Prevalence of and Factors Associated With High Blood Pressure at 15 Years of Age: A Birth Cohort Study.

BACKGROUND: Arterial hypertension is the greatest cause of morbidity and mortality worldwide. Our aim was to investigate the prevalence of and factors associated with high blood pressure (HBP) among adolescents. METHODS AND RESULTS: The Pelotas 2004 Birth Cohort included 4231 newborns from hospital births in Pelotas, Brazil. A digital automatic OMRON sphygmomanometer (model HEM 742) was used to measure blood pressure on 3 occasions (at 6, 11, and 15 years of age). Those with blood pressure ≥95th percentile for age, height, and sex on each of the 3 occasions were considered as presenting HBP. Independent variables included family (income and history of arterial hypertension), maternal (schooling, age, pregestational body mass index, and smoking during pregnancy), and adolescent characteristics at birth (sex, skin color, gestational age, intrauterine growth, and systolic and diastolic genetic factors), and at 15 years (sleep, physical activity, sodium intake, screen time, work, body mass index, fat mass index, fat-free mass index, growth pattern, and puberty status). The prevalence of HBP (95% CI) was calculated. Crude and adjusted odds ratios (ORs) stratified by sex were obtained by logistic regression. A total of 1417 adolescents with complete information on blood pressure on the 3 occasions were analyzed. The prevalence of HBP was 3.2% (95% CI, 1.9%-4.5%) in female adolescents and 4.3% (95% CI, 2.8%-5.8%) in male adolescents. Female adolescents with a family history of arterial hypertension had a 3 times higher chance of HBP than their counterparts (OR, 3.1 [95% CI, 1.26-7.54]). In male adolescents, excessive maternal pregestational weight was associated with a 2.3-fold increase in the chance of HBP. In both sexes, excessive adolescent weight was associated with HBP (ORs, 3.5 and 5.0, for female and male adolescents, respectively). A higher fat mass index and fat-free mass index in female (ORs, 1.4 and 1.2, respectively) and male adolescents (ORs, 2.5 and 3.0, respectively) increased the chance of HBP. Among male adolescents, the chance of HBP was higher among those with rapid weight gain between 48 months and 6 years and between 6 and 11 years and rapid height gain between 6 and 11 years. CONCLUSIONS: Higher fat mass in both sexes and rapid weight gain in male adolescents are risk factors for HBP in adolescents aged 15 years, potentially amenable to prevention.

Factors associated with periodontal diseases in pregnancy: Findings of the 2015 Pelotas Birth Cohort Study.

Although periodontal disease is common during pregnancy, little is known about socioeconomic, behavioral, or biological determinants related to clinically assessed periodontal condition during this period. We assessed the prevalence of periodontal disease and associated factors in pregnant women. This population-based survey used data used from the 2015 Pelotas Birth Cohort Study, Brazil. Pregnant women expected to give birth between December 2014 and May 2016 were interviewed and clinically examined by trained dentist, with periodontal measures collected in all teeth, six sites per tooth. Outcomes were periodontitis (using the 2012 Centers for Disease Control and Prevention and the American Academy of Periodontology criteria) and gingivitis (by the 2018 European Federation of Periodontology/ American Academy of Periodontology classification). Multivariate hierarchical Poisson regression was used to assess the associations between socioeconomic, systemic, and clinical oral factors and periodontal disease. A total of 2,474 pregnant women participated in the study. Prevalence of periodontitis and gingivitis was 14.63% and 21.67%, respectively. Lower educational level and calculus were associated with higher prevalence periodontitis and gingivitis (P<0.05). Smoking was also associated with periodontitis (P=0.05), and lower frequency of toothbrushing (P=0.005) with gingivitis. Periodontal disease, especially gingivitis, was prevalent in pregnant women and their determinants were socioeconomic, environmental, and clinical oral health factors.

Factors associated with periodontal diseases in pregnancy: Findings of the 2015 Pelotas Birth Cohort Study

Abstract Although periodontal disease is common during pregnancy, little is known about socioeconomic, behavioral, or biological determinants related to clinically assessed periodontal condition during this period. We assessed the prevalence of periodontal disease and associated factors in pregnant women. This population-based survey used data used from the 2015 Pelotas Birth Cohort Study, Brazil. Pregnant women expected to give birth between December 2014 and May 2016 were interviewed and clinically examined by trained dentist, with periodontal measures collected in all teeth, six sites per tooth. Outcomes were periodontitis (using the 2012 Centers for Disease Control and Prevention and the American Academy of Periodontology criteria) and gingivitis (by the 2018 European Federation of Periodontology/ American Academy of Periodontology classification). Multivariate hierarchical Poisson regression was used to assess the associations between socioeconomic, systemic, and clinical oral factors and periodontal disease. A total of 2,474 pregnant women participated in the study. Prevalence of periodontitis and gingivitis was 14.63% and 21.67%, respectively. Lower educational level and calculus were associated with higher prevalence periodontitis and gingivitis (P<0.05). Smoking was also associated with periodontitis (P=0.05), and lower frequency of toothbrushing (P=0.005) with gingivitis. Periodontal disease, especially gingivitis, was prevalent in pregnant women and their determinants were socioeconomic, environmental, and clinical oral health factors.

