Dietary patterns and socioeconomic, demographic, and health-related behaviors during pregnancy. A cross-sectional study

ABSTRACT BACKGROUND: The identification and understanding of dietary factors and other characteristics that influence gestational weight gain can contribute to the formulation of strategies to promote healthy eating habits before and during pregnancy. OBJECTIVE: To investigate the association between dietary patterns, sociodemographic and obstetric characteristics, and health-related behaviors in pregnant women. DESIGN AND SETTING: A cross-sectional study was conducted on women undergoing prenatal care in the Unified Health System of Colombo, Paraná, Brazil, from February 2018 to September 2019. METHOD: A weekly food frequency questionnaire was administered, and dietary patterns were identified through factor analysis. Median regression models were constructed to identify the associations between dietary pattern scores and variables. RESULTS: Complete data were obtained from 495 pregnant women. Three dietary patterns were identified: 1) "healthy," with higher factor loadings for the weekly consumption of raw vegetables, cooked vegetables, and fresh fruits; 2) "Western," including soft drinks or artificial juice, candies, milk, and dairy products, and processed cold meat; and 3) "traditional," beans and meat. Pregnant women aged 30 years or older (coefficient [Coef.] 0.86, 95% confidence interval [CI] 0.38-1.33) with moderate/intense physical activity (Coef. 0.32, 95% CI 0.02-0.62) had higher adherence to the "healthy" pattern. Adolescents and smokers adhered more to the "traditional" pattern (Coef. 0.17, 95% CI 0.01-0.33). CONCLUSION: Age, smoking status, and physical activity were associated with dietary patterns in pregnant women.

Tempo de tela, qualidade da dieta de adolescentes e características do entorno escolar / Screen time, quality of the adolescent diet, and profile of the school environment

Resumo Objetivou-se investigar a associação entre o tempo de uso excessivo de diferentes telas, a qualidade da dieta em adolescentes e características do entorno escolar. Adolescentes de 30 escolas estaduais de Curitiba/PR relataram tempo de tela: televisão, videogame e portáteis. A qualidade da dieta foi avaliada pela frequência de consumo de alimentos. A renda do entorno escolar foi obtida do Censo. O ambiente construído para atividade física investigado por observação sistemática do entorno escolar. A regressão de Poisson multinível foi empregada para estimar associações com as variáveis de exposição. Entre 1.200 adolescentes, 50,9% do sexo masculino, 74,4% tiveram tempo excessivo de tela. O tempo excessivo de TV (56,5%) esteve associado à pior qualidade da alimentação. O tempo excessivo de videogame (22,0%) foi menor no sexo feminino (RP 0,25; IC95% 0,18;0,36), associado à pior qualidade da alimentação, à menor renda do entorno escolar, e à pior classificação do ambiente construído para atividade física. O tempo excessivo de telas portáteis (53,2%) apresentou tendência de aumento com a renda do entorno escolar. O uso excessivo de TV e telas portáteis foi amplamente praticado por adolescentes, com diferentes variáveis demográficas e contextuais associadas de acordo com o tipo de dispositivo utilizado.

Abstract Adolescents from 30 state schools in Curitiba, State of Paraná, reported total screen time, namely television, video games and laptops. Diet quality was assessed by the frequency of food consumption. The income of the school environment was taken from the Census. The built environment for physical activity was investigated by systematic observation of the school surroundings. Multilevel Poisson Regression was used to estimate associations with the exposure variables. Among 1,200 adolescents, 50.9% being male, and 74.4% were found to be exposed to excessive screen time. Excessive TV screen time (56.5%) was associated with poor diet quality. Excessive video game time (22.0%) was lower among females (PR 0.25; 95%CI 0.18;0.36), associated with poor diet quality, lower school environment income, and the worst classification of the built environment for physical activity. Excessive use of portable screens (53.2%) tended to increase with the income of the school environment. Excessive use of TV and laptops was widespread among adolescents, with different demographic and contextual variables associated according to the type of device used.

Patterns of energy balance-related behaviors and food insecurity in pregnant women / Padrões de comportamentos relacionados ao balanço de energia corporal e insegurança alimentar em gestantes

Abstract The behaviors related to caloric balance during pregnancy can lead to short- and long-term repercussion over the life course. This study aimed to identify patterns of energy balance-related behavior (EBRB) and its association with food insecurity (FI) in pregnant women. Cross-sectional, with pregnant women undergoing prenatal care in public health units in Colombo, Brazil, in 2018/2019. EBRB patterns were identified by factor analysis, and the scores were compared according to FI levels (mild and moderate/severe (M/S) through quantile regression. Four EBRB patterns were identified among 535 pregnant women: Factor 1- household/caregiving activities, exercise/sport, and physical inactivity; Factor 2 - fruits and vegetables; Factor 3 - paid work and commuting; Factor 4 - soda and sweetened beverage, sweets, and goodies. After adjusted analyses, women with mild FI presented higher scores for Factor 1 and lower scores for Factor 3. Higher scores for Factor 4 (p25) were observed among women with mild FI in simultaneous quantile regression. M/S FI was associated with lower scores for Factor 3 (p75). Mixed patterns with factors negatively and positively associated with energy balance were identified among pregnant women with FI.

