ABSTRACT BACKGROUND: The impact of metabolic syndrome (MetS) on healthcare costs remains unclear in the literature. OBJECTIVES: To determine the impact of MetS on primary healthcare costs of adults, as well as to identify the impact of physical activity and other covariates on this phenomenon. DESIGN AND SETTING: This cross-sectional study was conducted in the city of Presidente Prudente, State of São Paulo/Brazil, in 2016. METHODS: The sample comprised 159 older adults (> 50 years) of both sexes (110 women) who were identified from their medical records in the Brazilian National Health Service. Healthcare costs (US$) were assessed through medical records and divided into medical consultations, medications, laboratory tests, and total costs. MetS was assessed using medical records. RESULTS: The Brazilian National Health Service spent more on consultations (US$ 22.75 versus US$ 19.39; + 17.3%) and medication (US$ 19.65 versus US$ 8.32; + 136.1%) among adults with MetS than among those without MetS, but the costs for laboratory tests were similar (P = 0.343). Total costs were 53.9% higher in adults with MetS than in those without the diagnosis of the disease (P = 0.001). Regarding total costs, there was an increase of US$ 38.97 when five components of MetS were present (P = 0.015), representing an increase of approximately 700%, even after adjusting for sex, age, and physical activity. CONCLUSION: In conclusion, the presence of the MetS is responsible for increasing primary care costs among older adults, especially in those related to medicines. BACKGROUND (MetS literature OBJECTIVES phenomenon SETTING crosssectional cross sectional Prudente PauloBrazil Paulo Brazil Paulo/Brazil 2016 METHODS 15 > ( 5 years 110 (11 women US medications RESULTS (US 2275 22 75 22.7 19.39 1939 19 39 17.3% 173 17 3 1965 65 19.6 8.32 832 8 32 136.1% 1361 136 1 P 0.343. 0343 0.343 . 0 343 0.343) 539 53 9 53.9 0.001. 0001 0.001 001 0.001) 3897 38 97 38.9 0.015, 0015 0.015 , 015 0.015) 700 700% sex age CONCLUSION conclusion medicines 201 11 (1 227 2 7 22. 19.3 193 17.3 196 6 19. 8.3 83 136.1 13 034 0.34 34 53. 000 0.00 00 389 38. 0.01 01 70 20 17. 8. 136. 03 0.3 0.0 0.

Resumen: La actividad física en el ocio parece relevante para prevenir el desarrollo de enfermedades crónicas y la obesidad. Sin embargo, poco se sabe sobre el impacto económico de estos comportamientos saludables, especialmente en estudios longitudinales. El objetivo de este estudio fue analizar el impacto de caminar y andar en bicicleta como actividades de ocio sobre la adiposidad y los costos de salud en adultos. Este estudio longitudinal se llevó a cabo en una ciudad brasileña de tamaño mediano e incluyó a 198 participantes sin datos indisponibles atendidos en el Sistema Único de Salud brasileño. Se evaluaron los hábitos de caminar y andar en bicicleta mediante un cuestionario y una entrevista cara a cara en cuatro momentos (inicial, 6 meses, 12 meses y 18 meses). Los costos de atención médica se evaluaron utilizando registros médicos. Los marcadores de adiposidad incluyeron la circunferencia de la cintura y la grasa corporal. Durante el período de seguimiento, los participantes que practicaban más ciclismo presentaron menos grasa corporal (p = 0,028) y costos de salud (p = 0,038). Sin embargo, en el modelo multivariado, el impacto del ciclismo en los costos dejó de ser significativo (p = 0,507) debido al impacto del número de enfermedades crónicas (p = 0,001). El hábito de andar en bicicleta en los momentos de ocio está inversamente relacionado con la adiposidad en los adultos, mientras que su papel en la prevención de enfermedades crónicas parece ser el principal aspecto que lo vincula con la reducción de costos. Resumen obesidad embargo saludables longitudinales adultos 19 brasileño inicial, inicial (inicial 1 meses. . meses) médicos seguimiento p 0,028 0028 0 028 0,038. 0038 0,038 038 0,038) multivariado 0,507 0507 507 0,001. 0001 0,001 001 0,001) 0,02 002 02 003 0,03 03 0,50 050 50 000 0,00 00 0,0 0,5 05 5 0,

