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          "pt" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Preval&#234;ncias de atividade f&#237;sica&#44; estado nutricional e pr&#225;tica de atividade f&#237;sica no tempo livre e suas associa&#231;&#245;es com a APS negativa em adolescentes de ambos os sexos&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introdu&#231;&#227;o</span><p id="par0005" class="elsevierStylePara elsevierViewall">A autopercep&#231;&#227;o de sa&#250;de &#40;APS&#41; &#233; um indicador usado em inqu&#233;ritos que&#44; embora subjetivo&#44; est&#225; fortemente relacionado a morbidade&#44; mortalidade&#44; longevidade e estado de sa&#250;de em diferentes subgrupos populacionais&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">1&#44;2</span></a> Especificamente na adolesc&#234;ncia a APS &#233; formada por cont&#237;nuas mudan&#231;as corporais&#44; sociais&#44; comportamentais e mentais&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">3</span></a> A preval&#234;ncia de APS negativa nessa faixa et&#225;ria varia entre 1&#44;2&#37; e 38&#37;&#44; as meninas apresentam maior preval&#234;ncia de APS negativa quando comparadas com os meninos&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Estudos epidemiol&#243;gicos t&#234;m demonstrado a exist&#234;ncia de uma associa&#231;&#227;o entre a pr&#225;tica de atividade f&#237;sica &#40;AF&#41; e a ado&#231;&#227;o de outros comportamentos relacionados &#224; sa&#250;de&#44; com resultante impacto na melhoria da qualidade de vida<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">5&#44;6</span></a> e da APS&#46;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">6&#8211;10</span></a> Revis&#227;o sistem&#225;tica que envolveu 16&#160;estudos transversais com adolescentes observou que em 88&#37; dos estudos existia uma associa&#231;&#227;o significativa entre a pr&#225;tica de AF e APS positiva&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">11</span></a> Entretanto&#44; os efeitos positivos da AF podem ser obtidos de diferentes maneiras e uma limita&#231;&#227;o importante &#233; que a maioria dos estudos tem avaliado apenas a AF total&#46; Assim&#44; outros dom&#237;nios&#44; por exemplo a AF de lazer e tipos de AF no tempo livre &#40;pr&#225;tica de exerc&#237;cios&#44; esportes&#44; dan&#231;as e artes marciais&#41;&#44; n&#227;o t&#234;m sido investigados&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Outro aspecto relevante associado &#224; APS nos adolescentes &#233; o estado nutricional&#44; os adolescentes com sobrepeso e obesidade apresentam mais APS negativa comparados com os eutr&#243;ficos&#44;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">12</span></a> o que tamb&#233;m n&#227;o tem sido considerado pelos estudos que testaram associa&#231;&#227;o entre AF e APS&#46; Ademais&#44; outra importante lacuna se deve ao fato de que as associa&#231;&#245;es n&#227;o t&#234;m sido estratificadas pelo sexo&#44; o que seria necess&#225;rio&#44; haja vista que as meninas apresentam maior preval&#234;ncia de APS negativa&#44; maior insatisfa&#231;&#227;o com o peso corporal&#44; fato que tem rela&#231;&#227;o direta com o estado nutricional&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">13&#44;14</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">A identifica&#231;&#227;o de fatores associados &#40;AF total&#44; AF no lazer&#44; AF no tempo livre e estado nutricional&#41; a APS em adolescentes estratificados por sexo poder&#225; fornecer subs&#237;dios espec&#237;ficos para os adolescentes&#44; auxiliar as interven&#231;&#245;es que visem a melhorar a APS dos adolescentes&#46; Desse modo&#44; o objetivo deste estudo foi avaliar a associa&#231;&#227;o entre AF total&#44; AF no tempo livre e o estado nutricional com a APS em adolescentes de ambos os sexos&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">M&#233;todos</span><p id="par0025" class="elsevierStylePara elsevierViewall">Trata&#8208;se de uma an&#225;lise secund&#225;ria dos dados de um levantamento epidemiol&#243;gico transversal&#44; de base escolar e abrang&#234;ncia estadual&#44; denominado &#8220;Pr&#225;tica de atividades f&#237;sicas e comportamentos de risco &#224; sa&#250;de em estudantes do Ensino M&#233;dio no Estado de Pernambuco&#8221;&#44; feito entre o primeiro &#40;maio e junho&#41; e o segundo semestre &#40;agosto&#44; setembro&#44; outubro e novembro&#41; de 2011&#46; O estudo foi aprovado pelo Comit&#234; de &#95;tica em Pesquisa com Seres Humanos da Universidade de Pernambuco &#40;CAAE&#160;n&#176;&#160;0158&#46;0&#46;097&#46;000&#8208;10&#47;CEP&#8208;UPE&#58;&#160;159&#47;10&#41;&#46; Todas as determina&#231;&#245;es da Resolu&#231;&#227;o n&#176; 196&#47;96&#44; do Conselho Nacional de Sa&#250;de&#44; foram respeitadas&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">A popula&#231;&#227;o alvo&#44; estimada em 373&#46;386 sujeitos&#44; foi constitu&#237;da por estudantes do Ensino M&#233;dio matriculados na rede p&#250;blica estadual de Pernambuco&#44; entre&#160;14&#160;e&#160;19&#160;anos&#46; Recorreu&#8208;se a um procedimento de amostragem aleat&#243;ria estratificada por conglomerados em dois est&#225;gios&#58; 1&#41;&#160;Porte da escola &#40;menos de 200&#160;alunos&#44; 200&#160;a&#160;499&#160;alunos e 500&#160;alunos ou mais&#41;&#44; levaram&#8208;se em considera&#231;&#227;o as 17&#160;Ger&#234;ncias Regionais de Educa&#231;&#227;o &#40;GREs&#41; do Estado de Pernambuco&#44; e 2&#41;&#160;Turno &#40;diurno e noturno&#41; e s&#233;rie &#40;1&#176;&#44;&#160;2&#176;&#160;e&#160;3&#176;&#160;ano&#41;&#46; As escolas e turmas foram sorteadas mediante o programa <span class="elsevierStyleItalic">randomizer</span>&#44; que forneceu n&#250;meros aleat&#243;rios&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Para o c&#225;lculo do tamanho amostral foram adotados os seguintes par&#226;metros&#58; Intervalo de Confian&#231;a de 95&#37;&#59; poder estat&#237;stico de 80&#37;&#59; erro m&#225;ximo toler&#225;vel de 2&#160;pontos percentuais&#59; efeito do desenho &#40;<span class="elsevierStyleItalic">deff</span>&#41;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#59; e&#44; por se tratar de estudo que abrangeu a an&#225;lise de m&#250;ltiplos comportamentos de risco e com diferentes frequ&#234;ncias de ocorr&#234;ncia&#44; definiu&#8208;se a preval&#234;ncia estimada em 50&#37;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">O instrumento usado para coleta de dados foi uma vers&#227;o adaptada do question&#225;rio <span class="elsevierStyleItalic">Global School&#8208;based Student Health Survey</span> &#40;GSHS&#41;<span class="elsevierStyleItalic">&#46;</span> Antes do in&#237;cio da coleta de dados&#44; o instrumento foi validado &#40;validade de conte&#250;do e de face&#41;&#44; submetido a estudo piloto e apresentou boa consist&#234;ncia nas medidas&#46; A maioria das quest&#245;es apresentou indicadores de reprodutibilidade de moderados a altos&#44; os coeficientes de concord&#226;ncia &#40;&#237;ndice kappa&#41; variaram de&#160;0&#44;62&#160;a&#160;1&#44;00&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">A aplica&#231;&#227;o dos question&#225;rios foi efetuada em sala de aula na forma de entrevista coletiva sem a presen&#231;a dos professores e os estudantes tiveram oportunidade de esclarecer as d&#250;vidas durante o preenchimento dos question&#225;rios &#40;dura&#231;&#227;o&#58;&#160;30&#160;e&#160;40&#160;minutos&#41;&#46; Um termo de consentimento foi usado para obter autoriza&#231;&#227;o dos pais de estudantes com menos de 18&#160;anos para que participassem do estudo&#46; Ademais&#44; todos os estudantes que participaram da pesquisa assinaram o Termo de Consentimento Livre e Esclarecido &#40;TCLE&#41; e indicaram a sua concord&#226;ncia em participar do estudo&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">A vari&#225;vel dependente deste estudo foi a APS&#44; em que os adolescentes respondiam a seguinte pergunta&#58; &#8220;Em geral&#44; voc&#234; considera que sua sa&#250;de &#233;&#63;&#8221; Com as seguintes op&#231;&#245;es de resposta&#58; ruim&#44; regular&#44; boa e excelente&#46; Para fins de an&#225;lise as op&#231;&#245;es foram categorizadas de forma dicot&#244;mica&#58; positiva &#40;excelente&#47;boa&#41; e negativa &#40;regular&#47;ruim&#41;&#44; conforme apresentado em estudos correlatos&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">4</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">As vari&#225;veis sociodemogr&#225;ficas mensuradas neste estudo foram&#58; &#8220;idade&#8221; &#40;14&#8211;15&#160;anos&#59; 16&#8211;17&#160;anos&#59; 18&#8211;19&#160;anos&#41;&#44; &#8220;ocupa&#231;&#227;o&#8221; &#40;trabalha ou n&#227;o trabalha&#41;&#44; &#8220;local de resid&#234;ncia&#8221; &#40;urbano e rural&#41;&#44; &#8220;escolaridade materna&#8221; estratificada em &#8804;&#160;8&#160;anos de estudo e<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>8 anos de estudo&#46; Em rela&#231;&#227;o &#224; vari&#225;vel &#8220;n&#237;vel de AF&#8221;&#44; foram consideradas duas