To examine and map the consequences of chronic pain in adulthood. Documents addressing the impact of chronic pain on the psychological and social spheres of people suffering from chronic pain, published in Spanish and English between 2013 and 2018, were included. Those who addressed pharmacological treatments, chronic pain resulting from surgical interventions or who did not have access to the full text were excluded. Finally, 28 documents from the 485 reviewed were included Studies show that pain is related to high rates of limitation in daily activities, sleep disorders and anxiety-depression spectrum disorders. People in pain have more problems to get the workday done and to maintain social relationships. Chronic pain is also associated with worse family functioning. This review shows that limitations in the ability to perform activities of daily living, sleep, psychological health, social and work resources and family functioning are lines of interest in published articles. However, knowledge gaps are detected in areas such as the influence of having suffered pain in childhood or adolescence, the consequences of non-fulfillment of working hours and gender inequalities. It can be classified according to etiology, anatomical location or duration2 . According to the latter, chronic non-cancer pain (CNCP) persists continuously or intermittently for a period of more than three months and is not associated with cancer processes3 .Pain is an unpleasant sensory and emotional experience that acts as a sign of biological alertness in the face of real or potential tissue damage4 , 19% of the European population5 and 17% of the Spanish population6 . When pain persists for long periods of time, it loses its protective purpose7 and becomes the result of a complex process in which biological, psychological and sociocultural8 factors interact with each other9 . Several international organizations, such as the European Pain Federation or the International Association for the Study of Pain, consider that a change of perspective in the assessment and treatment of pain is necessary, being addressed as an entity in itself10 , in which the family, social and cultural context that the person lives is considered11 .CNCP is considered a public health problem that affects 20% to 35% of the world’s population12 or limitations of daily activity13 , but also psychological and social factors such as anxiety, depression14 , self-esteem15 , coping16 , resilience13 , social and family support7 and/or use of toxic substances14 .In the last ten years, scientific production on the repercussions of pain has increased. Numerous studies state that the perception and appreciation of CNCP affect sleepTherefore, we consider it necessary to know the individual and social consequences that CNCP has on the adult population. For this, we conducted a Scoping Review of the scientific literature. Our goal is to examine and map the consequences of chronic pain in adulthood.16 . To accomplish this, we used the methodological framework proposed by Arksey and O’Malley17 and the Joanna Briggs Institute Reviewer’s Manual18 . Although the Scoping Review methodology does not require quality assessment, several authors consider it a strength19 , as it allows to make recommendations for clinical practice20 .The Scoping Review methodology is used to map the scientific literature and detect areas of study that are not sufficiently researched21 . In this case, LE and DR scores are related. Thus, for an investigation with NE 1++; 1+ or 1- is considered extremely recommended (DR A); for NE 2++, 2+ or 2- the recommendation rating would be favorable (DR B), and for LE 3 and 4 the degrees of recommendation would be favorable, but not conclusive (DR C), and it is not recommended or disapproved (DR D), respectively.In view of these considerations, we assessed the level of evidence (LE) and the degree of recommendation (DR) of the studies included in accordance with the Scottish Intercollegiate Guidelines NetworkThe search in the literature was performed in four scientific databases  and in gray literature deposits .They were held between November and December 2018 with the following search strategy: (“chronic pain” OR “persistent pain” OR “long term pain”) and (adult*) AND (impact* OR influenc* OR cause* OR outcome* OR result* OR consequence* OR effect* OR repercussion*).As inclusion criteria, documents addressing the biopsychosocial consequences of chronic non-cancer pain were considered: 1) documents addressing the biopsychosocial consequences of chronic non-cancer pain; (2) in adults between 18 and 65 years old, not hospitalized; 3) published between 2013 and December 2018 and 4) written in Spanish or English.Exclusion criteria were: 1) documents dealing with pharmacological treatments; 2) documents that address people with chronic non-cancer pain resulting from neurodegenerative diseases, chronic infectious diseases or cognitive impairment and 3) documents that did not have access to the full text.After the removal of duplicate articles in the research, the selection process was performed, evaluating the relevance of the studies identified. This process was performed by two reviewers independently.In the first phase, reviewers assessed the titles and abstracts found to exclude articles that did not meet the inclusion and exclusion criteria. Later, they reviewed their contents in full text and decided which ones were included in the data extraction phase. In case of disagreement about the inclusion of an article between the two reviewers, it was discussed with the rest of the research team until consensus was reached.Team members produced a document that served as a model for the extraction of information from the article to be standardized. In addition, they developed a protocol to systematize the work procedure. Two of the team members independently collected information about each of the articles . All team members discussed the information in cases of disagreement until consensus was reached.After the review, 485 articles whose titles met the inclusion criteria were obtained. The search for gray literature produced 60 documents. Once duplicates were removed, 285 titles and abstracts were reviewed using the inclusion and exclusion criteria. Exactly 170 full texts were recovered for screening. After reviewing the full texts, 142 were excluded, because they did not report the theme of the study, remaining 28 documents for analysis   . The st26 . People tend to avoid activities that cause or increase the severity of pain, leading to a decrease in activity levels compared with healthy people27 . In this sense, when pain interferes with the ability to perform daily activities, people tend to show a negative perception of themselves due to lower physical capacity and misunderstanding of people in their environment28 , a fact that translates into greater catastrophizing in the face of pain29 . In turn, studies indicate that people with CNCP spend more time sitting and less time standing, and that an increase in physical activity during the afternoon is related to the decrease in activities of daily living in the evening30 .Chronic Non-Cancer Pain increases in disability and limitation in daily activities31 , comorbidity of chronic diseases such as obesity or diabetes32 , more difficulty in self-care and increased use of health services33 .A less active lifestyle is also associated with persistence and more severe pain levels29 . Studies suggest pain management improve sleep quality by up to 14%. The results indicate there is a circular and dynamic interrelation in which pain causes sleep disorders, which, in turn, increase pain intensity36 .Sleep problems are a common consequence in people with CNCP37 and have abnormal brain activity during sleep38 . In a study conducted by Cranford et al.37 , it was reported that 30% of the participants had sleep problems every night and/or several times a night. The most common changes are difficulty in starting or maintaining sleep, waking up earlier, having fragmented or no-restorative sleep34 , and higher levels of fatigue during the day; more evident symptoms in women than in men38 .Other studies state that between 50 and 88% of people meet the diagnostic criteria for sleep disorders34 . Andrews et al.4 noted that people performing more intense activities during the day suffer more pain and stay awake longer periods at night.Sleep disorders due to CNCP are also related to limitation in performing daily activities and disability37 found that 80% of study participants responded to having used cannabis in the last six months to improve the quality of their sleep, showing a positive opinion about them. However, in 65% of cases people have developed cannabis dependence.On the other hand, some people resort to using cannabis to improve the quality of their sleep. Cranford et al.4 . Different studies have investigated this relationship, finding that mental illnesses are present in 75.3% of cases of pain14 , and anxiety and depression rates reach 30-40%, being more pronounced in women13 . Anxiety and depression cause fear of pain-enhancing activities, generating a spiral of pain, fear and avoidance42 .CNCP is associated with suffering from mental illness44 . The findings of El-Shormilisy et al.45 suggest that coping is also mediated by sex. Women with CNCP develop fewer adaptation strategies than men, resulting in worse functional outcomes.Several authors highlight the relationship between adaptability and CNCP experiences. Thus, people with higher self-esteem have much less unpleasant pain stimuli, improving the use of coping