Number of erupted teeth at the age of 12 and 24 months: a maternal report validation study

Aim: To verify the validity of maternal reports on the number of deciduous teeth erupted in their children. Methods: This cross-sectional study was performed with children enrolled in a Birth Cohort at the age of 12 months in the first stage and 24 months in the second stage. At both stages, children were clinically examined, and mothers reported the number of teeth of their children. Comparison between groups was performed using the Mann-Whitney non-paired Wilcoxon test. Level of agreement between two methods were estimated by the Observed Agreement, Weighted Kappa and Intraclass Correlation coefficients. Results: A total of 125 children were examined in the first stage, with mean number of reported teeth of 6.2. In the second stage, 149 children were examined, with mean number of reported teeth of 15.9. High level of agreement, kappa values and intraclass correlation coefficients were observed for both arches in both periods (p<0.001). Conclusions: Maternal report on the number of teeth erupted in children was reliable and valid. Thus, it seems to be a useful instrument for collecting data in population-based epidemiological studies targeting young children

Avaliação das internações dos recém-nascidos em uma UTI Neonatal durante uma pandemia / Evaluación de las hospitalizaciones de recién nacidos en una UCI Neonatal durante una pandemia / Assessment of hospitalizations of newborns in a Neonatal ICU during a pandemic

Objetivo: Avaliar as características das internações de recém-nascidos em uma unidade de terapia intensiva neonatal do extremo sul do Brasil durante um curto período de tempo. Método: Estudo observacional, com 85 neonatos, por dados secundários de pacientes internados na Unidade de Terapia Intensiva Neonatal, nos meses de maio de 2020 a outubro de 2020. Resultados: A prevalência das internações foi do sexo masculino, com diagnóstico de prematuridade, que pesavam entre 1500g e 2499g, não receberam leite materno na primeira hora de vida, receberam visitas dos pais, colo e leite materno durante a internação. As mães tinham mais de 6 consultas de pré-natal e os bebês nasceram de cesárea. Conclusão: O atendimento prestado de forma holística, baseado na ciência e maneira humanizada aos recém-nascidos e aos pais, pode reduzir a mortalidade infantil, trazer maior segurança aos pais e confi ança na equipe assistencial, além de evitar complicações futuras no desenvolvimento infantil.

Objetivo: Evaluar las características de las hospitalizaciones de recién nacidos en una unidad de cuidados intensivos neonatales en el extremo sur de Brasil durante un corto período de tiempo. Método: Estudio observacional, con 85 neonatos, con base en datos secundarios de pacientes hospitalizados en la Unidad de Cuidados Intensivos Neonatales, de mayo de 2020 a octubre de 2020. Resultados: La prevalencia de hospitalizaciones fue del sexo masculino, con diagnóstico de prematuridad, que pesaron entre 1500g y 2499g, no recibió leche materna en la primera hora de vida, recibió visitas de los padres, regazo y leche materna durante la hospitalización. Las madres tuvieron más de 6 consultas prenatales y los bebés nacieron por cesárea. Conclusión: La atención brindada de forma holística, basada en la ciencia y de forma humanizada a los recién nacidos y a los padres, puede reducir la mortalidad infantil, brindar mayor seguridad a los padres y confianza en el equipo de atención, además de prevenir futuras complicaciones en el desarrollo del niño.

Objective: To evaluate the characteristics of hospitalizations of newborns in a neonatal intensive care unit in the extreme south of Brazil during a short period of time. Method: Observational study, with 85 neonates, based on secondary data from patients hospitalized in the Neonatal Intensive Care Unit, from May 2020 to October 2020. Results: The prevalence of hospitalizations was male, with a diagnosis of prematurity, who weighed between 1500g and 2499g, did not receive breast milk in the first hour of life, received visits from parents, lap and breast milk during hospitalization. The mothers had more than 6 prenatal consultations and the babies were born by cesarean section. Conclusion: The care provided in a holistic way, based on science and in a humanized way to newborns and parents, can reduce infant mortality, bring greater security to parents and confidence in the care team, in addition to preventing future complications in child development.

Ultra-processed food consumption by children from a Pelotas Birth Cohort / Consumo de alimentos ultraprocessados por crianças de uma Coorte de Nascimentos de Pelotas

ABSTRACT OBJECTIVE Assessing the regular consumption of ultra-processed foods by children at 24 months of age from the 2015 Pelotas Birth Cohort and the main demographic, socioeconomic, and behavioral factors related to the consumption of these products. METHODS Population-based cohort in the city of Pelotas, RS, where 4,275 children were assessed at birth and 95.4% of them were followed up until 24 months of age. Food consumption was assessed by a questionnaire on regular consumption of ultra-processed foods, which collected information regarding sex, household income, maternal skin color, schooling level, and age, the child attending day care and having siblings, breastfeeding status, and obesity. The outcome was the sum of ultra-processed foods regularly consumed by a child. A multivariate Poisson regression analysis was used to calculate the association between the regular consumption of ultra-processed foods and exposure variables. RESULTS The mean number of ultra-processed foods consumed was 4.8 (SD = 2.3). The regular consumption of ultra-processed foods was positively associated with black skin color and having siblings, and negatively associated with household income and maternal schooling level and age. CONCLUSION The mean regular consumption of ultra-processed foods by children from the 2015 Pelotas Birth Cohort is high, which can negatively affect the children's diet. The risk of consuming this kind of food was higher among children from families of lower socioeconomic status, whose mothers present lower education level, black skin color, and younger age.

RESUMO OBJETIVO Avaliar o consumo habitual de alimentos ultraprocessados aos 24 meses de idade por crianças pertencentes à Coorte de Nascimentos de Pelotas de 2015 e os principais fatores demográficos, socioeconômicos e comportamentais relacionados ao consumo desses produtos. MÉTODOS Coorte de base populacional na cidade de Pelotas-RS, onde foram avaliadas 4.275 crianças ao nascimento, das quais 95,4% foram acompanhadas até os 24 meses. O consumo alimentar foi avaliado por meio de um questionário de consumo habitual de alimentos ultraprocessados, coletando informações sobre sexo, renda familiar, cor da pele, escolaridade e idade da mãe, frequentar creche, ter irmãos, status de amamentação e obesidade. O desfecho foi a somatória de alimentos ultraprocessados consumidos habitualmente pela criança. Análise multivariada por regressão de Poisson foi utilizada para estimar a associação entre consumo habitual de alimentos ultraprocessados e as variáveis de exposição. RESULTADOS O número médio de alimentos ultraprocessados consumidos habitualmente foi de 4,8 (DP = 2,3). O consumo habitual de alimentos ultraprocessados foi associado positivamente à cor da pele preta e ter irmãos e negativamente associado com renda familiar, escolaridade e idade materna. CONCLUSÕES A média de consumo habitual de alimentos ultraprocessados por crianças pertencentes à Coorte de Nascimentos de 2015 da cidade de Pelotas é elevada, o que pode causar um efeito negativo na dieta das crianças. O risco de consumo desses alimentos foi maior entre crianças de famílias de menor posição socioeconômica, filhas de mães de baixa escolaridade, de cor da pele preta, mais jovens e de baixa renda.