Abstract: Leisure-time physical activity seems relevant to prevent the development of chronic diseases and obesity. However, not much is known about the economic burden of these healthy behaviors, mainly in longitudinal designs. This study aimed to analyze the impact of walking and cycling on leisure-time on adiposity and healthcare costs among adults. This longitudinal study was conducted at a medium-size Brazilian city and included 198 participants with no missing data attended in the Brazilian Unified National Health System. Cycling and walking were assessed by a questionnaire with a face-to-face interview at four time-points (baseline, 6-month, 12-month, and 18-month). Healthcare costs were assessed using medical records. Adiposity markers included waist circumference and body fatness. Over the follow-up period, participants who were more engaged in cycling presented lower body fatness (p-value = 0.028) and healthcare costs (p-value = 0.038). However, in the multivariate model, the impact of cycling on costs was not significant (p-value = 0.507) due to the impact of number of chronic diseases (p-value = 0.001). Cycling on leisure-time is inversely related to adiposity in adults, whereas its role on preventing chronic diseases seems the main pathway linking it to cost mitigation. Abstract Leisuretime Leisure time obesity However behaviors designs leisuretime leisure adults mediumsize medium size 19 System facetoface face timepoints points baseline, baseline (baseline 6month, 6month month 6 month, 6-month 12month, 12month 12 12-month 18month. 18month 18 . 18-month) records followup follow up period pvalue p value 0.028 0028 0 028 0.038. 0038 0.038 038 0.038) model 0.507 0507 507 0.001. 0001 0.001 001 0.001) mitigation 1 18-month 0.02 002 02 003 0.03 03 0.50 050 50 000 0.00 00 0.0 0.5 05 5 0.

Resumo: A atividade física no lazer parece relevante para prevenir o desenvolvimento de doenças crônicas e obesidade. No entanto, pouco se sabe sobre o impacto econômico destes comportamentos saudáveis, principalmente em estudos longitudinais. O objetivo deste estudo foi analisar o impacto da caminhada e do ciclismo como atividades de lazer na adiposidade e nos custos de saúde em adultos. Este estudo longitudinal foi realizado em uma cidade brasileira de médio porte e incluiu 198 participantes sem dados indisponíveis atendidos no Sistema Único de Saúde brasileiro. A caminhada e o ciclismo foram avaliados por meio de questionário e entrevista presencial em quatro momentos (linha de base, 6 meses, 12 meses e 18 meses). Os custos de saúde foram avaliados por meio de prontuários médicos. Os marcadores de adiposidade incluíram circunferência da cintura e gordura corporal. Durante o período de acompanhamento, os participantes que praticavam mais ciclismo apresentaram menos gordura corporal (p = 0,028) e custos de saúde (p = 0,038). Porém, no modelo multivariado, o impacto do ciclismo nos custos deixou de ser significativo (p = 0,507) devido ao impacto do número de doenças crônicas (p = 0,001). O ciclismo no momento de lazer está inversamente relacionado à adiposidade em adultos, enquanto o seu papel na prevenção de doenças crônicas parece ser o principal aspecto que o liga à redução de custos. Resumo obesidade entanto saudáveis longitudinais adultos 19 brasileiro linha base 1 meses. . meses) médicos acompanhamento p 0,028 0028 0 028 0,038. 0038 0,038 038 0,038) Porém multivariado 0,507 0507 507 0,001. 0001 0,001 001 0,001) 0,02 002 02 003 0,03 03 0,50 050 50 000 0,00 00 0,0 0,5 05 5 0,