strategies45 . According to Campbell et al.3 , this relationship may be due to many people who do not reduce the intensity of their pain, despite undergoing lifelong treatment.On the other hand, the prevalence of suicidal ideation and suicide attempts in the population with CNCP is 20% and 5 to 14%, respectively, twice the general population14 , 25.3% of people with CNCP use tobacco, twice the general population. A study by Dirtre et al.48 found that 43% of participants who used tobacco also had CNCP. These people reported tobacco use as an agent who calmed anxiety caused by pain. In this sense, the relationship between CNCP and tobacco use is dynamic. Smokers have higher pain rates, increased number of painful sites and higher levels of anxiety and depression, which would encourage tobacco use48 . Thus, pain would strengthen tobacco dependence that results in greater pain48 .The relationship between CNCP and tobacco use is also complex. According to Orhurhu et al.47 . However, people who have greater social participation may have better health, reduced anxiety, depression and reduced perceived stress24 . In this sense, El-Shormilisy et al.11 , claim that women and men with CNCP are differently related to their social environment. According to this author, women are socialized from an early age to express their emotions and seek social support, and men would be more likely not to do so. This could translate into greater resources to deal with the CNCP in them.Several studies have shown CNCP causes social isolation, decreased leisure activities and work difficulties48 , most people need to keep working despite the pain, especially in these groups with fewer resources, and they may have less productivity at work.In the field of research, the existence of CNCP poses a great economic burden for the individual and the system. According to Dany et al.49 , as it impacts the family scope, its functioning, and how its members communicate or resolve conflicts. Reactions from other members can trigger different types of invalid responses, rejection, and/or support22 . In this sense, difficulties with the partner contribute to increased depression and anxiety50 .The family environment of people with CNCP may also be affected49 .Regarding parental relationships, parents model the perceptions and attitudes of their sons and daughters in the face of pain through their own experience, taking as an example the actions and discourses they observe. In turn, pain may affect parents’ ability to complete physical tasks related to creationThe increase in scientific production on chronic pain in adulthood allowed us to characterize aspects of interest and detect new lines of research, despite having this Scoping Review as the main limitation of linguistic bias, since there were no studies published in languages other than Spanish or English.This review shows the ability to perform activities of daily living, sleep, psychological health, labor socio-economic consequences and family functioning are lines of interest in articles published. However, knowledge gaps are detected in areas such as consequences of work, toxic consumption and gender inequalities.51 , found that about 30% of people with coronary heart disease and chronic obstructive pulmonary disease (COPD) also suffer pain. Torrance et al.52 state that comorbidity between chronic pain and one of these two diseases increases by up to three times the probability of dying compared with the population who do not suffer from pain. These authors explain this relationship as a result of the decrease in the daily functioning capacity of people with CNCP. These higher rates of comorbidity, mortality and dependence result in greater use of health services and, therefore, economic expenses, as found by Pitcher et al.31 , in our results. However, few studies produce actual figures on the real economic impact of CNCP. Direct and indirect costs in Europe are estimated at 200 million euros and in the US between US$560 million and US$635 million54 .There is an extensive literature on the impact of CNCP on functional capacity, but comorbidity with other chronic diseases is less known. Butchart et al.55 report that an effective approach and treatment of depression and anxiety in people with CNCP can improve their health by up to 14%, reducing thus functional limitation and impact on health systems. On the other hand, other authors consider this relationship inverse, that is, chronic pain would be one of the first consequences of mental illness59 . However, for authors such as Von Korff et al.60 , the temporal relationship between mental illness and CNCP is unclear, it seems to be bidirectional and both act as a positive reinforcement for the other.As to psychological health, numerous authors have found that the condition of mental illness, such as anxiety or depression in people with CNCP, is common. Knowing this relationship is important, because authors such as Rayner et al.13 and Ditre et al.48 affirm that tobacco habit increases the level of pain. However, Shi et al.61 observe that this relationship has not been shown, but they insist that depressive symptoms associated with tobacco use can increase pain levels.People with CNCP have higher rates of tobacco use. In our results, authors such as Catalano et al.62 in 2009, in which they show that alcohol may be used to relieve pain by its transient analgesic effect. Some results contradict the Danish cohort study by Ekholm et al.63 , concluding that patients with CNCP are less likely to consume alcohol, but it is risky when mixed with the drug64 .No studies on the relationship between chronic pain and alcohol consumption were found. We consider it necessary to conduct research on this subject considering the results obtained by Riley & King65 claim that people with CNCP may have lower productivity rates, which would be a heavy economic burden. In this sense, Pain Proposal’s results support this statement, adding that 21% of the population with CNCP felt unable to finish their working day, which translates into an impact on the labor market of 2.5 million euros and 52 million of lost working days per year10 . They also indicate that in Spain, the average number of days lost due to pain is 16.8 days a year66 .Regarding labor consequences, the loss of work and the economic cost that generates pain are little studied. Yamada et al.67 . Several studies have found great differences in subjective perception of pain or general well-being in women, despite having scores similar to those of men in analytical and radiological data, which may lead us to think that it is devaluing itself with the use of clinical indices that do not reflect the women’s reality. In addition, the authors emphasize the importance of gender analysis in the study of CNCP68 . In this review, the studies found prevalence data disaggregated by sex, and some, in a transversal way, identify differences in male and female experiences, but do not analyze them from a gender perspective69 .Regarding gender inequalities, research shows that, as in other clinical pathologies, women receive more precarious health care than men 1 . Se puede clasificar atendiendo a la etiología, localización anatómica o duración2 . Según esta última, el dolor crónico no oncológico (DCNO) es aquel que persiste de manera continua o intermitente durante un periodo superior a tres meses y no se asocia a procesos oncológicos3 .El dolor es una experiencia sensorial y emocional desagradable que actúa como señal biológica de advertencia ante un daño tisular real o potencial4 , 19% de la población europea5 y al 17% de la población en España6 . Cuando el dolor persiste durante periodos de tiempo largos pierde su propósito protector7 y se convierte en el resultado de un complejo proceso en el que influyen factores biológicos, psicológicos y socioculturales8 en interacción unos con otros9 . Distintas organizaciones internacionales como la European Pain Federation o la International Association for the Study of Pain consideran necesario un cambio de perspectiva en la valoración y tratamiento del dolor. Es preciso abordarlo como una entidad en sí misma10 , en la que se debe tener en cuenta el contexto familiar, social y cultural que vive la persona que lo padece11 .El DCNO es considerado un problema de salud pública que afecta al 20–35% de la población mundial12 o las limitaciones en la actividad diaria13 , pero también factores psicológicos y sociales como la ansiedad, depresión14 , autoestima15 , afrontamiento16 , resiliencia13 , apoyo social y familiar7 y/o consumo de sustancias tóxicas14 .En los últimos diez años se ha producido un incremento de la producción científica sobre las repercusiones del dolor. Numerosas investigaciones afirman que en la percepción y valoración del DCNO influyen factores como el sueñoScoping Review . Nuestro objetivo es examinar y mapear las consecuencias del dolor crónico en la edad adulta.Por ello, consideramos necesario conocer las consecuencias individuales y sociolaborales que tiene el DCNO en la población adulta. Para ello realizamos una revisión de la literatura científica mediante Scoping Review se utiliza para mapear la literatura científica y detectar las áreas de estudio que no están suficientemente investigadas16 Para llevarla a cabo utilizamos el marco metodológico propuesto por Arksey y O’Malley17 y el manual para Scoping Review del Joanna Briggs Institute18 . Si bien la metodología de la Scoping Review no requiere evaluación de la calidad, diversos autores la consideran una fortaleza19 ya que permite hacer recomendaciones para la práctica clínica20 .La metodología de revisión