Chronic non-communicable diseases and COVID-19: EPICOVID-19 Brazil results.

OBJECTIVE: Describing the prevalence of chronic diseases and associated socioeconomic and demographic factors, evaluating the patterns of social distancing and the antibodies prevalence against SARS-CoV-2 and COVID-19 symptoms in carriers and non-carriers of chronic diseases. METHODS: Data from 77,075 individuals aged 20 to 59 from three steps of the EPICOVID-19 Brazil (a nationwide serological survey conducted between May and June, 2021) were assessed. The presence of antibodies against SARS-CoV-2 was examined by rapid tests. Self-reported prevalence of hypertension, diabetes, asthma, cancer, chronic kidney disease and heart disease were investigated. The prevalence of mask use, adherence to isolation measures and antibodies were evaluated separately amid carriers and non-carriers of chronic diseases. The prevalence of symptoms was analyzed among carriers and non-carriers of chronic diseases with antibodies. RESULTS: The prevalence of at least one chronic disease was 43%, higher in the Southeast region, among white and indigenous individuals, women, less schooled and in lower socioeconomic position. The use of masks when leaving home was similar among carriers and non-carriers of chronic diseases (98%). The proportion of participants who reported adherence to isolation measures was higher amid carriers (15.9%) than non-carriers (24.9%) of chronic diseases. The prevalence of antibodies to SARS-CoV-2 was similar amongst carriers and non-carriers (2.4% and 2.3%). The prevalence of cough, dyspnea, palpitations and myalgia was significantly higher among carriers, but the proportion of symptomatic patients was similar between groups. CONCLUSION: The prevalence of chronic diseases in Brazil is high and the COVID-19 pandemic affects carriers and non-carriers of chronic diseases similarly. Carriers present more severe forms of COVID-19 and higher prevalence of symptoms. Greater adherence to social distancing measures among chronic patients is disassociated from a lower incidence of COVID-19 in this group.

Chronic non-communicable diseases and Covid-19: Epicovid-19 Brazil results / Doenças crônicas não transmissíveis e covid-19: resultados do estudo Epicovid-19 Brasil

ABSTRACT OBJECTIVE Describing the prevalence of chronic diseases and associated socioeconomic and demographic factors, evaluating the patterns of social distancing and the antibodies prevalence against SARS-CoV-2 and COVID-19 symptoms in carriers and non-carriers of chronic diseases. METHODS Data from 77,075 individuals aged 20 to 59 from three steps of the EPICOVID-19 Brazil (a nationwide serological survey conducted between May and June, 2021) were assessed. The presence of antibodies against SARS-CoV-2 was examined by rapid tests. Self-reported prevalence of hypertension, diabetes, asthma, cancer, chronic kidney disease and heart disease were investigated. The prevalence of mask use, adherence to isolation measures and antibodies were evaluated separately amid carriers and non-carriers of chronic diseases. The prevalence of symptoms was analyzed among carriers and non-carriers of chronic diseases with antibodies. RESULTS The prevalence of at least one chronic disease was 43%, higher in the Southeast region, among white and indigenous individuals, women, less schooled and in lower socioeconomic position. The use of masks when leaving home was similar among carriers and non-carriers of chronic diseases (98%). The proportion of participants who reported adherence to isolation measures was higher amid carriers (15.9%) than non-carriers (24.9%) of chronic diseases. The prevalence of antibodies to SARS-CoV-2 was similar amongst carriers and non-carriers (2.4% and 2.3%). The prevalence of cough, dyspnea, palpitations and myalgia was significantly higher among carriers, but the proportion of symptomatic patients was similar between groups. CONCLUSION The prevalence of chronic diseases in Brazil is high and the COVID-19 pandemic affects carriers and non-carriers of chronic diseases similarly. Carriers present more severe forms of COVID-19 and higher prevalence of symptoms. Greater adherence to social distancing measures among chronic patients is disassociated from a lower incidence of COVID-19 in this group.

RESUMO OBJETIVO Descrever a prevalência de doenças crônicas e fatores socioeconômicos e demográficos associados, avaliar os padrões de distanciamento social e a prevalência de anticorpos contra SARS-CoV-2 e sintomas de covid-19 em portadores e não portadores de doenças crônicas. MÉTODOS Foram avaliados dados de 77.075 mil indivíduos de 20 a 59 anos de três etapas do inquérito sorológico de abrangência nacional Epicovid-19 Brasil, realizadas entre maio e junho de 2021. A presença de anticorpos contra SARS-CoV-2 foi avaliada por teste rápido. Foram investigadas as prevalências autorreferidas de hipertensão, diabetes, asma, câncer, doença renal crônica e doença cardíaca. A prevalência de uso de máscara, de adesão a medidas de isolamento e de anticorpos foi avaliada separadamente entre portadores e não portadores de doenças crônicas. A prevalência de sintomas foi avaliada entre doentes crônicos e não doentes portadores de anticorpos. RESULTADOS A prevalência do pelo menos uma doença crônica foi de 43%, maior na região Sudeste, entre indivíduos brancos e indígenas, mulheres, menos escolarizados e em menor posição socioeconômica. O uso de máscara ao sair do domicílio não diferiu entre doentes crônicos e não doentes (98%). A proporção de participantes que referiram adesão ao isolamento foi maior entre doentes crônicos (15,9%) que entre não doentes (24,9%). A prevalência de anticorpos contra SARS-CoV-2 foi semelhante entre doentes crônicos e não doentes (2,4% e 2,3%). A prevalência de tosse, dispneia, palpitações e mialgia foi significativamente maior entre doentes crônicos, mas a proporção de sintomáticos não diferiu entre os grupos. CONCLUSÃO A prevalência de doenças crônicas no país é alta e a pandemia de covid-19 atinge de forma semelhante doentes e não doentes. Doentes crônicos apresentam formas mais graves de covid-19 e maior prevalência de sintomas. A maior adesão às medidas de distanciamento social entre doentes crônicos não se reflete em menor incidência de covid-19 nesse grupo.