Resumo Os comportamentos relacionados ao balanço de energia corporal (CRBEC) durante a gestação podem estar associados às repercussões de curto e longo prazo. Este estudo objetivou identificar os padrões de CRBEC e sua associação com a insegurança alimentar (IA) em gestantes. Estudo transversal com mulheres em acompanhamento pré-natal em unidades públicas de saúde de Colombo (PR), Brasil em 2018/2019. Padrões de CRBEC foram identificados por análise fatorial e os escores foram comparados de acordo com os níveis de IA (IA leve, IA moderada/grave (M/G) por meio de regressão quantílica. Quatro padrões de CRBEC foram identificados entre 535 gestantes: Fator 1- atividades domésticas/cuidados, exercícios/esporte e inatividade física; Fator 2- frutas e vegetais; Fator 3 - trabalho remunerado e deslocamento; Fator 4 - refrigerantes e bebidas açucaradas, doces e guloseimas. Após análise ajustada as mulheres com IA leve apresentaram maiores escores para o Fator 1 e menores escores para o Fator 3. Maiores escores foram observados entre as mulheres com IA leve no Fator 4 (p25) na regressão quantílica simultânea. IA M/G foi associada a escores mais baixos para o Fator 3 (p75). Padrões mistos com fatores negativa e positivamente associados ao balanço de energia foram identificados entre as gestantes com IA.

Sobrepeso e obesidade entre mulheres e associação com características demográficas e obstétricas entre usuárias de uma unidade de saúde especializada / Overweight and obesity between women and association with demographic and obstetric characteristics among users of a specialized health unit

Resumo Introdução O excesso de peso é um fator de risco para doenças crônicas. Objetivo Estimar a prevalência de sobrepeso e obesidade, e investigar sua associação com variáveis demográficas, socioeconômicas e reprodutivas e com comportamentos relacionados à saúde entre mulheres usuárias de unidade de atenção especializada. Método Estudo transversal com mulheres em atendimento por mastologista. O estado nutricional foi classificado por meio do índice de massa corporal. Foram utilizados modelos de regressão logística multinomial brutos e ajustados, com estimativa de razões de chance (RC) e intervalos de confiança de 95% (IC95%). A eutrofia foi considerada como categoria de referência. Resultados Participaram 182 mulheres com média de idade de 51 anos. A prevalência de sobrepeso foi de 34,1% (IC95% 27,1-41,0) e de obesidade foi de 31,8% (IC95% 25,0-38,7). Apresentaram maiores chances de obesidade as mulheres: com 60 anos ou mais, que exerciam atividade remunerada, que tiveram menarca antes dos 13 anos e com três ou mais gestações. Após análise ajustada, permaneceram associadas à maior chance de obesidade a menarca antes dos 13 anos (RC 4,40; IC95% 1,76-10,99) e três ou mais gestações (RC 8,50; IC95% 2,14-33,70). Conclusão Verificou-se elevada prevalência de sobrepeso e obesidade entre as participantes, associada às características reprodutivas.

Abstract Background Overweight is a risk factor for chronic diseases. Objective To estimate the prevalence of overweight and obesity and to investigate its association with demographic, socioeconomic, reproductive and health behaviors related among women users of specialized care units. Method Cross-sectional study with women in care by a mastologist. Nutritional status was classified by Body Mass Index (BMI). Gross and adjusted multinomial logistic regression models were used, to estimate an Odds Ratios (OR) and 95% Confidence Intervals (95% CI). Eutrophy was considered as a reference category. Results 182 women with a mean age of 51 years. The prevalence of overweight was 34.1% (CI 95% 27.1-41.0) and obesity was 31.8% (CI 95% 25.0-38.7). Women were more likely to be obese: 60 years of age or older, who were gainfully employed, who had menarche before age 13, and with three or more pregnancies. After adjusted analysis, they remained associated with a greater chance of the development of obesity to menarche before 13 years (OR 4.40 CI 95% 1.76-10.99) and three or more pregnancies (OR 8.50 CI 95% 2.14-33.70). Conclusion There was a high prevalence of overweight and obesity among the participants, associated with reproductive characteristics.

Intention of breastfeeding and association with sociodemographic, obstetric characteristics and experience with breastfeeding among pregnant women / Intenção de amamentar e associação com características sociodemográficas, obstétricas e experiência com o aleitamento materno entre mulheres grávidas

Abstract Objectives: to estimate the intention of breastfeeding (IBF) duration and its association with sociodemographic, obstetric characteristics and experience with breastfeeding among pregnant women undergoing prenatal care. Methods: cross-sectional study, with pregnant women undergoing prenatal care in public health services in Colombo, Paraná, Brazil. The duration of IBF was questioned to pregnant women. Negative binomial Poisson regression with robust variance adjustment allowed estimating crude and adjusted prevalence ratios (PR), and 95% confidence intervals (CI95%) of the association between IBF duration and exposure variables. Results: among the participating pregnant women (n = 604), 7.9% reported having IBF for less than six months, 28.0% from six to 11 months, 38.3% from 12 to 23 and 25.9% for 24 months or more. The mean IBF time was 13.5 ± 8.4 and median of 12 months. Pregnant women with moderate food insecurity (PR=1.34; CI95%=1.04-1.73), multiparous women (PR=1.13; CI95%=1.00-1.26), and who reported having been breastfed as babies (PR=1.19; CI95%=1.02-1.40) had a longer IBF time. Conclusions: food security situation, primiparity and exposure to breastfeeding in childhood are determinants of IBF during pregnancy.