ABSTRACT BACKGROUND: The impact of metabolic syndrome (MetS) on healthcare costs remains unclear in the literature. OBJECTIVES: To determine the impact of MetS on primary healthcare costs of adults, as well as to identify the impact of physical activity and other covariates on this phenomenon. DESIGN AND SETTING: This cross-sectional study was conducted in the city of Presidente Prudente, State of São Paulo/Brazil, in 2016. METHODS: The sample comprised 159 older adults (> 50 years) of both sexes (110 women) who were identified from their medical records in the Brazilian National Health Service. Healthcare costs (US$) were assessed through medical records and divided into medical consultations, medications, laboratory tests, and total costs. MetS was assessed using medical records. RESULTS: The Brazilian National Health Service spent more on consultations (US$ 22.75 versus US$ 19.39; + 17.3%) and medication (US$ 19.65 versus US$ 8.32; + 136.1%) among adults with MetS than among those without MetS, but the costs for laboratory tests were similar (P = 0.343). Total costs were 53.9% higher in adults with MetS than in those without the diagnosis of the disease (P = 0.001). Regarding total costs, there was an increase of US$ 38.97 when five components of MetS were present (P = 0.015), representing an increase of approximately 700%, even after adjusting for sex, age, and physical activity. CONCLUSION: In conclusion, the presence of the MetS is responsible for increasing primary care costs among older adults, especially in those related to medicines. BACKGROUND (MetS literature OBJECTIVES phenomenon SETTING crosssectional cross sectional Prudente PauloBrazil Paulo Brazil Paulo/Brazil 2016 METHODS 15 > ( 5 years 110 (11 women US medications RESULTS (US 2275 22 75 22.7 19.39 1939 19 39 17.3% 173 17 3 1965 65 19.6 8.32 832 8 32 136.1% 1361 136 1 P 0.343. 0343 0.343 . 0 343 0.343) 539 53 9 53.9 0.001. 0001 0.001 001 0.001) 3897 38 97 38.9 0.015, 0015 0.015 , 015 0.015) 700 700% sex age CONCLUSION conclusion medicines 201 11 (1 227 2 7 22. 19.3 193 17.3 196 6 19. 8.3 83 136.1 13 034 0.34 34 53. 000 0.00 00 389 38. 0.01 01 70 20 17. 8. 136. 03 0.3 0.0 0.

ABSTRACT BACKGROUND: The magnitude of economic losses attributed to sleep problems and insufficient physical activity (PA) remains unclear. This study aimed to investigate the association between insufficient PA, sleep problems, and direct healthcare costs. OBJECTIVE: To investigate the association between insufficient physical activity (PA), sleep problems, and direct healthcare costs among adults. DESIGN AND SETTING: Adults aged ≥ 50 years attended by the Brazilian National Health Service were tracked from 2010 to 2014. METHODS: Direct healthcare costs were assessed using medical records and expressed in US$. Insufficient PA and sleep problems were assessed through face-to-face interviews. Differences were identified using the analysis of covariance and variance for repeated measures. RESULTS: In total, 454 women and 166 men were enrolled. Sleep problems were reported by 28.9% (95%CI: 25.2% to 32.4%) of the sample, while insufficient PA was reported by 84.8% (95%CI: 82.1% to 87.6%). The combination of sleep problems and insufficient PA explained 2.3% of all healthcare costs spent on these patients from 2010 to 2014, which directly accounts for approximately US$ 4,765.01. CONCLUSION: The combination of sleep problems and insufficient PA plays an important role in increasing direct healthcare costs in adults. Public health stakeholders, policymakers, and health professionals can use these results to reinforce the need for strategies to improve sleep quality and increase PA, especially in nations that finance their National Health Systems. BACKGROUND (PA unclear OBJECTIVE , adults SETTING 5 201 2014 METHODS US facetoface face interviews measures RESULTS total 45 16 enrolled 289 28 9 28.9 95%CI 95CI CI 95 (95%CI 252 25 2 25.2 32.4% 324 32 4 sample 848 84 8 84.8 821 82 1 82.1 87.6%. 876 87.6% . 87 6 87.6%) 23 3 2.3 476501 765 01 4,765.01 CONCLUSION stakeholders policymakers Systems 20 28. 25. 32.4 84. 82. 87.6 2. 47650 76 0 4,765.0 32. 87. 4765 7 4,765. 476 4,765 47 4,76 4,7 4,