Scottish Intercollegiate Guidelines Network21 . En este caso, las puntuaciones NE y GR están relacionadas. Así, a una investigación con NE 1++; 1+ ó 1- se la considera extremadamente recomendable (GR A); para NE 2++, 2+ ó 2- el grado de recomendación sería favorable (GR B), y para NE 3 y 4 los grados de recomendación serían favorables pero no concluyentes (GR C) y no se recomienda ni se desaprueba (GR D) respectivamente.Teniendo en cuenta estas consideraciones, hemos realizado la evaluación del nivel de evidencia (NE) y del grado de recomendación (GR) de los estudios incluidos atendiendo a las pautas recomendadas por la American Pain Society, European Pain Federation e International Association for the Study of Pain ).La búsqueda en la literatura se realizó en cuatro bases de datos científicas  y en depósitos de literatura gris  and (adult*) AND (impact* OR influenc* OR cause* OR outcome* OR result* OR consequence* OR effect* OR repercussion*).Como criterios de inclusión se consideraron: 1) documentos que abordaban las consecuencias biopsicosociales que genera el dolor crónico no oncológico; 2) en personas adultas entre 18 y 65 años, no hospitalizadas; 3) publicados entre 2013 y diciembre de 2018 y 4) escritos en español o inglés.Como criterios de exclusión fueron usados: 1) documentos que abordaran tratamientos farmacológicos; 2) documentos que abordaran personas con dolor crónico no oncológico derivado de enfermedades neurodegenerativas, infecciosas de carácter crónico o deterioro cognitivo y 3) documentos que no dispusieran de acceso al texto completo.Tras la eliminación de los artículos duplicados en la búsqueda, se realizó el proceso de selección, evaluando la relevancia de los estudios identificados. Este proceso lo llevaron a cabo dos revisores de manera independiente.En la fase primera, los revisores evaluaron los títulos y resúmenes encontrados para excluir los artículos que no cumplían con los criterios de inclusión y exclusión. Posteriormente, revisaron su contenido a texto completo y decidieron cuáles fueron incluidos en la fase de extracción de los datos. En caso de desacuerdo en la inclusión de un artículo entre los dos revisores, se discutió con el resto del equipo de investigación hasta llegar a un consenso.Los miembros del equipo elaboraron un documento que sirvió como modelo para que la extracción de la información de los artículos estuviese estandarizada. Además, desarrollaron un protocolo para sistematizar el procedimiento de trabajo. Dos de los miembros del equipo recogieron de manera independiente información acerca de cada uno de los artículos . Todos los miembros del equipo discutieron la información en los casos de desacuerdo hasta llegar al consenso.Tras la revisión, se obtuvieron 485 artículos cuyos títulos cumplían los criterios de inclusión. La búsqueda de la literatura gris produjo 60 documentos. Una vez eliminados los duplicados, se procedió a la revisión de 285 títulos y resúmenes utilizando los criterios de inclusión y exclusión. Se recuperaron 170 textos completos para el cribado. Tras la revisión de los textos completos, 142 fueron excluidos, ya que no informaban acerca del tema de estudio, quedando finalmente 28 documentos para su análisis   . Los es22 . Las personas tienden a evitar actividades que causen o aumenten la severidad del dolor, lo que lleva a una disminución en los niveles de actividad en comparación con las personas sanas22 . En este sentido, cuando el dolor interfiere en la capacidad para realizar las actividades de la vida diaria, las personas tienden a mostrar una percepción negativa de sí mismas debido a la menor capacidad física y a la incomprensión de las personas de su entorno28 , hecho que se traduce en mayor catastrofismo ante el dolor29 . A su vez, los estudios indican que las personas con DCNO pasan más tiempo sentadas y menos de pie, y que un aumento de la actividad física durante la tarde se relaciona con disminución de las actividades de la vida diaria durante la noche30 .El Dolor Crónico no Oncológico ocasiona un aumento de la discapacidad y limitación en la actividad diaria31 , la comorbilidad de enfermedades crónicas como obesidad o diabetes32 , más dificultad para el autocuidado y mayor uso de servicios sanitarios33 .Un estilo de vida menos activo se asocia también con persistencia y niveles de dolor más severos29 . Los estudios apuntan que el control del dolor mejoraría la calidad del sueño hasta en un 14%. Los resultados indican que existe una interrelación circular y dinámica en la que el dolor ocasiona trastornos del sueño y los trastornos del sueño, a su vez, incrementan la intensidad del dolor34 .Los problemas del sueño son una consecuencia común en las personas con DCNO37 y presentan una actividad cerebral anormal durante el sueño38 . En un estudio de Cranford et al.37 refirieron que el 30% de los participantes indicaron que sus problemas del sueño ocurrían todas las noches y/o varias veces por noche. Las alteraciones más frecuentes son dificultad para la iniciación o mantenimiento del sueño, despertares tempranos, sueño fragmentado o no reparador34 , y mayores niveles de fatiga durante el día; síntomas más acusados en mujeres que en hombres38 .Otros estudios afirman que entre un 50–88% de las personas cumplen los criterios diagnósticos de trastornos del sueño34 . Andrews et al.4 , señalaron que las personas que realizan actividades de mayor intensidad durante el día padecen mayor número de puntos dolorosos y periodos de vigilia más largos durante la noche.Las perturbaciones del sueño debido al DCNO se relacionan también con la limitación en la realización de actividades de la vida diaria y la discapacidad37 , encontraron que el 80% de los participantes de su estudio respondieron haber consumido cannabis en los últimos seis meses para mejorar la calidad de su sueño, mostrando una opinión positiva sobre ellos. Sin embargo, en el 65% de los casos las personas desarrollaron dependencia al cannabis.Por otro lado, algunas personas recurren al consumo de cannabis para mejorar la calidad de su sueño. Cranford et al.4 . Diferentes estudios han investigado esta relación encontrando que las enfermedades mentales están presentes en el 75,3% de los casos de dolor14 y las tasas de ansiedad y depresión alcanzan el 30–40%, siendo más acusado en mujeres13 . La ansiedad y la depresión ocasionan temor ante las actividades que aumentan el dolor, generando una espiral de dolor, miedo y evitación39 .El padecimiento del DCNO se asocia con la comorbilidad de enfermedades mentales44 . Los hallazgos de El-Shormilisy et al.45 , sugieren que el afrontamiento también está mediado por el género. Las mujeres con DCNO desarrollan menos estrategias de adaptación que los hombres, lo que conlleva a peores resultados funcionales.Diversos autores ponen de manifiesto la relación entre la capacidad de adaptación y las vivencias del DCNO. Así, las personas con mayor autoestima presentan estímulos de dolor mucho menos desagradables, mejorando el uso de estrategias de afrontamiento45 . Según Campbell et al.3 , esta relación puede deberse a que muchas personas no logran la disminución de la intensidad de su dolor a pesar de seguir un tratamiento de por vida.Por otro lado, la prevalencia de ideación suicida e intentos de suicidio en la población con DCNO es del 20% y 5–14% respectivamente, el doble que en la población general14 , el 25,3% de las personas con DCNO consumen tabaco, el doble que en la población general. En un estudio de Dirtre et al.48 , encontraron que el 43% de los participantes consumidores de tabaco padecían también DCNO. Estas personas refirieron utilizar el tabaco como un agente que calmaba la ansiedad que les causaba el dolor. En este sentido, la relación entre el DCNO y el consumo de tabaco es dinámica. Los fumadores padecen tasas de dolor más elevadas, mayor número de localizaciones dolorosas y mayores niveles de ansiedad y depresión, lo que favorecería el consumo de tabaco48 . Así pues, el dolor actuaría como un reforzador de la dependencia tabáquica que se traduce en mayor dolor48 .La relación entre el DCNO y el consumo de tabaco también es compleja. Según Orhurhu et al.47 . Sin embargo, las personas que tienen mayor participación social pueden tener un mejor estado de salud, reducción de la ansiedad, depresión y menor estrés percibido24 . En este sentido, El-Shormilisy et al.11 , afirman que las mujeres y hombres con DCNO se relacionan de manera diferente con su entorno social. Según este autor, las mujeres son socializadas desde una edad temprana para expresar sus emociones y buscar apoyo social, y los hombres sería más probable que no lo hicieran. Esto podría traducirse en mayores recursos para afrontar el DCNO en ellas.Diversos estudios han manifestado que el DCNO provoca aislamiento social, disminución de las actividades de ocio y dificultades laborales48 , la mayoría de las personas necesitan continuar trabajando a pesar del dolor, especialmente en aquellos grupos con menos recursos, siendo probable que tengan una menor productividad laboral.En el ámbito laboral, la existencia de DCNO supone una gran carga económica para la persona y para el sistema. Según Dany et al.49 , ya que impacta en la atmósfera familiar, su funcionamiento y en la forma en la que sus miembros se comunican o resuelven conflictos. Las reacciones de los demás miembros pueden desencadenar diferentes tipos de respuestas invalidantes, de rechazo y/o de apoyo22 . En este sentido, las dificultades con la pareja contribuyen al aumento de depresión y ansiedad50 .El entorno familiar de las personas que padecen DCNO también puede verse afectado49 .En cuanto a las relaciones