Resumo Objetivos: estimar o tempo de intenção de amamentar (IA) e sua associação com características sociodemográficas, obstétricas e experiência com amamentação entre gestantes em acompanhamento pré-natal. Métodos: estudo transversal com gestantes em serviços públicos de saúde em Colombo, Paraná. O tempo de IA foi questionado às gestantes. Regressão de Poisson binomial negativa com ajuste robusto da variância permitiu estimar razões de prevalência (RP) brutas e ajustadas, e intervalos de confiança de 95% (IC95%) da associação entre tempo de IA e variáveis de exposição. Resultados: dentre as gestantes (n = 604), 7,9% afirmaram IA por menos de 6 meses, 28,0% de 6 a 11 meses, 38,3% de 12 a 23 e 25,9% por 24 meses ou mais. O tempo médio de IA foi de 13,5 ± 8,4 e mediana de 12 meses. Gestantes em insegurança alimentar moderada (RP=1,34; IC95%=1,04-1,73), multíparas (RP=1,13; IC95%=1,00-1,26), e que referiram terem sido amamentadas quando bebês (RP=1,19; IC95%=1,02-1,40) apresentaram maior tempo de IA. Conclusões: situação de segurança alimentar, primiparidade e exposição ao aleitamento materno na infância são determinantes da IA na gestação.

Quality assessment of prenatal and puerperium care

ABSTRACT Objective To evaluate prenatal and puerperium care levels received and identify their association with sociodemographic and obstetric characteristics. Methods This cross-sectional study was conducted from May to December 2020 and included women who gave birth at the Municipal Hospital of Fazenda Rio Grande, Paraná, Brazil. Data were collected through interviews and review of portfolios and medical records. The variables extracted from the prenatal protocols of Paraná and the Ministry of Health were grouped into five compliance indices: CI1 - clinical examination; CI2 - health education; CI3 - queries; CI4 - examinations and vaccines; and CI5 - postpartum appointments. Prenatal care was considered adequate when 80% or more adequacy was obtained. Results A total of 307 women participated in this study. Prenatal compliance was 16.6% considering the entire set of variables. The best performance was for CI4 (54.7%) and the worst for CI5 (13.3%). The lowest adequacy occurred among single women (10.9%) compared to those who lived with a partner (19.9%) (p=0.043) and among women with black/brown skin color (9.5%) compared to those with white/yellow skin color (20.3%) (p=0.016). Conclusion Most women did not receive adequate care, with those in situations of greater social vulnerability received worse quality care.

Cross-cultural adaptation of the Brazilian-Portuguese version of the Perceived Nutrition Environment Measures Survey / Adaptação transcultural da versão brasileira do Perceived Nutrition Environment Measures Survey

ABSTRACT Objective The objective of this study was to cross-culturally adapt the Perceived Nutrition Environment Measures Survey for use in the Brazilian context. Methods Independent translations into Portuguese of the original version and respective back-translations into English were performed. The steps were evaluated by an expert committee and the translated version was applied in a group of both genders, of different ages and education. Results After suggested modifications in the translation processes, the expert committee considered that the translated and adapted version presented conceptual and semantic equivalence. The translated version was applied to a sample of twenty people and only one question related to the amount of fat in the food required a new round to obtain understanding and clarity. Conclusion We present an adapted version of Perceived Nutrition Environment Measures Survey for the Brazilian context, which has adequate conceptual, cultural, and semantic equivalence, being objective and comparable to the original version. Future studies should confirm clarity, reliability, and validity.

RESUMO Objetivo O objetivo deste estudo foi adaptar transculturalmente o Perceived Nutrition Environment Measures Survey para uso no contexto brasileiro. Métodos Foram realizadas traduções independentes da versão original para o português e respectivas retrotraduções para o inglês. As etapas foram avaliadas por um comitê de especialistas e a versão traduzida foi aplicada em um grupo com pacientes de ambos os sexos, de diferentes idades e níveis de escolaridade. Resultados Após modificações sugeridas nos processos de tradução, o comitê de especialistas considerou que a versão traduzida e adaptada apresentou equivalência conceitual e semântica. A versão traduzida foi aplicada a uma amostra de 20 pessoas e apenas uma questão, relacionada à quantidade de gordura no alimento, requereu nova rodada para obter compreensão e clareza. Conclusão Uma versão do Perceived Nutrition Environment Measures Survey adaptada ao contexto brasileiro, a qual possui equivalências conceitual, cultural e semântica adequadas, sendo objetiva e comparável à versão original, é apresentada. Futuros estudos devem confirmar a clareza, confiabilidade e validade.

Quality of life in pregnant women: Association with demographic, socioeconomic, obstetric, and health conditions factors / Calidad de vida en gestantes: Asociación con factores demográficos, socioeconómicos, obstétricos y de condiciones de salud

Abstract Introduction During pregnancy, there are changes that influence a woman's quality of life. Objective To analyze the quality of life and its association with demographic, socioeconomic, obstetric, and health conditions in pregnant women. Method Quality of life was measured using the WHOQOL-BREF, and to evaluate the association between quality of life domains and exposure variables (demographics, socioeconomic, obstetrics, and health conditions) the inflated beta regression was used. Results In the physical domain, pregnant women had lower scores: with higher parity (OR = .71; 95% CI = [.59, .84]), third pregnancy trimester (OR = .74; 95% CI [.61, .89]), reported common symptom (OR = .80; 95% CI = [.67, .95]), or morbidity (OR = .67; 95% CI [.57, .79]). In the psychological domain, women with planned pregnancy had higher scores (OR = 1.20; 95% CI= [1.04, 1.37]), while those who reported common symptoms (OR = .75; 95% CI = [.63, .89]), or morbidity (OR = .82; 95% CI = [.70, .95]) had the worst scores. Higher income was associated with higher scores in the social relationships domain (OR = 1.22; 95% CI = [1.03, 1.45]). Women in their second pregnancy had lower scores in the environment domain (OR = .84; 95% CI = [.72, .98]), while those with intermediate income had higher scores (OR = 1.23; 95% CI = [1.05, 1.43]). Discussion and conclusion Lower quality of life scores were associated with obstetrics and health conditions variables, while higher scores were related with demographics and socioeconomics variables. The multidimensionality of factors associated with the domains of quality of life during pregnancy is also highlighted, which stresses the importance of intersectoral actions for women in social vulnerability.