Resumen: La actividad física en el ocio parece relevante para prevenir el desarrollo de enfermedades crónicas y la obesidad. Sin embargo, poco se sabe sobre el impacto económico de estos comportamientos saludables, especialmente en estudios longitudinales. El objetivo de este estudio fue analizar el impacto de caminar y andar en bicicleta como actividades de ocio sobre la adiposidad y los costos de salud en adultos. Este estudio longitudinal se llevó a cabo en una ciudad brasileña de tamaño mediano e incluyó a 198 participantes sin datos indisponibles atendidos en el Sistema Único de Salud brasileño. Se evaluaron los hábitos de caminar y andar en bicicleta mediante un cuestionario y una entrevista cara a cara en cuatro momentos (inicial, 6 meses, 12 meses y 18 meses). Los costos de atención médica se evaluaron utilizando registros médicos. Los marcadores de adiposidad incluyeron la circunferencia de la cintura y la grasa corporal. Durante el período de seguimiento, los participantes que practicaban más ciclismo presentaron menos grasa corporal (p = 0,028) y costos de salud (p = 0,038). Sin embargo, en el modelo multivariado, el impacto del ciclismo en los costos dejó de ser significativo (p = 0,507) debido al impacto del número de enfermedades crónicas (p = 0,001). El hábito de andar en bicicleta en los momentos de ocio está inversamente relacionado con la adiposidad en los adultos, mientras que su papel en la prevención de enfermedades crónicas parece ser el principal aspecto que lo vincula con la reducción de costos.

Abstract: Leisure-time physical activity seems relevant to prevent the development of chronic diseases and obesity. However, not much is known about the economic burden of these healthy behaviors, mainly in longitudinal designs. This study aimed to analyze the impact of walking and cycling on leisure-time on adiposity and healthcare costs among adults. This longitudinal study was conducted at a medium-size Brazilian city and included 198 participants with no missing data attended in the Brazilian Unified National Health System. Cycling and walking were assessed by a questionnaire with a face-to-face interview at four time-points (baseline, 6-month, 12-month, and 18-month). Healthcare costs were assessed using medical records. Adiposity markers included waist circumference and body fatness. Over the follow-up period, participants who were more engaged in cycling presented lower body fatness (p-value = 0.028) and healthcare costs (p-value = 0.038). However, in the multivariate model, the impact of cycling on costs was not significant (p-value = 0.507) due to the impact of number of chronic diseases (p-value = 0.001). Cycling on leisure-time is inversely related to adiposity in adults, whereas its role on preventing chronic diseases seems the main pathway linking it to cost mitigation.

Resumo: A atividade física no lazer parece relevante para prevenir o desenvolvimento de doenças crônicas e obesidade. No entanto, pouco se sabe sobre o impacto econômico destes comportamentos saudáveis, principalmente em estudos longitudinais. O objetivo deste estudo foi analisar o impacto da caminhada e do ciclismo como atividades de lazer na adiposidade e nos custos de saúde em adultos. Este estudo longitudinal foi realizado em uma cidade brasileira de médio porte e incluiu 198 participantes sem dados indisponíveis atendidos no Sistema Único de Saúde brasileiro. A caminhada e o ciclismo foram avaliados por meio de questionário e entrevista presencial em quatro momentos (linha de base, 6 meses, 12 meses e 18 meses). Os custos de saúde foram avaliados por meio de prontuários médicos. Os marcadores de adiposidade incluíram circunferência da cintura e gordura corporal. Durante o período de acompanhamento, os participantes que praticavam mais ciclismo apresentaram menos gordura corporal (p = 0,028) e custos de saúde (p = 0,038). Porém, no modelo multivariado, o impacto do ciclismo nos custos deixou de ser significativo (p = 0,507) devido ao impacto do número de doenças crônicas (p = 0,001). O ciclismo no momento de lazer está inversamente relacionado à adiposidade em adultos, enquanto o seu papel na prevenção de doenças crônicas parece ser o principal aspecto que o liga à redução de custos.

Resumo Nosso objetivo foi analisar a associação combinada entre características dos pais e indicadores de adiposidade dos filhos com o risco metabólico em adolescentes. Foi realizado estudo transversal com 972 adolescentes e seus pais. Observamos que adolescentes com sobrepeso que possuem mãe com peso normal apresentaram menor risco metabólico em comparação com seus pares com mães que apresentam sobrepeso. Concluímos que o status de peso da mãe modera a relação entre indicadores de obesidade e risco metabólico dos adolescentes.

Abstract Our aim was to analyze the joint association of parental characteristics and offspring obesity indicators with metabolic risk in adolescents. A cross-sectional study was carried out with 972 adolescents and their parents. We observed that overweight adolescents who have a normal weight mother show lower metabolic risk in comparison with their counterparts with overweight mothers. In conclusion, mother’s weight status moderates the relationship between offspring’ obesity indicators and metabolic risk in adolescents.