parentales, los progenitores modelan las percepciones y actitudes de los hijos e hijas ante el dolor a través de su propia experiencia tomando como ejemplo las acciones y discursos que observan. A su vez, el dolor puede afectar a la capacidad de los progenitores para completar tareas físicas relacionadas con la crianzaScoping Review el como principal limitación el sesgo de idioma, ya que no se incluyeron estudios publicados en idiomas diferentes al español o inglés.El aumento de la producción científica sobre el dolor crónico en la edad adulta nos ha permitido caracterizar los aspectos de interés y detectar nuevas líneas de investigación a pesar de tener esta Esta revisión pone de manifiesto que la capacidad para realizar actividades de la vida diaria, el sueño, la salud psicológica, las consecuencias socio-laborales y el funcionamiento familiar son líneas de interés en los trabajos publicados. Sin embargo, se detectan lagunas de conocimiento en áreas como las consecuencias laborales, el consumo de tóxicos y las desigualdades de género.51 , encontraron que alrededor de un 30% de las personas con patologías coronarias y enfermedad pulmonar obstructiva crónica (EPOC) padecen también dolor. Torrance et al.52 , afirman que la comorbilidad entre el dolor crónico y una de estas dos enfermedades aumenta hasta en tres la probabilidad de morir con respecto a la población que no padece dolor. Estos autores explican esta relación como el resultado de la disminución de la capacidad para el funcionamiento diario de las personas con DCNO. Estas mayores tasas de comorbilidad, mortalidad y dependencia ocasionan un mayor uso de los servicios sanitarios y por ende de gasto económico, tal y como hace referencia Pitcher et al.31 , en nuestros resultados. Sin embargo, existen pocos estudios que arrojen cifras reales sobre el impacto económico real del DCNO. Se estima que los costes directos e indirectos en Europa rondan los 200 millones de euros53 y en EE.UU. entre los 560 y los 635 millones de dólares54 .Existe amplia literatura acerca de las repercusiones que produce el DCNO en la capacidad funcional, pero la comorbilidad con otras enfermedades crónicas es menos conocida. Butchart et al.55 , refieren que un abordaje y tratamiento eficaz de la depresión y ansiedad en las personas con DCNO puede mejorar su salud hasta en un 14%, disminuyendo a su vez la limitación funcional y el impacto en los sistemas de salud. Por otro lado, otros autores consideran que esta relación es inversa, es decir, el dolor crónico sería una de las primeras consecuencias de las enfermedades mentales56 . Sin embargo, para autores como Von Korff et al.60 , la relación temporal entre las enfermedades mentales y el DCNO no está clara, parece ser bidireccional y ambas actúan como reforzador positivo de la otra.En cuanto a la salud psicológica, numerosos autores han encontrado que el padecimiento de enfermedades mentales, tales como la ansiedad o depresión en personas con DCNO, es frecuente. Conocer esta relación es importante ya que autores como Rayner et al.13 , y Ditre et al.48 , afirman que el hábito tabáquico aumenta el nivel de dolor. Sin embargo, Shi et al.61 , refieren que esta relación no se ha demostrado pero insisten que en que los síntomas depresivos asociados al consumo de tabaco sí podrían aumentar los niveles de dolor.Las personas con DCNO presentan mayores tasas de consumo de tabaco. En nuestros resultados, autores como Catalano et al.62 en 2009 en los que ponen de manifiesto que el alcohol se puede estar utilizando para paliar el dolor por su efecto analgésico transitorio. Resultados que contradicen el estudio de cohortes danés de Ekholm et al.63 , al concluir que los pacientes con DCNO tienen menos probabilidad de consumir alcohol, pero existen riesgos derivados de su consumo al mezclarlo con medicamentos64 .No se han encontrado estudios que aborden la relación entre el padecimiento de dolor crónico y el consumo de alcohol. Consideramos necesario realizar investigaciones al respecto teniendo en cuenta los resultados obtenidos por Riley & King65 , afirman que las personas con DCNO pueden mostrar menores tasas de productividad, lo que supondría una gran carga económica. En este sentido, los resultados de la encuesta Pain Proposal apoyan esta afirmación, añadiendo además que el 21% de la población con DCNO se sentía incapaz de finalizar su jornada laboral, lo que se traduce en un impacto en el mercado laboral de 2.500 millones de euros y 52 millones de jornadas laborales perdidas al año10 . Asimismo indican que, en España, el promedio de días perdidos por dolor es de 16.8 jornadas al año66 .Respecto a las consecuencias laborales, la pérdida de trabajo y el coste económico que genera el dolor están poco estudiados. Yamada et al.67 . Varios estudios han detectado grandes diferencias en la percepción subjetiva del dolor o bienestar general en las mujeres a pesar de presentar puntuaciones similares a los hombres en los datos analíticos y radiológicos, lo que nos puede llevar a pensar que se está infravalorando con el uso de índices clínicos que no reflejan la realidad de las mujeres. Además, los autores insisten en la importancia del análisis de género en el estudio del DCNO68 . En esta revisión, los estudios encontrados presentan datos de prevalencia desagregados por sexos, y algunos, de manera transversal, identifican diferencias en las vivencias de hombres y mujeres, pero no lo analizan desde una perspectiva de género69 .En relación con las desigualdades de género, las investigaciones ponen de manifiesto que, tal y como ocurre en otras patologías clínicas, las mujeres reciben una atención en salud más deficiente que los hombres70 y en la edad adulta, mapear todas las repercusiones que el DCNO genera en las personas que lo padecen.Como líneas prospectivas, sería conveniente profundizar en las consecuencias del dolor crónico en el adulto mayor. Esto permitiría, tras haber estudiado las consecuencias en la infancia y adolescencia


In 1969, Jean-Marie Souriau introduced a “Lie Groups Thermodynamics” in Statistical Mechanics in the framework of Geometric Mechanics. This Souriau’s model considers the statistical mechanics of dynamic systems in their “space of evolution” associated to a homogeneous symplectic manifold by a Lagrange 2-form, and defines in case of non null cohomology  a Gibbs density (of maximum entropy) that is covariant under the action of dynamic groups of physics . Souriau Lie Group Thermodynamics was also addressed 30 years after Souriau by R.F. Streater in the framework of Quantum Physics by Information Geometry for some Lie algebras, but only in the case of null cohomology. Souriau method could then be applied on Lie groups to define a covariant maximum entropy density by Kirillov representation theory. We will illustrate this method for homogeneous Siegel domains and more especially for Poincaré unit disk by considering SU group coadjoint orbit and by using its Souriau’s moment map. For this case, the coadjoint action on moment map is equivariant. For non-null cohomology, we give the case of Lie group SE(2). Finally, we will propose a new geometric definition of Entropy that could be built as a generalized Casimir invariant function in coadjoint representation, and Massieu characteristic function, dual of Entropy by Legendre transform, as a generalized Casimir invariant function in adjoint representation, where Souriau cocycle is a measure of the lack of equivariance of the moment mapping. La thèse de Kirillov, parue en 1962, a suscité immédiatement beaucoup d’intérêt…En outre, quantité de notions naturelles concernant les représentations s’interprètent géométriquement en terme d’orbites coadjointes: restriction à un sous-groupe, induction unitaire, produit tensoriel, mesure de Plancherel, la topologie de l’ensemble représentations unitaires irréductibles… Kirillov s’est vite convaincu, et il a convaincu la communauté mathématique que cette « méthode des orbites » devait être applicable à des groupes bien plus généraux que les groupes nilpotents. Il n’a pas hésité à aborder le cas des groupes de Lie connexes quelconques. Evidemment, des difficultés considérables ont surgi immédiatement. Néanmoins, Kirillov a indiqué une voie d’accès, qui ensuite a été largement utilisée.  Jacques Dixmier, Brèves remarques sur l’œuvre de A.A. Kirillov - On comprend ainsi comment Lagrange a pu développer les lois de la Mécanique des systèmes formés de solides sans s’occuper des variations de la température de ces corps et Fourier traiter des variations de la température de ces mêmes corps solides sans s’occuper de leur mouvement; comment on peut étudier le mouvement de la Terre, assimilée à un solide rigide, sans se préoccuper de la température de cet astre et étudier le refroidissement du globe terrestre sans se préoccuper de son mouvement. Une telle indépendance entre les problèmes qui ressortissent à la Mécanique et les problèmes qui ressortissent à la Théorie de la chaleur n’existe plus lorsque les systèmes auxquels on a affaire ne sont plus des systèmes classiques; si, par exemple, au lieu de regarder la Terre comme un solide rigide, d’état invariable, on tient compte des changements de volume, de forme, d’état physique et chimique qui accompagnent son refroidissement, on ne peut plus séparer le problème du mouvement de la Terre et le problème du refroidissement terrestre. … On sait que cette forme de relations supplémentaires avait été introduite par Newton et les géomètres du XVIIIème siècle dans la théorie du son. Ces considérations montrent que les questions qui ressortissent à la Thermodynamique ont dû solliciter l’attention des physiciens dès qu’on a voulu aborder l’étude des systèmes autres que des systèmes classiques; et, en fait, c’est la théorie de la propagation du son dans l’air qui a provoqué Laplace à créer la Thermodynamique.  