Resumen Introducción Durante el embarazo hay cambios que influyen en la calidad de vida de la mujer. Objetivo Analizar la calidad de vida y su asociación con las condiciones demográficas, socioeconómicas, obstétricas y de salud en gestantes. Método La calidad de vida se midió utilizando el WHOQOL-BREF, en tanto que para evaluar la asociación entre los dominios de la calidad de vida y las variables de exposición (demográficas, socioeconómicas, obstétricas y condiciones de salud) se utilizó la regresión beta inflada. Resultados en el dominio físico, las gestantes tuvieron puntuaciones más bajas: con mayor paridad (OR = .71; IC 95% [.59, .84]), tercer trimestre de gestación (OR = .74; IC 95% = [.61, .89]), síntoma común reportado (OR = .80; IC 95% = [.67, .95]) o morbilidad (OR = .67; IC 95% = [.57, .79]). En el dominio psicológico, las mujeres con embarazo planificado tuvieron puntuaciones más altas (OR = 1.20; IC 95% = [1.04, 1.37]), mientras que aquellas que informaron síntomas comunes (OR = .75; IC 95% = [63, .89]) o morbilidad (OR = .82; IC 95% = [.70, .95]) obtuvieron las peores puntuaciones. Los ingresos más altos se asociaron con puntuaciones más altas en el dominio de las relaciones sociales (OR = 1.22; IC 95% = [1.03, 1.45]). Las mujeres que estaban en su segundo embarazo tuvieron puntuaciones más bajas en el dominio del medio ambiente (OR = .84; IC 95% = [.72, .98]), mientras que aquellas con ingresos intermedios tuvieron puntuaciones más altas (OR = 1.23; IC 95% = [1.05, 1.43]). Discusión y conclusión Los puntajes más bajos de calidad de vida se asociaron con variables obstétricas y condiciones de salud, mientras que los puntajes más altos se asociaron con variables demográficas y socioeconómicas. También sobresale la multidimensionalidad de los factores asociados a los dominios de la calidad de vida durante el embarazo, lo que destaca la importancia de las acciones transversales para las mujeres en situación de vulnerabilidad social.

Perfil sociodemográfico e farmacoepidemiológico de crianças infectadas pelo HIV / Sociodemographic and pharmacoepidemiology profile of HIV infected children

RESUMO A terapia antirretroviral interfere na replicação do vírus HIV, impede a progressão da infecção para a Aids e previne a mortalidade precoce das crianças infectadas. Esta pesquisa investigou o perfil sociodemográfico e os parâmetros relacionados com o tratamento antirretroviral das crianças HIV positivas residentes no estado do Paraná. Trata-se de um estudo observacional descritivo e analítico realizado com dados secundários do ano de 2020 referentes às crianças com até 12 anos de idade. Foram investigados: perfil, prevalência, medicamentos em uso, abandono da terapia, resistência e supressão viral. Foram identificadas 148 crianças, com uma prevalência igual a 8,1/100 mil no Paraná. Apesar de todas as crianças diagnosticadas com HIV terem iniciado o tratamento, 17,2% encontravam-se em abandono da terapia antirretroviral. Entre as crianças que permaneciam em tratamento, 9,8% não atingiram a supressão viral e suas cargas virais comumente ultrapassavam mil cópias virais/mL. Houve um predomínio de esquemas medicamentosos provavelmente prescritos após falhas terapêuticas. Os resultados indicam que o Paraná apresenta bons resultados quanto ao início rápido da terapia e à supressão viral das crianças. Entretanto, existe um número considerável de abandonos da terapia e de falhas terapêuticas, indicando a necessidade de reforçar a vinculação desta população aos serviços de saúde.

ABSTRACT Antiretroviral therapy interferes with the replication of the HIV virus, stops the progression of infection, and prevents early mortality in infected children. This research investigated the sociodemographic profile and parameters related to the antiretroviral treatment of HIV positive children living in the state of Paraná. This is a descriptive observational and analytical study, carried out with secondary data from the year 2020, referring to children up to 12 years of age. The profile, prevalence, medicines in use, treatment abandonment, viral resistance, and viral suppression were investigated. A total of 148 children were identified, with a prevalence equal to 8.1/100,000 in Paraná. All infants had begun their treatment, but 17,2% abandoned it. Among children who remained on treatment, 9.8% did not achieve viral suppression and their viral loads commonly exceeded 1000 viral copies/mL. There was a predominance of drug regimens probably prescribed after treatment failures. The results indicate that Paraná presents good results in terms of rapid initiation of therapy and viral suppression in children. However, there is a considerable number of abandonments of therapy and therapeutic failures, indicating the need to strengthen the link between this population and health services.

Mental distress and food insecurity in pregnancy / Sofrimento mental e insegurança alimentar na gestação

Abstract Food insecurity is a source of daily stress, especially in women. The aim was to investigate the association between mental distress and food insecurity in pregnant women. Cross-sectional study with pregnant women from the public health service, regardless risk stratification, or gestational trimester in Colombo-PR, Brazil. Poisson regression models were progressively adjusted for exposure variables. Results: Among the participating pregnant women (N=513) the prevalence of mental distress was 50.1%; associated with mild food insecurity (PR 1.34, 95%CI 1.12; 1.61) and moderate/severe food insecurity (PR 1.70, 95%CI 1.33; 2.19). The variable that most changed the association between the outcome and mild food insecurity was income (-4.48%) and, for moderate/severe food insecurity, education (-7.60%). For mild and moderate/severe food insecurity, the greatest reduction occurred with socioeconomic variables 4.5% (PR 1.27, 95%CI 1.05; 1.53) and 8.0% (PR 1.50, 95% CI 1.17; 1.93), respectively. The association between food insecurity and mental distress was consistent, and increased with the degree of food insecurity, with a greater reduction for socioeconomic variables.