quest&#245;es do GSHS&#58; 1&#41;&#160;&#8220;Durante os &#250;ltimos 7&#160;dias&#44; quantos dias voc&#234; foi fisicamente ativo por um total de pelo menos 60 minutos por dia&#63;&#8221; e 2&#41; &#8220;Durante uma semana t&#237;pica ou normal&#44; em quantos dias voc&#234; &#233; fisicamente ativo por um total de pelo menos 60&#160;minutos ao dia&#63;&#8221; Para estimativa do n&#237;vel de AF&#44; foi adotado o procedimento sugerido por Prochaska&#44; Sallis e Longo<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">15</span></a> no que diz respeito &#224;s quest&#245;es&#160;1&#160;e&#160;2&#44; com a seguinte f&#243;rmula&#58; &#40;Quest&#227;o&#160;1<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>Quest&#227;o&#160;2&#41; &#247; 2&#46; Caso o resultado obtido tivesse sido um valor menor do que cinco dias&#44; os adolescentes foram considerados insuficientemente ativos&#44; ou seja&#44; n&#227;o cumpriam as recomenda&#231;&#245;es de AF&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">16</span></a> J&#225; a pr&#225;tica de AF no tempo livre foi determinada pela pergunta&#58; &#8220;Voc&#234; realiza&#44; regularmente&#44; algum tipo de atividade f&#237;sica no seu tempo livre&#44; como exerc&#237;cios&#44; esportes&#44; dan&#231;as ou artes marciais&#63;&#8221;&#44; a resposta dicot&#244;mica foi &#8220;sim&#8221; ou &#8220;n&#227;o&#8221;&#46; A atividade de lazer preferida foi categorizada de forma dicot&#244;mica em lazer ativo &#40;fazer exerc&#237;cios&#44; praticar esportes&#44; pedalar ou nadar&#41; e lazer passivo &#40;assistir TV&#44; jogar videogame&#44; usar o computador&#44; conversar com os amigos&#44; jogar domin&#243; ou cartas&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Nas avalia&#231;&#245;es antropom&#233;tricas&#44; todos os adolescentes trajavam roupas leves e permaneceram descal&#231;os&#46; A massa corporal foi avaliada por meio de uma balan&#231;a eletr&#244;nica da marca Beurer com capacidade m&#225;xima de 150&#160;kg e precis&#227;o de 100<span class="elsevierStyleHsp" style=""></span>g&#46; A estatura foi aferida por meio de um estadi&#244;metro port&#225;til &#40;marca Wiso&#41; com precis&#227;o de&#160;0&#44;5&#160;cent&#237;metro&#46; Foi calculado o &#205;ndice de Massa Corporal &#40;IMC&#41; pela divis&#227;o da massa corporal&#44; em quilogramas&#44; pelo quadrado da estatura&#44; em metros&#46; A classifica&#231;&#227;o dos casos de sobrepeso e obesidade nos adolescentes levou em considera&#231;&#227;o os pontos de corte propostos pelo <span class="elsevierStyleItalic">International Obesity Task Force</span> &#40;IOTF&#41; e publicados por Cole et al&#46; &#40;2000&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">17</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">A tabula&#231;&#227;o dos dados foi efetuada no EpiData &#40;vers&#227;o&#160;3&#46;1&#41;&#46; Recorreu&#8208;se &#224; dupla digita&#231;&#227;o a fim de conferir erros na entrada dos dados que&#44; quando identificados&#44; foram corrigidos com base nos valores originais das vari&#225;veis&#46; A an&#225;lise dos dados foi feita no programa <span class="elsevierStyleItalic">Statistical Package for Social Science</span>&#160;&#40;SPSS&#41; vers&#227;o&#160;17&#46;0 para Windows<span class="elsevierStyleItalic">&#46;</span> Na an&#225;lise descritiva recorreu&#8208;se &#224; distribui&#231;&#227;o de frequ&#234;ncias absoluta e relativa&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Para avaliar a associa&#231;&#227;o entre a vari&#225;vel dependente e as vari&#225;veis independentes foram feitas an&#225;lises bivariadas por meio do teste do qui&#8208;quadrado de Pearson &#40;&#967;<span class="elsevierStyleSup">2</span>&#41; e as vari&#225;veis que apresentaram n&#237;vel descritivo &#40;valor&#8208;p&#41; at&#233; 0&#44;20 foram selecionadas para a an&#225;lise m&#250;ltipla&#46; Na an&#225;lise m&#250;ltipla&#44; adotou&#8208;se o modelo de regress&#227;o de Poisson&#44; com vari&#226;ncia robusta&#44; para estimar a raz&#227;o de preval&#234;ncia &#40;RP&#41; e avaliar a magnitude da associa&#231;&#227;o entre a vari&#225;vel dependente e as vari&#225;veis independentes investigadas&#46; Nessa etapa da modelagem adotou&#8208;se n&#237;vel de signific&#226;ncia de 0&#44;05&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">An&#225;lise de multicolinearidade foi feita com <span class="elsevierStyleItalic">Variance Inflation Factors</span>&#160;&#8211;&#160;VIF&#160;&#706;&#160;5 e toler&#226;ncia&#160;&#706;&#160;0&#44;20&#46; A qualidade de ajuste dos dados ao modelo constru&#237;do foi avaliada por meio do teste Hosmer&#8208;Lemeshow &#40;p<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; Admitiram&#8208;se como significantes aquelas associa&#231;&#245;es que obtiveram &#945;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#37;&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Resultados</span><p id="par0080" class="elsevierStylePara elsevierViewall">Foram entrevistados 7&#46;195&#160;estudantes de 85&#160;escolas em 48&#160;munic&#237;pios pernambucanos&#46; Ap&#243;s 285&#160;recusas&#44; 269&#160;por parte dos adolescentes e 16&#160;dos pais&#44; e exclus&#227;o de 651&#160;question&#225;rios dos estudantes com idade inferior a&#160;14 e superior a&#160;19&#160;anos&#44; a amostra final foi 6&#46;259&#44; dos quais 59&#44;7&#37; eram do sexo feminino com m&#233;dia de 16&#44;6&#160;anos &#40;DP&#160;&#8805;&#160;1&#44;3&#160;anos&#41;&#59; que n&#227;o trabalhavam &#40;77&#44;7&#37;&#41;&#59; residiam na regi&#227;o urbana&#160;&#40;74&#44;5&#37;&#41; e tinham um menor n&#237;vel de escolaridade materna&#160;&#40;64&#44;7&#37;&#41;&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Foi observado que 27&#44;3&#37;&#160;&#40;IC 95&#37;&#58; 26&#44;2&#8211;28&#44;5&#41; dos adolescentes relataram uma APS negativa&#44; maior entre as meninas 33&#37;&#160;&#40;IC 95&#37;&#58;&#160;31&#44;5&#8211;34&#44;5&#41; em compara&#231;&#227;o com os meninos 19&#37;&#160;&#40;IC 95&#37;&#58;&#160;17&#44;5&#8211;20&#44;6&#41;&#46; A propor&#231;&#227;o de adolescentes que avaliaram APS negativa foi mais frequente entre os que residiam na &#225;rea rural&#44; com a m&#227;e com menor grau de escolaridade&#44; que n&#227;o praticavam exerc&#237;cios f&#237;sicos&#44; que eram insuficientemente ativos&#44; sobrepesados e que preferiam pr&#225;ticas de lazer mais passivas &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">Observou&#8208;se uma maior preval&#234;ncia de APS negativa entre os meninos que praticavam AF por dois ou menos dias &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; e entre as meninas classificadas como sobrepesadas ou obesas &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; Em rela&#231;&#227;o &#224; AF no tempo livre&#44; maiores preval&#234;ncias de APS negativa foram observadas tanto entre os meninos como entre as meninas que n&#227;o praticavam AF no tempo livre &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">Ap&#243;s testar a intera&#231;&#227;o&#44; constatou&#8208;se a necessidade de estratifica&#231;&#227;o por sexo&#46; Nesse sentido&#44; foi observado que os meninos que n&#227;o praticavam AF no tempo livre&#160;&#40;RP<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;44&#59; IC 95&#37;&#58;&#160;1&#44;15&#8211;1&#44;81&#41; e que eram classificados como insuficientemente ativos &#40;RP<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;27&#59; IC 95&#37;&#58;&#160;1&#44;04&#8211;1&#44;56&#41; tinham mais chances de ter uma APS negativa&#44; mesmo ap&#243;s o ajuste pelos potenciais fatores de confus&#227;o &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">Em rela&#231;&#227;o &#224;s meninas&#44; constatou&#8208;se que&#44; ap&#243;s o ajustamento&#44; aquelas n&#227;o praticavam AF no tempo livre &#40;RP<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;15&#59; IC 95&#37;&#58;&#160;1&#44;02&#8211;1&#44;29&#41; e que eram classificadas como sobrepesadas &#40;RP<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;27&#59; IC 95&#37;&#58;&#160;1&#44;01&#8211;1&#44;29&#41; tinham mais chances de ter uma APS negativa &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discuss&#227;o</span><p id="par0105" class="elsevierStylePara elsevierViewall">O principal objetivo deste estudo foi avaliar a associa&#231;&#227;o entre a AF total&#44; AF no tempo livre e o estado nutricional com a APS em adolescentes&#46; Os principais resultados foram&#58; &#40;i&#41;&#160;Uma elevada preval&#234;ncia da APS negativa foi observada&#44; particularmente entre as meninas&#59; &#40;ii&#41;&#160;Adolescentes que residiam na &#225;rea rural&#44; com a m&#227;e com menor grau de escolaridade&#44; que n&#227;o praticavam AF no tempo livre&#44; que eram insuficientemente ativos&#44; sobrepesados e que preferiam pr&#225;ticas de lazer mais passivas tinham uma maior APS negativa&#59; &#40;iii&#41;&#160;A APS negativa esteve associada ao estado nutricional entre as meninas e a um menor n&#237;vel de AF entre os meninos e &#40;iv&#41;&#160;Aqueles que n&#227;o praticavam AF no tempo livre tinham