Analysis of early and late maternal complications associated with delivery using propensity score / Análise das complicações maternas precoces e tardias associadas à via de parto utilizando escore de propensão

ABSTRACT: Objective: To analyze early and late maternal complications associated with the mode of delivery in a birth cohort in Brazil, using the propensity score technique for analysis. Methods: This is a prospective cohort study, using data from the Pelotas Birth Cohort, RS, 2004. A total of 4,189 women were included and a descriptive analysis of the data and subsequent calculation of the propensity and pairing score of vaginal delivery women and cesarean delivery women with similar scores (1,366 pairs). We then assessed the difference in outcome risk between the groups. Results: Women in the cesarean group had 2.9 percentage points (pp) more risk of postpartum infection, 1.13 p.p. more risk of urinary infection, 1.10 p.p. more risk of anesthetic complications and 1.24 p.p. higher risk of headache compared to vaginal delivery, but less risk of anemia (-2.43 pp) and hemorrhoids (-1.24 p.p.). The use of propensity scores is extremely useful for reducing bias and increasing accuracy in observational studies when experimental studies cannot be performed. Conclusion: Cesarean sections have been associated with a higher prevalence of postpartum and urinary tract infections, anesthetic complications and headache and lower prevalence of anemia and hemorrhoids, so they should be performed with clear indications and when their benefits outweigh potential risks.

RESUMO: Objetivo: Analisar as complicações maternas precoces e tardias, associadas à via de parto, em uma coorte de nascimentos no Brasil, utilizando para a análise a técnica de escores de propensão. Métodos: Trata-se de estudo do tipo coorte prospectiva, utilizando dados da Coorte de Nascimentos de Pelotas (RS), de 2004. Incluíram-se 4.189 mulheres, e realizaram-se análise descritiva dos dados e posterior cálculo do escore de propensão e pareamento das mulheres de parto vaginal com as mulheres de parto cesárea com escores semelhantes (1.366 pares), avaliando a diferença no risco do desfecho entre os grupos. Resultados: As mulheres do grupo cesárea apresentaram 2,9 pontos percentuais (p.p.) a mais de risco de infecção pós-parto, 1,13 p.p. a mais de risco de infecção urinária, 1,10 p.p. a mais de risco de complicações anestésicas e 1,24 p.p. a mais de risco de cefaleia que as de parto vaginal, porém apresentaram menor risco de anemia (-2,43 p.p.) e hemorroidas (-1,24 p.p.). A utilização de escores de propensão é extremamente útil para a redução de vieses e o aumento da precisão em estudos observacionais, quando estudos experimentais não podem ser realizados. Conclusão: As cesáreas associaram-se a maiores prevalências de infecções pós-parto e urinária, complicações anestésicas e cefaleia e menores prevalências de anemia e hemorroidas, portanto devem ser realizadas com indicações claras e quando seus benefícios superam potenciais riscos.

Prevalence, mortality and risk factors associated with very low birth weight preterm infants: an analysis of 33 years / Prevalência, mortalidade e fatores de risco associados ao prematuro de muito baixo peso ao nascer: uma análise de 33 anos

Abstract Objective: To assess the prevalence, mortality and risk factors associated with the birth of very low birth weight preterm infants over a period of 33 years. Methods: Four cross-sectional studies were analyzed, using data from perinatal interviews of birth cohorts in the city of Pelotas collected in 1982, 1993, 2004, and 2015. Based on perinatal questionnaires, anthropometric measurements of newborns and death certificates were analyzed to obtain the prevalence rate, neonatal mortality, and risk factors (maternal age, income and type of delivery) for very low birth weight. Results: A total of 19,625 newborns were included in the study. In the years 1982, 1993, 2004, and 2015, there were, respectively, 5909, 5232, 4226, and 4258 births. The prevalence of very low birth weight was, respectively, 1.1% (n = 64), 0.9% (n = 46), 1.4% (n = 61), and 1.3% (n = 54). There was no statistical evidence of an increasing trend over time (p = 0.11). Among the risk factors, family income in the three poorest quintiles was associated with prevalence rates that were approximately twice as high as in the richest quintile (p = 0.003). Mortality per 1000 live births for neonates weighing <1500 g decreased from 688 to 259 per thousand from 1982 to 2015 (p < 0.001), but still represented 61% of neonatal deaths in the latter year. Conclusion: Although mortality in very low birth weight decreased by more than 60% in recent years, this group still contributes with more than half of neonatal deaths. Low family income remains an important risk factor in this scenario.

