densidade demográfica e índice de Gini e reduziu com aumento taxas de envelhecimento. A mortalidade associou-se ao aumento do porte populacional e densidade demográfica. Conclusão: Embora a Covid-19 apresente potencial de disseminação para todos os municípios do estado de Santa Catarina, as características sociais e demográficas estão relacionados ao comportamento da pandemia.

To analyze the effects of anthropometric measures change on quality of life (QoL) in elderly, using measured anthropometric data on body mass index (BMI) and waist circumference (WC). Population-based cohort study investigating a sample of elderly (≥60) assessed in 2009 (n = 1705) and followed up in 2013 (n = 1197). QoL was evaluated in 2013 using the CASP-19. Variables evaluated as exposure including BMI and WC in 2009 (both standardized), categories of anthropometric measures change from 2009 to 2013 (excess weight = BMI ≥ 25.0 kg/m2; large WC = top quartile), and the absolute BMI and WC change in same period. Multivariate linear regressions adjusted for possible confounding factors and mediators were used. Both BMI and WC at baseline were associated with lower QoL scores, even after adjustment for confounding variables (β BMI = −0.9; 95 % CI −1.5; −0.3 and β WC = −1.0; 95 % CI −1.7; −0.4). Additionally, QoL scores were lower among elderly with excess weight (β = −1.4; 95 % CI −2.9; 0.0) or large WC (β = −3.3; 95 % CI −5.2; −1.4) in both waves than among those whose BMI and WC were always normal, but changes in anthropometric measures did not affect QoL. The presence of chronic diseases was a partial mediator of these associations, especially for effects of BMI change. Anthropometric measures change treated as a continuous variable was not associated with QoL. Having excess weight and large WC in both waves was associated with lower QoL scores in elderly, but changing the anthropometric measures did not affect this outcome. Maintaining weight and WC within normal limits during aging can help to preserve QoL.

Background:Understanding the built environment influence on specific domains of walking is important for public health interventions to increase physical activity levels among older adults.Purpose:The purpose was to investigate the association between built environment characteristics and walking among older adults.Methods:A population-based study was performed in 80 census tracts in Florianópolis, Brazil, including 1,705 older adults (60+ years old). Walking was measured using the International Physical Activity Questionnaire. Built environment characteristics were assessed through a geographic information system. All analyses were conducted through a multilevel logistic regression.Results:Individuals living in neighborhoods with a higher population density (odds ratio [OR]: 2.19; 95% confidence interval [CI], 1.40–3.42), with a higher street connectivity (OR: 1.85; 95% CI, 1.16–2.94), a higher sidewalk proportion (OR: 1.77; 95% CI, 1.11–2.83), and paved streets (medium tertile: OR: 1.61, 95% CI, 1.04–2.49; highest tertile: OR: 2.11; 95% CI, 1.36–3.27) were more likely to walk for transportation. Regarding walking for leisure, only 2 predictors were associated, area income (OR: 1.48; 95% CI, 1.04–2.12) and street density (OR: 1.47; 95% CI, 1.02–2.10).Conclusions:Improving the neighborhood built environment is an important step for achieving higher levels of walking in the elderly population in a middle-income country.

Why was the cohort set up? Latin America and the Caribbean (LAC) are characterized by much diversity in terms of socio-economic status, ecology, environment, access to health care,1,2 as well as the frequency of risk factors for and prevalence or incidence of non-communicable diseases;3–7 importantly, these differences are observed both between and within countries in LAC.8,9 LAC countries share a large burden of non-communicable (e.g. diabetes and hypertension) and cardiovascular (e.g. ischaemic heart disease) diseases, with these conditions standing as the leading causes of morbidity, disability and mortality in most of LAC.10–12 These epidemiological estimates—e.g. morbidity—cannot inform about risk factors or risk prediction, which are relevant to identify prevention avenues. Cohort studies, on the other hand, could provide this evidence. Pooled analysis, using data from multiple cohort studies, have additional strengths such as increased statistical power and decreased statistical uncertainty.13 LAC cohort studies have been under-represented,14 or not included at all,15–17 in international efforts aimed at pooling data from multiple cohort studies. We therefore set out to pool data from LAC cohorts to address research questions that individual cohort studies would not be able to answer. Drawing from previous successful regional enterprises (e.g. Asia Pacific Cohort Studies Collaboration),18,19 we established the Cohorts Consortium of Latin America and the Caribbean (CC-LAC). The main aim of the CC-LAC is to start a collaborative cohort data pooling in LAC to examine the association between cardio-metabolic risk factors (e.g. blood pressure, glucose and lipids) and non-fatal and fatal cardiovascular outcomes (e.g. stroke or myocardial infarction). In so doing, we aim to provide regional risk estimates to inform disease burden metrics, as well as other ambitious projects including a cardiovascular risk score to strengthen cardiovascular prevention in LAC. Initial funding has been provided by a fellowship from the Wellcome Trust Centre for Global Health Research at Imperial College London (Strategic Award, Wellcome Trust–Imperial College Centre for Global Health Research, 100693/Z/12/Z). Additional funding is being provided by an International Training Fellowship from the Wellcome Trust (214185/Z/18/Z). At the time of writing, the daily operations and pooled database are hosted at Imperial College London, though a mid-term goal is to transfer this expertise and operations to LAC. The collaboration relies fundamentally on a strong regional network of health researchers and practitioners