Resumo A insegurança alimentar é fonte de estresse diário, especialmente nas mulheres. Objetivou-se investigar associação entre sofrimento mental e insegurança alimentar em gestantes. Estudo transversal com gestantes do serviço público de saúde, independentemente do trimestre ou estratificação do risco gestacional em Colombo-PR, Brasil. Modelos de regressão de Poisson foram ajustados progressivamente para variáveis de exposição. A prevalência de sofrimento mental, entre os participantes (N=513) foi de 50,1%, e esteve associada à insegurança alimentar leve (RP 1,34, IC95% 1,12; 1,61) e moderada/grave (RP 1,70, IC95% 1,33; 2,19). A variável que mais alterou a associação entre o desfecho e insegurança alimentar leve foi renda (-4,48%) e, para insegurança alimentar moderada/grave, escolaridade (-7,60%). Para insegurança alimentar leve e moderada/ grave, a maior redução ocorreu com as variáveis socioeconômicas 4,5% (RP 1,27, IC95% 1,05; 1,53) e 8,0% (RP 1,50, IC95% 1,17; 1,93), respectivamente. A associação entre insegurança alimentar e sofrimento mental foi consistente, e aumentou com o grau de insegurança alimentar, com maior redução para as variáveis socioeconômicas.

Pharmacovigilance of antiretroviral dolutegravir in the state of Paraná

The aim of this study was to investigate adverse reactions to Dolutegravir, a drug recently made available by the Unified Health System (SUS) for treating HIV infections. The frequency, severity and sex distribution of adverse reactions to Dolutegravir were identified over the first 18 months of its availability in users in the state of Paraná. Information was obtained through the pharmacovigilance questionnaire prepared by the Ministry of Health, accessed through the Logistics Control System for Medicines(SICLOM). During the study period, dolutegravirwas dispensed to 9,865 patients in the state. However, 9,207 users (93.3%) answered the pharmacovigilance questionnaire. Among them, 1.75% reported 279 adverse reactions. This population was composed mainly of male people (69.57%), in the ratio of 2.29 men for each woman, white (67.08%), aged between 20 and 29 years (26.71%), single (45.34%) and with education between 8 and 11 years of study (41.61%). Gastrointestinal (36.92%) and nervous system (14.34%) disorders were the most prevalent. 77.78% adverse reactions were considered non-serious by users. It can be concluded that dolutegravirhad a low prevalence of adverse reactions in users in the state of Paraná, demonstrating to be safe for use by the population in therapy against HIV, in accordance with clinical trials.

Sociodemographic and pharmacoepidemiological profile of people on antiretroviral therapy in the coast of the state of Paraná

The aim of this study was to investigate possible factors related to antiretroviral therapy (ART) that contribute to the understanding of the highest rate of Aids detection on the coast of the state of Paraná, a port region identified administratively as the 1stRegional Health Division (1stHD) in the state of Paraná. Data on the sociodemographic profile of the population undergoing antiretroviral treatment (ART), medication changes, dropout of therapy, proportion of the population undergoing treatment and viral load were obtained through computerized systems. Between July 1, 2018 and June 31, 2019, 1,393 people were on ART in the 1stRS. Of these, 57.6% were male. During this period, 110 people started ART with a predominance of the age group between 30 and 39 years old. ART was switched for169 people and 211 patient dropouts were detected. The proportion of people diagnosed with HIV without treatment (gap) is still high, however 92.7% people on ART have suppressed viral load. It can be concluded that the lower educational level of the population undergoing treatment, the late diagnosis of those infected and the treatment gapprobably contribute to the highest rate of Aids detection in the 1stRS.

Completitude, consistência e não duplicidade dos registros de violência sexual infantil no Sistema de Informação de Agravos de Notificação em Santa Catarina, 2009-2019 / Completitud, consistencia y no duplicación de registros de violencia sexual infantil en el Sistema de Información de Enfermedades de Declaración Obligatoria en Santa Catarina, Brasil, 2009-2019 / Completeness, consistency and non-duplicity of records of child sexual abuse on the Notifiable Health Conditions Information System in the state of Santa Catarina, Brazil, 2009-2019

Objetivo: Avaliar a completitude, consistência e duplicidade de registros de violência sexual infantil no Sistema de Informação de Agravos de Notificação (Sinan) em Santa Catarina, Brasil, no período de 2009 a 2019. Métodos: Estudo transversal descritivo e analítico, para avaliar a qualidade dos dados do Sinan quanto à completitude, consistência e não duplicidade. Resultados: Foram notificados 3.489 casos de violência, observando-se aumento de 662,5% no número de notificações no período estudado, tendo o aumento do número de centros de referência ao atendimento das pessoas em situação de violência sexual no estado, explicado 46,7% da variação no número de casos, entre os anos estudados. A consistência foi excelente em 90,0% dos registros; e a completitude, entre excelente e boa em 92,3% deles. Para 14 variáveis, observou-se tendência de aumento da completitude no período. Não houve registro de duplicidades. Conclusão: Os dados do sistema de vigilância da violência sexual contra crianças foram considerados adequados nos quesitos avaliados.