mais chances de ter uma APS negativa em adolescentes de ambos os sexos&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">A preval&#234;ncia da APS negativa observada no presente estudo foi de 27&#44;3&#37;&#44; superior &#224; encontrada em outros estudos nacionais<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">3&#44;7&#44;18&#8211;21</span></a> e internacionais<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">8&#44;9&#44;22</span></a> com adolescentes&#46; No Brasil&#44; n&#227;o se disp&#245;e de levantamentos com abrang&#234;ncia nacional para esse subgrupo populacional&#46; Contudo&#44; estudos de abrang&#234;ncia estadual e municipal apresentam uma preval&#234;ncia de APS negativa em adolescentes que varia de 11&#44;5&#37;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">21</span></a> a 25&#44;7&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">20</span></a> Essas diferen&#231;as encontradas nos estudos brasileiros podem ocorrer pelas diferentes quest&#245;es socioecon&#244;micas&#44; culturais&#44; ambientais e pelo acesso e qualidade dos servi&#231;os e cuidados com a sa&#250;de oferecidos &#224; popula&#231;&#227;o&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">23</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">Assim como na maioria dos estudos<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">7&#44;8&#44;18&#8211;21</span></a> as meninas apresentaram uma maior preval&#234;ncia de APS negativa em compara&#231;&#227;o com os meninos&#46; Em conson&#226;ncia com esse resultado&#44; um estudo feito para avaliar a tend&#234;ncia temporal da APS em adolescentes de 32&#160;pa&#237;ses da Europa e Am&#233;rica do Norte observou que as meninas relataram uma APS negativa superior &#224; dos meninos em todos os pa&#237;ses investigados&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">24</span></a> Essa diferen&#231;a entre os sexos na APS pode estar relacionada a quest&#245;es culturais&#46; Acredita&#8208;se que as meninas fazem mais exames de rotina e visitam com maior frequ&#234;ncia o m&#233;dico&#44; o que aumenta a chance de diagn&#243;stico precoce de alguma doen&#231;a&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">25</span></a> Ademais&#44; acrescenta&#8208;se o fato de serem mais atentas&#44; sens&#237;veis e mais bem informadas em rela&#231;&#227;o &#224; sa&#250;de&#44; percebem&#8208;na de maneira global&#46;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">8&#44;25</span></a> Assim&#44; consideram um conjunto mais amplo de fatores ao fazer classifica&#231;&#245;es gerais de sa&#250;de em compara&#231;&#227;o com os meninos&#44; por exemplo fatores psicol&#243;gicos e pequenas queixas subjetivas de sa&#250;de&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">25</span></a> Al&#233;m disso&#44; pesquisas ressaltam uma maior insatisfa&#231;&#227;o corporal por parte das meninas&#44; talvez por uma press&#227;o midi&#225;tica exacerbada sobre o corpo feminino&#44; pode tal insatisfa&#231;&#227;o repercutir na APS&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">13&#44;14</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">No presente estudo&#44; fatores sociodemogr&#225;ficos&#44; como residir na &#225;rea rural e um menor grau de escolaridade materno&#44; estiveram associados a uma APS negativa&#46; Resultados similares foram encontrados em outros estudos nacionais<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">7&#44;18&#44;21</span></a> e demonstram a import&#226;ncia das quest&#245;es sociais e econ&#244;micas como aspectos que influenciam na APS dos adolescentes&#46; Especificamente no caso do Brasil&#44; pode&#8208;se observar que as vulnerabilidades n&#227;o est&#227;o distribu&#237;das de forma homog&#234;nea na rela&#231;&#227;o sociedade e espa&#231;o&#44; sobretudo em &#225;reas rurais&#44; reveladas&#44; sobretudo&#44; pela escassez de op&#231;&#245;es de lazer e cultura&#44; pela pr&#225;tica de esportes e ambientes de conv&#237;vio p&#250;blicos&#44; o que afeta a qualidade de vida dos adolescentes&#44; principalmente em aspectos relacionados &#224; sa&#250;de&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">26</span></a> Al&#233;m disso&#44; em estudo feito com adolescentes moradores de &#225;reas rurais brasileiras&#44; foi poss&#237;vel observar que as concep&#231;&#245;es de sa&#250;de revelaram iniquidades e dificuldades de acesso dos adolescentes ao atendimento de sa&#250;de&#44;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">27</span></a> o que pode explicar parcialmente os resultados encontrados&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">No que se refere &#224;s quest&#245;es sociais&#44; um maior poder aquisitivo representa um componente determinante no maior acesso a outras formas de atividades de lazer&#44; educa&#231;&#227;o&#44; moradia e servi&#231;os de sa&#250;de&#44; pode assim atuar como um mediador do n&#237;vel da APS&#46;<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">23&#44;24</span></a> Ademais&#44; pais com maior n&#237;vel de escolaridade tendem a entender melhor o que &#233; ser saud&#225;vel e o que seus filhos precisam&#44; o que os leva a apresentar n&#237;veis melhores de sa&#250;de&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">28</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">Outro ponto interessante encontrado no presente estudo &#233; que quest&#245;es comportamentais podem ter diferentes repercuss&#245;es na APS quando comparados os adolescentes de ambos os sexos&#46; &#201; importante ressaltar que meninos e meninas t&#234;m compreens&#245;es diferentes com rela&#231;&#227;o a seu estado de sa&#250;de&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">25</span></a> Nesse sentido&#44; observou&#8208;se que a APS negativa est&#225; associada com o n&#237;vel de AF total apenas entre os meninos&#46; Acredita&#8208;se que a pr&#225;tica de AF na adolesc&#234;ncia tenha um efeito positivo sobre a autoimagem e sobre a redu&#231;&#227;o dos sintomas de ansiedade e depress&#227;o e&#44; por conseguinte&#44; esses efeitos combinados s&#227;o capazes de gerar uma APS mais positiva&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">11</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">Foi observado que o estado nutricional entre as meninas&#44; que pode estar relacionado &#224; est&#233;tica&#44; tinha associa&#231;&#227;o com a APS&#44; no qual as que foram classificadas como sobrepesadas tinham mais chances de ter uma APS negativa&#44; associa&#231;&#227;o n&#227;o encontrada entre os meninos&#46; Em pesquisa feita com o mesmo p&#250;blico da presente pesquisa foi ressaltado que existe uma tend&#234;ncia de os meninos se sentirem bem com sua imagem corporal independentemente do estado nutricional&#44; diferentemente do que ocorre com as meninas&#44; que t&#234;m uma tend&#234;ncia de superestimar seu peso e mostrar uma maior insatisfa&#231;&#227;o com sua imagem corporal&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">13</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">Nesse sentido&#44; pode&#8208;se observar que as quest&#245;es antropom&#233;tricas&#44; como o excesso de peso&#44; interferem na APS&#44; principalmente para as meninas&#46; O resultado do estudo de Heshmat et al&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">12</span></a> mostrou existir uma associa&#231;&#227;o significativa entre meninas com maior IMC e uma APS negativa&#44; o mesmo resultado n&#227;o foi encontrado para os meninos&#46; Adolescentes com excesso de peso s&#227;o mais vulner&#225;veis a uma discrimina&#231;&#227;o social&#44; em particular as meninas s&#227;o mais preocupadas com a gordura corporal e mais propensas a se julgar gordas em compara&#231;&#227;o com os meninos&#46; Esses&#44; por sua vez&#44; t&#234;m menos interesse em perder peso e mais preocupa&#231;&#245;es relacionadas &#224; masculinidade&#44; como&#44; por exemplo&#44; um maior volume de massa muscular&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">29</span></a> Essas diferen&#231;as com rela&#231;&#227;o &#224; imagem corporal entre os sexos podem explicar parcialmente a associa&#231;&#227;o entre as quest&#245;es antropom&#233;tricas nas meninas e APS negativa&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Observou&#8208;se que n&#227;o praticar AF no tempo livre esteve associado com uma APS negativa em ambos os sexos&#46; Nesse sentido&#44; estudo feito com adolescentes suecos demonstrou que aqueles que n&#227;o praticavam esportes e que tinham um baixo n&#237;vel de AF apresentaram uma maior preval&#234;ncia de APS negativa&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">8</span></a> Uma das poss&#237;veis explica&#231;&#245;es para essa associa&#231;&#227;o est&#225; centrada no efeito ben&#233;fico da AF sobre as monoaminas no c&#233;rebro que afetam a neurotransmiss&#227;o e atenuam ansiedade&#44; tens&#227;o e estresse&#44;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">30</span></a> ou sobre a produ&#231;&#227;o de endorfinas e sua redu&#231;&#227;o da dor que potencializa uma