P. Duhem, L’intégrale des forces vives en thermodynamique, JMPA 4:5-19, 1898,2,3,4 - Sous cette aspiration, la physique qui était d’abord une science des “agents” doit devenir une science des “milieux”. C’est en s’adressant à des milieux nouveaux que l’on peut espérer pousser la diversification et l’analyse des phénomènes jusqu’à en provoquer la géométrisation fine et complexe, vraiment intrinsèque…Sans doute, la réalité ne nous a pas encore livré tous ses modèles, mais nous savons déjà qu’elle ne peut en posséder un plus grand nombre que celui qui lui est assigné par la théorie mathématique des groupes  Gaston Bachelard, Etude sur l’Evolution d’un problème de Physique –La propagation thermique dans les solides, 1928 - The previous French quotes by the Mathematician Jacques Dixmier, the Physicist Pierre Duhem, and the Philosopher Gaston Bachelard are important to introduce the epistemological context of models that will be developed in the paper. Jacques Diximer refers to Alexander Kirillov seminal idea of coadjoint orbits method to consider Lie group representation model. Pierre Duhem makes comments to the origin of the gap between the theory of heat and the theory of Mechanics. Finally, Gaston Bachelard make prediction that new Thermodynamics foundations will be given by groups. We will try in this paper, to prove that these ideas could be reconciled by the Souriau model of Lie groups Thermodynamics through the mathematical structure of Lie algebra cohomology.After a the state of the art and trends in Machine Learning based on Information Geometry, we will present, in this introduction, the main objective of this paper to jointly apply models from geometric statistical mechanics and tools from Information geometry to solve “Gauss density” definition problem for statistics on Lie groups and homogeneous manifolds. We will also present use-cases motivation for Lie group machine learning illustrating for Doppler statistics analysis with SU statistics, and for kinematics data analysis with SE(2) statistics.The classical simple gradient descent used in Deep Learning has two drawbacks: the use of the same non-adaptive learning rate for all parameter components, and a non-invariance with respect to parameter re-encoding inducing different learning rates. As the parameter space of multilayer networks forms a Riemannian space equipped with Fisher information metric, instead of the usual gradient descent method, the natural gradient or Riemannian gradient method, which takes account of the geometric structure of the Riemannian space, is more effective for learning. The natural gradient preserves this invariance to be insensitive to the characteristic scale of each parameter direction. The Fisher metric defines a Riemannian metric as the Hessian of two dual potential functions (the Entropy and the log-partition function). Yann Ollivier and Gaétan Marceau-Caron provided in 2016  the firsIn this paper, we will introduce how to extend these approaches for data as elements of Lie groups or data lying on a homogeneous manifold where a Lie group acts transitively. This extension is considered in the framework and interconnexion of Souriau “Lie groups Thermodynamics”, Information Geometry and Kirillov representation theory  to definSupervised learning approaches are based on neural networks whose parameters are estimated by natural gradient algorithms. Non-supervised algorithm are based on clustering by using technics called “k-means” or “Mean-shift” using distance between elements of the dataset. In both cases, if we want to extend these approaches for Lie groups dataset, we have to extend the notion of Gaussian densities and distance between elements. We propose to use Geometric Statistical Model coming from Geometric Statistical Mechanics to introduce “Gauss density” of Lie group elements. Jointly, we can associate a natural distance between these Lie group elements on the Symplectic manifold by means of KKS 2-form, introducing a natural Riemannian metric associated to Fisher Metric from Information Geometry. The objective of this paper is to explain how to use Geometric Statistical Mechanics tools in this context.The purpose of this article is multiple. The work of Professor Jean-Marie Souriau is well known in the field of “Geometric Mechanics” of which he is one of the founders with his book “structure of dynamic systems” published in 1969, and in which he introduced the foundations of Symplectic Geometry. Inside this book, chapter IV dealing with the extension of Geometric Mechanics to Statistical Mechanics, has been little read or misunderstood by this community. We have discovered that this model was part of and generalized another discipline, which is called Information Geometry. We have demonstrated in other previous articles that one could generalize Fisher metric (invariant metric used in Information Geometry) for Lie groups, with this model. It is therefore a question of rehabilitating the work of Jean-Marie Souriau in a broader framework, which concerns statistics and machine learning extended to objects considered as elements of a Lie group or a homogeneous manifold.The second goal is to solve with these new tools problems that were still unsolved in statistics and machine learning. These unresolved problems concern the definition and calculation of the expression of probability densities, playing the role of Gaussian density, for elements of a Lie group or elements of homogeneous manifolds. In this article, we completely solve the problem for 2 Lie groups very useful in machine learning but also in physics, the Lie groups SU and SE(2). The calculation is not a simple application of the Souriau model, because it is necessary to establish the “moment map” associated with these groups and define a Laplace transform on their coadjoint orbits of these groups . In a second step, we must use Information Geometry to write these covariant Gibbs densities in the correct parametrization which parametrizes the generalized Gaussian law from statistical moments on the homogeneous symplectic manifold associated with coadjoint orbits. In the case SU, which corresponds to a case of null cohomology (equivariance of the coadjoint operator on the moment application), as the homogeneous symplectic manifold to the coadjoint orbit is the Poincaré unit disk, we solve jointly, an open problem to define mathematically the notion of Gaussian density in this disk in hyperbolic geometry. With the property that this density is by construction invariant under the action of the group SU, which is the condition sine qua none to preserve the symmetries and the invariance of the associated Fisher metric. We show that this model achieves a breakthrough in machine learning, because we have a Gibbs density and a Fisher metric invariant by change of parametrization and invariant under the action of symmetries. Gibbs density allows us to extend the classical supervised statistical machine learning algorithms, and Fisher metric allows us to adress unsupervised learning problem as k-means problems in metric space. The model opens the way to machine learning for Lie groups with multiple applications in robotics, sensor signal processing, image processing.In the last part of the article, based on this model, we give a new “geometric” definition of Entropy by showing that Entropy is an invariant Casimir function in coadjoint representation. The Casimir functions have been widely studied within the framework of Poisson structures and manifolds ,14,15,16Machine learning is a field of study of artificial intelligence, which is based on statistical approaches to give computers the ability to “learn” from data, that is, to classify data from observations in a supervised or non-supervised way. Machine learning generally has two phases. The first consists in estimating a model from data, called observations. This so-called “training” phase is generally carried out before the practical use of the model. The second phase corresponds to the start of production: the model being determined, new data can then be classified. According to the information available during the learning phase, learning is qualified in different ways. If the data is labeled , it is supervised learning. We speak of classification if the labels are discrete, or of regression if they are continuous. In the most general case, without a label, we seek to determine the underlying structure of the data (which can be a probability density) and it is then unsupervised learning. Machine learning can be applied to different types of data, such as graphs, trees, curves, or more simply feature vectors, which can be continuous or discrete. We propose to extend the approach, when datasets are element of matrix lie groups.Learning algorithms can be categorized according to their learning mode. For supervised learning, the classes are predetermined and the examples known, and then the system learns to classify according to a classification model. An expert must label examples beforehand. The process takes place in two phases. For unsupervised learning, when the system or operator has only examples, but no label, and the number of classes and their nature have not been predetermined, we speak of unsupervised learning or clustering. No expert is required. The algorithm must discover for itself the more or less hidden structure of the data, by data partitioning and data clustering. The system