Rafael Martins da Costa

Negative mental health, operationalized here as symptoms anxiety, depression, and stress, is a critical adolescent challenge, particularly in understand regions like the Western Amazon. This study examined associations between physical activity (PA) domains (leisure, commuting, and school) and these symptoms. A cross-sectional study ( n = 349) of students aged 10–17 years utilized the DASS-21 and validated PA questionnaires. Data were analyzed using multiple linear regression adjusted for sociodemographic variables. High-volume active commuting (⩾150 minutes/week) was significantly associated with increased anxiety ( p = 0.011) and depression ( p = 0.001) scores. Conversely, moderate leisure-time PA (1–299 min/week) exerted a protective effect against depression ( p = 0.012). No significant associations emerged for school Physical Education or stress. The PA–mental health relationship is context-dependent. While leisure activity is beneficial, high-volume active commuting (⩾150 minutes/week) in hostile environments may exacerbate psychological distress; however, given the cross-sectional design, these findings reflect associations rather than causal effects. Public health strategies should prioritize safer environments for active leisure and curricular reforms.

Introduction: health literacy is crucial for managing type 2 diabetes mellitus (T2DM). In the Brazilian Amazon, geographical barriers limit access to care, exacerbating low adherence and poor glycemic control, impacting the disease progression. Objective: to analyze patterns of health literacy and their associations with sociodemographic, clinical, and behavioral factors among individuals with T2DM in the Brazilian Amazon, using a network analysis approach. Methods: a cross-sectional study was conducted with 137 adults with T2DM receiving care in six Primary Health Care units in a Brazilian Amazon city. Health literacy was assessed using the Brazilian version of the Test of Functional Health Literacy in Adults, and diabetes knowledge was measured using the DiAbeTes Education Questionnaire (DATE-Q). Sociodemographic, clinical, and behavioral data were collected through structured interviews. Descriptive and inferential analyses were performed, and network analysis was applied to explore the interrelationships among variables. Results: most participants had inadequate health literacy (57.7%), and only 1.5% had adequate literacy. Lower literacy levels were significantly associated with older age, fewer years of schooling, lower income, unemployment, and longer diabetes duration (p<0.05). Individuals with lower literacy also reported poorer dietary practices and lower adherence to recommended self-care behaviors. In the network model, health literacy emerged as a central node, with the highest strength and betweenness indices, closely connected to education, retirement status, and age, indicating its key role in the structure of associations. Conclusion: the prevalence of low health literacy among participants was 57.7%. Lower health literacy was significantly associated with older age, fewer years of schooling, lower income, and longer diabetes duration. These factors may be related to barriers to understanding and accessing health services in the region, such as low income and limited access.

We welcome the Letter to the Editor and their thoughtful commentary on our recently published study examining temporal trends in overweight and obesity among schoolchildren in Porto Velho, Rondônia, Brazil, from 2006 to 2024. We fully concur with their central argument: the evidence base on child and adolescent nutrition in the Amazon region remains heavily reliant on cross-sectional and repeated cross-sectional designs, with longitudinal cohort studies representing a critical and largely unmet need. Our own findings underscore the urgency of building the longitudinal infrastructure necessary to identify causal determinants of these trends. The Amazon basin, home to approximately 40 million people across nine countries and over 300 indigenous ethnic groups, presents a uniquely complex socio-ecological context marked by rapid urbanisation, nutrition transition, environmental exposures and profound structural inequities that cross-sectional evidence alone cannot adequately characterise. We endorse the authors’ call for the prioritisation of long-term longitudinal studies and, in particular, their vision of multi-centre, transnational Amazonian cohorts supported by multi-country funding. We further propose that our established school-based surveillance infrastructure in Western Amazonia could serve as a meaningful foundation for future binational or multi-site collaborative research. We invite the authors to explore this possibility and look forward to contributing to a broader, coordinated research agenda aimed at improving child and adolescent health across the Amazon basin.

Physical activity (PA), sedentary behavior (SB), and sleep – collectively known as movement behaviors – synergistically to affect individual’s health (Chaput et al., 2017; Fournier et al., 2023). S...