sensa&#231;&#227;o de bem estar&#44; a qual tem claras repercuss&#245;es em termos de sa&#250;de mental&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">11</span></a> Esses achados s&#227;o condizentes com outros estudos&#44; como&#44; por exemplo&#44; um estudo feito em Jo&#227;o Pessoa&#47;PB que observou que os adolescentes que n&#227;o atingiam as recomenda&#231;&#245;es de pr&#225;tica de AF e sobrepesados tinham tr&#234;s vezes mais chance de ter uma APS negativa comparados com seus pares suficientemente ativos e com peso normal&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">7</span></a> Contudo&#44; neste estudo n&#227;o foram estratificados os resultados pelo sexo e n&#227;o foi observada a participa&#231;&#227;o dos adolescentes em outros dom&#237;nios e tipos de AF&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Certas limita&#231;&#245;es do presente estudo devem ser consideradas&#46; O n&#237;vel de AF total e praticada no tempo livre foi obtido por medi&#231;&#227;o indireta&#44; sabe&#8208;se que os m&#233;todos diretos trariam informa&#231;&#245;es mais precisas&#46; Al&#233;m disso&#44; apesar de usar uma amostra representativa&#44; deve&#8208;se ter cautela com a generaliza&#231;&#227;o dos dados para todos os adolescentes&#44; visto que o estudo foi restrito aos escolares da rede p&#250;blica estadual de ensino&#46; Ademais&#44; h&#225; tamb&#233;m a possibilidade de causalidade reversa como uma caracter&#237;stica inerente em estudos transversais&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Entre os pontos fortes da presente pesquisa&#44; pode&#8208;se destacar a representatividade da popula&#231;&#227;o de estudantes das escolas da rede p&#250;blica do Ensino M&#233;dio do Estado de Pernambuco&#44; o uso de um question&#225;rio previamente testado que apresentou um n&#237;vel de reprodutibilidade de moderado a alto e o controle de vari&#225;veis intervenientes na an&#225;lise&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Conclui&#8208;se que a APS negativa esteve associada a estado nutricional entre as meninas e a um menor n&#237;vel de AF entre os meninos&#46; Ademais&#44; a pr&#225;tica de AF no tempo livre foi tida como fator de prote&#231;&#227;o para uma APS negativa para os adolescentes de ambos os sexos&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conflitos de interesse</span><p id="par0165" class="elsevierStylePara elsevierViewall">Os autores declaram n&#227;o haver conflitos de interesse&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To evaluate the association between total physical activities&#44; physical activity in free time and nutritional status with self&#8208;perceived health in adolescents of both genders&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">This is a quantitative study that integrates the school&#8208;based&#44; cross&#8208;sectional epidemiological survey with statewide coverage&#44; whose sample consisted of 6261 adolescents &#40;14&#8211;19 years old&#41; selected by random conglomerate sampling&#46; Data were collected using the Global School&#8208;based Student Health Survey&#46; The chi&#8208;squared test &#40;<span class="elsevierStyleItalic">&#967;</span><span class="elsevierStyleSup">2</span>&#41; and the Poisson regression model with robust variance were used in the data analyses&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">It was observed that 27&#46;3&#37; of the adolescents had a negative health self&#8208;perception&#44; which was higher among girls &#40;33&#46;0&#37; <span class="elsevierStyleItalic">vs&#46;</span> 19&#46;0&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; After adjusting for potential confounding factors&#44; it was observed that boys who did not practice physical activity during free time &#40;PR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;44&#44; 95&#37; CI&#58; 1&#46;15&#8211;1&#46;81&#41; and were classified as insufficiently active &#40;PR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;27&#44; 95&#37; CI&#58; 1&#46;04&#8211;1&#46;56&#41;&#44; as well as girls who did not practice physical activity during free time &#40;PR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;15&#44; 95&#37; CI&#58; 1&#46;02&#8211;1&#46;29&#41; and were classified as overweight &#40;PR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;27&#44; 95&#37; CI&#58; 1&#46;01&#8211;1&#46;29&#41; had a greater chance of negative health self&#8208;perception&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Behavioral issues may have different effects on health self&#8208;perception when comparing boys with girls&#46; Negative health self&#8208;perception was associated with nutritional status in girls and a lower level of physical activity in boys&#44; and the practice of physical activity in the free time was considered a protective factor against a negative health self&#8208;perception for adolescents of both genders&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Avaliar a associa&#231;&#227;o entre atividade f&#237;sica total&#44; atividade f&#237;sica no tempo livre e estado nutricional com a autopercep&#231;&#227;o de sa&#250;de em adolescentes de ambos os sexos&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Trata&#8208;se de um estudo com abordagem quantitativa&#44; que integra o levantamento epidemiol&#243;gico transversal de base escolar e abrang&#234;ncia estadual&#44; cuja amostra foi constitu&#237;da por 6&#46;261 adolescentes &#40;14 a 19 anos&#41; selecionados por meio de uma estrat&#233;gia de amostragem aleat&#243;ria de conglomerados&#46; Os dados foram coletados a partir do question&#225;rio <span class="elsevierStyleItalic">Global School&#8208;based Student Health Survey</span>&#46; O teste de qui&#8208;quadrado &#40;&#967;<span class="elsevierStyleSup">2</span>&#41; e o modelo de regress&#227;o de Poisson com vari&#226;ncia robusta foram usados nas an&#225;lises dos dados&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Observou&#8208;se que 27&#44;3&#37; dos adolescentes tinham uma autopercep&#231;&#227;o de sa&#250;de negativa&#44; maior entre as meninas &#40;33&#44;0&#37; <span class="elsevierStyleItalic">vs</span>&#46; 19&#44;0&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; Ap&#243;s o ajuste pelos potenciais fatores de confus&#227;o&#44; constatou&#8208;se que tinham maior chance de ter uma autopercep&#231;&#227;o de sa&#250;de negativa os meninos que n&#227;o praticavam atividade f&#237;sica no tempo livre &#40;RP<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;44&#59; IC 95&#37;&#58; 1&#44;15&#8208;1&#44;81&#41; e que eram classificados como insuficientemente ativos &#40;RP<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;27&#59; IC 95&#37;&#58; 1&#44;04&#8208;1&#44;56&#41; e as meninas que n&#227;o praticavam atividade f&#237;sica no tempo livre &#40;RP<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;15&#59; IC 95&#37;&#58; 1&#44;02&#8208;1&#44;29&#41; e que eram classificadas como sobrepesadas &#40;RP<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;27&#59; IC 95&#37;&#58; 1&#44;01&#8208;1&#44;29&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#227;o</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Quest&#245;es comportamentais podem ter diferentes repercuss&#245;es na autopercep&#231;&#227;o de sa&#250;de quando comparados os meninos e meninas&#46; A autopercep&#231;&#227;o de sa&#250;de negativa esteve associada ao estado nutricional entre as meninas e a um menor n&#237;vel de atividade f&#237;sica entre os meninos e a pr&#225;tica de atividade f&#237;sica no tempo livre foi tida como fator de prote&#231;&#227;o para uma autopercep&#231;&#227;o de sa&#250;de negativa para os adolescentes de ambos os sexos&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Como citar este artigo&#58; Silva AO&#44; Diniz PR&#44; Santos ME&#44; Ritti&#8208;Dias RM&#44; Farah BQ&#44; Tassitano RM&#44; et al&#46; Health self&#8208;perception and its association with physical activity and nutritional status in adolescents&#46; J Pediatr &#40;Rio J&#41;&#46; 2019&#59;95&#58;458&#8211;65&#46;</p>"
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                  \t\t\t\t"><span class="elsevierStyleItalic">N&#237;vel de atividade f&#237;sica</span></td><td class="td" title="\n
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                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;762</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0&#44;933</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ativo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Insuficientemente ativo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;90&#8211;1&#44;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;99&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " colspan="3" align="left" valign="\n