Resumo Nosso objetivo foi analisar a associação combinada entre características dos pais e indicadores de adiposidade dos filhos com o risco metabólico em adolescentes. Foi realizado estudo transversal com 972 adolescentes e seus pais. Observamos que adolescentes com sobrepeso que possuem mãe com peso normal apresentaram menor risco metabólico em comparação com seus pares com mães que apresentam sobrepeso. Concluímos que o status de peso da mãe modera a relação entre indicadores de obesidade e risco metabólico dos adolescentes.

Abstract Our aim was to analyze the joint association of parental characteristics and offspring obesity indicators with metabolic risk in adolescents. A cross-sectional study was carried out with 972 adolescents and their parents. We observed that overweight adolescents who have a normal weight mother show lower metabolic risk in comparison with their counterparts with overweight mothers. In conclusion, mother’s weight status moderates the relationship between offspring’ obesity indicators and metabolic risk in adolescents.

Resumo Objetivo: Analisar a associação entre o padrão do tempo sedentário (bouts e breaks) e o desempenho acadêmico, com ênfase no papel mediador do autoconceito. Métodos: Participaram deste estudo transversal 394 adolescentes (208 moças), de 10 a 14 anos, da sexta série de Londrina, Paraná, Brasil. O padrão do tempo sedentário foi obtido por meio de acelerometria. Definições: bouts sedentários — períodos ininterruptos em comportamento sedentário; breaks — período não sedentário entre duas séries sedentárias. O autoconceito foi estimado usando o Inventário Piers-Harris II. O desempenho acadêmico foi obtido pelas notas escolares. Resultados: Bouts sedentários curtos foram associados com maior desempenho acadêmico em rapazes (1–4 minutos: β=0,035, p=0,007) e moças (1–4 minutos: β=0,031, p=0,014; 5–14 minutos: β=0,054, p=0,001). Bouts longos (30 minutos) foram associados a menor desempenho acadêmico em rapazes (β=-0,023; p=0,011) e moças (β=-0,032; p<0,001). Para as moças, o autoconceito total e intelectual mediou a associação entre todos os padrões sedentários e o desempenho acadêmico (bouts de 1–4 minutos [total: 39% e intelectual: 42,8%]; bouts de 5–14 minutos [total: 21,5% e intelectual: 35,4%]; bouts ≥30 minutos [total: 22,6% e intelectual: 32,3%]; e breaks [total: 38,9% e intelectual: 40,7%]). Para os rapazes, o autoconceito total (56,4%) e intelectual (82,9%) mediaram apenas a associação entre bouts de 5–14 minutos e desempenho acadêmico. Conclusões: O padrão do tempo sedentário está associado ao desempenho acadêmico em adolescentes, e essa associação é mediada pelo autoconceito, principalmente em moças.

Abstract Objective: To analyze the association between the pattern of sedentary time (bouts and breaks) with academic performance, with an emphasis on the mediating role of self-concept. Methods: Participants in the cross-sectional study were 394 adolescents (208 girls), aged 10–14 years, from sixth grade from Londrina, Paraná, Brazil. The sedentary time pattern was measured through accelerometry. Definitions: sedentary bouts — uninterrupted periods of sedentary behavior; breaks — non-sedentary period between two sedentary bouts. The self-concept was estimated using the Piers-Harris II Inventory. Academic performance was obtained by school grades. Results: Short sedentary bouts were associated with higher academic performance in boys (1–4 minutes: β=0.035, p=0.007) and girls (1–4 minutes: β=0.031, p=0.014; 5–14 minutes: β=0.054, p=0.001). Long bouts (30 minutes) were associated with lower academic performance in boys (β=-0.023; p=0.011) and girls (β=-0.032; p<0.001). For girls, total and intellectual self-concept mediated the association between all sedentary pattern and academic performance (bouts 1–4 minutes [total: 39% and intellectual: 42.8%]; bouts 5–14 minutes [total: 21.5% and intellectual: 35.4%]; bouts ≥30 minutes [total: 22.6% and intellectual: 32.3%]; and breaks [total: 38.9% and intellectual: 40.7%]). For boys, the total (56.4%) and intellectual (82.9%) self-concept mediated only the association between bouts of 5–14 minute and academic performance. Conclusions: The pattern of sedentary time is associated with academic performance in adolescents and this association is mediated by self-concept, especially in girls.