must cluster the data according to their available attributes, to classify them into homogeneous groups of examples. Similarity is generally calculated according to a distance function between pairs of examples.We will illustrate two problems of Machine Learning on Lie groups coming from Radar Industry. Target recognition on Radar micro-Doppler data could be modeled by a problem of classification of dataset considered as elements of SU Lie group see . Radar cSU or SE(2) are also fundamental tools in Image Processing (Sub-Riemannian Geometry of vision with SE(2)), in robotics ), in Natural Langage Processing ), …. For instance, SU Lie group which acts on Poincaré unit Disk is highly studied to embed isometrically a graph in an hyperbolic space. It is used by GAFAM  for Natural Language Processing by reducing graph analysis to a Machine Learning problem in Hyperbolic Poincaré Unit Disk. Hyperbolic Neural network  have beeD is the Poincaré Unit Disk:Lie group structure appears naturally on Doppler data, if we consider time series of locally stationary signal and their associated covariance matrix. Covariance matrix is Toeplitz Hermitian Positive Definite. Based on Theorem due to Verblunsky ,24 and TThe Poincaré unit disk is an homogeneous bounded domain where the Lie group SU act transitively. This Matrix Group is given by:n−1) Matrix SU Lie group elements:We can observe that 3. More specifically, the formulas describe the derivatives of the so-called tangent, normal, and binormal unit vectors in terms of each other.When we consider a 3D trajectory of a mobile target, we can describe this curve by a time evolution of the local Frenet-Serret frame  as illustrated in We will consider motions determined by exponentials of paths in the Lie algebra. Such a motion is determined by a unit speed space-curve The instantaneous twist of the motion SE(3) Lie group elements:SE(3) elements:This is the Lie algebra element corresponding to the tangent vector to the curve -1st Part on “Gauss Density on Lie groups”: This part is totally new in Machine learning with an extension of “Gauss densities” (defined as Maximum Entropy model) for Lie groups coupling both Souriau model , with Information Geometry in Geometric Machine Learning domain. We illustrate with two use-cases SU and SE(2) that are the most useful Lie groups in Image Processing (Sub-Riemannian Geometry of vision with SE(2)), in robotics ), in Natural Langage Processing  with methods of graph-embedding in Poincaré disk), …. Some tentatives have been developed to define noise on Lie groups by adding additional Gaussian components on elements of the Lie algebra     « Il n’y a rien de plus dans les théories physiques que les groupes de symétrie si ce n’est la construction mathématique qui permet précisément de montrer qu’il n’y a rien de plus ». Jean-Marie Souriau (see riau see La notion classique d’ensemble canonique de Gibbs est étendue au cas d’une variété symplectique sur laquelle un groupe de Lie possède une action symplectique (“groupe dynamique”). La définition rigoureuse donnée ici permet d’étendre un certain nombre de propriétés thermodynamiques classiques , notamment des inégalités de convexité. Dans le cas de groupes non commutatifs, des propriétés particulières apparaissent: la symétrie est spontanément brisée, certaines relations de type cohomologique sont vérifiées dans l’algèbre de Lie du groupe .  Jean-Marie Souriau, Mécanique Statistique, Groupes de Lie et Cosmologie, colloque CNRS n°237 – Géométrie Symplectique et physique mathématique


To describe social distancing practices in nine municipalities of the state of Rio Grande do Sul, Brazil, stratified by gender, age, and educational attainment. Two sequential cross-sectional studies were conducted in the municipalities of Canoas, Caxias do Sul, Ijuí, Passo Fundo, Pelotas, Porto Alegre, Santa Cruz do Sul, Santa Maria, and Uruguaiana to estimate the population prevalence of COVID-19. The study was designed to be representative of the urban population of these municipalities. A questionnaire including three questions about social distancing was also administered to the participants. Here, we present descriptive analyses of social distancing practices by subgroups and use chi-square tests for comparisons. In terms of degree of social distancing, 25.8% of the interviewees reported being essentially isolated and 41.1% reported being quite isolated. 20.1% of respondents reported staying at home all the time, while 44.5% left only for essential activities. More than half of households reported receiving no visits from non-residents. Adults aged 20 to 59 reported the least social distancing, while more than 80% of participants aged 60 years or older reported being essentially isolated or quite isolated. Women reported more stringent distancing than men. Groups with higher educational attainment reported going out for daily activities more frequently. The extremes of age are more protected by social distancing, but some groups remain highly exposed. This can be an important limiting factor in controlling progression of the COVID-19 pandemic. Despite slightly different emphases and strategies, most of the country quickly adopted measures to restrict personal contact—so-called social distancing, including advice to stay at home, school closures, bans on activities and venues that cause crowding , and constraints on the operation of commercial establishments. This generally meant closing most retail establishments, except supermarkets, grocery stores, drugstores/pharmacies, and other essential facilitiest) after the implementation of social distancing measures, particularly school closures2. A meta-analysis of 29 studies (25 of which were modeling studies) also concluded that social distancing measures can check the spread of Covid-19, especially when combined with broader restrictions, such as school closures and travel bans3. Another meta-analysis studying the effects of distancing and the use of masks and eye protection showed that physical distancing reduces the risk of infection by approximately 80% . The effective distance was estimated at >1 m (preferably 2 m). Mask wearing has also proven highly effective4.Since the start of the pandemic, there has been mounting evidence that social distancing can reduce the spread of SARS-CoV-2. A study in Hong Kong found a 44% reduction in effective reproduction number  between the proportion of people staying at home and Rt6. The “social isolation index” calculated by In Loco was also incorporated into an elasticity model which showed that, on average, every 10% increase in the isolation index was associated with 26% fewer cases of Covid-19 and 18% fewer deaths7.In Brazil, the effect of social distancing on the spread of the epidemic has been evaluated in three studies using data from In Loco, a company which provides intelligence based on location datab, are unable to characterize subgroups of community populations. One cannot tell from these data whether those staying at home are younger or older adults, men or women. Thus, in the present investigation, we use data from the Epicovid19/RS studyc, designed to estimate the population prevalence of SARS-CoV-2 infection in the Brazilian state of Rio Grande do Sul, to present social distancing patterns in nine surveyed municipalities, assessing differences by city, age, sex, and educational attainment.Nevertheless, sources of mobility data, such as In Loco and GoogleThe Epicovid19/RS study is being carried out in nine sentinel municipalities across the state of Rio Grande do Sul. These municipalities—Canoas, Caxias do Sul, Ijuí, Passo Fundo, Pelotas, Porto Alegre, Santa Cruz do Sul, Santa Maria, and Uruguaiana—were chosen because they are the largest of each of the state’s geographic mesoregions, as defined by the Brazilian Institute of Geography and Statistics (IBGE), plus the second-largest municipality in the Greater Porto Alegre area.8. More detailed information on methodology has been published elsewhere9.In each of the municipalities, a sample of 500 households was selected by drawing of 50 urban census tracts with probability proportional to size and 10 households per tract. The households were selected randomly during the first round of the study from a list of addresses provided by IBGE. For the second round, households were selected systematically by skipping to the 10th household over from each of the households surveyed in the previous round. Households where no one was present at the time of the interview, or whose residents refused to participate, were replaced by the neighboring residence. In each selected household, a list of residents was compiled, and one resident was selected at random to be interviewed and tested for Covid-19. The study protocol provides for four independent rounds to be conducted, one every 2 weeks. The first and second rounds took place between 11–13 and 25–27 April, 2020, respectively. Testing was performed with a rapid serology assay that tests for the presence of anti-SARS-CoV-2 IgM and IgG and yields a result within 15 minutes. This test was previously validated by our groupThe study questionnaire was designed to collect information on sex, age, educational attainment of the respondent, highest educational attainment within the household, social distancing practices, co-morbidities, and symptoms of Covid-19. The three questions on social distancing are of particular interest to the present analysis. The first item asked, “To what extent do you are managing to follow the social distancing guidance from the health authorities, i.e., staying at home and avoiding contact with others?”