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                  \t\t\t\t  " rowspan="3" align="left" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sim&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>N&#227;o&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Lazer ativo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Estado nutricional</span></td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Eutr&#243;fico&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sobrepeso&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;27&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;01&#8211;1&#44;29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "pt" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Associa&#231;&#227;o entre autopercep&#231;&#227;o de sa&#250;de negativa e n&#237;vel de atividade f&#237;sica&#44; atividade f&#237;sica no tempo livre e estado nutricional em meninas</p>"
        ]
      ]
    ]
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      "titulo" => "Refer&#234;ncias"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
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            0 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Self&#8208;rated health and adverse events in CKD"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46; Robinson-Cohen"
                            1 => "Y&#46;N&#46; Hall"
                            2 => "R&#46; Katz"
                            3 => "M&#46;B&#46; Rivara"
                            4 => "I&#46;H&#46; De Boer"
                            5 => "B&#46;R&#46; Kestenbaum"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Clin J Am Soc Nephrol"
                        "fecha" => "2014"
                        "volumen" => "9"
                        "paginaInicial" => "2044"
                        "paginaFinal" => "2051"
                      ]
                    ]
                  ]
                ]
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              "identificador" => "bib0160"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Self rated health&#58; Is it as good a predictor of subsequent mortality among adults in lower as well as in higher social classes&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "B&#46; Burstr&#246;m"
                            1 => "P&#46; Fredlund"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Epidemiol Community Heal"
                        "fecha" => "2001"
                        "volumen" => "55"
                        "paginaInicial" => "836"
                        "paginaFinal" => "840"
                      ]
                    ]
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              "identificador" => "bib0165"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Autopercep&#231;&#227;o de sa&#250;de em adolescentes&#44; adultos e idosos"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "F&#46;F&#46; Reichert"
                            1 => "M&#46;R&#46; Loch"
                            2 => "M&#46;F&#46; Capilheira"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Cien Saude Colet &#91;Internet&#93;"
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Artigo Original
Health self‐perception and its association with physical activity and nutritional status in adolescents
Autopercepção de saúde e sua associação com atividade física e estado nutricional em adolescentes
Alison Oliveira da Silvaa,
Autor para correspondência
alison.oli@hotmail.com

Autor para correspondência.
, Paula R.B. Dinizb, Maria E.P. Santosc, Raphael M. Ritti‐Diasd, Breno Q. Farahe, Rafael M. Tassitanoe, Luciano M.F.T. Oliveirab,c
a Programa Associado de Pós‐Graduação em Educação Física (UPE/UFPB), Recife, PE, Brasil
b Universidade Federal de Pernambuco (UFPE), Recife, PE, Brasil
c Centro Universitário Tabosa de Almeida (Asces‐Unita), Caruaru, PE, Brasil
d Universidade Nove de Julho, São Paulo, SP, Brasil
e Universidade Federal Rural de Pernambuco (UFRPE), Recife, PE, Brasil
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e a ado&#231;&#227;o de outros comportamentos relacionados &#224; sa&#250;de&#44; com resultante impacto na melhoria da qualidade de vida<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">5&#44;6</span></a> e da APS&#46;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">6&#8211;10</span></a> Revis&#227;o sistem&#225;tica que envolveu 16&#160;estudos transversais com adolescentes observou que em 88&#37; dos estudos existia uma associa&#231;&#227;o significativa entre a pr&#225;tica de AF e APS positiva&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">11</span></a> Entretanto&#44; os efeitos positivos da AF podem ser obtidos de diferentes maneiras e uma limita&#231;&#227;o importante &#233; que a maioria dos estudos tem avaliado apenas a AF total&#46; Assim&#44; outros dom&#237;nios&#44; por exemplo a AF de lazer e tipos de AF no tempo livre &#40;pr&#225;tica de exerc&#237;cios&#44; esportes&#44; 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e o segundo semestre &#40;agosto&#44; setembro&#44; outubro e novembro&#41; de 2011&#46; O estudo foi aprovado pelo Comit&#234; de &#95;tica em Pesquisa com Seres Humanos da Universidade de Pernambuco &#40;CAAE&#160;n&#176;&#160;0158&#46;0&#46;097&#46;000&#8208;10&#47;CEP&#8208;UPE&#58;&#160;159&#47;10&#41;&#46; Todas as determina&#231;&#245;es da Resolu&#231;&#227;o n&#176; 196&#47;96&#44; do Conselho Nacional de Sa&#250;de&#44; foram respeitadas&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">A popula&#231;&#227;o alvo&#44; estimada em 373&#46;386 sujeitos&#44; foi constitu&#237;da por estudantes do Ensino M&#233;dio matriculados na rede p&#250;blica estadual de Pernambuco&#44; entre&#160;14&#160;e&#160;19&#160;anos&#46; Recorreu&#8208;se a um procedimento de amostragem aleat&#243;ria estratificada por conglomerados em dois est&#225;gios&#58; 1&#41;&#160;Porte da escola &#40;menos de 200&#160;alunos&#44; 200&#160;a&#160;499&#160;alunos e 500&#160;alunos ou mais&#41;&#44; 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Um termo de consentimento foi usado para obter autoriza&#231;&#227;o dos pais de estudantes com menos de 18&#160;anos para que participassem do estudo&#46; Ademais&#44; todos os estudantes que participaram da pesquisa assinaram o Termo de Consentimento Livre e Esclarecido &#40;TCLE&#41; e indicaram a sua concord&#226;ncia em participar do estudo&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">A vari&#225;vel dependente deste estudo foi a APS&#44; em que os adolescentes respondiam a seguinte pergunta&#58; &#8220;Em geral&#44; voc&#234; considera que sua sa&#250;de &#233;&#63;&#8221; Com as seguintes op&#231;&#245;es de resposta&#58; ruim&#44; regular&#44; boa e excelente&#46; Para fins de an&#225;lise as op&#231;&#245;es foram categorizadas de forma dicot&#244;mica&#58; positiva &#40;excelente&#47;boa&#41; e negativa &#40;regular&#47;ruim&#41;&#44; conforme apresentado em estudos correlatos&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">4</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">As vari&#225;veis sociodemogr&#225;ficas mensuradas neste estudo foram&#58; &#8220;idade&#8221; &#40;14&#8211;15&#160;anos&#59; 16&#8211;17&#160;anos&#59; 18&#8211;19&#160;anos&#41;&#44; &#8220;ocupa&#231;&#227;o&#8221; &#40;trabalha ou n&#227;o trabalha&#41;&#44; &#8220;local de resid&#234;ncia&#8221; &#40;urbano e rural&#41;&#44; &#8220;escolaridade materna&#8221; estratificada em &#8804;&#160;8&#160;anos de estudo e<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>8 anos de estudo&#46; Em rela&#231;&#227;o &#224; vari&#225;vel &#8220;n&#237;vel de AF&#8221;&#44; foram consideradas duas quest&#245;es do GSHS&#58; 1&#41;&#160;&#8220;Durante os &#250;ltimos 7&#160;dias&#44; quantos dias voc&#234; foi fisicamente ativo por um total de pelo menos 60 minutos por dia&#63;&#8221; e 2&#41; &#8220;Durante uma semana t&#237;pica ou normal&#44; em quantos dias voc&#234; &#233; fisicamente ativo por um total de pelo menos 60&#160;minutos ao dia&#63;&#8221; Para estimativa do n&#237;vel de AF&#44; foi adotado o procedimento sugerido por Prochaska&#44; Sallis e Longo<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">15</span></a> no que diz respeito &#224;s quest&#245;es&#160;1&#160;e&#160;2&#44; com a seguinte f&#243;rmula&#58; &#40;Quest&#227;o&#160;1<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>Quest&#227;o&#160;2&#41; &#247; 2&#46; Caso o resultado obtido tivesse sido um valor menor do que cinco dias&#44; os adolescentes foram considerados insuficientemente ativos&#44; ou seja&#44; n&#227;o cumpriam as recomenda&#231;&#245;es de AF&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">16</span></a> J&#225; a pr&#225;tica de AF no tempo livre foi determinada pela pergunta&#58; &#8220;Voc&#234; realiza&#44; regularmente&#44; algum tipo de atividade f&#237;sica no seu tempo livre&#44; como exerc&#237;cios&#44; esportes&#44; dan&#231;as ou artes marciais&#63;&#8221;&#44; a resposta dicot&#244;mica foi &#8220;sim&#8221; ou &#8220;n&#227;o&#8221;&#46; A atividade de lazer preferida foi categorizada de forma dicot&#244;mica em lazer ativo &#40;fazer exerc&#237;cios&#44; praticar esportes&#44; pedalar ou nadar&#41; e lazer passivo &#40;assistir TV&#44; jogar videogame&#44; usar o computador&#44; conversar com os amigos&#44; jogar domin&#243; ou