Objetivo: Evaluar la completitud, consistencia y duplicidad de los registros de violencia sexual infantil reportados en el Sistema de Información de Enfermedades de Notificación (Sinan), en Santa Catarina, Brasil, de 2009 a 2019. Métodos: Se realizó un estudio de corte transversal descriptivo y analítico, para evaluar la calidad de los datos del Sinan. Resultados: Se reportaron 3.489 casos de violencia, observándose un aumento del 662,5% en el número de notificaciones, lo que se puede relacionar en el 46,7% de las veces, con el aumento del número de centros de referencia para la atención de personas en situación de violencia sexual en el estado. La consistencia fue excelente en 90,0%, la completitud se consideró de excelente a buena un 92,3%. Para 14 variables, la tendencia temporal de completitud aumentó. No hubo registros de duplicidad. Conclusión: Los datos del sistema de vigilancia de la violencia sexual contra la niñez se consideraron adecuados en las preguntas estudiadas.

Objective To evaluate the completeness, consistency and duplicity of records of child sexual abuse on the Notifiable Health Conditions Information System (SINAN) in Santa Catarina, Brazil, between 2009 and 2019. Methods: This was a descriptive and analytical cross-sectional study aimed to assess the quality of SINAN data regarding completeness, consistency and non-duplicity. Results: 3,489 cases of violence were reported, with a 662.5% increase in the number of notifications in the period studied, with the increase in the number of referral centers for the care of people in situations of sexual violence in the state, explaining 46.7% of the variation in the number of cases, between the years studied. Consistency was excellent in 90.0% of the records; and completeness ranged between excellent and good in 92.3% of them. There was an increased trend in completeness for 14 variables in the period. There were no duplicate records. Conclusion: Data from the sexual violence against children surveillance system were considered adequate regarding the questions that were assessed in the study.

Untreated early childhood caries: the role of parental eating behavior

Abstract The aim of the present study was to analyze the association between parental eating behavior and untreated early childhood caries (ECC). A cross-sectional study was conducted with a representative sample of 432 parent-child dyads with children aged 18 to 36 months, at Municipal Child Education Centers in São José dos Pinhais, Brazil. The parents answered a questionnaire addressing demographic and socioeconomic characteristics, and the children were examined for dental caries (modified dmft index) by a single examiner (kappa = 0.80). A six-item questionnaire was administered addressing parental food consumption, parental control of the child's food consumption, and parental offering of foods to the child. Three items were considered indicative of positive behavior, and three, of negative behavior. Univariate and multivariate Poisson regression analyses with robust variance were used for the data analysis (α = 0.05). The prevalence of untreated ECC was 20.3% (95%CI: 16.7-24.4). In the multiple regression model adjusted for the child's age and the parent's schooling, negative parental behavior was associated with a greater frequency of untreated ECC (PRa = 1.213; 95%CI:1.032-1.427, p = 0.019), but lost its significance when adjusted by positive parental behavior (PRa = 1.156; 95%CI: 0.983-1.358, p = 0.079). Based on the present findings, positive parental eating behaviors are capable of minimizing the impact of negative parental behaviors on the prevalence of untreated early childhood caries.

Comparison between visual inspection of turbidity and quantitative determination of triglycerides in plasma bags / Comparação entre a inspeção visual da turbidez e a determinação quantitativa de triglicerídeos em bolsas de plasma

ABSTRACT Introduction Blood donor screening is an important stage of quality control in blood banks. Turbidity caused by increased levels of triglycerides is detected by visual inspection, but there is no consensus on its threshold at which plasma should be considered inappropriate for donation. Objective Compare triglycerides dosage and visual turbidity in decision making for the disposal of plasma. Material and methods Plasma bags (n=205) were classified by visual inspection as clear, moderately turbid or turbid and triglyceride concentration were determined in serum and plasma with enzimatic-colorimetric methodology by automation. Results Our results show a positive correlation between serum and plasma triglycerides levels (r=0,94) but we observed a higher concentration in serum when compared to plasma samples (p<0,03). Most of the plasma were classified as moderately turbid or turbid (75%). Visual inspection and triglycerides levels were moderately correlated in serum (rb=0,57) and plasma (rb=0,52). However, moderately turbid samples showed discordance between serum or plasma triglyceride levels and the visual inspection. Discussion Our findings corroborate with the literature data, supporting the subjectivity of the visual inspection. We recommend further studies to determine which triglyceride threshold should be used for the disposal of plasma bags combined with automated methods to enhance visual classification accuracy. Conclusion Quality improvement actions are critical for standardization of the screening in order to avoid unnecessary disposal of the plasma bags.

RESUMO Introdução A triagem das bolsas de plasma é uma etapa importante do controle de qualidade nos hemocentros. A turbidez causada pelo aumento de triglicerídeos é detectada por inspeção visual, mas não há consenso acerca do limite no qual o plasma deve ser considerado inadequado para doação. Objetivo Comparar a dosagem de triglicerídeos e a turbidez visual na tomada de decisão para o descarte do plasma. Material e métodos As bolsas de plasma (n=205) foram classificadas pela inspeção visual como límpidas, moderadamente turvas ou turvas e as concentrações de triglicerídeos foram determinadas no soro e plasma com metodologia enzimática-colorimétrica por automação. Resultados Nossos resultados mostraram uma correlação positiva entre soro e plasma (r=0,94) mas observamos que a concentração de triglicerídeos foi mais alta no soro do que no plasma (p<0,03). A maioria das bolsas foi classificada como moderadamente turva ou turva (75%). A inspeção visual e a concentração de triglicerídeos apresentaram uma correlação moderada para o soro (rb=0,57) e plasma (rb=0,52). Entretanto, no grupo moderadamente turvo, houve uma divergência significativa entre as concentrações de triglicerídeos no soro/plasma e a inspeção visual. Discussão Nossos achados corroboram com a literatura, reforçando a subjetividade da inspeção visual. Nós recomendamos a realização de estudos futuros para determinar o limite dos níveis de triglicerídeos para o descarte de plasma em conjunto com a combinação de métodos automatizados para aumentar a acurácia da classificação visual. Conclusão As ações voltadas para a melhoria da qualidade são críticas para a padronização da triagem e evitar o descarte desnecessário de plasma.