Objective: To verify the variation of the premature mortality rate caused the group of the main chronic noncommunicable diseases. Method: This is a time-series ecological study, which used secondary data of the Mortality Information System, from 2006 to 2014, from the 26 federal units and from the Federal District. Deaths caused by circulatory system diseases, cancer, diabetes and chronic respiratory diseases were included. The trend of adjusted mortality rate was analyzed by segmented linear regression. Results: Premature mortality tended to be reduced in most states, except for Maranhão and Rio Grande do Norte, which presented a stable premature mortality rate. Bahia, Pernambuco, Sergipe, Roraima and all the states from the South, Southeast and Central-West Regions reached the goal of reducing 2% per year in premature mortality caused by main diseases. Conclusion: Most of the states showed a reduced mortality rate and are reaching the proposed target. RESUMEN Objetivo: Verificar la variación de la tasa de mortalidad prematura por el conjunto de las principales enfermedades crónicas no transmisibles. Método: Estudio ecológico de series temporales, en que se utilizaron datos secundarios del Sistema de Información sobre Mortalidad, de 2006 a 2014, de las 26 Unidades Federativas y del Distrito Federal. Se incluyeron muertes con causa básica las enfermedades del aparato circulatorio, cáncer, diabetes y enfermedades respiratorias crónicas. La tendencia de la tasa ajustada de mortalidad se analizó por la regresión lineal segmentada. Resultados: Hubo tendencia de reducción de la mortalidad prematura en la mayoría de los estados, excepto Maranhão y Rio Grande do Norte que presentaron estabilidad de la tasa de mortalidad prematura. Los estados de Bahía, Pernambuco, Sergipe, Roraima y todos de la Región Sur, Sudeste y Centro-Oeste alcanzaron la meta de reducción del 2% al año en la mortalidad prematura por las principales enfermedades. Conclusión: La mayoría de los estados presentan reducción de la tasa de mortalidad y están alcanzando la meta propuesta. RESUMO Objetivo: Verificar a variação da taxa de mortalidade prematura pelo conjunto das principais doenças crônicas não transmissíveis. Método: Estudo ecológico de séries temporais, que utilizou dados secundários do Sistema de Informações sobre Mortalidade, de 2006 a 2014, das 26 unidades federativas e do Distrito Federal. Foram incluídos óbitos que tiveram como causa básica doenças do aparelho circulatório, câncer, diabetes e doenças respiratórias crônicas. A tendência da taxa ajustada de mortalidade foi analisada pela regressão linear segmentada. Resultados: Houve tendência de redução da mortalidade prematura na maioria dos estados, exceto Maranhão e Rio Grande do Norte, que apresentaram estabilidade da taxa de mortalidade prematura. Os estados da Bahia, Pernambuco, Sergipe, Roraima e todos das regiões Sul, Sudeste e Centro-Oeste atingiram a meta de redução de 2% ao ano na mortalidade prematura pelas principais doenças. Conclusão: A maioria dos estados apresentaram redução da taxa de mortalidade e estão atingindo a meta proposta.