Resumo Apesar das mudanças observadas nos relacionamentos sociais nos últimos anos, especialmente entre as gerações mais novas, pouca evidência está disponível sobre os fatores associados à percepção dos relacionamentos sociais. Neste estudo nós investigamos a associação entre a percepção das próprias relações sociais, comportamentos associados à saúde, maturação biológica e indicadores de saúde mental em adolescentes. Este é um estudo transversal conduzido com 1.336 adolescentes (605 meninos e 731 meninas) com idades entre 10 e 17 anos, alunos de escolas públicas. A percepção dos relacionamentos sociais (família, amigo e professores), frequência de sentimentos de estresse e tristeza, o desempenho acadêmico, consumo de álcool, tabaco e alimentos gordurosos, bem como o nível de atividade física e tempo de tela foram avaliados por questionário. A maturação biológica foi estimada a partir do pico de velocidade de crescimento. Observamos que as piores relações sociais percebidas estiveram relacionadas ao consumo de tabaco (família e professores), de álcool (professores), alto consumo de alimentos gordurosos (professores), sentimentos de estresse (família e professores) e de tristeza (família e amigos) mais frequentes, e pior percepção do desempenho acadêmico (amigos e professores).

Abstract Although changes have been observed in social relationships in the recent years, especially among younger generations, little evidence is available concerning factors associated with adolescents’ perceived social relationships. In this study we investigated the association between self-perceived social relationships, health-related behaviors, biological maturation, and mental health in adolescents. This is a cross-sectional study conducted with 1,336 adolescents (605 boys and 731 girls) aged between 10 to 17 years from public schools. Self-perceived social relationships (family, friends, and teachers), feelings of stress and sadness, academic performance, tobacco smoking, alcohol and fat consumption, physical activity, and screen time were evaluated by a questionnaire. Biological maturation was assessed by the peak height velocity. We observed that worse perceived social relationships were associated with tobacco smoking (family and teachers), alcohol drinking (teachers), higher consumption of fat (teachers), greater feelings of stress (family and teachers) and sadness (family and friends), and poor academic achievement (friends and teachers).

Resumo Apesar das mudanças observadas nos relacionamentos sociais nos últimos anos, especialmente entre as gerações mais novas, pouca evidência está disponível sobre os fatores associados à percepção dos relacionamentos sociais. Neste estudo nós investigamos a associação entre a percepção das próprias relações sociais, comportamentos associados à saúde, maturação biológica e indicadores de saúde mental em adolescentes. Este é um estudo transversal conduzido com 1.336 adolescentes (605 meninos e 731 meninas) com idades entre 10 e 17 anos, alunos de escolas públicas. A percepção dos relacionamentos sociais (família, amigo e professores), frequência de sentimentos de estresse e tristeza, o desempenho acadêmico, consumo de álcool, tabaco e alimentos gordurosos, bem como o nível de atividade física e tempo de tela foram avaliados por questionário. A maturação biológica foi estimada a partir do pico de velocidade de crescimento. Observamos que as piores relações sociais percebidas estiveram relacionadas ao consumo de tabaco (família e professores), de álcool (professores), alto consumo de alimentos gordurosos (professores), sentimentos de estresse (família e professores) e de tristeza (família e amigos) mais frequentes, e pior percepção do desempenho acadêmico (amigos e professores).

Abstract Although changes have been observed in social relationships in the recent years, especially among younger generations, little evidence is available concerning factors associated with adolescents’ perceived social relationships. In this study we investigated the association between self-perceived social relationships, health-related behaviors, biological maturation, and mental health in adolescents. This is a cross-sectional study conducted with 1,336 adolescents (605 boys and 731 girls) aged between 10 to 17 years from public schools. Self-perceived social relationships (family, friends, and teachers), feelings of stress and sadness, academic performance, tobacco smoking, alcohol and fat consumption, physical activity, and screen time were evaluated by a questionnaire. Biological maturation was assessed by the peak height velocity. We observed that worse perceived social relationships were associated with tobacco smoking (family and teachers), alcohol drinking (teachers), higher consumption of fat (teachers), greater feelings of stress (family and teachers) and sadness (family and friends), and poor academic achievement (friends and teachers).