cartas&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Nas avalia&#231;&#245;es antropom&#233;tricas&#44; todos os adolescentes trajavam roupas leves e permaneceram descal&#231;os&#46; A massa corporal foi avaliada por meio de uma balan&#231;a eletr&#244;nica da marca Beurer com capacidade m&#225;xima de 150&#160;kg e precis&#227;o de 100<span class="elsevierStyleHsp" style=""></span>g&#46; A estatura foi aferida por meio de um estadi&#244;metro port&#225;til &#40;marca Wiso&#41; com precis&#227;o de&#160;0&#44;5&#160;cent&#237;metro&#46; Foi calculado o &#205;ndice de Massa Corporal &#40;IMC&#41; pela divis&#227;o da massa corporal&#44; em quilogramas&#44; pelo quadrado da estatura&#44; em metros&#46; A classifica&#231;&#227;o dos casos de sobrepeso e obesidade nos adolescentes levou em considera&#231;&#227;o os pontos de corte propostos pelo <span class="elsevierStyleItalic">International Obesity Task Force</span> &#40;IOTF&#41; e publicados por Cole et al&#46; &#40;2000&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">17</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">A tabula&#231;&#227;o dos dados foi efetuada no EpiData &#40;vers&#227;o&#160;3&#46;1&#41;&#46; Recorreu&#8208;se &#224; dupla digita&#231;&#227;o a fim de conferir erros na entrada dos dados que&#44; quando identificados&#44; foram corrigidos com base nos valores originais das vari&#225;veis&#46; A an&#225;lise dos dados foi feita no programa <span class="elsevierStyleItalic">Statistical Package for Social Science</span>&#160;&#40;SPSS&#41; vers&#227;o&#160;17&#46;0 para Windows<span class="elsevierStyleItalic">&#46;</span> Na an&#225;lise descritiva recorreu&#8208;se &#224; distribui&#231;&#227;o de frequ&#234;ncias absoluta e relativa&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Para avaliar a associa&#231;&#227;o entre a vari&#225;vel dependente e as vari&#225;veis independentes foram feitas an&#225;lises bivariadas por meio do teste do qui&#8208;quadrado de Pearson &#40;&#967;<span class="elsevierStyleSup">2</span>&#41; e as vari&#225;veis que apresentaram n&#237;vel descritivo &#40;valor&#8208;p&#41; at&#233; 0&#44;20 foram selecionadas para a an&#225;lise m&#250;ltipla&#46; Na an&#225;lise m&#250;ltipla&#44; adotou&#8208;se o modelo de regress&#227;o de Poisson&#44; com vari&#226;ncia robusta&#44; para estimar a raz&#227;o de preval&#234;ncia &#40;RP&#41; e avaliar a magnitude da associa&#231;&#227;o entre a vari&#225;vel dependente e as vari&#225;veis independentes investigadas&#46; Nessa etapa da modelagem adotou&#8208;se n&#237;vel de signific&#226;ncia de 0&#44;05&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">An&#225;lise de multicolinearidade foi feita com <span class="elsevierStyleItalic">Variance Inflation Factors</span>&#160;&#8211;&#160;VIF&#160;&#706;&#160;5 e toler&#226;ncia&#160;&#706;&#160;0&#44;20&#46; A qualidade de ajuste dos dados ao modelo constru&#237;do foi avaliada por meio do teste Hosmer&#8208;Lemeshow &#40;p<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; Admitiram&#8208;se como significantes aquelas associa&#231;&#245;es que obtiveram &#945;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#37;&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Resultados</span><p id="par0080" class="elsevierStylePara elsevierViewall">Foram entrevistados 7&#46;195&#160;estudantes de 85&#160;escolas em 48&#160;munic&#237;pios pernambucanos&#46; Ap&#243;s 285&#160;recusas&#44; 269&#160;por parte dos adolescentes e 16&#160;dos pais&#44; e exclus&#227;o de 651&#160;question&#225;rios dos estudantes com idade inferior a&#160;14 e superior a&#160;19&#160;anos&#44; a amostra final foi 6&#46;259&#44; dos quais 59&#44;7&#37; eram do sexo feminino com m&#233;dia de 16&#44;6&#160;anos &#40;DP&#160;&#8805;&#160;1&#44;3&#160;anos&#41;&#59; que n&#227;o trabalhavam &#40;77&#44;7&#37;&#41;&#59; residiam na regi&#227;o urbana&#160;&#40;74&#44;5&#37;&#41; e tinham um menor n&#237;vel de escolaridade materna&#160;&#40;64&#44;7&#37;&#41;&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Foi observado que 27&#44;3&#37;&#160;&#40;IC 95&#37;&#58; 26&#44;2&#8211;28&#44;5&#41; dos adolescentes relataram uma APS negativa&#44; maior entre as meninas 33&#37;&#160;&#40;IC 95&#37;&#58;&#160;31&#44;5&#8211;34&#44;5&#41; em compara&#231;&#227;o com os meninos 19&#37;&#160;&#40;IC 95&#37;&#58;&#160;17&#44;5&#8211;20&#44;6&#41;&#46; A propor&#231;&#227;o de adolescentes que avaliaram APS negativa foi mais frequente entre os que residiam na &#225;rea rural&#44; com a m&#227;e com menor grau de escolaridade&#44; que n&#227;o praticavam exerc&#237;cios f&#237;sicos&#44; que eram insuficientemente ativos&#44; sobrepesados e que preferiam pr&#225;ticas de lazer mais passivas &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">Observou&#8208;se uma maior preval&#234;ncia de APS negativa entre os meninos que praticavam AF por dois ou menos dias &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; e entre as meninas classificadas como sobrepesadas ou obesas &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; Em rela&#231;&#227;o &#224; AF no tempo livre&#44; maiores preval&#234;ncias de APS negativa foram observadas tanto entre os meninos como entre as meninas que n&#227;o praticavam AF no tempo livre &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">Ap&#243;s testar a intera&#231;&#227;o&#44; constatou&#8208;se a necessidade de estratifica&#231;&#227;o por sexo&#46; Nesse sentido&#44; foi observado que os meninos que n&#227;o praticavam AF no tempo livre&#160;&#40;RP<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;44&#59; IC 95&#37;&#58;&#160;1&#44;15&#8211;1&#44;81&#41; e que eram classificados como insuficientemente ativos &#40;RP<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;27&#59; IC 95&#37;&#58;&#160;1&#44;04&#8211;1&#44;56&#41; tinham mais chances de ter uma APS negativa&#44; mesmo ap&#243;s o ajuste pelos potenciais fatores de confus&#227;o &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">Em rela&#231;&#227;o &#224;s meninas&#44; constatou&#8208;se que&#44; ap&#243;s o ajustamento&#44; aquelas n&#227;o praticavam AF no tempo livre &#40;RP<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;15&#59; IC 95&#37;&#58;&#160;1&#44;02&#8211;1&#44;29&#41; e que eram classificadas como sobrepesadas &#40;RP<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;27&#59; IC 95&#37;&#58;&#160;1&#44;01&#8211;1&#44;29&#41; tinham mais chances de ter uma APS negativa &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discuss&#227;o</span><p id="par0105" class="elsevierStylePara elsevierViewall">O principal objetivo deste estudo foi avaliar a associa&#231;&#227;o entre a AF total&#44; AF no tempo livre e o estado nutricional com a APS em adolescentes&#46; Os principais resultados foram&#58; &#40;i&#41;&#160;Uma elevada preval&#234;ncia da APS negativa foi observada&#44; particularmente entre as meninas&#59; &#40;ii&#41;&#160;Adolescentes que residiam na &#225;rea rural&#44; com a m&#227;e com menor grau de escolaridade&#44; que n&#227;o praticavam AF no tempo livre&#44; que eram insuficientemente ativos&#44; sobrepesados e que preferiam pr&#225;ticas de lazer mais passivas tinham uma maior APS negativa&#59; &#40;iii&#41;&#160;A APS negativa esteve associada ao estado nutricional entre as meninas e a um menor n&#237;vel de AF entre os meninos e &#40;iv&#41;&#160;Aqueles que n&#227;o praticavam AF no tempo livre tinham mais chances de ter uma APS negativa em adolescentes de ambos os sexos&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">A preval&#234;ncia da APS negativa observada no presente estudo foi de 27&#44;3&#37;&#44; superior &#224; encontrada em outros estudos nacionais<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">3&#44;7&#44;18&#8211;21</span></a> e internacionais<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">8&#44;9&#44;22</span></a> com adolescentes&#46; No Brasil&#44; n&#227;o se disp&#245;e de levantamentos com abrang&#234;ncia nacional para esse subgrupo populacional&#46; Contudo&#44; estudos de abrang&#234;ncia estadual e municipal apresentam uma preval&#234;ncia de APS negativa em adolescentes que varia de 11&#44;5&#37;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">21</span></a> a 25&#44;7&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">20</span></a> Essas diferen&#231;as encontradas nos estudos brasileiros podem ocorrer pelas diferentes quest&#245;es socioecon&#244;micas&#44; culturais&#44; ambientais e pelo acesso e qualidade dos servi&#231;os e cuidados com a sa&#250;de oferecidos &#224; popula&#231;&#227;o&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">23</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">Assim como na maioria dos estudos<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">7&#44;8&#44;18&#8211;21</span></a> as meninas apresentaram uma maior preval&#234;ncia de APS negativa em compara&#231;&#227;o com os meninos&#46; Em conson&#226;ncia com esse resultado&#44; um estudo feito para avaliar a tend&#234;ncia temporal da APS em adolescentes de 32&#160;pa&#237;ses da Europa e Am&#233;rica do Norte observou que