. This was scored on a five-point scale, with alternatives read aloud to the respondent: very little; little; some; quite; and practically isolated from everyone. The second question was, “What have your routine activities been?”. The alternatives were: staying home all the time; only leaving home only for essentials, such as groceries; leaving home from time to time to run errands and stretch legs; going out every day for regular activities; and out of the house all day, every day, either for work or for other regular activities. Finally, respondents were asked “Who has been in the house?”. The alternatives were: only those relatives who also live in the house, if any—no one else; some close relatives visit once or twice a week; some close relatives visit nearly every day; friends, distant relatives, or others visit once or twice a week; and friends, distant relatives, or others visit nearly every day. If the randomly selected respondent was a child (under age 12) or an older adult who was unable to answer, the question was asked of the respondent’s legal guardian.d, a contract research organization, with the aid of universities in each of the selected municipalities. Interviewers were selected among students of health programs at partner universities. All were trained in performing the rapid test and in administering the questionnaire. The questionnaire itself is included at the end of the supplementary material. All relevant biological safety guidance was followed to protect interviewers and respondents alike.Field work was carried out by Instituto Pesquisas de OpiniãoThe study protocol was approved by the National Research Ethics Committee . All respondents, or their legal guardians in case of children under 12 and disabled older adults, provided written informed consent for participation after receiving information about the objectives and procedures of the study.The statistical analyses presented herein are essentially descriptive and were based on group percentages and bar charts. When necessary, frequencies were compared using chi-square tests.e Overall, 12%, 13%, 30%, 26%, and 19% of respondents were aged 0–10, 11–19, 20–39, 40–59, and 60+ years. There were thus far fewer children and adolescents and far more older adults in our sample than would be expected in the population. This is probably attributable to school-aged residents being absent from home at the time of contact, as well as refusals to take the rapid test, which involves a fingerstick blood draw. Among all households approached, 9% refused to participate and 11% were replaced, the vast majority because there was no one home.The numbers of interviews carried out during the first two rounds of the Epicovid19/RS study, on April 11–13 and April 25–27, are shown in The most frequent response to the question “To what extent are you socially distancing” was “quite”, accounting for 41.1% of answers . The leaThe majority claimed to go out only for essential activities (44.5%), while 20.1% reported staying at home all the time. However, 19.4% of respondents stated they left the house every day . To bettRegarding visitation, more than half of the interviewees reported not letting anyone other than residents themselves in the house. Less than 10% reported visits by non-family members.Analysis of social distancing indicators by municipality, age, sex, and education revealed statistically significant differences in all cases. The results are shown in Social distancing and routine activities follow a very clear U-shaped pattern in relation to age . RespondRegarding sex , women wThe respondent’s educational attainment had a clear association with social distancing and routine activities . Assessm10. Between the first and the second rounds of the study, a statewide process of gradual lifting of restrictions on some business sectors began, the effect of which on social distancing indicators should be more clearly noticeable after the third round of surveys. From the point of view of distancing patterns, there was no relevant change from the first to the second round; thus, we believe their data are best presented jointly.This study provides an overview of social distancing patterns in 9 municipalities across the Brazilian state of Rio Grande do Sul, stratified by sociodemographic characteristics. The context of the state is one of low prevalence of SARS-CoV-2 exposure, as shown by the first two rounds of Epicovid19/RS, with point prevalence estimates of 0.05% and 0.13% respectivelyInformation on social distancing and mobility is based on reporting and may be subject to recall bias or, even more importantly, social expectation bias. In the current scenario, respondents may be embarrassed to reveal low compliance with recommended distancing practices. Our results may thus overestimate social distancing in the sample. Another limitation is that the sample was not constructed in a manner representative of the state, as it was based on a deliberately selected subset of municipalities. Nevertheless, we believe the picture presented herein gives an informative and useful profile of population behavior in the surveyed municipalities, which account for a significant portion of the state population.In brief, 65% of respondents are following social distancing guidelines and more than 80% of households have restricted visits to residents or close relatives, up to 2 times a week. However, there were quite significant variations between municipalities. Two of the three municipalities with the highest percentage of households in which visitation was restricted to family and residents are in the Greater Porto Alegre area, but the third is a smaller town located in the center of the state. There is no clearly identifiable pattern related to city size or geographic location.12.Regarding age and education, our findings show that children, adolescents, and older adults are most protected in terms of social distancing, with adults aged 20 to 59 being the most exposed group. This is an important finding, given the consensus in the literature that the elderly and persons with comorbidities are most at risk for severe Covid-19 and deathThe more educated segment of the population appears to be less protected in our analysis. When we specifically analyzed the group that reports leaving home every day for regular activities, it was essentially composed of predominantly adult, university-educated males. This finding is quite surprising, as we expected this profile of professionals to be working remotely from home, with blue-collar workers—particularly in the construction industry and the trades—would instead be leaving for work on a daily basis. Perhaps the drastic reduction in economic activities may explain this finding. On the other hand, more educated households also reported less movement of non-residents in and out of the home.In conclusion, we found that social distancing patterns varied significantly across the surveyed municipalities and among population subgroups with different sociodemographic characteristics. Older adults, one of the main high-risk groups, exhibited better social distancing behavior. The same was true of children and adolescents. Adults with a higher level of education exhibited the lowest adherence to social distancing recommendations.Completion of subsequent rounds of the Epicovid19/RS study should allow us to assess changes in behavior in response to the easing of lockdown measures since late April 2020. shopping centers, e regulando o funcionamento de estabelecimentos comerciais. Em geral, isso significou fechar boa parte do comércio, com exceção de supermercados, lojas de alimentos, farmácias e outros segmentos considerados essenciais1.No Brasil, desde a declaração de pandemia de Covid-19 pela Organização Mundial da Saúde, em 11 de março de 2020, estados e municípios, apoiados pelo Ministério da Saúde, começaram a estabelecer, ainda que com algumas diferenças, políticas e estratégias de distanciamento social. Rapidamente a maior parte do país passou a adotar medidas restritivas de contato pessoal, recomendando que as pessoas fiquem em casa, fechando escolas, atividades e locais que geram aglomerações, como eventos esportivos e t) da epidemia após a implementação de medidas de distanciamento social, em especial o fechamento de escolas2. Uma metanálise de 29 estudos, sendo 25 de modelagem, também concluiu que essas medidas podem reduzir a propagação da Covid-19, principalmente se associadas a ações amplas como fechamento de escolas e restrição a viagens3. Outra metanálise, que estudou os efeitos da distância e do uso de máscara e proteção ocular sobre o risco de infecção viral, mostrou que o distanciamento físico reduz em cerca de 80% a probabilidade de infecção . Distâncias acima de um metro já seriam efetivas, mas dois metros são a distância ideal, e o uso de máscara também se mostrou altamente efetivo4.Desde o início da pandemia se tem evidenciado que o distanciamento social pode reduzir a transmissão do Sars-CoV-2, vírus causador da Covid-19. Um estudo em Hong Kong encontrou redução de 44% na taxa de replicação  entre a proporção de pessoas ficando em casa e Rt6. O índice de isolamento social calculado pela In Loco também foi utilizado em um modelo de elasticidade que mostrou que um índice 10% maior implicou em 26% menos casos de Covid-19, em média. Essa mesma variação se associou a 18% menos mortes7.No Brasil, utilizando dados da empresa In Locob, não conseguem caracterizar subgrupos de uma população. Não é possível saber se quem fica em casa são adultos ou idosos, homens ou mulheres. Assim, usamos dados do estudo Epidemiologia da