RESUMO: O objetivo deste estudo foi verificar os fatores associados à autopercepção de saúde positiva de idosos longevos (80+). Estudo transversal conduzido no município de Florianópolis, Santa Catarina, Brasil, com 239 idosos participantes do EpiFloripa Idoso. Foram aplicados instrumentos de coleta para verificar dados sociodemográficos e econômicos, autorrelato do estado de saúde, quedas e estilo de vida. Para identificar os fatores associados à autopercepção de saúde positiva, utilizou-se regressão de Poisson ajustada por sexo. A autopercepção de saúde positiva foi mais prevalente nos idosos longevos sem a presença de depressão (RP = 0,49) e que faziam consumo de álcool (RP = 1,99). Compreender quais variáveis podem interferir na autopercepção de saúde de idosos longevos auxilia em melhores ações de saúde para essa população, principalmente para evitar depressão, além de reduzir custos com internações, medicamentos e tratamentos de saúde, muito frequentes em idosos longevos.

Objective: To evaluate the effect of using lubricant during speculum examination for Pap smear collection. Methods: A cross-sectional study was conducted involving 83 patients attending a medical school clinic. Participants were allocated into two groups: Group 1—Lubricant using; Group 2—No lubricant using. All patients were submitted to two successive collections and after were asked about their level of discomfort. Differences between groups regarding quality, artifacts, cytology, and level of discomfort were observed through chi-squared test. Odds ratios and 95% confidence intervals were also estimated. Statistical significance was set at P < .05. Results: No significant differences between groups regarding quality, presence of artifacts, and cytological results were observed. Significant lower discomfort level in Group 1 (lubricant using). Conclusion: The use of vaginal lubricant did not affect the results of cytology and could be a useful tool to reduce the discomfort during Pap smear collection.

Introduction: The burden of tuberculosis has been scarcely explored in developing countries. Objective: To estimate the trend of the burden of tuberculosis in the state of Santa Catarina, southern Brazil, from 2007 to 2011. Methods: Epidemiological time-series study on tuberculosis notifications and deaths reported in the Disease Notification System and the Mortality Information System between 2007 and 2011. Crude rates of Disability-Adjusted Life Years (DALY) and subcomponents were calculated and standardized by gender and age groups. Segmented linear regression was used to estimate the trends for burden of tuberculosis during the study period. Results: There were 696 deaths and 8,598 notifications during the study period. The highest rate was found in 2009, with 91.8 DALY/100,000 inhabitants, and the lowest in 2007, with 67.2 DALY/100,000 inhabitants. The highest burden was among men in economically active age groups. The study showed a non-significant increase of 3.8% per year in DALY rates. Conclusion: The burden of tuberculosis remained stable in Santa Catarina, Brazil between 2007 and 2011. RESUMO: Introdução: A carga da tuberculose vem sendo pouco estudada nos países em desenvolvimento. Objetivo: Estimar a tendência da carga da tuberculose no estado de Santa Catarina no período de 2007 a 2011. Métodos: Estudo epidemiológico de séries temporais realizado com base em dados de óbitos e notificações por tuberculose reportadas no Sistema de Informação de Mortalidade e no Sistema de Informação de Agravos de Notificação dos residentes no estado de Santa Catarina entre 2007 e 2011. Taxas brutas de anos de vida perdidos ajustados por incapacidade (DALY) e seus subcomponentes foram calculadas e posteriormente padronizadas segundo sexo e faixas etárias. Foi feita análise de regressão linear segmentada para estimar a tendência da carga no período estudado. Resultados: Foram observados 696 óbitos e 8.598 notificações de tuberculose nos anos em estudo. A maior taxa deu-se no ano de 2009, com 91,8 DALY/100 mil habitantes, e a menor, no ano de 2007, com 67,2 DALY/100 mil habitantes. Maior carga de tuberculose foi verificada no sexo masculino e em faixas etárias economicamente ativas. Encontrou-se aumento não significativo de 3,8% ao ano nas taxas de DALY no estado no período estudado. Conclusão: A carga da tuberculose manteve-se estável em Santa Catarina entre 2007 e 2011.