as meninas relataram uma APS negativa superior &#224; dos meninos em todos os pa&#237;ses investigados&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">24</span></a> Essa diferen&#231;a entre os sexos na APS pode estar relacionada a quest&#245;es culturais&#46; Acredita&#8208;se que as meninas fazem mais exames de rotina e visitam com maior frequ&#234;ncia o m&#233;dico&#44; o que aumenta a chance de diagn&#243;stico precoce de alguma doen&#231;a&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">25</span></a> Ademais&#44; acrescenta&#8208;se o fato de serem mais atentas&#44; sens&#237;veis e mais bem informadas em rela&#231;&#227;o &#224; sa&#250;de&#44; percebem&#8208;na de maneira global&#46;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">8&#44;25</span></a> Assim&#44; consideram um conjunto mais amplo de fatores ao fazer classifica&#231;&#245;es gerais de sa&#250;de em compara&#231;&#227;o com os meninos&#44; por exemplo fatores psicol&#243;gicos e pequenas queixas subjetivas de sa&#250;de&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">25</span></a> Al&#233;m disso&#44; pesquisas ressaltam uma maior insatisfa&#231;&#227;o corporal por parte das meninas&#44; talvez por uma press&#227;o midi&#225;tica exacerbada sobre o corpo feminino&#44; pode tal insatisfa&#231;&#227;o repercutir na APS&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">13&#44;14</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">No presente estudo&#44; fatores sociodemogr&#225;ficos&#44; como residir na &#225;rea rural e um menor grau de escolaridade materno&#44; estiveram associados a uma APS negativa&#46; Resultados similares foram encontrados em outros estudos nacionais<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">7&#44;18&#44;21</span></a> e demonstram a import&#226;ncia das quest&#245;es sociais e econ&#244;micas como aspectos que influenciam na APS dos adolescentes&#46; Especificamente no caso do Brasil&#44; pode&#8208;se observar que as vulnerabilidades n&#227;o est&#227;o distribu&#237;das de forma homog&#234;nea na rela&#231;&#227;o sociedade e espa&#231;o&#44; sobretudo em &#225;reas rurais&#44; reveladas&#44; sobretudo&#44; pela escassez de op&#231;&#245;es de lazer e cultura&#44; pela pr&#225;tica de esportes e ambientes de conv&#237;vio p&#250;blicos&#44; o que afeta a qualidade de vida dos adolescentes&#44; principalmente em aspectos relacionados &#224; sa&#250;de&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">26</span></a> Al&#233;m disso&#44; em estudo feito com adolescentes moradores de &#225;reas rurais brasileiras&#44; foi poss&#237;vel observar que as concep&#231;&#245;es de sa&#250;de revelaram iniquidades e dificuldades de acesso dos adolescentes ao atendimento de sa&#250;de&#44;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">27</span></a> o que pode explicar parcialmente os resultados encontrados&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">No que se refere &#224;s quest&#245;es sociais&#44; um maior poder aquisitivo representa um componente determinante no maior acesso a outras formas de atividades de lazer&#44; educa&#231;&#227;o&#44; moradia e servi&#231;os de sa&#250;de&#44; pode assim atuar como um mediador do n&#237;vel da APS&#46;<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">23&#44;24</span></a> Ademais&#44; pais com maior n&#237;vel de escolaridade tendem a entender melhor o que &#233; ser saud&#225;vel e o que seus filhos precisam&#44; o que os leva a apresentar n&#237;veis melhores de sa&#250;de&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">28</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">Outro ponto interessante encontrado no presente estudo &#233; que quest&#245;es comportamentais podem ter diferentes repercuss&#245;es na APS quando comparados os adolescentes de ambos os sexos&#46; &#201; importante ressaltar que meninos e meninas t&#234;m compreens&#245;es diferentes com rela&#231;&#227;o a seu estado de sa&#250;de&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">25</span></a> Nesse sentido&#44; observou&#8208;se que a APS negativa est&#225; associada com o n&#237;vel de AF total apenas entre os meninos&#46; Acredita&#8208;se que a pr&#225;tica de AF na adolesc&#234;ncia tenha um efeito positivo sobre a autoimagem e sobre a redu&#231;&#227;o dos sintomas de ansiedade e depress&#227;o e&#44; por conseguinte&#44; esses efeitos combinados s&#227;o capazes de gerar uma APS mais positiva&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">11</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">Foi observado que o estado nutricional entre as meninas&#44; que pode estar relacionado &#224; est&#233;tica&#44; tinha associa&#231;&#227;o com a APS&#44; no qual as que foram classificadas como sobrepesadas tinham mais chances de ter uma APS negativa&#44; associa&#231;&#227;o n&#227;o encontrada entre os meninos&#46; Em pesquisa feita com o mesmo p&#250;blico da presente pesquisa foi ressaltado que existe uma tend&#234;ncia de os meninos se sentirem bem com sua imagem corporal independentemente do estado nutricional&#44; diferentemente do que ocorre com as meninas&#44; que t&#234;m uma tend&#234;ncia de superestimar seu peso e mostrar uma maior insatisfa&#231;&#227;o com sua imagem corporal&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">13</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">Nesse sentido&#44; pode&#8208;se observar que as quest&#245;es antropom&#233;tricas&#44; como o excesso de peso&#44; interferem na APS&#44; principalmente para as meninas&#46; O resultado do estudo de Heshmat et al&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">12</span></a> mostrou existir uma associa&#231;&#227;o significativa entre meninas com maior IMC e uma APS negativa&#44; o mesmo resultado n&#227;o foi encontrado para os meninos&#46; Adolescentes com excesso de peso s&#227;o mais vulner&#225;veis a uma discrimina&#231;&#227;o social&#44; em particular as meninas s&#227;o mais preocupadas com a gordura corporal e mais propensas a se julgar gordas em compara&#231;&#227;o com os meninos&#46; Esses&#44; por sua vez&#44; t&#234;m menos interesse em perder peso e mais preocupa&#231;&#245;es relacionadas &#224; masculinidade&#44; como&#44; por exemplo&#44; um maior volume de massa muscular&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">29</span></a> Essas diferen&#231;as com rela&#231;&#227;o &#224; imagem corporal entre os sexos podem explicar parcialmente a associa&#231;&#227;o entre as quest&#245;es antropom&#233;tricas nas meninas e APS negativa&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Observou&#8208;se que n&#227;o praticar AF no tempo livre esteve associado com uma APS negativa em ambos os sexos&#46; Nesse sentido&#44; estudo feito com adolescentes suecos demonstrou que aqueles que n&#227;o praticavam esportes e que tinham um baixo n&#237;vel de AF apresentaram uma maior preval&#234;ncia de APS negativa&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">8</span></a> Uma das poss&#237;veis explica&#231;&#245;es para essa associa&#231;&#227;o est&#225; centrada no efeito ben&#233;fico da AF sobre as monoaminas no c&#233;rebro que afetam a neurotransmiss&#227;o e atenuam ansiedade&#44; tens&#227;o e estresse&#44;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">30</span></a> ou sobre a produ&#231;&#227;o de endorfinas e sua redu&#231;&#227;o da dor que potencializa uma sensa&#231;&#227;o de bem estar&#44; a qual tem claras repercuss&#245;es em termos de sa&#250;de mental&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">11</span></a> Esses achados s&#227;o condizentes com outros estudos&#44; como&#44; por exemplo&#44; um estudo feito em Jo&#227;o Pessoa&#47;PB que observou que os adolescentes que n&#227;o atingiam as recomenda&#231;&#245;es de pr&#225;tica de AF e sobrepesados tinham tr&#234;s vezes mais chance de ter uma APS negativa comparados com seus pares suficientemente ativos e com peso normal&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">7</span></a> Contudo&#44; neste estudo n&#227;o foram estratificados os resultados pelo sexo e n&#227;o foi observada a participa&#231;&#227;o dos adolescentes em outros dom&#237;nios e tipos de AF&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Certas limita&#231;&#245;es do presente estudo devem ser consideradas&#46; O n&#237;vel de AF total e praticada no tempo livre foi obtido por medi&#231;&#227;o indireta&#44; sabe&#8208;se que os m&#233;todos diretos trariam informa&#231;&#245;es mais precisas&#46; Al&#233;m disso&#44; apesar de usar uma amostra representativa&#44; deve&#8208;se ter cautela com a generaliza&#231;&#227;o dos dados para todos os adolescentes&#44; visto que o estudo foi restrito aos escolares da rede p&#250;blica estadual de ensino&#46; Ademais&#44; h&#225; tamb&#233;m a possibilidade de causalidade reversa como uma caracter&#237;stica inerente em estudos transversais&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Entre os pontos fortes da presente pesquisa&#44; pode&#8208;se destacar a representatividade da popula&#231;&#227;o de estudantes das escolas da rede