Availability of public outlets and regular consumption of fruits and vegetables among adolescents in public schools / Disponibilidade de equipamentos públicos de comércio no entorno de escolas públicas e consumo regular de frutas e hortaliças em adolescentes

ABSTRACT Objective: To assess the association between the presence of public outlets selling fruits and vegetables and the regular intake of these foods by adolescents from public schools in the city of Curitiba, Paraná, Brazil. Methods: Data collection was carried out by a questionnaire answered by the adolescents. Regular intake was defined as eating fruits and vegetables five or more times a week. Environmental data were obtained by assessing the availability and prices of fruits and vegetables traded in public outlets within a 1.6-km radius from 30 randomly selected public schools. Results: A total of 1,232 students from 30 public schools participated in the study. 43.4% of the adolescents reported a regular intake of fruits; 67.0% of them reported a regular intake of vegetables. In the schools, fruit intake ranged from 26.8 to 68.0%, and the vegetables intake ranged from 54.8 to 82.2%. A total of 22 schools had fruit and vegetables being traded in their surroundings. Regular intake of vegetables was positively correlated with their variety (r=0.82; p=0.007). The Moran's local index indicated low fruit intake in a high-supply region; in other three regions with low supply, there was a high intake of fruits; and there was a high consumption of vegetables in a high-supply region. Conclusions: There are differences in the supply of fruits and vegetables of public outlets in the school's surroundings as well as in the distribution of regular intake among regions. The density of public outlets and the variety were both associated with greater intake of fruits and vegetables among adolescents of public school.

RESUMO Objetivo: Avaliar a associação entre presença de equipamentos públicos de comércio de frutas e hortaliças com seu consumo regular por adolescentes de escolas públicas de Curitiba, Paraná. Métodos: Informações dos adolescentes foram coletadas por meio de questionário. Considerou-se como regular o consumo de frutas e hortaliças cinco ou mais vezes na semana. Foram incluídos dados do ambiente obtidos por auditagem de equipamentos públicos de venda de frutas e hortaliças no raio de 1,6 km do entorno de 30 escolas estaduais aleatoriamente sorteadas, no qual foram avaliados a disponibilidade e os preços desses alimentos. Resultados: Participaram do estudo 1.232 alunos de 30 escolas estaduais. O consumo regular de frutas foi referido por 43,4% e de hortaliças por 67,0% dos adolescentes. Nas escolas, o consumo de frutas variou entre 26,8 e 68,0% e o de hortaliças entre 54,8 e 82,2%; 22 escolas contavam com oferta de frutas e hortaliças no entorno. O consumo regular de hortaliças esteve correlacionado positivamente com a sua variedade (r=0,82; p=0,007). O índice de Moran local indicou baixo consumo de frutas em uma regional de alta oferta e, em outras três, alto consumo de frutas e hortaliças para baixa oferta e alto consumo de hortaliças em uma regional de alta oferta. Conclusões: Existem diferenças na oferta de frutas e hortaliças dos equipamentos públicos no entorno escolar e na distribuição do consumo regular entre as regionais. Características relacionadas à densidade de equipamentos de comércio e à variedade estiveram associadas ao maior consumo de frutas e hortaliças entre os adolescentes de escolas públicas.

Distribuição espacial e preço praticado em equipamentos públicos de comercialização de alimentos orgânicos / Spatial distribution and price priced on public markets of organic foods / Distribución espacial y tarificación de equipos públicos para la comercialización de alimentos orgánicos

Este estudo comparou a existência de pontos de comercialização de frutas e hortaliças provenientes de sistemas de produção convencional e orgânicos, verificando diferenças nos preços desses alimentos em Curitiba (PR). A coleta de dados aconteceu em 2018, mapeando os pontos de venda cadastrados na Secretaria Municipal de Abastecimento de Curitiba, registrando os alimentos ofertados (convencional e orgânico), e os preços de frutas, legumes e verduras, listados no instrumento de avaliação de estabelecimentos de comercialização dos alimentos para consumo em domicílio (ESAO-s Feiras Livres). Realizou-se o cálculo da razão de preços do dia, registrado conforme os preços praticados na central de abastecimento de Curitiba. Os alimentos convencionais foram encontrados em mais pontos (n =74) em relação aos alimentos orgânicos (n = 15). A oferta dos orgânicos ficou limitada a áreas mais centrais e regiões com maior renda. A maioria dos orgânicos apresentaram preços mais altos que os convencionais. Foi demonstrado que existem desigualdades na distribuição espacial e no preço entre frutas e hortaliças orgânicas e convencionais, indicando que a população do município não tem qualidade no acesso a estes alimentos, dispendendo valores maiores, caso queira optar por escolhas orgânicas.

The study compared the existence of points of commercialization of fruits and vegetables from conventional and organic production systems and verifying differences in the prices of these foods in Curitiba, Paraná. Data collection took place in 2018, mapping the points of sale registered with the Curitiba Municipal Secretariat of Supply, registering the foods offered (conventional / organic), and the prices of fruits and vegetables, listed in the Instrument of Evaluation of establishments in marketing of food for consumption at home (ESAO-s Feiras Livres). The price ratio of the day was calculated, recorded according to the prices practiced at the Central de Abastecimento of Curitiba. Conventional foods were found in more points (n = 74) in relation to organic foods (n = 15). The supply of organics was limited to more central areas, a region with higher income. Most organic products had higher prices than conventional ones. It has been shown that there are inequalities in the spatial distribution and in the price between organic and conventional fruits and vegetables, indicating that the population of the municipality does not have quality access to these foods and may have higher values if they want to choose organic choices.