To investigate the association between dementia and anthropometric indicators in the elderly from Florianópolis.This is a cross-sectional population-based survey performed with 1,197 elderly (≥ 60 years) in 2013/2014. Dementia was defined as the combined evidence of low MMSE (Mini-Mental State Examination) score and moderate/severe disability in the activities of daily living. The independent variables were body mass index (BMI), waist circumference (WC), conicity index and waist-to-height ratio (WHtR). Logistic regression (crude and adjusted) was performed to identify associated factors.Dementia prevalence was estimated at 15.1%. After adjustment for sociodemographic characteristics, lifestyle and depressive symptoms, dementia was positively associated with the upper tertiles of the BMI (OR: 2.32; CI95%: 1.26-4.25), WC (OR: 2.22; CI95%: 1.20-4.11) and WHtR (OR: 2.30; CI95%: 1.19-4.43).Results have shown that both obesity and abdominal fat were associated with the outcome, suggesting that BMI, WC and WHtR should be considered in the investigation of this relationship.O objetivo deste artigo é investigar a associação entre demência e indicadores antropométricos em idosos de Florianópolis. Estudo transversal, de base populacional, realizado com 1.197 idosos (≥ 60 anos) em 2013/2014. A demência foi considerada como a presença conjunta de escore baixo no Miniexame do Estado Mental (MEEM) e a incapacidade funcional moderada/grave nas atividades de vida diária (AVD). As variáveis independentes avaliadas foram: índice de massa corporal (IMC), perímetro da cintura (PC), índice de conicidade e relação cintura/estatura (RCEst). A regressão logística (bruta e ajustada) foi utilizada para identificar os fatores associados. A prevalência estimada de demência foi de 15,1%. Após ajustes para características sociodemográficas, estilo de vida e sintomas depressivos, a demência foi positivamente associada aos tercis superiores do IMC (OR: 2,32; IC95%: 1,26-4,25), PC (OR: 2,22; IC95%: 1,20-4,11) e RCEst. (OR: 2,30; IC95%: 1,19-4,43). De acordo com os resultados, tanto a obesidade quanto a gordura abdominal foram associados ao desfecho, sugerindo que o IMC, o PC e a RCEst. devam ser considerados na investigação dessa relação.

The aim of this study was to analyze the factors associated with positive self-perceived health of octogenarians participating in community groups in the city of Florianopolis, Southern Brazil. A cross-sectional study was conducted with 343 older adult individuals aged 80 years or older, of both sexes, participating in community groups. A questionnaire was applied through a face-to-face interview, including socio-demographic and economic data, self-reported health status, falls, lifestyle and leisure domain from the International Physical Activity Questionnaire. Poisson regression was used to identify the factors associated with positive self-perceived health, adjusted for socio-demographic, economic, behavioral, health condition and fall variables. The prevalence of positive self-perceived health among octogenarians was 49.0% (95%CI=44.0-54.0). The factors associated with positive self-perceived health were as follows: to receive a monthly income higher than six minimum wages (PR=1.39; 95%CI=0.91-2.11), to smoke currently (PR=1.75; 95%CI=1.25-2.46), to be physically active during leisure time (PR=1.33; 95%CI=1.06-1.67), to have arthritis or rheumatism (PR=0.55; 95%CI=0.37-0.80), diabetes (PR=0.54; 95%CI=0.37-0.79) and cardiovascular disease (OR=0.71; 95%CI=0.53-0.95), apart from using medications (PR=0.74; 95%CI=0.60-0.91). Thus, it could be concluded that some modifiable factors were identified, such as income, smoking, leisure physical activity, and use of medications, which can interfere with the positive self-perceived health of octogenarians participating in community groups.

Objective: To determine the association between nutritional status and demographic, socioeconomic, lifestyle, and health condition factors in the elderly. Methods: A population-based, cross-sectional study, held in 2009, with 1705 elderly in Florianopolis. Nutritional status was assessed by body mass index. We analyzed the data using a multinomial logistic regression. Results: The prevalence of under- and overweight was 7.7% and 56.8% in women, respectively, and 9.9% and 44.9% in men. In women, being overweight was associated with being insufficiently active, three or more comorbidities, and disability in daily living activities. In men, underweight was associated with being single, less educated, and lack of Internet use, whereas overweight was associated with lower incomes, being a former smoker, moderate/severe disability, and poorer health perception. In men 80 years of age or older, income in the third quartile and smoking were associated with low and overweight, respectively. Conclusions: In women, nutritional status was associated with modifiable lifestyle habits, chronic diseases and disabilities. In men, it was related to sociodemographic factors. Thus, strategies to maintain the nutritional status of women and men must be differentiated. DOI: 10.12957/demetra.2016.22093