Resumo Objetivo: Verificar a prevalência, mortalidade e fatores de risco associados aos nascimentos de prematuros de muito baixo peso ao nascer (MBPN) ao longo de 33 anos. Métodos: Série de quatro estudos transversais com o uso de dados das entrevistas perinatais das coortes de nascimento da cidade de Pelotas coletados em 1982, 1993, 2004 e 2015. A partir de questionários perinatais, medidas antropométricas dos recém-nascidos e certidões de óbito, foram analisadas a prevalência, a mortalidade neonatal e os fatores de risco (idade materna, renda e tipo de parto) para prematuros de muito baixo peso ao nascer. Resultados: Foram incluídos no estudo 19.625 recém-nascidos. Em 1982, 1993, 2004 e 2015 ocorreram, respectivamente, 5.909, 5.232, 4.226 e 4.258 nascimentos. A prevalência de prematuros de muito baixo peso ao nascer naqueles anos foi, respectivamente, de 1,1% (n = 64), 0,9% (n = 46), 1,4% (n = 61) e 1,3% (n = 54). A tendência de aumento durante o período não alcançou significância estatística (p = 0,11). Entre os fatores de risco, a renda familiar nos três quintis mais pobres esteve associada a prevalências cerca de duas vezes mais altas do que no quintil mais rico (p = 0,003). A mortalidade por 1.000 nascidos vivos para os neonatos com peso < 1500 g caiu de 688 para 259 por mil ao longo dos anos (p < 0,001), mas ainda representa 61% dos óbitos neonatais em 2015. Conclusão: Embora a mortalidade nos prematuros de muito baixo peso ao nascer tenha diminuído em mais de 60% nos últimos anos, esse grupo ainda contribui com mais da metade dos óbitos neonatais. A baixa renda familiar continua a ser fator de risco importante nesse cenário.

Internet addiction in students from an educational institution in Southern Brazil: prevalence and associated factors

Abstract Objective To evaluate the prevalence of Internet addiction (IA) and its associated factors among students at an Educational Institution in Southern Brazil. Method This is a cross-sectional study, targeting a sample of students aged from 14 to 20 years. They were selected by random sampling to be representative of the 4038 students enrolled at the institute at the time. IA was assessed using the Internet Addiction Test (IAT). Screening for anxiety and/or depressive disorders was performed using the Well-Being Index (WHO-5). Results The prevalence of IA was 50.8% and the rate was higher among individuals who had screened positive for depressive or anxiety disorders than among those who had not (p = 0.003). There was an association between IA and access to certain types of content, such as gaming (p = 0.010), work and study related content (p = 0.030), and using the internet to access sexual content (p < 0.001). Conclusion Further studies are needed to confirm the high prevalence of IA and explore factors associated with it in samples with similar characteristics to ours. The associations between this dependency and positive screening for anxiety and/or depressive disorders and the types of content accessed are an alert to the existence of these important relationships and illustrate the importance of studying them further. Knowledge about these associations provides an opportunity to implement measures for prevention, such as psychoeducation, and to offer adequate treatment.

Growth from birth to adolescence and bone mineral density in young adults: The 1993 Pelotas birth cohort.

BACKGROUND: The study examined the association of body size (weight and length) at birth and gain in height and weight during childhood and adolescence with areal bone mineral density (aBMD) in adulthood for women and men. METHODS: 756 members (335 men and 421 women) of the 1993 Pelotas (Brazil) Birth cohort were studied. Data on weight and length/height were obtained at birth and subsequent follow-ups at 1, 4, 11, 15, 18, and 22 years of age and specific z scores were calculated by sex. The outcome was whole body aBMD (g/cm²) measured at 22 years of age using dual-energy X-ray absorptiometry (DXA). The effects of exposures, weight and length/height gain, were analyzed using conditional relative weight (CWh) and conditional length/height (CH). Linear regression models were adjusted for multiple confounders, including mother's educational level, family income, maternal smoking during pregnancy, gestational age, breastfeeding and skin color. RESULTS: In the adjusted models, among men greater height gain at 4, 11, and 18 years of age was associated with higher whole body aBMD, and the result with greatest magnitude was at 11 years of age (ß 0.018 g/cm²; 95%CI 0.006; 0.030). Among women, aBMD was associated with height gain at all assessments from 1-15 years, with greatest effect size at 4 years of age (ß 0.017 g/cm²; 95%CI 0.007; 0.027). Regarding to body weight, among men, greater weight at 4 and 15 years were associated with higher aBMD, with the highest coefficients for 15 years of age (ß 0.015 g/cm²; 95%CI 0.003; 0.027); for women, except at birth, all weight gain variables were associated with aBMD and the highest coefficients were observed at 4 years (ß 0.025 g/cm²; 95%CI 0.015; 0.035). CONCLUSIONS: In this birth cohort, height and weight gain, especially from 4 to 15 years have important positive implications for aBMD to early adulthood.

Noncommunicable diseases among nursing professionals at a charitable hospital in Southern Brazil. / Doenças crônicas não transmissíveis em profissionais de enfermagem de um hospital filantrópico no Sul do Brasil.

OBJECTIVE: to describe the prevalence of noncommunicable diseases (NCDs), long term (current) drug therapy, blood pressure levels and capillary glycemia among a nursing team at a charitable hospital in Pelotas/RS. METHODS: This was a cross-sectional study. The questions were adapted from the Vigitel system questionnaire (Telephone Surveillance of Chronic Disease Risk and Protection Factors). All participants had their blood pressure and blood glucose measured. RESULTS: Of the 272 staff assessed, 29.4% reported having NCDs, 48.9% were on long term (current) drug therapy and 73.9% reported a family history of NCDs. Among those interviewed, 20.6% reported using antihypertensive drugs, of these 27.7% had high blood pressure levels, and 2.6% reported using antihypoglycemic agents, 42.9% of whom had high blood glucose. CONCLUSION: Among those professionals who stated they had high blood pressure and diabetes, those who were on medication had higher blood pressure and glucose levels than those who were not on medication.

Eosinophilic esophagitis-Where are we today? / Esofagite eosinofílica - Qual é a nossa posição atual?