El estudio comparó la existencia de puntos de comercialización de frutas y verduras de sistemas de producción convencionales y orgánicos, y verificó diferencias en los precios de estos alimentos en Curitiba, Paraná. La recolección de datos se llevó a cabo en 2018, mapeando los puntos de venta registrados en la Secretaría de Abastecimiento Municipal de Curitiba, registrando los alimentos ofertados (convencionales / orgánicos), y los precios de frutas y verduras, enumerados en el Instrumento de Evaluación de Establecimientos de comercialización de alimentos para consumo en el hogar (ESAO-s Feiras Livres). Se calculó la ratio de precios del día, registrado de acuerdo con los precios practicados en la Central de Abastecimento de Curitiba. Los alimentos convencionales se encontraron en más puntos (n = 74) con relación a los alimentos orgánicos (n = 15). La oferta de productos orgánicos se limitó a áreas más centrales, una región con mayores ingresos. La mayoría de los orgánicos tenían precios más altos que los convencionales. Se ha demostrado que existen desigualdades en la distribución espacial y en el precio entre frutas y verduras orgánicas y convencionales, lo que indica que la población del municipio no tiene acceso de calidad a estos alimentos y puede tener valores más altos si así lo desea elija opciones orgánicas.

Caracterização dos pontos de venda de bebidas alcoólicas no entorno de escolas estaduais / Classification of alcohol outlets in the area surrounding state schools

Resumo O objetivo foi caracterizar o entorno das escolas estaduais de Curitiba em relação à comercialização de bebidas alcoólicas e investigar a associação com indicadores socioeconômicos dos locais. Trata-se de um estudo transversal em estabelecimentos comerciais do entorno de 30 escolas estaduais do município. Aplicou-se questionário para descrever as características dos locais em relação à disponibilidade de bebidas alcóolicas. Diferenças nos entornos das escolas de acordo com a renda foram estimadas por modelo de regressão multinível misto. Foram avaliados 200 estabelecimentos, 66,0% comercializavam bebidas alcoólicas. Dos locais avaliados, 52 (39,4%) foram pontos de venda para consumo de álcool no local, e 80 (60,6%) para consumo fora do local. Nesta categoria, os mercados de bairro (16,5%) e os postos de gasolina (10,1%) tiveram maior presença e metade das escolas tinham esse tipo de estabelecimento em sua vizinhança. Esses locais apresentaram maior variedade de bebidas alcoólicas e menores preços. Nos entornos das escolas localizadas em bairros de menor renda, o número de mercados de bairro e bares foi maior. Observou-se presença de estabelecimentos que comercializavam bebidas alcoólicas e com atendimento ao público durante o período de aulas nas proximidades das escolas avaliadas.

Abstract The aim of this study was to characterize the environments of Curitiba's state schools in relation to commercialization of alcoholic beverages and investigate the association with local socio-economic indicators. A cross-sectional study in commercial establishments was carried out around 30 state-owned schools. We applied a survey to characterize the locations in relation to the availability of alcoholic beverages. Differentiation between school environments regarding income was estimated by multilevel mixed-effects model. We evaluated 200 commercial establishments, 66.0% commercialized alcohol. Of them, 52 (39.4%) were off-premise alcohol outlets and 80 (60.6%) on-premise. In on-premise category, neighborhood markets (16.5%) and gas stations (10.1%) had higher presence and half of schools had this type of this establishment in their environment. These establishment had more variety of alcoholic beverages and lower prices. In school's environments located in lower income's neighborhoods, the number of neighborhood market and bars were higher. It was observed the presence of establishments that commercialized alcoholic beverages and with attendance to the public during the classes period, near the evaluated schools.

Prevalence of childhood obesity in Brazil: systematic review and meta-analysis

Abstract Objective: To estimate the prevalence of childhood obesity in Brazil by means of a systematic review of representative studies. Sources: We searched for population-based studies that assessed obesity in Brazilian children aged < 10 years in MEDLINE, EMBASE, Scopus and other sources up to September, 2019. Paired researchers selected studies, extracted data and assessed the quality of these studies. Meta-analysis of prevalence and confidence interval (95% CI) was calculated, weighted by the population sizes using Freeman-Tukey double-arccosine transformation. Heterogeneity (I2) and publication bias were investigated by meta-regression and Egger's test, respectively. Summary of the findings: 53 studies were included (n = 122,395), which were held from 1986 to 2015 and limited mainly due to inadequate response rates. Prevalence of obesity in the threedecade period was of 8.2% ([95% CI]: 8.1-8.4%, I2 = 98.5%). Higher prevalence was observed in boys (9.7% [9.4-9.9%], I2 = 97.4%) than girls (7.3% [7.1 7.5%], I2 = 96.1%). Prevalence increased according to the decade (1990: 6.5% [6.0-7.0 %], I2 = 96.8%; 2000: 7.9% [7.7-8.0 %], I2 = 98.8%; 2010: 12.0% [11.5-12.6 %], I2 = 95.8%), and Brazilian region (Northeast: 6.4% [6.2−6.7%], I2 = 98.1%; North: 6.7% [6.3−7.2%], I2 = 98.8%; Southeast:10.6% [10.2−11.0%], I2 = 98.2%; South: 10.1 [9.7−10.4%], I2 = 97.7%). Heterogeneity was affected by age and region (p < 0.05) and publication bias was discarded (p = 0.746). Conclusion: For every 100 Brazilian children, over eight had obesity in the three-decade period and 12 in each 100 had childhood obesity in more recent estimates. Higher prevalence occurred in boys, recent decades and more developed Brazilian regions.