Background : Despite the considerable epidemiological relevance of cancer in developing countries, there are very few studies of the burden related to cancer. The aim of this study was to present and discuss data from a burden-of-cancer study performed in a Southern Brazilian state. Methods : An epidemiological study of ecological design was performed to calculate the disability-adjusted life year (DALY) index. The study was based on records of individuals admitted and treated for cancer in the Brazilian National Health System Hospitals, or individuals who had died of cancer while residing in the state of Santa Catarina in 2008. Results : A total of 73,872.9 DALYs were estimated, which generated a rate of 1220.5 DALYs/100,000 inhabitants. The highest DALYs were those for cancer of the trachea, bronchus and lung with 179.0/100,000 inhabitants, gastric cancer with 101.7/100,000 inhabitants, and breast cancer with 99.7/100,000 inhabitants. The percentage contribution of the DALY component varied according to cancer type; however, mortality was the major component in all types. The highest rates were observed in 60–69-year-olds with 6071.3/100,000 inhabitants, in 70–79-year-olds with 5095.4/100,000 inhabitants, and in 45–59-year-olds with 3189.0 DALY/100,000 inhabitants; 53.7% of DALYs occurred in males. Conclusions : The greatest burden of disease due to cancer in Santa Catarina was attributed to cancer of the trachea, bronchus and lung, followed by gastric and breast cancers. The mortality component was responsible for the greatest burden.

to identify sociodemographic, behavioral and health changes in a follow-up of participants in the health survey EpiFloripa Idoso.this is a population-based longitudinal study with elderly individuals in Florianópolis-SC, Brazil.1,702 elderly individuals were interviewed in 2009-2010 and 1,197 in 2013-2014 (response rate: 89.1% and 70.2%, respectively); among followed-up individuals, most of them remained with a partner (53.4%), living with other people (76.0%), not working (78.0%), with positive health perception (44.0%), not using the Internet (67.5%), not smoking (57.5%), not consuming alcohol (53.3%), not physically active (56.3%), consuming5 servings of fruits/vegetables (57.3%), independent (60.5%), overweight (47.0%), with negative screening for cognitive impairment (69.4%), with no depressive symptoms (72.0%) and not having suffered falls (60.6%).most elderly did not show significant changes in their sociodemographic, behavioral and health characteristics; the need to rethink more effective actions to improve the elderly health stands out.

The objective of this study was to identify the factors associated with positive self-perceived health of long-lived elderly (80+) individuals. This cross-sectional study was conducted in the city of Florianópolis, Santa Catarina, Brazil, and included 239 elderly participants from the EpiFloripa Ageing Project. We used collection instruments to verify sociodemographic and economic data, self-reported health status, falls, and lifestyle. Then, we identified factors associated with positive self-perceived health using a Poisson regression adjusted for sex. We found that a positive self-reported health status was more prevalent among the long-lived elderly who were not depressed (PR = 0.49), and among those who consumed alcohol (PR = 1.99). Understanding which variables may interfere in the self-perceived health of the long-lived elderly can result in better health options for this population, mainly, new methods to prevent depression. Additionally, this information can help reduce costs associated with hospitalizations, medications and health treatments, all of which are very common among the long-lived elderly.

to propose and present a stratification of Brazilian municipalities into homogeneous groups for evaluation studies of health management performance.this was a methodological study, with selected indicators which classify municipalities according to conditions that influence the health management and population size; data for the year 2010 were collected from demographic and health databases; correlation tests and factor analysis were used.seven strata were identified - Large-sized; Medium-sized with favorable, regular or unfavorable influences; and Small-sized with favorable, regular or unfavorable influences -; there was a concentration of municipalities with favorable influences in strata with better purchasing power and funding, as well as a concentration of municipalities with unfavorable influences in the North and Northeast regions.the proposed classification grouped similar municipalities regarding influential factors in health management, which allowed the identification of comparable groups of municipalities, setting up a consistent alternative to performance evaluation studies.