RESUMO O objetivo deste trabalho é relatar um caso clínico de reabilitação facial com prótese nasal acrílica implanto-retida pós-rinectomia parcial decorrente da ressecção de um carcinoma basocelular em um paciente do sexo masculino, vaqueiro, 53 anos de idade, caucasiano e normossistêmico. Após exame clínico e de posse da tomografia computadorizada, foi realizada a cirurgia de instalação dos implantes dentários convencionais na região da pré-maxila (lado esquerdo). Depois de realizada a cirurgia, esperou-se a osseointegração dos implantes por três meses e, posteriormente, foi realizada a confecção da prótese nasal que, ao final do tratamento, apresentou adaptação periférica, retenção e estética satisfatórias. O paciente tem retornado a cada 6 meses para proservação quanto à análise da cor da prótese, saúde periimplantar, higienização, troca dos magnetos e reembasamentos quando necessários. Os autores concluem que essa terapia pode ser bem indicada em defeitos nasais parciais e totais, desde que haja correto planejamento e execução das fases cirúrgica, clínica e laboratorial.

ABSTRACT The objective of this study was to report a clinical case of facial rehabilitation with an acrylic implant-retained nasal prosthesis after partial rhinectomy resulting from the resection of a basal cell carcinoma in the patient, a 53-year-old Caucasian, normosystemic, professional cowboy. After clinical examination and in possession of computed tomography images, surgery was performed for the placement of conventional dental implants in the premaxillary region (left side). After the surgery, a three-month period of waiting was observed to allow osseointegration of the implants. Later, the nasal prosthesis was prepared, and at the end of treatment, this presented satisfactory peripheral adaptation, retention and esthetics. The patient has returned for follow-up every 6 months, regarding analysis of the prosthesis color, peri-implant health, hygiene, and exchange of the magnets and relays when necessary. The authors concluded that this therapy may be well indicated in patients with partial and total nasal defects, provided that there is correct planning and execution of the surgical, clinical and laboratory phases.

ABSTRACT BACKGROUND: Physical activity (PA) practices seem to differ between weekdays and weekends and these pattern changes can affect body fat differently. However, previous studies did not assess the mediation effect of weekday and weekend PA on maintenance of body fat using sophisticated statistical models. OBJECTIVE: To analyze the mediation effect of PA during weekdays and weekends on maintenance of fat mass over a 12-month follow-up. DESIGN AND SETTING: Longitudinal cohort study (12 months) conducted at a public university in Presidente Prudente, Brazil. METHODS: A sample of 225 adults (117 females) was used. Body fatness and fat mass were assessed using dual-energy X-ray absorptiometry. PA levels were assessed using a pedometer. The statistical analysis consisted of paired-sample t tests, independent-sample t tests, Pearson correlations and mediation models. RESULTS: After 12 months, weekend PA had decreased while body composition indicators remained stable (without changes). The correlation between fat mass at baseline and follow-up was high for both sexes (men: 0.966; women: 0.941; P-value = 0.001 for both). Moreover, PA indices were inversely but moderately related to fat mass at baseline and follow-up. Lastly, weekend PA mediated the association between fat mass at baseline and follow-up (P-value < 0.05) by around 2% and 4%. CONCLUSION: Weekend PA mediated the association between fat mass at baseline and fat mass after one year of follow-up among these adults. Further studies are required to investigate the association between physical activity, body fat and other variables such as dietary patterns and sleep time.

BACKGROUND: This study was based on filling a gap in our knowledge regarding the issue of what the protective effect of physical exercise on patients within the Brazilian National Health System could be, in relation to low back pain. OBJECTIVES: To determine the prevalence of chronic low back pain (CLBP) and to analyze the protective effect of physical exercise among patients over 50 years old attended at primary healthcare units (PHUs). DESIGN AND SETTING: Analytical cross-sectional study at Universidade Estadual Paulista (UNESP) that was conducted in two PHUs (Parque Cedral and Vila Real), located in different regions of the city of Presidente Prudente, Brazil. METHODS: In total, 327 patients were interviewed and evaluated at which retrospective characteristics covering the previous 12 months. The Nordic questionnaire was used to classify CLBP, and the Baecke questionnaire for physical activity level. The body mass index (kg/m2) was calculated using body mass and height values, both collected at the time of the interview. RESULTS: High prevalence of low back pain was found; 175 patients (53.5%) reported having had at least one episode of low back pain in the previous year. Of these, 71 (21.7%) answered yes to all four questions on the Nordic questionnaire and were classified as CLBP. Physical exercise remained associated with CLBP, independent of other factors (odds ratio = 0.35; 95% confidence interval = 0.15-0.80). CONCLUSION: High prevalence of low back pain was identified among PHU users. Physical exercise was associated as an independent protective factor against this pathological condition.