Abstract Objective: The objective of this review is to provide an overview of the practical diagnostic and therapeutic approaches to eosinophilic esophagitis and to increase the visibility of the disease among pediatricians. Sources: A search of the MEDLINE, Embase, and CINAHL databases and recent consensus statements and guidelines were performed. Summary of the findings: The definition of eosinophilic esophagitis is based on symptoms and histology. It is important to rule out other diseases associated with esophageal eosinophil-predominant inflammation. It is not yet clear whether the increased prevalence is due to a real increase in incidence or a result of increased awareness of the disease. Various options for management have been used in pediatric patients, including proton pump inhibitors, dietary restriction therapies, swallowed topical steroids, and endoscopic dilations. More recently, proton pump inhibitor-responsive esophageal eosinophilia and eosinophilic esophagitis have been contemplated on the same spectrum, and proton pump inhibitors should be considered the initial step in the treatment of these patients. Conclusions: Eosinophilic esophagitis is a relatively new disease with a remarkable progression of its incidence and prevalence in the past two to three decades, and diagnostic criteria that are constantly evolving. It is important to better understand the pathogenesis of the disease, the predisposing factors, the natural history, and the categorization of varying phenotypes to develop diagnostic and therapeutic strategies that meet the clinical needs of patients.

Resumo Objetivo: Fornecer uma visão geral do diagnóstico e do tratamento da esofagite eosinofílica na prática clínica e aumentar a visibilidade da doença entre os pediatras. Fontes dos dados: Foi feita uma busca na literatura relevante nos bancos de dados Medline, Embase, CINAHL e consensos e diretrizes recentes foram revisados. Síntese dos dados: A definição de esofagite eosinofílica é baseada nos sintomas e na histologia. É importante excluir outras doenças associadas com inflamação esofágica predominantemente eosinofílica. Ainda não está claro se o aumento na prevalência é devido a um real aumento da incidência ou se é o resultado da maior suspeição diagnóstica. Várias opções para tratamento, inclusive inibidores de bomba de prótons, restrições dietéticas, esteroides tópicos deglutidos e dilatações endoscópicas têm sido usadas em pacientes pediátricos. Mais recentemente a eosinofilia esofágica responsiva a inibidores de bomba de prótons e a esofagite eosinofílica têm sido contempladas no mesmo espectro e os inibidores de bomba de prótons devem ser considerados como opção inicial no tratamento desses pacientes. Conclusões: A esofagite eosinofílica é uma doença relativamente nova com uma notável progressão da incidência e prevalência nas últimas 2-3 décadas e critérios diagnósticos estão em evolução constante. É importante entender melhor a patogênese dessa doença, os fatores predisponentes, a história natural e a categorização dos diferentes fenótipos para desenvolver estratégias diagnósticas e terapêuticas que vão ao encontro das necessidades clínicas dos pacientes.

Eosinophilic esophagitis-Where are we today?

OBJECTIVE: The objective of this review is to provide an overview of the practical diagnostic and therapeutic approaches to eosinophilic esophagitis and to increase the visibility of the disease among pediatricians. SOURCES: A search of the MEDLINE, Embase, and CINAHL databases and recent consensus statements and guidelines were performed. SUMMARY OF THE FINDINGS: The definition of eosinophilic esophagitis is based on symptoms and histology. It is important to rule out other diseases associated with esophageal eosinophil-predominant inflammation. It is not yet clear whether the increased prevalence is due to a real increase in incidence or a result of increased awareness of the disease. Various options for management have been used in pediatric patients, including proton pump inhibitors, dietary restriction therapies, swallowed topical steroids, and endoscopic dilations. More recently, proton pump inhibitor-responsive esophageal eosinophilia and eosinophilic esophagitis have been contemplated on the same spectrum, and proton pump inhibitors should be considered the initial step in the treatment of these patients. CONCLUSIONS: Eosinophilic esophagitis is a relatively new disease with a remarkable progression of its incidence and prevalence in the past two to three decades, and diagnostic criteria that are constantly evolving. It is important to better understand the pathogenesis of the disease, the predisposing factors, the natural history, and the categorization of varying phenotypes to develop diagnostic and therapeutic strategies that meet the clinical needs of patients.

Doenças crônicas não transmissíveis em profissionais de enfermagem de um hospital filantrópico no Sul do Brasil / Enfermedades crónicas no transmisibles en profesionales de enfermería de un hospital filantrópico en el sur de Brasil / Noncommunicable diseases among nursing professionals at a charitable hospital in Southern Brazil

Objetivo: descrever a prevalência de doenças crônicas não transmissíveis (DCNT), uso de medicamentos, valores tensionais e glicemia capilar de uma equipe de enfermagem de um hospital filantrópico de Pelotas, RS, Brasil. Métodos: estudo transversal; as perguntas foram adaptadas do questionário do sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (Vigitel); todos tiveram pressão arterial e glicemia aferidos. Resultados: do total de 272 funcionários avaliados, 29,4% afirmaram ter DCNT, 48,9% faziam uso de medicamento contínuo e 73,9% referiram antecedentes familiares para DCNT; dos entrevistados, 20,6% usavam anti-hipertensivos, e destes, 27,7% apresentaram níveis tensionais elevados e 2,6% referiram usar hipoglicemiantes; destes últimos, 42,9% apresentaram níveis glicêmicos elevados. Conclusão: dos profissionais autodeclarados hipertensos e diabéticos, aqueles em uso de medicações apresentaram valores tensionais e glicemia mais elevados do que os que não faziam tratamento medicamentoso.

Objetivo: Describir la prevalencia de enfermedades crónicas no transmisibles (ECNT), uso de medicamentos y valores de tensión y glucemia capilar de un equipo de enfermería de un hospital filantrópico de Pelotas/RS. Métodos: Estudio transversal; las preguntas fueron adaptadas del cuestionario Vigilancia de Factores de Riesgo y Protección para Enfermedades Crónicas por Encuesta Telefónica (Vigitel). Todos tuvieron la presión arterial y la glucemia medidas. Resultados: Del total de 272 funcionarios evaluados, un 29,4% reportó tener ECNT, un 48,9% hacía uso de medicamento continuado y 73,9% refería antecedentes familiares para ECNT. Entre los entrevistados, 20,6% refirió usar antihipertensivos, de estos 27,7% presentaron niveles de tensión elevados, y un 2,6% refirieron usar hipoglucemiantes, de los cuales 42,9% presentó niveles glucémicos elevados. Conclusión: Los profesionales que se autodeclararon hipertensos y diabéticos y estaban en uso de medicamentos presentaron valores de tensión y glucemia más elevados que aquellos que no hacían tratamiento medicamentoso.