Type 2 diabetes mellitus (T2DM) is a major global public-health problem, and physical inactivity contributes to poor disease control. In settings with limited access to health services, as in the Brazilian Amazon, interventions delivered by Community Health Workers (CHWs) within Primary Health Care (PHC) may offer a pragmatic strategy to increase physical activity (PA). We aimed to evaluate the effect of a CHW-led, theory-based intervention on PA among adults with T2DM in PHC in a cluster-randomized, community-based trial. A total of 274 participants were enrolled (intervention: n = 140, control: n = 134). CHWs in the intervention group completed a blended training (e.g., asynchronous modules, printed educational materials, and hands-on guidance). They conducted six home visits over six months to support behavior change, including increased PA. PA was measured using the International PA Questionnaire (IPAQ-LF), which assessed active commuting, walking, moderate-to-vigorous PA (MVPA), and total PA. Group-by-time effects were examined using mixed-effects zero-inflated Gamma models. No significant intervention effects were observed for the conditional mean of minutes or the probability of participation in active commuting, walking, or total PA. However, for MVPA, the zero-inflated Gamma model revealed a significant intervention effect on the probability of engaging in activity. The intervention group showed a marked reduction in the likelihood of remaining at zero minutes of MVPA (Odds Ratio = 0.08; 95% CI = 0.01–0.79; p = 0.001) compared to the control group, indicating effective behavioral activation among previously inactive participants. These findings suggest that empowering CHWs to deliver structured, theory-driven interventions within PHC can reduce inactivity among high-risk adults with T2DM in underserved communities.

This cross-sectional study identified mental health profiles among Brazilian adolescents and examined their associations with domain-specific physical activity (leisure time, school, and active commuting) and television (TV) viewing time. Data were obtained from 144,046 adolescents in the 2019 Brazilian National Survey of School Health (PeNSE, acronym in Portuguese). Self-reported indicators included the frequency of five emotional states, weekly minutes of physical activity in leisure time, physical education, and commuting, and daily TV hours. Latent class analysis classified adolescents based on their mental health profiles, and multinomial logistic regression estimated associations between physical activity domains and TV viewing time with mental health classes, adjusting for covariates. Six mental health profiles were identified: (1) school-related concern; (2) anxious and stressed; (3) subthreshold internalizing; (4) anxious, sad, and angry; (5) low symptom; (6) severe internalizing. Adolescents who engaged in physical activity in their leisure time and at school were more likely to belong to the low symptom class, while those who engaged in physical activity during commuting were more likely to be in class 6 (severe internalizing). Adolescents who watched two to four hours of TV per day were more likely to belong to class 1 (school-related concern), class 4 (anxious, sad, and angry), and class 5 (low symptom), whereas those who watched TV more than four hours/day were less likely to belong to class 3 (subthreshold internalizing) and class 6 (severe internalizing). These findings underscore that both the context and quantity of physical activity and TV time are differentially related to adolescent mental health profiles, implying the need for targeted surveillance and interventions.

The aim of this study is to update the estimates of the prevalence of global physical activity (PA) among Brazilian children and adolescents, as part of the Brazil Report Card. A systematic review search was conducted in eight databases (PubMed, Scopus, Web of Science, LILACS, SPORTDiscus, BIREME, SciELO, and Google Scholar). Studies published between 2020 and June 2025 that assessed global PA among Brazilian youth were selected in pairs. Information on prevalence was extracted and aggregated with the set of studies from previous reviews. The initial search identified 6,938 potentially relevant titles (2,933 after duplicate removal); 34 studies (27 unique) met all inclusion criteria, resulting in a total of 125 studies included in the Report Card analyses. Few changes in the methodological characteristics of the studies were observed. Most of the studies included in the update were conducted in the Southern region (41.2%). Eight studies reported data from national surveys (23.5%), and one study included only children (6 to 10 years old). Three studies used accelerometry. In the update, the overall proportion of youth who were physically active ranged from 20.2% to 84.2%. Overall, an increase in PA prevalence was observed, except among girls. Advances in epidemiological research involving Brazilian children and adolescents are needed, particularly to improve the monitoring, evaluation, and promotion of global PA in Brazil.