ABSTRACT Our aim was to analyze hospitalization due to affective disorders in Brazil from 2003 to 2017 and the possible association with economic indicators during crises. We used data on hospitalizations due to affective disorders within the Brazilian National Health System, obtained from DATASUS; data on health-related behavior (television-viewing and physical activity) from the VIGITEL database; and economic data from the World Bank database. We found that the numbers of hospitalizations increased one year after the 2009 crisis and one year after the 2016 crisis. Negative changes in health-related behavior also followed changes in the numbers of hospitalizations due to affective disorders.

RESUMO Objetivo: Revisar sistematicamente a literatura para verificar a relação entre indicadores da aptidão neuromuscular na infância/adolescência e variáveis de resistência óssea na idade adulta. Fonte de dados: Revisão sistemática com pesquisa de artigos conduzida no PUBMED, SCOPUS, SPORTDiscus, Web of Science, PsycINFO, LILACS and SciELO, abrangendo todo o período da base até março de 2019. Síntese dos dados: A busca identificou 1.149 estudos, após análise de duplicidade e dos critérios de elegibilidade, quatro estudos foram relatados. Em um dos estudos, o baseline foi a infância e, nos demais, a adolescência. Na infância, ao ajustar o modelo por idade e índice de massa corporal, foi encontrada relação estatisticamente significativa para as meninas: salto em distância com índice quantitativo de ultrassom (β=0,11; p<0,05) e com velocidade do som (β=0,14; p<0,01). Entretanto, ao se fazer o controle do desempenho muscular na idade adulta, a relação deixou de ser significativa. Na adolescência, coeficientes variaram de 0,16 para bateria neuromotora e densidade mineral óssea (DMO) lombar a 0,38 para o teste de elevação de pernas em suspensão e a DMO dos braços. Variação explicada entre 2% (suspensão na barra e DMO do corpo total) e 12% (elevação de pernas em suspensão e DMO dos braços), portanto, melhor desempenho na aptidão neuromuscular na adolescência, mais resistência óssea na idade adulta. Conclusões: Em adultos, variáveis de resistência óssea apresentaram correlação significativa em magnitude baixa a moderada com indicadores da aptidão neuromuscular na adolescência, mas não na infância, após controlar pelo desempenho adulto na aptidão neuromuscular. No entanto, existe evidência limitada para apoiar a aptidão neuromuscular na juventude como fator determinante da resistência óssea na fase adulta.

ABSTRACT Objective: To systematically review the literature to verify the relationship between neuromuscular fitness indicators in childhood/adolescence and bone strength variables in adulthood. Data sources: A systematic review was conducted in PUBMED, SCOPUS, SPORTDiscus, Web of Science, PsycINFO, LILACS, and SciELO, covering the entire period until March 2019. Data synthesis: The search identified 1149 studies. After duplicity analysis and eligibility criteria, four studies were reported. In one study, baseline was childhood and, in the others, adolescence. In childhood, when adjusting the model for age and body mass index, a statistically significant relation was found for girls: standing long jump with quantitative ultrasound index (β=0.11; p<0.05) and with speed of sound (β=0.14; p<0.01). However, when controlling muscular performance in adulthood, the relationship was no longer significant. In adolescence, coefficients ranged from 0.16 for neuromotor battery and bone mineral density (BMD) in the lumbar region to 0.38 for hanging leg lift test and BMD of arms. The explained variance varied between 2% (bent arm hang for BMD total) and 12% (hanging leg-lift for BMD arms), therefore, a higher performance in neuromuscular fitness in adolescence was associated with better bone strength in adulthood. Conclusions: In adults, bone strength variables showed significant correlation from low to moderate magnitude with neuromuscular fitness indicators in adolescence, but not in childhood, after controlling for adult performance in neuromuscular fitness. However, there is limited evidence to support the neuromuscular fitness in early life as a determinant of bone strength in adulthood.