p&#250;blica do Ensino M&#233;dio do Estado de Pernambuco&#44; o uso de um question&#225;rio previamente testado que apresentou um n&#237;vel de reprodutibilidade de moderado a alto e o controle de vari&#225;veis intervenientes na an&#225;lise&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Conclui&#8208;se que a APS negativa esteve associada a estado nutricional entre as meninas e a um menor n&#237;vel de AF entre os meninos&#46; Ademais&#44; a pr&#225;tica de AF no tempo livre foi tida como fator de prote&#231;&#227;o para uma APS negativa para os adolescentes de ambos os sexos&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conflitos de interesse</span><p id="par0165" class="elsevierStylePara elsevierViewall">Os autores declaram n&#227;o haver conflitos de interesse&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To evaluate the association between total physical activities&#44; physical activity in free time and nutritional status with self&#8208;perceived health in adolescents of both genders&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">This is a quantitative study that integrates the school&#8208;based&#44; cross&#8208;sectional epidemiological survey with statewide coverage&#44; whose sample consisted of 6261 adolescents &#40;14&#8211;19 years old&#41; selected by random conglomerate sampling&#46; Data were collected using the Global School&#8208;based Student Health Survey&#46; The chi&#8208;squared test &#40;<span class="elsevierStyleItalic">&#967;</span><span class="elsevierStyleSup">2</span>&#41; and the Poisson regression model with robust variance were used in the data analyses&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">It was observed that 27&#46;3&#37; of the adolescents had a negative health self&#8208;perception&#44; which was higher among girls &#40;33&#46;0&#37; <span class="elsevierStyleItalic">vs&#46;</span> 19&#46;0&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; After adjusting for potential confounding factors&#44; it was observed that boys who did not practice physical activity during free time &#40;PR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;44&#44; 95&#37; CI&#58; 1&#46;15&#8211;1&#46;81&#41; and were classified as insufficiently active &#40;PR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;27&#44; 95&#37; CI&#58; 1&#46;04&#8211;1&#46;56&#41;&#44; as well as girls who did not practice physical activity during free time &#40;PR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;15&#44; 95&#37; CI&#58; 1&#46;02&#8211;1&#46;29&#41; and were classified as overweight &#40;PR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;27&#44; 95&#37; CI&#58; 1&#46;01&#8211;1&#46;29&#41; had a greater chance of negative health self&#8208;perception&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Behavioral issues may have different effects on health self&#8208;perception when comparing boys with girls&#46; Negative health self&#8208;perception was associated with nutritional status in girls and a lower level of physical activity in boys&#44; and the practice of physical activity in the free time was considered a protective factor against a negative health self&#8208;perception for adolescents of both genders&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Avaliar a associa&#231;&#227;o entre atividade f&#237;sica total&#44; atividade f&#237;sica no tempo livre e estado nutricional com a autopercep&#231;&#227;o de sa&#250;de em adolescentes de ambos os sexos&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Trata&#8208;se de um estudo com abordagem quantitativa&#44; que integra o levantamento epidemiol&#243;gico transversal de base escolar e abrang&#234;ncia estadual&#44; cuja amostra foi constitu&#237;da por 6&#46;261 adolescentes &#40;14 a 19 anos&#41; selecionados por meio de uma estrat&#233;gia de amostragem aleat&#243;ria de conglomerados&#46; Os dados foram coletados a partir do question&#225;rio <span class="elsevierStyleItalic">Global School&#8208;based Student Health Survey</span>&#46; O teste de qui&#8208;quadrado &#40;&#967;<span class="elsevierStyleSup">2</span>&#41; e o modelo de regress&#227;o de Poisson com vari&#226;ncia robusta foram usados nas an&#225;lises dos dados&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Observou&#8208;se que 27&#44;3&#37; dos adolescentes tinham uma autopercep&#231;&#227;o de sa&#250;de negativa&#44; maior entre as meninas &#40;33&#44;0&#37; <span class="elsevierStyleItalic">vs</span>&#46; 19&#44;0&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; Ap&#243;s o ajuste pelos potenciais fatores de confus&#227;o&#44; constatou&#8208;se que tinham maior chance de ter uma autopercep&#231;&#227;o de sa&#250;de negativa os meninos que n&#227;o praticavam atividade f&#237;sica no tempo livre &#40;RP<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;44&#59; IC 95&#37;&#58; 1&#44;15&#8208;1&#44;81&#41; e que eram classificados como insuficientemente ativos &#40;RP<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;27&#59; IC 95&#37;&#58; 1&#44;04&#8208;1&#44;56&#41; e as meninas que n&#227;o praticavam atividade f&#237;sica no tempo livre &#40;RP<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;15&#59; IC 95&#37;&#58; 1&#44;02&#8208;1&#44;29&#41; e que eram classificadas como sobrepesadas &#40;RP<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;27&#59; IC 95&#37;&#58; 1&#44;01&#8208;1&#44;29&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#227;o</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Quest&#245;es comportamentais podem ter diferentes repercuss&#245;es na autopercep&#231;&#227;o de sa&#250;de quando comparados os meninos e meninas&#46; A autopercep&#231;&#227;o de sa&#250;de negativa esteve associada ao estado nutricional entre as meninas e a um menor n&#237;vel de atividade f&#237;sica entre os meninos e a pr&#225;tica de atividade f&#237;sica no tempo livre foi tida como fator de prote&#231;&#227;o para uma autopercep&#231;&#227;o de sa&#250;de negativa para os adolescentes de ambos os sexos&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Como citar este artigo&#58; Silva AO&#44; Diniz PR&#44; Santos ME&#44; Ritti&#8208;Dias RM&#44; Farah BQ&#44; Tassitano RM&#44; et al&#46; Health self&#8208;perception and its association with physical activity and nutritional status in adolescents&#46; J Pediatr &#40;Rio J&#41;&#46; 2019&#59;95&#58;458&#8211;65&#46;</p>"
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                  \t\t\t\t"><span class="elsevierStyleItalic">Escolaridade materna</span></td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>8 anos de estudo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">442&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8804; 8 anos de estudo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1012&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="8" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " colspan="7" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Atividade f&#237;sica no tempo livre</span></td><td class="td" title="\n
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                  \t\t\t\t  " rowspan="3" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sim&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>N&#227;o&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">N&#237;vel de atividade f&#237;sica</span></td><td class="td" title="\n
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                  \t\t\t\t  " rowspan="3" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ativo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Lazer de prefer&#234;ncia</span></td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Lazer ativo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Lazer passivo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">1006&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">59&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Estado nutricional</span></td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Eutr&#243;fico&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">3&#46;706&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Lazer passivo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;16&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;02&#8211;1&#44;34&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;97&#8211;1&#44;29&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sobrepeso&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;24&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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          "pt" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Associa&#231;&#227;o entre autopercep&#231;&#227;o de sa&#250;de negativa e n&#237;vel de atividade f&#237;sica&#44; atividade f&#237;sica no tempo livre e estado nutricional em meninas</p>"
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      "titulo" => "Refer&#234;ncias"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "A&#46; Pelegrini"
                            1 => "Coqueiro R da S"
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