Objective: Overweight and obesity have become a global public health concern, with prevalence rising sharply in low- and middle-income countries. This study analysed temporal trends in overweight and obesity among schoolchildren in the largest capital city of Brazil, from 2006 to 2024. Design: Repeated cross-sectional. Setting: Schoolchildren aged 6 to 19 years from Porto Velho, Rondônia, Brazil. Participants: A total of 12 646 participants were evaluated. To assess the BMI z -score, standardised body mass and height measurements were used, stratified by sex (male and female) and age group (6–10 and 11–19 years). Temporal trends were assessed using joinpoint regression analysis. Results: Overall, 17·8 % of participants were classified with overweight, and 8·6 % were classified with obesity. The study also found that obesity prevalence was consistently higher among younger age groups compared to adolescents. The results revealed a significant increase in obesity prevalence among girls (annual percentage change (APC) = 5·81 %; 95 % CI = 1·03–10·81; P -value = 0·021) and children aged 6 to 10 years (APC = 5·20 %; 95 % CI = 1·17–9·39; P -value = 0·017), while no significant trends were observed for overweight or for male adolescents or adolescents aged 11 to 19 years. Conclusions: Our findings indicate rising obesity among girls and children aged 6–10 years and support the need for urgency. We recommend targeted action, including implementing mandatory quality physical education and school nutrition standards, enforcing restrictions on marketing to children and prioritising municipal policies that increase access to healthy foods.

Interventions have focused on evaluating effective strategies for increasing physical activity (PA) and reducing sedentary behavior (SB) in children and adolescents, which is still a challenge mainly in low- and middle-income countries. Thus, this study aimed to assess the effect of the Movimente Study on device-measured PA and SB in two-time segments of the school day amongst Brazilian adolescents. Six elementary schools were randomized into the intervention (IG) or control group (CG). Participants were in 7th -9th grades. A school year (2017) multicomponent intervention was delivered consisting of three components: (1) teacher training, (2) education curriculum, and (3) school environment. PA and SB were assessed using GT3x + ActiGraph hip-worn accelerometers. The trial’s primary outcome was overall device-measured PA and SB. Exploratory secondary analyses examined PA and SB within in-School (08:00–11:59) and out-of-school (12:00–22:00) time segments. A two-level linear mixed model assessed the effect of the intervention on light-intensity PA (LPA), moderate- to vigorous-intensity PA (MVPA), SB, and MVPA/SB ratio within and between groups. There was a significant effect on the IG compared to the CG for MVPA (Coefficient [Coef.] = 16.2; 95% Confidence Interval [95%CI] = 6.9;25.5; p-value = 0.001), SB (Coef. = -22.7; 95%CI = -44.7;-0.7; p-value = 0.043), and MVPA/SB ratio (Coef. = 3.2; 95%CI = 1.2;5.3; p-value = 0.002) performed in the out-of-school segment, but not in the In-school segment. However, there were no significant differences within- nor between-group differences in LPA in both day segments. The Movimente Study was associated with greater increases in MVPA, improvements in the MVPA/SB ratio, and reductions in SB during the out-of-school period compared with control peers. Clinical Trials - NCT02944318. Registration Date: 10/24/2016.

Objetivo: Analisar como os agrupamentos de determinantes sociais da saúde estão associados a práticas de estilo de vida saudável entre adultos e idosos adventistas no Brasil. Método: Estudo transversal com 216 participantes. Os comportamentos de saúde foram avaliados por meio do Questionário dos Oito Remédios Naturais. Utilizaram-se Análise de Classes Latentes e modelos de regressão linear para identificar padrões comportamentais e associações com fatores socioeconômicos. Resultados: Foram identificadas duas classes latentes. Indivíduos da Classe 2, com menor escolaridade e condição socioeconômica, apresentaram pontuação significativamente menor em comportamentos relacionados ao exercício físico. Não houve diferenças significativas em outros hábitos de vida. Conclusão: Os resultados indicam que níveis socioeconômicos e educacionais mais baixos influenciam negativamente os hábitos de exercício entre adventistas, destacando a importância de intervenções em saúde pública direcionadas.