Objective: to describe the prevalence of noncommunicable diseases (NCDs), long term (current) drug therapy, blood pressure levels and capillary glycemia among a nursing team at a charitable hospital in Pelotas/RS. Methods: This was a cross-sectional study. The questions were adapted from the Vigitel system questionnaire (Telephone Surveillance of Chronic Disease Risk and Protection Factors). All participants had their blood pressure and blood glucose measured. Results: Of the 272 staff assessed, 29.4% reported having NCDs, 48.9% were on long term (current) drug therapy and 73.9% reported a family history of NCDs. Among those interviewed, 20.6% reported using antihypertensive drugs, of these 27.7% had high blood pressure levels, and 2.6% reported using antihypoglycemic agents, 42.9% of whom had high blood glucose. Conclusion: Among those professionals who stated they had high blood pressure and diabetes, those who were on medication had higher blood pressure and glucose levels than those who were not on medication.

[Evolution of overweight and obesity into adulthood, Pelotas, Rio Grande do Sul State, Brazil, 1982-2012]. / Evolução do excesso de peso e obesidade até a idade adulta, Pelotas, Rio Grande do Sul, Brasil, 1982-2012.

This study assessed the prevalence of overweight and obesity in adolescence and adulthood among subjects enrolled in the 1982 Pelotas Birth Cohort, Rio Grande do Sul State, Brazil, according to social and demographic characteristics. In 1982, hospital births in Pelotas were identified and all live born infants (n = 5,914) were examined and have been followed since. The data were collected at 15, 18, 23, and 30 years of age. In women, prevalence of overweight increased from 23.6% at 15 years to 52.4% at 30 years of age, while obesity increased from 6.6% to 23.8%. In men, overweight increased from 22.9% to 62.9%, and obesity from 7.5% to 22.1%. Overweight and obesity increased more among individuals of both sexes with lower socioeconomic status, which can lead to more inequality in the occurrence of chronic diseases.

Evolução do excesso de peso e obesidade até a idade adulta, Pelotas, Rio Grande do Sul, Brasil, 1982-2012 / Evolution of overweight and obesity into adulthood, Pelotas, Rio Grande do Sul State, Brazil, 1982-2012 / Evolución del exceso de peso y obesidad hasta la edad adulta, Pelotas, Rio Grande do Sul, Brasil, 1982-2012

Este trabalho analisou a prevalência de excesso de peso e obesidade na adolescência e idade adulta em indivíduos pertencentes a coorte de nascimentos de 1982, da cidade de Pelotas, Rio Grande do Sul, Brasil, segundo características sociais e demográficas. Em 1982, os nascimentos hospitalares que ocorreram na cidade de Pelotas foram identificados e os nascidos vivos (n = 5.914) cuja família residia na zona urbana da cidade têm sido acompanhados. No presente estudo, foram utilizados dados coletados aos 15, 18, 23 e 30 anos. Nas mulheres, a prevalência de excesso de peso aumentou de 23,6% aos 15 anos para 52,4% aos 30 anos, enquanto para a obesidade aumentou de 6,6% para 23,8%. Nos homens, o excesso de peso passou de 22,9% para 62,9%, enquanto para a obesidade o incremento foi de 7,5% para 22,1%. O incremento de excesso de peso e obesidade foi maior entre indivíduos com menor nível socioeconômico em ambos os sexos, o que pode levar ao aumento da desigualdade na ocorrência de doenças crônicas não transmissíveis.

This study assessed the prevalence of overweight and obesity in adolescence and adulthood among subjects enrolled in the 1982 Pelotas Birth Cohort, Rio Grande do Sul State, Brazil, according to social and demographic characteristics. In 1982, hospital births in Pelotas were identified and all live born infants (n = 5,914) were examined and have been followed since. The data were collected at 15, 18, 23, and 30 years of age. In women, prevalence of overweight increased from 23.6% at 15 years to 52.4% at 30 years of age, while obesity increased from 6.6% to 23.8%. In men, overweight increased from 22.9% to 62.9%, and obesity from 7.5% to 22.1%. Overweight and obesity increased more among individuals of both sexes with lower socioeconomic status, which can lead to more inequality in the occurrence of chronic diseases.

Este estudio examinó la prevalencia de exceso de peso y obesidad en la adolescencia y la edad adulta en los individuos de la cohorte de nacimientos de 1982, de la ciudad de Pelotas, Rio Grande do Sul, Brasil, de acuerdo a características sociales y demográficas. En 1982, se identificaron los nacimientos hospitalarios ocurridos en Pelotas y nacidos vivos (n = 5.914), a cuya familia residente en la zona urbana de la ciudad se le realizó un seguimiento. En este estudio se utilizaron los datos recogidos a los 15, 18, 23 y 30 años. En las mujeres, la prevalencia de exceso de peso aumentó de 23,6% a los 15 años a 52,4% a los 30 años, mientras que para la obesidad el aumento fue de un 6,6% a un 23,8%. En los hombres, el exceso de peso aumentó de un 22,9% a un 62,9%, mientras que para la obesidad, el aumento fue de un 7,5% a un 22,1%. El incremento de sobrepeso y obesidad fue mayor entre las personas con menor nivel socioeconómico en ambos sexos, lo que puede conducir a una mayor desigualdad en la aparición de enfermedades crónicas no transmisibles.