Background: Viral hepatitis is a major health problem in Brazil and worldwide. The state of Santa Catarina has high endemic areas, and the disease burden is unknown. Objectives: To estimate and analyze the burden of hepatitis B in the state of Santa Catarina, in 2005 - 2010. Materials and Methods: A time-series analysis was conducted using notification data of incidence and mortality rates from hepatitis B. The Disability-Adjusted Life Years (DALY) and the components Years of Life Lost (YLL) and Years Lived with Disability (YLD) were calculated. The annual variation was estimated using segmented linear regression, identifying the points at which there were changes in the trend. Results: The state of Santa Catarina showed an increase of 11.9% (95% CI 0.9, 24.2) per year in YLL rates. A significant increase was observed for men and within the 70 - 79 age group. There was a significant decrease of -9.4% (95% CI -16.1, -2.2) in the YLD rates per year. The decline was significant for women and within the 15-34 age group. Regarding the DALY rates, the state of Santa Catarina showed a decline of -6.6% (95% CI: -11.0, -2.0) per year. Significant decreases occurred for females and within the 15 - 29 and 45 - 59 age groups. However, there was a significant increase within the 70 - 79 age range. Conclusions: The state of Santa Catarina has reduced the disease burden rates attributed to disability from hepatitis B, but there has been an increase in the burden of premature mortality from 2005 to 2010.

Resumo Objetivo: descrever as caracteristicas de exposicao e medidas de protecao solar contra câncer da pele no municipio de Florianopolis, estado de Santa Catarina, Brasil. Metodologia: estudo transversal, do Inquerito Domiciliar sobre Comportamento de Risco e Morbidade Referida de Doencas e Agravos nao Transmissiveis. Foram calculadas medidas de frequencia e aplicado o teste qui-quadrado. Resultados: dentre os 851 entrevistados, 77,1% declararam se expor ao Sol. A exposicao solar foi mais frequente entre homens, jovens, solteiros e fisicamente ativos. Entre as medidas de protecao solar adotadas pela populacao exposta ao Sol, a mais utilizada foi o filtro solar (36,7% das mulheres e 10,5% dos homens). A utilizacao de filtro solar foi positivamente associada a escolaridade. Conclusao: a frequencia de exposicao ao Sol sem nenhum tipo de protecao foi elevada. Estes dados visam a colaborar na implementacao de politicas publicas especificas para o fator de risco prevenivel na carcinogenese do câncer da pele: a exposicao inadequada ao Sol. Palavras-chave: neoplasia cutânea/prevencao & controle; neoplasia cutânea/etiologia; luz solar/efeitos adversos; estudos transversais.

http://dx.doi.org/10.5007/1807-0221.2017v14n25p45Este estudo buscou investigar os parâmetros antropométricos, cardiovasculares e índices glicêmicos de participantes de um programa de promoção da saúde na cidade de Araranguá, bem como seus níveis de atividade física. Foi realizado um estudo transversal no período de julho a dezembro de 2015. A coleta dos dados foi realizada com 323 indivíduos com idade entre 18 a 90 anos, e observou-se alta prevalência de excesso de peso e obesidade (78,5%) e hipertensão autorreferida (43,3%). Avaliar fatores de risco para doenças cardiovasculares é um aspecto importante do processo de avaliação global de saúde, em particular nos domínios de detecção precoce e prevenção de doenças crônicas. Nesse contexto, este e outros estudos que tem sido desenvolvidos e estão em andamento, pretendem fornecer informações sobre o estado de saúde de participantes de um programa de promoção de saúde da cidade de Araranguá, a fim de auxiliar a implementação de serviços de saúde.

The objective was to identify factors associated with positive self-rated health in the elderly in Florianópolis, Santa Catarina State, in the South of Brazil. This population-based cross-sectional study evaluated 1,705 elderly. Self-rated health was classified as positive (very good or good) or negative (fair, poor, and very poor). Crude and adjusted Poisson regression was used to identify associated factors. Prevalence of positive self-rated health was 51.2%, associated with male gender (PR = 1.13), more than 5 years of schooling, moderate (PR = 1.33) or high alcohol intake (PR = 1.37), leisure-time activity (PR = 1.20), Internet use (PR = 1.21), fewer diseases, mild/moderate dependence (PR = 2.20) or no dependence (PR = 2.67), no falls (PR = 1.19), and non-use of polypharmacy (PR = 1.27). Several modifiable factors were identified that can affect positive self-rated health in the elderly and contribute to the development of strategies to improve their quality of life.