Covid-19 no Rio Grande do Sul (Epicovid19/RS)c – cujo objetivo principal é estimar a prevalência populacional da infecção por Sars-CoV-2 – para apresentar os padrões de distanciamento social nas nove cidades gaúchas pesquisadas, avaliando diferenças por cidade, idade, sexo e escolaridade.Contudo, as fontes de dados de mobilidade, como a In Loco e o GoogleO estudo está sendo realizado em nove municípios-sentinela do estado do Rio Grande do Sul, escolhidos por serem os maiores das regiões intermediárias do estado, definidas pelo Instituto Brasileiro de Geografia e Estatística (IBGE), mais o segundo maior município da região metropolitana de Porto Alegre. Os municípios escolhidos no Epicovid19/RS foram Canoas, Caxias do Sul, Ijuí, Passo Fundo, Pelotas, Porto Alegre, Santa Cruz do Sul, Santa Maria e Uruguaiana.Em cada um dos municípios foi selecionada amostra de 500 domicílios a partir de 50 setores censitários urbanos com probabilidade proporcional ao tamanho, sendo incluídos dez domicílios por setor. Os domicílios foram selecionados aleatoriamente com base em uma lista de endereços do IBGE na primeira rodada. Na segunda rodada, os participantes foram selecionados de forma sistemática, a partir de um pulo de nove domicílios a contar dos entrevistados na rodada anterior. Domicílios em que não havia ninguém no momento da entrevista ou em que houve recusa em participar foram substituídos pelo domicílio vizinho. Em cada local participante os moradores foram listados e um deles selecionado de forma aleatória para ser entrevistado e testado para Covid-19.8. Outros detalhes da metodologia do estudo são apresentados em outra publicação9.O estudo prevê a realização de quatro rodadas independentes, uma a cada duas semanas. A primeira e a segunda rodadas aconteceram entre 11 e 13 e entre 25 e 27 de abril de 2020, respectivamente. Foi utilizado teste sorológico rápido que verifica a presença de imunoglobulinas M (IgM) e G (IgG) com resultado em 15 minutos, validado pelo grupo de investigadoresO questionário utilizado no estudo coleta informações sobre sexo, idade e escolaridade do entrevistado, escolaridade máxima do domicílio, distanciamento social praticado e sintomas relacionados a Covid-19. De especial interesse para este trabalho são as três perguntas sobre distanciamento social: 1) “Com relação ao distanciamento social que está sendo orientado pelas autoridades de saúde, ou seja, ficar em casa e evitar contato com outras pessoas, quanto você acha que está conseguindo fazer?”, sendo as possíveis respostas, lidas para o entrevistado, “muito pouco”, “pouco”, “mais ou menos”, “bastante”, “praticamente isolado de todo mundo”; 2) “Como tem sido a sua rotina de atividades?”, com as repostas “fica em casa o tempo todo”, “sai apenas para coisas essenciais, como comprar comida”, “sai de vez em quando para fazer compras e esticar as pernas”, “sai todos os dias para alguma atividade”, “sai todos os dias, o dia todo, para trabalhar ou outra atividade regular”; e 3) “Pensando na rotina da casa, quem tem entrado na casa?”, com as respostas “somente os familiares que moram junto, se tiver, e mais ninguém”, “alguns parentes próximos visitam de uma a duas vezes por semana”, “alguns parentes próximos visitam quase que todos os dias”, “amigos, parentes ou outros visitam de uma a duas vezes por semana”, e “amigos, parentes ou outros visitam quase todos os dias”. Nos casos em que o morador selecionado era criança menor de 12 anos ou idoso incapaz de responder, as perguntas foram direcionadas para um adulto responsável.d com a colaboração de universidades localizadas nos municípios pesquisados. Os entrevistadores foram selecionados entre alunos de cursos da área de saúde das universidades parceiras e foram treinados a realizar o teste e aplicar o questionário. Todos os requisitos de biossegurança foram adotados para proteger entrevistadores e participantes.O trabalho de campo foi realizado pela empresa Instituto Pesquisas de OpiniãoO protocolo de pesquisa foi aprovado pela Comissão Nacional de Ética em Pesquisa (processo 30721520.7.1001.5313). Todos os entrevistados ou seus responsáveis assinaram termo de consentimento livre e esclarecido após receber informações sobre os objetivos e procedimentos da pesquisa.As análises apresentadas são essencialmente descritivas, baseadas no cálculo de percentuais de grupos e gráficos de barras. Quando necessário, as frequências foram comparadas usando testes qui-quadrado.e, na qual temos 12% para o grupo etário de 0 a 10 anos, 13% para o grupo de 11 a 19 anos, 30% para o de 20 a 39 anos, 26% para o de 40 a 59 anos e 19% para o grupo de 60 anos ou mais. Em nossa amostra há muito menos crianças e adolescentes e um excesso de idosos, provavelmente pela ausência de pessoas no domicílio na hora da entrevista e recusas para fazer o teste que envolve uma punção de polpa digital. Entre todos os domicílios abordados, 9% se recusaram a participar e 11% foram substituídos, na maioria das vezes por não haver ninguém em casa.A Em termos de grau de distanciamento social, a resposta mais frequente foi “bastante”, com 41,1% . A respoRelataram ficar em casa o tempo todo 20,1% dos entrevistados, e a maioria respondeu que sai apenas para atividades essenciais . O grupo que sai todos os dias foi 19,4% do total , e suas Sobre o movimento na casa, mais da metade dos entrevistados relatou não receber ninguém além dos próprios moradores, e menos de 10% relataram visitas de não parentes.Analisando os indicadores de distanciamento social por município, idade, sexo e escolaridade, encontramos diferenças estatisticamente significativas em todos os casos. Os resultados são apresentados nas Os padrões de distanciamento social e rotina de atividades apresentam uma forma em U bem clara em relação à idade , ou sejaEm relação ao sexo , fica clA escolaridade do respondente tem clara associação com o distanciamento social e a rotina de atividades . Se aval10. Entre a primeira e a segunda rodadas da pesquisa iniciou-se no estado um processo de reabertura controlada de alguns segmentos do comércio, cujo efeito sobre os indicadores de distanciamento social deve ser sentido de forma mais evidente a partir da terceira rodada. Do ponto de vista dos padrões de distanciamento, não houve mudança relevante da primeira para a segunda rodada, de forma que julgamos melhor usar os dados conjuntamente.Este estudo oferece uma perspectiva do distanciamento social em nove municípios do Rio Grande do Sul e seus padrões por características sociodemográficas. O contexto do estado é de baixa prevalência de Covid-19, como mostraram as duas primeiras rodadas do Epicovid19/RS, com estimativas de 0,05% e 0,13%, respectivamenteAs informações sobre distanciamento e mobilidade se baseiam em relatos e podem estar sujeitas a vieses de memória ou, mais importante, de expectativa social. No atual momento, o respondente pode ser sentir constrangido em revelar fraca aderência às práticas preconizadas para seu município. Nossos resultados, nesse sentido, podem superestimar o distanciamento social. Outra limitação dos dados refere-se à amostra não ser representativa do estado, mas baseada em um conjunto selecionado de cidades. Ainda assim, acreditamos que o quadro apresentado nos oferece um perfil informativo e útil do comportamento da população nas cidades estudadas, que congregam parcela significativa dos habitantes do estado.Pelo relatado, cerca de 65% dos entrevistados aderiram ao distanciamento social e mais de 80% dos domicílios restringiram as visitas a moradores ou parentes próximos até duas vezes por semana. Observa-se também que há variações expressivas entre cidades, apesar de serem todas do mesmo estado. Duas das três cidades com maior percentual de acesso apenas aos moradores situam-se na região metropolitana, mas a terceira é uma cidade de menor porte, localizada no centro do estado. Não se identifica de forma clara um padrão relacionado a porte ou localização geográfica.12.Em relação a idade e escolaridade, vemos que crianças, adolescentes e idosos estão mais protegidos em termos de distanciamento social, estando os adultos de 20 a 59 anos mais expostos. Esse é um resultado importante, visto o consenso já existente na literatura sobre idosos e portadores de comorbidades serem os grupos de maior risco para quadros graves e óbitoOs mais escolarizados aparecem menos protegidos em nossa análise, dado que evidentemente o grupo que relata sair de casa todos os dias para atividades regulares é composto essencialmente por adultos de escolaridade mais alta, predominando homens. Essa constatação surpreende, visto que se esperaria que este perfil profissional estivesse trabalhando a distância, em escritório doméstico, e que o trabalhador manual, da construção ou indústria, estivesse quotidianamente saindo para atividades laborais. Talvez a drástica redução das atividades econômicas possa explicar o achado. Ao mesmo tempo, as casas de pessoas com maior escolaridade relatam menos circulação de não moradores.Em conclusão, vemos que os padrões de distanciamento social variam de forma significativa entre as cidades estudadas e entre subgrupos com diferentes características sociodemográficas. Os idosos, um dos principais grupos de risco, apresentam os melhores indicadores de distanciamento, assim como as crianças e os adolescentes, enquanto adultos com maior nível de escolaridade compõem o grupo com menor adesão ao distanciamento social.Com a realização das rodadas seguintes do estudo no estado do Rio Grande do Sul será possível avaliar as mudanças de comportamento que podem ter ocorrido a partir da flexibilização das medidas restritivas, desde o final de abril de 2020.