Pai pobre, filho pobre? Uma análise da mobilidade intergeracional de renda na coorte de nascimentos de 1982, Pelotas, Rio Grande do Sul, Brasil / Poor dad, poor child? An investigation of intergenerational income mobility in the 1982 Birth Cohort in Pelotas, Rio Grande do Sul State, Brazil / ¿Padre pobre, hijo pobre? Un análisis de la movilidad intergeneracional de ingresos en la cohorte de nacimientos de 1982, Pelotas, Rio Grande do Sul, Brasil

O Brasil é apontado como um dos países com as menores mobilidades intergeracionais de renda do mundo. O principal objetivo do artigo é analisar a mobilidade intergeracional de renda na coorte de nascimentos de 1982 em Pelotas, Rio Grande do Sul. São utilizados dois métodos de estimação: elasticidade intergeracional de renda e regressões quantílicas para mensuração de possíveis heterogeneidades na mobilidade intergeracional em função dos diferentes níveis de renda dos pais no passado. Os resultados mostram uma mobilidade intergeracional de renda relativamente alta para os padrões brasileiros. A explicação reside, sobretudo, no fato de terem sido usados dados de renda dos filhos em idade jovem, em torno de 23 anos. As análises das regressões quantílicas indicam que a maior mobilidade social acontece nas camadas sociais intermediárias. Os resultados encontrados reforçam a existência de dois polos opostos de armadilhas: armadilha da pobreza e da riqueza.

Brazil is one of the countries with the lowest intergenerational income mobility. This article aimed to analyze intergenerational income mobility in the 1982 Birth Cohort in Pelotas, Rio Grande do Sul State. Two methods were used, intergenerational income elasticity and quantile regressions, in order to measure heterogeneity in income mobility as a function of different levels of parents’ past income. The results show relatively high income mobility for Brazilian standards. The main explanation is that the data cover the children’s income at a younger age (about 23 years). Quantile regressions show higher social mobility in the intermediary social stratum. The results reinforce the notion of two opposite “traps”, poverty and wealth.

Brasil está considerado como uno de los países con menor movilidad intergeneracional de ingresos del mundo. El principal objetivo de este estudio es examinar la movilidad intergeneracional de ingresos en la cohorte de nacimientos de 1982 en Pelotas, Rio Grande do Sul. Se utilizan dos métodos para la estimación: la elasticidad intergeneracional de los ingresos y regresiones por cuartiles de ingresos para los diferentes niveles de ingresos de los padres en el pasado. Los resultados sugieren una movilidad intergeneracional de ingresos relativamente alta para los estándares brasileños. La explicación radica principalmente en el hecho de que fueron utilizados datos de ingresos de los hijos cuando eran muy jóvenes, alrededor de 23 años. Los análisis de regresiones por cuartiles indican que una mayor movilidad social se produce en las capas intermedias. Los resultados refuerzan la existencia de dos polos opuestos: el de la pobreza y el de la riqueza.

HPV infection and cervical cancer: a review of screening and preventive strategies in developed countries and brazilian policies / Infecção por HPV e câncer cervical: uma revisão de triagem eestratégias preventivas nos países desenvolvidos e políticas brasileiras

Cervical cancer is currently the third malignance on number of female deaths in the world. Persistent HPV infection is the main agent involved in cervical cancer development, particularly of high risk (HR) HPV types 16 and 18, accountable for approximately 75% of cervical camcer cases. These aspect has increased demand for HPV detection molecular tests. Objectives: To summarize and update the current knowledge on HPV and cervical cancer screening techniques and, also, discuss HPV-related data and screening techniques in Brazil. Methods: We include articles published in the past 10 years, both in English and Portuguese. Scientific search engine as Scopus, Cochrane Library and Pubmed were used for the terms "cervical cancer", "HPV", "cervical carcinoma", "HPV vaccine". Only research articles and reviews were considered. Results: The most used techniques for HPV detection are PCR and Hybrid Capture 2(HC2). However, techniques for detection of HPV E6/7 mRNA and p16INK4a have been developed, which are still being validated. These tests may help distinguished transient from persistent HPV infections. Conclusion: To reduce the number of cervical cancer cases, screening strategies could be adjusted to contain the best combination of cytological and molecular tests. The ideal screening strategy requireshigh sensitivity to minimize false negative results, and high specificity, to avoid false positives and over referral. Optimization may be achieved by using by co-testing, combining HPV genotyoing and cytology triage with low-grade intraepithelial lesions (LSILs) or with atypical squamous cells of undertermined significance (ASC-US). Besides, strategies to prevent cervical cancer cases include HPV vaccination.

O câncer do colo uterino é a terceira causa de morte em mulheres no mundo. Infecção persistente pelo HPV é o principal fator no desenvolvimento do câncer de colo uterino, particularmente HPV de alto risco (AR), tipos 16 e 18, responsáveis por, aproximadamente, 75% dos casos de câncer de colo uterino. Este conhecimento incrementou a demanda de testes moleculares para detecção de HPV. Objetivos: Sumarizar e atualizar o conhecimento atual em técnicas diagnósticas para HPV e rastreamento de câncer cervical, e discutir dados a respeito do diagnóstico de HPV e métodos de rastreamento no Brasil. Métodos: Foram incluídos artigos originais ou revisões publicados nos últimos 10 anos, em inglês e português, utilizando as bases de dados Scopus, Cochrane Library and Pubmed, e os termos "cervical cancer", "HPV", "cervical carcinoma", "HPV vaccine". Resultados: As técnicas mais utilizadas para a detecção de HPV são a PCR e a captura híbrida. Contudo, técnicas para detecção de RNAm de HPV E6/7 e p16NK4 já foram desenvolvidas estando em fase de validação. Estes testes poderão auxiliar na distinção de infecções transientes e persistentes. Conclusão: Para reduzir o número de casos de câncer cervical, estratégias de rastreamento podem ser ajustadas para a melhor combinação de testes citológicos e moleculares. Estratégias de rastreamento ideais requerem alta sensibilidade, minimizando resultados falsos positivos e excesso de encaminhamentos. A otimização pode ser obtida combinando testes de genotipagem de HPV e triagens citológicas. Além disso, estratégias para prevenção de casos de câncer cervical incluem a vacinação contra o HPV.